Trust and service engagement among people who inject drugs after release from prison.

BACKGROUND: Compounding histories of injecting drug use and incarceration can marginalise people engaging with services, making it difficult for them to address their health and social welfare needs, particularly when they navigate community re-entry service supports. Drawing on Hall and colleagues' five components of trust, this paper seeks to understand how trust in service providers fosters (or inhibits) effective service engagement from the perspective of people who inject drugs during the prison post-release period. METHODS: Between September 2018 and May 2020, qualitative in-depth interviews were completed with 48 adults (33 men, 15 women) recruited from SuperMIX (a longitudinal cohort study of people with a history of injection drug use in Victoria, Australia). Data relating to service engagement were coded against the five components of trust: competence, fidelity, honesty, global trust, and confidence. RESULTS: Reflections of post-release service engagement frequently focused on interactions with community corrections (parole) officers. Depictions of trust were consistently portrayed within the context of negative experiences and deficits, whereby trusting provider relationships and interactions were rarely described. Most participants recounted a stark absence of fidelity (that is, "pursuing a [client's] best interests"), with some participants detailing circumstances in which their vulnerability was purposefully, almost strategically, exploited. These encounters nearly always had the consequence of impeding the participant's positive progression in the post-release integration period. CONCLUSION: There is an urgent need to prioritise the client in health and social service delivery in the post-release transition-to-community period and recognise the importance of trust in delivering effective services to people whose life histories make them highly vulnerable to marginalisation.

"You need a designated officer" - Recommendations from correctional and justice health personnel for scaling up hepatitis C treatment-as-prevention in the prison setting.

INTRODUCTION: Hepatitis C (HCV) is highly prevalent among people who are incarcerated. HCV treatment-as-prevention was implemented in the SToP-C trial in four correctional centres in New South Wales , Australia to determine whether prison-wide scale up of antiviral treatment was an effective strategy to reduce HCV incidence and prevalence in the prison setting. A qualitative assessment was undertaken with prison-based correctional and health personnel at each of the four prisons to understand operational, sociological, and cultural barriers and enablers to scale up. Informed by a framework for scaling up population health interventions, this analysis examines recommendations by correctional and justice health personnel for HCV treatment-as-prevention scale up in the prison setting. METHODS: Correctional (n=24) and justice health (n=17) personnel, including officers, nurses, and senior administrators, participated in interviews across the four prisons where SToP-C was delivered and included two maximum security, one minimum security, and one women's medium/minimum security prisons. RESULTS: Scaling up HCV treatment-as-prevention was contingent on compatibility (including sentence length), efficacy (securely funded positions for dedicated personnel and continuity of care for patients transferring between prisons), stakeholder analysis (generally the whole of prison workforce, particularly custodial officers and senior administrators), reach (reliant on peer and officer champions), and legitimised change (via dedicated officers who could instigate cultural shifts). CONCLUSION: Achieving scale up of such an intervention should be guided by an understanding of the potential barriers and enablers. This analysis showed key considerations for HCV treatment-as-prevention scale up in correctional centres.

Hepatitis C treatment as prevention in the prison setting: Assessments of acceptability of treatment scale up efforts by prison correctional and health personnel.

BACKGROUND: Hepatitis C (HCV) infection is prevalent in the prison setting, with sharing of unsterile injecting equipment the most common mode of transmission in high income countries. Mathematical modelling suggests that HCV treatment scale-up could prevent onward transmission, known as treatment as prevention. Direct-acting antivirals have enabled rapid scale up of HCV treatment, underpinning the first clinical trial of treatment as prevention in the prison setting. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study was carried out in four correctional centres in New South Wales, Australia. This paper utilises Sekhon's Theoretical Framework of Acceptability to examine correctional, prison health, and study personnel's assessments of acceptability of HCV treatment as prevention in the prison setting. METHODS: Correctional (n=24) and health personnel (n=17) including officers, nurses (including seven study nurses), and senior administrators across the four prisons where SToP-C was delivered, participated in interviews. This included two maximum security, one minimum security, and one women's medium/minimum security prison. Data analysis was informed by a seven-component theory of acceptability. RESULTS: Participants reported broad acceptability of HCV treatment as prevention in the prison setting across five components of acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy). Attributes contributing to acceptability included reduced HCV prevalence within the prison, and public health benefits for the community when people are released without HCV (affective attitude). Elements which may negatively impact on acceptability included limited clinic space (burden) and lack of correctional officers' understanding of availability of equivalent healthcare in the community (ethicality). System-wide prison participation was viewed as necessary for treatment as prevention to be successful (perceived effectiveness), while nonjudgmental care was seen as instrumental to HCV treatment scale up efforts (self-efficacy). CONCLUSION: Correctional and prison-based health personnel view HCV treatment as prevention as an acceptable health intervention. Overall, environmental issues relating to implementation (i.e., clinic space) were viewed as requiring a strategic approach to support prison-wide HCV treatment scale up.

