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      Twenty five years of the Spanish Journal of Prison Health Translated title: Veinticinco años de la Revista Española de Sanidad Penitenciaria

      editorial
      1 , 2 , 3
      Revista Española de Sanidad Penitenciaria
      Sociedad Española de Sanidad Penitenciaria

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          Abstract

          A recent leader published in the Spanish Journal of Prison Health (RESP) 1 commemorated the first steps taken by a group of professionals (Gaspar Garrote, Vicente Martín and myself) to organise the first Conferences of Prison Health in Spain. I participated in the first attempt, led by Gaspar Garrote in the early 90s, which did not bear fruit, and in the two subsequent events, which were a success: in Leon in 1993, as a Speaker 2 , and in Barcelona in 1998, as Chair of the Organising Committee 3 . This second Conference, which received no external support in the early stages, was backed up by the recently created Spanish Society of Prison Health (SESP) some months before the opening date, and so in historical terms it was the first Conference to be organised by the SESP. A few months before the Barcelona Conference, I received a phone call from José Manuel Arroyo, who proposed that we should meet in Zaragoza. During this conversation, he invited me to form part of a project to create what would be the first Spanish biomedical journal on prison health. He also told me that he wanted the publication of the first edition to coincide with the Conference in Barcelona with the idea that the journal would be given “in situ” to the attendants. José Manuel was - and I believe that this is a well-known and acknowledged fact - the real driving force behind the project; the person who led the creation of the RESP, who continued in the post of director and/or editor of the journal for more than eighteen years until 2016. As planned, the first edition of the RESP was published in 1998 and was given by hand to the participants of the Barcelona Conference. The Editorial Board sent two clear messages in the leader of the first edition: 1) the RESP would be the journal of scientific communication of the SESP, the recently created Spanish Society of Prison Health, which would take on responsibility for printing and distributing the journal; and 2) it was created to be a ”meeting point” for prison and external healthcare professionals and function exclusively as a vehicle of scientific transmission 4 . This first leader was written by José Manuel and myself, who would later be the directors and editors for many years, and by another fifteen professionals who formed part of the Editorial Board at that time. As a leader that commemorated 20 years of the RESP 5 mentions, five persons - almost 30% - of the original group still participate in the Editorial Board, while other professionals have joined up to replace those who have left over these twenty five years. The aims expressed in the first leader mentioned above were followed and expressed in an example of collaboration with other scientific societies in the International Tuberculosis Workshop held in 1999, where the RESP was given the task of publishing the presentations held at this event 6 . Just one year later, the RESP was recognised by the Spanish Health Sciences Bibliographical Index (IBECS), a body established as part of the Carlos III Health Institute to guarantee the quality of Spanish biomedical journals. Since that first edition, the Editorial Board has not ceased in its efforts to study and evaluate initiatives that might help to increase the transmission and impact of the RESP. One such initiative, and an important one, was the approval in 2005 of the bilingual publication (Spanish and English) of the contents of the RESP 7 . Another part of its work to improve the quality of the journal, and one that I find truly remarkable, is the decision by the Editorial Board to submit the editorial work and its results to specialised external criticism in an effort to discover any deficits, potential limitation and options for improvement. An example of this is the request made to the Department of Information and Communication of the University of Granada to appraise and evaluate the journal, the results of which were published in the journal in the form of a leader or special article 8 , 9 . The changes made after the appraisals helped the RESP to pass the evaluations it had to undergo and that later led to it being indexed in the SCIELO 10 and in the Medline database, regarded as the best biomedical bibliographical information system in the world 11 . Other remarkable developments have taken place since then. Examples include the elimination of the journal in paper, to be replaced by an exclusively online format, and most importantly, the option of accessing publications at no charge, which makes the RESP stand out from other conventional biomedical journals. Taken together, all these improvements have led to a higher visibility, especially after the first ten years of publication, an increase in the number of consultations of the website and a growing number of manuscripts sent from outside Spain 10 , a phenomenon that has continued up to the present day 12 . Twenty five years have passed since those early days; a long time culminating in what is now our “silver anniversary” that has come about from persistence and constant effort. We believe that in this period the RESP has positioned itself as a vehicle for scientific transmission to become a good journal and one of the best on pathologies in the prison setting. Its creation was a response - as mentioned on other occasions 8 to the demand from a collective that was looking for an instrument that would socially and professionally articulate and institutionalise the discipline that it represented. That was its strength. And this strength has been further reinforced thanks to the efforts of the Editorial Board (its past and present members), the support of the SESP and the trust of the authors who have chosen the RESP to publish and transmit their research. On this very happy anniversary, the only thing left to do is to give our deepest thanks to everyone who has made it possible for us to continue to be a “meeting point between professionals”.

