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PubMed2001

Health care needs assessment in prisons: a toolkit.

BACKGROUND: Since 1999, prison health services and health authorities have been jointly responsible for assessing the health care needs of the prison population. To facilitate this process, the Department of Public Health and Epidemiology at the University of Birmingham developed a toolkit for carrying out a health care needs assessment of the prison population. METHODS: This paper describes the principles of the epidemiological approach to needs assessment and presents a stepped approach to carrying out a health care needs assessment in prisons. Some examples of the kind of health care needs to be found in prisons are presented. RESULTS: A systematic approach to the assessment of the health care needs of prisoners ensures that all the essential components of this important planning exercise are considered. The prison population is described, health problems are identified and quantified, and a review of current services is carried out. This allows the most effective solutions to addressing the health problems to be established. The process can be time consuming and is reliant on good data sources, but it does ensure that health problems and service elements are considered and addressed together rather than in a disjointed manner. CONCLUSION: The stepped approach to epidemiological needs assessment allows health problems and current services to be identified. It also allows these to be matched to appropriate service requirements.

Adolescent↗
PubMed2005

Opportunities for health promotion in the Queensland women's prison system.

OBJECTIVE: To compare the health of Queensland women prisoners with that of community women using the target areas of public health promotion identified by Health Determinants Queensland as a framework. METHODS: Data from the Queensland Women Prisoners' Health Survey was compared with published community data in each of the target areas. RESULTS: Queensland women prisoners had poorer nutrition, did less exercise, had higher rates of smoking and had a greater prevalence of asthma and diabetes than women in the community. They seemed to have a greater prevalence of mental health disorders. CONCLUSIONS: Within the framework, women prisoners had significantly poorer measured outcomes than community women in all areas except cervical screening, breast cancer screening and overweight and obesity. IMPLICATIONS: The Health Determinants Queensland target areas for Queensland women are of even greater priority in the subgroup of women prisoners. Benefits for the health of prisoners, and therefore the community, could be gained by expanding existing community health promotion activities to prisons through collaboration and partnerships.

Adolescent↗
PubMed1996

Point prevalence of mental disorder in unconvicted male prisoners in England and Wales.

OBJECTIVES: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. DESIGN: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. SETTING: Three young offenders' institutions and 13 adult men's prisons. SUBJECTS: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. MAIN OUTCOME MEASURES: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. RESULTS: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). CONCLUSIONS: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness.

Adult↗
PubMed2003

Providing treatment to prisoners with mental disorders: development of a policy. Selective literature review and expert consultation exercise.

BACKGROUND: Mental disorder is more prevalent among people in prison than in the general population. Prisoners who require transfer to psychiatric hospitals for treatment face long delays. Doctors working in prisons regularly face ethical and legal dilemmas posed by prisoners with mental illness. AIMS: To develop a policy for providing treatment under the common law to prisoners with mental disorders who lack treatment decision-making capacity, while arrangements are made to transfer them to hospital. METHOD: The policy was developed through literature review and consultation with the Faculty of Law at Southampton University and health care staff at Winchester prison in the UK. RESULTS: The policy provides guidelines for establishing decision-making capacity, standards for documentation, and guidelines for implementation based on the Mental Health Act Code of Practice, other best-practice guidelines and case law. CONCLUSIONS: It can be argued that case law allows more-extensive treatment to be provided in the best interests of the incompetent prisoner, beyond emergency situations. The policy has ethical implications and its use should be carefully monitored.

Decision Making↗
PubMedDate not supplied

A review of the legal and ethical issues for the conduct of HIV-related research in prisons.

This article sets the stage for future discussions of expanding prisoners' access to clinical trials in an effort to move from commentary and recommendations to changes in practice. It describes barriers to access to clinical trials, the demographics of HIV/AIDS in prisons, the unique situation posed by the potential for HIV-related research in prisons, and examines briefly the history of prisoner research in the U.S. The article considers both ethical and legal responses to clinical trials in prisons, noting the potential for and limitations of legal actions. Finally, it makes recommendations for conditions necessary to conduct ethical research in prisons and calls for more cooperation between prison systems and HIV/AIDS clinical trials researchers to make expanded access to clinical trials a reality.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Chest radiograph screening for tuberculosis in a Hong Kong prison.

