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Dichtl A, Jamin D, Stöver H, Grabski M, Knorr B. [Hepatitis C in prisons : Treatment and barriers to the elimination goals of the United Nations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:36-44. [PMID: 38155308 PMCID: PMC10776704 DOI: 10.1007/s00103-023-03808-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite general advances in the treatment of people with hepatitis C in Germany, it is unclear to what extent this also applies to specific key populations, such as prisoners. METHODS In a short survey conducted in June 2021, the ministries of justice in the federal states were asked about data collection and diagnostic methods as well as the prevalence of infections caused by the hepatitis C virus (HCV) and HCV treatment among prisoners in Germany. In addition, expert interviews were conducted regarding HCV treatment barriers and missed opportunities in prisons. RESULTS It is evident that there is no complete and comprehensive data collection within the ministries of justice. Prevention measures, such as opiate substitution therapy in prison, are available in all participating federal states. More specific offers and measures (e.g., razor and syringe exchange) are only found in a few cases and are sometimes subject to a charge. Experts point out that although treatment in prison generally complies with the equivalence principle: it is more difficult to reach the target group. CONCLUSIONS Comprehensive education and counselling on HCV treatment, consistent HCV testing and treatment, and preventive measures to avoid (re-)infection are important for successful HCV elimination in prisons.
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Affiliation(s)
- Anna Dichtl
- Institut für Suchtforschung, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland
| | - Daniela Jamin
- Institut für Suchtforschung, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland
| | - Heino Stöver
- Institut für Suchtforschung, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland
| | - Meryem Grabski
- Institut für Suchtforschung, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland.
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Nóvoa-Lôbo NMD, Campos MR, Pires DC. [Tuberculosis in the Brazilian prison system: scenarios via Joinpoint, from 2007 to 2019]. CAD SAUDE PUBLICA 2023; 39:e00166722. [PMID: 37792817 PMCID: PMC10552813 DOI: 10.1590/0102-311xpt166722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 10/06/2023] Open
Abstract
This study describes and compares tuberculosis (TB) data among persons deprived of liberty and the general Brazilian population, from 2007 to 2019, using the Joinpoint tool to observe changes in trends. This study focuses on women and older adults, for HIV testing, and on the number of detainees according to prison capacity. This is a retrospective, quantitative, and analytical study, which uses methods of regression of time series data from secondary data of unrestricted access collected from the Brazilian Information System for Notifiable Diseases (SINAN), Brazilian Institute of Geography and Statistics (IBGE), and from analytical reports made available by the Brazilian National Penitentiary Department (DEPEN). The results show a considerably higher increase in the prevalence of TB in persons deprived of liberty in all perspectives analyzed; increased HIV testing; and a debatable trend of stability in the number of detainees according to prison capacity. When analyzing trends in prevalence, services, and determinants, it is curious to see the temporal non-coincidence in most cases. Clearly, national policies against TB do not have the same effect within prisons and even the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP) showed restricted effects in view of the health situation herein analyzed. Despite working with secondary data of variable reliability, comparisons were reached that can impact health decisions and actions. Although lacking complete and definitive answers, it was possible to launch a new point-of-view on the evolution of questions for which reflection is essential.
