Association between traumatic brain injury and prison charges: a population-based cohort study.

BACKGROUND: Traumatic Brain Injury (TBI) is a serious hidden health issue disproportionately affecting people who experience incarceration. OBJECTIVE: We examined the association between TBI and serious disciplinary charges among men and women sentenced by the courts to terms of two or more years. METHODS: The study originated in Ontario, Canada and used linked administrative health and correctional data. The cohort included adults experiencing their first federal sentence between 1998 and 2011 (N = 12,038). We examined disciplinary charges incurred 2 years post-sentence commencement. TBI was defined using the International Classification of Diseases (ICD-9 and ICD-10) diagnostic codes. Robust Poisson regression was conducted to assess the association between TBI and disciplinary charges. FINDINGS: The prevalence of TBI for the full sample was 13.2%. One-third of adults with a recent TBI had a serious disciplinary charge. The unadjusted risk of incurring a serious charge for those with a history of TBI was 39% higher than those with no history of TBI (CI: 1.29-1.49). The adjusted risk was 1.14 (CI: 1.06-1.22). CONCLUSIONS: TBI is a serious health concern that makes it difficult for incarcerants to adjust to prison. Additional support/resources are needed to support those with histories of TBI.

Approved and Off-Label Use of Prescribed Psychotropic Medications among Federal Canadian Inmates.

OBJECTIVE: To examine psychotropic medication prescription practices in federal Canadian penitentiaries. METHOD: 468 files were drawn from a purposive sample of thirteen Canadian federal institutions representing the five regions, different security levels, and male and female designated facilities. Information on the names of all psychotropic medications prescribed, indications for use, dosage, frequency, and route of administration was retrieved. Designation of approved or off-label use of medications was determined by consulting: (1) the Health Canada (2016) Drug Product Database, (2) the Canadian Compendium of Pharmaceuticals and Specialties 2016, and (3) the American Hospital Formulary Service Drug Information 2016. Prescription rates were examined by gender, Indigenous ancestry, drug class, institutional infractions, and current offence. RESULTS: 36.2% of prescriptions for psychotropic medication were coded as 'off-label'. Anxiolytic/hypnotics drugs were the psychotropic drugs most commonly used for off-label purposes. There were no differences in the prevalence of approved versus off-label prescriptions based on Indigenous ancestry or gender, and no pattern of elevated off-label prescription practices for offenders involved in institutional misconducts or those sentenced for the most serious crimes. CONCLUSIONS: The rates of prescribing 'off-label' psychotropic medication are not elevated relative to other correctional settings or to rates cited in Canadian surveys conducted in the community.

Social determinants of health among Canadian inmates.

Purpose International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical disorders relative to the general population. Although social determinants of health have been found to affect the mental health of a population, less information is available regarding the impact of social determinants on physical health, especially among offenders. The purpose of this paper is to examine the relationship between social determinants and the physical health status of federal Canadian offenders. Design/methodology/approach The study included all men admitted to federal institutions between 1 April 2012 and 30 September 2012 ( n=2,273) who consented to the intake health assessment. Logistic regression analyses were used to explore whether age group, Aboriginal ancestry, and each of the individual social determinants significantly predicted a variety of health conditions. Findings The majority of men reported having a physical health condition and had experienced social determinants associated with adverse health outcomes, especially men of Aboriginal ancestry. Two social determinants factors in particular were consistently related to the health of offenders, a history of childhood abuse, and the use of social assistance. Research limitations/implications The study is limited to the use of self-report data. Additionally, the measures of social determinants of health were indicators taken from assessments that provided only rough estimates of the constructs rather than from established measures. Originality/value A better understanding of how these factors affect offenders can inform strategies to address correctional health issues and reduce the impact of chronic conditions through targeted correctional education and intervention programmes.

The Impact of Participation in Victim-Offender Mediation Sessions on Recidivism of Serious Offenders.

The federal correctional agency in Canada offers victim-offender mediation services to address serious crime. The current study used survival analysis to compare revocation rates of 122 offenders who participated in facilitated face-to-face meetings to a matched sample of 122 of non-participants. Results indicated that there was no significant difference between revocation rates when offenders participated while incarcerated, although the trend was that participants did better. When the meetings were held in the community post-release, however, participants were significantly more likely to spend a longer period of time under supervision in the community without returning to custody and were less likely to be revoked than their matched counterparts. The findings support participation in restorative justice sessions while under community supervision for higher risk offenders with histories of serious and violent crimes. The authors discuss how factors not controlled in the matching procedure may have contributed to this effect.