SETTING: Long-stay prisoners are not regularly screened for TB in Hong Kong. OBJECTIVE: To evaluate tuberculosis (TB) screening in prison. METHOD: All prisoners in a maximum security prison as of 31 October 2001 were screened by chest radiograph (CXR), except for those being followed up for TB or examined by CXR in the last 6 months. RESULTS: A total of 814 male prisoners aged 34.6 +/- 9.6 (mean +/- SD) years were successfully screened. Of 53 cases (6.51%) with radiographic abnormalities, 10 active TB cases (8 culture-negative, 2 culture-positive) were diagnosed, giving an overall yield of 1.23% (95%CI 0.59-2.26). There was no statistical difference in age, ethnicity, place of birth or residency status between those with and those without TB (all P > 0.05). Incarceration > or = 2 years, being in current prison > or = 2 years and not having CXR in last 2 years were associated with TB in univariate analysis (all P < 0.05), but only the last remained an independent predictor in multiple logistic regression (OR 16.8, 95%CI 2.1-132.9, P = 0.008). In that group, the yield was 3.1% (95%CI 1.42-5.89). No further cases were detected in the subsequent 2 years. CONCLUSION: CXR screening of long-stay prisoners gave a high yield in this study.

Adult↗
PubMed2006

Tuberculosis and tuberculosis control in European prisons.

OBJECTIVE: Correctional facilities have often been cited as reservoirs for tuberculosis (TB), presenting a potential threat to the general population. Although correctional facilities are recognised as ideal settings for interventions, little is known about the TB epidemiology within them. The purpose of our survey was to collect data on TB in prisons of the WHO European Region and on existing control measures. DESIGN: A questionnaire was sent to 52 EuroTB correspondents asking for 2002 data on the total number of inmates, number of prisoners with TB, resistance rates, screening strategies, monitoring and responsibilities. RESULTS: Twenty-two (42.3%) countries completed the questionnaire. The median TB notification rate was 232 per 100,000 inmates (0-17,808). Prisoners had up to 83.6 times more TB than civilians. The majority (90.9%) of the participating countries reported performing active screening for TB on entry into prison, with a median detection rate of 393/100,000 (42-2362). Of the respondent countries, 81.8% claimed to perform contact investigations and 86.4% to house infectious TB patients separately. CONCLUSION: Although response to this survey was only 42.3% and might be biased by a country's engagement in TB control in prisons, the results highlight the vulnerability of prisoners to TB and emphasise the need for adequate case-finding and containment strategies in prison.

Communicable Disease Control↗
PubMed1997

The benefits of social support for mentally ill offenders: prison-to-community transitions.

This paper provides results of a longitudinal study of 27 mentally ill prison inmates who were released from Ohio state prisons in 1994-1996. The object of this paper is to test the hypothesis that subjects who receive better social support will experience more positive social adjustment, higher quality of life, and lower recidivism. Subjects, identified by prison staff, were interviewed and given independent psychological evaluations shortly before their release. They were then interviewed repeatedly during the first year after their release from prison about many aspects of social adjustment. Social support, provided both in and after release from prison, was associated with higher quality of life after release from prison. Social support provided in either context, however, was not significantly related to criminal recidivism or psychiatric hospitalization after release from prison.

Adult↗
PubMed1988

Auditory event related potentials in violent and nonviolent prisoners.

