Lack of health insurance among juvenile offenders: a predictor of inappropriate healthcare use and reincarceration?

OBJECTIVES: Relationships between the health insurance status and healthcare use among justice-involved youths transitioning into adulthood is an underexplored topic, even if transition to adulthood is a crucial time period for healthcare outcomes. To fill in these knowledge gaps, this study had two aims: (1) to examine trajectories of health insurance coverage and healthcare use among serious juvenile offenders transitioning into adulthood; and (2) to explore associations between the lack of health insurance, healthcare use and reincarceration. STUDY DESIGN: We conducted a secondary analysis on the data of the US longitudinal Pathways to Desistance study between ages 20 and 23 years (2000-2010). METHODS: Participant data on health insurance coverage, healthcare use, reincarceration and sociodemographic variables (n = 1215) were extracted and analysed using descriptive statistics, generalized linear regressions and cross-lagged panel models. RESULTS: About half of the young offenders had no health insurance coverage or intermittent coverage between the age of 20 and 23 years. Emergency services were used (≥17.4%), notably more by insured participants and were increasingly used over time. Being uninsured at the age of 20 years was associated with reincarceration at the age of 23 years (b = -0.052, p = 0.014, odd-ratio = 0.95), but incarceration at the age of 20 years did not predict the insurance status at the age of 23 years (b = 0.009, p = 0.792). CONCLUSIONS: Serious juvenile offenders, especially if uninsured, faced major barriers to accessing health care and often reported an inappropriate healthcare use. This likely led to reincarceration. The lack of continuity of care and of access to health care may, therefore, increase health disparities, and efforts are needed to mitigate detrimental outcomes, by effective in and out of detention coordination of health insurance coverage and among health services.

Syphilis, human immunodeficiency virus, herpes genital and hepatitis B in a women's prison in Cochabamba, Bolivia: prevalence and risk factors.

OBJECTIVE: To determine the prevalence and factors associated with syphilis, human immunodeficiency virus (HIV), hepatitis B (HBV) and herpes type 2 (HSV2) among women in the prison of San Sebastian in Cochabamba (Bolivia). MATERIAL AND METHODS: We carried out a cross-sectional study including a standardized questionnaire to assess socio-demographics characteristics and risk factors (sexual practices and exposure to blood); and serological tests for syphilis, HSV2, VIH, and HBV. We performed bivariate and multivariate analyses to test the associations between variables of interest and infections. RESULTS: A total of 219 out of 220 prisoners (99.5%) participated in the study. For syphilis, 12.8% of participants had both reactive tests (RPR+/TPPA+). The prevalence of HSV2 and VIH was 62.6% and 1.4%, respectively. Anti-HBc, indicating a resolved or chronic HBV, was positive in 11.9% of participants and 0.5% had active HBV (HBsAg positive). A low level of education was associated with syphilis, HSV2 and HBV. Having occasional sexual partners was associated with syphilis and HSV2. Being over 36 years old and having more than 3 children were associated with HBV. The number of sexual partners, history of prostitution and rape, having sexual intercourses in prison and detention time were not associated with any of these infections. DISCUSSION: The prevalence of syphilis, HIV, HSV2 and HBV was higher in this vulnerable female population than in the general population in Bolivia. Control measures in detention are needed to limit the spread of these infections both in prisons and in the community.

Rapid diagnostic testing to improve access to screening for syphilis in prison.

OBJECTIVES: To assess the accuracy of on-site rapid treponemal test for syphilis diagnosis in women deprived of liberty in Bolivia. MATERIAL AND METHODS: Serological tests for syphilis were performed on 219 women deprived of liberty from the San Sebastián prison in Cochabamba, Bolivia. Syphilis was diagnosed using RPR (bioMérieux) and TPPA (Fujirebio) serological tests, and the results were compared to on-site rapid treponemal test (Alere DetermineTM Syphilis TP) in whole blood. Diagnostic performance of two FTA tests were also compared (bioMérieux and Biocientífica). RESULTS: All participants (28) with RPR+/TPPA+ had the rapid syphilis test positive (sensitivity 100%). Eleven participants had rapid syphilis test positive without RPR and TPPA both positive; nevertheless 7 of them had RPR or TPPA positive. Of 33 participants with FTA-bioMérieux positive, 22 (66.6%) had FTA-Biocientífica positive. DISCUSSION: The rapid syphilis test Determine shows excellent performance as a screening tool among women deprived of liberty affected by high prevalence of syphilis. This test is particularly indicated when there are barriers for access to conventional serological tests. It is inexpensive, easy to use and does not require electricity and laboratory infrastructure. The FTA test performed with reagents from Biocientífica had a suboptimal sensitivity.

