Estudio sobre las características de la información sanitaria en las conducciones entre centros penitenciario / Study of the characteristics of medical information in transfers between prisons

Introducción: La movilidad de la población penitenciaria precisa que la información transmitida en los traslados entre centros garantice una óptima continuidad asistencial. Objetivo: Valorar la calidad de la transmisión de información sanitaria cuando los internos son trasladados en conducción entre centros penitenciarios de todo el territorio español. Material y método: Estudio observacional, descriptivo y transversal, consistente en la revisión de historias clínicas de los internos que transitaron por el Centro Penitenciario (CP) Madrid III en un periodo de tres meses. Todas las variables medidas fueron cualitativas, expresadas en frecuencias absolutas y relativas. Resultados: Durante ese tiempo, 1.168 internos transitaron por el CP Madrid III. Solo 21 procedían de centros penitenciarios de Cataluña, País Vasco o Navarra, cuya historia clínica es diferente a la del resto del Estado, y solo el 57,14% aportaban algún tipo de información sanitaria. Del resto de internos, el 70,79% aportaba algún tipo de información: el 63,90% del total tenía medicación prescrita y el 5% metadona. De aquellos que tenían medicación, el 89,10% la tenían prescrita en la prescripción electrónica, siendo correcta en el 98% de los casos. Respecto a la metadona, solo el 75,44% lo tenía prescrito electrónicamente, siendo correcta en todos los casos. La fecha de la última dosis administrada solo se indicó en el 72,40% de los tratamientos. Discusión: Solo el 34,70% de las historias presentaban una calidad óptima en cuanto a la información transmitida, siendo en el 2,50% de los casos la información recibida deficiente. El uso de herramientas informáticas facilita la transmisión de la información, reduce la carga de trabajo y mejora la seguridad del paciente.(AU)

Introduction: The mobility of the prison population creates a need for information transmitted in transfers between centers that can guarantee optimal care continuity. Objective: To assess the quality of transmission of health information when inmates are transferred between prisons in Spain. Material and method: Observational, descriptive and cross-sectional study, consisting of a review of medical records of inmates who passed through Madrid III Prison in a three-month period. All measured variables were qualitative, and were expressed in absolute and relative frequencies. Results: 1,168 inmates passed through Madrid III Prison in this period. Only 21 came from prisons in Catalonia, the Basque Country or Navarre, where their medical records are different from those in the rest of Spain, and only 57.14% provided some type of health information. Of the remaining inmates, 70.79% provided some type of information: 63.90% of the total had prescriptions for medication and 5% were prescribed with methadone. Of those taking medication, 89.10% were prescribed it in electronic prescriptions, which were correct in 98% of the cases. For methadone, only 75.44% had electronic prescriptions,which were correct in all cases. The date of the last dose administered was only indicated in 72.40% of the treatments. Discussion: Only 34.70% of the records presented optimal quality in terms of the information transmitted, and in 2.50% of the cases the information received was deficient. The use of computerized tools facilitates the transmission of information, reduces the workload and improves patient safety.(AU)

Acceso al diagnóstico rápido de VIH/sífilis en contextos de encierro: relato de experiencia en una unidad penal de la provincia de Buenos Aires en el año 2021 / Access to rapid diagnosis of HIV/syphilis in confinement contexts: an experience report in a penal unit in the province of Buenos Aires in the year 2021

En Argentina se estima que 140 mil personas viven con VIH y de ellas el 17% no conocen su diagnóstico (Ministerio de Salud, 2021). La Dirección de Sida y Enfermedades de Transmisión Sexual (DSyETS) del Ministerio de Salud de la Nación realizó un estudio que mostró una prevalencia global de VIH de 2,68% en unidades del servicio penitenciario federal (DSyETS; 2017). Por ello nuestro objetivo fue favorecer el acceso al testeo y a la prevención de estas enfermedades en personas privadas de su libertad en una unidad penal de la provincia de Buenos Aires en el marco de la pandemia. Relato de experiencia: en diciembre del 2021 se ofreció el testeo voluntario, gratuito y confidencial para VIH y sífilis y accedieron 38 personas. Participaron de la actividad docentes, estudiantes del Departamento de Ciencias de la Salud de la Universidad Nacional del Sur y referentes del programa de VIH-ITS y HV de la Región Sanitaria I del ministerio de salud de la provincia de Buenos Aires. Conclusiones: Esta experiencia mostró la importancia de construcción de redes para la articulación de prácticas que favorezcan el acceso a un diagnóstico temprano y tratamiento oportuno para VIH y sífilis a las personas viviendo en contexto de encierro (AU)

