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Coronavirus disease 2019 (COVID-19) may affect anybody, and prisoners are a susceptible group in terms of the risk of contracting infectious illnesses owing to a variety of situations such as overcrowding, confinement, and poor cleanliness. Therefore, this study aimed to assess prisoners’ Knowledge, Attitude, and Practice (KAP) of COVID-19 and its determinants in southern Ethiopia.
Method:
The Institutional cross-section study was conducted among 404 prisoners selected using simple random sampling obtained from the prisoner’s registration book. To collect data from prisoners, an interviewer-based face-to-face data-collecting technique was used. Multivariate ordinal logistic regression was used to identify determinants of KAP toward COVID-19.
Results and Conclusions:
The majority of the prisoners had limited understanding and poor preventive strategies application toward COVID-19. Being male, living in a rural area, having a low educational standing, and being a farmer were related to limited knowledge, negative attitude, and poor practice toward COVID-19. Furthermore, having little understanding was linked with poor practice toward COVID-19. As a result, the focus should be on convicts, creating awareness, and addressing specific socioeconomic features of prisoners, as well as boosting COVID-19 preventive activities that should get attention in the prison.
From 2000 to 2008, election overload fatigued voters when the Zimbabwe government balloted citizens in six elections – an average of one election every fourteen months. The July 2013 election was also harmonised, ending the shaky MDC–Zanu PF coalition government. The election was preceded by a generally peaceful adoption of a new constitution on 16 March 2013. The constitution was a milestone achievement but a dead letter, stipulating that all security forces and government institutions, including the state media, must be impartial and that reforms on all freedoms must be implemented. However, as in the past, Zanu PF dragged its feet on the full implementation of critical reforms needed to improve the human rights environment and create conditions for democratic elections. Such pipe dream reforms included: police training; renouncing the use of violence; ensuring that the government fully and impartially enforced domestic laws in bringing all perpetrators of politically motivated violence to justice; freedom from harassment and intimidation; the respect for the rule of law; and full realisation of the rights to freedom of association and assembly, and the promotion of freedom of expression and communication.
This chapter examines the ways in which people with mental health conditions who also belong to other excluded groups may be particularly disadvantaged, in general and by mental health services. People with mental health conditions are at risk of social exclusion, but many from certain social identity groups are particularly at risk: for example, women, people from black and minority ethnic groups, and those from sexual minorities. In addition, certain groups of people are defined by their exclusion from society, such as refugees and asylum seekers, prisoners, and the homeless. The occurrence of mental health conditions in these groups is much higher than in the general population and they will often face barriers to accessing essential material resources and adequate healthcare. The presence of mental health conditions and group characteristics intersect to exacerbate the degree of exclusion experienced by the people in these groups. Some combinations may result in particularly profound states of deprivation and destitution. These severe and multiple forms of exclusion have been named ‘deep social exclusion’ or ‘people with multiple and complex needs’, two examples of which are seen in ‘multiple exclusion homelessness’ and people with multiple diagnoses.
“The Longest Day in Graignes,” recounts the three German assaults on the village on 11–12 June. The paratroopers rebuffed the numerically superior enemy, until they ran out of ammunition. The 17th SS Panzergrenadier Division also employed heavy guns, including artillery, against the village. The Germans damaged the twelfth-century Romanesque Church. Once they seized the center of the village, the SS troops proceeded to murder the village priest, Father Albert Le Blastier, and his aides for tending to wounded Americans. The Nazi troops terrorized other villagers. The Nazis also executed nineteen US prisoners, many of whom had been wounded in action. The length of the battle held the 17th SS Panzergrenadier Division back from its central mission, namely the recapture of the strategically vital port town of Carentan.
Malingering, the practice of feigning medical conditions for specific purposes, became a pressing concern for many practitioners of legal medicine following the introduction of conscription during the Revolutionary and Napoleonic Wars. A burgeoning medicolegal literature on malingering revealed that some doctors went to great lengths to detect and expose malingerers by using deceit, coercion, painful procedures, and altered states of consciousness as diagnostic tools. Doctors justified the far-reaching tactics used in adversarial contests with suspected malingerers in the name of the public good. Acting on behalf of the state to expose them, doctors engaged in adversarial relationships with suspected malingerers. These encounters also provided an impetus for debates about medical ethics; however, ethical concerns about doctors’ methods of detecting malingering were rarely raised and debated until the end of the nineteenth century.
Covid-19 has induced many changes to society, including some in the practice of medicine and psychiatry. Among them is increasing use of telecommunications. A previous editorial outlined the possible uses and dangers of telemedicine with prisoners (Gunn et al 2020). Forensic psychiatry is also concerned with providing expert evidence to courts and other arbitration bodies and, increasingly, these bodies too are relying on such technology. Further in addition to traditional paper-style records (many now held electronically rather than literally on paper) there is increasing use of video recording of interviews, of day to day behaviour on secure hospital units and by bodycams when intervening in a tense, potentially violent situation. To what extent are these being used in court? Is there a European framework for guiding us on how to proceed? How has this been interpreted to date in countries across Europe? In this paper these issues will be addressed.
Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.
Objectives
In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.
Methods
Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.
Results
Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.
Conclusions
Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.
The campaign songs of Abraham Lincoln help to carry a working-class hero into the White House, while no songs are sung about his background as a wealthy corporate lawyer. Lincoln’s love of opera is only one further dimension to the music of the Civil War era; the sides are drawn in the popular music of the Union and the Confederacy, while the songs of the newly emancipated Black soldiers herald the turn of the tide toward Union victory. The Irish contribution is also charted musically, as are such contentious subjects as the New York Draft Riots and the fate of the war’s prisoners and its disabled veterans. The hope of emancipated Black Americans in the wake of Sherman’s March through Georgia is sung to the skies, before the assassination of Lincoln paves the way for Andrew Johnson and the betrayal of Reconstruction.
Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.
Aims
To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.
Method
We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.
Results
In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.
Conclusions
ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
Using recently published general population studies, this chapter updates an earlier Moran review on the epidemiology of ASPD. It examines the prevalence, comorbidity, psychosocial functioning, impact on health services and cultural differences of those with ASPD and, to a lesser extent, of those with psychopathy and on prisoners. It finds that the prevalence of ASPD ranges between 0.6% and 4.3% in men (which is significantly higher than in women). It has multiple comorbidities – both with other mental disorders (especially with substance misuse and affective disorder) together with other Cluster B PDs. Despite significant mental health and psychosocial impairment, those with ASPD rarely seek treatment for their disorder. There are marked cultural differences in the prevalence of ASPD with studies in the United States showing significantly higher rates than in Europe or in Asia. The prevalence of ASPD among prisoners is c. 55% among men and 31% among women with community prevalence rates for psychopathy ranging from 0.6% in the United Kingdom and 1.0% in the United States. Both ASPD and psychopathy have a positive association with both increased mortality and suicidality, suggesting that, together with their other impairments, they are a group that require mental health interventions.
There is growing interest in the relationship between head injury, offending and recidivism and in developments in the criminal justice and forensic health systems to assess and manage the impact of associated brain injury. This chapter summarises evidence indicating that the head injury is particularly prevalent in offenders, and that it is likely to be a causative factor that increases the risk of criminal behaviour. This is explained in relation to the neurobehavioural effects of head injury and characteristics of offenders with head injury, the impact of brain damage early in life and the high risk of multiple head injuries. The need to assess head injury at key points in the criminal justice system and means of doing so is given, together with a context of interventions, service need and directions for future research.
This paper examines the presence of lonely, isolated and impoverished older citizens in Japan's prison population, many of whom have turned to petty crime only recently and arguably lack a genuine need for corrective services. The paper offers empirical evidence drawn from a mixed-methods study that appears to confirm their compliant, ‘law-abiding’ attributes. It argues that their influx into prisons can be seen, at least in part, as citizens who are already socially excluded and stigmatised leveraging law to assert an additional risk-laden and stigmatised identity, which provides protection. The outcome is the subversion of prisons as de facto aged-care communities. This analysis resonates with an emerging body of literature that Chua and Engel (2018; 2019) have described as the ‘Identity’ school of legal-consciousness scholarship. This literature centres on empirical studies of marginalised cohorts who leverage legal structures to embrace an identity that complicates their stigma while providing desired protections.
Paraguay is a landlocked country in South America. It is a democratic low-middle-income nation, and the Ministry of Public Health and Social Welfare is responsible for its healthcare system. Mental health services receive just 1–2% of healthcare budgets, and there are only 1.6 psychiatrists per 100 000 inhabitants. There are insufficient resources to adequately assess and treat mental disorders in high-risk populations such as children, adolescents and prisoners. Despite several improvements to mental health policies within the past two decades, the nation still lacks a Mental Health Act and specific policies required to optimise the mental health of the population.
In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.
Methods
We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.
Results
The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).
Conclusions
Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.
Self-harm among prisoners is a common phenomenon. This study aims to estimate the prevalence of self-injurious behavior (SIB) among Greek male prisoners, record their motives and determine independent risk factors.
Methods
A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. The questionnaire included items on self-harm/SIB, demographic parameters, childhood history, family history, physical and mental disease, lifestyle and smoking habits, alcohol dependence (CAGE questionnaire), illicit substance use, aggression (Buss–Perry Aggression Questionnaire [BPAQ] and Lifetime History of Aggression [LTHA]), impulsivity (Barrat Impulsivity Scale-11) and suicidal ideation (Spectrum of Suicidal Behavior Scale). Univariate nonparametric statistics and multivariate ordinal logistic regression were performed.
