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[The hospital at Ilebu prison. From sentences 1945-50].

Ilebu Prison held the majority of men sentenced for treason in Norway after the Second World War. About one third of all prisoners convicted of treason served their sentence at Ilebu, which was one of the few prisons or camps which had a well organised hospital with a patient registration protocol. The protocols were recently (1995) brought to light; complete case records are stored in the National Archive. We have gone through a number of the case records and compared them with the protocols. The typical patient at Ilebu in 1945 was below 39 years of age, whereas in 1949 those over 40 were in majority. Average age and length of stay increased over the years as the oldest convicts also got the longest sentences. High age and long sentences contributed to increased morbidity, mental and psychosomatic disease as well as functional illness. The most common reason for admission was infectious disease. Ilebu Prison escaped serious epidemics, most likely because of good facilities for isolation as well as vaccination. However, the large number of prisoners suffering from tuberculosis was a cause for concern.

Adult↗

[Frederik Holst and prisons].

BACKGROUND: In the mid-19th century, Norwegian public services were expanded, among them asylums and prisons. The physician Frederik Holst (1791-1871) was instrumental in the development of both fields. He travelled extensively abroad studying public institutions and had considerable influence on the planning of a new modern penitentiary in Oslo, Botsfengselet, which opened in 1851. MATERIAL AND METHODS: The article is based on Holst's printed lectures and reports. RESULTS: Holst was obviously influenced by the Enlightenment ideas of the 18th century and the contemporary international debate on prisons. He promoted panoptic asylums and prisons with good hygienic standards and the necessary degree of confinement. In the case of asylums, the panoptic principles were discarded before they were implemented, but the new Oslo prison was built as a panoptic institution and according to the Philadelphia system of one cell for each inmate. INTERPRETATION: Holst's writing indicates a commitment to health issues, though he maintained that serving time in a prison was an intended punishment with social rehabilitation as the desired outcome.

Facility Design and Construction↗

Public health, health promotion and the health of people in prison.

Recent policy changes in England and Wales have transferred commissioning and funding of prison healthcare from the prison service to the National Health Service for the first time in its history. Most health services in prisons are now provided by primary care trusts (PCTs), with the consequence that PCTs have a new highly vulnerable population for whom health needs must be assessed and services provided. This article describes what is currently known about the health needs of prisoners and the subsequent implications for public health and health promotion. Following a brief discussion of national and international policy on health promotion in prisons, an overview is given of recent national and local initiatives on public health issues.

England↗

The provision of racially aware healthcare services in prisons.

In a report published in 2005 the Inspectorate of Prisons explored the fact that many black and minority ethnic (BME) prisoners have poor perceptions of their treatment in all areas of prison life. It also attempted to identify barriers that still exist to delivering race equality in prisons and examined the extent to which prison healthcare departments are providing a racially aware health service that assesses and meets individual needs.

Cultural Diversity↗

Nuremberg and the issue of wartime experiments on US prisoners. The Green Committee.

Defense attorneys at the Nuremberg Medical Trial argued that no ethical difference existed between experiments in Nazi concentration camps and research in US prisons. Investigations that had taken place in an Illinois prison became an early focus of this argument. Andrew C. Ivy, MD, whom the American Medical Association had selected as a consultant to the Nuremberg prosecutors, responded to courtroom criticism of research in his home state by encouraging the Illinois governor to establish a committee to evaluate prison research. The governor named a committee and accepted Ivy's offer to chair the panel. Late in the trial, Ivy testified--drawing on the authority of this committee--that research on US prisoners was ethically ideal. However, the governor's committee had never met. After the trial's conclusion, the committee report was published in JAMA, where it became a source of support for experimentation on prisoners.

Advisory Committees↗

HIV/AIDS and human rights in prison. The Costa Rican experience.