In Argentina, it is estimated that 140 thousand people live with HIV and 17% of them do not know their diagnosis (Ministry of Health, 2021). The Directorate of AIDS and Sexually Transmitted Diseases (DSyETS) of the Ministry of Health of the Nation carried out a study that showed a global prevalence of HIV of 2.68% in units of the federal prison service (DSyETS; 2017). For this reason, our objective was to promote access to testing and the prevention of these diseases in people deprived of their liberty in a penal unit in the province of Buenos Aires in the context of the pandemic. Experience report: in December 2021, voluntary, free and confidential testing for HIV and syphilis was offered and 38 people agreed. Teachers, students from the Department of Health Sciences of the National University of the South and referents of the HIV-STI and HV program of the Sanitary Region I of the Ministry of Health of the province of Buenos Aires participated in the activity. Conclusions: This experience showed the importance of building networks for the articulation of practices that favor access to early diagnosis and timely treatment for HIV and syphilis for people living in a confinement context (AU)

Effects of an Emotional Education Program on Prisoners: An Experimental Study.

BACKGROUND: Emotional education has beneficial effects on physical and/or emotional health, resulting in a better quality of life. Thus, it is beneficial to provide prisoners with emotional education, because of the difficulties they often have, to attain these benefits. PURPOSE: The aim of the study was to analyze the effects of a nursing intervention program in emotional education for incarcerated persons. METHODS: Experimental study with pretest-posttest repeated measures with a control group was conducted at a penitentiary center in the southeast of Spain. Forty-eight prisoners participated in the emotional education intervention program, and another 48 were part of the control group. The emotional intelligence questionnaire 24-item Trait Meta-Mood Scale, the resilience scale Connor-Davidson Resilience Scale, the Rosenberg Self-Esteem Scale, the Rathus Assertiveness Questionnaire, and the 36-item Short Form Health Survey were utilized. FINDINGS: The intragroup, preintervention and postintervention comparisons in the study group showed improvements in self-esteem (p = 0.00, r = 0.51), resilience (p = 0.00, r = 0.42), assertiveness (p = 0.00, r = 0.46), and emotional intelligence in its dimensions of repair (p = 0.00, r = 0.32) and clarity (p = 0.02, r = 0.22) as well as in most of the quality of life dimensions. Significant intergroup differences were also found in all of these variables, except for attention and emotional clarity dimensions. CONCLUSION: The intervention improved the socioemotional health and quality of life of the prisoners, highlighting the importance of these interventions to be performed by the nursing personnel on a regular basis as a programmed activity within prisons.

Feasibility and Acceptability of a Smoking Cessation Program for Individuals Released From an Urban, Pretrial Jail: A Pilot Randomized Clinical Trial.

