A Systematic Review of Randomized Controlled Trials of Interventions to Improve the Health of Persons During Imprisonment and in the Year After Release

We systematically reviewed randomized controlled trials of interventions to improve the health of people during imprisonment or in the year after release. We searched 14 biomedical and social science databases in 2014, and identified 95 studies.Most studies involved only men or a majority of men (70/83 studies in which gender was specified); only 16 studies focused on adolescents. Most studies were conducted in the United States (n = 57). The risk of bias for outcomes in almost all studies was unclear or high (n = 91). In 59 studies, interventions led to improved mental health, substance use, infectious diseases, or health service utilization outcomes; in 42 of these studies, outcomes were measured in the community after release.Improving the health of people who experience imprisonment requires knowledge generation and knowledge translation, including implementation of effective interventions.Worldwide, more than 11 million people are imprisoned at any given time, and the prison population continues to grow at a rate faster than that of the general population.1 Substantial evidence reveals that people who have experienced imprisonment have poor health compared with the general population, as indicated by the prevalence of mental illness, infectious diseases, chronic diseases, and mortality.2There are several reasons to focus on improving the health of people who experience imprisonment.3 The burden of disease in this population affects the general population directly through increased health care costs and through the transmission of communicable diseases (e.g., HIV, HCV, and tuberculosis) after people are released from detention. Imprisonment has also been associated with worse health in family members of those who are detained, compared with the general population, including chronic diseases4 and poor mental health5,6 in adult relatives and mortality in male children.7 At the community level, higher rates of incarceration have been associated with adverse health outcomes, such as sexually transmitted infections and teen pregnancies.8 There is also evidence that poor health in persons who are released from detention, particularly those with inadequately treated mental illness and substance use disorders,3 may affect public safety and reincarceration rates,3 and that better access to health care is associated with less recidivism.9,10 Finally, the right to health and health care is enshrined in international human rights documents,11,12 and is a legislated responsibility of governments in many countries.Intervening during imprisonment and at the time of release could improve the health of people who experience imprisonment and public health overall.13 Knowledge translation efforts, such as syntheses of effective interventions, could lead to the implementation and further evaluation of interventions,14 and identify areas where further research is needed. To date, only syntheses with a limited focus have been conducted in this population, for example, reviews of interventions related to HIV15 or for persons with serious mental illness.16 Decision makers, practitioners, and researchers in this field would benefit from a broader understanding of the state of evidence regarding interventions to improve health in people who experience imprisonment.To address this gap, we systematically reviewed randomized controlled trials of interventions to improve health in persons during imprisonment and in the year after release. We chose this population because we view imprisonment as a unique opportunity to deliver and to link with interventions for this population, and to highlight interventions that could be implemented by those responsible for the administration of correctional facilities. We limited this study to randomized controlled trials, recognizing that randomized controlled trials provide the highest quality of evidence compared with other study designs.17     

Motor-unit synchrony within and across compartments of the human flexor digitorum superficialis

An interesting feature of the muscular organization of the human hand is that the main flexors and extensors of the fingers are compartmentalized and give rise to multiple parallel tendons that insert onto all the fingers. Previous studies of motor-unit synchrony in extensor digitorum and flexor digitorum profundus indicated that synaptic input to motor neurons supplying these multitendoned muscles is not uniformly distributed across the entire pool of motor neurons but instead appears to be partially segregated to supply subsets of motor neurons that innervate different muscular compartments. Little is known, however, about the organization of the synaptic inputs to the motor neurons supplying another multitendoned finger muscle, the flexor digitorum superficialis (FDS). Therefore in this study, we estimated the extent of divergence of last-order inputs to FDS motor neurons by measuring the degree of short-term synchrony among motor units within and across compartments of FDS. The degree of synchrony for motor-unit pairs within the same digit compartment was nearly twofold that of pairs of motor units in adjacent compartments and more than fourfold that of pairs in nonadjacent compartments. Therefore like other multitendoned muscles of the hand, last-order synaptic inputs to motor neurons supplying the FDS appear to primarily supply subsets of motor neurons innervating specific finger compartments. Such an organization presumably enables differential activation of separate compartments to facilitate independent movements of the fingers.     