HIV and AIDS issues deal directly with Human Rights and Public Health. Four basic principles have been acknowledged internationally in connection with HIV/AIDS: Autonomy, confidentiality, right to health and non-discrimination. According to these principles, it is not possible to adopt illegal or unethical measures toward HIV- infected persons. However, these may rarely be necessary in the case of prisoners, taking into account the possibilities of unpredictable behavior, violence and use of drugs, which are common in prisons. The World Health Organization as well as the United Nations have established the possibility of taking measures, different from those outside the jail, that may be illegal but necessary in order to protect the human rights of inmates, the general prison population and the security of the penitentiary system. Therefore coercive measures such as isolation may be imposed upon an inmate infected by HIV when he or she deliberately may try to infect others. This paper examines different types of situations dealing with HIV/AIDS in prison and reviews the international recommendations and the way the Costa Rican legal and penitentiary system have adopted them in accordance with its legal system and national prison characteristics.

Acquired Immunodeficiency Syndrome↗

Life events and prisoners.

This study explores retrospectively the relationship of the accumulation of life events as it relates to prison incarceration and extends further the concept that coping with increasing environmental changes results in a variety of overt behaviors. The prison sample comprised 176 male inmates of a federal prison (McNeil Island, Washington) and a state penitentiary (Walla Walla, Washington). Life change scores were derived from the Schedule of Recent Experience (SRE). There was an escalation of annual life change scores of prisoners, indicating the mounting frequency of occurrence of life events prior to incarceration. The SRE may have value in the prediction of socially deviant behavior as with health changes. Variables seen as influencing life change scores were race, age, and education. Analyses of life event frequencies as compared to a normative group indicated that prisoners have evolved a coping life-style that reflects antisocial and criminal behavior.

Adult↗

Depression, hopelessness and suicide ideation among vulnerable prisoners.

BACKGROUND: Self-harm among prisoners is high, and suicide rates increasing. Assessment of depressive characteristics is easy. To what extent are these linked with previous self-harm? AIMS: To compare depressive characteristics of prisoners who report previous self-harm with those who do not. METHODS: Twenty-four new arrivals at an adult male category B local prison who reported previous episodes of suicidal behaviour (including self-harm and/or explicit attempted suicide) were assessed using the Beck Hopelessness Scale, the Beck Depression Inventory-II, and the Beck Scale for Suicide Ideation. A further 24 new arrivals were matched as closely as possible with them on sociodemographic and offending characteristics. RESULTS: Mean scores on the Beck Hopelessness Scale, the Beck Depression Inventory-II, and the Beck Scale for Suicide Ideation were significantly higher among the prisoners with a history of self-harm. DISCUSSION: Prisoners with a previous history of self-harm are more likely than those without to show a range of depressive symptoms than their imprisoned peers without such a history, suggesting a continued vulnerability to self-harm and perhaps suicide.

Adult↗

Patterns of self-harm and attempted suicide among white and black/mixed race female prisoners.

AIM: The aim was to investigate ethnic differences in lifetime self-harm and attempted suicide in women prisoners, and to examine relationships between self-harm, suicide and substance use on dependence. BACKGROUND: Previous studies have suggested that there may be ethnic differences in the proportion of prisoners reporting substance misuse, self-harm and attempted suicide, although relatively few minority ethnic women have been studied in the UK. This study examines drug and alcohol dependence in white and black British women in prison, and explores possible associations with self-harm, suicide attempts, and family violence. METHODS: 301 women (190 white, 111 black or mixed race) were interviewed in ten prisons from different parts of England. Measures included the Alcohol Use Disorders Identification test (AUDIT), the severity of Dependence Scale (SDS), and section C (suicidality) of the MINI International Neuropsychiatric Interview. RESULTS: Half of the women in the sample reported at least one act of self-harm in their life and 46% reported making a suicide attempt at some time. Lifetime self-harm was associated with a history of harmful drinking and with being a victim of violence, including physical assault, sexual assault and violence from family and friends. Lifetime suicide attempts were associated with reported violence from family or friends. Current high suicide risk was most common among women on remand. Drug dependence and reported violence from family or friends were both more common amongst white women than black/mixed race women. Self-harm and attempted suicide were generally more common among white women, but black/mixed race women dependent on drugs had the highest proportion of women reporting self-harm. There was tentative support for a three-way association between ethnicity, dependence and self-harm; this raises the possibility that drug dependence may be a predictor of self-harm in the black female prison population.

