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PubMed1992

[Rheumatic complaints and diseases in ex-prisoners of war in Croatia in 1991. A review of medical prognosis for work capacity].

The results are presented of an examination of the locomotor system in 48 ex-prisoners of war, previously maltreated in prison camps in Serbia and occupied areas of Croatia. They were part of a group of 508 prisoners of war, examined in the Clinic for Infectious Diseases in Zagreb. They were all male, aged 33.9 +/- 11.56 years, in whom, after the first medical examination a rheumatological examination was indicated because of disorders of the locomotor system. Only 16.7% of the subjects had not been physically maltreated. Blows to the lumbo-sacral spine were the most frequent (43.7%), shoulders (33.4%) and the head (27.0%). Earlier rheumatic disorders were reported by 41.7% of the ex prisoners, and during the examination in our Rheumatological clinic 70.8%. In 21% of the ex-prisoners the rheumatological disorders started as a direct consequence of maltreatment in the prison camps. In one of the ex-prisoners acquisition of ankylosis spondylitis occurred and in another uric arthritis. In 50% of the ex-prisoners a marked reduction in work ability was confirmed. Disability retirement was proposed for two ex-prisoners. Optimal health treatment is discussed and medical prognosis of work ability.

Adolescent↗
PubMed2004

Outbreak of chickenpox in a Scottish prison.

An outbreak of chickenpox occurred in a Scottish prison in April 2003. Three clinical cases (one virologically confirmed) were identified, two prisoners and one staff member. All were male and aged between 30 and 45 years. A further six possible cases were identified. The source of the outbreak was likely to have been a prisoner's child who visited the prison with a chickenpox rash. The outbreak was point source in nature, and no secondary spread of infection occurred within the prison despite the crowded conditions, possibly reflecting high levels of natural immunity. The outbreak serves as a reminder of the prison environment and the vulnerability of the prison population to infectious disease, both because of the prison environment and the clinical characteristics of the prison population.

Adult↗
PubMed2004

Bangkok 2004. Prisoners' health and human rights in the HIV/AIDS epidemic.

Prisoners exist on the margins of society, often without access to HIV prevention, care, treatment, or support. Depriving prisoners of the means to protect themselves from HIV infection, and failing to provide prisoners living with HIV with care, treatment, and support equivalent to that available in the community, offend international human rights norms. This article provides a summary of a draft paper prepared for Human Rights at the Margins: HIV/AIDS, Prisoners, Drug Users and the Law, a satellite meeting held in Bangkok on 9 July 2004, and organized by the Canadian HIV/AIDS Legal Network and the Lawyers Collective HIV/AIDS Unit (India). The full text of the final paper, including references, is available on the Legal Network's website. The article reviews some of the international laws and instruments that protect the rights of prisoners and that set out minimum standards for treatment of prisoners; outlines activities in the prison setting that place prisoners at risk for HIV; describes some of the policies and societal factors that fuel the HIV/AIDS epidemic in prisons; and proposes a series of specific actions that should be taken now to respond to this epidemic.

Guidelines as Topic↗
PubMed2004

[Prevalence infections and risk factors due to HIV, Hepatitis B and C in a prison establishment in Leiria].

The present study emerged due to HIV, Hepatitis B and C test samples that have been taking place in a prison establishment in Leiria. The samples were taken from 788 (77%) of the 1019 prisoners that entered the prison during the periods between February of 1999 to September 2003. A questionnaire was carried to the transmission of HIV, Hepatitis B and C infections and blood samples were also taken to determine the immunologic situation in relationship to the same viruses. Of the 788 prisoners that participated, 699 (89%) were male and 89(11%) were female. The average age was 32.3, the oldest person was 70 and the youngest was 16 years old. 294 (40%) prisoners admitted using injectable drugs and 606 (84%) confirmed they had more than one sexual partner. HIV infection were found in 47 (6%) of the prisoners, HCV infection in 326 (42%), HBsAg in 21 (3%), HBsAc in 309 (40%) and HBcAc in 312 (40%) of the prisoners. Statistics confirm a significant relationship between injectable drugs and the presence of HIV infection and HBcAc and between sexual relationships with an infected partner and the presence of HBcAc, anti-HCV and HIV infection. The prevalence of infected prisoners with HIV was 6%, with HBV 40% and with HCV 42%. Hepatitis B and C infected 70% of the prisoner who used injectable drugs. The prevalence of hepatitis B and C and HIV infection that were found compel for the continuation of prevention.

