Patients, prisoners, or people? Women prisoners' experiences of primary care in prison: a qualitative study

BACKGROUND: The development of primary care services within prisons has been central to improvements in the provision of health care in this setting over the past decade. Despite national imperatives to involve patients in the development of services and numerous policy initiatives, there has been no systematic evaluation of changes in the delivery of primary care and little published evidence of consultation with prisoners. AIM: To explore women prisoners' experiences of primary healthcare provision in prison. DESIGN OF STUDY: Qualitative study using focus groups and interviews. SETTING: Two women's prisons in southern England. METHOD: Six focus groups involving 37 women were conducted, as well as 12 semi-structured individual interviews. Focus groups and interviews were recorded, transcribed, and analysed thematically. RESULTS: Women prisoners' perceptions of the quality of prison health care were mixed. There were accounts of good-quality care where practitioners were regarded as knowledgeable and respectful, but many perceived that the quality of care was poor. They complained about difficulties accessing care or medication, disrespectful treatment, and breaches of confidentiality by practitioners. They voiced the belief that staff were less qualified and competent than their counterparts in the community. CONCLUSION: The prison environment presents unique challenges to those providing health care, and much work has been done recently on modernising prison health care and improving professional standards of practice. However, the accounts of women prisoners in this study suggest that there is a gap between patient experience and policy aspirations.     

The relative influence of socio-demographic, lifestyle, environmental factors and co-morbidity on self rated health of the Irish prisoner population

A National survey of prisoners' health status was undertaken in 1999/2000 across 13 prisons. Median age of all male prisoners (n = 718) was 25 years. At univariate level, prisoners demonstrated high levels of ill-health, associated with poor self-rated health, including chronic activity limiting illness, GHQ caseness, anxiety and depression. Those with poor self rated health were also of lower educational status, more likely to smoke, or to have taken drugs. In a final multivariate model (n = 512), education level, GHQ caseness, prescribed medication, chronic self limiting illness and reported verbal abuse by prison officers were all independently predictive of poor self rated health. Upstream policy interventions are required to limit the impact of social disadvantage on offending and to maximise proactive health care and rehabilitation during prison stay.     

Insomnia symptoms and subsequent cardiovascular medication: a register‐linked follow‐up study among middle‐aged employees

Sleep disturbances have been associated with an increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidaemia, the main modifiable cardiovascular risk factors, are less studied. We especially lack understanding on the longitudinal effects of insomnia on dyslipidaemia. We aimed to examine the associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidaemia using objective register‐based follow‐up data. Baseline questionnaire surveys among 40–60‐year‐old employees of the City of Helsinki, Finland, were conducted in 2000–2002 (n = 6477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5–7 years prior to and 5 years after baseline. Associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non‐restorative sleep) and hypertension and dyslipidaemia medication during the follow‐up were analysed using logistic regression analysis (odds ratios with 95% confidence intervals). Analyses were adjusted for pre‐baseline medication, sociodemographic and work‐related factors, health behaviours, mental health, and diabetes. Frequent insomnia symptoms were reported by 20%. During the 5‐year follow‐up, 32% had hypertension medication and 15% dyslipidaemia medication. Adjusting for age, gender and pre‐baseline medication, frequent insomnia symptoms were associated with hypertension medication (odds ratio 1.57, 95% confidence interval 1.23–2.00) and dyslipidaemia medication (odds ratio 1.59, 95% confidence interval 1.19–2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. To conclude, insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors.     

Change counselling in diabetes: the development of a training programme for the diabetes team

Skills in counselling for behaviour change may help staff working in diabetes care to facilitate self management in people with diabetes. A feasibilty study was conducted to define the essential competencies (attitudes, knowledge and skills), training methods, and assess whether this approach was practicable in a diabetes resource centre. Semi structured interviews with staff were routinely conducted throughout the duration of the study. The findings suggest that the stages of change model, motivational interviewing and behavioural techniques are relevant to work in this area. Acquiring the competencies was harder to achieve than anticipated, though most were evident after one years training. The most valued training methods were individual supervision and video examples. However, the competencies were difficult to apply in the clinical setting given time constraints, the strength of existing staff routines and the patients’ readiness to change. The lessons learned and suggestions for future work are presented.     