A rising incidence and poorer male outcomes characterise early onset paediatric inflammatory bowel disease.

BACKGROUND: The incidence of paediatric inflammatory bowel disease diagnosed before age 10 years is reportedly increasing, but national data are limited. AIM: To characterise the epidemiology, phenotype and clinical outcomes of children diagnosed with inflammatory bowel disease before age 10 years, and compare with data from children diagnosed aged 10-16 years. METHODS: A review of all Irish cases of early onset inflammatory bowel disease (diagnosis <10 years, EO-IBD) presenting between January 2000 and December 2014 was undertaken and compared to a cohort of later onset paediatric inflammatory bowel disease patients (diagnosis between 10 and 16 years, LO-IBD). Diagnostic investigations, phenotype, treatments, and long-term clinical and surgical outcomes were analysed. RESULTS: One hundred and ninety children (99 male) with EO-IBD were identified; 92 (48%) CD, 77 (41%) UC and 21 (11%) IBDU. The incidence of EO-IBD increased by 0.6 per 100 000 per year (0.8-3.2 per 100 000 per year), with a significant increase in UC by 0.06 per 100 000 per year (P=.02). Males with CD had more upper GI disease (L4a; 48% vs 21%; P=.007), more extensive disease distribution (L3±L4; 31% vs 11%; P=.05) and more severe disease activity at presentation (52% vs 31%; P=.05) than females. Fewer patients with early onset than later onset Crohn's disease had ileocolonic disease (L3; 10% vs 20%; P<.001). More relapses were observed in the first year post-diagnosis in early onset than later onset IBD (1.02 vs 0.5 mean relapses; P<.001). CONCLUSIONS: EO-IBD is increasing in incidence. Males have more extensive and severe disease phenotypes, and younger patients have higher relapse rates than older children. Further research to explain these findings is warranted.

Social capital strategies to enhance hepatitis C treatment awareness and uptake among men in prison.

Prisoner populations are characterized by high rates of hepatitis C (HCV), up to thirty times that of the general population in Australia. Within Australian prisons, less than 1% of eligible inmates access treatment. Public health strategies informed by social capital could be important in addressing this inequality in access to HCV treatment. Twenty-eight male inmates participated in qualitative interviews across three correctional centres in New South Wales, Australia. All participants had recently tested as HCV RNA positive or were receiving HCV treatment. Analysis was conducted with participants including men with experiences of HCV treatment (n=10) (including those currently accessing treatment and those with a history of treatment) and those who were treatment naïve (n=18). Social capital was a resourceful commodity for inmates considering and undergoing treatment while in custody. Inmates were a valuable resource for information regarding HCV treatment, including personal accounts and reassurance (bonding social capital), while nurses a resource for the provision of information and care (linking social capital). Although linking social capital between inmates and nurses appeared influential in HCV treatment access, there remained opportunities for increasing linking social capital within the prison setting (such as nurse-led engagement within the prisons). Bonding and linking social capital can be valuable resources in promoting HCV treatment awareness, uptake and adherence. Peer-based programmes are likely to be influential in promoting HCV outcomes in the prison setting. Engagement in prisons, outside of the clinics, would enhance opportunities for linking social capital to influence HCV treatment outcomes.

Outcomes of exclusive enteral nutrition in paediatric Crohn's disease.

BACKGROUND/OBJECTIVES: Exclusive enteral nutrition (EEN) is a safe and effective treatment modality for inducing remission in paediatric Crohn's disease (CD). The primary aim of this study was to compare the outcomes of EEN to corticosteroid (CS) therapy in newly diagnosed, treatment-naïve patients with CD. A secondary aim was to describe the outcomes of EEN in a national cohort of paediatric CD patients over a 10-year period. SUBJECTS/METHODS: A retrospective chart review was conducted at the Irish national referral centre for paediatric CD. A case-matched analysis was conducted on two cohorts matched for age, gender, disease location, disease behaviour and disease activity, who received CS or EEN as their initial treatment. Subsequently, cohort analysis was conducted on all patients who undertook a course of EEN therapy between 2004 and 2013. RESULTS: The case-matched analysis found higher remission rates after treatment with EEN (24/28, 86%) compared with those with CS (15/28, 54%; P=0.02). Dietetic contacts were found to be pivotal to the success of treatment and the attainment of remission. In total, 59 patients completed EEN at some time-point in their disease course and were included in the cohort analysis. Sixty-nine per cent of this cohort entered clinical remission (41/59). EEN was found to be most effective when used as an initial treatment (P=0.004) and less effective in patients aged under 10 years (P=0.04). CONCLUSIONS: EEN should be strongly considered as a favourable primary treatment over CS, especially in those diagnosed over the age of 10 years.