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Affiliation(s)
| | - Mônica Rodrigues Campos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de janeiro, Brasil
| | - Débora Castanheira Pires
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Colombo MG, Joos S, Koch R. Implementing interprofessional video consultations with general practitioners and psychiatrists in correctional facilities in Germany: results from a mixed-methods study. BMC Health Serv Res 2023; 23:578. [PMID: 37277811 DOI: 10.1186/s12913-023-09592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Adequate health care in correctional facilities is often limited by staff shortage, which entails time-consuming consultations with physicians outside of these facilities. Video consultations (VC) have been implemented in many different health care settings and may also be useful in correctional facilities. As part of a pilot project, synchronous VC were implemented in five correctional facilities in Germany in June 2018. The aim of this study was to describe the implementation process from the providers' perspective and to identify factors promoting or inhibiting the implementation process of VC with a focus on interprofessional collaboration between nursing staff and telemedicine physicians. METHODS As part of the mixed-methods evaluation of the pilot project, site visits to the five correctional facilities were carried out. Nursing staff from the five correctional facilities (n=49) and telemedicine physicians (n=10) were asked to participate in interviews and a questionnaire survey. Interviews were analyzed using qualitative content analysis and questionnaires were evaluated using descriptive statistical methods. The results from both data sources were integrated and discussed in the framework of Normalization Process Theory. RESULTS Interviews were conducted with 24.5% (n=12) of nursing staff and 20.0% (n=2) of telemedicine physicians, while questionnaires were returned by 22.5% (n=11) of nursing staff and 33.3% (n=3) of telemedicine physicians. VC with general practitioners and psychiatrists were perceived as an additional support during times when physicians were absent from the correctional facilities. Allocating telemedicine physicians to specific correctional facilities might further improve interprofessional collaboration with nursing staff during VC. Inhibiting factors comprised the lack of integrating nursing staff into the implementation process, increased workload, insufficient training and the implementation of VC at an inconvenient time. CONCLUSIONS To summarize, VC are a promising supplement to face-to-face health care in correctional facilities despite several limitations. These might be compensated by improving interprofessional cooperation and by integrating telemedicine physicians into local health care teams.
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Affiliation(s)
- Miriam Giovanna Colombo
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany.
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany
| | - Roland Koch
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany
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Stöver H, Dichtl A, Schäffer D, Grabski M. HIV and HCV among drug users and people living in prisons in Germany 2022: WHO elimination targets as reflected in practice. Harm Reduct J 2023; 20:50. [PMID: 37055763 PMCID: PMC10100628 DOI: 10.1186/s12954-023-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/20/2023] [Indexed: 04/15/2023] Open
Abstract
People who inject drugs (PWID) and prisoners are considered key populations at risk for human immunodeficiency virus (HIV) and/or Hepatitis C Virus (HCV). In 2016, the Joint United Nations Program on HIV/AIDS (UNAIDS) was implemented to eliminate HIV and AIDS by 2030 and the World Health Organization (WHO) presented the first strategy to eliminate viral hepatitis by 2030 as well. Following the objectives of the WHO and the United Nations, the German Federal Ministry of Health (BMG) presented the first integrated overall strategy for HIV and HCV in 2017. This article discusses the situation of PWID and prisoners in Germany with regard to HIV and HCV five years after the adoption of this strategy, on the basis of available data and against the background of the most recent practice in the field. In order to meet the elimination goals by 2030, Germany will have to improve the situation of PWID and prisoners substantially, mainly through the implementation of evidence-based harm reduction measures as well as the promotion of diagnosis and treatment in prisons and in freedom.
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Affiliation(s)
- H Stöver
- Institute of Addiction Research, Health and Social Work, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Germany.