The neurophysiologic substrates of violence and aggression have been extensively studied. Although the EEG is often normal in violent persons any abnormalities are generally nonspecific in nature. Evoked potentials have been infrequently used to study such behavior disorders. Long latency auditory event-related potentials (AEPs) were studied in prison inmates incarcerated for unmotivated violent crimes or violence during the commission of other crimes, and in prisoners jailed for non-violent offenses. Habitually violent inmates were compared with an equal number of non-violent prisoners and neurologically and audiologically intact controls. AEPs were recorded to an "oddball" paradigm from vertex and left and right temporal electrodes. None of the prisoners had latencies more than 3 standard deviations beyond the normal group mean. N1 and P2 components were longer in latency and lower in amplitude in prisoners than in controls, but this was not statistically significant. Violent and non-violent individuals did not differ in these measures. P3 was significantly prolonged in latency in violent inmates, but not in those who had committed a violent act. All components were longer in latency on the right in violent prisoners, while amplitudes were lower but not significantly so. This asymmetry was not present in non-violent prisoners or control subjects. Caution is needed in identifying differences between criminals and the general population, and in seeking markers of violent behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Prescription of hypnotics and tranquilisers at the Geneva prison's outpatient service in comparison to an urban outpatient medical service.

OBJECTIVES: Examine whether an overconsumption of tranquillizers exists in prison and discuss possible reasons. METHODS: Comparative study during three weeks at Geneva: prison outpatient service and Medical Policlinic (MP) of the University Hospital. RESULTS: When comparing the 113 (prison) and 151 (MP) male patients younger than 39 years, we found important differences concerning the quality and quantity of prescriptions of psychoactive drugs: ten times more prison patients than patients from the MP were treated with benzodiazepines (BZD). The differences persisted even when considering only prisoners who were not known to be street drug, alcohol or long time BZD consumers. CONCLUSIONS: The differences cannot be explained by the high percentage of drug addicts in prison. Our results suggest the importance of factors related to the prison environment.

Adult↗
PubMed2006

The association between a self-reported history of mental health problems and a history of parasuicide in a sample of UK male prisoners.

BACKGROUND: Prisoner parasuicide is a major public and mental health concern worldwide and within the United Kingdom. OBJECTIVES: This study used a cross-sectional design to examine the association between a self-reported history of mental health problems and a history of parasuicide in male prisoners. METHODS: A total sample of 192 convicted prisoners who were about to be released from a local category "B" prison in the UK were approached and asked to complete the "Toolkit for Healthcare Needs Assessment in Prisons" which contained a range of demographic, mental and physical health questions. Unadjusted and adjusted odds ratios (with 95% confidence intervals) were determined using logistic regression. RESULTS: Fifty-one prisoners participated. The unadjusted odds ratio for having a self-reported history of mental health problems and a self-reported history of parasuicide was 15.6 (95% C.I., 2.96-82.16). Following adjustment for age, living alone, homelessness, illegal drug use and alcohol problems the odds ratio was 11.32 (95% C.I., 1.80-71.13). DISCUSSION: This study provides good evidence of an association between a history of mental health problems and a history of parasuicide in a group of UK male prisoners.

Adult↗
PubMed2005

The prevalence of HCV antibody in South Australian prisoners.

OBJECTIVES: The study was aimed at identifying the hepatitis C virus (HCV)-antibody status of prisoners incarcerated in South Australia in order to develop an HCV prevalence estimate for the whole prison system. METHODS: The health records of persons incarcerated within eight prisons (accommodating approximately 93% of the jurisdiction's adult incarcerated population) were audited for evidence of HCV infection, age, sex, Indigenous status (Australian Aboriginal or Torres Strait Islander) and date of entry to prison. These data were analysed using both univariate and multivariate techniques. RESULTS: Among 1347 prisoners (1254 males and 93 females), 30.2% were HCV-antibody positive. After excluding those with no history of testing, HCV-antibody prevalence rose to 41.3% (males 39.8%, females 66.1%). HCV-antibody positivity was significantly associated with age, sex and Indigenous status in both univariate and multivariate analyses. CONCLUSIONS: Consistent with the literature, the prevalence of HCV infection in the SA prison system appears to be extremely high. This study suggests that HCV prevention efforts in prison settings should be considered as an important priority.

