Acute drug-related mortality of people recently released from prisons.

The rate of acute drug-related mortality, or overdose deaths, among prisoners in the immediate post-release period is unacceptably high. Such incidents result from many factors, including decreased tolerance after a period of relative abstinence during imprisonment and the concurrent use of multiple drugs which, with every additional illicit drug consumed in combination with opioids, nearly doubles the risk of death from opioids. Other important factors are the lack of pre-release counselling, post-release follow-up and failure to identify those at risk. Substance dependence is a chronic disorder with high relapse rates and often requires long-term continuous treatment. The deaths are preventable and a number of interventions including opioid substitution treatment reduces the risk of overdose among opioid users after release.

Women's health in prisons: it is time to correct gender insensitivity and social injustice.

Women form a minority group within the prisons of Europe. Prisons have been built and they are run with the needs of the majority of prisoners in mind, namely men. Evidence collected throughout Europe about women's health in prisons showed that the services provided in some countries failed to meet even basic needs of women and provided examples of considerable gender insentivity and failures to observe their human rights. Along with UNODC, a joint report was issued called the WHO/UNODC Declaration which presented the evidence and made recommendations for urgently required improvements.

Women in prison: the central issues of gender characteristics and trauma history.

Insufficient attention is being paid to two key issues which are critical to a better understanding of what can be done to improve present services for women in prison. Firstly, the demographics, determinants and profiles of imprisoned women clearly show factors that should be central to any prison policy for women. Secondly, an analysis of the role of trauma history shows its strong influence on offending behaviour. Any modern approach to providing a more acceptable criminal justice policy for women must pay much greater attention to these two important issues.

Good practice for mental health programming for women in prison: reframing the parameters.

Afflicting the majority of female offenders, mental illness is grossly over-represented among incarcerated women. It is a substantial contributor to the poor health status of this population. Of particular concern are the effects of trauma and substance use disorders, which are often a result of past victimization. The prison experience frequently compounds this disadvantage and psychological distress by failing to address the underlying trauma and the particular mental health needs of female prisoners. Evidence-based best-practice models are summarized in this paper. The conclusion reached advocates for integrated trauma-informed mental health service provision and programming which target the complexity of mental health concerns among women in prison.

Drug use in prisons in Kyrgyzstan: a study about the effect of health promotion among prisoners.

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and needle/syringe exchange (NSE) programmes have been shown to decrease risk behaviour among injecting drug users. In Kyrgyzstan, an intervention study with training of prison staff and prisoners was performed in one prison. Before and after the training, a random selection of the prisoners answered a questionnaire about drug use, risk behaviour and health care. The survey was carried out in both the intervention prison and in a reference prison. The number of drug users, the use of drugs and risk behaviour were improved significantly within half a year and, especially, the injection and use of drugs decreased in the intervention group. The study clearly shows that increased focus, improved healthcare and training of prisoners and staff on drug use and harm reduction can reduce both use of drugs and risk behaviour.

[Self-rated health as a predictor of ischemic heart disease development]. / Selvvurderet helbred som praediktor for udvikling af iskaemisk hjertesygdom.

The study objective was to analyse the association between self-rated health and the incidence of fatal and non-fatal coronary heart disease in a Danish cohort followed up over 16 years. The study included 1052 men and women born in 1936. During the 16 years' follow-up 50 cases of coronary heart disease were registered either with the Danish register of deaths or the register of hospital admissions. Univariate analysis showed the following relative risks of coronary heart disease in the four self-rated health groups: "extremely good": 1.0, "good": 4.0, "poor": 5.8, "miserable": 12.1 (p = 0.02). After control for the conventional coronary risk factors and a substantial number of other potential confounders the relative risks were: 1.0, 4.2, 6.5, and 18.6 (p = 0.02) respectively. Self-rated health was an independent predictor of coronary heart disease in this recent cohort. If confirmed, the association between self-rated health and coronary heart disease may lead to new insights into psychosocial processes leading to this disease.

[Influenza vaccination of the elderly in the municipality of Copenhagen]. / Influenzavaccination af aeldre i Københavns Kommune.

