The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods

Objectives. We examined whether residence in neighborhoods with high levels of incarceration is associated with psychiatric morbidity among nonincarcerated community members.Methods. We linked zip code–linked information on neighborhood prison admissions rates to individual-level data on mental health from the Detroit Neighborhood Health Study (2008–2012), a prospective probability sample of predominantly Black individuals.Results. Controlling for individual- and neighborhood-level risk factors, individuals living in neighborhoods with high prison admission rates were more likely to meet criteria for a current (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.7, 5.5) and lifetime (OR = 2.5; 95% CI = 1.4, 4.6) major depressive disorder across the 3 waves of follow-up as well as current (OR = 2.1; 95% CI = 1.0, 4.2) and lifetime (OR = 2.3; 95% CI = 1.2, 4.5) generalized anxiety disorder than were individuals living in neighborhoods with low prison admission rates. These relationships between neighborhood-level incarceration and mental health were comparable for individuals with and without a personal history of incarceration.Conclusions. Incarceration may exert collateral damage on the mental health of individuals living in high-incarceration neighborhoods, suggesting that the public mental health impact of mass incarceration extends beyond those who are incarcerated.The United States leads the world in the percentage of its population that serves time in prison or jail.1,2 As of 2012, nearly 7 million men and women are on probation, parole, or under some other form of community supervision, which means that nearly 3% of the American adult population is currently involved in correctional supervision.3 The burden of incarceration in the United States is not equally distributed in the population. Current estimates from the Bureau of Justice Statistics indicate that 1 of every 3 Black men will serve time in prison in their lifetimes.4 In some communities, these figures are even starker. In Washington, DC, for example, more than 95% of Black men have been in prison in their lifetimes.1 Because of the scope of incarceration within particular subgroups, the current state of the US criminal justice system has been described in such terms as mass imprisonment5 and hyperincarceration.6Research on the health consequences of incarceration falls largely into 2 broad categories. The first, which has received the most empirical attention, has focused on individuals directly involved in the criminal justice system. Individual incarceration exposure is associated with adverse mental7–9 and physical10 health outcomes. A second line of inquiry has evaluated the broader health consequences of incarceration—what has been variously called the “long arm” of corrections,11 the collateral consequences of mass incarceration,5 and “spillover” effects related to incarceration.12 For example, female partners of recently released male prisoners experience depression and anxiety symptoms,13,14 and the children of incarcerated parents are at increased risk for behavioral and mental health problems.15,16 The deleterious health effects of incarceration are not merely confined to the family members of incarcerated individuals, however. Nonincarcerated individuals living in the communities from which inmates are drawn also appear to be at heightened risk for a variety of adverse outcomes, including increased crime rates17 and infectious diseases.18Although this research provides important initial insights into some of the negative consequences of incarceration at the community level, it remains largely unknown whether incarceration influences the mental health of community members who reside in neighborhoods with high-incarceration rates. How might incarceration affect community mental health? High levels of incarceration in neighborhoods can alter the social ecology of communities by eroding social capital and disrupting the kinds of social and family networks and relationships that are necessary for sustaining individuals’ mental health as well as the well-being of communities.1,19–22We examined whether high levels of incarceration in neighborhoods affect the mental health of individuals living in these neighborhoods. We treated incarceration as an ecological or contextual effect, rather than as an individual-level risk factor, which has characterized the majority of research on incarceration and mental health.7,23 That is, rather than examining the mental health consequences of incarceration among those who have themselves been incarcerated or among their family members, we examined the mental health of individuals living in communities that have been exposed to elevated levels of incarceration.     

髓芯减压结合aFGF并髂骨混合物植入治疗犬股骨头坏死的效果

目的探讨髓芯减压结合酸性成纤维细胞生长因子(aFGF)并髂骨混合物植入治疗犬股骨头坏死的效果。方法将13只成年健康杂种犬分为5组,A、B、C、D组用液氮冷冻法制备单侧股骨头坏死模型,然后A组(3只)采用髓芯减压结合aFGF并髂骨混合物植入进行治疗,B组(3只)采用髓芯减压后髂骨植入进行治疗,C组(3只)采用单纯髓芯减压进行治疗,D组(3只)作为造模后对照,E组(1只)作为空白对照。各组分别于术后4、8、12周行髋部MR检查,A~D组并在相应时间处死1只动物进行病理检查。结果 A、B、C、D组造模均成功,4周时A组即有明显血管和新骨生成,程度明显强于其他各组。8周时A组修复基本完成,12周时B组修复基本完成,C组修复缓慢。结论髓芯减压结合aFGF并髂骨混合物植入能促进犬股骨头坏死的修复。     

