Deaths in jail: a retrospective analysis of autopsies performed at the Legal Medicine Unit of Pavia (1999-2022).

Introduction: The high rate of incarceration, now exceeding 11.5 million people worldwide, has raised concerns about the conditions within penal institutions, such as the consequences of incarceration on the person. This retrospective study aims to investigate the issue of death in custody, exploring the relationship between incarceration, health vulnerabilities, and death from the forensic pathologist's point of view. Methods: We analyzed, from a forensic, clinical and toxicological perspective, 86 cases of deaths in detention facilities in North-Western Italy from 1999 to 2022. Results: The analysis has shown that suicide, mainly committed by hanging, plastic bag suffocation and butane intoxication, represents the leading type of violent death (52%), followed by accidental deaths (16%). On the other hand, cardiovascular diseases are the leading cause of natural deaths (42%), followed by infectious diseases (especially HIV-related). Discussion: The present study identifies the most frequent and critical situations and risk factors related to death in custody and the profile of the inmate who is at a higher risk of death, allowing to highlight the issues to be addressed from a public health point of view. On the whole, it calls for comprehensive reforms, aligned with international human rights standards, addressing mental and physical care gaps, improving correctional officers' education, and training, and focusing on rehabilitation with well-being and dignity.

Impulsivity, trauma history, and interoceptive awareness contribute to completion of a criminal diversion substance use treatment program for women.

Introduction: In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples. Methods: The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women's Risk/Needs Assessment (WRNA). Results: ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81). Discussion: Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.

Financial incentives to increase engagement across the hepatitis C care cascade among people at risk of or diagnosed with hepatitis C: A systematic review.

BACKGROUND: Reversing declining rates of people initiating and completing hepatitis C (HCV) treatment, observed in many countries, is needed to achieve global HCV elimination goals. Providing financial incentives to increase HCV testing and treatment uptake among people at-risk of or living with HCV infection could be an effective intervention. We conducted a systematic review to assess evidence regarding the effectiveness of financial incentives to improve engagement and progression through the HCV care cascade. METHODS: We searched MEDLINE, PubMed and EMBASE for studies published from January 2013 to January 2023 that evaluated financial incentives offered to people living with and at-risk of HCV to increase HCV antibody and or RNA testing, linkage to care, treatment initiation, treatment adherence, treatment completion, and sustained viral load (SVR) testing. Open-label randomised controlled trials (RCTs), controlled non-randomised studies, cohort or observation studies and mixed-methods studies were included, whereas literature reviews, case series and studies which did not report data were excluded. RESULTS: We identified 1,278 studies, with 21 included after full-text screening (14,913 participants); three randomised controlled trials and 18 non-randomised studies. Studies evaluated incentives aimed at improving test uptake (n = 11), engagement in care (n = 13), treatment initiation (n = 8), adherence (n = 3), completion (n = 3) and attainment of SVR (n = 5). Findings provided inconclusive evidence for the effectiveness of incentives in improving engagement in the HCV cascade of care. Determining incentive effectiveness to improve care cascade engagement was limited by low quality study designs, heterogeneity in type (cash or voucher), value (US$5 to $600) and cascade stage being incentivised. No randomised controlled trials assessed the effectiveness of incentives to promote HCV testing, and none showed an impact on treatment uptake. In non-randomised studies (observational comparative), some evidence suggested that incentives promoted HCV testing, but evidence of their role in promoting linkage to care, HCV treatment adherence and treatment completion were mixed. CONCLUSION: Currently, there lacks high-quality evidence evaluating whether financial incentives improve HCV testing and treatment outcomes. Future research should seek to standardise methodologies, compare incentive types and values to enhance engagement in HCV care, and determine factors that support incentives effectiveness.

Redemption or Manipulation? Revisiting the Art of a Serial Killer-A Dialogue.

This article revisits an ongoing dialogue between the co-authors, examining their divergent perspectives on whether the art of serial killers was used to perpetuate their psychopathic cycles after their murderous sprees were interrupted, or whether the art-particularly a piece done by one serial killer, Glen Rogers-reflects remorse and redemption. The two art therapists draw from their own clinical and professional experiences to argue their respective outlooks. After explaining what art therapy is, re-examining the concept of murderabilia, and underscoring psychopathy, this article provides an in-depth evaluation of two art pieces done by the serial killer through both of their viewpoints. Ultimately, while neither author completely changed their overall conclusions, elements from both sides of the argument were found relevant. Ultimately, this article emphasized the chaotic and messy connections between art and violence, yet through new perspectives explored on the complexities and motivations within the mayhem, mutual understandings emerged.

