Failure of erythropoietin treatment in a case with primary autonomic failure

All prisons provide healthcare services which aim to meet the needs of prisoners. The goal of the service is to give prisoners access to the same quality and range of health care as the NHS gives the general public. However, within the prison environment priorities centre around order, control and discipline and therefore an ethos of health care needs to be developed. Custody reduces the prisoner's opportunity for self-care and independent action as inmates have to consult nursing or medical staff for even the most simple remedies. Nursing staff in the prison service can play a significant part in primary health care, mental disorder and health promotion. Nurses have the knowledge, skills and attitudes needed to deal with this diverse and vulnerable prison population and to promote a positive interface between custody and care.     

Psychology and the limits to prison pain: Confronting the coming crisis in Eighth Amendment law.

This article examines the nexus between modern psychological theory (especially contextual or situational models of behavior), contemporary prison policy, and the legal concept of cruel and unusual punishment. It briefly reviews the history of imprisonment in the United States and the role of psychology in the development of prison punishment. An analysis of research on the psychological effects of imprisonment is presented, followed by a discussion of contemporary 8th Amendment law. Finally, modern psychological theory is used as the basis for a series of proposed correctional and legal reforms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Illness and injury among U.S. prisoners of war from Operation Desert Storm

United States prisoners of war had to endure a variety of medical problems during Operations Desert Shield and Desert Storm. All but one of the prisoners suffered some form of injury or illness. Orthopedic injuries were most common. Hematologic, dermatologic, neurologic, and infectious disorders were also noted. Some injuries were combat-related and others were due to mistreatment during incarceration. The prisoners' condition upon repatriation reflected their limited access to appropriate medical care, sanitation, and nutritional support.     

HIV infection among male prisoners in South Australia, 1989 to 1994

The prevalence of human immunodeficiency virus (HIV) in male prisoners in South Australia from July 1989 to June 1994 was ascertained from a repeated cross-sectional study. We also compared the criminological and demographic characteristics and histories of drug use of 39 HIV-infected prisoners and a randomly selected sample of 86 uninfected prisoners admitted at the same time. The numbers of HIV-infected prisoners in prison in any month ranged from 4 to 12. Prevalence among the total prison population ranged from 0.4 per cent to 1.4 per cent, and among the subpopulation of injecting drug users from 1.25 per cent to 4.36 per cent. Many HIV-infected prisoners continued after their diagnosis to have lifestyles that resulted in imprisonment. Infected prisoners were significantly older, had spent longer in prison and were more likely to be users of heroin (OR = 13.1) and methadone (OR = 25.4) than controls. Infection with HIV among South Australian prisoners has been continuous since at least the mid-1980s. The recidivism among many of the infected prisoners contributes to the variation in prevalence but also raises concerns about their management. Greater effort to minimise the recidivism of the HIV-infected prisoners could reduce the prevalence of HIV in the prison population.     

Prisoners as patients. The experience of delivering mental health nursing care in an Australian prison

Correctional or prison mental health nursing is a highly specialized area of practice that has undergone substantive role development in recent years. However, little research has explored aspects of prison-based nursing practice or practice arrangements. The experience of delivering mental health nursing care in prison can be disempowering, resulting in feelings of frustration, isolation, and stigma. In developed nations, prison mental health nurses face the rewarding challenge of gaining greater recognition for the specialized nature of their practice and their key role in the correctional and criminal justice continuum.     

Controversy concerning the criminal justice system and its implications for the role of mental health workers.

