Intrauterine fallopian tube incarceration: an uncommon complication of termination of pregnancy by vacuum aspiration

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.     

腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿的临床研究

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊颈部结石嵌顿的可行性、安全性和手术时机.方法 回顾性分析腹腔镜胆囊切除术治疗280例胆囊颈部结石嵌顿患者的临床资料.结果 本组中转开腹8例,LC成功率97.1%,无一例发生胆管、肠管损伤,均获治愈.结论 在术者熟练的操作技巧、合理选择中转开腹时机的前提下,胆囊颈部结石嵌顿患者行腹腔镜胆囊切除术是安全可行的.     

腹腔镜在急性胆囊结石嵌顿手术中的应用

目的：总结急性胆囊炎伴结石嵌顿患者行急诊腹腔镜胆囊切除术（ELC）的时机、可行性及治疗经验。方法：回顾分析我院近5年腹腔镜手术治疗175例急性胆囊结石嵌顿患者的临床资料。结果：本组中转开腹6例,主动中转4例,被动中转2例,ELC成功率为96.58%,术后早期3例发生胆总管残留结石,行EST治疗,无死亡病例。结论：具有丰富腹腔镜经验的外科医生,急性胆囊炎伴结石嵌顿患者施行ELC是安全可行的,但须严格把握其中转开腹的指征并注重术前检查判断胆总管结石存在的可能性。     

磁共振成像在妊娠期子宫嵌顿诊治中的应用探讨

目的: 探讨磁共振成像（magnetic resonance imaging,MRI）在妊娠期子宫嵌顿诊治中的应用价值。方法: 回顾性分析2010—2020年于北京大学第三医院产科诊治的4例妊娠期子宫嵌顿病例,回顾MRI和超声检查对该病例诊断的经验和术前评估的价值。结果: 2例初次超声提示完全性前置胎盘,2例超声提示宫颈及子宫下段回声杂乱,4例经MRI检查后明确诊断妊娠期子宫嵌顿,其中1例孕中期复位后自然分娩,1例因为合并胎盘植入孕中期终止妊娠,2例于孕晚期结合MRI图像制定围术期方案,母儿结局良好。结论：MRI 能够对疑似妊娠期子宫嵌顿的病例进行明确诊断,同时可以指导制定手术方案。超声疑似子宫嵌顿病例应及时完善MRI明确诊断,有助于改善母儿结局。     

肛管直肠异物嵌顿29例临床分析

目的探讨肛管直肠异物嵌顿的临床诊治方法和疗效。方法收集1994～2010年间绵阳市肛肠病医院在临床实践中诊治的肛管直肠异物29例,采取分类统计的方法,对患者病史、体征、辅助检查、手术治疗方法及恢复情况等进行回顾分析。结果所有29例直肠异物的种类和大小各异,均接受手术治疗,其中经扩肛后直接用手指取出4例;局部麻醉后经肛门直视下取出13例、破碎后经肛门取出7例;剖腹探查、经肛门异物取出术3例;剖腹探查、结肠切开异物取出术2例。术后住院1～14 d,予以抗生素、对症等治疗,所有患者均康复出院。术后并发肠粘连1例,经保守治疗后好转,并发症发生率为3.4%。结论根据肛管直肠异物嵌顿的不同情况,采取不同的手术治疗方法,是顺利取出直肠异物、提高治愈率,减少并发症的关键。     

胆囊颈部结石嵌顿性胆囊炎腹腔镜手术68例治疗体会

目的:探讨不同病理状态下胆囊颈部结石嵌顿性胆囊炎LC的手术时机、处理方法及并发症的防治。方法:对68例的临床资料进行回顾性分析。结果:行LC469例中颈部结石嵌顿性胆囊炎68例,63例LC成功,成功率92.6％,并发症1例。结论:既往将胆囊颈部结石嵌顿列为LC的禁忌证,特别是Calot三角致密粘连者或伴胆囊壁坏疸者。随着LC经验的积累,掌握操作技巧及术中配合胆道造影,现已成为LC的适应证,LC治疗胆囊颈部结石嵌顿性胆囊炎安全,可靠。     