Importance: Tobacco use prevalence among individuals involved in the criminal-legal system is 125% higher than that of the general population and leads to high levels of smoking-related morbidity and mortality. Objective: To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated. Design, Setting, and Participants: This pilot randomized clinical trial was conducted from January 2019 to May 2020. Participants were recruited in a pretrial county jail in a large Midwestern US city and were followed up after release. Participants were incarcerated, smoked daily before incarceration, desired to stay quit or reduce cigarette smoking upon release, and expected to be released to the community within 90 days of enrollment. Data analysis was performed from June to October 2020. Interventions: Participants randomized to the counseling plus nicotine replacement therapy (NRT) group received 1 hour of smoking cessation counseling in jail, a supply of nicotine lozenges upon release, and up to 4 telephone counseling sessions after release. Those randomized to brief health education (BHE) received 30 minutes of general health education in jail. Main Outcomes and Measures: The primary clinical outcome was biologically verified 7-day point prevalence abstinence (PPA) at 3 weeks after release. Secondary clinical outcomes included 7-day PPA at 12 weeks, changes in number of cigarettes per day, and time to smoking lapse and relapse. Results: A total of 46 participants (42 men [91%]; mean [SD] age, 38.2 [9.1] years) were enrolled and remained eligible at release; 23 were randomized to the counseling plus NRT group and 23 were randomized to the BHE group. Recruitment, enrollment, and retention of participants was feasible and acceptable. There were no significant differences in smoking abstinence between groups as determined by 7-day PPA at 3 weeks (adjusted 7-day PPA, 11.9% for counseling plus NRT vs 10.6% for BHE; odds ratio, 1.13; 95% CI, 0.14-9.07) and at 12 weeks (adjusted 7-day PPA, 11.1% for counseling plus NRT vs 14.3% for BHE; odds ratio, 0.75; 95% CI, 0.09-6.11). Cigarettes per day for the counseling plus NRT group decreased more compared with the BHE group at both 3 weeks (difference [SE], -4.58 [1.58] cigarettes per day; 95% CI, -7.67 to -1.48 cigarettes per day; P = .007) and 12 weeks (difference [SE], -3.26 [1.58] cigarettes per day; 95% CI, -5.20 to -0.20 cigarettes per day; P = .04) after release. Conclusions and Relevance: Initiation of counseling plus NRT during incarceration and continuing after release is feasible and acceptable to participants and may be associated with reduced cigarette use after release. However, additional supports are needed to increase engagement in telephone counseling after release. A larger clinical trial is warranted to determine the effectiveness of counseling plus NRT. Trial Registration: ClinicalTrials.gov Identifier: NCT03799315.

Effectiveness of a Culturally Tailored HIV and Sexually Transmitted Infection Prevention Intervention for Black Women in Community Supervision Programs: A Randomized Clinical Trial.

Importance: Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs. Objective: To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-American Women on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition. Design, Setting, and Participants: This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach. Intervention: E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information. Main Outcomes and Measures: Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12-month period. Results: A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P = .01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P = .04). Conclusions and Relevance: The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women. Trial Registration: ClinicalTrials.gov Identifier: NCT02391233.

Influences of Antenatal Smoking Cessation Education on Smoking Rates of Incarcerated Women.

The project purpose was to examine the impact of smoking cessation education, targeting associated antenatal risks on smoking rates in female prisoners of childbearing age. The project used a pre-/postdesign for the assessment of awareness of antenatal smoking risks and smoking habits and was conducted at a female state prison in the Southeastern United States. Data analysis resulting from a comparison of means of tests identified knowledge increases posteducation. Qualitative data collected pre- and postintervention identified changes in smoking habits. The educational intervention effectively increased participant knowledge of antenatal smoking risks and resulted in a reduction in the number of cigarettes smoked daily.

How repeated exposure to informal science education affects content knowledge of and perspectives on science among incarcerated adults.

Over two million men, women, and youth are incarcerated in the United States. This large and ethnically diverse population has, in general, more limited exposure to education, particularly in scientific fields, than the general public. Formal educational programs for the incarcerated can be expensive and logistically difficult to initiate and maintain, but informal science education (ISE) approaches have the potential to significantly improve inmates' view of science and of themselves as science learners. However, "dosage effects"-how repeated exposure to educational experiences may affect listeners-are poorly documented. In this study, we evaluated the longitudinal effects of an ISE program in Utah, which provided a monthly lecture series delivered by academic scientists on a range of science topics. Science content knowledge, self-perception as a science learner, interest in science, and a desire to seek out more scientific information all significantly improved for inmates attending lectures. We also found that seeing a greater number of lectures is positively associated with a desire to seek out additional information. We documented an inverse relationship between education background and the increase in a desire to learn more, suggesting that those with more limited exposure to science manifest the greatest increase in seeking out more information. These results suggest that ISE for the incarcerated significantly improves their knowledge of, and relationship with, science; that some of these effects carry over across months or years; and that ISE programs can have the largest impact by focusing on those with more limited prior exposure to science.