Adolescent↗
PubMed2000

[Transmission of tuberculosis in the prisons of Madrid].

BACKGROUND: Prisons are recognized as high-risk settings for tuberculosis transmission. The purpose of this study was to describe the characteristics of prisoners with tuberculosis and to determine the extent of transmission of tuberculosis in the prison population of Madrid. PATIENTS AND METHODS: Patients with positive culture for Mycobacterium tuberculosis between 1997 and 1998 from the prison system of Madrid were included. The medical records for these patients were reviewed, and they were also interviewed. Patients were included in clusters when their isolates contained 1) six or more IS6110 bands in an identical pattern or 2) five or fewer IS6110 bands that matched identically and had an identical spoligotyping pattern. RESULTS: Culture-proven tuberculosis was diagnosed in 97 prisoners (case rate: 693 per 100.000 per year). Isolates from 73 (75%) patients were available for fingerprinting. The mean age of these patients was 33 yr (SD: 6,9), 92% were male, and 14% were immigrants. Seventy-one percent (71%) of patients were HIV-positive, 32% were active intravenous drug users and 70% nonintravenous drug users in the last two years. Primary drug resistance to isoniazid was 1,8%. Forty-one percent of prisoners (41%) were grouped in 9 clusters. Epidemiological links were found in 37% of clustered patients. Risk factors for clustering were not detected. CONCLUSION: The results suggest recent transmission of tuberculosis in the prisons of Madrid. It is essential that correctional facilities comply fully with the recomendations for prevention and control of tuberculosis.

Adult↗
PubMedDate not supplied

Sexually transmitted infections among prison inmates in a rural district of Malawi.

As part of a comprehensive human immunodeficiency virus (HIV) prevention strategy targeting high-risk groups, sexually transmitted infection (STI) clinics are offered to all prisoners in Thyolo district, southern Malawi. Prison inmates are not, however, allowed access to condoms as it is felt that such an intervention might encourage homosexuality which is illegal in Malawi. A study was conducted between January 2000 and December 2001 in order to determine the prevalence, incidence, and patterns of STIs among male inmates of 2 prisons in this rural district. A total of 4229 inmates were entered into the study during a 2-year period. Of these, 178 (4.2%) were diagnosed with an STI. This included 83 (46%) inmates with urethral discharge, 60 (34%) with genital ulcer disease (GUD), and 35 (20%) inmates with epididymo-orchitis. Fifty (28%) STIs were considered incident cases acquired within the prisons (incidence risk 12 cases/1000 inmates/year). GUD was the most common STI in this group comprising 52% of all STI. This study shows that a considerable proportion of STIs among inmates are acquired within prison. In a setting of same-sex inmates, this suggests inter-prisoner same-sex sexual activity. The findings have implications for HIV transmission and might help in developing more rational policies on STI control and condom access within Malawi prisons.

Adult↗
PubMed2002

Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys.

BACKGROUND: About 9 million people are imprisoned worldwide, but the number with serious mental disorders (psychosis, major depression, and antisocial personality disorder) is unknown. We did a systematic review of surveys on such disorders in general prison populations in western countries. METHODS: We searched for psychiatric surveys that were based on interviews of unselected prison populations and included diagnoses of psychotic illnesses or major depression within the previous 6 months, or a history of any personality disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors. We determined prevalence rates of serious mental disorders, sex, type of prisoner (detainee or sentenced inmate), and other characteristics. FINDINGS: 62 surveys from 12 countries included 22790 prisoners (mean age 29 years, 18530 [81%] men, 2568 [26%] of 9776 were violent offenders). 3.7% of men (95% CI 3.3--4.1) had psychotic illnesses, 10% (9--11) major depression, and 65% (61--68) a personality disorder, including 47% (46--48) with antisocial personality disorder. 4.0% of women (3.2--5.1) had psychotic illnesses, 12% (11--14) major depression, and 42% (38--45) a personality disorder, including 21% (19--23) with antisocial personality disorder. Although there was substantial heterogeneity among studies (especially for antisocial personality disorder), only a small proportion was explained by differences in prevalence rates between detainees and sentenced inmates. Prisoners were several times more likely to have psychosis and major depression, and about ten times more likely to have antisocial personality disorder, than the general population. INTERPRETATION: Worldwide, several million prisoners probably have serious mental disorders, but how well prison services are addressing these problems is not known.