MicroRNA-34a dependent regulation of AXL controls the activation of dendritic cells in inflammatory arthritis.

Current treatments for rheumatoid arthritis (RA) do not reverse underlying aberrant immune function. A genetic predisposition to RA, such as HLA-DR4 positivity, indicates that dendritic cells (DC) are of crucial importance to pathogenesis by activating auto-reactive lymphocytes. Here we show that microRNA-34a provides homoeostatic control of CD1c+ DC activation via regulation of tyrosine kinase receptor AXL, an important inhibitory DC auto-regulator. This pathway is aberrant in CD1c+ DCs from patients with RA, with upregulation of miR-34a and lower levels of AXL compared to DC from healthy donors. Production of pro-inflammatory cytokines is reduced by ex vivo gene-silencing of miR-34a. miR-34a-deficient mice are resistant to collagen-induced arthritis and interaction of DCs and T cells from these mice are reduced and do not support the development of Th17 cells in vivo. Our findings therefore show that miR-34a is an epigenetic regulator of DC function that may contribute to RA.

Outcomes of Offenders With Co-Occurring Substance Use Disorders and Mental Disorders.

OBJECTIVE: Whether a diagnosis of a mental disorder contributes to the risk of poorer correctional outcomes is controversial. This study aimed to clarify the extent to which mental and substance use disorders individually and in combination contribute to correctional outcomes in order to determine optimal treatment and promote public safety. METHODS: Differences were examined between four groups of federal offenders in Canada (N=715): those with a mental disorder only, those with a substance use disorder only, those with co-occurring mental and substance use disorders, and those with no disorder. Groups were compared on profiles, criminal histories, charges while incarcerated (institutional charges), and reconvictions after release from incarceration by using chi-square tests and Cox regression analyses that controlled for risk factors. RESULTS: Of the four groups, those with co-occurring disorders had the most substantial criminal histories and the highest rates of institutional charges, transfers to segregation while incarcerated, and reconvictions. The group with only mental disorders had outcomes intermediate between the groups with only substance use disorders and the group with neither type of disorder. CONCLUSIONS: Having a substance use disorder appeared to be the key factor contributing to poorer correctional outcomes for offenders with mental disorders. Psychiatric services in correctional facilities must screen for substance use disorders and, if they are present, ensure provision of treatment to improve quality of life for this population and promote public safety.

Chronic Health Conditions Among Incoming Canadian Federally Sentenced Women.

Over a 13-month period, health data on all consecutive incoming Canadian federally sentenced women offenders were collected and analyzed ( N = 280). The most common health conditions cited were back pain, head injury, hepatitis C virus (HCV), and asthma. Rates of chronic health problems were generally similar to those of their male offender counterparts, with the notable exception of HCV, which was higher for women. Aboriginal women offenders had particularly high rates of HCV. The study provides valuable information on the self-reported physical health status of federally sentenced women offenders that can be used as a benchmark to examine health trends over time.

The impact of a community mental health initiative on outcomes for offenders with a serious mental disorder.

BACKGROUND: The Community Mental Health Initiative (CMHI) is mandated to assist offenders with serious mental disorders in their transition from institutions to the community, but this incorporates different styles of service. An important unanswered question is whether these are equivalent. AIMS/HYPOTHESES: Our aim was to compare outcomes for different intervention styles within the CMHI, a programme for serious offenders in prison who also have at least one major mental disorder. Our specific research questions were as follows: do outcomes differ according to whether offenders with mental health difficulties receive (1) clinical discharge planning only; (2) community mental health services only; (3) the combined services or (4) none, although meeting criteria for any CMHI service? METHODS: Survival analyses, controlling for variables with a significant effect on recidivism or return to prison, were used to test for differences in recidivism or return to prison rates between the intervention and no-intervention groups during a fixed follow-up period. RESULTS: Men receiving only community mental health services had a significantly lower risk of returning to custody and of recidivism than men receiving discharge planning alone or no community mental health service at all, even after controlling for potential confounders including age, number of previous imprisonments and number of previous community failures. The advantages were apparent within 3-6 months and sustained for up to 4 years. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Provision of specialised community mental health services for higher-risk male offenders with a mental disorder may reduce recidivism in the short and longer term - within 3 months and up to 4 years respectively. Statistical modelling also pointed to the need to include treatment for substance abuse and assistance in identifying stable accommodation and brokerage of community services among the interventions and services. Copyright © 2016 John Wiley & Sons, Ltd.