预混胰岛素联合格列美脲治疗2型糖尿病临床观察

目的观察应用较大剂量胰岛素联合非促泌剂治疗血糖仍然控制不佳的2型糖尿病患者增加格列美脲的疗效及对胰岛素使用剂量的影响。方法选择每日胰岛素用量均≥40单位的患者,所选病例在饮食及运动量不变的情况下,随机分为原方案组(胰岛素组)和加用格列美脲组(格列美脲组),胰岛素组根据血糖情况继续增加胰岛素剂量至血糖控制理想,格列美脲组在原治疗方案的基础上加用格列美脲,根据血糖情况调整胰岛素和格列美脲的剂量。比较治疗12周后两组治疗前后空腹血糖、餐后2 h血糖和糖化血红蛋白的变化、胰岛素日剂量、低血糖事件、体重和血脂的变化。结果治疗前后比较,格列美脲组血糖控制明显好于胰岛素组,胰岛素日剂量明显降低,体重低于胰岛素组,两组间低血糖事件比较差异无统计学意义;两组对血脂的影响差异无统计学意义。格列美脲组治疗后各项指标较治疗前也有明显好转。结论胰岛素联合非促泌剂血糖控制不佳的2型糖尿病患者加用格列美脲后胰岛素的日剂量明显降低,在不增加低血糖和患者经济负担基础上持续改善患者的血糖控制,节省外源性胰岛素用量,体重低于单纯胰岛素组。     

心电监护仪智能化质控平台的研究

目的:设计一个对心电监护仪的质控管理平台,使检测人员能迅速、客观评判监护仪的质量控制结果并实现质控工作全流程的监控和记录.方法:通过对现行心电监护仪质量控制方法的深入研究,利用现有检测设备,采用数据库技术和基于神经网络的数字识别技术完成质控平台的设计.结果:该平台能够实现对心电监护仪质控数据的智能采集、识别、数据分析以及统计和评判工作.结论:该平台的应用将大大推动军队医院质控工作朝着准确、高效和客观的方向发展,增强心电监护仪的质控管理力度,提高医疗服务水平.     

间充质干细胞成骨和成脂分化调控机制研究

间充质干细胞（MSCs）是人体内参与免疫平衡、维持组织器官的稳态和功能以及组织损伤修复的一类重要成体干细胞。MSCs具有自我更新能力和多向分化潜能,国际干细胞协会将MSCs向脂肪、成骨等细胞分化的能力作为其重要的检测标准。作为骨细胞和脂肪细胞的共同来源,MSCs在成骨和成脂分化之间相互协调和相互竞争,并在多种调控因素作用下保持着微妙的平衡。对MSCs成骨、成脂分化的信号通路、调控因素进行分析,并对其分化诱导方法以及鉴定方法进行总结,以期为MSCs基础研究及临床应用提供参考依据。     

每搏量与脉搏压变异度对机器人辅助肝脏手术预测液体反应的价值

目的探讨每搏量变异度(stroke volume variation,SVV)、脉搏压变异度(pulse pressure variation,PPV)对机器人辅助肝脏手术预测液体的准确性及阈值变化的价值。方法选择拟在全身麻醉下行机器人辅助肝脏手术患者26例,全身麻醉后连续监测心率(HR)、平均动脉压(MAP)、每搏量(SV)、每搏量指数(SVI)、SVV、PPV等血流动力学指标,在反Trendelenburg体位下建立人工气腹后进行容量负荷试验,记录输液前后各血流动力学指标数值,然后以输液前后每搏量变异指数的差(ΔSVI)将患者分为两组,即有反应组(ΔSVI≥15%)和无反应组(ΔSVI<15%)组,绘制SVV和PPV判断扩容效应的受试者工作特征性(ROC)曲线,确定机器人辅助肝脏手术特殊的体位及气腹条件下SVV和PPV预测容量状况的准确性、诊断阈值及两者的相关性。结果 SVV和PPV判断扩容有效的ROC曲线下面积分别为0.830和0.875,SVV的诊断阈值为13.5%,PPV的诊断阈值为14.5%,两者的相关性为r=0.772(P<0.01)。结论 SVV和PPV均能准确预测机器人辅助肝脏手术中全身麻醉机械通气患者的容量状况,两者预测容量状况的准确性相似且呈正相关,但两者的诊断阈值较标准值均有所降低。     

关节镜下经皮空心钉固定治疗急性移位单纯性肱骨大结节骨折

目的探讨关节镜下空心钉固定治疗急性移位单纯性肱骨大结节骨折的方法及近期疗效。方法2010年1月-2013年2月,采用关节镜下空心钉固定治疗15例急性移位单纯性肱骨大结节骨折患者。其中男8例,女7例;年龄31~66岁,平均44.9岁。均由摔伤致病。受伤至手术时间4~19 d,平均9.9 d。术前肩关节活动度:前屈上举(74.13±17.19)°、外展(121.67±17.50)°、内旋(T11±2)°、外旋(39.27±8.08)°。术前疼痛视觉模拟评分(VAS)为(6.46±1.30)分,Costant评分为(62.27±11.90)分。结果术后切口均I期愈合。15例均获随访,随访时间12~27个月,平均15个月。复查X线片示骨折对位、对线良好,骨折均愈合,愈合时间6~13周,平均8周。末次随访时肩关节活动度为:前屈上举(169.33±7.99)°、外展(156.67±10.47)°、内旋(T6±2)°、外旋(71.67±7.94)°,与术前比较差异均有统计学意义(P0.05);末次随访时VAS为(1.73±1.02)分,Costant评分为(96.20±2.34)分,与术前比较差异均有统计学意义(t=—8.51,P=0.00;t=11.50,P=0.00)。随访期间无内固定物失效、骨折移位、神经或血管损伤以及肩关节粘连等并发症发生。结论关节镜下空心钉固定治疗急性移位单纯性肱骨大结节骨折近期疗效好、创伤小、恢复快,是一种安全可靠的治疗方法。