Diabetes and hypertension care among male prisoners in Mexico City: exploring transition of care and the equivalence principle

Diabetes Self-Management and Care Among Incarcerated Individuals: A Systematic Review

Diabetes is prevalent among incarcerated individuals, necessitating effective management within prison settings. This study aims to assess diabetes management among incarcerated individuals and analyze the methodological aspects of relevant research focusing on incarcerated individuals with diabetes. A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases, with data parameters from 1990 to 2021 and following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, to investigate diabetes management in incarcerated individuals. The search yielded 706 records, from which 14 English-language quantitative studies meeting inclusion criteria were selected for analysis. These studies were predominantly retrospective with low levels of evidence. However, they consistently demonstrated the beneficial effects of dietary interventions, educational programs, and nursing guidance on diabetes management in incarcerated populations. This study highlights the need for more comprehensive and high-evidence research to further explore health professionals' practices with incarcerated individuals with diabetes and the effectiveness of diabetes management. Such studies are crucial for improving the quality of care provided to this vulnerable population.

Understanding and improving the quality of primary care for people in prison: a mixed-methods study

Background

People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities.

Objective

To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved.

Design

A mixed-methods study with six interlinked work packages.

Setting

Predominantly the North of England.

Methods

Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups.

Findings

Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment.

Limitations

Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ.

Conclusions

Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change.

Study registration

This study is registered at researchregistry.com (Ref: 5098).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.

Health-related quality of life of prisoners with diabetes mellitus

The study explored health related quality of life of prisoners with diabetes mellitus (DM).48 male inmates incarcerated in a Greek prison, completed a demographic and clinical traits questionnaire. Prisoners with DM and those with additional health problems had worse physical, mental health and psychological well-being outcomes (p = 0.002, p < 0.001 and p = 0.014 respectively). People with DM in correctional facilities should receive specialized primary health care services either health services within the correctional institution or community liaison. The implementation of services targeting DM should be evaluated with the target of improving offenders' physical and mental health.

Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison

BACKGROUND

Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa.

METHODS

A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention.

RESULTS

We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (.

CONCLUSION

Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.

Cardiovascular risk factors in people deprived of their liberty: an integrative review

ABSTRACT Objective: To investigate the scientific evidence on the most frequent risk factors for cardiovascular disease in persons deprived of their liberty. Methods: An integrative literature review carried out in the CINAHL, Medline/Pubmed, Scopus, LILACS, CUIDEN, Web of Science and Virtual Health Library portal databases using the following keywords: cardiovascular diseases, risk factors, prisons, prisoners. Results: The final sample consisted of 17 primary articles published in English and Spanish. Overweight and obesity were the most cited cardiovascular risk factors besides diabetes, hypertension, smoking, dyslipidemia, consumption of alcohol and other drugs, physical inactivity, metabolic syndrome, anxiety, depression and unhealthy heart diet. Conclusions: The most frequent risk factors for cardiovascular disease in persons deprived of their liberty were those classified as modifiable. In the prison setting, these factors are enhanced due to an environment with little modification of these opportunities.

How have researchers defined and used the concept of 'continuity of care' for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

BACKGROUND

Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare.

METHODS

This scoping review adopted the modified framework for interpretive scoping literature reviews. A systematic literature search in PubMed was performed, followed by a study selection process and data extraction, analysis and synthesis. Extracted data regarding the context of using CoC and the definition of CoC were analysed inductively to identify similar patterns; based on this, articles were divided into groups. MaxQDA was then used to re-code each article with themes according to the CoC definition to perform a cross-case synthesis under each identified group.

RESULTS

A total of 55 peer-reviewed articles, comprising reviews or commentaries and qualitative or quantitative studies, were included. The number of articles has increased over the years. Five groups were identified as those (1) reflecting a change across stages or systems of care, (2) mentioning continuity or lack of continuity without a detailed definition, (3) researching CoC in HIV/AIDS programmes and its scaling up to support management of NCDs, (4) researching CoC in NCD management, and (5) measuring CoC with validated questionnaires.

CONCLUSION

Research or policy documents need to provide an explicit definition of CoC when this terminology is used. A framework for CoC is suggested, acknowledging three components for CoC (i.e. longitudinal care, the nature of the patient-provider relationship and coordinated care) while considering relevant contextual factors, particularly access and quality.