Drug-drug interactions in inmates treated for human immunodeficiency virus and Mycobacterium tuberculosis infection or disease: an institutional tuberculosis outbreak.
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The use of rifamycins is limited by drug interactions in human immunodeficiency virus (HIV)-infected persons who are receiving highly active antiretroviral therapy (HAART). During a tuberculosis (TB) outbreak at a prison housing HIV-infected inmates, rifabutin was used to treat 238 men (13 case patients and 225 contacts). Steady-state peak plasma rifabutin concentrations were obtained after rifabutin dosages were adjusted for men receiving single-interacting HAART (with either 1 protease inhibitor [PI] or efavirenz), multi-interacting HAART (with either 2 PIs or > or =1 PI with efavirenz), and for noninteracting HAART (>1 nucleoside reverse-transcriptase inhibitor or no HAART) without rifabutin dose adjustments. Low rifabutin concentrations occurred in 9% of those receiving noninteracting HAART, compared with 19% of those receiving single-interacting and 29% of those receiving multi-interacting HAART (chi2, 3.76; P=.05). Of 225 contacts treated with rifabutin-pyrazinamide, 158 (70%) completed treatment while incarcerated. Rifabutin-pyrazinamide therapy was difficult to implement, because of the need for dosage adjustments and expert clinical management. (+info)
The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997.
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OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return. (+info)
Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.
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OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites. (+info)
Psychosis and drug dependence: results from a national survey of prisoners.
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BACKGROUND: The links between drug use and psychosis are of major aetiological and prognostic significance. Psychosis and drug dependence frequently co-occur within the prison population, providing the opportunity to study this link more closely. AIMS: To explore the relationship between psychosis and drug dependence in a sample of prisoners. METHOD: A total of 3142 prisoners were surveyed nationally, and structured clinical data were obtained from a subsample of 503 respondents. Psychiatric assessment was based on the Schedules for Clinical Assessment in Neuropsychiatry (version 1.0). Measures of amphetamine, cannabis, cocaine and heroin use and dependence were obtained through self-report. RESULTS: Logistic regression analyses indicated that first use of amphetamines or cocaine before the age of 16 years and severe cannabis or cocaine dependence were related to an increased risk of psychosis. In contrast, severe dependence on heroin was associated with a reduced risk of this classification. CONCLUSIONS: Severe dependence on cannabis and psychostimulants is associated with a higher risk of psychosis and is in contrast to severe dependence on heroin, which has a negative relationship with psychosis. (+info)
Impulsivity and HIV risk among adjudicated alcohol- and other drug-abusing adolescent offenders.
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Although impulsivity is likely to be related to HIV risk--particularly in incarcerated substance-abusing youth--this area of research has been understudied. To investigate the relationship between impulsivity and various HIV/AIDS risk behaviors and attitudes, a sample of court-referred and incarcerated culturally diverse inner-city adolescents (males: N = 266; females: N = 111) were divided into high and low impulsive groups based on the Millon Adolescent Clinical Inventory Impulsivity Scale. Findings showed that compared to the less impulsive group, the highly impulsive adolescents reported more frequent marijuana and alcohol use in the last 3 months as well as a significantly higher proportion of unprotected sex when high on alcohol and marijuana, higher perceived susceptibility to HIV, more AIDS-related anxiety, greater HIV knowledge, less sexual self-efficacy, and less favorable sexual attitudes. Implications for interventions among incarcerated youth are discussed. (+info)
Causes of death among people in custody in Ontario, 1990-1999.
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BACKGROUND: People in custody are more likely to die prematurely, especially of violent causes, than similar people not in custody. Some of these deaths may be preventable. In this study we examined causes of death (violent and natural) among people in custody in Ontario. We also compared the causes of deaths in 3 custodial systems (federal penitentiaries, provincial prisons and police cells). METHODS: We examined all available files of coroners' inquests into the deaths of people in custody in federal penitentiaries, provincial prisons and police cells in Ontario from 1990 to 1999. Data collected included age, cause of death, place of death, history of psychiatric illness and history of substance abuse. Causes of death were categorized as violent (accidental poisoning, suicide or homicide) or natural (cancer, cardiovascular disease or "other"). Crude death rates were estimated for male inmate populations in federal and provincial institutions. There were inadequate numbers for women and inadequate denominator estimates for police cells. RESULTS: A total of 308 inmates died in custody during the study period; data were available for 291 (283 men, 8 women). Of the 283 deaths involving men, over half (168 [59%]) were from violent causes: suicide by strangulation (n = 90), poisoning or toxic effect (n = 48) and homicide (n = 16). Natural causes accounted for 115 (41%) of the deaths among the men, cardiovascular disease being the most common (n = 62 cases) and cancer the second most common (n = 18). Most (137 [48%]) of the deaths among the men occurred in federal institutions; 88 (31%) and 58 (21%) respectively occurred in provincial institutions and police cells. The crude rate of death among male inmates was 420.1 per 100,000 in federal institutions and 211.5 per 100 000 in provincial institutions. Compared with the Canadian male population, male inmates in both federal and provincial institutions had much higher rates of death by poisoning and suicide; the same was true for the rate of death by homicide among male inmates in federal institutions. The rates of death from cardiovascular disease among male inmates in federal and provincial institutions -- 102.7 and 51.7 per 100,000 respectively -- were also higher than the national average. INTERPRETATION: Violent causes of death, especially suicide by strangulation and poisoning, predominate among people in custody. Compared with the Canadian male population, male inmates have a higher overall rate of death and a much higher rate of death from violent causes. (+info)
Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.
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OBJECTIVES: This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. OBSERVATIONS: Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. CONCLUSION: Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use. (+info)
Rifampin- and multidrug-resistant tuberculosis in Russian civilians and prison inmates: dominance of the beijing strain family.
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Consecutive patient cultures (140) of Mycobacteriium tuberculosis were collected from five Russian civilian and prison tuberculosis laboratories and analyzed for rifampin (rpoB) and isoniazid resistance (inhA, katG, ahpC); transmission of Beijing family isolates; and the importance of prison and previous therapy in drug resistance. Rifampin, isoniazid, and multidrug resistance occurred in 58.2%, 51.6%, and 44.7% of cultures, respectively; 80% of prison cultures were rifampin resistant. Spoligotyping and variable number tandem repeat (VNTR) fingerprinting divided the isolates into 43 groups. Spoligotyping demonstrated that a high proportion (68.1%) of patients were infected with Beijing family strains and that most (69.1%) were rifampin resistant; the highest proportion (81.6%) occurred in prison. One VNTR subgroup (42435) comprised 68 (72.3%) of the Beijing isolates with a small number of IS6110 types; 50 (73.5%) were rifampin resistant. Rifampin-resistant Beijing isolates are dominant within the patient population, especially among prisoners, and threaten treatment programs. (+info)