Examines the 2 major philosophies of treatment for criminal behavior: (a) the view that criminal behavior is a symptom of psychological disturbance and should be treated with psychotherapy rather than imprisonment (i.e., treat the man rather than the act); and (b) the refutation of this view, which suggests that therapeutic treatment may be a violation of individual rights and may be of more harm than incarceration in conventional prison facilities (i.e., treat the deed rather than the man). The role of the mental health worker in the criminal justice system as a whole, in a therapeutically-oriented system, in the traditional prison setting, and in partial or post-release settings is discussed. Issues involved in testifying in court or working in mandatory treatment programs are presented, and research into effective treatment procedures is suggested using personnel from outside correctional settings. Implications for training are considered. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cone-and-plate device for the investigation of platelet biomaterial interactions

As part of a class action suit, the author was asked to assess the quality of mental health services in eight prisons in Georgia. This paper describes the background to the suit, reviews selected literature on assessing quality of correctional mental health care, and describes methods used to survey prison mental health services. A standardized survey instrument was developed with probe questions to assess the quality of services. Individual cases were reviewed, inmates were interviewed, and the quality of mental health structures, processes, and outcomes were assessed. Key findings from the survey are summarized. The author concluded that the quality of mental health services in the prisons surveyed was so low overall as to constitute a pattern of deliberate indifference, and that the services were constitutionally inadequate.     

Issues in prison hospice: toward a model for the delivery of hospice care in a correctional setting

This paper examines issues in prison hospice care based on the author's nine years experience as a prison hospice worker and trainer and on data gathered by the National Prison Hospice Association (NPHA) from a number of federal and state prison medical facilities with operational or developing hospice programs, including both scatter-bed and hospice unit models, employing inmate hospice volunteers and the services of outside community hospice agencies and volunteers. The paper discusses DNR orders and curative vs. palliative care decisions, pain management, AIDS care, interdisciplinary care teams, staff and volunteer training and supervision, and the need for compassionate early release and community placement programs. The author proposes a set of preliminary guidelines for the delivery of hospice care in the correctional setting.     

Stay safe! Stay healthy! Surviving old age in prison

Although elderly inmates form a small minority in the U.S. prison population (6.6%), this number is expected to increase by 2005. Elderly prisoners consist of first-time offenders, habitual offenders, and those who have "aged in place" (received very long sentences at a young age). Violence is an identified stressor affecting the elderly prisoner. This enduring stressor can add to physical deterioration, particularly in the inmate with chronic illness. Violence in prison falls into three categories: prisoner-prisoner, staff-prisoner, or prisoner-staff (Clear & Cole, 1994). Prisoner-prisoner incidents account for the majority of violence within prison systems. The convict in today's prison will use extremes of violence to combat threats to his or her reputation or self-concept of "machismo," or if the inmate feels "disrespected." The aging prisoner may have chronic, pervasive stress levels disguised under a tough veneer, although he or she may no longer be strong enough physically or emotionally to fend off potential attackers. Interventions with elderly prisoners include thorough physical and cognitive assessment, including signs and symptoms of depression or stress related to environmental disturbances. Educational training for correctional staff about age-specific developmental changes is necessary. Building partnerships with community, state, and national organizations can assist elderly inmates in their adjustment to prison and foster successful community release programs. Special care units may be considered for frail elderly inmates or those with chronic health problems.     

Charity and community: the role of nonprofit ownership in a managed health care system

As American medicine has been transformed by the growth of managed care, so too have questions about the appropriate role of nonprofit ownership in the health care system. The standards for community benefit that are increasingly applied to nonprofit hospitals are, at best, only partially relevant to expectations for nonprofit managed care plans. Can we expect nonprofit ownership to substantially affect the behavior of an increasingly competitive managed care industry dealing with insured populations? Drawing from historical interpretations of tax exemption in health care and from the theoretical literature on the implications of ownership for organizational behavior, we identify five forms of community benefit that might be associated with nonprofit forms of managed care. Using data from a national survey of firms providing third-party utilization review services in 1993, we test for ownership-related differences in these five dimensions. Nonprofit utilization review firms generally provide more public goods, such as information dissemination, and are more "community oriented" than proprietary firms, but they are not distinguishable from their for-profit counterparts in addressing the implications of medical quality or the cost of the review process. However, a subgroup of nonprofit review organizations with medical origins are more likely to address quality issues than are either for-profit firms or other nonprofit agencies. Evidence on responses to information asymmetries is mixed but suggests that some ownership related differences exist. The term "charitable" is thus capable of a definition far broader than merely the relief of the poor. While it is true that in the past Congress and the federal courts have conditioned the hospital's charitable status on the level of free or below cost care that it provided for indigents, there is no authority for the conclusion that the determination of "charitable" status was always so limited. Such an inflexible construction fails to recognize the changing economic, social and technological precepts and values of contemporary society. -Circuit Court of Appeals, District of Columbia, Eastern Kentucky Welfare Rights Organization v. Simon (1974).     

