Smoke-free prisons in England: indoor air quality before and after implementation of a comprehensive smoke-free policy.

OBJECTIVES: High levels of particulate pollution due to secondhand smoke (SHS) have previously been recorded in English prisons. As part of an evaluation to ascertain whether a new comprehensive smoke-free policy introduced in the first four prisons in England was successfully implemented, this study compares indoor air quality on prison wing landing locations three months before and three months after going smoke-free. DESIGN: An indoor air quality monitoring study, comparing SHS levels before and after a comprehensive smoke-free prison policy. SETTING: The first four prisons in England to implement a comprehensive smoke-free policy. PRIMARY AND SECONDARY MEASURES: We compared concentrations of airborne particulate matter <2.5 microns in diameter (PM2.5), as a marker for SHS, on wing landing locations three months before and three months after the smoke-free policy was implemented. Static battery operated aerosol monitors were used to sample concentrations of PM2.5 on wing landings. RESULTS: After discarding data from monitors that had been tampered with we were able to analyse paired data across four prisons from 74 locations, across 29 wing landing locations, for an average sampling time of five hours and eight minutes. When comparing samples taken three months before with the paired samples taken three months after policy implementation (paired for prison, day of the week, time of day, wing location and position of monitor), there was a 66% reduction in mean PM2.5 concentrations across the four prisons sampled, from 39 to 13 µg/m³ (difference 26 µg/m³, 95% CI 25 to 26 µg/m³). CONCLUSION: Prison smoke-free policies achieve significant improvements in indoor air quality. A national smoke-free policy would therefore be an effective means of protecting prisoners and staff from harm due to SHS exposure in the prison environment.

Assistência à saúde das pessoas privadas de liberdade provisória: análise da efetividade do plano nacional de saúde do sistema penitenciário / Health assistance for imprisoned people: analysis of the effectiveness of the national health plan for the penitentiary system

O Brasil apresenta a terceira maior população carcerária do mundo com 726.712 pessoas encarceradas. Verifica-se um déficit de 358.663 vagas no sistema prisional. A Constituição Brasileira de 1988 garante o direito à saúde as pessoas privadas de liberdade. Como estratégia para efetivar ações de saúde no âmbito prisional, em 2003, foi instituído o Plano Nacional de Saúde do Sistema Penitenciário no SUS. Durante 10 anos a sua execução buscou garantir cuidado de saúde à população carcerária. Trata-se de uma pesquisa qualitativa, do tipo descritiva e exploratória. O objetivo principal foi compreender a assistência à saúde das pessoas residentes no CDP, na cidade de Pau dos Ferros/RN/Brasil. Participaram da pesquisa profissionais de saúde (n=4) e da justiça (n=9). Como instrumento de coleta de dados utilizou-se a entrevista semiestruturada, que após transcrição foram analisadas e interpretadas pelo método da Análise Temática. Ao final, quatro categorias emergiram: Conhecimento dos Trabalhadores da Saúde e da Justiça sobre a garantia da Saúde no Sistema Prisional. As ações de saúde realizadas para atender as necessidades e problemas das pessoas privadas de liberdade. O diálogo entre as instituições de saúde e da justiça no sentido de garantir o direito à saúde. A efetivação do direito à saúde no sistema prisional: limites e possibilidades. O estudo demonstrou o quanto é carente a assistência em saúde aos homens em situação de detenção provisória e, como é cogente a aplicação na prática dos princípios do SUS, somente assim, há de se conquistar a quimera que é o diálogo entre a saúde e a justiça para a real operacionalização da Política Nacional de Atenção Integral da Saúde Prisional, resultando assim numa melhoria da situação de saúde vivenciada no sistema prisional.

