Oral health status of prison inmates--New South Wales, Australia

BACKGROUND: This paper assesses the oral health status in a prison population and identifies risk factors associated with oral health. METHODS: Cross-sectional stratified random sample of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales, stratified by sex, age and aboriginality. A face to face interview was used to collect information on health status and behavioural risk factors. A subset of participants (312 males and 22 females) received an oral examination which enabled the decayed, missing or filled permanent teeth (DMFT) score to be calculated. RESULTS: In the last 12 months 391 (50 per cent) inmates had visited a dentist. Reports on treatment received at this last visit were mainly for dental examinations, (62 per cent), dental fillings, (38 per cent), and dental extractions (28 per cent). Self-reported dental needs indicated that 42 per cent perceived the need for a check-up; the perceived need for dental fillings was highest in females compared with males. The mean DMFT for the population was 20.4 and 3.4 for decayed teeth. CONCLUSIONS: This survey demonstrates that the standard of past oral health care for prison inmates is low. There is a need to be more attentive to oral health promotion as eventually respondents will be returning to the community.     

Le psychotraumatisme en milieu pénitentiaire

Post-traumatic stress disorder (PTSD), and particularly complex PTSD, is over-represented in prisons and corrections. In this interview with Jean-Pierre Bouchard, Thomas Fovet, Clément Villa, Bettina Belet, Fanny Carton, Timothée Bauer, Suzanne Buyle-Bodin and Fabien D’Hondt draw on their clinical experience and recent epidemiological research to provide an overview of the issue. The clinical aspects specifically found in the prison environment, especially the questions of comorbid psychiatric and substance use disorders or PTSD in perpetrators of violent crime, are developed. The current state of knowledge regarding the management of post-traumatic symptoms in prison is also discussed and put into perspective with daily practice.     

2007年广东省监狱系统HIV／AIDS患者的CD4^＋T细胞计数结果分析——附436例报告

目的：了解广东省监狱系统在押HIV／AIDS犯人的细胞免疫状况,为临床防治AIDS提供参考。方法：应用流式细胞仪对436例广东省监狱系统的在押的HIV／AIDS患者进行CD4^＋T细胞计数,并定期监测。结果与结论：436例中的感染者CD4^＋T细胞计数结果少于200／μL者占24．5％,200～350／μL者占26．6％,超过350／μL者占48．9％。不同年龄组之间CD4^＋T细胞计数存在差异,25岁以后随着年龄增长,CD4^＋T细胞计数呈下降趋势。未经治疗的201例患者3个月后CD4^＋T细胞计数较首次检测明显下降,而经治疗的20例则明显增加。提示应对HIV／AIDS患者的CD4^＋T细胞计数进行检测及定期监测,以了解其免疫状态的变化,并应予积极的抗病毒治疗以改善其免疫状况。     

Prevention of violence in prison – The role of health care professionals

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach.Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings.In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations.     

Insights into the population structure of Mycobacterium tuberculosis using spoligotyping and RDRio in a southeastern Brazilian prison unit

Tuberculosis (TB) is still a serious public health problem, continuing to be an important threat for confined populations. We used spoligotyping to estimate the genotypic clades of Mycobacterium tuberculosis isolates from inmates in two blocks in a southeastern Brazilian prison unit, with TB incidence rate of 8185/100.000. The Latin American Mediterranean (LAM) clade is well represented in the country, and the LAM specific molecular markers, RD^Rio large sequence polymorphism and the SNP on the Rv3062 [ligB¹²¹²], were used to characterize spoligotype signatures from prison isolates. Typing of RD^Rio and ligB increase LAM clade from 66.7% (n = 72/108) to 69.4% (n = 75). The LAM2 SIT17 (n = 23) and SIT179 (n = 12) signatures comprised one third of all isolates, followed by Haarlem (11.5%, n = 12), T (8.7%, n = 9) and X (5.7%, n = 6) clades. Strains with unknown signatures represented 5.5% (n = 6), and four (3.7%) did not match any lineage. We observed RD^Rio among 64 (59.2%) isolates, and 54 (50%) were of the LAM clade. In particular, the LAM2/RD^Rio sub-lineage was significantly associated with clustering (p = 0.02) and its frequency was higher (32%) when compared to that of the previous general TB cases in RJ (4.29%). Overall cluster frequency defined by spoligotyping/IS6110-RFLP was 62%. The two evolutionary markers helped to evaluate some LAM signature misconceptions and demonstrate that LAM2/RD^Rio was found with high frequency, hitherto being unnoticed. All these data, allied to high clustering, imply that public health measures to minimize the escalation of TB in prison is essential, and both spoligotyping as well as RD^Rio would be useful tools to monitor the effects of the measures with respect to M. tuberculosis lineage variation.     