Peer support for health, social care, and educational needs in adult prisons: a systematic scoping review.

OBJECTIVES: Prisoners face inequalities relating to health and social care and educational needs. Peer support (prisoners providing support to other prisoners) is used in addition to professional support to address needs. It is not clear how effective or cost-effective peer-support services are, how they are implemented or experienced, or how best to evaluate such schemes. This review aimed to evaluate the following: 1. Outcomes and economic outcomes that have been studied for prison peer support, and data sources used. 2. Effectiveness and cost of prison peer support. 3. Implementation and experiences with prison peer support. STUDY DESIGN: A rapid systematic scoping review (registered on International Prospective Register of Systematic Reviews: CRD42022351592) that focussed on peer support within adult prisons. METHODS: The search included six databases, grey literature databases, handsearching journals, and reviewing reference lists (June 2022). Studies were screened, and data were extracted. Narrative synthesis was used to analyse findings. RESULTS: Seventy papers were included (qualitative: 30, quantitative: 21, and mixed-methods: 19). No studies measured cost/cost-effectiveness. A range of methods were used to measure effectiveness (e.g., surveys, routinely collected data), implementation, and experience (e.g. interviews, surveys, observation). There was evidence of some positive effects (e.g., disease detection, mental health). Factors influencing peer support in prisons included individual, service, and organisational factors. Benefits (for prisons/prisoners/staff) and challenges (e.g., burden, exploitation) were identified. CONCLUSION: Prison peer support services are internationally used to address public health. Future research could robustly evaluate effectiveness and cost effectiveness. Attention should be given to potential risks and barriers affecting implementation.

Antisocial personality disorder and determinants among prisoners in South Gondar zone correctional institutions, Northwest Ethiopia: An institution-based cross-sectional study.

BACKGROUND: Antisocial personality disorder (ASPD) is a common mental health condition with major public health consequences, affecting 0.2-3.3 % of the general population. ASPD has become increasingly common in correctional settings. Therefore, this study aimed to assess antisocial personality disorder and its determinants among prisoners in South Gondar zone correctional centers, which has a vital role in early intervention. METHODS: An institution-based cross-sectional study was conducted using the simple random sampling technique to recruit a total of 552 participants. Antisocial personality disorder was assessed by the Diagnostic and Statistical Manual of Mental Disorders 5th text revision (DSM-5) using an interviewer-administered questionnaire. We used binary and multivariate analyses to identify factors associated with ASPD. Statistical significance was declared at a 95 % confidence interval (CI) of p-value ˂0.05. RESULTS: A total of 552 participants took part with a response rate of 97.87 %. The prevalence of antisocial personality disorder among prisoners was found to be 27.5 %, with a 95 % CI (23.96, 31.42). The study revealed that male sex (AOR = 5.25, 95 % CI: 1.60, 17.31), being unemployed (AOR = 4.38, 95 % CI: 1.27, 15.08), family history of mental illness (AOR = 2.23, 95 % CI: 1.30, 3.81), and repeated incarceration (AOR = 2.04, 95 % CI: 1.28, 3.23) were factors significantly associated with antisocial personality disorder. CONCLUSIONS: This study showed a higher prevalence of antisocial personality disorder among prisoners. Male sex, unemployment, family history of mental illness, and history of incarceration were significantly associated with antisocial personality disorder. Therefore, the findings of this study recommend that incarcerated people require more attention and early intervention for antisocial personality disorder in correctional centers.

Nutritional Characteristics of Menus in State Prisons.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.

Suicidal Ideation Among Older Adults in Prison: A Qualitative Study.

Suicide is a serious public health concern, and people who are incarcerated represent a particularly high-risk group. Although research on the suicidality of persons in prison has gained interest in recent decades, the issue of suicide among older adults in prison has been understudied. Therefore, the aim of the present study was to explore the ways in which older adults in prison understood their experiences of suicidal ideation. Interpretive phenomenological analysis was utilized to analyze interviews with 16 incarcerated older adults. The analysis of the findings revealed four themes: (1) Suicide intentions as a control strategy; (2) Suicide intentions as an act of resistance; (3) Suicide intentions as a means of self-redemption, and (4) Suicide intentions in the absence of other choices. Guided by the life course perspective, the findings suggest that suicidal ideation serves as a means of expressing distinct emotional states that may be unique to older adults in carceral environments.

Long-term outcomes of a decentralized, nurse-led, statewide model of care for hepatitis C among people in prison in Victoria, Australia.