四川省三级医院ICU医护人员早期活动知识学习及 ICU早期活动开展影响因素研究

目的 了解影响ICU医护人员早期活动知识学习的因素及在ICU开展早期活动的影响因素。方法 通过自行设计调查问卷,采用目的抽样的方法,对四川省20所三级综合医院的中心ICU医护人员进行问卷调查。结果 ①管理方面影响医护人员早期活动知识学习的因素排在前三的是:缺乏相关培训（74.88%）,时间与精力（73.38%）,缺乏激励机制（63.23%）;②患者方面影响早期活动开展的因素排在前三的是:患者病情不稳定（82.70%）,有导致监测、治疗仪器设备的线路、管道移位的风险（77.37%）,患者带有气管插管（70.55%）;③医护人员方面影响早期活动开展的因素排在前三的是:科室人力资源配备是否足够（99.17%）,是否有可获取的相关仪器和设备（80.53%）,是否进行早期活动相关的专业知识培训（76.87%）。结论 多种因素可影响ICU医护人员对早期活动知识的学习及早期活动在ICU的开展。其中,应特别注意对ICU医护人员进行多种形式的培训,以提高他们早期活动的知识水平,同时合理配备人力资源和设备,支持和鼓励ICU医护人员开展患者早期活动实践。     

European guideline for the diagnosis and treatment of insomnia

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).     

HIV / AIDS and STD prevention in Surinamese prisons

The Suriname National AIDS Program (NAP) developed an education and support program involving activities for prison inmates, staff, and non-prison personnel and organizations. Male inmates and prison warders were selected for training as peer educators. Male inmates formalized their status by forming the Boma AIDS Education Collective (BAEC). Female inmates were not included in the training because most of them served short sentences and were instead involved in educational sessions which focused on sexual and mother-child transmission of STDs. BAEC produced AIDS education leaflets in three languages (Dutch, English, and Sranan Tongo) for new and discharged inmates at the prison and also for all prisoners in Suriname. The leaflets were then pre-tested and modified based on comments from 17 inmates. The Program was officially introduced in April 1992 when BAEC organized an AIDS/STD week. The week's activities included AIDS educational sessions, video shows, discussions, and HIV testing. A permanent AIDS/HIV counseling system, which specifies that among other things HIV testing must be done on a voluntary basis, was implemented at Santo Boma prison for both male and female inmates. A manual was produced for peer educators, and AIDS/STD education has since been included in the prison warder training curriculum. A number of collaborative activities with non-prison organizations were organized to demonstrate that prisoners are part of a wider community concerned about HIV/AIDS. However, some prisoners are against condom distribution in the prisons, because they feel that it would encourage homosexual contacts. Prison authorities have not yet approved official condom distribution.     

An Ohio telemedicine system for prison inmates: a case report.

BACKGROUND: A project was established by The Ohio State University Medical Center (OSUMC) and the Ohio Department of Rehabilitation and Corrections (ODRC) to investigate the use of telemedicine in providing health care to Ohio's prison inmates. OBJECTIVES: To determine the effects of telemedicine on continuity of inmate care, the sense of isolation experienced by health care providers at remote institutions, the security risks incurred when transporting inmates to outside facilities, and the overall cost of care. In tracing the initial adoption and implementation of the project, the authors describe health care in Ohio's prisons and the unique nature of providing that care. METHODS: The project was conducted over a 1-year period, from November 1994 through December 1995, using a variety of methods: direct observation of inmate consultations; participation in task force meetings; unstructured interviews with physicians, prison administrators, ancillary health care personnel, and security guards; and initial collection of survey data. RESULTS: Telemedicine enables Ohio's inmates to receive health care in a more timely fashion than before. Physicians and inmates were generally satisfied, and the costs of providing inmate medical care were reduced by lessening or eliminating the need for additional security guards, vans, chase vehicles, and travel time for physicians. CONCLUSIONS: Some initial hurdles in using the system, such as scheduling and triage, are being overcome as new methods are devised, and additional incentives for specialty physicians to use the system are being investigated. The OSUMC/ODRC project suggests that the advantages of using telemedicine in prison settings are immense, and the ODRC plans to expand the network to include two more remote sites early in 1996.     