| | - A Dichtl
- Institute of Addiction Research, Health and Social Work, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Germany
| | | | - M Grabski
- Institute of Addiction Research, Health and Social Work, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Germany
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SeyedAlinaghi S, Pashaei Z, Rahimi E, Saeidi S, Mirzapour P, Noori T, Ghasemzadeh A, Afzalian A, Dashti M, Habibi P, Farhoudi B, Aghaie N, Shamsabadi A, Dadras O, Mehraeen E. Prevalence of sexually transmitted infections and associated risk behaviors in prisoners: A systematic review. Health Sci Rep 2022; 5:e819. [PMID: 36177400 PMCID: PMC9478043 DOI: 10.1002/hsr2.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Aims Sexually transmitted infections (STIs) are one of the major health concerns globally. Generally, prisoners are at higher risks for STIs due to risk factors including; drug‐use, high‐risk sexual behaviors, densely populated prisons, and poor living conditions. Therefore, we aimed to conduct a systematic review to evaluate the existing data on STI prevalence, and its associated risk factors among prisoners. Methods We conducted a systematic search of the literature using the keywords in Scopus, PubMed, Web of Science, and Google Scholar online databases. We selected all the relevant original studies in English through title/abstract and full‐text screening process. Results Based on the inclusion and exclusion criteria, we selected and reviewed 32 studies out of 96 identified papers. The most important STI‐associated risk factors among prisoners were drug use, low educational levels, and unsafe sex. The prevalence of STIs was heterogenous in selected studies and was reported as follows; Human Immunodeficiency Virus (HIV) (0%−14.5%), hepatitis B viruses (HBV) (0.04%−27.23%), hepatitis C viruses (HCV) (0.17%−49.7%), Syphilis (0.2%−22.1%), Chlamydia Trachomatis (CT) (1.02%−6.7%), Gonorrhea (0.6%−7.8%), and herpes simplex virus‐2 (HSV‐2) 22.4%. Conclusion This systematic review indicates that the prevalence of STIs (HIV, HBV, HCV, Syphilis, Chlamydia Trachomatis, Gonorrhea, and HSV‐2) among prisoners appears to be higher than the general population, with drug abuse, low educational levels, and unsafe sex as major risk factors.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Zahra Pashaei
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Ensiyeh Rahimi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Solmaz Saeidi
- Department of Nursing Khalkhal University of Medical Sciences Khalkhal Iran
| | - Pegah Mirzapour
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Tayebeh Noori
- Department of Health Information Technology Zabol University of Medical Sciences Zabol Iran
| | | | - Arian Afzalian
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Mohsen Dashti
- Department of Radiology Tabriz University of Medical Sciences Tabriz Iran
| | - Pedram Habibi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
| | - Behnam Farhoudi
- Social Determinants of Health Research Center, Amiralmomenin Hospital, Tehran Medical Sciences Islamic Azad University Tehran Iran
| | - Narjes Aghaie
- School of Nursing and Midwifery Tehran University of Medical Sciences Tehran Iran
| | - Ahmadreza Shamsabadi
- Department of Health Information Technology Esfarayen Faculty of Medical Sciences Esfarayen Iran
| | - Omid Dadras
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High‐Risk Behaviors Tehran University of Medical Sciences Tehran Iran
- Department of Global Public Health and Primary care University of Bergen Bergen Norway
| | - Esmaeil Mehraeen
- Department of Health Information Technology Khalkhal University of Medical Sciences Khalkhal Iran
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von Bernuth K, Seidel P, Krebs J, Lehmann M, Neumann B, Konrad N, Opitz-Welke A. Prevalence of Opioid Dependence and Opioid Agonist Treatment in the Berlin Custodial Setting: A Cross-Sectional Study. Front Psychiatry 2020; 11:794. [PMID: 32903474 PMCID: PMC7435061 DOI: 10.3389/fpsyt.2020.00794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT. MATERIALS AND METHODS We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention. RESULTS Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%. CONCLUSIONS The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates.