In October/November 1996 all people living in the city of Copenhagen aged 70 and above were invited to receive an influenza vaccination. Of a total of 62,600 people, 35,423 were vaccinated which is a participation rate of 56%. The participation rate increased with increasing age and in the older age groups the participation rate was 80%. The vaccinations were performed by nurses and most of the participants were vaccinated in special clinics (74.9%). Immobile participants were vaccinated either in their own homes (14.3%), in nursing homes (9.2%), or in hospitals (1.6%). One single case of hospitalisation of a chronically ill patient was registered, because of a weak influenza. No other side effects were registered. The total cost of all vaccinations was 4 million dkr. which is 115 dkr. (approximately 10 Pounds sterling) for each vaccination.

Elevated insulin levels in men: an 11-year follow-up study.

BACKGROUND: Hyperinsulinaemia is linked to cardiovascular disease. This follow-up study examines factors influencing the fasting insulin level in men. METHODS: All men born in 1936 living in a certain area within the county of Copenhagen were invited for a health examination in 1976 and 1987; 425 men (73%) participated in both examinations. The following variables were analysed: fasting insulin levels, body mass index (BMI), fasting blood glucose, physical activity during leisure time, alcohol consumption and smoking. RESULTS: In both multivariate analyses at age 40 years and age 51 years, the BMI, the fasting glucose level and lack of physical activity showed a positive independent association with the insulin level. In follow-up analyses over 11 years, only BMI changes and fasting glucose changes were associated with changes in insulin level. CONCLUSIONS: Our analyses suggest that BMI and changes in BMI over a period of time are major risk factors for an elevation of the serum insulin level, but that physical activity may have beneficial effects on the insulin level.

Fasting serum insulin levels and coronary heart disease in a Danish cohort: 17-year follow-up.

AIM: Our objective was to examine the association between the fasting serum insulin level and coronary heart disease (CHD) and cardiovascular disease in 40-year-old men and women. METHODS: In 1976, all of the men and women born in 1936 living in four municipalities in the County of Copenhagen were invited for a health examination. The participation rate was 87% (504 men and 548 women). All of the participants were followed through the Danish register of deaths and the register of hospital admissions until 1993. RESULTS: After controlling for relevant risk factors (sex, fasting glucose, total cholesterol, high density lipoprotein cholesterol, systolic blood pressure, smoking, triglycerides, body mass index, physical activity and alcohol consumption) the P value for the association between the insulin level and CHD or cardiovascular disease was found to be 0.002; the above risk factors did not appear to be intermediate variables in a causal chain from insulin level to the development of CHD or cardiovascular disease. The significant association between body mass index and CHD disappeared when the fasting insulin level was controlled for, and insulin seemed to be an intermediate factor between body mass index and CHD. CONCLUSION: The fasting serum insulin level in both men and women is a very good predictor of the development of CHD and cardiovascular disease even after controlling for relevant confounding factors.

[Smoking and sudden infant death]. / Rygning og pludselig uventet spaedbarnsdød.

Sudden Infant Death Syndrome (SIDS) is a death where autopsy and other examinations cannot explain the proper cause of death. Epidemiologic studies have recognized some risk factors, namely prone sleeping position, lack of breast feeding, overheating, and maternal smoking. In Denmark, the official recommendation concerning the prone sleeping position was changed in December 1991, and since then the incidence of SIDS has been diminished by approximately 60-70%. A large number of epidemiologic studies find that there is a possible risk for SIDS in connection with maternal smoking. The odds ratio for a pregnant smoker to lose an infant to SIDS is about 2-4. Thirty to forty percent of Danish women smoke during pregnancy, and about half of all children are exposed to passive smoking in their homes. These data show that about 20% of the SIDS cases are due to maternal smoking. Further information and individual advice to pregnant, smoking women and their partners are needed. The authors suggest that this advice should become part of the existing ante-natal care programme.

[Lead--a possible risk factor of increased blood pressure and cardiovascular disease]. / Bly--en mulig risikofaktor for forhøjet blodtryk og hjerte-kar-sygdom.

