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PubMed2002

Tuberculosis in Thai prisons: magnitude, transmission and drug susceptibility.

BACKGROUND: Because of the human immunodeficiency virus (HIV) epidemic, tuberculosis has reemerged as a major public health problem in Thailand. Prison inmates are at high risk for developing tuberculosis because of the high prevalence of HIV infection. OBJECTIVES: To determine the magnitude, transmission, and drug susceptibility of tuberculosis in Thai prisons. SETTINGS: Four provincial prisons in Southern Thailand. DESIGN: Cross-sectional, descriptive, clinical and molecular study. RESULTS: Miniature chest roentgenograms were performed on 304 (6.4%) of 4751 inmates screened for a > or = 2 week history of chronic cough and fever. At least 17 (35%) of 49 inmates who had a miniature chest roentgenogram compatible with tuberculosis were HIV-positive. The prevalence of smear-positive pulmonary tuberculosis was 568 per 100,000 inmates, which was eight times higher than that in the general population. Eight (38%) of 21 culture-positive Mycobacterium tuberculosis isolates had DNA fingerprints matching those of another inmate who was housed in the same room or in the same dormitory unit; 39% of the M. tuberculosis isolates were resistant to isoniazid; three of these isolates were also borderline resistant to rifampicin. CONCLUSION: The prevalence of pulmonary tuberculosis in these prisons was high. A substantial proportion were acquired in the prisons. Isoniazid (INH) resistance was common, and theoretically precludes the use of INH-preventive therapy for contacts of these cases. Active case finding should be done and directly observed therapy implemented to prevent the spread of tuberculosis into the community.

Adult↗
PubMed2002

Anti-tuberculosis drug resistance in community and prison patients, Orel Oblast, Russian Federation.

SETTING: Orel Oblast, Russian Federation. OBJECTIVES: To determine baseline levels of anti-tuberculosis drug resistance in Orel Oblast. DESIGN: Drug susceptibility testing (DST) records from 1 July 1999 to 30 June 2000 for patients with sputum acid-fast bacilli smear-positive pulmonary tuberculosis were reviewed. Treatment and incarceration status were obtained from the tuberculosis register. Patients with 1 month or less of prior treatment were defined as new cases; those previously treated for more than 1 month were defined as retreatment cases. RESULTS: Of 246 smear-positive isolates, 212 (86%) had DST performed. Of these, 190 (90%) were from new and 22 (10%) from retreatment cases; 171 (81%) were from community and 41 (19%) were from prison patients. Any drug resistance was more common among prison than community patients (44% vs. 30%, P = 0.05). MDR-TB was found in 14 (6.6%) of 212 isolates, and was more prevalent in prison compared with community patients (12% vs. 5%, P = 0.05). Retreatment cases were more likely than new cases to have MDR-TB (prevalence ratio [PR] = 8.5, 95%CI = 3.3-22.3), although the PR was higher for prison than for community retreatment cases (10.0 vs. 5.8). CONCLUSIONS: New cases with MDR-TB were less prevalent in Orel Oblast compared with other survey sites in Russia. Any drug resistance and MDR-TB were associated with prior treatment, especially in the prison population. Continued monitoring of trends in drug resistance following DOTS implementation is needed.

Adult↗
PubMed2001

HIV/AIDS, prisons and the Human Rights Act.

This article considers current practice in the treatment of HIV positive prisoners, in light of the rights contained in the Human Rights Act, and of international standards. In particular, the article considers the current practice of the prison service in relation to measures to prevent the spread of HIV, including the provision of condoms, and needle exchange programmes, and considers the extent of positive obligations on the prison service to take such preventative measures. The adequacy of medical care available to HIV positive prisoners, and the obligations on the prison service in relation to medical confidentiality, are also examined. The author assesses the possibilities for legal challenges under the Human Rights Act, and suggests that the Convention may be a useful tool for policy development in this area.

Condoms↗
PubMed2002

[Psychosocial characteristics of victims of suicide in prisons].

