Infectious diseases in post-trial detention and comparisons with pre-trial detention: A study in Geneva, Switzerland.

BACKGROUND: Prevalence rates of infectious diseases in post-trial prisons have been scarcely investigated. Due to the specific characteristics of these prison populations, these prevalence rates may differ from pre-trial prisons and more information is needed for developing adequate prevention and treatment interventions. This study compared prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV), susceptibility to varicella zoster virus (VZV) and measles in pre- and post-trial detention. METHODS: Data were collected in Geneva post-trial prisons among males (n=250), including serological tests, demographics, and risk factors, and were compared to those of the Geneva pre-trial prison (n=273). RESULTS AND CONCLUSIONS: Incarcerated men in post-trial detention shared a disproportionate burden of infectious diseases compared to community (chronic HBV: 5.9%, HVC: 2.8%, susceptibility to VZV: 5.9%, to measles: 4.7%). Susceptibility to VZV and prevalence rate of HCV were lower in post-trial prisons (p=.034 and p=.080). Prevalence rates of infectious diseases in prison should be interpreted in light of the prison population's characteristics. Screening and treatment should be promoted in all types of prison settings. Since overcrowding and turnover of pre-trial prisons restrict the access to screening, prevention and treatment of infectious diseases, interventions are crucial in post-trial prisons.

Opioid substitution treatment in pretrial prison detention: a case study from Geneva, Switzerland.

BACKGROUND: Opioid substitution treatment (OST) is not uniformly provided in all prisons as recommended by international guidelines. The Swiss prison of Champ-Dollon in Geneva is an exception, where OST has been available for the last 20 years. The aims of this study were to describe the OST programme in this pretrial prison setting, and the patients involved. METHODS: We reviewed health records of 2566 detainees entering Switzerland's largest pretrial prison in 2007. Sociodemographic characteristics, substance use diagnosis and history, OST history and prison course, medical complications, and evidence of OST side effects were assessed by questionnaire. RESULTS: The mean age was 29.6 years (SD 7.1) and 95.4% of prisoners were male. Among 233 opioid users (9.1%) at baseline, 221 (94.8%) used other substances, and 39.9% had used drugs intravenously. Opioid dependence was confirmed in 71.2% of opioid users. OST was offered to all dependent users, and all patients accepted treatment. Methadone was the treatment of preference, with a prescribed mean dose of 41.7 mg (standard deviation 29.1) upon departure. No serious side effects or death by overdose occurred. There was postrelease OST continuity-of-care for 49.7% of OST patients. CONCLUSIONS: Prescription of OST for opioid dependent detainees by trained physicians is feasible and safe in a pretrial setting. The methadone dose was lower when compared with general OST treatment recommendations. Nevertheless, treatment was available in accordance with national and international guidelines. In-prison OST offers access to a much needed and safe healthcare service for this vulnerable population.

Health care in small prisons: incorporating high-quality standards.

PURPOSE: In the past, health management in Geneva's six post-trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re-organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards. DESIGN/METHODOLOGY/APPROACH: Geneva's post-trial prisons are small and close to one another in geographical proximity - ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process. FINDINGS: The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence. ORIGINALITY/VALUE: From the perspective of the HMT members, the authors provide the "lessons learned" through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.

Hunger strike among detainees: guidance for good medical practice.

Hunger strike is a regularly reported problem in prison. Although clinical situations are rarely severe, hospitalisation is often considered. In consequence, it is not only physicians working in prisons, but also hospital medical teams who face challenges related to hunger strike, involving somatic, psychological, legal and human rights aspects. Furthermore, deontological rules must be strictly respected when delivering care, particularly in prison setting. Starvation involves metabolic changes and can cause severe, and sometimes even irreversible or fatal complications. Moreover, the phase of re-alimentation should not be trivialised, as re-feeding syndrome is a potentially fatal phenomenon. This article provides guidance for monitoring and management of patients on hunger strike.

Implementation and impact of anti-smoking interventions in three prisons in the absence of appropriate legislation.