Black People↗

Prevalence of antibodies to hepatitis C virus and association with intravenous drug abuse and tattooing in a national prison in Norway.

A study was performed in order to determine the prevalence of anti-hepatitis C virus (HCV) antibodies, the risk factors for HCV infection and the markers of hepatic disease in a population of prisoners. Of 101 new prisoners admitted to a Norwegian national prison over a three month period, 70 were included in the study, of whom 32 (46%) were anti-HCV positive. Intravenous drug abuse was the predominant risk factor for HCV infection, although a history of tattooing was found by logistic regression analysis to be a significant risk factor independent of intravenous drug abuse. Most anti-HCV positive prisoners had a history of previous incarcerations. Among the anti-HCV positive subjects, increased alanine aminotransferase (> 50 U/l) was found in 23 (72%). HCV infection was the major cause of hepatic abnormalities in the study population. Only 15 (47%) of the anti-HCV positive prisoners reported knowledge of previous hepatic disease.

Adolescent↗

Prisoners are at risk for hepatitis C transmission.

OBJECTIVE: Determine the incidence of hepatitis C virus antibodies among a cohort of prisoners. DESIGN: Follow-up study of a random sample of prisoners who participated in a cross-sectional survey in 1996. SETTING: 29 correctional centres in New South Wales (Australia). PARTICIPANTS: 181 adult prisoners (163 men and 18 women). RESULTS: The incidence of hepatitis C virus antibody among the 90 inmates who were seronegative at the first test in 1996 was 7.1 per 100 person-years (16 seroconverters). Among the 90 inmates, 37 had re-entered the prison system following release into the community and 53 had been continuously detained. The seroconversion rate was higher among the re-entrants compared with those who had been continuously incarcerated (10.8 vs. 4.5 per 100 person-years, p=0.07). However, when the data was stratified by injecting status, the serocon-version rate in the two groups was similar. Most of the seroconverters had histories of injecting drug users (14/16). The overall incidence among injectors was 19.3 per 100 person years (95% CI: 9.1-29.2). CONCLUSIONS: Hepatitis C transmission occurs inside the prison with injecting drug use the likely cause. Among non-injectors, tattooing was the most likely mode of transmission. Harm minimisation measures with proven effectiveness need to be considered for this environment.

Adult↗

Patterns of injecting and sharing in a Scottish prison.

Although the potential for prisons to act as the setting for HIV transmission has been recognised, there is an enduring lack of knowledge in this area. Data are presented on patterns of injecting and sharing in Edinburgh prison (Scotland), 1993-1994. There was a relatively low level of injecting in Edinburgh prison during this period, with 13% (8/60) of a sample of drug users having injected at some point during their current sentence. The majority (6/8) of those who had injected had shared injecting equipment. Where sharing took place, the level of HIV risk was variable, but would have been higher had cleaning fluids not been available within the prison, or had they not been used by sharers. The implications of this study for drug service provision in prisons is discussed.

Adult↗

The relationship between temporal discounting and the prisoner's dilemma game in intranasal abusers of prescription opioids.

Previous research on college students has found that cooperation in iterated prisoner's dilemma game is correlated with preference for delayed rewards in studies of temporal discounting. The present study attempted to replicate this finding in a drug-dependent population. Thirty-one individuals who intranasally abuse prescription opioids participated in temporal discounting and iterated prisoner's dilemma game procedures during intake for a treatment study. Rate of temporal discounting was determined for each participant at two hypothetical reward magnitudes, as well as proportion of cooperation in a 60-trial iterated prisoner's dilemma game versus a tit-for-tat strategy. Cooperation in the prisoner's dilemma game and temporal discounting rates were significantly correlated in the predicted direction: individuals who preferred delayed rewards in the temporal discounting task were more likely to cooperate in the prisoner's dilemma game.

Administration, Intranasal↗

Suicides in male prisoners in England and Wales, 1978-2003.