Current and future practices in hospital foodservice.

OBJECTIVES: To identify current operational practices and expectations for future practices in hospital foodservice; establish the probability that current practices will change; and determine whether differences in practices exist on the basis of profit status and hospital size. DESIGN: A questionnaire, to determine current practices, probability of change, and expectations for future practices, was mailed to foodservice directors. SUBJECTS: A random sample of 500 foodservice directors in US hospitals with 200 or more beds. A total of 214 questionnaires were returned for a response rate of 43%. STATISTICAL ANALYSIS: Descriptive statistics were used to report current practices, probability of change, and expectations for future practices. The Kruskal-Wallis test was conducted to examine whether the probability of change ratings differed on the basis of hospital profit status and size. chi 2 Analysis was used to examine whether expectations for future practices differed based on hospital profit status and size. RESULTS: Currently 81% of hospital foodservice departments have fewer than 100 employees; 73% have revenue budgets of less than $2 million; 49% have expense budgets greater than $2 million; 55% use a selective menu, often (43%) 1-week in length; 74% use conventional food production technology; 81% have a centralized, hot tray line; 91% operate a cafeteria; 96% do on-site catering; 69% have differential pricing for employee meals; 58% have subsidized employee meals; and 19% have coffee kiosks. Changes in current practices are expected in several areas. Foodservice directors expect to serve meals to fewer inpatients (71%), employ less staff (73%), have smaller expense budgets (70%), and generate more revenue (61%). Kruskal-Wallis and chi 2 analyses indicated few differences on the basis of hospital profit status and size. There was little consensus among directors on how to best respond to these environmental changes. APPLICATIONS: Hospital foodservice practices will change in the future. Foodservice directors are using a variety of strategies (e.g., revenue-generating ventures, menu changes) to respond to current environmental changes. Increased emphasis will be placed on running a hospital foodservice department as a profit center rather than a cost center.

Marijuana use prevention: the In-DEPTH model program.

Over the past five years marijuana use has doubled among eighth, 10th and 12th grade students, and in several demographics it has tripled. The recent debate over the legalization of medical marijuana (California's Proposition 215), positive media messages, lack of parent/child discussion, and denial by schools and communities may be contributing factors to the rise of drug use among adolescents. The In-DEPTH program, a unique drug education model that educates, prevents, and provides intervention strategies in adolescent marijuana use, has in small multisite surveys shown initial success in decreasing marijuana use and positively changing beliefs. The program is based on pharmacology, addiction medicine principles, economics and the pharmaceutical sales model, and examines drug dealing as well as drug use.

Stability of Revex, nalmefene hydrochloride injection.

The stability of Revex, nalmefene hydrochloride injection, has been studied at several temperatures for periods up to 36 months. The data were obtained using a HPLC method for the potency determination, and for the level of the sole degradation product (2,2'-bisnalmefene). These methods were found to be characterized by excellent precision, linearity, and accuracy over the analyte concentration ranges established. The stability data were found to be interpretable using first-order kinetics, and essentially comparable rate constants were calculated for both the potency loss and the formation of 2,2'-bisnalmefene. Applying the Arrhenius equation to these data, a rate constant of 0.00441 month-1 was deduced for the reactions taking place at 25 degrees C. This low value is consistent with the excellent stability exhibited by the product, and amply justifies its shelf life.

Credentials and skills required for hospital food and nutrition department directors.

The perceptions of hospital administrators, food and nutrition department directors, and management dietetic educators were compared with respect to the credentials and administrative skills required for a director of a food and nutrition department in a hospital with 300 beds or more. Questionnaires were mailed to the director of food and nutrition services and the vice president of hospital operations at 132 hospitals in five midwestern states. Fifty-six questionnaires were mailed to all educators on the 1986 to 1988 membership list of the Foodservice Systems Management Education Council. Response rates of directors, administrators, and educators were 68%, 53%, and 82%, respectively. The questionnaire consisted of three parts. Part one addressed credentials required; part two required participants to rank 14 skill categories in order of importance; and part three focused on facility descriptors and credentials of participating administrators and directors. Findings of the survey indicate that the minimum qualifications for department directors were registered dietitian status, at least a bachelor's degree in food and nutrition, and work experience in foodservice systems management. Although administrators ranked foodservice management skills higher than nutrition skills, they ranked nutrition skills significantly (p less than .001) higher than did directors or educators. These findings may guide career development of practitioners who aspire to department director positions.