Many epidemiological and animal experiment studies support the hypothesis of there being a causal association between lead exposure and increased blood pressure/cardiovascular disease. This study includes 1,052 men and women from Copenhagen County, Denmark, who were examined in 1976 and 1981; in 1987, only the men were examined. Blood lead fell by approximately 40% for the men during the 11-year period and by approximately 30% for the women during the first 5-year period. There was a univariate association between systolic blood pressure and blood lead for both sexes in 1976, but it disappeared at the following examinations. The authors found a significant univariate association between changes in blood lead and changes in systolic blood pressure from 1976 to 1987 in the males. All participants taking part in the study in 1976 were followed with respect to hospital admissions and deaths throughout a follow-up period lasting 14 years. There was a significant univariate association between blood lead levels in 1976 and total mortality, coronary heart disease, and cardiovascular disease. However, with regard to coronary heart disease and cardiovascular disease, the association disappeared when controlling for confounders. Blood lead was a significant predictor of total mortality after control for relevant confounders. This study supports the hypothesis of there being a weak causal association between blood lead and blood pressure, total mortality, coronary heart disease, and cardiovascular disease. The importance of this association is very modest for the individual, but the population attributable risk may be considerable.

[Alcohol consumption in a Danish cohort study over a period of 11 years]. / Alkoholforbruget i en dansk kohorte gennem 11 år.

A cohort living in Copenhagen County, originally consisting of 1198 persons, 577 men and 621 women, who were 40 years old in 1976, was reexamined in 1981 and again in 1987, 1052 (88%) participated in 1976, 922 (84%) in 1981, and 965 (85%) in 1987. The purpose of this study was to describe alcohol consumption changes in the cohort, with a view to identifying subgroups who significantly change their alcohol consumption behaviour. The same questionnaire was employed all three times to measure the alcohol consumption level and frequency. Alcohol consumption peaked in 1981 (45-years old) with 10.4 drinks on average a week. Men increased 8% and women 37%. There is an overall downward tendency in the consumption frequency among men whereas the opposite is the case among women. The two groups are converging toward a weekly consumption level. It seems now that the women are leading the change in the content of consumption with relatively more wine consumption. Therefore it is concluded that female consumption should be considered a target in future preventive programs.

[Social status and cardiovascular risk factors in Danish males]. / Social status og kardiovaskulaere risikofaktorer hos danske maend.

In a prospective investigation of a cohort of 504 men from the population studies in Glostrup, the participants were examined at the ages of 40 and 51 years. On both of these occasions, the social status was investigated together with a series of cardiovascular risk factors. The main hypothesis of the investigation was that the risk of cardiovascular disease was greater the lower the social status. This hypothesis was confirmed as regards the following risk factors at the examination at the age of 51 years: Plasma-fibrinogen (p less than 0.001), low stature (p less than 0.001), smoking (p less than 0.05), physical inactivity during leisure time (p less than 0.01), shift work (p less than 0.05), job strain (p less than 0.05), living alone (p less than 0.01) and a poor social network (p less than 0.05). Two factors showed a significantly opposite association with social status: Type A behaviour (p less than 0.001) and physical inactivity during work (p less than 0.001). In many countries, during the past 10-15 years, a tendency towards an even more marked association between social status and the risk factors for cardiovascular disease has been observed. This tendency was not observed in the present investigation.

[Plasma fibrinogen and cardiovascular disease]. / Plasma-fibrinogen og hjerte-kar-sygdom.

In prospective epidemiological studies the plasma fibrinogen level is correlated to cardiovascular diseases even after statistical correction for the major risk factors. The fibrinogen level is positively correlated with many risk factors such as life-style variables including smoking, lack of physical activity and high-fat diet. Psychosocial variables are in many studies closely correlated with the fibrinogen level even after adjustment for the traditional (established) risk factors.

Physical activity, physical fitness, and cardiovascular risk factors.

Physical activity at work and during leisure time, physical fitness, and cardiovascular risk factors are analysed in a birth cohort of 577 Danish men examined in 1976 at age 40 and in 1987 at age 51. Despite increasing age, the physical activity over the 11 years was relatively constant during leisure time, but decreasing at work. While there was no correlation between socioeconomic status and physical activity during leisure time at age 40, there was a clear tendency towards greater activity among those belonging to the higher social strata in the study of the 51-year-old. At both time points, there was a negative correlation between socio-economic status and physical activity at work; that is, physical activity at work decreases with increasing socio-economic status. There was no tendency towards a more beneficial cardiovascular risk profile among those increasing their physical activity during leisure time as compared with those with a constant or decreasing activity. As expected, physical activity during leisure time correlated with the cardiovascular risk factors, whereas physical activity at work did not. Increased physical activity during leisure time reduced the serum cholesterol level only in those men who concomitantly reduced their body weight. The study corroborates results from other countries demonstrating increasing inequalities between social strata as to the distribution of cardiovascular risk factors.