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          Most cited references15

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          La Revista Española de Sanidad Penitenciaria, punto de encuentro entre profesionales

          (1998)
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            Los retos competitivos de Revista Española de Sanidad Penitenciaria

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              Biomedical research in Spanish prisons: a reality full of difficulties

              (2021)
              A sizeable increase has been observed in the number of manuscripts from outside Spain that appear in the Spanish Journal of Prison Health in the last five years (2016-2020). Only 14 articles of those published in this period were written by Spanish prison healthcare teams and eight (more than half) came from prison teams in Catalonia. There has also been a marked drop in non-Catalan Spanish original manuscripts, to the point where no article of this type was sent to the journal in 2020. Obviously there are prison healthcare professionals who send their work to other biomedical journals, but 14 original manuscripts is a very low number for what should be a basic activity of medical 1 and nursing 2 , professionals, especially in a country like Spain, regarded as the tenth ranking country in terms of medical research 3 . The causes of the low level of research activity in the Spanish prison sector are most likely several. These include the lack of training in this field, which limits potential initiatives, and the absence of research habits in primary care in general and in prison primary healthcare in particular. Another possible cause may be the lack of time, especially in prisons under the ambit of the Ministry of Home Affairs, where staff numbers have been drastically reduced, to the extent that all the staff’s time and effort is now spent on work, and so other highly recommendable activities such as research are now feeling the pinch. We believe that another highly important factor is that prison research usually takes place in the prison itself, which is managed by a “non-medical” administration that is traditionally reluctant to show what goes on inside a prison and which also gives higher priority to problems that have nothing to do with health. This mentality neither stimulates nor creates an environment conducive to research activity. Finally, we believe that the organisation of healthcare also plays a role: little in the way of collaboration between teams, and the chronic isolation from conventional health networks, which makes it difficult to share work with healthcare services outside prison or even coordinate and prepare common projects with other health services within the prison healthcare setting. Despite all this, research is an activity that should be demanded both inside and outside prison. The objective of research is to create knowledge, solve practical problems and act as a professional stimulus. The only limits on research should be the technical conditions of what is to be researched (quality, feasibility and, above all, relevance), the privacy/confidentiality of the material used, the informed consent of the population being researched and the ethical conditions of the project. Although at first sight this seems complex, there is information and standards on how to do research in prisons. Legal requirements are found in Spanish legislation (including the current Prison Regulations and the Regulations on the Organisation and Functioning of Prison Services in Catalonia) and in international regulations (standards drawn up by the Council for International Organisations of Medical Sciences [CIOMS] 4 , supported by the World Health Organisation [WHO]); there are also many certified and independent clinical research ethical committees with recognised prestige and experience on the oversight of moral issues. Any intervention that focuses on research should be based on such regulations and be carried out not in a restrictive spirit, but rather with the aim of encouraging and improving the activity within the limits we mention above. However, health research in Spanish prisons is scarce, which implies that there is a problem that needs to be addressed. What is going wrong? In Spanish prisons managed by the Spanish national government, prison research is regulated by Instruction 12/2019 on “Research in the prison setting” of the Secretary General of Prisons (SGIP in Spanish). In the other prison administration, there are no specific instructions or circulars, but research is much more common and appears to take place with far fewer obstacles. However it is difficult to obtain data about medical research in Spanish prisons. The 2018 General Report of the SGIP 5 states that the General Sub-directorate of Institutional Relations and Territorial Coordination authorised 116 research projects or studies in said year. The vast majority (81.9%) were approved for external demands, in other words, for studies not requested by professionals working in prisons. What is not shown is how many applications there really were, how many projects were about issues of prison health, how many were rejected or what the main reasons for the rejection were. One can deduce from all this that the General Sub-directorate of Institutional Relations and Territorial Coordination is the body responsible for evaluating the projects, but the names and qualifications of the members of the evaluation committee (if there is one) are not mentioned. The final decision is left to the discretion of the Administration, when the recommendable thing would be, as is the case outside prisons, for the evaluation committee