Understanding needle‐related distress in children with cystic fibrosis

Objective. To explore the nature and management of needle‐related distress in children and adolescents with cystic fibrosis (CF). Design. Qualitative study using semi‐structured interviews. Methods. Fourteen child–parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7–17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio‐economic backgrounds. Interviews were transcribed and analysed using thematic analysis. Results. Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered ‘taking control’ to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle‐related distress. Parent and staff influences on needle‐related distress are also examined. Conclusions. Needle‐related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management.     

Pediatric asthma, a qualitative and quantitative approach to needs assessment

This article describes an approach to needs assessment in a specific location using both focus group interviews and a written questionnaire. In this case study, the target population consists of parents of asthmatic children (0-4 years of age). Six focus group interviews were conducted with the purpose of discussing parents' experiences with health care for asthma, their beliefs and knowledge of general aspects of asthma, medication and preventive actions. As a supplement, parents completed a written questionnaire providing additional quantitative information on parental knowledge and misconceptions. Results indicated that parental knowledge of asthma in general was not adequate, especially with respect to medication, preceding signs and preventive activities. Important misconceptions, which might contribute to noncompliance with self-management behaviors, were revealed during discussions with the parents. Several differences were found between results of the interviews and the questionnaire, for instance regarding parental knowledge about preventive measures, medication and perceived parental satisfaction with health care for asthma. These differences indicate the value of using both a survey and a focus group.     

Adherence to medication in stroke survivors: a qualitative comparison of low and high adherers

Objectives. The aim of this study was to investigate factors that may explain variance in adherence to medication in stroke patients. Design. A qualitative comparison of high and low adherers to medication. Methods. Thirteen participants, selected from a sample of 180 stroke survivors because they self‐reported the lowest adherence to medication regimes, were matched with 13 reporting maximal adherence. All took part in semi‐structured qualitative interviews. Results. Thematic analysis revealed that those with poor adherence to medication reported both intentional and non‐intentional non‐adherence. Two main themes emerged: the importance of stability of a medication routine and beliefs about medication and treatment. High adherers reported remembering to take their medication and seeking support from both family and health professionals. They also had a realistic understanding of the consequences of non‐adherence, and believed their medicine did them more good than harm. Low adherers reported forgetting their medication, sometimes intentionally not taking their medication and receiving poor support from medical staff. They disliked taking their medication, had limited knowledge about the medication rationale or intentions, and often disputed its benefits. Conclusions. Our findings suggest that appropriate medication and illness beliefs coupled with a stable medication routine are helpful in achieving optimal medication adherence in stroke patients. Interventions designed to target both intentional and non‐intentional adherence may help maximize medication adherence in stroke patients.     

Knowledge and perception related to sickle cell disease among tribal community,India: A mixed-method study