Brazil has the third largest prison population in the world with 726,712 people incarcerated. There is a deficit of 358,663 places in the prison system. The Brazilian 1988 Federal Constitution guarantees the right to health to persons deprived of their freedom. As a strategy to implement health actions in prison, in 2003, the National Health Plan of the Penitentiary System in the Single Health System was established. For 10 years, its execution sought to guarantee health care to the imprisoned population. This study presents a descriptive, exploratory qualitative research, where the main objective was to understand the health care provided to people living in CDP, in the city of Pau dos Ferros in the state of Rio Grande do Norte, Brazil. Health professionals (n = 4) and justice professionals (n = 9) participated in the research. A semi-structured interview was used as a data collection instrument, which, after transcription, was analyzed and interpreted by the Thematic Analysis method. In the end, four categories emerged: Knowledge of Health and Justice Professionals about Health Care in the Prison System. Health actions taken to address the needs and problems of persons deprived of their freedom. Dialogue between health and justice institutions in order to guarantee the right to health. The right to health accomplishment in the prison system: limits and possibilities. The study demonstrated the lack of health care for men in custody and, as the practical application of the SUS principles is required, it is the only way to conquer the chimera that is the dialogue between health and justice for the real operationalization of the National Policy of Integral Prison Health Care resulting in an improvement of the health situation experienced within the prison system.

Constituents of "teabacco": A forensic analysis of cigarettes made from diverted nicotine replacement therapy lozenges in smoke-free prisons.

Following the implementation of prison smoke-free policies, there have been reports of prisoners creating substitute cigarettes made from nicotine replacement therapy patches or lozenges infused with tea leaves ("teabacco"). No studies have analyzed the chemical constituents of teabacco made from nicotine lozenges, so as to document any potential related health hazards. Teabacco samples were made by a participant who reported creating teabacco while incarcerated in a smoke-free prison in Queensland, Australia, and the process was video-recorded for replication in a laboratory. A simple linear smoking system captured the teabacco smoke for analysis. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was used to analyze elemental composition and gas chromatography coupled with a mass spectrometer (GC-MS) analyzed the captured smoke using the National Institute of Standards and Technology mass spectral library. Analyses determined that quantities of copper, aluminum, and lead concentrations, and levels of inhaled total particulate matter, were above recommended guidelines for safe ingestion. Analysis of teabacco smoke using GC-MS identified potentially toxic compounds catechol and nicotine. However, our findings show that smoking this form of teabacco is less harmful than smoking teabacco made from nicotine patches, or smoking traditional tobacco cigarettes. Considering the limited potential health harm of smoking teabacco made from lozenges, and that nicotine lozenges represent the only form of smoking cessation support for individuals entering smoke-free prisons, we caution against the removal of nicotine lozenges from Queensland's prisons, at least until further research directly establishes health harms associated with this form of teabacco.

La morte in carcere conseguente all'inalazione di gas: la responsabilità dello psichiatra.

In ambito penitenziario il suicidio e l'autolesionismo rappresentano quasi una caratteristica strutturale, rendendo la prevenzione un obiettivo primario. L'Amministrazione penitenziaria ha emanato in materia di prevenzione del suicidio un ampio spettro di provvedimenti. Il presente studio prende in esame la misura attualmente vigente in alcuni istituti di valutare i detenuti autorizzati all'utilizzo dello strumentario a gas, con monitoraggio delle condotte, da parte dello psichiatra.

Adolescent arrestees detained in police cells: an observational study in the Paris, France, area.

OBJECTIVE: Custody conditions in police cells are often demeaning and considered inappropriate for human beings. The detention of young adolescents in police custody has received little attention. Our study aimed to describe the characteristics of adolescents under 18 detained in custody. METHODS: We studied all arrestees aged 13-17 examined in 1 year (January 01-December 31, 2014) in a suburban district near Paris. We evaluated the proportion of adolescents under 18 among all arrestees detained in custody and their medical history, addictive behaviors, perceived health status, and opinion on custody. RESULTS: Arrestees aged 13-17 accounted for 1859 individuals. They were predominantly males (94%) and accounted for 19% of all examinations in custody. Nearly half of the arrestees aged 13-15 (42%), and two thirds of those aged 16-17 (65%) had been previously detained in police cells. Somatic and psychiatric disorders were reported by 7% and 4%, respectively, of arrestees aged 13-17. Alcohol, tobacco, and cannabis consumption were reported by 5%, 24%, and 12%, respectively, of arrestees aged 13-15. These proportions were lower than the 16%, 50%, and 35%, respectively, reported by arrestees aged 16-17 (p < 0.0001). Assaults were reported by 18% of arrestees aged 13-17. They had a fair, bad, or very bad opinion on custody in 43% of cases. CONCLUSION: The detention of adolescents in police stations is commonly associated with assaults at the time of arrest. High proportions of adolescent arrestees smoke tobacco or cannabis. We suggest that the medical examination in custody could be an opportunity for adolescents to initiate access to health care.

