High rates of tuberculosis, including multidrug-resistant tuberculosis (MDR-TB), have been reported from the former Soviet Union. Our laboratory has supported operational studies in jails in Baku, Azerbaijan, and Mariinsk, Siberia. Combining the results from these two penal systems, the rates of MDR-TB among 'newly enrolled' and 'non-responding' cases were 24.6% and 92.1%, respectively. Restriction fragment length polymorphism (RFLP) studies strongly suggest transmission of MDR-TB between prisoners. In Mariinsk, the high rates of MDR-TB have been associated with failure rates of 23%-50% among smear-positive cases receiving fully-supervised standard short-course treatment. There are no coherent guidelines for TB control programmes confronted by high pre-existing levels of MDR-TB but who have only limited laboratory, clinical, pharmaceutical and financial resources. A 'DOTS plus' strategy has been advocated in which an established TB control programme is complemented by facilities to treat MDR-TB patients. However, the exact format of these programmes remains unresolved. Further research is required to describe the natural history of MDR-TB infection, to determine the failure rate of (and the additional resistance induced by) standard short-course treatment when MDR-TB is prevalent, to decide whether standardised or individualised second-line regimens can be employed, and to define the laboratory facilities required by a 'DOTS plus' programme.
The 2004 terror attack on a school in Beslan, North Caucasus, with more than 1300 children and their families taken hostage and 334 people killed, ended after extreme violence. Following the disaster, many survivors with blast ear injuries developed complications because no microsurgery services were available in the region. Here, we present our strategies in North Ossetia to strengthen subspecialty surgical care in a region of instable security conditions. Disaster modifies disease burden in an environment of conflict-related health-care limitations. We built on available secondary care and partnered international with local stakeholders to reach and treat victims of a humanitarian disaster. A strategy of mutual commitment resulted in treatment of all consenting Beslan victims with blast trauma sequelae and of non disaster-related patients. Credible, sustained partnerships and needs assessments beyond the immediate phases after a disaster are essential to facilitate a meaningful transition from humanitarian aid to capacity building exceeding existing insufficient standards. Psychosocial impacts of disaster might constitute a barrier to care and need to be assessed when responding to the burden of surgical disease in conflict or post-conflict settings. Involving local citizen groups in the planning process can be useful to identify and access vulnerable populations. Integration of our strategy into broader efforts might strengthen the local health system through management and leadership.
We examined the involvement of alcohol consumption, chronic alcohol abuse or dependence, the soundness of the police determination of alcohol-related intoxication, and the importance of other drugs in deaths in police custody in a survey of the cases reported to the Chief Coroner of Ontario during the past 10 years. The data suggest no mismanagement by the police. At least 86% of the fatalities were associated with recent alcohol consumption or chronic alcohol abuse/dependence. Use of drugs other than alcohol was far less common. Promoting use and further development of simple tests to estimate blood alcohol concentration, chronic alcohol problems, and suicide risk, before incarceration takes place, may save lives.
Violent crime has been associated with the abuse of anabolic-androgenic steroids (AAS) in several reports. Speculations concerning such associations have been raised with regard to several recent crimes committed in Sweden. To test this hypothetical relationship, individuals in a Stockholm jail who had been arrested for violent crimes were screened for AAS in the urine. No AAS were detected in the urine samples of 50 prisoners who had volunteered for the study. However, 16 prisoners refused to participate. AAS abuse was admitted by two of the participating subjects. Although there is a great need for epidemiological studies to objectively confirm the association of AAS abuse and violence, it seems that such studies will be impossible to conduct as long as they, for legal reasons, depend on voluntary participation.
Our objective was to examine the characteristics of international travelers from Canada who have been arrested or detained while abroad, and to review the health implications of incarceration.
An EpiInfo 6 program was created to analyse all of the Consular reports received in 1995 via the Secure Integrated Global Network (SIGNET) which provides communications and computerization services to the Department of Foreign Affairs and International Trade, Canada. The Consular Management and Operations System was designed to support the delivery of consular services by the Department, and to link Headquarters in Ottawa with missions in other countries through case management files, including a "Prisoners" file. Information obtained included personal demographics (age, gender), date, country, and reason for arrest or detention, and outcome of judicial process.
There were 1, 086 arrest or detention reports received from Consular services via SIGNET in 1995. Males outnumbered females 5.6:1. Most individuals arrested were young: 57.5% were less than 40 years, and 79% were less than 50 years. Drug related charges were cited in 33.1% of all cases, with 52.8% of arrested females charged with drug related offenses. The documented conviction rate was 96%. The majority of detained Canadian travelers were held in countries within the Americas (791 cases - 69.2%), with 642 (59.1%) being detained in the USA.
Arrest and detention is an unusual occurrence for international travelers but relative youth, male gender, and female drug couriers were identifiable risk characteristics. Public awareness campaigns can be targeted to specific population demographics, but all international travelers need to be counseled on the consequences of transgressing laws in foreign countries.
Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.
To investigate the associations between major classes of psychotropic medications and violent reoffending.
This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.
Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.
Violent crime after release from prison.
The cohort included 22?275 released prisoners (mean [SD] age, 38  years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11?026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15?725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR?=?1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.
Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.