Rare case of iatrogenic aortic valve leaflet tear following a diagnostic coronary angiogram

We report a rare case of a 44-year-old male who underwent a diagnostic coronary angiogram following a non-ST elevation myocardial infarction complicated by an aortic valve leaflet tear requiring surgical intervention. Routine transthoracic echocardiogram demonstrated a mobile echogenic structure prolapsing into the left ventricular outflow tract. An intraoperative transesophageal echocardiogram confirmed that the structure originated from the ventricular side of left coronary cusp, causing malcoaptation between left and right coronary cusps, and subsequent moderate to severe aortic regurgitation.     

Predictors of mortality and cost among surgical patients requiring rapid response team activation

BackgroundPrior studies of rapid response team (RRT) implementation for surgical patients have demonstrated mixed results with respect to reductions in poor outcomes. The aim of this study was to identify predictors of in-hospital mortality and hospital costs among surgical inpatients requiring RRT activation.MethodsWe analyzed data prospectively collected from May 2012 to May 2016 at The Ottawa Hospital. We included patients who were at least 18 years of age, who were admitted to hospital, who received either preoperative or postoperative care, and and who required RRT activation. We created a multivariable logistic regression model to describe mortality predictors and a multivariable generalized linear model to describe cost predictors.ResultsWe included 1507 patients. The in-hospital mortality rate was 15.9%. The patient-related factors most strongly associated with mortality included an Elixhauser Comorbidity Index score of 20 or higher (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.96–6.60) and care designations excluding admission to the intensive care unit and cardiopulmonary resuscitation (OR 3.52, 95% CI 2.25–5.52). The strongest surgical predictors included neurosurgical admission (OR 2.09, 95% CI 1.17–3.75), emergent surgery (OR 2.04, 95% CI 1.37–3.03) and occurrence of 2 or more operations (OR 1.73, 95% CI 1.21–2.46). Among RRT factors, occurrence of 2 or more RRT assessments (OR 2.01, 95% CI 1.44–2.80) conferred the highest mortality. Increased cost was strongly associated with admitting service, multiple surgeries, multiple RRT assessments and medical comorbidity.ConclusionRRT activation among surgical inpatients identifies a population at high risk of death. We identified several predictors of mortality and cost, which represent opportunities for future quality improvement and patient safety initiatives.     

Coordination of grasping and walking in Parkinson’s disease

Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.     

Gastric acid secretion induced by impromidine in the dog and man: analysis of dose-response relationships

The new histamine H2-receptor agonist, impromidine, was used to assess three models of dose-response curves in vivo. Vm and ED50 values were calculated for gastric acid output to infusions of impromidine in the dog with a Heidenhain pouch and in man. In two models Michaelis-Menten kinetics were assumed: the linear transformation using the Eadie-Hofstee plot and the non-linear hyperbola, but in the third method the logistic function allowed the data to be analysed without making assumptions about the steepness of the curves. In the dog all three models gave similar results both for calculated Vm and ED50. Curve steepness from the logistic function was found to be 0.98 +/- 0.023 - not different from that assumed for the hyperbola (where steepness = 1). The results in man were different: the Eadie-Hofstee plot did not produce a significantly linear fit while the logistic function produced the smallest standard errors. The logistic curve slope was almost twice that assumed for the hyperbola (1.8 : 1) and it seems, therefore, that impromidine-induced gastric acid secretion does not follow Michaelis-Menten kinetics in man and data should be analysed using methods which allow the calculation of curve steepness.     

Differential blockade of ganglionic transmission by extract from venom gland of black widow spider (Latrodectus mactans)

The effect of an extract from the venom gland of the black widow spider (BWSV) on transmission in the rabbit superior cervical ganglion was studied in vitro by electrophysiological techniques. Within 1 min after addition of BWSV to the bathing solution, spontaneous asynchronous postganglionic potentials were observed, but reduction of postganglionic action potentials evoked by stimulation of the preganglionic nerve occurred progressively over a 20–80 min period. BWSV had a selective depressive effect on one of the two major components of the compound postganglionic action potential; the second, S₁, spike being depressed more readily than the first, S₁, spike. Washing out the venom did not restore transmission but did stop the progressive reduction in postganglionic potentials. Increasing the calcium concentration three-fold in the external saline solution transiently stopped the progressive development of block. Repetitive stimulation of the preganglionic nerve at 5 or 10 Hz did not augment the BWSV-induced block.