Sífilis, virus de la inmunodeficiencia humana, herpes tipo 2 y hepatitis B en una prisión de mujeres en Cochabamba, Bolivia: prevalencia y factores de riesgo / Syphilis, human immunodeficiency virus, herpes genital and hepatitis B in a women's prison in Cochabamba, Bolivia: prevalence and risk factors

Objetivo: Determinar la prevalencia y los factores asociados a la infección por sífilis, virus de la inmunodeficiencia humana (VIH), virus de hepatitis B (VHB) y virus herpes tipo 2 (HSV2) en las mujeres privadas de libertad (MPL) en la prisión de San Sebastián en Cochabamba (Bolivia). Material y método: Se realizó un estudio transversal. Mediante un cuestionario estandarizado se registraron las características sociodemográficas, las prácticas sexuales y la existencia de exposición a la sangre. Se realizaron pruebas serológicas para sífilis, HSV2, VIH y VHB. Para conocer la asociación entre las variables de interés y las enfermedades, se llevaron a cabo análisis bi y multivariantes. Resultados: Participaron 219 de 220 MPL (99,5%). La prevalencia de sífilis (RPR+/TPPA+), HSV2, VIH y VHB crónico (ABsAg+) fue de 12,8%, 62,6%, 1,4% y 0,5%, respectivamente. La sífilis y el HSV2 se asociaron con un bajo nivel de educación y con el hecho de tener parejas sexuales ocasionales. El VHB se asoció con un bajo nivel de educación, la edad y el hecho de tener más de tres hijos. Estas infecciones no se asociaron con el número de parejas sexuales, los antecedentes de prostitución o violación, las relaciones sexuales en prisión y la duración de la pena privativa de libertad. Discusión: La prevalencia de las enfermedades investigadas (sífilis, VIH, HSV2 y VHB) es más elevada en la población penitenciaria femenina que en la población general de Bolivia. Es necesario implementar medidas de control en la prisión para limitar la propagación de estas infecciones, tanto en prisiones como en la comunidad

Objective: To determine the prevalence and factors associated with syphilis, human immunodeficiency virus (HIV), hepatitis B (HBV) and herpes type 2 (HSV2) among women in the prison of San Sebastian in Cochabamba (Bolivia). Material and methods: We carried out a cross-sectional study including a standardized questionnaire to assess socio-demographics characteristics and risk factors (sexual practices and exposure to blood); and serological tests for syphilis, HSV2, VIH, and HBV. We performed bivariate and multivariate analyses to test the associations between variables of interest and infections. Results: A total of 219 out of 220 prisoners (99.5%) participated in the study. For syphilis, 12.8% of participants had both reactive tests (RPR+/TPPA+). The prevalence of HSV2 and VIH was 62.6% and 1.4%, respectively. Anti-HBc, indicating a resolved or chronic HBV, was positive in 11.9% of participants and 0.5% had active HBV (HBsAg positive). A low level of education was associated with syphilis, HSV2 and HBV. Having occasional sexual partners was associated with syphilis and HSV2. Being over 36 years old and having more than 3 children were associated with HBV. The number of sexual partners, history of prostitution and rape, having sexual intercourses in prison and detention time were not associated with any of these infections. Discussion: The prevalence of syphilis, HIV, HSV2 and HBV was higher in this vulnerable female population than in the general population in Bolivia. Control measures in detention are needed to limit the spread of these infections both in prisons and in the community

Levantar las barreras al diagnóstico de la sífilis en las cárceles gracias a una prueba diagnóstica rápida / Rapid diagnostic testing to improve access to screening for syphilis in prison

Objetivos: Evaluar una prueba treponémica rápida in situ para el diagnóstico de la sífilis en mujeres privadas de libertad en Bolivia. Material y métodos: Se realizaron pruebas serológicas para la sífilis a 219 mujeres privadas de libertad (MPL) de la cárcel San Sebastián de Cochabamba, Bolivia. Esta enfermedad fue diagnosticada utilizando como referencia las pruebas serológicas reagina plasmática rápida (RPR, rapid plasma reagin, bioMérieux S.A.) y el ensayo de aglutinación de partículas de Treponema pallidum (TPPA, Treponema pallidum particle assay, Serodia(R) Fujirebio Inc.). Los resultados fueron comparados con la prueba rápida Alere DetermineTM Syphilis TP (PRADS) en sangre total. Se compararon también dos pruebas de anticuerpos treponémicos fluorescentes (FTA, fluorescent treponemal antibody) de marcas diferentes (bioMérieux y Biocientífica). Resultados: Las 28 mujeres privadas de libertad con RPR+/TPPA+ tenían la PRADS positiva (con una sensibilidad del 100%). Once participantes tenían la PRADS positiva sin RPR y TPPA, ambos reactivos; sin embargo, siete de ellos tenían la RPR o TPPA reactivo. De las 33 participantes con FTA-bioMérieux reactivo, 22 (el 66,6%) tenían el FTA-Biocientífica reactivo. Discusión: La PRADS muestra un excelente desempeño como prueba de despistaje en una población de mujeres privadas de libertad afectada por una alta prevalencia de sífilis. Esta herramienta está particularmente indicada cuando existen en las cárceles barreras de acceso a las pruebas serológicas convencionales. Es de bajo costo, de fácil uso y no necesita electricidad ni una infraestructura de laboratorio. La prueba treponémica FTA realizada con los reactivos Biocientífica tiene una sensibilidad subóptima