Comment In: JAMA. 2016 Nov 1;316(17 ):1771-177227802525
The bulk of studies pertaining to addiction among delinquents have been conducted on male subjects. However, the few studies examining female inmates show that a significant proportion of them present an addictive disorder. Furthermore, the HIV infection rate is higher among these women than among incarcerated men. This study attempts to verify if women presenting a combination of criminal and addictive behaviors are at a higher risk of developing an earlier and a more severe delinquency than other delinquent women. Another goal is to determine whether women showing this comorbidity present a higher incidence of HIV-related risk behaviors. The study was conducted on a sample of 210 women from the Montreal detention center. It shows that addicted inmates present earlier onsets of both drug use and criminal behaviors compared to other female inmates. Addicted women also exhibit significantly more HIV-related risky behaviors, both in their drug use and in their sexual practices.
Bacteremic pneumococcal pneumonia (BPP) is an important disease that should be frequently re-evaluated due to changes in demographics and recommended treatment. We conducted a prospective study from 2000 to 2002 in adults aged 17 years and over who presented to any of 6 hospitals and 1 freestanding emergency room in Edmonton, Alberta, with signs and symptoms compatible with pneumonia, a chest radiograph interpreted as pneumonia by the attending physician, and a positive blood culture for Streptococcus pneumoniae. We identified 129 patients with BPP, for an overall incidence of 9.7/100,000 person years. The rate was markedly higher among pregnant women, homeless persons, and those in prison. Sixteen percent were managed as outpatients, 61.2% as ward patients, and 22.5% required admission to the intensive care unit (ICU). Tobacco smoking was predictive of BPP, and antibiotic therapy before presentation was protective. According to pneumonia severity index, 47.3% were in low-risk classes I-III, 31.0% were in class IV, and 21.7% were in class V. Twelve (9.3%) patients died. Four died within 24 hours of arrival at hospital, and 2 had end-stage lung disease that resulted in a decision to discontinue therapy. Of the S. pneumoniae isolates, 12.5% were not susceptible to penicillin. The overall rate of BPP appears to be decreasing, although the rate is markedly increased in certain populations, which now should be targeted for vaccination. We identified 3 subsets of patients with BPP according to the site of care (ambulatory, ward, and ICU), with different outcomes.
AIM: To estimate psychiatric and somatic morbidity in a nation-wide prison population, as inferred from detailed medication sheets. METHOD: Medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected and examined by experienced clinicians. All inmates on medication were assigned best-estimate psychiatric and/or somatic diagnoses according to the International Classification of Primary Care diagnostic system. RESULTS: Among the 2617 inmates 919 (35%) had psychiatric disorders, as estimated by our methodology. Depressive disorders (11%) and sleep disorders (11%) were most prevalent. Twenty-six inmates (1%) were prescribed medication indicative of affective psychosis and an additional 77 (3%) received anti-psychotic drugs in doses indicating other psychotic disorders, bringing the sum total of psychosis up to 103 (4%). A total of 848 inmates (32%) were estimated to suffer from somatic disorders. Various pain conditions were prevalent (11%) in addition to obstructive airway diseases and asthma (4%). Both psychiatric and somatic disorders were more prevalent in female prisoners. CONCLUSION: This study has demonstrated high psychiatric and somatic morbidity in a nation-wide population of prison inmates receiving adequate health services. As the morbidity estimates are inferred from prescription drug use they must be interpreted with caution. However, we do believe that our study, utilizing this unconventional but readily available source of information, has yielded valuable knowledge regarding the physical and mental health of a nation-wide prison population.
People in custody are more likely to die prematurely, especially of violent causes, than similar people not in custody. Some of these deaths may be preventable. In this study we examined causes of death (violent and natural) among people in custody in Ontario. We also compared the causes of deaths in 3 custodial systems (federal penitentiaries, provincial prisons and police cells).
We examined all available files of coroners' inquests into the deaths of people in custody in federal penitentiaries, provincial prisons and police cells in Ontario from 1990 to 1999. Data collected included age, cause of death, place of death, history of psychiatric illness and history of substance abuse. Causes of death were categorized as violent (accidental poisoning, suicide or homicide) or natural (cancer, cardiovascular disease or "other"). Crude death rates were estimated for male inmate populations in federal and provincial institutions. There were inadequate numbers for women and inadequate denominator estimates for police cells.
A total of 308 inmates died in custody during the study period; data were available for 291 (283 men, 8 women). Of the 283 deaths involving men, over half (168 [59%]) were from violent causes: suicide by strangulation (n = 90), poisoning or toxic effect (n = 48) and homicide (n = 16). Natural causes accounted for 115 (41%) of the deaths among the men, cardiovascular disease being the most common (n = 62 cases) and cancer the second most common (n = 18). Most (137 [48%]) of the deaths among the men occurred in federal institutions; 88 (31%) and 58 (21%) respectively occurred in provincial institutions and police cells. The crude rate of death among male inmates was 420.1 per 100,000 in federal institutions and 211.5 per 100 000 in provincial institutions. Compared with the Canadian male population, male inmates in both federal and provincial institutions had much higher rates of death by poisoning and suicide; the same was true for the rate of death by homicide among male inmates in federal institutions. The rates of death from cardiovascular disease among male inmates in federal and provincial institutions -- 102.7 and 51.7 per 100,000 respectively -- were also higher than the national average.
Violent causes of death, especially suicide by strangulation and poisoning, predominate among people in custody. Compared with the Canadian male population, male inmates have a higher overall rate of death and a much higher rate of death from violent causes.
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