Análisis de la aplicación de la prisión provisional en la España actual: Críticas y propuesta de mejora.

Desde que la prisión preventiva se implantó como medida cautelar en los sistemas jurídicos modernos, ha sido duramente criticada por la doctrina científica, especialmente desde la aparición de las nuevas tecnologías, con las que asegurar la presencia del investigado durante el proceso es sencillo, sin necesidad de tener que recurrir al cautiverio tradicional. Dada cuenta que la libertad es el valor supremo del ordenamiento jurídico y como tal debe respetarse, el autor, junto a sus directores, pretenden que la forma de entender la prisión provisional cambie en favor de la libertad del acusado durante todo el proceso, evitando, por consecuente, la vulneración sistemática el principio de inocencia. En base a ello, hemos considerado conveniente poner de relieve las críticas relativas a la vulneración que se hacen de la prisión provisional respecto de sus fines, así como de los principios informadores que la que la sustentan, y que han de cumplirse; también críticas sobre el procedimiento establecido para su adopción, ya que son numerosos los puntos en los que la literatura legal se aleja en demasía de la práctica ejercida. Hemos analizado el uso abusivo al que la misma es sometida; el efecto estigmatizante que conlleva su mal uso, generando un entorno alarmista y de inseguridad constante; la restricción implícita y explícita que implica para la libertad del encausado, ya que éste puede verse privado de su libertad y condenado socialmente, además del sobrevenido deterioro de su salud física y psicológica, dados los largos períodos a los que se extiende la prisión provisional y los juicios, prejuicios y rumores (en gran número condenatorios) a los que se ven sometidos por la sociedad. Hemos traído a colación la conformidad del reo como fin del problema, y que puede dar lugar a que, en ocasiones, el procesado se declararse culpable por hechos delictivos que no haya cometido (o han cometido de forma distinta), aunque es rentable conformarse dada cuenta del tiempo cumplido en prisión provisional y los años de pena reducida que se quedarían con la confesión, antes que arriesgarse a un juicio en el que, el mero intento de tratar de defender la propia inocencia, la persona se expone a penas en abstracto más elevadas. De lo más llamativo, al menos a nuestro juicio, es la falta de estadísticas en relación a los presos preventivos y la situación actual que, sobre la temática de la presente tesis, acontece, al igual que la inexplicable impunidad de la que disfrutan el ministerio fiscal y el juez instructor ante la absolución del preso provisional, los cuales no incurren en responsabilidad personal alguna, ante el hecho derivado de haber acordado de forma incorrecta o innecesaria la prisión provisional. Esta impunidad favorece aún más el automatismo, binomio libertad-prisión. Asimismo, hemos profundizado en el perjuicio económico patrimonial y laboral para el investigado; la pérdida cada vez más creciente de los derechos individuales en pos de una seguridad ficticia que ofrece el Estado como garantía ante la mencionada cesión; así como el estado policial que ello acaba constituyendo, en el que vivir, se convierte en algo existencialmente peligroso. Analizamos y reflexionamos acerca del hecho de que el derecho a información, un derecho constitucional basado en el legítimo derecho a conocer la verdad, nos está llevando a un vivir peligrosamente, donde la renuncia a parcelas cada vez mayores del derecho a la libertad del ser humano se encuentran justificadas, con el argumento de velar por una seguridad global ficticia, que cuenta cada vez con más aceptación en la sociedad. Sin libertad, no hay seguridad, o al menos, consideramos que ésta sería una seguridad condicionada, dictatorial, falaz, que es lo que finalmente ocurre con la prisión provisional; un cautiverio que, casi como en sus orígenes, vuelve a ser autoritario y déspota. Para subsanar todo ello, en esta tesis doctoral, dada cuenta de la imperiosa necesidad de que regulación actual de la prisión provisional sea adecuada al panorama y necesidades reales del mundo actual, se propone un catálogo de mejoras, consistentes en: la modificación relativa a los extensos plazos; el uso de aplicaciones y sistema de geolocalización permanente, a fin de tener controlados a los encausados sin necesidad de ingresar en prisión; aumentar las medidas alternativas menos gravosas a la prisión provisional; generar un modelo de penas y medidas cautelares cierto y claro, lo más aproximado a un sistema tasado de «numerus clausus», similar al baremo previsto para los accidentes de tráfico, de tal forma, que la prisión provisional se presente como indiscutible en determinados delitos, en otros no proceda bajo ninguna circunstancia, y otros muchos en los que sea necesario un estudio profundo de las circunstancias de la persona y de los hechos para considerar si procede o no acordar el cautiverio; aumentar los supuestos indemnizables y de las indemnizaciones a todo aquel que haya sufrido una privación de su libertad y finalmente resulte absuelto o suspenda la pena; implantar un sistema de prisión provisional en régimen en semilibertad a modo de un tercer grado preventivo; modificar la regulación de la prisión provisional atenuada; reforzar la proposición de prueba respecto de las audiencias a las que hace referencia el artículo 505 LECrim, para que pueda equilibrarse el principio de igualdad de partes; establecer como condición necesaria para ingreso en prisión provisional un informe psicosocial del detenido, el cual sea emitido por el equipo técnico adscrito al juzgado, es decir, por psicólogos, trabajadores sociales y profesionales de la criminología, que valoren de forma eficaz, si el encausado ha de someterse a la más dura de las medidas cautelares personales; mejorar las condiciones de salud física, psíquica y emocional de los presos. Por consiguiente, entendemos que, de ponerse en marcha estas propuestas de mejora que contribuirán a una mayor seguridad jurídica, a que se respete el principio de inocencia y a encumbrar las garantías que el ordenamiento jurídico ofrece, se reduciría el gasto penitenciario del Estado español, se restituiría de mejor forma el perjuicio causado a la víctima y a la sociedad y se mejoraría la calidad de vida de los encausados, de ahí la relevancia de orientar estas medidas privativas de libertad hacia la reeducación y reinserción social de los penados, en armonía con lo preceptuado en el 25.2 CE y en otras normas concordantes.Derech

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women