'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans.

INTRODUCTION AND AIMS: Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks. DESIGN AND METHODS: This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth. RESULTS: The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison. DISCUSSION AND CONCLUSIONS: Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.

Outcomes and associated factors in malpractice litigation involving inferior vena cava filters.

OBJECTIVE: Placement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. METHODS: The legal databases LexisNexis and Westlaw were searched from 1967 to 2016 for all published legal cases in the United States involving placement of IVC filters. Keywords included "IVC," "inferior vena cava," "filter," and "malpractice." Social Security Disability claims, product liability actions, and hospital employment contract disputes were excluded. RESULTS: There were 310 search results eligible for initial review. After application of exclusion criteria, 29 cases involving medical malpractice were included in final analysis. The majority of excluded cases were insurance disputes and tax revenue cases. Overall, private practitioners were most often sued (11/29 [37.9%]), whereas 24.1% of defendants were academic hospitals (7/29), 20.7% were prisons (6/29), and 17.2% were community hospitals (5/29). The most common specialty named was vascular surgery (8/29), whereas interventional radiologists were named only twice. The most common indications for IVC filter placement were hypercoagulable state (8/29 [29.6%]), recurrent pulmonary embolism (PE; 6/29 [22.2%]), and trauma (5/29 [18.5%]). The most common underlying allegations involved failure to insert IVC filter when indicated (14/29 [48.3%]), intraprocedural negligence (5/29 [17.2%]), and failure to timely remove device (5/29 [17.2%]). Common complications included failure to prevent occurrence of PE (14/29 [48.3%]), device migration (4/29 [13.8%]), and perforation of organs or vasculature (3/29 [10.3%]). Death of the patient occurred in 41.4% of total cases (12/29). In cases in which the patient died, the most common indications for filter placement were trauma (4/12 [33.3%]) and deep venous thrombosis (3/12 [25.0%]), and the most common complication in those patients who died was the failure to prevent a subsequent PE (9/12 [75.0%]). Available verdicts favored defendants (13/14 [92.9%]). In cases with defense verdicts, the most common indications for filter placement similarly were trauma (4/13 [30.8%]) and deep venous thrombosis (3/13 [23.1%)], and the most common complication was failure to prevent PE (9/14 [64.3%]). CONCLUSIONS: Analysis of malpractice cases involving IVC filters revealed key factors associated with litigation. Overall, verdicts favored defendants. Private practitioners were most commonly sued, and the most common reasons for bringing suit were failure to insert filter, intraprocedural complications, and failure to remove filter. Deeper awareness of issues related to malpractice litigation can inform clinical practice and improve patient care and safety.

Relapse to smoking following release from smoke-free correctional facilities in Queensland, Australia.

BACKGROUND: Smoke-free prison policies are increasingly common, but few studies have investigated relapse to smoking after release from prison. This study investigated return to tobacco smoking and correlates of smoking at reduced levels after release among adults recently released from smoke-free prisons in Queensland, Australia. METHODS: A cross-sectional survey of 114 people at parole offices within two months of release from prison was used. The survey measured health, social, and criminological factors related to tobacco smoking. We used logistic regression to identify factors associated with reduced post-release smoking levels compared to pre-incarceration levels. RESULTS: 94% of participants relapsed to smoking within two months of release; 72% relapsed on the day of release. 62% of participants smoked significantly less per day after compared with before incarceration. Living with a partner (Odds Ratio (OR) 2.77, 95%CI 1.02-7.52), expressing support for smoke-free prison policies (OR 2.44, 95%CI 1.12-5.32), intending to remain abstinent post-release (OR 4.29, 95%CI 1.88-9.82), and intending to quit in the future (OR 3.88, 95%CI 1.66-9.07) were associated with reduced smoking post-release. Use of illicit drugs post-release was negatively associated with reduced smoking post-release (OR 0.27, 95%CI 0.09-0.79). In multivariate analyses, pre-release intention to remain smoke-free was associated with reduced smoking post-release (AOR 2.69, 95%CI 1.01-7.14). DISCUSSION: Relapse to smoking after release from smoke-free prisons is common, but many who relapse smoke less than before incarceration, suggesting that smoke-free prison policies may reduce post-release tobacco smoking. There is a need for tailored, evidence-based tobacco cessation interventions for people recently released from prison.