BACKGROUND: Besides some cases reported by the media in recent years about prison inmates who committed suicide, hardly anything is known concerning social, criminological and psychiatric characteristics of suicide victims in jails and prisons in Austria. It therefore seems necessary to evaluate jail and prison suicides in order to establish effective means of prevention. METHODS: A study was conducted evaluating all suicides in Austrian prisons between 1975 and 1999. In addition to nationality, education and working status, other indicators of social integration and psychiatric history of suicide victims were studied. RESULTS: 220 personal files of 250 suicides were available. During the observation period the suicide rate of imprisoned foreigners decreased slightly (mean 106.6/100,000), whereas the suicide rate of Austrian citizens increased significantly (mean 172.0/100,000). Of all suicide victims, 41% had neither finished school nor had they any professional education. 44% were unemployed before incarceration, 50% did not work while incarcerated. A high frequency of suicidal behavior amongst suicide victims before committing suicide (49% suicide attempts, 37% suicide threats), and a high prevalence of mental disorders (37% psychopharmacological treatment, 48.6% were assessed by a psychiatrist) could be detected. CONCLUSIONS: Screening instruments should be applied which are easy to handle for prison officers and indicate the appropriate management of inmates at a high suicide risk.

Adult↗
PubMed2003

[Molecular epidemiology of tuberculosis among prisoners].

The subject of the investigation is a group of 27 strains of Mycobacterium tuberculosis isolated in 2000 from prisoners with the diagnosis of tuberculosis, 19 Czechs and 8 foreigners (mean age 41 and 35 years resp.). The molecular-epidemiological examination of these strains was made using the RFLP fingerprint technique (Restriction Fragment Length Polymorphism) with evidence of the insertive sequence IS6110 and the technique of spoligotyping, based on detection of hybridization of spacer oligonucleotides. DNA fingerprinting revealed a high polymorphism in the number and molecular weight of sequence IS6110 which is common in Czech and other European strains of M. tuberculosis. All strains with the exception of two had mutually different fingerprint profiles. In the two with identical fingerprints probably a duplicit examination of the same material was involved which occurred by mistake during transport or in the laboratory. The fingerprint method thus did not prove interhuman transmission of tuberculosis between the examined prisoners. The technique of spoligotyping revealed the finding of genotype Beijing M. tuberculosis in two sick prisoners, one Algerian and one Albanese, and in one Czech prisoner. This genotype found in a high percentage of patients in southeastern Asia and in migrants from this area was detected for the first time in the Czech Republic. The findings are evidence of a satisfactory standard of the programme of tuberculosis control in the Czech prison system and at the same time draw attention to the potential possibility of the spread of tuberculosis from migrants coming from areas with a high prevalence.

Adult↗
PubMed2002

Giving until it hurts: prisoners are not the answer to the national organ shortage.

This Note argues that prisoners, whether executed or living, should not become organ donors. The introduction acknowledges the shortage of transplantable organs in the United States and the steps that have been taken to ameliorate the crisis. Part I discusses the procurement of organs from executed prisoners, beginning with a brief examination of China, a country where this type of procurement is routinely practiced. Part I also examines organ procurement legislation pertaining to executed prisoners. Finally, Part I asserts the reasons that prisoners should not become donors, including the dead donor rule, the ban against physicians as executioners, the Oath of Hippocrates, the risk of transmissible diseases, and the negative perception that would result if organ procurement was tied to executions. Part II of this Note discusses prisoners donating their organs in return for mitigated sentences. Part II then argues that this practice should not be adopted because of the lack of informed consent and voluntary choice. Finally, Part III of this Note introduces potential solutions to the possibility of maintaining a voluntary system, moving to a presumed consent system, and using financial inducements to create a larger supply of transplantable organs.

Cadaver↗
PubMed2003

Extensive transmission of Mycobacterium tuberculosis among congregated, HIV-infected prison inmates in South Carolina, United States.

