Prisons and health reforms in England and Wales.

Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty's Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.

A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446).

OBJECTIVE: To determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes. RESEARCH DESIGN AND METHODS: A 9-month randomized trial compared glucose self-monitoring real-time result transmission and feedback of results for the previous 24 h in the control group with real-time graphical phone-based feedback for the previous 2 weeks together with nurse-initiated support using a web-based graphical analysis of glucose self-monitoring results in the intervention group. All patients aged 18-30 years with HbA(1c) (A1C) levels of 8-11% were eligible for inclusion. RESULTS: A total of 93 patients (55 men) with mean diabetes duration (means +/- SD) 12.1 +/- 6.7 years were recruited from a young adult clinic. In total, the intervention and control groups transmitted 29,765 and 21,400 results, respectively. The corresponding median blood glucose levels were 8.9 mmol/l (interquartile range 5.4-13.5) and 10.3 mmol/l (6.5-14.4) (P < 0.0001). There was a reduction in A1C in the intervention group after 9 months from 9.2 +/- 1.1 to 8.6 +/- 1.4% (difference 0.6% [95% CI 0.3-1.0]) and a reduction in A1C in the control group from 9.3 +/- 1.5 to 8.9 +/- 1.4% (difference 0.4% [0.03-0.7]). This difference in change in A1C between groups was not statistically significant (0.2% [-0.2 to 0.7, P = 0.3). CONCLUSIONS: Real-time telemedicine transmission and feedback of information about blood glucose results with nurse support is feasible and acceptable to patients, but to significantly improve glycemic control, access to real-time decision support for medication dosing and changes in diet and exercise may be required.

A real-time, mobile phone-based telemedicine system to support young adults with type 1 diabetes.

Telemedicine systems have been proposed as a means of supporting people with diabetes in the self-management of their condition. Requirements for monitoring parameters of care, including glycaemic control, extent of analysis and interpretation of data, patient-clinician contacts, and involvement of a multidisciplinary care team with effective communication, can be addressed by telemedicine systems. We describe the development and implementation of an innovative real-time telemedicine system based around transmission and feedback of data to and from a mobile phone. Proprietary Java-based programs were used to link a blood glucose meter to a mobile phone. In addition to immediate transmission of blood glucose data, information about insulin dose, eating patterns and physical exercise were collected. Immediate feedback to the phone included a colour histogram to draw attention to levels of control over glycaemia over the previous two weeks. Clinicians supporting patients had access to summary screens identifying users not testing, and those with levels of blood glucose outside pre-defined limits. More detailed graphical displays of data were used to provide data about control of insulin dose and the degree to which it was modified in response to diet and exercise. The system has been evaluated in a clinical trial conducted in secondary care and is now being adapted for use in a trial in primary care, which is designed to assess its effectiveness in providing integrated management for the patient, general practitioner and pharmacist.

Static and dynamic novelty detection methods for jet engine health monitoring.

Novelty detection requires models of normality to be learnt from training data known to be normal. The first model considered in this paper is a static model trained to detect novel events associated with changes in the vibration spectra recorded from a jet engine. We describe how the distribution of energy across the harmonics of a rotating shaft can be learnt by a support vector machine model of normality. The second model is a dynamic model partially learnt from data using an expectation-maximization-based method. This model uses a Kalman filter to fuse performance data in order to characterize normal engine behaviour. Deviations from normal operation are detected using the normalized innovations squared from the Kalman filter.

The World Health Organization European Health in Prisons Project after 10 years: persistent barriers and achievements.

The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country's public health services.However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network's fundamental aim of noticeable improvements in the health and care of prisoners is further achieved.

Пациент или заключенный: так ли важно, какое министерство отвечает за охрану здоровья заключенных?

The work of the WHO Health and Prisons Project over the last 15 years has demonstrated the importance of health as a key area in managing the prison setting effectively, to the benefit of both prisoners and society in general. This briefing paper for Network Members provides a brief examination of rationale for, and experience of, integrating prison health services with public health services, and moving health care for prisoners out of the jurisdiction of the Ministry of Justice and into the Ministry of Health.

Patient or prisoner: does it matter which Government Ministry is responsible for the health of prisoners? A briefing paper for network meeting, Copenhagen October 2010

The work of the WHO Health and Prisons Project over the last 15 years has demonstrated the importance of health as a key area in managing the prison setting effectively, to the benefit of both prisoners and society in general. This briefing paper for Network Members provides a brief examination of rationale for, and experience of, integrating prison health services with public health services, and moving health care for prisoners out of the jurisdiction of the Ministry of Justice and into the Ministry of Health.