Imprisonment of Opioid-Dependent People in New South Wales, Australia, 2000–2012: A Retrospective Linkage Study

There are few data about the incarceration of opioid-dependent people involving large representative cohorts. We aimed to determine the prevalence and duration of incarceration in a large cohort of opioid-dependent people in Australia using data linkage methods, and estimate the costs associated with their incarceration.

Retrospective linkage study of all entrants to opioid substitution therapy (OST) for the treatment of opioid dependence in NSW, 1985–2010, with data on incarceration, 2000-2012. The number and duration of incarcerations were calculated. The average daily cost of incarceration was applied to days of incarceration in the cohort.

Among 47,196 opioid-dependent people, 37% (43% of men and 24% of women) had at least one episode of incarceration lasting one or more days. Men had a median of three(ranging between 1-47) incarcerations, and women, two (1-35). Indigenous men spent 23% of follow-up time incarcerated, compared with 8% for non-Indigenous men; similarly, Indigenous women spent a substantially greater proportion of time incarcerated than non-Indigenous women (8% vs. 2%). Costs of incarceration of this cohort between 2000 and 2012 totalled nearly AUD $3 billion.

This is the first study to examine incarceration of opioid-dependent people across an entire population of such users. Our findings suggest that a substantial minority of opioid-dependent people experience incarceration, usually on multiple occasions and at significant cost. Treatment for opioid dependence, inside and outside prisons, may help reduce incarceration of this cohort.

Purchase full article at:   http://goo.gl/2PzGpO

By:  Degenhardt L1, Larney S, Gisev N, Trevena J, Burns L, Kimber J, Shanahan M, Butler T, Mattick RP, Weatherburn D.

• 1National Drug and Alcohol Research Centre, University of New South Wales; 2. Melbourne School of Population and Global Health, University of Melbourne, Victoria. l.degenhardt@unsw.edu.au 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Hepatitis C Seroprevalence and Risk Factors in Adult Population of Chaharmahal and Bakhtiari Province of Iran in 2013

Hepatitis C is the second leading viral infectious disease worldwide. In Iran, hepatitis C is the most important and prevalent reason for chronic hepatitis and liver cirrhosis in the multi transfused population.

This study was conducted to determine seroprevalence and burden of hepatitis C in Chaharmahal and Bakhtiari province and to plan for controlling it.

For this analytical, population-based study, 3000 samples were older than 15 years old and were enrolled from urban and rural areas of Chaharmahal and Bakhtiari province, southwest Iran per cluster sampling. Written informed consent was obtained from the participants and the demographic data, transmission route and risk factors were collected after blood sample taking. Hepatitis C virus antibody (HCV Ab) and western blotting were consecutively run.

Data analysis was done by SPSS 19 using descriptive statistics, and chi-square test, Fisher's exact test, and logistic regression Ap value of 0.05 was considered as the level of significance.

The prevalence of HCV Ab was obtained 1.4% (95% CI, 0.95-1.7) and that of positive hepatitis C by western blotting 0.9% (95% CI, 0.65-1.3). The prevalence in men (1.2%) was obtained two times higher than women. The highest prevalence was obtained in 35 to 44-year-old population (2%). The prevalence was higher in married individuals and less in higher educated. History of hospital stay, first degree relatives infected with HCV, jaundice, history of blood transfusion, tattoo, outpatient surgery, imprisonment, contact with the infected, intravenous (IV) drug abuse, and smoking had significant association with disease prevalence (p<0.05). The highest odds ratio was obtained for history of IV drug abuse (OR=38.2, 95% CI, 14.06-103.9) followed by imprisonment (OR=8.9, 95% CI, 2.97-26.6). However, by logistic regression only history of IV drug abuse was obtained as significant (p<0.05).

Hepatitis C is growing and emerging as the most prevalent chronic, viral hepatic disease, so further consideration of risk factors and routes of transmission is crucial for appropriate planning for, and preventing, treating, and controlling hepatitis C. IV drug abusers as the most important group need special consideration and surveillance in order to cut infection chain and decrease the disease incidence.

Full article at:  http://goo.gl/7zb3Vy

By: Moezzi M1, Imani R2, Karimi A3, Pourheidar B4.

• 1Faculty, Department of Community Medicine, Shahrekord University of Medical Sciences , Shahrekord, IR Iran.
• 2Faculty, Department of Infectious Diseases, Shahrekord University of Medical Sciences , Shahrekord, IR Iran .
• 3Faculty, Department of Microbiology, Shahrekord University of Medical Sciences , Shahrekord, IR Iran .
• 4Central Disease Control Unit, Shahrekord University of Medical Sciences , Shahrekord, IR Iran .

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Subcultural Manifestations of Self-Injury in Correctional Settings

Self-injury, defined as the act of deliberately harming your own body, is a common behavior among certain groups of inmates¹. This is determined because among the imprisoned population there are a series of related factors which are more common than in the general population. On one hand, psychopathology is more prevalent in this population, especially as far as depression and anxiety are concerned but regarding psychopathology and impulse control disorders too, all of them related to self-harming behaviors^2-3. On the other hand, correctional facilities are socially isolated settings which involve the development of a culture of their own. When anthropologists consider human culture, they usually refer to a certain lifestyle, socially acquired between a group of people which manifests as standard recurrent ways of thinking, feeling and acting. The term subculture is used to make reference to certain models of culture particular to certain groups within society⁴. Life in prison facilitates the expression and maintenance of a specific subculture among inmates. Most of the inmates show in their behavior a series of values permeated by the marginalization of the social groups to which they belonged before their imprisonment. Other learnt and shared behavior and thinking patterns are developed as a consequence of their own experience of imprisonment and become part of what we could define as a real penitentiary subculture.