BackgroundSickle cell disease (SCD) is a public health problem. In absence of a pan-country intervention program in India, SCD prevalence is ascending without control. Since knowledge and perception of a community is a prerequisite for developing an intervention strategy, the current study was designed to assess it in a high SCD burden tribal-dominated district of Odisha.MethodsA mixed-method study combining qualitative and quantitative methods was conducted in the Kandhamal district, Odisha, India. A cross-sectional survey was conducted among randomly selected 1600 individuals, using a pre-tested questionnaire and 26 in-depth interviews were conducted with key informants.ResultsAlthough 74.2% of the participants in the studied area had heard about the disease, only 13.6% know the cause of the disease. 69% had the knowledge to opt for modern medication. However, treatment compliance was poor, patients resort to using medications only during the crisis stage. Individuals who had knowledge about disease aetiology got to know about SCD from lived experiences of themselves, close relatives, or villagers and rarely from health workers. The community members had no clarity regarding which health centre to be approached for routine medication and management of SCD crisis.ConclusionThe area is endemic for SCD, yet, the community lacks knowledge about the cause and treatment modality of the disease. In addition, currently there is no government-run intervention programme for screening and management of SCD related morbidity. Hence, a community based intervention strategy needs to be implemented urgently for enhancing the knowledge, perception, and aptitude related to SCD.     

Prison within a prison

No prison systems in the United States have adopted the 1991 recommendations from the National Commission on AIDS. Distribution of condoms and bleach kits is illegal in many places. Most prisons have inadequate bilingual staff, lack education and prevention programs, do a limited amount of testing and counseling, and do not treat HIV and AIDS aggressively through drug treatments. Until the 1970s, many clinical trials involved prisoners, but that is no longer true. The Centers for Disease Control and Prevention (CDC) estimates that the incidence of AIDS in the prison population is six times the level in the general population.     

2012至2015年哈尔滨市某监狱在押人员结核病发病情况分析

目的 分析2012-2015年哈尔滨市某监狱在押人员结核病发病情况和治疗效果,了解监狱内结核病的流行分布趋势,为结核病的防治提供依据.方法 在2012-2015年,对监狱在押服刑人员通过入监体检、普查、巡诊和因症就诊等几种方式,按照结核病诊断标准,根据痰培养和X光胸片确诊结核病,获得结核病患者人群.调查该人群基本情况、患病情况,同时给予化学药物治疗,并判定治疗预后.结果 2012-2015年该监狱内结核病共确诊病例有98例,发病率为1.69％.其中涂阳肺结核占31.6％(31/98),涂阴肺结核占60.2％ (59/98),结核性胸膜炎占8.2％ (8/98).2012-2015年监狱内结核病发病率分别为2.46％、1.83％、1.36％和1.19％,其中入监体检占49.0％ (48/98),普查占16.3％(16/98),因症就诊占34.7％(34/98).2012-2015年监狱内结核病治愈率为85.7％,各年度分别为81.3％(26/32)、85.7％(24/28)、86.9％(20/24)和93.3％ (14/15),呈现治愈率逐渐上升趋势.结论 2012-2015年监狱内结核病发病率呈现逐年下降的趋势;结核病患者的治愈率呈现逐年上升的趋势.现监狱内实行的结核病防治和管理工作取得了良好的疗效.     

Circadian motor activity affected by stimulant medication in children with attention‐deficit/hyperactivity disorder

Attention‐deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder occurring in approximately 3–5% of school‐aged children. The core symptoms of ADHD are effectively treated with stimulant medications such as methylphenidate; however, there are also negative side effects, including insomnia. It has been suggested that administration of stimulant medication may alter the timing or regularity of circadian motor activity levels. This study aimed to investigate the impact of stimulant medication on the strength and timing of circadian rhythms in 16 stimulant medication‐naïve children with ADHD. Participants were monitored for changes in motor activity during a 3‐week blinded placebo‐controlled medication trial to examine the impact of immediate‐release methylphenidate hydrochloride. Motor activity was measured by actigraphy, and 24‐h activity profiles were analysed using cosinor analyses to identify measurable changes in circadian rhythms. The children in this sample demonstrated significant increases in motor activity during the sleep‐onset latency period. They also showed a significant reduction in relative circadian amplitude and a phase‐delay in the timing of the daily rhythm. Clinicians and parents of children being treated with stimulant medication for ADHD should be aware that stimulant medication may cause disruption of sleep/circadian rhythms. Behavioural strategies to improve sleep may be useful for children experiencing these negative effects from medication.     