Reproductive health needs of recently incarcerated youth during community reentry: a systematic review.

BACKGROUND: Youth involved in the juvenile justice system have high reproductive health needs and, on exiting detention, face the challenging transition of reentry. We conducted a systematic literature review to describe what is known about youths' reproductive health needs during community reentry after incarceration. METHODS: We searched PubMed, CINAHL, Cochrane Library, and Google Scholar for articles containing key words with the concepts 'child or adolescent', 'incarcerated' and 'reentry'. In the search, we defined the concept of 'reentry' as within 1 month prior to release (to include interventions involving pre-release planning) and up to 18 months after release from incarceration. RESULTS: Our search yielded 2187 articles. After applying all exclusion criteria, 14 articles on reproductive health remained for extraction. The articles provided data on the following aspects of youths' reproductive health: frequency of condom use (eight articles), sexual risk behaviours other than lack of condom use (seven articles), and prevalence of sexually transmitted infections (three articles). CONCLUSIONS: The literature on the reproductive health needs of youth undergoing reentry is extremely limited. Current intervention studies yield mixed but promising results and more intervention studies that address both pre-release reentry planning and the post-incarceration period are needed. Given incarcerated youths' well-documented reproductive health disparities compared with non-incarcerated adolescents, the identified gaps represent important opportunities for future research and programmatic emphasis.

A Pilot Study of Cancer 101 for Incarcerated Male Smokers.

Incarcerated men in the United States, an understudied population, have not been the focus of cancer prevention research. This pilot study explored the impact of Cancer 101 for imprisoned male smokers to increase cancer knowledge and promote cancer prevention activities in the prison population. Cancer 101 was pilot tested for adoption with representatives from the target audience in three prison facilities located in the northeastern region of the United States, and based on their feedback, modifications were implemented. Pretest and posttest surveys were used to assess knowledge of attitudes regarding the benefits of cancer prevention activities at baseline and immediately after completing Cancer 101. Furthermore, a paired t test procedure was used to determine whether cancer knowledge improved after participating in the Cancer 101 program. A total of 161 men completed all of the modules, participated in pre/post assessments, and qualitatively described their behavioral intentions to participate in activities that could reduce cancer risk. The mean cancer knowledge scores differed before and after completing Cancer 101, t(163) = -14.67, p < .001. Regarding age, the older the respondent, the higher their cancer knowledge score, r = .29, p < .001. This study showed improvements in cancer knowledge scores and behavioral intentions to participate in activities to reduce cancer. Cancer 101 provides opportunities for inmates to increase cancer knowledge, as well as promote action for cancer control during incarceration.

Do In-Prison Correctional Programs Affect Postrelease Employment and Earnings?

The objective of this research is to examine the effects of general educational development (GED) attainment in prison and therapeutic community participation on postrelease employment and earnings. The participants are all males released from prisons in Idaho during 2004. The dependent variables are employment and mean quarterly earnings up to 57 months after release. Propensity score matching analysis was used to enhance the equivalence of the comparison groups, with a small percentage of overly influential observations trimmed. Logistic regression was used to examine the effects of programming on employment. GED had no effect on employment. The effect of therapeutic community approached significance. The statistical analyses on earnings used generalized linear models based on the gamma distribution due to the highly skewed distribution of this variable. These analyses found that GED had no effect on earnings and that participation in a therapeutic community had a highly significant effect on mean quarterly earnings.

Schooling while incarcerated as a turning point for serious juvenile and young adult offenders.