The number of suicides in English and Welsh prisons is increasing, but the excess compared with the general population has not been reliably quantified. We therefore compared, in narrow age bands, all 1312 suicides of male prisoners in England and Wales between 1978 and 2003 with suicide rates in the general male population. The overall standardised mortality ratio for suicide was 5.1 (95% CI, 4.8-5.3), suggesting a five-fold excess of suicides in male prisoners, with a particularly striking excess in boys aged 15-17 years (standardised mortality ratio 18 [13-26]). The proportional excess of suicides of male prisoners has been increasing during the past quarter of a century, which underscores the need for substantial improvements in suicide prevention in prisons.

Adolescent↗

The disease profile of Texas prison inmates.

PURPOSE: Whereas prison inmates are reported to exhibit poorer overall health status and higher rates of health care utilization than the general population, no current information exists on the overall disease profile of the U.S. prison population. The present study examined the prevalence of major acute and chronic conditions in one of the nation's largest prison populations. METHODS: The study population consisted of 170,215 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between August 1997 and July 1998. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Infectious diseases (29.6%) constituted the most prevalent major disease category among inmates. This was followed by diseases of the musculoskeletal system and connective tissue (15.3%), diseases of the circulatory system (14.0%), mental disorders (10.8%), and diseases of the respiratory system (6.3%). Among the specific conditions examined, evidence of tuberculosis infection without active pulmonary disease (20.1%) was found to be the most prevalent condition, followed by hypertension (9.8%), asthma (5.2%), low back pain (5.1%), and viral hepatitis (5.0%). CONCLUSIONS: The present study shows that for a number of conditions, the prison population exhibited prevalence rates that were substantially higher than those reported for the general population. Moreover, estimates for a number of diseases varied substantially according to age, race, and gender. Understanding the disease profile in U.S. incarcerated populations will permit correctional administrators to develop more efficient health care delivery systems for prison inmates.

Adolescent↗

Hepatitis B outbreak at Glenochil prison during January to June 1993.

This data linkage study examined the extent of hepatitis B transmission and co-infection with HIV among 636 former inmates of Glenochil prison, Scotland, during an outbreak of bloodborne diseases in 1993 which was related to needle sharing. Eleven inmates imprisoned during the first half of 1993 presented with hepatitis B infection, of whom co-infection with HIV was detected in six. Based on dates of test results in relation to time of imprisonment, seven definitely acquired their hepatitis B infection within the prison. Only two infections were reported to Scotland's hepatitis B register and neither could be prison-linked. This outbreak of hepatitis B is the first of its kind to be reported but not the first to have occurred. It not only highlights the urgency for measures to prevent further spread of infection among prisoners but also illustrates the need for comprehensive surveillance of hepatitis B infection, and the need for a protocol on how to manage such outbreaks and on how to establish the extent of transmissions when acute hepatitis B occurs in prison.

Adolescent↗

The prevalence of mental illness in prison.

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

Cross-Sectional Studies↗

Suicide in Greek prisons: 1977 to 1996.

Data obtained from the records of the Greek Ministry of Justice revealed that there were 457 deaths in the Greek prison system (which includes prisons, mental hospitals and other general hospitals) over the past 20 years. Of these deaths, 93 were recorded as suicides--an average of 4.65 suicides per year or 112 per 100,000 inmates classified as convinced, on remand or hospitalized. The suicide rates fluctuated widely, from a low rate 32.3 in 1982 to the incredibly high rate of 390.8 in 1979 (11 total suicides, 10 of which occurred in prison hospitals). The present study, the first of its kind in Greece, was based solely on unpublished prison data, which revealed defects in recording (e.g., 11% of the deaths recorded by the correctional administration remained without specification of cause in the years 1977 through 1996; social and penal demographic data of the inmates who committed suicide were kept unsystematically; detailed information on the circumstances of suicide was not always available, etc.). Despite a noticeable decrease in the suicide rate in the years 1995 and 1996, the limited data suggest that the suicide rate in the Greek prison system has basically remained stable over the past 20 years.

Cause of Death↗