Nursing in prisons. Career opportunities in the nursing service for prisoners

This paper looks at the organisation and recent transformation of the nursing service for prisoners. Formerly the majority of health care within the prison service was provided by discipline officers, who had had training in first aid and basic nursing duties. However, the service is now increasingly employing registered nurses.     

The professionalization of English prison psychologists.

Currently, about 90 psychologists are employed in the English prison service. Their major tasks are to (a) advise the prison governor and senior managerial staff on such topics as staff morale, inmate management, and communication; (b) train the staff; (c) diagnose, assess, and interpret psychological test information to match treatment to the inmate in allocation decisions; (d) provide treatment (e.g., individual and group counseling and psychotherapy, social skills training, and behavior modification); and (e) conduct research, especially on the effectiveness of treatments, the prediction of behavior after release, and validity of psychological tests and other assessment techniques. Major professional problems facing prison psychologists are (a) ethical issues (e.g., confidentiality, informed consent, and whether their clients are the prison staff or the prisoners; (b) restrictions on communication with professional colleagues; (c) lack of a recognized training course; (d) their status as specialist advisers rather than as part of the management structure; and (e) their lack of influence on governmental committees dealing with penal policy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inmate Perceptions of Mental Health Services.

With the increasing rise in the U.S. prison population, meeting the mental health needs of inmates before, during, and after incarceration remains an obstacle. What are the mental health experiences of inmates? For what types of problems are inmates willing to seek help, and what are the barriers to their service utilization? This study investigated inmates' attitudes and perceptions toward mental health services and examined whether these attitudes and perceptions vary with respect to ethnic group membership or among inmates of differing security levels. Implications of these findings for psychologists, including psychologists not employed in correctional settings, are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder following political imprisonment: The role of mental defeat, alienation, and perceived permanent change.

An interview study of 81 former political prisoners investigated whether posttraumatic stress disorder (PTSD) is related to the way individuals process the prison experience. In contrast to participants without PTSD, those with chronic or remitted PTSD were more likely to perceive mental defeat and an overall feeling of alienation from other people. Chronic PTSD was also related to perceived negative and permanent change in their personalities or life aspirations. The groups did not differ in their attempts to gain control during imprisonment. Evidence for a relationship between political commitment and PTSD was mixed. The results suggest that mental defeat, alienation, and permanent change are related to PTSD after interpersonal trauma and may need to be addressed in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive factors of Mycobacterium tuberculosis infection and pulmonary tuberculosis in prisoners

BACKGROUND: Tuberculosis currently represents a serious problem in prison populations. METHODS: With the aim of studying the predictive factors for, and the prevalence of, Mycobacterium tuberculosis infection and pulmonary tuberculosis in a Spanish prison, all those admitted during 1991 and 1992 were included (N = 1314). The tuberculin skin test, HIV serology, chest X-ray and bacteriological examination of sputum were carried out. Statistical analysis was done by univariant tests, stratified analysis and logistic regression. RESULTS: The prevalence of M. tuberculosis infection was 55.5% (95% confidence interval [CI] 52.5-58.5). An association was found with sex, imprisonment more than once, HIV infection and age. The co-infection rate (tuberculosis plus HIV) was 9.2%. Logistic regression showed a greater risk with age (4.4% per year), time spent in prison and for males. The prevalence of pulmonary tuberculosis was 1.26% and an association was found with M. tuberculosis infection, HIV infection (odds ratio [OR] = 13.7), intravenous drug users (OR = 17.2) and imprisonment more than once (OR = 7.3). Logistic regression showed an association with HIV co-infection (OR = 20.2). CONCLUSIONS: The prevalence of M. tuberculosis infection and pulmonary tuberculosis is high when compared with similar studies. The influence of age, time spent in prison and co-infection with HIV is relevant to recommendations for specific tuberculosis prevention programmes in correctional facilities.     

