Journal of Correctional Health Care

The effect of incarceration on sepsis outcomes in the United States is infrequently described in the literature. This study sought to investigate whether being incarcerated affected mortality rates in sepsis. The retrospective study used data from October 1, 2013, to November 30, 2016, of patients admitted with a diagnosis of sepsis at a tertiary care center with a primary outcome of in-hospital mortality. The study cohort included 8,568 cases of sepsis, of which 8,448 were noninmates and 120 were inmates. Overall mortality was 15.7%; for noninmates, the rate was 15.3%, and for inmates, 42.5%. The risk of death among inmates was 2.8 times that of noninmates. Neither age, sex, nor race were significant confounders. Findings suggest a direct association between incarceration and sepsis mortality. Larger regional or nationwide case-control studies should be conducted to confirm these findings.

Two California state prisons (A and B) have very high rates of coccidioidomycosis (Valley Fever). The prison health care service sought to improve their prevention strategy by risk stratification with a newly available spherulin-based Coccidioides delayed-type hypersensitivity test. Of the 36,789 voluntarily screened inmates, 4.7% experienced adverse reactions. A positive test (8.6% of those tested) was independently associated with (1) incarceration at prisons A and B, (2) admission to prison from a Coccidioides-endemic county, (3) length of stay at prisons A and B, and (4) increasing age. These findings suggest that the test is safe and performing well at risk stratification; the prison system now restricts inmates with negative tests from prisons A and B. This novel use of the test might benefit other coccidioidomycosis prevention programs.

This qualitative article presents and compares the views of older prisoners and expert stakeholders on the topic of nutrition and exercise. The study highlights measures for improving the health of older prisoners. Older prisoners report the need to improve quality of meals provided in prison. They note that prison food is of poor quality and not adapted to their needs. With regard to exercise, they point out the lack of proper opportunities to engage in exercise and sports, and describe several factors that make physical activities either unsuitable or unfeasible. Expert stakeholders see prison as an opportunity to improve the health of those convicted of crimes. In light of the increasing number of older prisoners, age-appropriate nutritional and exercise interventions should take priority in prisons.

Individuals with serious mental illness detained in jail may require frequent psychiatric hospitalization due to the destabilizing nature of the jail environment. This study examined the impact of a pilot treatment program involving continuity of patient care across jail and hospital settings aimed at reducing hospitalizations and negative health outcomes for a population of high-risk, incarcerated individuals with mental illness. This study examined rate ratios of psychiatric hospitalizations, injuries, and suicide watches, comparing 15 patients in the treatment program to themselves pretreatment and to a control group of 15 frequently rehospitalized patients. Patients in treatment experienced significant decreases in overall hospitalizations (p < .001), 15-day rehospitalizations (p < .002), and suicide watches in jail (p < .02), compared to themselves pretreatment. A boundary-spanning treatment program lowered hospitalization rates and need for suicide watch for a small, yet clinically complicated and challenging group of patients.

This study evaluated the effectiveness of formulary substitution from products or regimens containing name brand emtricitabine to alternative regimens containing generic lamivudine among virologically suppressed HIV-infected patients in a correctional managed health care system. Results of this retrospective cohort study showed that 94.9% of patients switched from emtricitabine to lamivudine (n = 447) and 93.0% of emtricitabine control patients (n = 449) had an undetectable viral load at last available test over a 2-year period. The two groups also showed similar values for CD4 counts, compliance, discontinuation, and M184V mutation; however, a slightly greater proportion of lamivudine patients experienced respiratory symptoms. Nonetheless, this study demonstrates that switching virologically suppressed HIV-infected patients from name brand emtricitabine-containing regimens to generic lamivudine-based regimens may reduce costs without compromising safety or effectiveness in correctional managed health care systems with directly observed therapy.

The aim of the study was to describe oral health status as well as risk factors related to the oral health in a prison inmate population at admission. A sample of 186 men admitted to one of Sweden’s prisons were examined and interviewed to collect information. The results indicate a high prevalence of untreated oral disease and oral health risk factors in the sample. Seventy-one percent of the study population indicated drug abuse. Only 4.9% were assessed with completely healthy periodontal tissues, and 66% showed at least one tooth with untreated caries. According to the current regulations on dental care for inmates, only 11% of the study population was entitled to basic dental treatment (except emergency).

The purpose of this 3-month quasi-experimental pilot study was to examine the effect of a physical activity and dietary education program on body mass index (BMI) and resilience. Participants were given data-storing pedometers to record their physical activity, attended classes on healthy eating, and used portion control tools from http://ChooseMyPlate.gov. MyPlate usage and commissary purchases were collected weekly. BMI and resilience scores were measured at baseline, 6 weeks, and 12 weeks. Twenty-nine female prisoners completed the study. There was a statistically significant reduction in BMI after 12 weeks (χ² = 7.56, p = .023) and resilience levels increased but did not reach statistical significance (χ² = 1.66, p = .437). A physical activity and dietary intervention delivered by a correctional health nurse practitioner was an efficacious approach to reducing BMI and improving resilience among female prisoners.

Social capital has been associated with improved health outcomes. Measures of social capital have been developed specifically for different population groups, cultures, and contexts; however, there is no readily available measure for use among inmates in the prison setting. This study sought to translate a community concept into the prison setting through the development and piloting of the Inmate Social Capital Questionnaire (ISCQ). Thirty male inmates (living with hepatitis C) participated in the pilot phase of the ISCQ (n = 23 sentenced and n = 7 held on remand). Dimensions of social capital were influenced by length of incarceration (time already served as well as time to release), connections with family, and duration at current prison.