BACKGROUND: In August 1999, a prison inmate infected with the human immunodeficiency virus (HIV) was diagnosed with pulmonary tuberculosis (TB). This source patient lived in a prison dormitory housing over 300 HIV-infected men, and was symptomatic for at least 2 months prior to diagnosis. We report a large outbreak of TB in HIV-infected prison inmates with subsequent transmission of Mycobacterium tuberculosis outside the prison. METHODS: Exposed inmates were screened by symptom review, chest radiograph and tuberculin skin test (TST) in September and December 1999. We recorded CD4 cell counts, viral loads and receipt of highly active antiretroviral therapy (HAART). RESULTS: The source patient lived on the right side of a two-sided dormitory exclusively housing HIV-infected men. Of 114 men tested from the right side, 75 (66%) had documented TST conversions. Of 96 converters overall, 82 (85%) had TSTs measuring > or = 15 mm. Within 6 months of diagnosis of TB in the source patient, 30 additional inmates and a healthcare worker who cared for the source patient developed TB disease. Two other inmates developed TB disease in spring of 2001. CONCLUSIONS: We describe extensive transmission of M. tuberculosis in a group of HIV-infected prison inmates with high TST conversion rates and subsequent transmission in the community. In settings where HIV-infected persons are congregated, the consequences of TB outbreaks are magnified.

Adult↗
PubMed2003

[Reducing the risks in prison surroundings. Between policies and realities, the challenge persists].

Numerous health problems Prison population demographics have dramatically increased during the last thirty years and there is no element that foresees a forthcoming inflection of this tendency. Many studies carried out both in France and elsewhere have assessed the extent of the health problems both on admission to prison and during detention. Difficulties in reducing the risks While available data fully justify the need of a true risk reduction policy, there is an obvious lack of pragmatism and courage in many of the field workers and professionals. Confusion between global prevention, general measures of hygiene and education, and true risk reduction programmes makes the risk reduction policy unclear. The strategy to be adopted All efforts should be dedicated today to make the measures of risk reduction widely available, in particular drug maintenance treatments and condoms, to train prison staff, and to evaluate on a regular basis the clinical practices and their effects. Only a voluntarist and clear health and drug policy, together with a motivated prison staff, including health professional and administration staff, are the keys to success for an efficient risk reduction strategy. It is crucial to implement and to test innovative programs, and to regularly assess all the facets of the risk reduction policy in prisons.

Efficiency, Organizational↗
PubMed2004

Implementation of the DOTS strategy in prisons at provincial level, Thailand.

SETTINGS: Sixteen prisons located in four geographic regions in Thailand. OBJECTIVES: To assess treatment outcomes of tuberculosis (TB) patients under the DOTS strategy in a prison programme. METHOD: The programme prospectively included 1412 consecutive TB patients registered during Year 1 (June 1999-May 2000), Year 2 (June 2000-May 2001) and Year 3 (June 2001-May 2002). DOTS implementation consisted of government commitment; passive detection by sputum smear microscopy; standardised short-course chemotherapy, including directly observed treatment by prison nurses; maintenance of drug stocks at provincial health offices; and a recording and reporting system. Data were collected using prison TB registers. RESULTS: The number of TB patients increased from 348 in Year 1 to 490 in Year 2 and to 574 in Year 3. New smear-positive patients accounted for 82.0% of the total. Of the 1158 new smear-positive cases, 68.7% were cured, 17.6% died, 10.6% were transferred out, 2.6% failed, and 0.5% completed treatment. CONCLUSIONS: DOTS implementation in these prisons could not achieve the national target to cure 85% of new smear-positive cases. More interventions are needed to help reduce the deaths and transferred cases that mainly affected the treatment outcomes in these settings.

Adult↗
PubMed2004

Psychic disorders in former prisoners of war.