The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans.

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD, depression, and substance use disorders independently predicted health status over time among OEF/OIF veterans. Information regarding psychiatric and medical conditions and health care utilization was culled for 4,463 OEF/OIF veterans enrolled in Veterans Administration primary care for a period of 6 years. Data were analyzed using multilevel modeling and generalized estimating equations. Results suggest that PTSD, depression, and substance use disorders are independently associated with increased medical disease burden and mental health care utilization but not increased medical health care utilization. The association between PTSD and medical disease burden strengthened over time. These data suggest that OEF/OIF veterans with PTSD may be at risk for increasingly poorer physical health in terms of medical disease burden over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High rates of drug use, but low rates of HIV risk behaviours among injecting drug users during incarceration in Dutch prisons

AIMS: To determine levels of injecting drug use and sexual risk behaviours in injecting drug users during and immediately following imprisonment in The Netherlands. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of drug injectors attending methadone clinics, a sexually transmitted disease clinic and a central research site in Amsterdam. The mean age of the 188 participants was 35 years, 78% were male and 34% had HIV antibodies. MEASUREMENTS: Self-reported drug use and sexual behaviours during the last period of imprisonment in Dutch prisons within the previous 3 years and injecting drug use in the week following release from prison. FINDINGS: A period of imprisonment in the preceding 3 years was reported by 188 (41%) of 463 interviewed drug injectors. The mean duration of last imprisonment was 3.6 months. Any use of cannabis, heroin or cocaine during imprisonment was reported by 55%, 37% and 20%, respectively. Five injectors (3%) admitted to having injected in prison, but no sharing of needles and syringes was reported. Vaginal or anal sex was reported by two (1%) of the men and none of the women. Relapse to drug injecting during the week following release from prison was reported by 78/186 (42%) participants, in most cases (34%) at the very first day of release. Drug use behaviours during imprisonment were similar for those who were designated current injectors at the time of imprisonment and those who were not, but injecting in the first week following release from prison was far higher among 'current' injectors (63%) than among those who were not (11%). CONCLUSIONS: Contrary to findings from other countries, low levels of HIV risk behaviours occur among imprisoned drug injectors in The Netherlands. Intra-prison HIV preventive measures should be considered taking into account the nationally, regionally or locally varying conditions within the existing prisons.     

Personal, medical, and healthcare utilization among homeless veterans served by metropolitan and nonmetropolitan veteran facilities.

This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of prior and current alcohol use on use of services by patients with depression and chronic medical illnesses

OBJECTIVE: Alcohol use often co-occurs with other major chronic conditions, but its effect on health care utilization in this context is not understood. This study examines the impact of alcohol consumption on health care use by patients with chronic medical conditions or depression, or both. DATA SOURCES/STUDY SETTING: Data came from the Medical Outcomes Study, an observational study of patients from the offices of general medical providers and mental health specialists in three U.S. cities. STUDY DESIGN: Longitudinal data spanning four years for outpatient general medical visits and outpatient mental health visits were analyzed using a two-part model to assess the impact of alcohol use disorder, problem drinking, and current and past alcohol consumption on health care use by patients, controlling for patient demographics and health status. DATA COLLECTION/EXTRACTION METHODS: Data were collected from 2,546 adult patients with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), and/or current major depression or subthreshold depression using periodic, self-report surveys detailing health care utilization and health status information. PRINCIPAL FINDINGS: Current alcohol consumption increases outpatient doctor visits, and problems related to current drinking decrease outpatient mental health visits. CONCLUSIONS: Patterns of alcohol consumption have an impact on both mental health and overall health care use by patients with chronic medical conditions or depression.