The role of microRNA-155/liver X receptor pathway in experimental and idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is progressive and rapidly fatal. Improved understanding of pathogenesis is required to prosper novel therapeutics. Epigenetic changes contribute to IPF; therefore, microRNAs may reveal novel pathogenic pathways. OBJECTIVES: We sought to determine the regulatory role of microRNA (miR)-155 in the profibrotic function of murine lung macrophages and fibroblasts, IPF lung fibroblasts, and its contribution to experimental pulmonary fibrosis. METHODS: Bleomycin-induced lung fibrosis in wild-type and miR-155-/- mice was analyzed by histology, collagen, and profibrotic gene expression. Mechanisms were identified by in silico and molecular approaches and validated in mouse lung fibroblasts and macrophages, and in IPF lung fibroblasts, using loss-and-gain of function assays, and in vivo using specific inhibitors. RESULTS: miR-155-/- mice developed exacerbated lung fibrosis, increased collagen deposition, collagen 1 and 3 mRNA expression, TGF-ß production, and activation of alternatively activated macrophages, contributed by deregulation of the miR-155 target gene the liver X receptor (LXR)α in lung fibroblasts and macrophages. Inhibition of LXRα in experimental lung fibrosis and in IPF lung fibroblasts reduced the exacerbated fibrotic response. Similarly, enforced expression of miR-155 reduced the profibrotic phenotype of IPF and miR-155-/- fibroblasts. CONCLUSIONS: We describe herein a molecular pathway comprising miR-155 and its epigenetic LXRα target that when deregulated enables pathogenic pulmonary fibrosis. Manipulation of the miR-155/LXR pathway may have therapeutic potential for IPF.

Association between traumatic brain injury and incarceration: a population-based cohort study.

BACKGROUND: There is recent evidence to suggest that sustaining a traumatic brain injury (TBI) increases risk of criminal justice system involvement, including incarceration. The objective of this study was to explore the association between TBI and risk of incarceration among men and women in Ontario. METHODS: We identified a cohort of 1.418 million young adults (aged 18-28 yr) on July 1, 1997, living in Ontario, Canada, from administrative health records; they were followed to Dec. 31, 2011. History of TBI was obtained from emergency and hospital records, and incarceration history was obtained from the Correctional Service of Canada records. We estimated the hazard of incarceration using Cox proportional hazard models, adjusting for relevant sociodemographic characteristics and medical history. RESULTS: There were 3531 incarcerations over 18 297 508 person-years of follow-up. The incidence of incarceration was higher among participants with prior TBI compared with those without a prior TBI. In fully adjusted models, men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI. INTERPRETATION: Traumatic brain injury was associated with an increased risk of incarceration among men and women in Ontario. Our research highlights the importance of designing primary, secondary and tertiary prevention strategies to mitigate risk of TBI and incarceration in the population.

MicroRNA-155 regulates monocyte chemokine and chemokine receptor expression in Rheumatoid Arthritis.

OBJECTIVE: To test the hypothesis that miR-155 regulates monocyte migratory potential via modulation of chemokine and chemokine receptor expression in RA, and thereby is associated with disease activity. METHODS: The miR-155 copy-numbers in monocytes from peripheral blood (PB) of healthy (n = 22), RA (n = 24) and RA SF (n = 11) were assessed by real time-PCR using synthetic miR-155 as a quantitative standard. To evaluate the functional impact of miR-155, human monocytes were transfected with control or miR-155 mimic, and the effect on transcript levels, and production of chemokines was evaluated by Taqman low-density arrays and multiplex assays. A comparative study evaluated constitutive chemokine receptor expression in miR-155-/- and wild-type murine (CD115 + Ly6C + Ly6G-) monocytes. RESULTS: Compared with healthy monocytes, the miR-155 copy-number was higher in RA, peripheral blood (PB) and SF monocytes (PB P < 0.01, and SF P < 0.0001). The miR-155 copy-number in RA PB monocytes was higher in ACPA-positive compared with ACPA-negative patients (P = 0.033) and correlated (95% CI) with DAS28 (ESR), R = 0.728 (0.460, 0.874), and with tender, R = 0.631 (0.306, 0.824) and swollen, R = 0.503 (0.125, 0.753) joint counts. Enforced-expression of miR-155 in RA monocytes stimulated the production of CCL3, CCL4, CCL5 and CCL8; upregulated CCR7 expression; and downregulated CCR2. Conversely, miR155-/- monocytes showed downregulated CCR7 and upregulated CCR2 expression. CONCLUSION: Given the observed correlations with disease activity, these data provide strong evidence that miR-155 can contribute to RA pathogenesis by regulating chemokine production and pro-inflammatory chemokine receptor expression, thereby promoting inflammatory cell recruitment and retention in the RA synovium.