BACKGROUND: Prisons provide a key strategic opportunity to upscale hepatitis C testing and treatment in a high prevalence setting and are crucial for elimination efforts. METHODS: A decentralized, statewide nurse-led model of care offering hepatitis C treatment for people in prison was implemented in Victoria, Australia in 2015. The program provides hepatitis C care to all 14 adult prison sites in the jurisdiction. We prospectively evaluated treatment uptake between 1 November 2015 and 31 December 2021. Data on all people in prison treated were recorded in a clinical database. The primary outcomes were i) total number of people in prison with hepatitis C treated; ii) total number of DAA treatment courses. RESULTS: 3,133 DAA treatment courses were prescribed to 2,768 people in prison. The proportion of total Victoria DAA prescriptions the program was responsible for increased from 6% in 2016 to a peak of 23% in 2020. Of those treated, median age was 39 years, 91% were male and 9% had cirrhosis. Few (20%) had previously engaged in hepatitis C care in the community and at first treatment course in prison, only 6% had previously accessed hepatitis C treatment. Complete follow up data were available for 1,757/2,768 (63%) treated, with 1,627/1,757 (93%) achieving SVR12. CONCLUSIONS: A decentralized, nurse-led, statewide model of care was highly effective in treating large numbers of people in prison with hepatitis C and achieved high rates of SVR12. Nurse-led prison programs are playing a crucial role in eliminating hepatitis C as a public health threat in Australia.

Associations of Reversal Learning Performance With Personality Disorder Profile and Drug Abuse History in a Sample of Prison Inmates.

Prison inmate samples present a high prevalence of impulsivity- and compulsivity-related behavioral problems. The Probabilistic Reversal Learning Task (PRLT) is a useful tool to assess decision-making, and we explore its associations with inmates' personality disorder (antisocial personality disorder, APD; obsessive-compulsive personality disorder, OCPD; or both) and history of drug abuse. Mixed-effects methods were used to model acquisition and reacquisition curves across PRLT, in a sample of 275 prison inmates diagnosed with OCPD, APD, or both. Two aspects were assessed: general discrimination learning and decision-making inflexibility. Participants with a mixed personality disorder profile showed a clear pattern of decisional inflexibility. A history of drug abuse was associated with a general poorer performance but not with decision-making inflexibility. Inability to adapt to changing contingencies, and thus to adverse consequences of previously rewarded choices, was not linked to compulsivity, as hypothesized to be present in OCPD and substance use disorders, but to the mixed APD/OCPD profile.

Court-ordered forensic psychiatry treatment in prison: determinants of outcome and risk mitigation.

Background: Court-ordered forensic psychiatry treatments (COT) are specifically designed to reduce the risk of violence in mentally disordered offenders. Given their high costs and ethical issues, mental health professionals need admission criteria to be able to select those candidates with optimal benefit. This study analyses offender-related and treatment-related determinants of COT outcome and risk mitigation. Methods: This two-year longitudinal study assessed the evolution of 117 adult offenders admitted to a specialized medium-security forensic psychiatry clinic. Treatment outcome included court-ordered discharge locations and the Historical Clinical Risk Management (HCR) score evolution. Treatment progress was assessed every six months across five time-points including measures of protective factors, work rehabilitation and security. Outcome determinants included psychiatric diagnosis and type of offence. Results: Discharge locations are predicted by pre-treatment risk level. Lower HCR scores are associated with discharge into low-security psychiatry wards independently of the psychiatric diagnosis. Risk reduction follows diagnosis-specific and offense-related patterns and reveals that mentally disordered offenders with Cluster B personality disorders or those sentenced for drug crimes are significantly less prone to benefit from COT. Conclusions: Our findings indicate that criminological characteristics at baseline as well as diagnosis of personality disorders are the main determinants of treatment outcome in our care setting. Inmates with concomitant higher violence risk at baseline and presence of Cluster B personality disorders might benefit the least from court-ordered forensic inpatient psychiatric care in prison.

Healthcare accessibility in the prison environment: oral health.

This article aims to assess the importance of caring for oral health among prisoners, as an often-overlooked aspect of general health well-being in prisons. The incidence of oral disease among prisoners compared to the general population is much higher due to many factors such as limited access to dental care, unhealthy lifestyles and overcrowded cells. The research review confirms the need to increase access to dental care and promote hygiene awareness among inmates. Differences between genders and the impact of the length of the sentence on oral health are also pointed out.

Using nominal group technique with people who are incarcerated in Canadian federal prisons to identify barriers and solutions to improving Prison Needle Exchange Program uptake.

BACKGROUND: Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate. METHODS: Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving >10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully. RESULTS: Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access. CONCLUSION: Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised.

Yield of TB screening in prisons in Tajikistan.

BACKGROUND: The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan's prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan. METHODS: A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test. RESULTS: A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001). CONCLUSION: The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.