Results
Of all the participants, 49.4% (95% CI: 41.5–57.3%) disclosed self-harm (direct or indirect). The prevalence of SIB was equal to 34.8% (95% CI: 27.5–42.6%). Most frequently, SIB coexisted with indirect self-harm (80.7%). The most common underlying motives were to obtain emotional release (31.6%) and to release anger (21.1%). At the univariate analysis, SIB was positively associated with a host of closely related factors: low education, physical/sexual abuse in childhood, parental neglect, parental divorce, alcoholism in family, psychiatric condition in family, recidivism, age, sentence already served, impulsivity, aggression, alcohol dependence, self-reported diagnosed psychiatric condition and illicit substance use. Childhood variables were particularly associated with the presence of diagnosed psychiatric condition. At the multivariate analysis, however, only three parameters were proven independent risk factors: self-reported diagnosed psychiatric condition, illicit substance use and aggression (BPAQ scale).
Conclusion
The prevalence of SIB is particularly high. Psychiatric condition, illicit substance use and aggression seem to be the most meaningful risk factors; childhood events seem only to act indirectly.
The aim of this study was the effectiveness of emotion regulation and distress tolerance skills on improving coping strategies and reduce perceived stress in prisoners in Foman city in Iran.
Method
The study population was consisted of 200 prisoners of Foman Penitentiary in 2016. Then, 30 prisoners were selected randomly in two groups (15 persons each group) were replaced. Emotion regulation and distress tolerance training was given to the experimental group for 12 sessions and the control group were in waiting list. Both groups at baseline and end of intervention phase filled coping responses inventory Bellinger and mouse and Cohen perceived stress questionnaire – version 14 questions (PSS-14). Data were analysed by using the software spss22.
Findings
Emotion regulation and distress tolerance skills have been effective on Improving problem-focused coping strategies and reduce perceived stress in prisoners (P < 0/001).
Discussion and conclusion
emotion regulation and distress tolerance skills can improve problem-focused coping strategies and reduce the use of emotion-focused coping strategies and perceived stress in prisoners.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Previous research indicates that prisoners have severe psychological distress. To assess their distress level and potential need for treatment, the present study compared the subjective psychological distress of long- and short-term prisoners with that of psychiatric and forensic patients.
Methods:
Long- (n = 98) and short-term prisoners (n = 94) and forensic (n = 102) and psychiatric (n = 199) patients completed the German versions of the Symptom Checklist Revised (SCL-90-R) and Brief Symptom Inventory (BSI).
Results:
In general, long-term prisoners showed the same level of mental distress as psychiatric patients and more than that reported by forensic patients. Short-term prisoners reported the least level of distress. Long- but not short-term prisoners showed clinically significant results on the scales for depression, paranoid ideation, and psychosis.
Conclusions:
The improvements in psychiatric treatment for inmates demanded by many stakeholders need to differentiate between long- and short-term prisoners. Because depression seems to cause the most psychological distress among inmates, suicide prevention seems to be an important issue in prisons.
Not all captured Australians survived the tumult of battle. After the 7th Brigade’s failed attack on the Windmill at Pozières on 28 July 1916, a German officer approached an Australian Lewis gunner nursing a bullet wound to his leg. ‘You are the Machine Gunner?’ asked the officer. ‘Yes, sir,’ the man replied. Without hesitation, the officer drew his automatic pistol and shot the man through the heart and the head, killing him instantly. ‘That’s the way to deal with English swine.’
In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18–81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18–27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86–3.86], physical abuse (OR 2.16, 95% CI 1.60–2.91), emotional abuse (OR 2.70, 95% CI 1.92–3.79), emotional neglect (OR 2.29, 95% CI 1.69–3.10), physical neglect (OR 1.57, 95% CI 1.27–1.94) and combined abuse (OR 3.09, 95% CI 2.14–4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.
Offensive and defensive army action responded to multiple, partly contradictory logics. The supreme commander and his staff designed the official strategy to defeat the rebels, which officers at the lower levels were called upon to implement. The motives of officers and soldiers “on the spot,” such as personal gain, were frequently at odds with the official strategy, however, and shaped military activities and the use of force to suit their own needs. Finally, situational factors such as the immediate threats soldiers faced on duty, i.e., attacks, hunger and illness, impeded the pursuit of long-term goals. The need to procure food by harvesting enemy cornfields, or the quest for enrichment by looting or putting prisoners to work often triggered external violence. Both rebel and government forces were guilty of strategic massacres and other atrocities in a show of force or an attempt to demoralize the enemy or as acts of hatred and revenge. Looting was not simply an incidental feature of warfare. It became an integral part of the government system to compensate soldiers and volunteers for their efforts in the struggle against the rebels and to cover campaign expenses.