Paediatric hereditary angioedema: a survey of UK service provision and patient experience

Hereditary angioedema (HAE) is a rare disease characterized by episodes of potentially life‐threatening angioedema. For affected children in the United Kingdom, there are relatively few data regarding disease prevalence, service organization and the humanistic burden of the disease. To improve knowledge in these areas, we surveyed major providers of care for children with HAE. A questionnaire was sent to major paediatric centres to determine patient numbers, symptoms, diagnostic difficulties, management and available services. In addition, all patients at a single centre were given a questionnaire to determine the experiences of children and their families. Sixteen of 28 centres responded, caring for a total of 111 UK children. Seven children had experienced life‐threatening crises. One‐third of patients were on long‐term prophylactic medication, including C1 inhibitor prophylaxis in four children. Eight centres reported patients who were initially misdiagnosed. Broad differences in management were noted, particularly regarding indications for long‐term prophylaxis and treatment monitoring. We also noted substantial variation in the organization of services between centres, including the number of consultants contributing to patient care, the availability of specialist nurses, the availability of home therapy training and the provision of patient information. Ten of 12 patient/carer questionnaires were returned, identifying three common themes: the need to access specialist knowledge, the importance of home therapy and concerns around the direct effect of angioedema on their life. To our knowledge, this study represents the first dedicated survey of paediatric HAE services in the United Kingdom and provides useful information to inform the optimization of services.     

Prevalence and management of chronic insomnia in Swiss primary care: Cross‐sectional data from the “Sentinella” practice‐based research network

We investigated the prevalence and treatment of patients with chronic insomnia presenting to Swiss primary care physicians (PCPs) part of “Sentinella”, a nationwide practice‐based research network. Each PCP consecutively asked 40 patients if they had sleep complaints, documented frequency, duration, comorbidities, and reported ongoing treatment. We analysed data of 63% (83/132) of the PCPs invited. The PCPs asked 76% (2,432/3,216) of included patients about their sleep (51% female); 31% (761/2,432) of these had had insomnia symptoms; 36% (875/2,432) had current insomnia symptoms; 11% (269/2,432) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) criteria for chronic insomnia (61% female). In all, 75% (201/269) of patients with chronic insomnia had comorbidities, with 49% (99/201) reporting depression. Chronic insomnia was treated in 78% (209/269); 70% (188/268) took medication, 38% (102/268) benzodiazepines or benzodiazepine receptor agonists, 32% (86/268) took antidepressants. Only 1% (three of 268) had been treated with cognitive behavioural therapy for insomnia (CBT‐I). A third of patients presenting for a non‐urgent visit in Swiss primary care reported insomnia symptoms and 11% met the DSM‐5 criteria for chronic insomnia. Hypnotics were the most common treatment, but almost no patients received first‐line CBT‐I. Reducing the burden of insomnia depends on disseminating knowledge about and access to CBT‐I, and encouraging PCPs to discuss it with and offer it as a first‐line treatment to patients with chronic insomnia.     

Unmet needs in asthma: Global Asthma Physician and Patient (GAPP) Survey: global adult findings

BACKGROUND: The Global Asthma Physician and Patient (GAPP) Survey is the first global quantitative survey designed to uncover asthma attitudes and treatment practices among separate groups of physicians and patients, with the goal of identifying barriers to optimal management. METHOD: A total of 5582 physician and patient interviews were conducted globally online, by telephone and face-to-face. This paper highlights key global findings from the adult arm (3559 interviews) conducted in 16 countries. RESULTS: Physician and patient responses were found to differ when respondents were asked the same set of questions. Perceptions of time spent on asthma education, the quality of physician-patient communications, awareness and experience of side effects and understanding and knowledge of treatment noncompliance were found to differ between these two sets of respondents. CONCLUSIONS: The GAPP Survey not only defines an unmet need in asthma treatment, but also reveals that there is a direct relationship between the quality of physician-patient communication, the level of treatment side effects and the extent of patient compliance. These survey findings highlight a clear need for improved patient-focused care in asthma.