INTRODUCTION: Attending school and working are consistently associated with positive outcomes for juvenile offenders returning to the community. METHODS: Using longitudinal data from the Pathways to Desistance Study, we used structural equation modeling to test whether better school experiences while incarcerated was positively connected to adjustment upon release among serious juvenile offenders (91% male) in the U.S. Adjustment was assessed as attending school for 310 legal minors (<18 years), and engaging in work for 259 emerging adults (≥18 years), as well as self-reported delinquency for all participants. RESULTS: Accounting for incarceration and school history, results showed that facility school attachment, but not grades, was associated with decreased delinquency 12 months after release across sex in both age groups. Additionally, facility school attachment predicted engagement in school for returning minors. However, facility school experience was not related to engaging in work for returning emerging adults. CONCLUSIONS: Results indicate that facility school climate matters for all juvenile offenders returning to their communities and that correctional education done right presents an important opportunity to reconnect returning minors with school, an important normative context of development. Conversely, results suggest that returning offenders who have 'aged out' of high school are a separate vulnerable group who may need additional support for successful reentry.

Problem-solving training: assessing the feasibility and acceptability of delivering and evaluating a problem-solving training model for front-line prison staff and prisoners who self-harm.

OBJECTIVES: Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study. DESIGN AND SETTING: A mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK. PARTICIPANTS: (i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks. INTERVENTION: The intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies. OUTCOMES: We assessed the study processes-coverage of training; recruitment and retention rates and adequacy of intervention delivery-and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere. RESULTS: Recruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to 'treatment as usual'. Outcome measures of self-harm, quality of life and depression were found to be acceptable. CONCLUSIONS: The intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.

Prisons as Schools: Inmates' Participation in Vocational and Academic Programs in Chinese Prisons.

Although the idea of criminal rehabilitation in China has a long history, research on offender rehabilitation in contemporary China is limited. Although Chinese scholars generally agree that rehabilitation through correctional education helps inmates with social reintegration and reduces recidivism, few have examined factors associated with prisoners' participation in such programs. Building on relevant theory and studies in Western societies, this study examines how Chinese prisoners' participation in vocational and academic programs is associated with a range of push and pull factors. Our research questions are addressed with binary and multinomial logistic regressions based on a unique prisoner data set collected in Zhejiang, China. Results show that some factors found to affect inmate participation in the West failed to demonstrate significant relationships with participation among Chinese prisoners. Furthermore, factors most significantly associated with participation appear to be incarceration related, such as prison visits, prison phone calls, and sentence lengths. We conclude with a discussion of the implications of our results.

Parenting from a County Jail: Parenting from Beyond the Bars.

The incarceration of mothers affects 1.7 million minor children who are at high risk of behavioral problems, emotional trauma, and future incarceration. The jail setting removes women from society for brief periods of time providing an opportunity to offer essential interventions for those who will be returning to the community, and possibly their children, rather quickly. Utilizing a pre- and post-test quasi-experimental design, we measured the self-reported treatment effects for female inmates, housed in a county jail in the New York metropolitan area, who completed an evidence-based parenting program. Program participants reported reduced depression, increased parental knowledge, and increased communication with their families and fellow inmates. The results indicated that alternative ways of measuring program success are needed - particularly for populations who present with long histories of criminal justice involvement and drug use.

Group life skills training for promoting mental health in women after released from prison: A randomized pilot efficacy trial.

The aims of the researchers were to determine the effectiveness of Life Skills Training for promoting mental health in the women after released. The study design was semi-experimental with pretest, posttest, follow-up, and control group. One hundred and fifty women after released were selected by convenience sampling. They were randomly assigned to experimental group and control group. The experimental group received the life skills training, while the control group did not. The research measurement instrument comprised the General Health Questionnaire. MANCOVA models were used to test the study hypothesis. We analyzed data and thus believe that mental health increased among women.

Adaptation of an Evidence-Based Intervention to Reduce HIV Risk in an Underserved Population: Young Minority Men in New York City Jails.

To address HIV-risk among justice-involved minority men, New York City Health + Hospitals Correctional Health Services implemented a modified version of Choosing Life: Empowerment, Action Results (CLEAR), an evidence-based intervention to influence behavior. A total of 166 young (i.e., 20-29 years old) minority (e.g., non-Hispanic Black or Latinx) men at risk for HIV and incarcerated in New York City jails completed the adapted group-format intervention and corresponding evaluation assessments. Participants showed significantly improved HIV knowledge on the 18-item HIV-KQ-18 scale (mean increase = 3.11 correct, from 13.23 [SD = 3.80] pre-intervention to 16.34 [SD = 2.29] post-intervention). Similarly, participant summary scores for substance use risk, sexual risk, and health promotion improved significantly. At 90 days after jail release, participants reported improved "CLEAR thinking," reduced risk behaviors and improved health-promoting behaviors. Health and HIV-prevention education programs implemented in the jail setting may help reduce health inequities and improve health outcomes.