to be publicly known, recognised for its experience in the field of research, and include experts from outside the institution. Another recommendable feature would be that the evaluation process be described and its contents made public beforehand, while any final decisions should be contained in the final report, with sections describing the reasons for approving or rejecting projects that are presented, and the research groups that are affected. Finally, the SGIP demands a favourable opinion from a clinical research ethics committee, which it then does not consider to be binding. This creates a situation where a research project that has successfully passed evaluation by an ethics committee is then rejected, which is surprising to say the least. One of the arguments used to justify the lack of prison healthcare research is that it is restricted because prisoners are a vulnerable population group. This Editorial Committee supports the belief that research on incarcerated populations must provide absolute guarantees with regard to ethical issues. Research on incarcerated persons must be done with extreme care, because of the limitations on their capacities and autonomy to make decisions, imposed by their imprisonment and by the hierarchical and dependent relationships that they are subject to. However, it should be remembered that prisons hold persons deprived of their liberty, but these persons have not been deprived of many of the other rights that belong to any citizen. The Administration should ensure that this population is not inappropriately used, but it also has the duty to ensure that imprisonment is not a punishment that stops prisoners from benefiting from research. An adequate balance between the risks that research subjects might run and the potential benefits of same, and free will and the right to privacy/confidentiality, are basic features of any research project. As far as free will and consent are concerned, a Spanish study showed that inmates who had already participated in a research project had done so of their own free will and without pressure. What is more, this participation, when it took place, was motivated more by altruism than by the supposed rewards that were promised or received 6 . International documents on research 4 , 7 - 9 , operate along these lines (balance of benefit/risk, confidentiality, free will and ethics), and not on the prohibition of research with vulnerable groups such as prison inmates. If these rules are followed, there is no reason to believe that an inmate cannot give valid consent to participating in a research project 10 . The reaction to past abuse and criminal practices and the obligation of the Administration to guarantee the life and health of inmates should not lead to them being converted into an overprotected population that, paradoxically, is harmed by the very same process 11 . What is clear from a reading of the regulations of the CIOMS/WHO 4 is that the concept of “vulnerability” should be revised to ensure that it is not understood as a simple label for complete groups of people, but rather that it should facilitate analysis of the specific characteristics that may make people or populations more likely to suffer harm through research. This approach more effectively protects vulnerable persons and does not categorically exclude them from investigation, as has traditionally been the case with the wish to protect groups regarded as vulnerable. It is exactly because of such categorical exclusions that there is little evidence for diagnosis, prevention and treatment of the diseases that afflict such groups 12 . This is a kind of inequality that the system needs to resolve. The fact of the matter is that Spanish prison health research is very scarce. High quality research is a right for any population, including prison inmates. The absence of such studies can only be damaging for the prison population and discredits the prison administration, which has the obligation to encourage this activity and not to restrict it, and to guarantee that it is carried out in accordance with current international regulations on the issue. Therefore, not researching, not researching enough or not doing it adequately, is a failure of the prison system. Success lies in doing it and doing it well. This is the challenge; we need to unite and work together to make it a reality.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                Sep-Dec 2023
                28 November 2023
                : 25
                : 3
                : 87-88
                Affiliations
                [1 ] original Editorial Board of the Spanish Journal of Prison Health normalizedSpanish Journal of Prison Health orgdiv1Editorial Board orgnameSpanish Journal of Prison Health Spain
                [2 ] original Prison Health Programme of the Catalan Health Institute normalizedCatalan Health Institute orgdiv1Prison Health Programme orgnameCatalan Health Institute Spain
                [3 ] original CIBER of Epidemiology and Public Health (CIBERESP) normalizedCIBER of Epidemiology and Public Health (CIBERESP) orgnameCIBER of Epidemiology and Public Health (CIBERESP) Spain
                Author notes
                [Correspondence ] Andrés Marco Mouriño. E-mail: amarco@ 123456gencat.cat
                Article
                10.18176/resp.00073
                10910324
                38289169
                eef6f188-82fc-40ca-989f-1d54801660cb

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 13 September 2023
                : 18 September 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 02
                Categories
                Editorial

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