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Purpose
To explore detainees and staff's attitudes towards tobacco use, in order to assist prison administrators to develop an ethically acceptable tobacco control policy based on stakeholders’ opinion.Design
Qualitative study based on in-depth semi-structured interviews with 31 prisoners and 27 staff prior (T1) and after the implementation (T2) of a new smoke-free regulation (2009) in a Swiss male post-trial prison consisting of 120 detainees and 120 employees.Results
At T1, smoking was allowed in common indoor rooms and most working places. Both groups of participants expressed the need for a more uniform and stricter regulation, with general opposition towards a total smoking ban. Expressed fears and difficulties regarding a stricter regulation were increased stress on detainees and strain on staff, violence, riots, loss of control on detainees, and changes in social life. At T2, participants expressed predominantly satisfaction. They reported reduction in their own tobacco use and a better protection against second-hand smoke. However, enforcement was incomplete. The debate was felt as being concentrated on regulation only, leaving aside the subject of tobacco reduction or cessation support.Conclusion
Besides an appropriate smoke-free regulation, further developments are necessary in order to have a comprehensive tobacco control policy in prisons. 相似文献Objectives
To assess the health needs of prisoners in a male category B prison in Bristol, England, to identify areas for improving health in the prison.Study design
Cross-sectional and qualitative.Methods
Analysis of prisoners’ self-reported health needs at reception and at a secondary health screen; prisoners’ access to primary care, inpatients, mental health, sexual health and substance misuse services; and prescribed medications. Random selection of prisoners for interviews. Focus groups and interviews with staff and stakeholders.Results
18 prisoners were interviewed (29% of those randomly selected), five focus groups were held with staff and stakeholders involved in health care provision in the prison and four interviews were held with staff and stakeholders. The areas of greatest health needs were identified as dental care, mental health and substance misuse. Prisoners and staff generally reported good access to most health care staff, provision of prescribed medication, bloodborne virus vaccination and treatment of substance misuse. Twenty nine recommendations were identified with five high-priority areas for improvement including an urgent review of dental services; stronger joint commissioning arrangements for health and social care; installing an integrated IT system; prevention of disease and health promotion; better use of the voluntary sector. A detailed action plan was developed to address all the recommendations and this has formed the basis of a programme of ongoing quality improvement work which is monitored by the Prison Partnership Board. Progress has been made against all key areas.Conclusions
The mixed methodology which involved analysis of health data and talking to a wide group of stakeholders, including prisoners, helped triangulate the data. The process of undertaking the health needs assessment shifted the focus from ’health care’ to ’health’. This has facilitated a significant reframing of the concepts of ’health’ and ’health need’ with ongoing work now focused on the prison as a whole system, not merely on the provision of health care within the prison. Many improvements have already been made in response to the assessment. 相似文献Aim of this study
In this article we wish to question the effects of incarceration on minors. The history of prison reveals that it is the work of a humanist and philanthropic discourse that ensued from the effects of revolutionary ideas. However, from the moment of its reform – that transformed it from a place of confinement to a penal institution – it has only demonstrated its dysfunctional aspect. Our objective is to initiate a reflection on the effects of incarceration, whether it be collective or individual and in particular when it involves adolescents.Patients and methods
Applying a clinical method, we are analyzing four specific cases: either within a psychiatric department for people under criminal justice control, or in an adult detention center.Results
The starting point for the “antisocial” behavior is situated, according to our study, at the time of adolescence. Indeed the presence of violence, aggressiveness, and impulsiveness, in other words the “behavioral disorders”, is a constant in each case that is presented. The heart of this, the unifying theme between the psychopathology and the delinquency/criminality, is a feeling of exclusion: an exclusion already present in childhood/adolescence and that is reactivated, in a second instance, by imprisonment. Similarly, identity and identification – already clearly involved in acting out, crime or criminal offences – undergo a further weakening.Discussion
Through a historical reminder of the questions surrounding criminality and criminals, we will demonstrate that it is not solely a case of finding the causes, undoubtedly important though they be, but of inventing solutions for and with these subjects who have committed a crime or criminal offence. As is indicated in the results, juvenile detention centers appear to further muddle questions of identity and identification, leading to an unleashing of violence and aggressiveness. Thus an experience of abandonment and of exclusion re-enforces that of belonging. The challenge, as much for psychiatry as for psychoanalysis, is to find solutions that enable these youngsters to overcome their violence rather than actualize it.Conclusion
The incarceration of minors increases and inscribes an aggressiveness and violence that, at the start, was only a need to belong: to the social being, to society, to the social tie. It is not so much the question of the structure or the type of underlying disorder – behavioral, of the personality or psychiatric – that is in question, but rather the effects of a deprivation of freedom that could lead to decompensation, acting out, repeat offending, and to the crystallizing of violence as a mode of discourse. 相似文献Methods: We searched on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. We carried out bias assessments, rated studies for quality and ran a heterogeneity test. We meta-analysed prevalence rates of psychiatric disorders through an aggregate weighted mean and calculated relative risk (RR) and statistical significance against community studies. Sensitivity analyses were further performed.
Results: We reviewed nine studies and obtained the following prevalence: ‘Any psychiatric disorder’ 38.4%, depression 28.3%, schizophrenia/psychoses 5.5%, bipolar disorder 4.5%, dementia 3.3%, cognitive impairment 11.8%, personality disorder 22.9%, alcohol abuse 15.9%, anxiety disorders 14.2%, PTSD 6.2%. Older prisoners were found to have higher RR for every single psychiatric disorder against older people in the community, with the sole exception of alcohol abuse (RR = 1) and dementia (RR = .75). The prevalence rates were statistically significantly higher (p < .05) among the prisoners for ‘Any psychiatric disorder’, depression and personality disorder. Overall, the sensitivity analyses confirmed our original results.
Conclusion: Our findings point at a high prevalence of every single psychiatric disorder among older prisoners, who also experience rates of dementia and alcohol abuse comparable to those reported in the community. Our results have relevant implications for policy and practice in this area. Further research is crucial to confirm findings from this study. 相似文献