Objectives: To assess the accuracy of on-site rapid treponemal test for syphilis diagnosis in women deprived of liberty in Bolivia. Material and methods: Serological tests for syphilis were performed on 219 women deprived of liberty from the San Sebastián prison in Cochabamba, Bolivia. Syphilis was diagnosed using RPR (bioMérieux) and TPPA (Fujirebio) serological tests, and the results were compared to on-site rapid treponemal test (Alere DetermineTM Syphilis TP) in whole blood. Diagnostic performance of two FTA tests were also compared (bioMérieux and Biocientífica). Results: All participants (28) with RPR+/TPPA+ had the rapid syphilis test positive (sensitivity 100%). Eleven participants had rapid syphilis test positive without RPR and TPPA both positive; nevertheless 7 of them had RPR or TPPA positive. Of 33 participants with FTA-bioMérieux positive, 22 (66.6%) had FTA-Biocientífica positive. Discussion: The rapid syphilis test Determine shows excellent performance as a screening tool among women deprived of liberty affected by high prevalence of syphilis. This test is particularly indicated when there are barriers for access to conventional serological tests. It is inexpensive, easy to use and does not require electricity and laboratory infrastructure. The FTA test performed with reagents from Biocientífica had a suboptimal sensitivity

Sífilis congénita en 2 niños de una cárcel de Bolivia / Congenital syphilis in 2 children in a Bolivian prison

En el año 2013, se realizó un estudio transversal que reveló 28 casos de sífilis activa en 219 mujeres privadas de libertad (MPL) en una cárcel de Cochabamba, Bolivia. Se buscó la sífilis congénita (SC) en los niños que convivían con las madres infectadas. Resulta importante la prevención de la transmisión vertical de la sífilis mediante un despistaje sistemático de las embarazadas y el tratamiento oportuno por profesionales entrenados, dentro del ámbito carceral que representa una población clave para el control de esta enfermedad responsable de complicaciones graves (AU)

In 2013 a cross-sectional study was carried out that revealed 28 cases of active syphilis amongst female inmates in a prison of Cochabamba, Bolivia. A search was conducted for congenital syphilis amongst the children that lived with the infected mothers. It is important to note the prevention of perinatal transmission of syphilis by systematic screening of pregnant women and appropriate treatment given by trained professionals within the prison environment, which represents a key population for controlling this disease, which is responsible for causing severe complications (AU)

Persistent infectious and tropical diseases in immigrant correctional populations.

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.

Enfermedades infecciosas y tropicales persistentes en población inmigrante penitenciaria / Persistent infectious and tropical diseases in inmigrant correctional populations

Son muchas las enfermedades en viajeros y poblaciones inmigrantes que suponen un problema de salud pública de primer orden. Algunas tienen un periodo largo de incubación o son asintomáticas o paucisintomático durante muchos años antes de provocar manifestaciones clínicas significativas y/o complicaciones. La infección por VIH, hepatitis B y C, la tuberculosis o la sífilis latente se encuentran entre las enfermedades persistentes más relevantes en población emigrante. La esquistosomiasis y la estrongiloidiasis, por ejemplo, son infecciones helmínticas persistentes que pueden causar importante morbilidad, especialmente en pacientes coinfectados por VIH, hepatitis B y C. La enfermedad de Chagas, que inicialmente se creyó limitada a América Latina, ahora también tiene que ser considerada en los inmigrantes de países endémicos. La leishmaniasis visceral y la malaria son otros ejemplos de enfermedades parasitarias que tienen que tenerse en cuenta cuando se trata con inmigrantes encarcelados. El objetivo de este artículo es revisar el riesgo de las enfermedades tropicales desatendidas en especial dada la vulnerabilidad de la población penitenciaria y el riesgo de las enfermedades infecciosas que normalmente afectan a emigrantes pero que a menudo son infraestimadas (AU)

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated (AU)

Prevención y manejo de la hepatitis B en las cárceles de Ginebra, Suiza: facilidad entre barreras - una síntesis narrativa de la práctica actual / No disponible