AIM: To analyze the kind and the representation of psychic disorders in former prisoners of war and war veterans who were not detained in camps. METHODS: The analyzed sample consisted of 160 respondents divided into two groups. A group of 100 former prisoners of war and a group of 60 war veterans who had not been detained in camps. All the respondents are males and were psychically in healthy condition prior to the war. The modified Harvard Trauma Questionnaire was used to diagnose traumatic experience, and a questionnaire according to the DSM IV criteria was used to diagnose posttraumatic stress disorder. The Depressiveness Scale D-92 was used to diagnose depressiveness; the questionnaire STAI was used to diagnose anxiety; CAGE Questionnaire was used to diagnose alcoholism. RESULTS: The former prisoners of war had traumatic experience at a higher level as compared to the war veterans who had not been detained in camps (P < 0.05). The symptoms of PTSD were manifested by 55% of camp inmates as compared to 33.3% of war veterans (P < 0.05). Depressive disorder was diagnosed in 52% of camp inmates and 31.7% of war veterans (P < 0.05). No statistically significant difference was found among the analyzed groups relating to anxiety and alcohol drinking. CONCLUSIONS: The former prisoners of war were living through a severer stage and had a more sundry traumatic experience. Severer stage of traumatic experience conditioned statistically higher representation of psychic disorders (PTSD and depressiveness) in the former prisoners of war as compared to the war veterans.

Adult↗
PubMed2004

Hepatitis A vaccination--a prison-based solution for a community-based outbreak?

In December 2001, an increase in cases of hepatitis A was observed in South Yorkshire. Cases were predominantly young males who reported injecting drug use. A community-based vaccination programme was introduced in November 2002, but new cases continued to occur. In March 2003, a vaccination campaign was implemented in the local prison for a four-week period. One thousand two hundred and thirty-six (91%) prisoners were vaccinated. Two thirds (895/1,363) of the prisoners came from the area affected by the outbreak and 52% (465/895) reported injecting drugs. The median age of injectors was 25 years. Notifications of cases of hepatitis A from South Yorkshire ceased in August 2003. Although on this occasion the prison vaccination campaign was probably implemented too late to have had a significant impact on the local outbreak, a large number of young male injectors from the local area were successfully vaccinated. This suggests that a prison-based intervention offers a potentially effective way of immunising the IDU population and interrupting a community-based outbreak.

Adolescent↗
PubMed2005

Pulmonary tuberculosis in two remand prisons (SIZOs) in St Petersburg, Russia.

The tuberculosis (TB) situation in the Russian penitentiary system has received much attention. We performed a descriptive epidemiological study of TB in two St Petersburg remand prisons (SIZOs). The medical databases of the TB divisions in these prisons were searched for all diagnosed cases of TB from 1 January 2000 to 31 December 2002. The main diagnostic method was chest x ray. The total number of reported TB cases in these two remand prisons during this three-year period was 876. Out of these, 432 were diagnosed at entry to prison, and 444 developed the disease during incarceration, with the proportion diagnosed during incarceration increasing over time. The majority of cases were aged under 30 years. TB incidence in Russian remand prisons is still very high and needs to be monitored closely.

Adolescent↗
PubMed2005

US: developments in the treatment of HIV-positive prisoners in two states.

Legal actions have been launched in Alabama and Mississippi to address living conditions and medical care of HIV-positive prisoners in state prisons. These were the only two states to allow complete segregation of HIV-positive prisoners in state prisons into the 1990s. The two cases highlight the ways in which the courts have been involved in supervising prison conditions in the United States.

Alabama↗
PubMed1991

Chronic morbidity of former prisoners of war and other Australian veterans.

OBJECTIVE: This report is the first summary article from a review of studies on long-term morbidity associated with war service or internment, commissioned by the Sir Edward Dunlop Medical Research Foundation. DATA SOURCES: The Medlars database, from 1966 to the present, under the terms military personnel, veterans, veterans' disability claims, combat disorders and prisoners (matched against war); databases of the Department of Veterans' Affairs (Victoria) and the Central Library, Commonwealth Department of Defence, using the term "prisoner of war"; and the microfiche listings of the Department of Veterans' Affairs, under "prisoner of war" and "repatriation". Only studies in English or French were reviewed, reaching a total of 172. STUDY SELECTION: Forty-eight studies are considered in the present summary, presenting the most significant evidence about long-term morbidity attributable to war-time experiences. Studies concerning Australian veterans are emphasised. DATA EXTRACTION: Studies considered valid were summarised for an annotated bibliography, but only reports of major public health significance are reviewed here. DATA SYNTHESIS: The review confirms that strongyloidiasis, peptic ulcer, anxiety states, depression and hepatitis B are more prevalent in former prisoners of war than in relevant comparison groups. We have not identified further diagnoses that should be attributed specifically to war-time exposures. Attribution of long-term neurological and musculoskeletal disorders to war-time exposures remains uncertain. CONCLUSIONS: Former prisoners of war and veterans constitute a population of survivors highly selected by the rigours of war and imprisonment. Occurrence of the five conditions listed above may be reasonably attributed to war-time exposure. We recommend further research on ageing (including neurological, visual, hearing and musculoskeletal disability), family disruption and rehabilitation strategies in these groups.

