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The Medical journal of Australia 10/2012; 197(7):382. · 2.81 Impact Factor
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ABSTRACT: To evaluate the assessment and treatment outcomes of a prison hepatitis service.
A retrospective, observational cohort study of prison inmates who attended hepatitis clinics from 1996 to 2005 at correctional centres in New South Wales.
Inmates who attended the clinics, including a nested case-control series of patients who received antiviral treatment and age- and sex-matched patients who did not receive treatment.
Demographic and clinical characteristics of patients who attended the service; correlates of selection for antiviral treatment; and clinical and virological outcomes of treatment.
Of the 1043 inmates who attended the clinics, 851 were men (82%) and 994 (95%) were referred for HCV infection; the mean age for this group was 33 years (range, 18-74 years). In the case-control series (185 treated and 186 untreated patients), selection for treatment was not biased by culturally and linguistically diverse background, current methadone treatment or psychiatric status. In the treated group, 76 of 138 genotyped patients had a genotype that is predictive of favourable treatment response, and a small minority of those with available liver biopsy results had established cirrhosis (7/119 patients). Of treated patients for whom complete follow-up data were available, 55% achieved sustained virological response and 100% adhered to therapy. In addition, treatment episodes were not especially complicated.
Although the prison population has high rates of injecting drug use and poor mental health, imprisonment offers an opportunity for assessment and treatment of chronic HCV infection.
The Medical journal of Australia 05/2010; 192(9):496-500. · 2.81 Impact Factor
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ABSTRACT: Health-state utilities for prisoners have not been described.
We used data from a 1996 cross-sectional survey of Australian prisoners (n = 734). Respondent-level SF-36 data was transformed into utility scores by both the SF-6D and Nichol's method. Socio-demographic and clinical predictors of SF-6D utility were assessed in univariate analyses and a multivariate general linear model.
The overall mean SF-6D utility was 0.725 (SD 0.119). When subdivided by various medical conditions, prisoner SF-6D utilities ranged from 0.620 for angina to 0.764 for those with none/mild depressive symptoms. Utilities derived by the Nichol's method were higher than SF-6D scores, often by more than 0.1. In multivariate analysis, significant independent predictors of worse utility included female gender, increasing age, increasing number of comorbidities and more severe depressive symptoms.
The utilities presented may prove useful for future economic and decision models evaluating prison-based health programs.
Health and Quality of Life Outcomes 02/2009; 7:78. · 2.11 Impact Factor
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ABSTRACT: To determine the risk of suicide and drug overdose death among recently released prisoners.
Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002.
Association between time after release and risk of suicide and overdose death.
Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months.
Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.
The Medical journal of Australia 11/2007; 187(7):387-90. · 2.81 Impact Factor
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ABSTRACT: Australian prisons have been identified as a focus of the ongoing hepatitis C epidemic. Harm minimisation is the major strategy directed to community-based public health measures to control hepatitis C. Harm-minimisation strategies to protect inmates and workers are incompletely and inconsistently applied in Australian prisons. Overseas experience has demonstrated that introducing injecting-equipment exchange programs and professional tattoo parlours in prisons could at least partially reduce the risks of ongoing hepatitis C transmission, and would support prevention and treatment programs. A two-stage approach is suggested: firstly, implementing programs of proven effectiveness consistently across the eight Australian jurisdictions, and, secondly, expanding current initiatives in the light of international "best practice".
The Medical journal of Australia 07/2007; 186(12):647-9. · 2.81 Impact Factor
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ABSTRACT: We examined factors associated with increased mortality in a cohort of 85,203 adults with a history of imprisonment in New South Wales, Australia, between 1988 and 2002. Information on death was collected through linkage to the Australian National Death Index. The influence of demographic and criminological factors on the standardised mortality ratio (SMR) for all-cause mortality, and deaths due to drug overdose and suicide was examined using negative binomial regression models. The number of deaths identified was 5,137 (4,714 men, 423 women, 303 in custody). The overall SMR was 3.7 (3.6-3.8) in men and 7.8 (7.1-8.5) in women. SMRs raised for deaths due to drug overdose (men: 12.8, women: 50.3) and suicide (men: 4.8, women: 12.2). The high SMR was associated with hospitalisation for mental illness, multiple imprisonments, and early stage of follow-up independently of causes of death. Being released from prison increased the SMRs for all-cause and drug-related mortality, but not suicide. For women, significant trends for decreasing risk with increasing age were noted. Minority groups, in particular men, had a lower risk of death than white people. In men a sex or drug offence was associated with a lower risk and a property or violence offence was related to higher mortality. Our results reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Certain demographic and imprisonment characteristics are indicators of high mortality among this population. The underlying causes of some of these characteristics such as mental illness or multiple imprisonments are potentially treatable and preventable. Prison health services need to develop interventions targeting high-risk groups to avoid this situation.