Adolescent↗
PubMed1984

Attitude change and a prison health care experience.

Nursing in a prison setting has recently emerged as a field of concern. One of the issues in staff working with prisoners is attitudes and attitude change. Since the most favorable site for attitude formation and/or change is a student's educational experience, the present study was undertaken to explore if nursing students who have a clinical experience with prisoners will demonstrate a change toward more favorable attitudes toward prisoners. The research design was a pre-test, post-test control group design. The instrument was a Likert scale, adapted from previously developed scales dealing with attitudes toward prisoners, the mentally ill, and drug addicts. An important control was contained in the instrument, in that not only were there statements dealing with prisoners, but also dealing with the mentally ill and addicts, with whom none of the students would have student clinical experience. The results revealed that there was no significant difference in attitudes toward prisoners, drug addicts, and the mentally ill on the pre-test for either experimental or control group. However, on the post-test, there was a significantly lower (more positive) score on the scale for prisoners for the experimental group, who had a prison clinical experience. This finding suggests that attitudes can be favorably altered by a relevant student clinical experience.

Attitude↗
PubMedDate not supplied

Licensed physicians who work in prisons: a profile.

A profile of the personal and professional characteristics of the physicians who work in America's prisons was obtained by analyzing data from a larger study of all licensed physicians in the United States who worked in a prison at least 12 hours a month during the fall of 1979. Psychiatrists were not included, nor were physicians working in jails. The population of 382 prison physicians comprised two major groups--those who worked in prisons full time and those who worked in them part time. Part-time physicians, who represented the majority of physicians involved in prison work (58 percent), were found to resemble closely the typical physician in the United States; they were predominantly trained in America, specialized, and board certified. In contrast, full-time prison physicians, who accounted for 73 percent of the total hours physicians spent working in prisons, differed significantly from the typical U.S. physician. They were older, less specialized, less likely to be board certified, and more likely to be graduates of non-U.S. medical schools. The professional characteristics of the full-time prison physicians raise serious questions about the quality of medical care they are likely to provide. It would seem, based on their professional attributes, that the part-time physicians are able to provide better quality care than their full-time colleagues. Prison health system could thus assure higher quality care to inmates by relying primarily on part-time rather than full-time practitioners.

Adult↗
PubMedDate not supplied

[Evaluation of the prevalence of HIV infection in prison inmates at the time of their imprisonment during the period 1991-1995].

BACKGROUND: Inmates of Spanish prisons include a high number of intravenous drug users (IVDUs) and other people whose practices entail the risk of infection with the human immunodeficiency virus (HIV). The aim of this work is to find out the evolution of the prevalence of HIV infection at the time of admission to prison and the factors associated with it in this population group. This may enable us to form an idea of the effectiveness of risk reduction strategies and help to improve them. METHODS: All those people who were placed in a provincial penal institution in the northwest of Spain between 1991 and 1995. Socio-demographic, penal and HIV risk factor variables were gathered. The HIV infection test (ELISA and Western-blot) was carried out with the consent of the subjects. RESULTS: Of the 1,663 people studied, 19.4% were HIV-positive. The prevalence HIV infection was particularly marked statistically in: women (26.0%), the 25-34 age group (29.1%), whites (20.9%), single people (22.8%), those people with a tattoo (29.9%), those people with a background in self-inflicted injuries (42.2%), IVDUs (46.3%), those who admitted sharing syringes (61.5%) and those with a prison record of one or more years (37.3%). Logistical regression analysis showed the following as predictors of HIV infection: IVDUs, those who went to prison in 1992, women, the 25-34 and 35-44 age group, tattooed men, those with a background in self-inflicted injuries and those with a prison record, of more than one year. The gypsy ethnic group revealed a lower probability of HIV infection. The HIV infection time trend, stratified according to the prison record showed an almost significant drop (P = 0.064). The infection trend per IVDU did not show any modification (P = 0.16). CONCLUSIONS: A high prevalence of HIV infection was detected in a prison located in a region which has not been particularly affected by AIDS. IVDUs and some characteristics that may be related to this population group have an enormous influence on this phenomenon. The time trend for this infection in this population group has decreased through the lower number of IVDUs that are admitted to prison although very high levels of prevalence of the infection were maintained in this group over the five years of the study. It is recommended that risk-reduction programmes in prisons be fostered (methadone maintenance programmes, syringe exchange pilot programmes).

