Health status and access to health services of female prisoners in Greece: a cross-sectional survey

The Alonissos Study: Cross-Sectional Study of the Healthcare Access and User Satisfaction in the Community of a Non-Profit-Line Greek Island

Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.

Prevalence of Mental Health Needs, Substance Use, and Co-occurring Disorders Among People Admitted to Prison

OBJECTIVE

People who are incarcerated experience social exclusion and have higher rates of mental and substance use disorders than the general population. Prisons are not suitable for treating mental illness, and understanding how the profile of prison populations changes provides essential information for correctional service planning. This study examined changes in the prevalence of mental and substance use disorders among people admitted to provincial prisons in British Columbia (BC), Canada.

METHODS

The study included all people admitted to any of the 10 provincial prisons in BC from 2009 through 2017 (N=47,117). Using the Jail Screening Assessment Tool, a validated intake screening tool designed for rapid identification of mental health needs, the authors calculated the period prevalence (by calendar year) of mental health needs, substance use disorders, and drug use.

RESULTS

The proportion of people with co-occurring mental health needs and substance use disorders increased markedly per year, from 15% in 2009 to 32% in 2017. Prevalence of methamphetamine use disorder increased nearly fivefold, from 6% to 29%, and heroin use disorder increased from 11% to 26%. The proportion of people with any mental health need and/or substance use disorder increased from 61% to 75%.

CONCLUSION

The clinical profile of people admitted to BC prisons has changed, with dramatic increases in the proportion of people with co-occurring disorders and reported methamphetamine use. More treatment and efforts to address social and structural inequities for people with complex clinical profiles are required in the community to reduce incarceration among people with multifaceted and complex mental health care needs.

Tobacco Use Among People Incarcerated in Western Europe: A Systematic Review and Meta-analysis

Background

Evidence suggests that the prevalence of tobacco use has declined significantly in the general population but still remains high among people incarcerated in high-income countries. Tobacco use is the second leading risk factor of mortality and morbidity worldwide. The objective of this study is to synthesize evidence on the prevalence of smoking among people incarcerated in Western European countries.

Methods

We searched the PubMed database for articles published between June 2010 and June 2020, website of international organizations and hand-searching references. One author reviewed studies that met pre-defined inclusion criteria, and this was cross-validated by a second reviewer, following the MOOSE guidelines. The Meta prop command of Stata (V16) was used for pooling smoking prevalence estimates. Random effects modelling, heterogeneity with subgroup analysis and publication bias was assessed.

Results

Out the 236 identified articles, 25 with full texts were eligible, and 16 were finally included in this study. The overall pooled estimate of smoking prevalence was 72.3%, 95% CI (54.8–84.7), and high heterogeneity (I2 = 99.73%). Females had a pooled prevalence 44.1% (95% CI 9.4–82.6) while males 83.3% (95% CI 72.0–92.1). The total number of prisoners combined in this study was 16,435 (ranging from 31-21,451) with age ranging from 24-43 years.

Conclusion

A relatively high smoking rate was observed among incarcerated people - higher among the male population. The study findings are useful for informing policy-makers of the existing burden of smoking in special vulnerable populations across Western Europe-and the need for comprehensive tobacco control policies in different population settings.

Assessment of Satisfaction with Health Services among Prisoners—Descriptive Study

