Intellectual Disability & The Prison Setting

INTRODUCTION:

The prevalence of intellectual disability (ID) in the prison setting has scarcely been studied. Although some approximations or estimates regarding people with intellectual disabilities have been performed in Spain, there is little in the way of reliable data.

OBJECTIVES:

1) To determine the prevalence of ID in a sample population in the residential modules of a Spanish prison, 2) Obtain data on the prevalence of ID in prison psychiatric units and hospitals.

METHODS:

1) A TONI II test was performed on a sub-sample (n = 398) of a prevalence study in Spanish prisons33 to identify inmates with intellectual disabilities. 2) We reviewed the reports of the psychiatric department of Parc Sanitari Sant Joan de Deu to establish the diagnosis at discharge of patients with a primary diagnosis of intellectual disability 3) Data from the Directorate General of Prisons on the prevalence of ID in Prison Psychiatric Hospitals was reviewed.

RESULTS:

The data obtained from the TONI II test found 3.77% of the study population has an IQ below 70, and 7.54 % has a borderline IQ rate. Assessment of penitentiary psychiatric hospitalization data showed these figures to be higher.

CONCLUSIONS:

The data from a Spanish prison population showed that ID levels were higher than those in the community, especially amongst prisoners requiring specialized psychiatric care. What is also evident is that adequate resources are required in prisons and in the community to provide better care for people with intellectual disabilities who are in the pathway of the criminal justice system.

Full article at:   http://goo.gl/Dd5VoV

By:  V. Tort¹, R. Dueñas¹, E. Vicens¹, C. Zabala², M. Martínez² and D.M. Romero²

¹ Parc Sanitari Sant Joan de Deu. Sant Boi de LLobregt (Barcelona) 
² Facultad de Terapia Ocupacional, Logopedia y Enfermería de la UCLM. Talavera de la Reina (Toledo)

Rev Esp Sanid Penit. 2016 Jun;18(1):25-32. doi: 10.4321/S1575-06202016000100004.

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Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages

Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. 

The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. 

The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments. 

In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men. 

We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.

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By:  Vásquez-Vera H1,2,3, Rodríguez-Sanz M1,2,4,5, Palència L2,4, Borrell C6,7,8,9,10.

• 1Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
• 2Agència de Salut Pública de Barcelona, Barcelona, Spain.
• 3Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Temuco, Chile.
• 4CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.
• 5Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
• 6Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. cborrell@aspb.cat.
• 7Agència de Salut Pública de Barcelona, Barcelona, Spain. cborrell@aspb.cat.
• 8CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain. cborrell@aspb.cat.
• 9Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. cborrell@aspb.cat.
• 10Agència de Salut Pública de Barcelona, Avinguda Lesseps 1, ES-08023, Barcelona, Spain. cborrell@aspb.cat. 
• J Urban Health. 2016 Mar 3.

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Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

Introduction

Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals’ experiences offering HIV tests to migrants in Barcelona and Madrid.

Methods

We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization “5 Cs” principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality.

Results

Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of—and sometimes because of—partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma.

Conclusion

PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed to safeguard the rights of the most vulnerable.

Full article at:   http://goo.gl/Xg3Hnk

By:  Navaza B1, Abarca B1, Bisoffi F1, Pool R2, Roura M1.

• 1ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
• 2Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands. 
• PLoS One. 2016 Feb 25;11(2):e0150223. doi: 10.1371/journal.pone.0150223.

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Spain - PornHub 2015 Use Review

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How Substandard Dwellings & Housing Affordability Problems Are Associated with Poor Health in a Vulnerable Population During the Economic Recession of the Late 2000s

Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health.

We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona’s residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models.

In Barcelona, people seeking Caritas’s help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health.

This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.

Full article at: http://goo.gl/efFiDN

By: Ana M. Novoa, Julia Ward, Davide Malmusi, Fernando Díaz, Mercè Darnell, Carme Trilla, Jordi Bosch, and Carme Borrell

Agència de Salut Pública de Barcelona, Barcelona, Spain

Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain

Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA

CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

Cáritas Diocesana de Barcelona, Barcelona, Spain

Universitat Pompeu Fabra, Barcelona, Spain

Ana M. Novoa, Email: tac.bpsa@aovona.