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Evolution of the prevalence of Mycobacterium tuberculosis infection in a penitentiary population on admission to prison from 1991 to 1996].

BACKGROUND: In Spanish prisons tuberculosis is a serious problem of public health. The analysis of temporal trends of tuberculous infection can show the effectiveness of interventions developed. PATIENTS, MATERIAL AND METHODS: All admissions in a prison between July 1991 and June 1996, without antecedents of chemotherapy or chemoprophylaxis, were included. We gathered sociodemographic variables as well as prison-related variables and HIV-risk factors. Tuberculin skin test was performed with 2 U of PPD RT-23 following the Spanish Consensus to Criterion of Tuberculous Infection. Statistic analysis was based on multivariate analysis (logistic regression). RESULTS: 37% of 1,459 prisoners analyzed were infected with M. tuberculosis. The tuberculous infection was more frequent among older prisoners (p < 0.001) and those with more time spent in prison (p < 0.001). Those with BCG-vaccination showed lesser levels of tuberculin reaction (p = 0.001). Temporal trends of tuberculous infection didn't show variations, but in intravenous drug users IVDU (p = 0.012) and those with time spent in prison (p = 0.08) it was increased. CONCLUSIONS: We detected a high prevalence of tuberculous infection and the time spent in prison was one of the risk factors. The infection was probably underestimate among those with BCG-vaccination because of the criterion used. The tuberculous infection was increased among IVDU and those with antecedent of time spent in prison.

Adolescent↗
PubMed1995

[AIDS prevention in European prisons].

Informations on HIV/AIDS in prisons which include 32 prison-systems in 17 European countries have been collected. The principle of equivalence of preventive measures and health care between prisons and the outside community, prison authorities should strive to prevent HIV transmission in prisons. There have been major developments in effective prevention programmes in the community, there has been less progress within the prison-systems. Information on AIDS is provided to prisoners in almost all prison-systems. While condom distribution is practiced in a growing number of systems, no prison systems have adopted syringes/needle distribution or exchange during incarceration. A few system have accepted distribution of a disinfectant (diluted bleach) with instruction on cleaning injection materials. Despite clear recommendations made by international bodies in 1987/88, it must be concluded that discrimination and segregation (restriction from access to workshops, specially work in kitchens) remain widespread in 1992.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The effect of hepatitis C virus infection on health-related quality of life in prisoners.