Adult↗
PubMed1987

AIDS in prison.

A survey carried out in 17 countries on behalf of the Council of Europe shows how prison doctors and administrations have reacted to the AIDS epidemic in ways that are not always scientifically and ethically sound. The pressing need to control HIV infection in prison, to counsel and support seropositive prisoners, to care for prisoners who get AIDS, and to cope with the psychosocial pressures within a closed, authoritarian environment pose a serious challenge to prison medical services; it is far from certain that they have sufficient resources and professional independence to cope. Failure to react adequately to the AIDS epidemic in prisons would have serious consequences both for the community as a whole and for the ethical position of prison doctors.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Dispersion of the corrected QT interval in the electrocardiogram of the ex-prisoners of war.

The study of electrocardiograms (ECGs) was performed in a subgroup of 181 men, ex-prisoners of war with mean age 35.8+/-11.0 years and mean duration of imprisonment 164.5+/-87.1 days, chosen at random from the total sample of released prisoners (N=1458). The control group was pair-matched. The analysis of ECGs was done according to the Minnesota code, and Bazett's formula gave the values of the corrected QT interval (QT(c)). The dispersion of the QT(c) interval is determined by the difference between the longest and the shortest measured QT(c) interval in each ECG lead. The results of descriptive statistics in the group of ex-prisoners showed the range of QT(c) dispersion of 8.0-122.0 ms (mean 52.4+/-21.6 ms), while in the control group the range was 6.0-72.0 ms (mean 30.4+/-13.8 ms) (df=360, t=11.536; P<0.001). The QT(c) interval from 422.0 to 480.0 ms had 60.2% ex-prisoners and 30.4% controls, while a QT(c) interval over 480.0 ms had 19.3% ex-prisoners and 1.10% controls (P<0.0001). In the ex-prisoners group, the QT(c) dispersion over 50 ms was present in 51.4%; of those, a dispersion of 95 ms and more was found in 3.9%, while in the controls a QT(c) dispersion over 50 ms was found in 8.3%, but a dispersion of 95 ms and more was not recorded (P<0.0001). The odds ratio estimated for the prolonged QT(c) interval was 8.467 and for enlarged QT(c) dispersion it was 11.695 in the ex-prisoners versus controls (P<0.001). In conclusion, persons exposed to long-term maltreatment in detention camps have significantly greater QT(c) dispersion, as well as a higher relative risk of prolonged QT(c) interval and greater QT(c) dispersion than a control group.

Adolescent↗
PubMedDate not supplied

[Jails and AIDS. Risk factors for HIV infection in the prisons of Madrid].

The spread and risk factors for HIV infection were studied in 288 men and 95 women at the prisons of Carabanchel and Yeserias, Madrid. These men and women requested care at the AIDS prevention program in the jails of Madrid, from April to December 1987. Among the men studied at Carabanchel, 55% were positive to HIV (77% seropositivity among intravenous drug users, IVDU). Tattooing (OR = 2.8), and number of times in prison (OR = 4.5 comparing those who had been 8 or more times in prison with those who had been in prison only once) were independent risk factors for infection, after controlling for IVDU. No association was found between seropositive status to HIV and reported anal intercourse. Among the women studied at Yeserias, the proportion of HIV seropositive women was 26% (70% of the IVDUs were seropositive). Tattooing, number of times in prison, history of prostitution and history of syphilis were associated with HIV infection. When controlling for IVDU, number of times in prison and history of prostitution were not independent risk factors for infection. These data indicate that there is a need for control measures to avoid further spread of the HIV infection among the inmate population, in particular through the use of contaminated needles while in prison.

Female↗