European Journal of Epidemiology 02/2007; 22(7):417-28. · 4.71 Impact Factor
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ABSTRACT: Hepatitis C virus (HCV) infection in prisoners represents an important public health problem. However, there is very little information about HCV-related health-related quality of life (HRQOL). We examined the effect of HCV antibody positivity, HCV viremia, and being a prisoner on prisoners'' HRQOL. Population-based health surveys incorporating HCV screening were conducted among prisoners at New South Wales (NSW), Australia, correctional centers in 1996 and 2001. HCV antibody and HCV RNA status were determined from venous blood sampling. HRQOL and mood status were assessed using the Short Form-36 (SF-36) Health Survey and Beck Depression Inventory (BDI). Comparison of HRQOL scores between HCV antibody negative, HCV antibody positive/non-viremic, and HCV antibody positive/viremic and assessment of temporal change in HRQOL between 1996 and 2001 within groups were made using ANCOVA adjusting for confounders. Factors associated with HRQOL were determined in linear regression models. Analyses between HCV antibody negative (n = 423), HCV positive/non-viremic (n = 89), and HCV positive/viremic (n = 178) prisoners found no measurable effect of HCV on HRQOL, including that attributable to HCV viremia. Compared to uninfected Australian population norms, prisoners had lower HRQOL irrespective of HCV status. The prevalence of 'moderate' to 'severe' depressive symptoms was greater in the HCV antibody positive/viremic group than the HCV antibody positive/non-viremic group or the HCV antibody negative group. Selected demographic factors (age), co-morbidity, severity of depressive symptoms and medical care utilization influenced HRQOL. There was evidence to support the effect of knowledge of HCV status on HRQOL. In conclusion, our findings contrast with previous studies in non-prisoner groups in which HCV infection appears to decrease overall HRQOL. Non-HCV factors may override HCV-specific HRQOL impairment in this population. Targeted management strategies are required to improve HRQOL of prisoners.
Journal of Urban Health 04/2006; 83(2):275-88. · 2.13 Impact Factor
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ABSTRACT: To estimate the number and proportion of children in New South Wales affected by parental incarceration, and to describe the health impact of punitive incarceration on the children of prisoners.
In 2001, NSW Corrections Health Service conducted a cross-sectional survey of prison inmates randomly selected from each of the 29 prisons in NSW, representing 11% of male and 30% of female inmates in the State. The survey included questions regarding parental status and number of children. A population model was developed, which incorporated increases in the prison population and recidivism, to estimate the number of children under 16 years of age in NSW ever having experienced parental incarceration.
In 2001, there were approximately 14,500 children under the age of 16 years in NSW who experienced parental incarceration during the year. It is estimated that in 2001 there were 60,000 children under 16 years in NSW who had ever experienced parental incarceration in their lifetime, representing 4.3% of all children and 20.1% of Indigenous children.
The number of children who have experienced parental incarceration is significant in NSW and across Australia. Indigenous children are much more likely to experience parental incarceration than non-Indigenous children.
Children of prisoners are at high risk of negative health outcomes and are themselves at an increased risk of offending later in life. The needs of these children must be recognised and policies introduced to reduce the adversities they face. The social, politico-legal and economic conditions that are contributing to the continuing rise in incarceration rates must be recognised, and measures must be taken to reduce this trend.
