Tuberculosis outbreaks in prison housing units for HIV-infected inmates--California, 1995-1996.
During 1995-1996, staff from the California departments of corrections and health services and local health departments investigated two outbreaks of drug-susceptible tuberculosis (TB). The outbreaks occurred in two state correctional institutions with dedicated HIV housing units. In each outbreak, all cases were linked by IS6110-based DNA fingerprinting of Mycobacterium tuberculosis isolates. This report describes the investigations of both outbreaks; the findings indicated that M. tuberculosis can spread rapidly among HIV-infected inmates and be transmitted to their visitors and prison employees, with secondary spread to the community. (+info)
Medical practice: defendants and prisoners.
It is argued in this paper that a doctor cannot serve two masters. The work of the prison medical officer is examined and it is shown that his dual allegiance to the state and to those individuals who are under his care results in activities which largely favour the former. The World Health Organisation prescribes a system of health ethics which indicates, in qualitative terms, the responsibility of each state for health provisions. In contrast, the World Medical Association acts as both promulgator and guardian of a code of medical ethics which determines the responsibilities of the doctor to his patient. In the historical sense medical practitioners have always emphasized the sanctity of the relationship with their patients and the doctor's role as an expert witness is shown to have centered around this bond. The development of medical services in prisons has focused more on the partnership between doctor and institution. Imprisonment in itself could be seen as prejudicial to health as are disciplinary methods which are more obviously detrimental. The involvement of medical practitioners in such procedures is discussed in the light of their role as the prisoner's personal physician. (+info)
The place of medicine in the American prison: ethical issues in the treatment of offenders.
In Britain doctors and others concerned with the treatment of offenders in prison may consult the Butler Report (see Focus, pp 157) and specialist journals, but these sources are concerned with the system in Britain only. In America the situation is different, both in organization and in certain attitudes. Dr Peter L Sissons has therefore provided a companion article to that of Dr Paul Bowden (page 163) describing the various medical issues in prisons. The main difference between the treatment of offenders in prisons in America and in Britain lies in the nature of the federal system which means that each state may operate a different system in a variety of prisons and prison medical services are as various. Nationally, the prison systems are 'structured to treat and cure the offender'. Therefore it follows that the prison medical officer is only one of the professionals concerned with this 'cure' of the offender. This principle also applies to any form of research: medical research in prisons is part of a programme which covers a wide field of social and judicial research. The prison medical officer (where there is one) has of course to look after sick prisoners, and the American idea of 'cure' is also expressed in the need for more corrective surgery where, for example, it is necessary to remove physical impediments to social rehabilitation. But a doctor is only found on the staff of those institutions which are large: in the smaller prisons there may be only first-aid facilities, and no specially appointed doctor in the community. Moreover medicines are often dispensed by medical auxiliaries who are sometimes prisoners themselves. Finally, in America prisoners are regularly invited to volunteer as subjects for medical and social research for which they are paid. In short, although it is hoped to 'cure' a prisoner he is a criminal first and a patient second. (+info)
Dilemmas of medical ethics in the Canadian Penitentiary Service.
There is a unique hospital in Canada-and perhaps in the world-because it is built outside prison walls and it exists specifically for the psychiatric treatment of prisoners. It is on the one hand a hospital and on the other a prison. Moreover it has to provide the same quality and standard of care which is expected of a hospital associated with a university. From the time the hospital was established moral dilemmas appeared which were concerned with conflicts between the medical and custodial treatment of prisoners, and also with the attitudes of those having the status of prisoner-patient. Dr Roy describes these dilemmas and attitudes, and in particular a special conference which was convened to discuss them. Not only doctors and prison officials took part in this meeting but also general practitioners, theologians, philosophers, ex-prisoners, judges, lawyers, Members of Parliament and Senators. This must have been a unique occasion and Dr Roy's description may provide the impetus to examine these prison problems in other settings. (+info)
Incident syphilis among women with multiple admissions to jail in New York City.
Although early syphilis morbidity in New York City (NYC) has declined to a record low, syphilis seroreactivity among women jailed in NYC is approximately 25%. By use of a retrospective cohort-type analysis of longitudinal serologic and treatment data collected at the time of each incarceration, the incidence of syphilis infection among 3579 susceptible women jailed multiple times in NYC between 23 March 1993 and 10 April 1997 was estimated. Syphilis incidence densities were estimated by use of continuous, time-homogeneous Markov models. There was a total of 289 incident infections. The overall incidence density was 6.5 infections per 100 woman-years (95% confidence interval, 5.7-7.2), which exceeds the 1997 early syphilis rate among women in NYC by>1000-fold. The persisting high incidence of syphilis in this population underscores the importance of aggressive syphilis control in correctional settings, even in the face of declining local early syphilis rates. (+info)
Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis.
OBJECTIVE: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects. METHOD: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested. Vaccination against hepatitis B was administered to all susceptible subjects. RESULTS: Hepatitis B carriage was found in 10 people, six of whom were prisoners. Fifteen of the subjects tested were found to be positive for anti-HBc, six of whom were house workers. Anti-HCV were found to be positive in seven prisoners and one worker. A vaccination programme against hepatitis B was introduced in 27 susceptible subjects (58.7% of unexposed subjects) and was completed in 22. CONCLUSION: Prisoners and staff at Neapolis Prison constitute a high-risk group for hepatitis B and C. Compliance rate in screening was high and GPs were successful in having a desirable response rate in the administration of vaccines. (+info)
High prevalence of chlamydial and gonococcal infection in women entering jails and juvenile detention centers--Chicago, Birmingham, and San Francisco, 1998.
The prevalence of sexually transmitted diseases (STDs) is high among women entering corrections facilities. Screening for STDs in these facilities, however, is difficult because of the large number of persons admitted each day and the frequent shortage of medical staff and examination space. New, sensitive urine tests for gonorrhea and chlamydia have made screening practical outside of medical settings. To assess the feasibility of screening women in corrections facilities for chlamydial and gonococcal infection using urine tests and to determine the prevalences of these infections, the Chicago Department of Public Health and the University of Alabama at Birmingham (UAB) began testing women and adolescent females entering the Cook County Jail and the Cook County Juvenile Temporary Detention Center in Chicago and the Jefferson County Jail and the Jefferson County Youth Detention Center in Birmingham, respectively, in 1998. The San Francisco Department of Public Health has been testing women at the San Francisco County jails for chlamydial and gonococcal infections using urine tests since 1996 and adolescent females at the San Francisco Youth Guidance Center since 1997. This report summarizes the findings for testing incarcerated women in 1998 in the three cities; preliminary results indicate that, in these facilities, testing for chlamydial and gonococcal infections is feasible and that a high percentage of women test positive for these infections. (+info)
Method used to identify previously undiagnosed infections in the HIV outbreak at Glenochil prison.
Four years after the occurrence of an outbreak of hepatitis B and HIV infection among injecting drug user inmates at Her Majesty's Prison Glenochil in Scotland, a study design was developed to complete the epidemiological account of the HIV outbreak. Our aim was to identify potential cases of (1) HIV transmission not diagnosed during the original outbreak investigation and (2) the source(s) of the outbreak. Scotland's HIV positive case register was searched for matches to a soundexed list of 636 Glenochil inmates imprisoned during January-June 1993. Eight HIV infections that may have been acquired in Glenochil and four possible sources of the outbreak were identified. The second stage of follow-up molecular epidemiological techniques used on stored sera samples from identified individuals is described in the companion paper. Without breach of medical or prisoner confidentiality, indirect and anonymous follow-up has proved possible for the Glenochil inmates. (+info)