Below:  It is common that some inmates simultaneously harm themselves to support a third inmate or that in a particular module some are forced to self-injury behaviors upon the order of a "Kie" of boss, in an attempt to manipulate the environment. Usually, the most common form of self-injury: puncture on the left arm, is used as a means of protest charged with drama and aggressiveness against regimental decisions.

Below:  Sometimes self-injurers try to recreate the ritual of needle puncture in the more common areas of intravenous puncture to mitigate craving symptoms, although without syringes and abuse substances. In these cases, the needle needs to be removed if it is accidentally hosted in the venous return

Below:  Another aspect of prison subculture with regard to self-harm is the way of quickly and easily obtaining objects able of causing puncture injuries. I such cases, cigarette filters, previously pressed and later burnt can be used to obtain a sharp surface to cause injuries that although superficial bleed sufficiently

Full article at: http://goo.gl/ELb66N

By: J.M. Arroyo-Cobo

General Sub-Directorate for the Coordination of Prison Health
General Secretariat of Penitentiary Institutions

  

More at:  https://twitter.com/hiv_insight

Mothering at a Distance: What Incarcerated Mothers Value About a Parenting Program

Children with incarcerated mothers experience a range of adverse health, social, emotional and economic circumstances, and are a particularly vulnerable group within the Australian community. Mothers in custody face significant challenges to their capacity to parent their children. This study presents findings from a mixed-methods evaluation of a parenting support program for incarcerated mothers in NSW Australia. It examines responses to open and closed questions on a questionnaire to identify participants' views on the program's impact on their parenting role. 

Quantitative data indicated that participants found the program worthwhile and relevant, and that it helped build their parenting knowledge and confidence. Qualitative responses highlighted the aspects of the program which participants valued, specifically gaining support for their parenting role in complicated circumstances, a greater understanding of child development and perspectives, and a range of practical strategies for enhancing relationships with their children during their incarceration. Respondents reported feeling validated as mothers due to improved self-perception and feeling more confident and hopeful in their mothering role.

Purchase full article at:  http://goo.gl/jrGrTD

By: Rossiter C1, Power T1, Fowler C1,2, Jackson D3,4, Hyslop D5, Dawson A1.

• 1a Faculty of Health , University of Technology Sydney , Australia.
• 2b Tresillian Family Care Centres.
• 3c Oxford Brookes University , UK.
• 4d University of New England , NSW , Australia.
• 5e Corrective Services New South Wales.  

More at:  https://twitter.com/hiv_insight

Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province, Iran from 2006 to 2011

Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients.

This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used.

The result showed that imprisonment and the TB case of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion.

We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients.

Full article at: http://goo.gl/D9IfvA

By:  Marzieh Shahrezaei, Mohammad Reza Maracy,1 and Fariba Farid2

²

1Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

2General Practitioner, Group Fighting Against Diseases, Isfahan Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

1Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

More at:  https://twitter.com/hiv_insight

High Treatment Retention Rate in HIV-Infected Patients Receiving Antiretroviral Therapy at Two Large HIV Clinics in Hanoi, Vietnam

Loss to follow-up (LTFU) is viewed as a major challenge in improving retention in HIV treatment. In Vietnam, the reasons for disengagement from clinics and the effect of injection drug use (IDU) on LTFU with unknown outcome (true LTFU) are not well known.

Patients receiving antiretroviral therapy (ART) from two HIV clinics in Hanoi were included in this observational study between 2007 and 2012, and followed up every 6 months until the end of 2013. The reasons for disengagement from the clinic, and ART status during imprisonment were investigated in patients with a history of IDU to identify true LTFU. The retention rate at 6–54 months and true LTFU rate were calculated. Cox proportional hazards regression models were performed to identify factors associated with true LTFU.

There were 1,431 patients, with a follow-up time of 4,371 person-years (median 2.49 years). At the end of the follow-up period, 71 (5.0%) patients died, 79 (5.5%) transferred to other clinics, 16 (1.1%) disengaged from the clinics, and the calculated true LTFU was 45 (3.1%), with 12-month ART retention rate of 95.3% for the entire study population. Imprisonment was the most frequent reason for disengagement from the clinics. True LTFU correlated significantly with low CD4 count and high plasma viral load, but not history of IDU.

Imprisonment is a major cause of disengagement from HIV care among patients with a history of IDU.

Below:  Retention rate for ART at 6–54 months after study enrollment.

The retention rate was calculated by dividing the number of patients who were still alive and on ART at 6–54 months by the total number of patients who had been followed up for 6–54 months, including those who died, those lost to follow-up, and those who disengaged from the clinic. Patients who were transferred to other clinics were excluded. Months; months after enrollment, n: number of the subjects for analysis,—;95%CI.

Full article at: http://goo.gl/QmM1sK

By:

Shoko Matsumoto, Junko Tanuma, Daisuke Mizushima, Shinichi Oka

AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan

Shoko Matsumoto

Graduate School of Public Health, Teikyo University, Tokyo, Japan

Daisuke Mizushima

Center for AIDS Research, Kumamoto University, Kumamoto, Japan

Ngoc Chi Thi Nguyen, Thanh Thuy Thi Pham, Cuong Duy Do, Tuan Quang Nguyen

Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam

Dung Thi Nguyen, Hoai Dung Thi Nguyen, Lam Tien Nguyen, Kinh Van Nguyen

National Hospital of Tropical Diseases, Hanoi, Vietnam

More at:  https://twitter.com/hiv_insight