Children detained in French police cells.

AIM: Police custody is detention in response to a suspicion of crime. In France, until the age of 13, pre-trial detention and police custody are not allowed. We aimed to evaluate the practical implementation of police detention of children aged between 10 and 12 years and describe the medical characteristics and history, perceived health status and opinion on custody of the potentially affected children. METHODS: A descriptive study was conducted in a French reference regional department of forensic medicine at the time of medical examination in police cells among arrestees younger than 13 years old examined over a 5-year period (1 January 2011-31 December 2015). RESULTS: Children aged 10-12 years (n = 60; males, 48, 80%), accounting for 60 of 57 687 examined arrestees (0.1%), were examined over the study period. Six individuals (10%) were arrested twice or more times during the study period (for a total of 76 detentions analysed). The most common suspected crimes were theft or robbery (42/76, 55%) and physical assault (22/76, 29%). Arrestees had a favourable opinion of custody in 33 of 76 cases (43%). Children reported physical assault by the police in 6 of 76 cases (8%), and the physicians observed recent traumatic injuries in 7 of 76 cases (9%). Daily tobacco consumption was reported by 4 of 60 children (7%). No child was considered unfit for detention by the physician. CONCLUSIONS: Children aged 10-12 years suspected of serious crimes accounted for 0.1% of detained individuals in police cells. Although infrequent, such situations are a matter of concern.

Análise do clamor por punição e redução da idade penal / Análisis del clamor por punición e reducción de la edad penal / Analysis of the outcry for punishment and reduction of criminal liability age

Resumo Tendo como disparador da escrita o livro "Capitães de Areia", de Jorge Amado, objetivamos discutir o encarceramento de adolescentes no Brasil e no Espírito Santo, tomando como campo de análise a produção do clamor pelo controle/punição dos "perigosos". A análise baseia-se em revisão da literatura científica sobre o tema e a discussão se pauta em matérias jornalísticas e em documentos oficiais de sítios governamentais. A discussão assinala a importância de atentarmo-nos para a judicialização da vida, guiada por práticas de julgamento e culpabilização, que engrena a produção de violência. O discurso punitivo e de extermínio é compreendido a partir da difusão da ideia binária de mundo, da disseminação do medo e da insegurança como política para a segregação e identificação daqueles que devem ser descartados da sociedade. Aponta-se como urgente a visibilidade de questões que possibilitem a mudança de rumo no qual nos encontramos de clamor por segurança penal.

Resumen Teniendo como disparador de la escrita el libro Capitanes de la Arena, de Jorge Amado, intentamos discutir el encarcelamiento de adolescentes en Brasil y en el estado de Espírito Santo, tomando como campo de análisis la producción del clamor por el control/punición de los "peligrosos". El análisis se basa en revisión de la literatura científica referente al tema y la discusión se enfoca en materiales periodísticos y en documentos oficiales de sitios gubernamentales. La discusión apunta la importancia de fijarnos en la judicialización de la vida, regida por las prácticas de juicio y culpabilización, que suscita la producción de violencia. El discurso punitivo y de exterminio se comprende a partir de la difusión de la idea binaria de mundo, de la propagación del miedo y de la inseguridad como política para la segregación e identificación de aquellos que deben ser desechados de la sociedad. Se señala la urgencia de la visibilidad de cuestiones que posibiliten el cambio de rumbo en el que nos encontramos de clamor por seguridad penal.