Tuberculosis case detection by trained inmate peer educators in a resource-limited prison setting in Ethiopia: a cluster-randomised trial.

BACKGROUND: To improve tuberculosis case detection, interventions that are feasible with available resources are needed. We investigated whether involving trained prison inmates in a tuberculosis control programme improved tuberculosis case detection, shortened pre-treatment symptom duration, and increased treatment success in a resource-limited prison setting in Ethiopia. METHODS: In this cluster-randomised trial we randomly assigned prisons in the regions Amhara and Tigray of Ethiopia to an intervention group or a control group, after matching them into pairs based on their geographical proximity and size. Larger prisons were considered eligible whereas smaller prisons were excluded. We selected three to six prison inmates in each intervention prison. The recruited prison inmates who received a 3-day training course and were capable of identifying presumptive tuberculosis cases then provided health education to all other prison inmates about tuberculosis prevention and control every 2 weeks for 1 year. They also actively searched for symptomatic prison inmates and undertook routine symptom-based tuberculosis screening. The control prisons followed the existing passive case finding system. The primary outcome was the mean case detection rate at the end of the year, measured at cluster (prison) level. This trial is registered at ClinicalTrials.gov, number NCT02744521. FINDINGS: We randomly assigned 16 prisons with a total population of 18 032 inmates to either the intervention group (n=8) or the control group (n=8) from April 1, 2016, to March 31, 2017. During the 1-year study period, 75 new tuberculosis cases (1% of 8874 total inmates) were detected in the intervention prisons and 25 new cases (<1% of 9158 total inmates) were detected in the control prisons. The mean case detection rate was significantly higher in the intervention group than in the control group (mean difference 52·9 percentage points, 95% CI 17·5-88·3, p=0·010). INTERPRETATION: Involving trained inmate peer educators in the tuberculosis control programme in Ethiopian prisons significantly improved the tuberculosis case detection rate. The findings have important implications for clinical and public health policy, particularly in prisons of low-income countries where tuberculosis burden is high and the recommended tuberculosis diagnostic and treatment algorithms have generally not been implemented. FUNDING: Nuffic, Mekelle University.

Designing Prison-Based Parenting Programs to Maximize Their Outcomes.

Parenting programs are increasingly being offered in prison as governments seek to reduce the negative consequences of parental imprisonment and encourage desistance from crime. However, little is known about the design and delivery of such programs and how this may shape program effectiveness. This article seeks to address this gap by examining how the design and delivery of the Families Matter program for imprisoned adult fathers in Northern Ireland affected its ability to achieve its goals of improving family relationships and fathers' parenting skills. Examples of good practice are offered, as well as challenges that remain to be overcome. It is argued that more attention needs to be paid to the design and delivery of these programs if their ability to achieve long-term improvements in family relationships and parenting skills are to be improved.

Vulnerabilidade de pessoas privadas de Liberdade ao virus da imunodeficiência humana / Vulnerabilidad de las personas privadas de libertad ante el virus de la inmunodeficiencia humana / Vulnerability of incarcerated people to the human immunodeficiency virus