Aim: The aim of the study was to assess the access of prisoners to healthcare services, as well as the level of satisfaction with the provided services and health assessment among prisoners. Methods: The research was conducted in one of the penitentiary centers in Poland among people jailed between 1 January to 31 January 2020. The response rate of the self-administrated questionnaire was 52.05% (469/901) participants. There were 389 men and 77 women. Results: Prisoners assessed access to health services including GP doctors, specialist doctors, dentists, and hospitals in 3 categories: “bad” ranged: 27.03–67.60%; “medium” ranged: 22.54–53.57%; “good” ranged: 7.02–33.96% depending on the type of arrest, but no statistical significance was demonstrated. Satisfaction with the health services defined as “bad” ranged: 25.00–61.11%; “medium” ranged: 18.97–55.56%; “good” ranged: 5.56–34.62% depending on the type of arrest but no statistical significance was demonstrated. Of 469 prisoners, 215 prisoners (45.84%) declared no addictions. The frequency of addiction does not differ depending on the place/type of punishment served (p = 0.9). In turn, 317 prisoners (68%) declared no chronic diseases. Conclusions: Most of the prisoners described access to health services as “bad”, except female prisoners from a semi-open facility. In turn, satisfaction with healthcare services was most often assessed as “bad”, except for temporarily arrested men and female prisoners from a semi-open facility.

Risk for impaired cardiovascular function nursing diagnosis: Content analysis to evaluate women in jail

OBJECTIVE

To analyze the content of the diagnostic proposal, risk for impaired cardiovascular function, focusing on incarcerated women.

METHODS

A methodological study of nursing diagnosis content validation carried out from December/2018 to June/2019. A sample of 24 judges evaluated the proposed definition and the relevance of the proposed etiological factors of risk for impaired cardiovascular function. To determine the content validity of the etiological factors, the Content Validity Index was calculated and a value of 0.9 was adopted, in addition to the Wilcoxon test.

RESULTS

The diagnostic definition was considered consistent with the diagnostic label. All 18 etiological factors were validated with a Content Validity Index statistically >0.9 and categorized into risk factors, associated conditions, and at-risk populations.

CONCLUSION

The definition and 18 etiological factors of risk for impaired cardiovascular function were validated.

IMPLICATIONS FOR THE NURSING PRACTICE

The study allowed the new proposal for the risk for impaired cardiovascular function nursing diagnosis to be accepted to return to the taxonomy of NANDA International with an expanded and more consistent structure. The return of the referred nursing diagnosis to the taxonomy favors the nurse's diagnostic reasoning and the documentation of all nursing actions, linked to this diagnosis, which are aimed at minimizing cardiovascular risk.

Diseases and access to treatment by the Peruvian prison population: an analysis according to gender

Objective

In Peru, prisons are spaces with overcrowding, deteriorated infrastructure, poor sanitary conditions and difficult access to medical treatment. The objective of this study is to estimate the burden of disease and access to treatment for different morbidities in the Peruvian inmate population.

Methods

An analysis of secondary data of the First National Penitentiary Census (PCNP) 2016 in Peru was carried out. The absolute frequencies and percentages of each self-reported health condition, the presence of a diagnosis of a disease before entering the prison system and access to treatment were obtained.

Results

74,130 inmates were included in the analysis. The most common diseases in prisons are depression (9.6%), anxiety (8.6%), chronic lung disease (8.4%) and arterial hypertension (6.9%). All diseases included, with the exception of hepatitis, have a diagnostic before the incarceration of less than 60%. Access to medical treatment was higher in women than in men and in general, mental health illnesses had low access to medical treatment.

Conclusions

Chronic and infectious diseases are frequent in those deprived of liberty, with mental health problems being more prevalent in women. In general, access to treatment is low, especially in men and for mental health illnesses. This situation reflects the need to develop intervention programs that promote health and increase the universality of health care in those deprived of liberty.

Cardiovascular risk factors in people deprived of their liberty: an integrative review

ABSTRACT Objective: To investigate the scientific evidence on the most frequent risk factors for cardiovascular disease in persons deprived of their liberty. Methods: An integrative literature review carried out in the CINAHL, Medline/Pubmed, Scopus, LILACS, CUIDEN, Web of Science and Virtual Health Library portal databases using the following keywords: cardiovascular diseases, risk factors, prisons, prisoners. Results: The final sample consisted of 17 primary articles published in English and Spanish. Overweight and obesity were the most cited cardiovascular risk factors besides diabetes, hypertension, smoking, dyslipidemia, consumption of alcohol and other drugs, physical inactivity, metabolic syndrome, anxiety, depression and unhealthy heart diet. Conclusions: The most frequent risk factors for cardiovascular disease in persons deprived of their liberty were those classified as modifiable. In the prison setting, these factors are enhanced due to an environment with little modification of these opportunities.