National Prevalence of Mental Disorders among Incoming Canadian Male Offenders.

OBJECTIVE: A current estimate of prevalence rates of mental disorder among Canadian federal offenders is required to facilitate treatment delivery and service planning. METHOD: The study determined prevalence rates of major mental disorders among newly admitted male offenders entering the federal correctional system in Canada. Data were collected at each regional reception site on consecutive admissions for a 6-month period (N = 1110). Lifetime and current prevalence rates were estimated using the Structured Clinical Interview for DSM Axis I Disorders (SCID-I) and the SCID Axis II Disorders (SCID-II). Degree of impairment was estimated using the Global Assessment of Functioning (GAF) scale. Results were disaggregated by Aboriginal ancestry. RESULTS: The national prevalence rate for any current mental disorder was 73%. The highest rates were for alcohol and substance use disorders; however, over half of participants met the lifetime criteria for a major mental disorder other than alcohol or substance use disorders or antisocial personality disorder. Thirty-eight percent met the criteria for both a current mental disorder and one of the substance use disorders. Fifty-seven percent of offenders with a current Axis I mental disorder were rated as experiencing minimal to moderate functional impairment based on the GAF, indicating that most participants do not require intensive psychiatric services. CONCLUSIONS: These results underscore the challenge posed to Canadian federal corrections in providing the necessary mental health services to assist in the management and rehabilitation of a significant percentage of the offender population with mental health needs.

Offenders with Cognitive Deficits in a Canadian Prison Population: Prevalence, Profile, and Outcomes.

Impaired cognitive function has been associated with criminal behavior. In Canada it is unknown the extent to which this disorder affects federal inmates or its impact on key correctional outcomes. In this study, 488 incoming male offenders were assessed on the Cognistat, a neuropsychological screening tool. Twenty-five percent of offenders were found to have some level of cognitive deficit. Lower levels of educational achievement, unstable employment history, learning disability, serious alcohol problems, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were significantly associated with the presence of cognitive deficits in this sample. Although there was a significant trend for offenders with cognitive deficits to have more admissions to segregation, level of cognitive deficit was not consistently related to rates of institutional charges or rates of completion of required correctional programs. On release, cognitive deficits were not related to returns to custody or returns to custody with an offence. These results indicate that while offenders with cognitive deficits may require assistance with educational upgrading and employment to improve their reintegration potential, they do not pose a particular management problem in the community after release relative to offenders without cognitive deficits.

Chronic health conditions reported by male inmates newly admitted to Canadian federal penitentiaries.

BACKGROUND: International health studies have shown that inmates have higher rates of infectious diseases, chronic diseases and psychiatric disorders relative to the general population. We conducted a systematic collection of data on chronic physical health conditions reported by newly admitted inmates in Canadian federal penitentiaries. METHODS: Over a 6-month period from April to September 2012, we collected and analyzed data from a standardized health interview routinely conducted with consenting incoming male inmates (n = 2273). Prevalence rates of health conditions were determined and disaggregated by age (< 50 yr and ≥ 50 yr) and by Aboriginal status. RESULTS: The most common health conditions reported by respondents were head injury (34.1%), back pain (19.3%), asthma (14.7%) and hepatitis C virus (HCV) infection (9.4%). Rates of many health conditions were higher among inmates 50 years of age or older than among younger inmates. Compared with their non-Aboriginal counterparts, Aboriginal inmates had higher rates of head injury and HCV infection. INTERPRETATION: Our study provides a benchmark that can be used to examine health trends within Canada's federal penitentiaries over time and points to subgroups of newly admitted inmates for whom health services may need to be concentrated.

The Effectiveness of the Tupiq Program for Inuit Sex Offenders.