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Affiliation(s)
- Kira von Bernuth
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Seidel
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Julia Krebs
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany
| | - Marc Lehmann
- Prison Hospital Berlin, Plötzensee Prison, Berlin, Germany
| | - Britta Neumann
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Norbert Konrad
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Stöver H, Jamin D, Michels II, Knorr B, Keppler K, Deimel D. Opioid substitution therapy for people living in German prisons-inequality compared with civic sector. Harm Reduct J 2019; 16:72. [PMID: 31864356 PMCID: PMC6925451 DOI: 10.1186/s12954-019-0340-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago. Studies have shown that substitution therapies are best suited to treat opioid use disorder and reduce the risk of HIV and hepatitis C transmission and overdose. However, huge health inequalities exist in and outside of prison due to the different implementation of opioid substitution therapy (OST). People living in prisons are entitled to the best possible health care. This is established by the Universal Declaration of Human Rights and by the International Convention on Economic, Social and Cultural Rights. Solely the imprisonment, and not the loss of fundamental human rights, constitutes the punishment. METHODS A qualitative literature search using PubMed and Google Scholar was performed in order to identify relevant publications. RESULTS This review shows the inequality in availability of opioid substitution therapy for people living in prison compared with people outside of prison in Germany. It also gives possible reasons and evidence for this inequality, showing that continuing or initiating OST in prison is more beneficial for the health of people living in prison than abstinence-oriented treatment only. CONCLUSION It is important that drug use disorder is treated as a serious illness also in prison. Joint efforts are needed to provide people living in prison with the best possible treatment and to minimize the adverse effects of drug use. Therefore, with laws, policies, and programs that conform to international human rights standards, each state must ensure that people living in prison receive the same health care as people outside of prison.
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Affiliation(s)
- Heino Stöver
- Fachbereich 4: Soziale Arbeit und Gesundheit, Faculty “Health and Social Work”, Institute for Addiction Research, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt, Germany
| | - Daniela Jamin
- Fachbereich 4: Soziale Arbeit und Gesundheit, Faculty “Health and Social Work”, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt, Germany
| | - Ingo Ilja Michels
- Fachbereich 4: Soziale Arbeit und Gesundheit, Faculty “Health and Social Work”, Institute for Addiction Research, Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt, Germany
| | - Bärbel Knorr
- Deutsche AIDS-Hilfe, Wilhelmstr. 138, 10963 Berlin, Germany
| | | | - Daniel Deimel
- Department Aachen, German Institute of Addiction and Prevention Research, Catholic University of Applied Science North Rhine-Westphalia, Robert-Schumann-Str. 25, 52044 Aachen, Germany
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Opitz-Welke A, Lehmann M, Seidel P, Konrad N. Medicine in the Penal System. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:808-814. [PMID: 30642429 DOI: 10.3238/arztebl.2018.0808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 02/12/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infectious diseases, substance dependencies, and dental diseases are the most important health problems affecting incarcerated persons. In Germany, for example, prisoners are 48 to 69 times more likely to be infected with the hepatitis C virus (HCV) than the general population, and 7 to 12 times more likely to be infected with the human immunodeficiency virus (HIV). The prevalence of mental illnesses is also markedly higher in the incarcerated than in the general population. METHODS This review is based on pertinent publications retrieved by a selective search in two databases (PubMed and Google Scholar) for any of the terms "health care," "primary health care," "mental health care"; "infectious disease," "opioid maintenance treatment," and "severe mental disorder" in conjunction with "prison," "jail," "detention," and "incarceration." RESULTS Among prisoners in German prisons, approximately 20% consume heroin, 20-50% suffer from alcohol dependency and abuse, and 70-85% smoke. The prevalence of tuberculosis in German prisons in 2002 was 0.1%. The provision of needles to incarcerated persons has a preventive effect on infection with hepatitis C, hepatitis B, and HIV, yet programs of this type have been discontinued in most penal facilities. In a systematic review, psychotic disorders were found in 3.6% (95% confidence interval [CI]: [3.1; 4.2]) of male inmates and 3.9% [95% CI: 2.7; 5.0] of female inmates. 25% of incarcerated persons suffer from attention-deficit-hyperac- tivity disorder. Persons recently released from prison have an above average mortality, largely due to drug intoxication. CONCLUSION An analysis of medical prescribing data reveals deficiencies in the provision of HCV treatment to all affected persons and in the provision of substitution treatment to persons with opiate dependency. In view of the known risks associated with imprisonment, greater emphasis should be placed on the provision of treatment for infectious diseases, substance dependencies, and mental illness, both in prison and in outpatient care after release.
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Affiliation(s)
- Annette Opitz-Welke
- Prison Hospital Berlin, JVA Plötzensee, Berlin; Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin
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