Australian and New Zealand Journal of Public Health 09/2004; 28(4):339-43. · 1.20 Impact Factor
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Jeffrey J Post,
Yong Pan,
Anthony J Freeman,
Charles E Harvey,
Peter A White,
Patricia Palladinetti,
Paul S Haber,
George Marinos, Michael H Levy,
John M Kaldor,
Kate A Dolan,
Rosemary A Ffrench,
Andrew R Lloyd,
William D Rawlinson
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ABSTRACT: Understanding the earliest virological and immunological events in acute hepatitis C virus (HCV) infection may provide insight into the determinants of protective immunity. Four cases of HCV viremia with subsequent viral clearance, but without biochemical hepatitis or anti-HCV seroconversion, are reported from a prospective cohort study of prison inmates. Two of the subjects who developed sustained viremia were assessed for production of interferon (IFN)- gamma, by use of the enzyme-linked immunospot (ELISPOT) method and by assessment of HCV cytotoxic T lymphocyte (CTL) activity, CD4 lymphocyte proliferative responses, HCV load, and genotype. After 2-6 months of viremia, all 4 subjects cleared serum HCV RNA. Specific cellular responses were detected in both of the subjects who were assessed, and production of IFN- gamma was demonstrated in one subject. All subjects had weak, but consistent, serological reactivity against HCV nonstructural proteins on immunoblot testing, despite repeatedly nonreactive HCV ELISA tests. These cases highlight the potential for cellular immune responses against HCV to facilitate viral clearance, responses that may model those required for effective HCV vaccination.
The Journal of Infectious Diseases 06/2004; 189(10):1846-55. · 6.41 Impact Factor
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ABSTRACT: 1. Describe an outbreak of varicella in a prison system. 2. Highlight the risks of disease transmission within the prison environment. 3. Promote infection control guidelines for high-risk sub-groups within the prison system, including the application of quarantine.
Four prisons, one prison hospital, the prison transport system, one courthouse.
Number of cases of varicella infection; reported varicella immunity status of cases and contacts; immunity status of known HIV antibody positive inmates.
Five cases of chickenpox were identified. There were 23 contacts of the Index Case occurring during transport between prison and court and whilst being held in the court holding cells. Two of these contacts developed chickenpox despite having given a prior history of infection. There were over 300 inmates exposed to varicella zoster virus (VZV) during the outbreak, including one HIV antibody positive inmate who had serologically confirmed immunity. This inmate developed shingles following exposure to VZV from one of the cases.
There is an elevated risk of respiratory transmission of infections such as chickenpox in prisons. Clear guidelines should be in place to protect HIV antibody positive people, pregnant women, and others who are at increased risk of complications from such infections. In the case of varicella, all inmates and staff without documented immunity should be screened to determine immunity, and if non-immune, should be offered VZV vaccination. Every effort should be made to prevent HIV antibody positive inmates being exposed to varicella, regardless of their varicella immunity status. If an HIV antibody positive inmate, who is known to be non-immune is exposed to varicella, Varicella Zoster immunoglobulin should be given within 96 h.
Public Health 12/2003; 117(6):446-51. · 1.35 Impact Factor
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ABSTRACT: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting.
Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV followed up for up to 14 months.
Two Australian prisons between November 2000 (time of exposure) and December 2001.
Two index patients (both infected with HIV and HCV; one also infectious for HBV) from two different prisons, and 104 inmates who shared needles and syringes.
Seroconversions to HIV, HBV and HCV related to the high-risk exposure and uptake and completion of HIV PEP determined from medical records of inmates.
There were four seroconversions to HCV within 14 months of the potential exposure (14% of those susceptible in the cohort), but no recorded HIV or HBV seroconversions. Forty-six inmates (82% of those eligible) were offered PEP, and 34 of these (74%) elected to receive it. Only eight (24% of the 34) completed the full PEP course.
HCV transmission in the prison setting is related to high-risk needle- and syringe-sharing. Administering HIV PEP in the prison setting is complicated by challenging risk assessment and follow-up.
The Medical journal of Australia 07/2003; 178(11):546-9. · 2.81 Impact Factor
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ABSTRACT: This study compares the prevalence of Mantoux positivity among prisoners in NSW in 1996 and 2001 and examines factors associated with Mycobacterium tuberculosis infection.
Cross-sectional random samples of prisoners, including a longitudinal cohort of prisoners screened in both 1996 and 2001. Setting: 29 correctional centres.
747 men and 167 women participated in the 2001 NSW Inmate Health Survey; a cohort of 104 prisoners from the 1996 and 2001 NSW Inmate Health Surveys.
The prevalence of Mantoux positivity remained stable between 1996 and 2001 (12% and 14%, p = 0.2), and increased among prisoners from Asian backgrounds (21% and 47%, p = 0.02). The annual risk of infection in the cohort among those detained continuously between 1996 and 2001 was 3.1%, and among recidivists it was 2.7% (p = 0.6).
The risk of M. tuberculosis infection for Australian prisoners is assessed to be approximately four times higher than that for the community, however there is no attributable risk to the prison environment itself.
New South Wales Public Health Bulletin 18(7-8):119-24.