Comparison of access to health services among urban-to-urban and rural-to-urban older migrants, and urban and rural older permanent residents in Zhejiang Province, China: a cross-sectional survey

BACKGROUND

While much literature reported the access of Chinese older migrants to health services, little was known about the differences among sub-groups of older adults, including urban-to-urban and rural-to-urban migrants, and urban and rural permanent residents. This study aimed to examine the access of these four groups to health services in Zhejiang Province, China and provide an evidence for the development of health services policies.

METHODS

A cross-sectional survey was conducted in community-dwelling older adults (aged 60 years or above) in 2013. Participants were recruited by random sampling. Demographic information and access to health services for the elderly populations were obtained via interviews using a self-designed structured questionnaire. Pearson's chi-square tests and Cochran-Mantel-Haenszel (CMH) tests were performed to examine the differences in access to health services among the four groups. Binary logistic regression was conducted to explore the associations of participants' visits to doctors with their group status after controlling confounding factors.

RESULTS

The two-week hospital visiting rates were significantly lower in migrants (55.56% in rural-to-urban and 62.50% in urban-to-urban) than that in urban and rural permanent residents (67.40 and 82.25%, respectively; p < 0.01). The majority of older adults who received a diagnosis indicating need for hospital treatment accepted the treatment, with no significant difference among the four groups after controlling for health service need (χ2 = 7.08, p = 0.07). On the other hand, 30.05% of the older adults did not visit a doctor when they got ailments in the past 2 weeks prior to the survey, and 16.42% (33/201) did not receive hospital treatment after receiving a diagnosis indicating need for hospital treatment. Factors including age, marital status, educational attainment, major financial source, and living with family members did not influence health services use.

CONCLUSIONS

Targeted social and health policies integrating the strengths of government, society and families should be implemented to further improve health services use for different groups of older adults.

Risk factors associated with drug use before imprisonment in Peru

OBJECTIVE

To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru.

MATERIALS AND METHODS

A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use.

RESULTS

Out of a population of 76,180 prisoners, 71,184 (93.4%) answered the survey (men 67,071, 94.2%). The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women), the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women). The most commonly used drugs were marijuana (58.2%), coca paste/cocaine or crack (40.3%) and inhalants (1%). The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%), history of previous imprisonment (59.1%), unemployment (48.4%), relationships at school with classmates who had problems with the law (46.9%), background of a family member who attended a penitentiary (38.4%), and history of running away from home before age 15 (35.9%).

CONCLUSIONS

In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is important to consider these in the design of social and health policies focused on specific subpopulations to prevent drug use and crime.

Epidemiology and Treatment of Hepatitis B in Prisoners

PURPOSE OF REVIEW

The review details recent literature reports regarding Hepatitis B Virus (HBV) and, in particular, Hepatitis B prevalence/incidence in incarcerated populations around the world. Furthermore, the review will summarize the national/international guidelines regarding HBV and look at diagnosis, vaccination, treatment, and linkage to care after release.

RECENT FINDINGS

HBV affects prisoners at a much higher rate than the general populations. Many who are at increased risk for HBV infection are also at increased risk for incarceration. Incarcerated settings also have higher rates of HBV transmission.

SUMMARY

Incarcerated individuals should be immunized if they are not already immune to HBV. Increased access to safe injecting and tattoo paraphernalia, condoms, and personal hygiene equipment could reduce the spread of HBV and other blood-borne and sexually transmitted infections. Future research should focus on ways to prevent the spread of HBV and similar viruses in incarcerated settings in order to protect incarcerated individuals and the general public. Research on effective linkage to community HBV care following release is needed.