OBJECTIVE: To assess the acceptability and impact of anti-smoking policies in three prisons in Switzerland. METHODS: A before-after intervention study in A) an open prison for sentenced prisoners, B) a closed prison for sentenced prisoners, and C) a prison for pretrial detainees. Prisoners and staff were surveyed before (2009, n=417) and after (2010-2011, n=228) the interventions. Medical staff were trained to address tobacco dependence systematically in prisoners. In prison A, a partial smoking ban was extended. No additional protection against second-hand smoke was feasible in prisons B and C. RESULTS: In prison A, more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, p=0.012). In prison A, prisoners and staff reported less exposure to second-hand smoke in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (p=0.001); in common rooms: 43% vs 8%, (p<0.001). No changes were observed in prisons B and C. CONCLUSIONS: Reinforcement of non-smoking rules was possible in only one of the three prisons but had an impact on exposure to tobacco smoke and medical help to quit. Implementing anti-smoking policies in prisons is difficult in the absence of appropriate legislation.

[Oral health as the mirror of health: the primary care medicine's poor relative?]. / L'etat buccodentaire comme miroir de la santé: l'enfant pauvre de la médecine de premier recours?

Oral health (OH) is indivisible from general health. Several studies have established the link between morbi-mortality, especially cardiovascular, and bad OH, particularly in the case of edentation. Regrettably, part of the population choses dental care renunciation for financial reasons. The primary care physician (PCP), as the health professionnal with the most frequent and intense contacts with the patients, plays an important role to reinforce prevention measures, OH maintenance and to detect oral pathologies. To fulfill this mission, he has to be trained to endo-buccal examination. Furthermore, both the PCP and the dentist have to proactively build an interprofessional approach to promote patients' OH.

Improvement of measles immunity among migrant populations: lessons learned from a prevalence study in a Swiss prison.

BACKGROUND: Measles persists worldwide despite the implementation of general vaccination campaigns. The environmental and demographic characteristics in many prisons increase the risk of measles epidemics. A large proportion of inmates come from countries where immunisation coverage is low. We aimed to estimate the susceptibility to measles among prisoners in order to implement preventative measures. METHODS: Serology screening for measles was carried out among 116 inmates in Switzerland's largest pre-trial prison. Socio-demographic characteristics were collected through a structured questionnaire. Risk factors for lack of measles immunity were examined. RESULTS: A total of 7 out of 116 (6%) inmates were not immune to measles. All 37 inmates from sub-Saharan Africa were immune. Considering only people native from regions other than sub-Saharan Africa, 7 of 40 inmates born after 1981 were susceptible (18.5%), whereas none of the 39 inmates born in 1981 or before were susceptible (p = 0.006). CONCLUSION: Susceptibility to measles was fairly low in this prison population composed mainly of migrants. Living in sub-Saharan Africa during childhood, and birth before 1982 were protective factors associated with the presence of immunity against measles. The heterogeneity of vaccination campaigns in the various regions of the world, particularly in terms of the timing of their introduction and scale of diffusion, explains epidemiological variability. Targeted vaccination in accordance to origin and age would offer excellent herd immunity and would substantially reduce risks of outbreaks as well as costs.

[Pain and its treatment in prison]. / Douleur, antalgie et milieu carcéral: quelles spécificités?

Frequency of pain in detention contrasts with the scarcity of the literature about this precise topic. Prescription practice makes a point of best observing the fundamental principles of penitentiary medicine, including the equivalence of care. Addictive pathology is highly prevalent. Analgesia for individuals with physical dependence to opioids requires specific knowledge and skills to avoid symptom underestimating. In case of in-cell prescription drugs accumulation, pain killers are among the most frequently found. This stirs up a questioning on good medical practice, prescription's appropriateness and both symbolic and practical roles of these pilings. Current knowledge is insufficient for answering to it. For the moment, the classical guideline of multidimensional management applies.

[Hunger strike and forced feeding: a historical look at medical practices]. / Jeûne de protestation et alumentation forcée: relevé de pratiques historiques.

Hunger strike is not a disease but a common situation in prisons. This article takes a historical look at medical practices in connection with the forced feeding of hunger strikers. We now know the fate of the strikers who were subjected to forced feeding. Depending on the context and the political situation in the country, the fate of these people, mostly political prisoners, is described as humiliating and abominable frequently ending in death or irreparable consequences. Particularly difficult for health professionals, this act raises clinical, ethical and legal questions and refers to the fundamental principles of medicine.