RESUMO Introdução: A infecção pelo vírus da imunodeficiência humana é um problema de saúde pública mundial. No contexto de vulnerabilidade, o sistema prisional favorece a transmissão de doenças infectocontagiosas. Objetivo: Analisar a vulnerabilidade para a infecção pelo vírus da imunodeficiência humana, na população privada de liberdade em Teresina-Piauí. Métodos: Estudo transversal desenvolvido por meio de inquérito epidemiológico envolvendo 950 detentos. Resultados: A faixa etária predominante foi até 30 anos de idade (65,37 porcento). A expressiva maioria não frequentou a escola (91,68 porcento), 79,16 porcento referiram beber, 61,37 porcento declararam uso de alguma droga ilícita. Evidenciou-se que 66,21 porcento dos detentos têm tatuagem e 15,58 porcento tem piercing. Quanto às práticas sexuais, 90,84 porcento tem relações sexuais com o sexo oposto, apenas 27,26 porcento usam regularmente preservativo. A maioria dos detentos (75,26 porcento) possui algum conhecimento sobre o vírus. Verificou-se associação estatisticamente significativa no cruzamento do conhecimento com anos de estudo e renda familiar (p<0,01), utilização de algum tipo de droga (p=0,01), compartilhamento de material perfuro cortante (p<0,01), uso de piercing (p=0,01), parceria sexual (p<0,01) e uso de camisinha (p<0,01). Conclusões: Os resultados deste estudo reiteraram que as pessoas privadas de liberdade compõem um grupo vulnerável à infecção pelo vírus e evidenciam a necessidade de ações públicas, incluindo estratégias, que contemplem a demanda de saúde dos internos do sistema prisional do Estado(AU)

RESUMEN Introducción: La infección con el virus de la inmunodeficiencia humana es un problema de salud pública mundial. En el contexto de la vulnerabilidad, el sistema penitenciario favorece la transmisión de enfermedades infecciosas. Objetivo: Analizar la vulnerabilidad a la infección por el virus de la inmunodeficiencia humana, sobre las personas privadas de libertad. Métodos: Estudio transversal, desarrollado a través de la encuesta epidemiológica con 950 reclusos en Teresina, Piauí. Resultados: El grupo de edad predominante fue de 30 años (65,37 por ciento). La mayoría no asistió a la escuela (91,68 por ciento), 79,16 por ciento reportó el uso de bebidas alcohólicas, 61,37 por ciento reportó el uso de cualquier droga ilícita. Se demostró que el 66,21 por ciento de los internos tiene tatuaje y el 15,58 por ciento piercing. En cuanto a las prácticas sexuales, 90,84 por ciento tenía relaciones con el sexo opuesto, solo el 27,26 por ciento utiliza regularmente condones. La mayoría de los internos (75,26 por ciento) tiene algún conocimiento sobre el virus. Se observó asociación estadísticamente significativa al cruzar las variables años de estudio, los ingresos familiares (p <0,01), uso de alguna droga (p = 0,01), corte de perforación intercambio de equipo (p <0,01), uso de perforación (p = 0,01), pareja sexual (p <0,01) y el uso del condón (p <0,01). Conclusiones: Los resultados de este estudio reiteraron que las personas privadas de libertad constituyen un grupo vulnerable a la infección por el virus y ponen de relieve la necesidad de acciones públicas, incluidas las estrategias que responden a las demandas de salud del sistema penitenciario de ese Estado(AU)

ABSTRACT Introduction: The human immunodeficiency virus infection is a world public health problem. In terms of vulnerability, the penitentiary system favors the transmission of infectious diseases. Objective: To analyze the vulnerability of prisoners to human immunodeficiency virus infection. Methods: Cross-sectional study conducted in 950 inmates in Teresina, Piaui based on an epidemiological survey. Results: The prevailing age group was 30 years (65.37 percent). Most of them (91.68 percent) had never attended school, 79.16 percent reported the use of alcohol beverages and 61.37 percent reported the use of any kind of illicit drug. It was proved that 66.21 percent of inmates had tattoos and 15.58 had piercing. As to sexual practice, 90.84 percent had intercourse with the opposite sex but just 27.26 percent regularly used condoms. Most of the prisoners had certain knowledge about the virus. There was statistically significant association when crossing the variables such as years of study, family incomes (p< 0.01), use of some drug (p= 0,01), piercing cut and exchange of devices (p< 0,01), use of piercing (p= 0.01), sexual partner (p< 0.01) and use of condom (p< 0.01). Conclusions: The results of this study reiterated that the prisoners represent a vulnerable group to the virus infection and underlined the need for public actions including the strategies responding to the health demands of the penitentiary system of that state(AU)