Hepatitis C virus (HCV) infection in prisoners represents an important public health problem. However, there is very little information about HCV-related health-related quality of life (HRQOL). We examined the effect of HCV antibody positivity, HCV viremia, and being a prisoner on prisoners'' HRQOL. Population-based health surveys incorporating HCV screening were conducted among prisoners at New South Wales (NSW), Australia, correctional centers in 1996 and 2001. HCV antibody and HCV RNA status were determined from venous blood sampling. HRQOL and mood status were assessed using the Short Form-36 (SF-36) Health Survey and Beck Depression Inventory (BDI). Comparison of HRQOL scores between HCV antibody negative, HCV antibody positive/non-viremic, and HCV antibody positive/viremic and assessment of temporal change in HRQOL between 1996 and 2001 within groups were made using ANCOVA adjusting for confounders. Factors associated with HRQOL were determined in linear regression models. Analyses between HCV antibody negative (n = 423), HCV positive/non-viremic (n = 89), and HCV positive/viremic (n = 178) prisoners found no measurable effect of HCV on HRQOL, including that attributable to HCV viremia. Compared to uninfected Australian population norms, prisoners had lower HRQOL irrespective of HCV status. The prevalence of 'moderate' to 'severe' depressive symptoms was greater in the HCV antibody positive/viremic group than the HCV antibody positive/non-viremic group or the HCV antibody negative group. Selected demographic factors (age), co-morbidity, severity of depressive symptoms and medical care utilization influenced HRQOL. There was evidence to support the effect of knowledge of HCV status on HRQOL. In conclusion, our findings contrast with previous studies in non-prisoner groups in which HCV infection appears to decrease overall HRQOL. Non-HCV factors may override HCV-specific HRQOL impairment in this population. Targeted management strategies are required to improve HRQOL of prisoners.

Adult↗
PubMed1994

Behavioural change amongst drug injectors in Scottish prisons.

A study of injecting behaviour amongst a purposive sample of drug-users in Scottish prisons found that 32% reported injecting prior to current sentence. The percentage of these who were injecting during their current prison sentence (i.e. inside the prison) had fallen to 11%. Of those who were injecting prior to imprisonment, 24% reported sharing injecting equipment at that time. Of those who were still injecting in prison, however, 76% reported sharing equipment. Overall, therefore, there were fewer injectors in prison, but a higher proportion of these shared needles. Factors most closely identified with current sharing of injecting equipment in prison were: (a) having injected a wider range of drugs in prison (during both current and previous sentences); (b) frequency of Temgesic use; and (c) being prescribed methadone in the community, then having that prescription discontinued on entry to prison.

Adult↗
PubMed2006

An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales.

This study describes ecological associations between self-inflicted death rates and prison-level environmental indicators over the period 2000-2002 in England and Wales. The objective was to assist in the development of interventions for reducing the incidence of self-inflicted deaths in prisons in England and Wales, by identifying risk factors, including overcrowding, positive drug tests, the number of assaults, purposeful activity, offending behaviour programmes, and cost per prisoner. Poisson regression was used to estimate associations between self-inflicted death rates and these potential risk factors, controlling for different categories of prison. The annual rate of self-inflicted death during 2000-2002 was 1.14 per 1000 (95% CI 0.98 to 1.34), with no evidence for a difference in the two years. Highest rates were in the Male Local and Women's prisons at 1.86 (95% CI 1.42 to 2.26) and 2.27 (95% CI 1.35 to 3.84) per 1000 respectively. In a multivariate analysis, overcrowding, assault rate and purposeful activity were significant. In an analysis controlling also for prison category, only purposeful activity remained independently significant, as a protective factor (RR 0.57, 95% CI 0.35 to 0.92, p=0.02) with weaker evidence for a positive association with positive drug tests (RR 1.41, 95% CI 0.96 to 2.05, p=0.08). Despite concerns about the quality of routinely collected data and the interpretation of ecological associations, this study suggests that a higher level of purposeful activity is independently associated with lower rates of self-inflicted death, whatever the prison category. This adds support to other studies conducted at the level of the individual prisoner.

Activities of Daily Living↗
PubMed2001

Prevalence of psychiatric disorders in New Zealand prisons: a national study.

OBJECTIVE: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. METHOD: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview - Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. RESULTS: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive- compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. CONCLUSIONS: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.

Adult↗
PubMed2004

Screening for hepatitis C virus in the Dartmoor prison population: an observational study.