Abstract Having as writing trigger the book Captains of the Sands, by Jorge Amado, we aim to discuss the adolescent imprisonment in Brazil and in Espírito Santo state by considering as field of analysis the production of the outcry for governance/punishment of the "dangerous". The analysis is based on a scientific literature review concerning the subject and the discussion utilizes journalistic news reports as well as official documents found on governmental websites. The discussion highlights the importance of turning our attention towards judicialization of life, guided by judgment and blaming practices which engages violence production. Punitive and extermination speech is understood as starting from the diffusion of the binary idea of the world, from dissemination of fear and insecurity as a policy for segregation and identification of those who can be disregarded from society. The visibility of questions that promote a changing on the course in which we find ourselves of criminal safety outcry is urgently pointed out.

Unexpected increase in indoor pollutants after the introduction of a smoke-free policy in a correctional center.

Correctional centers (prisons) are one of the few non-residential indoor environments where smoking is still permitted. However, few studies have investigated indoor air quality (IAQ) in these locations. We quantified the level of inmate and staff exposure to secondhand smoke, including particle number (PN) count, and we assessed the impact of the smoking ban on IAQ. We performed measurements of indoor and outdoor PM2.5 and PN concentrations, personal PN exposure levels, volatile organic compounds (VOCs), and nicotine both before and after a complete indoor smoking ban in an Australian maximum security prison. Results show that the indoor 24-h average PM2.5 concentrations ranged from 6 (±1) µg/m(3) to 17 (±3) µg/m(3) pre-ban. The post-ban levels ranged from 7 (±2) µg/m(3) to 71 (±43) µg/m(3) . While PM2.5 concentrations decreased in one unit post-ban, they increased in the other two units. Similar post-ban increases were also observed in levels of PN and VOCs. We describe an unexpected increase of indoor pollutants following a total indoor smoking ban in a prison that was reflected across multiple pollutants that are markers of smoking. We hypothesise that clandestine post-ban smoking among inmates may have been the predominant cause.

Prison tobacco control policies and deaths from smoking in United States prisons: population based retrospective analysis.

OBJECTIVE: To determine the mortality attributable to smoking and years of potential life lost from smoking among people in prison and whether bans on smoking in prison are associated with reductions in smoking related deaths. DESIGN: Analysis of cross sectional survey data with the smoking attributable mortality, morbidity, and economic costs system; population based time series analysis. SETTING: All state prisons in the United States. MAIN OUTCOME MEASURES: Prevalence of smoking from cross sectional survey of inmates in state correctional facilities. Data on state prison tobacco policies from web based searches of state policies and legislation. Deaths and causes of death in US state prisons from the deaths in custody reporting program of the Bureau of Justice Statistics for 2001-11. Smoking attributable mortality and years of potential life lost was assessed from the smoking attributable mortality, morbidity, and economic costs system of the Centers for Disease Control and Prevention. Multivariate Poisson models quantified the association between bans and smoking related cancer, cardiovascular and pulmonary deaths. RESULTS: The most common causes of deaths related to smoking among people in prison were lung cancer, ischemic heart disease, other heart disease, cerebrovascular disease, and chronic airways obstruction. The age adjusted smoking attributable mortality and years of potential life lost rates were 360 and 5149 per 100,000, respectively; these figures are higher than rates in the general US population (248 and 3501, respectively). The number of states with any smoking ban increased from 25 in 2001 to 48 by 2011. In prisons the mortality rate from smoking related causes was lower during years with a ban than during years without a ban (110.4/100,000 v 128.9/100,000). Prisons that implemented smoking bans had a 9% reduction (adjusted incidence rate ratio 0.91, 95% confidence interval 0.88 to 0.95) in smoking related deaths. Bans in place for longer than nine years were associated with reductions in cancer mortality (adjusted incidence rate ratio 0.81, 95% confidence interval 0.74 to 0.90). CONCLUSIONS: Smoking contributes to substantial mortality in prison, and prison tobacco control policies are associated with reduced mortality. These findings suggest that smoking bans have health benefits for people in prison, despite the limits they impose on individual autonomy and the risks of relapse after release.