Carceral-community epidemiology,structural racism,and COVID-19 disparities

Black and Hispanic communities are disproportionately affected by both incarceration and COVID-19. The epidemiological relationship between carceral facilities and community health during the COVID-19 pandemic, however, remains largely unexamined. Using data from Cook County Jail, we examine temporal patterns in the relationship between jail cycling (i.e., arrest and processing of individuals through jails before release) and community cases of COVID-19 in Chicago ZIP codes. We use multivariate regression analyses and a machine-learning tool, elastic regression, with 1,706 demographic control variables. We find that for each arrested individual cycled through Cook County Jail in March 2020, five additional cases of COVID-19 in their ZIP code of residence are independently attributable to the jail as of August. A total 86% of this additional disease burden is borne by majority-Black and/or -Hispanic ZIPs, accounting for 17% of cumulative COVID-19 cases in these ZIPs, 6% in majority-White ZIPs, and 13% across all ZIPs. Jail cycling in March alone can independently account for 21% of racial COVID-19 disparities in Chicago as of August 2020. Relative to all demographic variables in our analysis, jail cycling is the strongest predictor of COVID-19 rates, considerably exceeding poverty, race, and population density, for example. Arrest and incarceration policies appear to be increasing COVID-19 incidence in communities. Our data suggest that jails function as infectious disease multipliers and epidemiological pumps that are especially affecting marginalized communities. Given disproportionate policing and incarceration of racialized residents nationally, the criminal punishment system may explain a large proportion of racial COVID-19 disparities noted across the United States.