Australia↗
PubMed1987

Seroepidemiology of hepatitis D (delta agent) and hepatitis B among Virginia State prisoners.

A serosurvey of hepatitis D (HDV) and hepatitis B (HBV) was conducted in an asymptomatic population of newly incarcerated prison inmates in Virginia. Of 459 men entering the prison, 445 provided both sera and demographic and personal information. Six (1.3%) had antibody to HDV (anti-HDV). Evidence of past infection with HBV was found in 146 (32.8%); 9 (2.0%) were positive for HBV surface antigen (HBsAg). HBV seropositivity correlated with intravenous drug abuse, nonwhite race, and tattoos acquired in prison. Sera obtained after an interval of seven to ten months revealed seroconversion to anti-HDV in one of two HBsAg-positive men who admitted to parenteral drug use while incarcerated. Because he had been incarcerated elsewhere for more than one year before entering this prison, it is concluded that HDV transmission occurred in prison. The association of HDV infection with progression to chronic active and fulminant hepatitis suggests that serologic surveillance of HBsAg-positive inmates may be indicated for identification of possible HDV index cases.

Adolescent↗
PubMed1986

Hepatitis B in prisons.

Prisoners have been thought to be at high risk of contracting hepatitis B. Prevalence studies throughout the world show a similar hepatitis B marker rate of 28 to 51%. Seroconversion studies have shown a 0.8 to 1.4% incidence in male prisoners. These results are far less than the predicted 5 to 10% annual attack rate for a similar non-incarcerated population. Cost considerations prevent universal vaccination of prisoners, but IV drug abusers and female prisoners seem to be at especially high risk and should be targeted for immunization now. Prisoners who are chronic carriers of HBsAg and who are also "e" antigen positive or delta antibody positive should be segregated.

Carrier State↗
PubMedDate not supplied

Attitude of prison nurse officers to drug misusers.

The key group involved in delivering health care to drug misusers in prison is the prison nurse officers. The literature suggests that the skills and knowledge base of this professional group has received very little attention. This study looked at the attitudes of prison nurse officers in Scotland towards intravenous drug misusers. Age, sex and grade appeared to affect attitudes, but the results were not clear cut. Some stereotyping of drug misusers was evident among respondents. Drug misusers are a marginalised group in terms of health care and it is important that their needs are addressed in prison. Prison nurse officers should be proactive in meeting such needs, and should be given adequate support to do so. This paper suggests that the skills of such staff are often not being used appropriately.

Adult↗
PubMed1995

[Characteristics of AIDS cases detected at a prison in Barcelona (1991-1993)].

OBJECTIVE: To describe the cases of AIDS detected in a Barcelona prison. DESIGN: A prospective study. SETTING: A penitentiary for men in Barcelona. PATIENTS: All those inmates who had AIDS or were diagnosed with the illness during their stay in prison during the 36 months between 1/1/1991 and 31/12/93. RESULTS: 220 cases of AIDS (91.7% PVDA), 60% of which were diagnosed in prison. The PVDA were younger (p < 0.0001). There were a greater number of Spaniards among the UDVP (p < 0.01) and among those with tattoos (p < 0.001). The first manifestation of the disease in 53% of the cases was extrapulmonary Tuberculosis. CONCLUSIONS: Prisons are key places in the prevention and monitoring of HIV infection. The use of care programmes, including maintenance programmes using Methadone, for drug-dependent patients are recommended. The continuation of programmes tracking Tuberculosis, the main illness related to HIV infection in prison, is also recommended.

Acquired Immunodeficiency Syndrome↗