La hepatitis B (HBV) constituye un problema sustancial de salud pública y el riesgo de contraer HBV en la cárcel y durante los meses posteriores a la liberación es alto. En la cárcel preventiva de Ginebra la prevalencia de HBV crónica es 20 veces más alta que dentro de la población general de Suiza, afectando principalmente a los inmigrantes encarcelados. Las acciones realizadas en la prisión preventiva de Ginebra para el control de la hepatitis B en los presos y profesionales trabajando con ellos, engloban la prevención, la educación, la vacunación, el despistaje y el tratamiento. Estas acciones se basan en las guías nacionales y son adaptadas a los datos epidemiológicos confirmados en estudios científicos. La prisión representa una oportunidad única para intervenciones de control de la HBV, en una población vulnerable con acceso limitado a la atención médica en la comunidad. Sin embargo, las estrategias deben ser mejoradas para hacer frente a varios desafíos, tales como las barreras del idioma o la continuidad de la atención. La prisión es un paso intermedio para estas personas. Así, la implementación de programas de educación y de prevención dirigidos a los presos protege igualmente a toda la comunidad (AU)

No disponible

[Persistent tropical diseases among migrants]. / Maladies tropicates persistantes chez les migrants.

Several infectious diseases may remain a- or pauci-symptomatic for many years before causing major clinical manifestations. Migrants are particularly vulnerable to several persistent infectious diseases due to exposure in their country of origin and their specific living conditions. This article emphasizes neglected parasitic diseases among migrants, such as schistosomiasis, strongyloidiasis and Chagas disease. In the case of co-infection with HIV, hepatitis B and C, some of these persistent parasitosis may induce more significant morbidity. These aspects are particularly important to know as these diseases, both viral and parasitic, are particularly common among migrants.

[Diseases transmitted by ticks locally and abroad]. / Maladies transmises par des tiques d'ici et d'ailleurs.

This article provides a brief overview of some diseases transmitted by ticks. These vectors do not transmit only Lyme disease and tickborne-encephalitis, even in Switzerland. Several tick-borne diseases cause nonspecific flu-like symptoms. Nevertheless sometimes severe, some of these diseases can be treated with specific treatments. Repellents, appropriate clothes impregnated with permethrine and prompt removal of the tick are effective preventive measures to limit the risk of infection. There is an effective vaccine which protects against tick-borne encephalitis.

[Melioidosis: a poorly known tropical disease]. / Mélioïdose: une pathologie tropicale méconnue.

A 35 year-old man was admitted to the hospital for fever upon returning from the Caribbean area. He died 48 hours later, after developing pulmonary lesions that were complicated by multi-organ failure, despite rapid diagnosis of melioidosis by mass spectrometry on blood cultures. Melioidosis is a rare bacterial disease in the traveller that is caused by Burkholderia pseudomallei. Although the clinical presentation is variable, pneumonia is the most frequent finding. Diagnosis may be considered in travellers returning from tropical and subtropical regions, especially during rainy seasons. Accordingly, when confronted with a patient who presents with fever after travelling, it is important to carefully specify the regions visited, potential expositions, and rapidly offer adequate laboratory testing.

Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010.

We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

[Exotic snake bites in Switzerland]. / Morsures de serpents exotiques en Suisse.

Exotic snake bites are not rare in Switzerland. Treatment can be challenging for medical staff particularly as rapid and focused management are critical to improve patient outcome. The case of a young herpetologist bitten by an exotic venomous snake is used to review measures to be taken before arrival at the emergency department and to highlight key points of management. Resources for the obtention of expert advice and antivenoms are also reported.

[Lymphoma and pruritus: search for parasites]. / Lymphome et prurit: une association parfois parasitée.

Strongyloides stercoralis is a parasite that can be acquired not only in tropical and subtropical areas, but also in some European countries. This helminthiasis is often a- or paucisymptomatic, and may persist in a latent state for several decades. In case of immunosuppression, a reactivation of the disease can occur, that may result in severe -- sometimes fatal -- complications, due to a syndrome of hyperinfestation. We present two cases of reactivation in patients suffering from lymphoma under chemotherapy. Screening of this parasite should be proposed for patients that have stayed in an endemic area before any corticotherapy or other immunosuppressive treatment, and in the presence of a disease reducing the immunity.

[The management of travellers' diarrhoea]. / La prise en charge de la diarrhée des voyageurs.

Travellers' diarrhoea represents the most frequent health problem when travelling in developing countries. In most cases it is a self-limited disease. Nonetheless it can cause incapacitation and significant morbidity. It can become persistent in up to 3% of travellers who have suffered from acute diarrhoea in regions at high risk. This article discusses the investigations and the management of diarrhoea in returning travellers, preventive measures and its management during travel.