CONTEXTE: On estime que le taux de TB dans les établissements pénitentiaires est 23 fois plus élevé que dans la population générale. Il existe peu de documentation sur le dépistage de la TB dans les prisons du Tadjikistan. Cette étude vise à rendre compte des résultats d'un dépistage de la TB mené dans des établissements pénitentiaires au Tadjikistan. MÉTHODES: Un dépistage systématique de la TB a été réalisé entre juillet 2022 et septembre 2023, selon un algorithme adapté localement et basé sur les recommandations de l'OMS. Le rendement du dépistage a été calculé comme la proportion de cas confirmés de TB, avec des variables catégorielles comparées à l'aide d'un test χ2. RÉSULTATS: Au total, 7 223 dépistages ont été effectués, permettant d'identifier 31 cas de TB, dont 17 cas de TB sensible aux médicaments, 8 cas de TB résistante aux médicaments et 6 cas diagnostiqués cliniquement. Le rendement global du criblage était de 0,43%. Notamment, le rendement du dépistage était de 3,4% chez les personnes présentant au moins un symptôme de la TB et de 0,03% chez celles ne présentant pas de symptômes de la TB (P < 0,001). CONCLUSION: Le taux de TB identifié dans ces prisons est cinq fois plus élevé que dans la population générale. Les personnes symptomatiques avaient une probabilité plus élevée d'être diagnostiquées comme atteintes de TB, et l'utilisation de radiographies pulmonaires améliorait considérablement le rendement du dépistage. Nous recommandons d'augmenter la capacité de dépistage par radiographie thoracique afin d'améliorer la prévention et le contrôle de la TB en milieu carcéral.

Transfer to community and prison mental health care from Ireland's main remand prison over three years: 2015-2017.

Background: The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings. Objectives: We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service. Method: This retrospective observational cohort study was based in Ireland's main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants. Results: There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20-31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first face-to face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service. Conclusion: Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports.

Correctional Transgender Policy in Canada's Federal Prison System.

Since December 2017, Canada's federal correctional system provides prisoners the opportunity to be assigned to living units according to their self-identified gender. Still organized around sex, conceptually and spatially, prison policies and procedures surrounding transgender prisoners require navigation to adhere to the rights of all prisoners. Based on interviews conducted between October 2019 and October 2021 with 74 correctional officers (COs) from the Canadian federal prison system, we discuss how correctional officers view and operationalize Canada's transgender policy to understand its unintended consequences for both prisoners and prison staff. Unintended consequences revolve around the potential risk for prisoner victimization, prisoner pregnancy, lack of adequate housing, strip search complications, officers' fear of being labeled transphobic, and uncertainty and discretion; all having effects on staff wellness. The policy, although well-intended, may potentially compromise prisoner safety, making correctional work even more stressful.

Impact of the COVID-19 pandemic on hepatitis C virus screening in provincial prisons in Montreal, Quebec, Canada.

Background: Little is known about the impact of the COVID-19 pandemic on hepatitis C (HCV) screening efforts in carceral settings. We explored the impact of the pandemic on HCV screening in two of Quebec's largest provincial prisons. Methods: Retrospective data of HCV-related laboratory tests between July 2018 and February 2022 at l'Établissement de détention de Montréal (EDM) and l'Établissement de détention de Rivière-des-Prairies (EDRDP) were obtained. To examine the association between the pandemic and the number of HCV-antibody (HCV-Ab) tests, a three-level time period variable was created: pre-outbreak, outbreak, and post-outbreak. Negative binomial regression (with monthly admissions as an offset) was used to assess the change in HCV-Ab tests across time periods and by prisons. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated. Results: A total of 1,790 HCV-Ab tests were performed; 56 (3%) were positive. Among these, 44 (79%) HCV RNA tests were performed; 23 (52%) were positive. There was a significant decrease in HCV-Ab screening at EDM during the outbreak (aOR 0.29; 95% CI 0.17-0.48) and post-outbreak (aOR 0.49; 95% CI 0.35-0.69) periods, compared to the pre-outbreak period. There was no significant change in HCV-Ab screening at EDRDP during the outbreak (aOR 0.98; 95% CI 0.49-2.11) but a significant increase in HCV-Ab screening post-outbreak (aOR 1.66; 95% CI 1.04-2.72). Conclusion: The COVID-19 pandemic negatively affected HCV screening at EDM but had minimal impact at EDRDP. To eliminate HCV from carceral settings, minimizing screening interruptions during future outbreaks and combined HCV/SARS-CoV-2 screening should be prioritized.