  

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A Group Intervention to Reduce Intimate Partner Violence among Female Drug Users. Results from a Randomized Controlled Pilot Trial in a Community Substance-Abuse Center

A greater proportion of drug dependent women are victims of intimate partner violence (IPV) than women in the general population; however, few interventions have been developed to reduce IPV among drug dependent women.

An adapted version of the Women's Wellness Treatment, to address IPV and depressive symptoms, was piloted in a randomized controlled trial conducted in outpatient treatment program in Barcelona, Spain among 14 women receiving outpatient treatment for a drug use disorder who screened positive for IPV in the previous month. Participants were randomly assigned to receive the 10 session cognitive behavioral therapy (IPaViT-CBT) group intervention or treatment as usual. The frequency of IPV, depressive symptoms, substance use, quality of life and health status were assessed at baseline and 1, 3 and 12 months post intervention. Intention to treat analysis was performed.

Moderate effects for the intervention were found in reducing psychological maltreatment, increasing assertiveness of IPV and reducing aggressiveness in the partner relationship, and in reducing the frequency of drinking up to 3 months post intervention. The intervention did not significantly reduce the likelihood of any IPV, depressive symptoms, quality of life or self-reported health status, up to 12-months post intervention.

This pilot trial suggests some initial support for the 10-session CBT group intervention among IPV victims who received treatment for drug use. Study findings indicate that it is feasible to deliver the intervention in a community substance abuse center.  An adequately powered trial is required to replicate these results.

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By: Tirado-Muñoz J1, Gilchrist G, Lligoña E, Gilbert L, Torrens M.

• 1Addiction Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques; Universitat Autónoma de Barcelona, Barcelona.  

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Epidemiology of Infections by HIV, Syphilis, Gonorrhea & Lymphogranuloma Venereum in Barcelona City: A Population-Based Incidence Study

The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city.

Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend.

HIV. 

• 66.8% of the HIV cases were men who had sex with men (MSM). 
• The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. 

Syphilis. 

• 74.2% of the syphilis cases were MSM. 
• The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. 
• and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000.

Gonorrhea. 

• 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. 
• and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. 

Lymphogranuloma venereum (LGV). 

• 95.3 % of the LGV cases are MSM. 
• The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. 
• and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh.

An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.

Below: Incidence of syphilis, gonorrhea, lymphogranuloma venereum and HIV by sex. Barcelona, 2007–2011

Below: Incidence of syphilis, gonorrhea, lymphogranuloma venereum and HIV in men by sexual conduct. Barcelona, 2007–2011

Below: Incidence of syphilis, gonorrhea, lymphogranuloma venereum in men by sexual conduct and education level. Barcelona, 2007–2011

Full article at: http://goo.gl/lzeGw0

By: Marc Martí-Pastor¹², Patricia García de Olalla^13*, Maria-Jesús Barberá⁴, Christian Manzardo⁵, Inma Ocaña⁴, Hernando Knobel⁶, Mercè Gurguí⁷, Victoria Humet⁸, Martí Vall⁴,Esteban Ribera⁴, Judit Villar⁶, Gemma Martín⁶, Maria A. Sambeat⁷, Andres Marco⁸, Alvaro Vives⁹, Mercè Alsina⁵, Josep M. Miró⁵, Joan A. Cayl๳ and and the HIV Surveillance Group

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Trends in Inequalities in the Use of Condom by Urban Teenagers in Spain

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. 

We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95 % CI) using robust Poisson regression models. 

The prevalence of condom use

• among boys was 87.0 % in 2004 and 76.2 % in 2012, 
• and 76.7 and 64.7 % among girls, respectively. 

This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period.

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By:  Alvarez-Bruned L1, Garcia-Continente X2,3, Gotsens M2,4, Pérez A2,4,3, Pérez G5,6,7,8.

• 1Faculty of Health and Life Sciences, University Pompeu Fabra, Barcelona, Spain.
• 2Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain.
• 3Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research), Barcelona, Spain.
• 4CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
• 5Faculty of Health and Life Sciences, University Pompeu Fabra, Barcelona, Spain
• 6Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain
• 7CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
• 8Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research), Barcelona, Spain