RESUMEN
Background: Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI). Objective: To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment. Methods: Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision. Results: In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings. Conclusions: Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.
RESUMEN
OBJETIVO: El virus de la hepatitis C (VHC) se ha relacionado repetidamente con un peor rendimiento de las funciones cognitivas. Sin embargo, no existe consenso acerca de la gravedad o del tipo de afectación cognitiva. Además, rara vez se controlan las variables que puedan influir en ello. El objetivo del presente estudio es definir el perfil cognitivo de los pacientes con VHC tras controlar el efecto de posibles covariables. MÉTODOS: Se dividió a 42 pacientes con VHC en 2 grupos según la existencia de coinfección con virus de la inmunodeficiencia humana y se incluyó a un tercer grupo de 22 controles sanos. La evaluación neuropsicológica incluyó medidas de velocidad de procesamiento, funciones ejecutivas, memoria verbal, memoria visual y memoria de trabajo. Para explorar diferencias e identificar posibles covariables se tomaron medidas de depresión (BDI), ansiedad (HAM-A), fatiga (MAF), anhedonia (PAS), insomnio (ISI), calidad de vida (SF-36) y antecedentes de consumo de drogas (DAST-20). RESULTADOS: Los pacientes con VHC (incluyendo coinfectados por virus de la inmunodeficiencia humana) tuvieron un rendimiento peor que el grupo control en todos los dominios cognitivos. Sin embargo, tras controlar el efecto de BDI, HAM-A, MAF, ISI, SF-36 y DAST-20, solo la memoria verbal de los pacientes con VHC mostró diferencias entre los grupos. CONCLUSIONES: En consonancia con estudios previos, nuestros resultados muestran una relación entre la memoria verbal y el efecto del VHC en el cerebro, aunque el presente estudio no ha podido relacionar la afectación frontoestriatal de los pacientes con VHC con su rendimiento cognitivo
OBJECTIVE: Reduced performance in several cognitive domains has been repeatedly related to hepatitis C virus (HCV). Nevertheless, there is no consensus about the severity or cognitive profile. Moreover, other possible influential variables are scarcely controlled. The aim of this study is to define the specific cognitive profile in HCV after controlling for confounding variables. METHODS: Forty-two HCV patients were distributed in 2groups according to the presence of co-infection with human immunodeficiency virus; a third group with 22 healthy controls was also included. The neuropsychological assessment included tests that assess processing speed, executive functioning, verbal memory, visual memory and working memory. Measures of depression (BDI), anxiety (HAM-A), fatigue (MAF), anhedonia (PAS), insomnia (ISI), quality of life (SF-36) and history of drug abuse (DAST-20) were taken in order to explore differences among groups and to control for their possible influence on cognitive performance. RESULTS: HCV patients (including human immunodeficiency virus-coinfection) performed significantly worse in all cognitive measures. However, when the effect of BDI, HAM-A, MAF, ISI, SF-36 & DAST-20 was controlled, only verbal memory of HCV patients differed among groups. Coinfected patients performed worse in verbal memory. CONCLUSIONS: According to previous studies verbal memory is the unique cognitive domain related to the effect of HCV. The present study does not support that the neurovirulence effect of HCV is decreasing cognitive performance in HCV patients. Nevertheless, the present study cannot relate the fronto-striatal disruption with the cognitive performance in HCV patients
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos del Conocimiento/virología , Hepacivirus , Hepatitis C/psicología , Calidad de Vida , Anhedonia , Ansiedad/diagnóstico , Estudios de Casos y Controles , Depresión/diagnóstico , Función Ejecutiva , Fatiga/diagnóstico , Infecciones por VIH/psicología , Memoria , Análisis Multivariante , Pruebas Neuropsicológicas , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
OBJECTIVE: Reduced performance in several cognitive domains has been repeatedly related to hepatitis C virus (HCV). Nevertheless, there is no consensus about the severity or cognitive profile. Moreover, other possible influential variables are scarcely controlled. The aim of this study is to define the specific cognitive profile in HCV after controlling for confounding variables. METHODS: Forty-two HCV patients were distributed in 2groups according to the presence of co-infection with human immunodeficiency virus; a third group with 22 healthy controls was also included. The neuropsychological assessment included tests that assess processing speed, executive functioning, verbal memory, visual memory and working memory. Measures of depression (BDI), anxiety (HAM-A), fatigue (MAF), anhedonia (PAS), insomnia (ISI), quality of life (SF-36) and history of drug abuse (DAST-20) were taken in order to explore differences among groups and to control for their possible influence on cognitive performance. RESULTS: HCV patients (including human immunodeficiency virus-coinfection) performed significantly worse in all cognitive measures. However, when the effect of BDI, HAM-A, MAF, ISI, SF-36 & DAST-20 was controlled, only verbal memory of HCV patients differed among groups. Coinfected patients performed worse in verbal memory. CONCLUSIONS: According to previous studies verbal memory is the unique cognitive domain related to the effect of HCV. The present study does not support that the neurovirulence effect of HCV is decreasing cognitive performance in HCV patients. Nevertheless, the present study cannot relate the fronto-striatal disruption with the cognitive performance in HCV patients.