This study examines the effectiveness of the Tupiq program, a culturally specific program for Inuit sex offenders that incorporates cognitive behavioural methods with traditional Inuit knowledge and culture led by Inuit healers and facilitators. Outcomes of 61 offenders who participated in the Tupiq program and were released were compared with outcomes of a cohort of 114 released Inuit sex offenders incarcerated during the same time period who had taken alternative sex offender treatment programs, or had not attended any sex offender program. On release, Tupiq participants had significantly lower rates of general reoffending and violent reoffending than those in the combined comparison group. The hazard of reoffending for the comparison group was almost twice that of the Tupiq group. Although the sexual reoffending rate for the Tupiq participants was less than half of that of the comparison group, the difference between the two groups was not significant because of reduced statistical power. Survival analysis controlling for covariates confirmed significantly lower rates of general reoffending for the Tupiq group. Further analyses comparing the outcomes of the subgroup of offenders in the comparison group who participated in alternative sex offender treatment programs with those who participated in Tupiq indicated that Tupiq participants had significantly lower rates of both general and sexual reoffending. These positive results for this culturally specific program suggest that similarly designed interventions have a probability of contributing to the reduction of sexual offending within Inuit communities and, potentially, other jurisdictions that work with cultural minority sex offender groups from relatively isolated communities.

Profile and programming needs of federal offenders with histories of intimate partner violence.

This study presents data on male perpetrators of domestic violence (DV) in the Correctional Service of Canada (CSC) using two samples: (a) a snapshot of all male offenders in CSC who had been assessed for DV (n = 15,166) and (b) a cumulative sample of male offenders in CSC from 2002-2010 who had been assessed as moderate or high risk for further DV (n = 4,261) DV offenders were compared to a cohort sample of non-DV offenders (n = 4,261). Analyses were disaggregated for Aboriginal and non-Aboriginal offenders. Results indicated that 40% of the federal male population had a suspected history of DV and were therefore screened in for in-depth DV risk assessment. Of these, 45% were assessed as moderate or high risk for future DV. DV offenders had higher risk and criminogenic need ratings, more learning disabilities, more mental health problems, and more extensive criminal histories than those without DV histories. Aboriginal DV offenders had high levels of alcohol dependence, suggesting a need for substance abuse treatment as part of DV programming. Most federal offenders with DV histories would be described as belonging to the Antisocial/Generalized Aggressive typology and, therefore, adhering to the Risk-Need-Responsivity principles of the effective correctional literature, cognitive-behavioral treatment that focuses on teaching skills of self-management, and changing attitudes supporting relationship violence would be recommended.

Effectiveness of correctional programs with ethnically diverse offenders: a meta-analytic study.

Numerous studies have examined the effects of cognitive-behavioural therapy (CBT) on criminal recidivism, and several meta-analyses have confirmed the overall effectiveness of this approach. Few studies, however, have examined the efficacy of these programs specifically with adult offenders from diverse ethnic backgrounds. The present research uses meta-analytic techniques to examine the outcomes for Canadian federal offenders participating in correctional programs according to self-identified ethnic group (Caucasian, Aboriginal, Black, and Other). Correctional programs within the Correctional Service of Canada adhere to the Risk, Need, Responsivity principles outlined in the effective correctional literature. Within-group analyses compared offenders from the same ethnic background who participated in correctional programs with a nontreatment comparison group. Odds ratios ranged from 1.36 to 1.76, indicating significant reductions in recidivism for offenders participating in correctional programs, regardless of ethnic status. Furthermore, the difference in effect size magnitude between ethnic groups was nonsignificant suggesting offenders from a wide variety of ethnic backgrounds can benefit from correctional programs rigorously developed and implemented using a CBT framework.

Attention deficit hyperactivity disorder in a Canadian prison population.

Previous research has shown that a significant percentage of offenders are affected by adult attention deficit hyperactivity disorder (ADHD) and its related symptoms, however it is unknown the extent to which this disorder affects federal inmates in Canada and the impact ADHD has on key correctional outcomes. Four hundred and ninety-seven male federal offenders were assessed at intake over a fourteen month period using the Adult ADHD Self-Report Scale (ASRS). Approximately 16.5% scored in the highest range, which is consistent with the clinical threshold for diagnosis for the disorder; a further 25.2% reported sub-threshold symptoms in the moderate range. ADHD symptoms were found to be associated with unstable job history, presence of a learning disability, lower educational attainment, substance abuse, higher criminal risk and need levels, and other mental health problems. ADHD symptoms were also found to predict institutional misconduct. Additionally, offenders with high levels of ADHD symptomatology fared more poorly on release to the community. Implications for institutional behavior management and the need for additional resources and adapted interventions are discussed.