Prevalence of sexually transmitted infections and human papillomavirus in cervical samples from incarcerated women in São Paulo, Brazil: a retrospective single-center study.

Introduction: Sexually transmitted infections (STIs) cause considerable morbidity worldwide and, depending on the specific pathogen, may lead to serious complications in the female reproductive tract. Incarcerated women are particularly vulnerable to health problems with a disproportionate high rate of STIs, including infections with human papillomavirus (HPV). Methods: Here, cervical swab samples collected from 299 women (18 to 64 years) living in one of the women's prisons of São Paulo, Brazil were submitted for liquid-based cytology to determine the prevalence of precancerous lesions. Furthermore, direct detection of 30 genital HPV genotypes (18 high-risk and 12 low-risk types) and 11 additional STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium and hominis, Treponema pallidum, Trichomonas vaginalis, Ureaplasma parvum and urealyticum) were performed by molecular typing using two PCR-based DNA microarray systems, i.e., EUROArray HPV and EUROArray STI (EUROIMMUN), respectively. Results: The overall prevalence of cytological abnormalities was 5.8%, including five women with low-grade and five women with high-grade squamous intraepithelial lesions. The overall prevalence of HPV was 62.2, and 87.1% of the HPV-positive women were infected with oncogenic high-risk (HR) HPV types. HPV types 16 (24.1%), 33 and 52 (both 10.4%) were the most frequently detected. The prevalence of the other STIs was 72.8%. Up to four different pathogens were found in the infected women, the most frequent being Ureaplasma parvum (45.3%), Mycoplasma hominis (36.2%) and Trichomonas vaginalis (24.8%). Conclusion: The high number of HR-HPV infections and other STIs described here highlights the fact that the Brazilian female prison population requires more attention in the country's health policies. The implementation of screening programs and treatment measures might contribute to a decrease in the incidence of STIs and cervical cancer in this vulnerable population. However, for such measures to be effective, further studies are needed to investigate the best practice to get more women to engage in in-prison prevention programs, e.g., through offering further sexual health education and self-sampling.

Data linkage studies of primary care utilisation after release from prison: a scoping review.

BACKGROUND: Primary care plays a central role in most, if not all, health care systems including the care of vulnerable populations such as people who have been incarcerated. Studies linking incarceration records to health care data can improve understanding about health care access following release from prison. This review maps evidence from data-linkage studies about primary care use after prison release. METHODS: The framework by Arksey and O'Malley and guidance by the Joanna Briggs Institute (JBI) were used in this review. This scoping review followed methods published in a study protocol. Searches were performed (January 2012-March 2023) in MEDLINE, EMBASE and Web of Science Core Collection using key-terms relating to two areas: (i) people who have been incarcerated and (ii) primary care. Using eligibility criteria, two authors independently screened publication titles and abstracts (step 1), and subsequently, screened full text publications (step 2). Discrepancies were resolved with a third author. Two authors independently charted data from included publications. Findings were mapped by methodology, key findings and gaps in research. RESULTS: The database searches generated 1,050 publications which were screened by title and abstract. Following this, publications were fully screened (n = 63 reviewer 1 and n = 87 reviewer 2), leading to the inclusion of 17 publications. Among the included studies, primary care use after prison release was variable. Early contact with primary care services after prison release (e.g. first month) was positively associated with an increased health service use, but an investigation found that a large proportion of individuals did not access primary care during the first month. The quality of care was found to be largely inadequate (measured continuity of care) for moderate multimorbidity. There were lower levels of colorectal and breast cancer screening among people released from custody. The review identified studies of enhanced primary care programmes for individuals following release from prison, with studies reporting a reduction in reincarceration and criminal justice system costs. CONCLUSIONS: This review has suggested mixed evidence regarding primary care use after prison release and has highlighted challenges and areas of suboptimal care. Further research has been discussed in relation to the scoping review findings.

Testing the job demands - resources model to explain organizational trust among private prison staff.

Two major forms of organizational trust are supervisor trust and management trust. Guided by the job demand-resources model, this exploratory study examined how the job demand variables of role conflict, role ambiguity, role overload, and fear of being victimized at work and the job resource variables of instrumental communication, job autonomy, job variety, and quality training were linked to both forms of organizational trust among staff at a private U.S. prison. Results showed that workplace variables predicted both types of trust and were generally stronger predictors than personal attributes. Moreover, resources played a greater role than job demands in shaping both supervisor and management trust. Among the demands, only role conflict was a significant negative predictor of supervisor trust and management trust. Instrumental communication, job autonomy, and job variety were significant positive predictors of supervisor trust. Job autonomy and job variety both had significant positive associations with management trust.