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      Disease profiles of detainees in the Canton of Vaud in Switzerland: gender and age differences in substance abuse, mental health and chronic health conditions

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          Abstract

          Background

          Literature on the disease profile of prisoners that differentiates by age and gender remains sparse. This study aimed to describe the health of correctional inmates in terms of substance abuse problems and mental and somatic health conditions, and compare it by gender and age.

          Methods

          This study examined cross-sectional data from the Canton of Vaud in Switzerland on the health conditions of detainees who were in prison on January 1, 2011 or entered prison in 2011. Health conditions validated by physician examination were reported using the International Classification of Diseases (ICD) version 10. The analyses were descriptive by groups of prisoners: the entire sample (All), Men, Older adults and Women.

          Results

          A total of 1,664 individuals were included in the analysis. Men comprised 91.5 % of the sample and had a mean age of 33 years. The other 8.5 % were women and had an average age of 39. Older adults (i.e., age 50 and older) represented 7 % of the total sample. Overall, 80 % of inmates were non-Swiss citizens, but the proportion of Swiss prisoners was higher among the older adults (51 %) and women (29 %). Overall, 41 % of inmates self-reported substance abuse problems. Of those, 27 % were being treated by psychiatrists for behavioral disorders related to substance abuse. Chronic infectious diseases were found in 9 % of the prison population. In addition, 27 % of detainees suffered from serious mental health conditions. Gender and age had an influence on the disease profile of this sample: compared to the entire prison population, the older inmates were less likely to misuse illegal drugs and to suffer from communicable infections but exhibited more problems with alcohol and a higher burden of chronic health conditions. Female prisoners were more disposed to mental health problems (including drug abuse) and infectious diseases. In terms of chronic diseases, women suffered from the same conditions as men, but the diseases were more prevalent in women.

          Conclusion

          It is important to understand the different disease profiles of prisoners by gender and age, as it helps identify the needs of different groups and tailor age-and gender-specific interventions.

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          Most cited references51

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          Substance abuse and dependence in prisoners: a systematic review.

          To review studies of the prevalence of substance abuse and dependence in prisoners on reception into custody. A systematic review of studies measuring the prevalence of drug and alcohol abuse and dependence in male and female prisoners on reception into prison was conducted. Only studies using standardized diagnostic criteria were included. Relevant information, such as mean age, gender and type of prisoner, was recorded for eligible studies. The prevalence estimates were compared with those from large cross-sectional studies of prevalence in prison populations. Thirteen studies with a total of 7563 prisoners met the review criteria. There was substantial heterogeneity among the studies. The estimates of prevalence for alcohol abuse and dependence in male prisoners ranged from 18 to 30% and 10 to 24% in female prisoners. The prevalence estimates of drug abuse and dependence varied from 10 to 48% in male prisoners and 30 to 60% in female prisoners. The prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women with drug problems. This highlights the need for screening for substance abuse and dependence at reception into prison, effective treatment while in custody, and follow-up on release. Specialist addiction services for prisoners have the potential to make a considerable impact.
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            The health and health care of US prisoners: results of a nationwide survey.

            We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates. We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates. Among inmates in federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition. Among inmates with a mental condition ever treated with a psychiatric medication, only 25.5% (SE = 7.5%) of federal, 29.6% (SE = 2.8%) of state, and 38.5% (SE = 1.5%) of local jail inmates were taking a psychiatric medication at the time of arrest, whereas 69.1% (SE = 4.8%), 68.6% (SE = 1.9%), and 45.5% (SE = 1.6%) were on a psychiatric medication after admission. Many inmates with a serious chronic physical illness fail to receive care while incarcerated. Among inmates with mental illness, most were off their treatments at the time of arrest. Improvements are needed both in correctional health care and in community mental health services that might prevent crime and incarceration.
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              Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs.

              HIV-infected drug users have increased age-matched morbidity and mortality compared with HIV-infected people who do not use drugs. Substance-use disorders negatively affect the health of HIV-infected drug users, who also have frequent medical and psychiatric comorbidities that complicate HIV treatment and prevention. Evidence-based treatments are available for the management of substance-use disorders, mental illness, HIV and other infectious complications such as viral hepatitis and tuberculosis, and many non-HIV-associated comorbidities. Tuberculosis co-infection in HIV-infected drug users, including disease caused by drug-resistant strains, is acquired and transmitted as a consequence of inadequate prescription of antiretroviral therapy, poor adherence, and repeated interfaces with congregate settings such as prisons. Medication-assisted therapies provide the strongest evidence for HIV treatment and prevention efforts, yet are often not available where they are needed most. Antiretroviral therapy, when prescribed and adherence is at an optimum, improves health-related outcomes for HIV infection and many of its comorbidities, including tuberculosis, viral hepatitis, and renal and cardiovascular disease. Simultaneous clinical management of multiple comorbidities in HIV-infected drug users might result in complex pharmacokinetic drug interactions that must be adequately addressed. Moreover, interventions to improve adherence to treatment, including integration of health services delivery, are needed. Multifaceted, interdisciplinary approaches are urgently needed to achieve parity in health outcomes in HIV-infected drug users. Copyright 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                karine.moschetti@chuv.ch
                stadelmann.pierre@gmail.com
                tenzin.wangmo@unibas.ch
                alberto.holly@unil.ch
                Patrick.Bodenmann@hospvd.ch
                Jean-Blaise.Wasserfallen@chuv.ch
                b.elger@unibas.ch
                bruno.gravier@chuv.ch
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                10 September 2015
                10 September 2015
                2015
                : 15
                : 872
                Affiliations
                [ ]Institut universitaire de médecine sociale et préventive, Unité d’evaluation des soins, University Hospital of Lausanne (CHUV), Route de la Corniche 10, 1010 Lausanne, Switzerland
                [ ]Technology Assessment Unit (UET), University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland
                [ ]Institute for Biomedical Ethics, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, 4056 Switzerland
                [ ]Institut d’économie et management de la santé (IEMS), HEC Lausanne and Département d’économétrie et d’économie politique (DEEP), University of Lausanne, Internef Building, Lausanne, 1015 Switzerland
                [ ]Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, 1011 Switzerland
                [ ]Service of Correctional Medicine and Psychiatry (SMPP), University Hospital of Lausanne (CHUV), Prilly-Lausanne, 1008 Switzerland
                [ ]Centre universitaire romand de médecine légale, University of Geneva, Geneva, Switzerland
                [ ]IEMS - Plateforme interfacultaire en économie et management de la santé, University of Lausanne CH, Internef Building, Lausanne, 1015 Switzerland
                Article
                2211
                10.1186/s12889-015-2211-6
                4566300
                2015fba6-25ae-44d5-8b57-f3b7b07259ac
                © Moschetti et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 July 2014
                : 2 September 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Public health
                Public health

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