BACKGROUND: Prisons are a potential setting for hepatitis C screening. This study describes prisoner flows through such screening for all prisoners entering Dartmoor prison between 1 January 1998 and 30 June 2001. METHODS: We identified numbers at each step of the screening pathway, from screening to result, referral, biopsy and outcome. We describe the proportions of those screened who were seropositive; seropositives who were confirmed virus-positive; virus-positive cases attending for biopsy; and virus-positive cases eligible for treatment. RESULTS: Of 3034 entries into Dartmoor, 12 per cent were screened, with 16 per cent of these seropositive. Seventynine per cent of seropositive prisoners with a polymerase chain reaction result were confirmed virus-positive, and 27 per cent of these prisoners had a biopsy. Two prisoners were eligible for treatment. CONCLUSIONS: Screening uptake is low. Attrition rates are high, especially at the referral interface between the prison and specialist care. Finally, the yield of individuals eligible for treatment is low, at 7/1000 tested.

Cohort Studies↗
PubMed1978

A study of 128 deaths in New York City correctional facilities (1971-1976): implications for prisoner health care.

During a 5 1/2 year period, January, 1971 through July, 1976, 128 deaths occurred in New York City. The epidemiology of prisoner deaths including suicide was examined in a large incarcerated population. Each death was categorized according to the International Classification of Diseases. The mean age of the prisoner death was 34 years. Only 3 deaths occurred among females. Ethnic distribution of these deaths was similar to the prison population. Deaths of prisoners fell into 2 categories: external causes (suicide, accidents, homicide, legal intervention) and nonviolent causes. External causes accounted for 71 deaths. The leading cause of death was suicide, accounting for 52 deaths. Suicides occurred in all time periods of incarceration. The highest rate was in the 35 to 44 year age group. History of drug or alcohol abuse was reported by 69 per cent of the suicides. One-third of the prisoners committing suicides had histories of previous attempts or previous mental hospitalizations. Except for 2 individuals, the method was hanging. For the most part, prisoners at risk for suicide exhibited a common pattern and were identifiable. During the last 2 1/2 years of the study period, deaths were reviewed by a prisoner death committee. Deficiencies of care in deaths of nonviolent causation were categorized as "provider," "corrections," or "system." The most common deficiency in care was delay in hospitalization of prisoners requiring care.

Adolescent↗
PubMed2001

Problems in prisons worldwide, with a particular focus on Russia.

The link between prisons and disease has existed as long as prisons have been used for punishment. The prisons of the world still have high rates of infection with hepatitis, HIV, mental illness, and tuberculosis. TB is a major cause of death in prisons, mainly as a result of overcrowding, poor physical conditions, and lack of adequate treatment. The priorities of prisoners and of public health officials are often at odds with the priorities of prison administrators and prosecutors. Prison health care should be independent of prison administration and should be answerable only to the national public health program. Efforts should be made in those countries with the highest inprisonment rates to find other solutions to maintaining order in the interests of improving public health.

Humans↗
PubMed2005

Psychosis in the community and in prisons: a report from the British National Survey of psychiatric morbidity.

OBJECTIVE: Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. METHOD: A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. RESULTS: The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. CONCLUSIONS: This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.

Adolescent↗
PubMed2006

A framework for management of hepatitis C in prisons.

The prevalence of chronic hepatitis C virus (HCV) infection in prisons ranges from 12% to 31%. There are generally accepted--albeit still evolving--guidelines for identification and treatment of hepatitis C in the community. However, there is less agreement among health professionals caring for prisoners about best practices for identification, medical management, and treatment of hepatitis C. Inmates often lack health care before incarceration. In prisons, infected persons could be identified and the management of infection initiated; however, the high prevalence of HCV infection among prisoners would impose a disproportionate cost for hepatitis C care on the correctional system. The optimal solution is for prison and public health systems in the United States to jointly provide targeted HCV testing and standard-of-care hepatitis C medical management, treatment, and prevention programs to prison inmate populations. The authors report on a January 2003 meeting of experts in prison health, public health, hepatology, and infectious diseases and explore the clinical care, prevention, and collaboration needed to provide hepatitis C management in prisoners.

Cooperative Behavior↗