Promoting health in prisons

Analysis of outpatient medical services for correctional institution's inmates entitled to national health insurance: A prison in Taiwan

BACKGROUND

To formulate better future policies, this study aims to understand the outpatient services provided in a prison in Southern Taiwan by the contracted hospital in two phases.

METHODS

Data were analyzed through the outpatient medical services performed by the contracted hospitals in prison in two phases (2013-2015 and 2016-2018). SPSS 20.0 software was used to analyze data such as age, medical fees, department, outpatient visits, average number of visits per patient, and common diseases.

RESULTS

The average age of the treated inmates was 49.34 and 47.04 years in the first and second phases, respectively. Most patients belong in the age group of 41-50 years. The number of medical visits per person increased from 15.6 to 20.6 visits. The average medical fee per visit increased from NTD 748 to NTD 775, and the average days of medication per visit decreased from 14 to 13 days. Commonly visited were family medicine, general medicine, orthopedics, and psychiatry departments. Disease of the skin and subcutaneous tissue was the first common disease in both phases, and hypertension was the most common disease.

CONCLUSION

The number of medical visits and the average medical fee increased. The medical cost of inmates is higher than the generally insured individuals. If environmental conditions in the correctional facility are improved, the consumption of medical resources will be reduced. There should be a complete therapy and medical treatment plan for mentally ill inmates for a successful return to the society after serving time.

Guidelines for youth sports clubs to develop, implement, and assess health promotion within its activities

The settings approach to health promotion is a world-known concept concerning settings like city, hospital, school, and workplace. The concept has also been used in some regionally specific settings, such as island, prison, or university. However, there are still many, often noninstitutional, settings that have a lot of potential but have not yet been recognized. One of the newcomers is the youth sports club, which has the potential to reach a lot of children and adolescents and is effective, via its casual educational nature based on voluntary participation. According to research, health is an important aim for most youth sports clubs, but it has not been converted into practical actions. Indeed, the clubs often recognize the importance of healthy lifestyles, but there is a lack of understanding of what to do to reinforce it within one's activities. That is why, on the basis of the results of the Health Promoting Sports Club survey in Finland, guidelines for clubs to enhance health promotion as a part of their activities were created. The aim of this article is to present the guidelines, theirs rationale, and practical examples.

A review of settings-based health promotion with applications to sports clubs

Sports clubs have a long and traditional history in many countries, yet they remain underdeveloped and underutilized settings for health promotion. Leisure time settings, in general, have been in minor role among settings-based health promotion initiatives. Current health concerns in western countries, such as sedentary lifestyles and obesity, have aroused a need to expand health promotion to include also settings with greater potential to reach and engage children and adolescents in more vigorous activity. To develop these alternative, most often non-institutional, settings to the level of the established ones, it is important to review what has been done, what has been accepted and what is known from research, theory and practice to have contributed to health. Given that settings approaches have been implemented with diverse scope and without close cooperation between different initiatives, the first aim of this paper is, on the basis of a review of commonly used theories and practices, to propose a mutual definition for the settings approach to health promotion. The second is to examine the applicability of the theoretical basis to youth sports club settings. Sports clubs are used as a reflective setting when reviewing the traditional ones.

Impact of a newly opened prison on an accident and emergency department

OBJECTIVE

To determine the impact of a newly opened prison on an accident and emergency (A&E) department.

METHOD

A new category B prison opened in April 1999, the first privately run prison in Scotland and the third largest in population. All prisoners referred to the A&E department for treatment were identified prospectively during the first year after the opening of the prison.

RESULTS

99 prisoners and four members of staff attended during the one year period. Ages ranged from 18-64 years with a mean age of 29.8 years. Presentations were as a result of deliberate self harm (22%), injury after violence (18%), sports injury (15%), surgical condition (15%), medical illness (13%), accidental injury (9%), ENT problem (2%), and miscellaneous (6%). Thirty seven prisoners (35.6%) were admitted to the hospital. Further review at outpatient clinics was arranged for 15 prisoners. One prisoner died, the result of suicide by hanging. The remaining prisoners were returned to the prison for further management by the prison medical and nursing team. Twelve prisoners re-attended a total of 37 times, ranging from twice to a maximum of eight visits. Some 42.3% of attendances were during "working hours" (09.00-17.00) and 57.7% attended "out of hours" (17.00-09.00). Twenty four referrals (23.1%) were deemed inappropriate by the prison medical team on retrospective review. Sixteen of these occurred "out of hours". Forty one prisoners (39.4%) were known to have a history of injecting drug misuse. Including re-attenders, 59 presentations (56.7%) to the A&E department had a history of injecting drug misuse. Of these 41 prisoners, 11 (26.8%) were hepatitis C positive, with eight of these having a positive polymerase chain reaction test. No prisoners had HIV and only one prisoner was hepatitis B positive.

CONCLUSION

The opening of the prison resulted in only a slight increase in the workload of the A&E department. A significant proportion of prisoners were admitted to the hospital highlighting the practical and logistical problems of managing people restrained and in custody. Most cases can be safely referred back to the prison. Increased input is required from the prison medical team when dealing with deliberate self harm, frequent attenders, and "out of hours" referrals. All A&E staff must be aware of the increased risk of hepatitis C infection when dealing with a confined prison population.

Health, place and British prisons

This short communication considers people's health care needs in prison. It shows that people have a wide range of health care needs that are not always met when they spend time in prison. To locate these issues the paper draws on the "patient or prisoner" debate to understand the challenges that face future policies.