High rates of incarceration in crowded detention facilities have been documented as a significant population-level risk factor for the transmission of infectious diseases such as HIV, influenza, tuberculosis, viral hepatitis, and yet other diseases (1–11). Such facilities function as disease incubators, providing sites for easy viral and bacterial replication with a ready supply of tightly packed bodies that are rendered even more vulnerable by inadequate healthcare, poor living conditions, and associated comorbidities (12, 13). As a result, notably overcrowded prisons, jails, and immigrant detention facilities under a system of mass incarceration in the United States effectively constitute infectious disease multipliers (14–21). Given the daily inflow/outflow of staff and detainees, these disease reservoirs—cultivated through disregard for the welfare of incarcerated people — also function as epidemiological pumps that fuel continued disease penetrance in surrounding communities (22–26). We refer to this dynamic as “carceral-community epidemiology” to emphasize that health in carceral facilities is in continuous biosocial interrelation with community health, national public health, and global biosecurity.During the COVID-19 pandemic, American jails and prisons have predictably emerged as the world’s leading sites of COVID-19 outbreaks. Prior to the resumption of the school year, carceral facilities constituted 90 of the top 100 clusters in the United States as of September 1, 2020 (27). As of March 2021, they featured more than 626,000 publicly documented cases––almost certainly a substantial undercount due to the absence of oversight to ensure adequate testing protocols, data accuracy, and public reporting (27, 28). This crisis was not unanticipated (19, 20, 29, 30). Amid long-standing political acceptance of mass incarceration in the United States, which houses nearly 25% of the world’s incarcerated people despite only representing 4.2% of the global population (31), early warnings from public health experts were followed by delayed and inadequate policy action to alter arrest and incarceration practices in response to pandemic conditions (21, 32) Furthermore, while US jail populations initially declined in late spring and summer months, they have since rebounded toward prepandemic levels, increasing by 10% in the final months of 2020 (33). In this context, it is notable that while a considerable amount of appropriate attention has focused on the risks to which incarcerated individuals are being subjected during COVID-19, comparatively little scientific, media, and policy attention has highlighted the risks that carceral epidemics pose not only to incarcerated people but also to the health of the public at large (34).It is clear that COVID-19 spreads quickly within US prisons and jails (35), but ascertaining the degree to which cases manifesting in carceral institutions spread to surrounding communities requires more investigation. An early modeling study, which necessarily relied on various assumptions and estimated an eventual total toll of 200,000 deaths from COVID-19, suggested that up to 76,000 deaths in US communities could result from spillover of COVID-19 epidemics in prisons and jails (36, 37). As the number of COVID-19 deaths in the United States now approaches 600,000, it appears likely that a large proportion of total COVID-19 deaths may ultimately be attributable to jail- and prison-linked spread of the novel coronavirus.As of yet, only one peer-reviewed study has addressed carceral-community epidemiological ties during the COVID-19 pandemic with empirical data analysis based on real-world, rather than projected, dynamics. Controlling for race, poverty, public transit use, and population density, the study’s cross-sectional analysis showed a strong independent association between the arrest and cycling of individuals through Cook County Jail in Chicago before release and COVID-19 case rates in these individuals’ home ZIP codes in Illinois (38).In addition to this preliminary finding, parallel racial disparities in the American criminal punishment system and COVID-19 cases also suggest a likely epidemiological link between COVID-19 outbreaks in carceral institutions and high case rates in highly policed Black and Hispanic communities (39). American policing and carceral practices disproportionately affect communities of color, who make up only 37% of the general population but 67% of the prison population (40). Communities subjected to high rates of poverty, which often overlap with racialized communities in the United States but also include poor White communities, are also disproportionately affected by policing and incarceration (41, 42) As has been widely noted, COVID-19 cases and deaths in the United States are, like arrest and incarceration, disproportionately affecting communities of color and communities in poverty (43–46). Despite these demographic overlaps and the questions they provoke, little research exists on the relationship between policing and/or incarceration policies and community rates of COVID-19.The lack of research in this area owes in large part to inadequate data access, low data quality, and obstructive noncooperation from authorities overseeing jails, prisons, and immigration detention facilities (28). The collection and distribution of such data are often controlled, with little to no regulatory oversight, by county sheriffs and related officials whose positions depend upon electoral politics, both directly and indirectly. This may foster a prioritization of anticipated ramifications of negative media coverage rather than a prioritization of effective public health action and facilitation of necessary research (47).The hazards of this system were confirmed, for example, in an August 2020 Supreme Court case, in which documents revealed that the Orange County Jail deliberately misled a lower court. The dissenting opinion, written by Justices Sotomayor and Ginsberg, affirmed a lower court’s assessment that “the Jail was deliberately indifferent to the health and safety of its inmates.” Furthermore, they noted that “despite knowing the severe threat posed by COVID–19 and contrary to its own apparent policies, the Jail exposed its inmates to significant risks from a highly contagious and potentially deadly disease [… and] has misrepresented its actions to the District Court and failed to safeguard the health of the inmates in its care” (48). Amid widespread legal failures to protect public health, including the Supreme Court’s majority opinion in this case, such abuses and misrepresentations by jail and prison administrators remain difficult to detect, document, and prevent. In this context, recent bicameral legislative efforts in Congress that attempt to force greater data transparency are important for collecting vital public health data and facilitating evidenced-based policymaking (49, 50). Currently proposed legislation does not, however, include adequate provisions to address the problem of data quality, possible data manipulation and misrepresentation, and the associated need for independent oversight to ensure proper COVID-19 testing protocols, accurate data collection, and publicly accessible data infrastructure.In this setting of minimal high-quality data access and correspondingly few peer-reviewed studies, researchers have suspected that the constant circulation of staff and detainees between jails and communities—a weekly flow of 200,000 jail detainees (51) alongside daily movement of over 420,000 jail and prison guards (52)—poses considerable risk for the broader transmission of COVID-19 in communities. Although prisons, which house those who have been convicted of crimes and are serving sentences typically longer than one year, are also porous institutions in constant biosocial interrelation with surrounding communities, the degree of daily inflow/outflow of jails is notably higher. While prisons release ∼600,000 people annually, jails cycle through nearly 11 million admissions each year (41, 53). It is also important to note that jails primarily house pretrial detainees who have not been convicted of a crime and most of whom remain in jails for only a matter of hours, days, or weeks before being released to their communities. Pretrial detainees make up 74% of the typical daily population in US jails (and 43% of this daily population is comprised of Black individuals, who constitute only 13% of the overall national population) alongside a minority of jail detainees who have been convicted of low-level offenses and are serving sentences of less than one year (41). Highly dynamic jail populations with constant flow of new immunologically naïve individuals suggests that jails are an especially important nexus for spread of COVID-19 in US communities.Against this backdrop, this study improves upon our previously published cross-sectional analysis of the relationship between incarceration and community spread of COVID-19 (38). With new access to longitudinal COVID-19 data that corresponds with jail release data at the ZIP code level, we are able to further characterize our previous study’s observed correlation between jail cycling and COVID-19 case rates in Illinois ZIP codes by including analyses over time to better inform an evaluation of possible causal relationships between jail cycling and COVID-19 spread in surrounding communities. We also more closely analyze the relationship between jail-linked coronavirus spread and racial health inequities as a mechanism of structural racism (39, 54). Our previous study’s single cross-sectional analysis added preliminary quantitative evidence to anecdotal observations, but it could not assess temporal patterns, the plausibility of reverse causality (i.e., that higher preexisting COVID-19 case rates in ZIP codes with high rates of jail cycling––not jail cycling itself––account for the observed relationship), nor the longer-term epidemiological dynamics associated with jail cycling. We now use repeated cross-sectional analyses to examine temporal dynamics in the relationship between jail cycling and community COVID-19 spread.     