Syringe Exchange in Germany

Syringe exchange in Germany is clearly linked to a recent shift of local responses to drug-use(r) associated problem. Since the end of the 1980s metropolitan communities in Northern and Central Germany-concerned by the emergence of “Open Drug Scenes,” increasing HIV and mortality rates among drug users, and drug-use-related property crime-began to favor measures of survival-oriented drug-user help. While die Federal Government still favors repression and law enforcement efforts, they nevertheless made syringe exchange explicitly legal in 1992-some 5 years after the creation of local Syringe Exchange Programs. In general, the new approach of local authorities includes a variety of services, such as housing facilities, crisis intervention centers, primary medical care, maintenance with substitute drugs, and syringe exchange programs. The creation of pilot heroin maintenance programs is planned for Frankfurt and Hamburg. While the established programs are successfully functioning in large cities such as Hamburg, Bremen, and Frankfurt, the demand for sterile needles and syringes remains unmet in smaller cities and in the conservative governed Bundesländer (states), where pharmacies remain the primary and often single legal supply source for syringes. Another major problem continues to be the drug-use situation in prisons. Although injection drug use is common in prisons, injection equipment is not legally available for the 10,000 injecting drug users imprisoned at any given time. Two of Germany's 220 prisons started an experimental syringe exchange in 1996.     

From niche to stigma—Headshops to prison: Exploring the rise and fall of synthetic cannabinoid use among young adults

The aim of this paper will be to consider the rise and subsequent fall in NPS use at national and local level with a focus on synthetic cannabinoid products in Kent. We will examine the local practice and policy responses by Kent’s Young Persons’ Drug and Alcohol Service towards a possible change in patterns of NPS drug consumption. The county has seen an expansion in the number of Headshops and we present local media coverage on NPS, and the Trading Standards and Kent Police intervention Operation Lantern to regulate Headshops. Through quantitative and qualitative data sets on socially vulnerable young people and prison populations we explore young adults’ perception of pleasure and harm in the use of NPS. Emergent data suggests young adults are now assessing the differences between NPS and more traditional illicit drugs, with this impacting on decision-making about the substances being used. When ‘legal highs’ first appeared they were associated with a more niche middle class demographic, ‘psychonauts’ and experimental users interested in pursuing recreational drug diversity. We examine macro and micro data to suggest that populations most likely to become involved in NPS use are those with degrees of stigma linked to socially vulnerable young adults suggesting that Spice is no longer a feature of middle class recreational drug use.     

Incident hepatitis B virus infection and immunisation uptake in Australian prison inmates

IntroductionDespite an effective vaccine, hepatitis B virus (HBV) infection continues to impose a large burden of disease globally. Until childhood immunisation achieves high adult population coverage, people who inject drugs (PWID), including prison inmates remain at risk. PWID have a higher prevalence of HBV than the wider population, and lower rates of vaccine-conferred immunity. This study sought to identify the incidence and predictors of HBV transmission and uptake of immunisation in PWID prisoners in Australia.MethodsLongitudinally collected, stored sera from subjects previously enrolled in a prospective study of hepatitis C in recently incarcerated PWID prisoners (n = 590) were serologically tested for HBV. Interviews recording demographic and behavioural risks were analysed. Multivariate statistical analyses were applied to identify associations of incident infection or immunisation.ResultsUpon imprisonment there were n = 373 (63%) individuals who were HBV susceptible, of whom 140 remained susceptible at the subsequent enrolment into the cohort, and had one or more follow-up visits (a total of 406.73 person years [p.y.]), and so were included in this analysis. There were 7 incident cases of HBV infection (1.7 per 100 p.y.) in this group, with transmission being associated with injecting drug use daily or more often. There were 48 individuals who were successfully immunised (11.8 per 100 p.y.) with younger age and continuous imprisonment predicting this outcome.ConclusionsThe Australian prison environment poses a high risk for HBV infection, and also provides an opportunity for immunisation for PWID. Further efforts are required to improve coverage and prevent ongoing transmissions.     

Producing the ‘problem’ of new psychoactive substances (NPS) in English prisons

BackgroundThere has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a ‘problem’ in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016.MethodsDrawing on Bacchi’s ‘What’s the problem represented to be’ framework, the ways in which the NPS ‘problem’ in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package.ResultsFrom the various measures introduced to deal with the ‘problem’, NPS use is produced primarily as a law, order and control ‘problem’ requiring regulation, penalties and control, rather than a ‘demand problem’ calling for prevention, education, treatment and harm reduction or a ‘regime problem’ demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time.ConclusionThe law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.