Prior Incarceration and Barriers to Receipt of Services among Entrants to Alternative to Incarceration Programs: A Gender-Based Disparity

The high levels of health and psychosocial needs among correctional populations strongly shape the well-being of the urban communities from which a large number of criminal justice-involved individuals come or to which they return. The benefits of providing services to correction-involved individuals and linking them to providers such as with alternative to incarceration (ATI) programs may be limited if they encounter difficulties accessing such services. This study identified the types of barriers that have prevented entrants into ATI programs from receiving health and psychosocial services. We then tested the association between number of prior incarcerations and number of barriers by gender. From a random sample of adults (N = 322; 83 women and 239 men) entering ATI programs in New York City, data were collected via structured interviews that elicited self-reported sociodemographics, substance use, prior incarcerations, and barriers that had actually prevented a participant from visiting or returning to a service provider. Participants reported an average of 3.0 barriers that have prevented them from receiving health and psychosocial services. The most prevalent barriers predominantly concerned service providers’ inability to accommodate constraints on participants’ time availability or flexibility, transportation, and money. Compared to women, men had a significantly different association that was in the adverse direction—i.e., more prior incarcerations was associated with more barriers—between prior incarcerations and encountering service barriers. Findings indicate that ATI program entrants experience many barriers that have prevented them from receiving health and/or psychosocial services. Furthermore, men with more extensive incarceration histories particularly are disadvantaged. ATI programs can improve the public health of urban communities if such programs are prepared and resourced to facilitate the receipt of services among program participants, especially men who have more extensive incarceration histories.     

Psychiatric Disorders in Aging Prisoners

Abstract

Objective:The purpose of this study is to describe and compare older individuals (over the age of 55) presently incarcerated in the Tennessee State Prison System who have diagnosed with mental illnesses with those older prisoners without diagnoses of mental illnesses.

Method (Design, Setting, Participants):This study examined 671 Tennessee State Prison inmates 55 years of age and older. These prisoners were divided into two groups: those having a diagnosis of mental illness and those without such a diagnosis. Factors such as incidence of reincarceration, length of sentencing, mental illnesses and offenses committed were compared.

Results (Interventions, Measurements):This study showed many characteristics of the mentally ill geriatric offender. Significance was found between gender and psychiatric illness, as well as between gender and the illnesses of depression and dementia. Women with a depressive disorder were more likely to have committed murder, and men with dementia were more like to have committed a sex crime.

Conclusions:These findings indicate that there are a number of older individuals currently incarcerated in Tennessee prisons. Sixteen percent of these individuals had a diagnosis of a mental illness. This study's findings raise critical issues relative to the older incarcerated mentally ill population, which require additional research.     

Drug Abuse and Incarcerated Women: A Research Review

Drug abuse is the primary reason women enter prison and is the primary health problem of women in prison. There has been little research conducted specifically with this population; information must be drawn from studies with nonincarcerated addicted women and incarcerated addicted men. The purpose of this paper is to review what is known about the treatment and aftercare needs of this group (including relapse and recidivism prevention) and to propose an agenda for future research.