What Women Want: A Qualitative Study of Contraception in Jail

OBJECTIVES

We undertook this study to understand women's perceptions of receiving contraception at Rikers Island Jail.

METHODS

We conducted semi-structured in-depth interviews in 2011 to 2012 with 32 women incarcerated at Rikers Island Jail. We analyzed the data using standard qualitative techniques.

RESULTS

Almost all participants believed that contraception should be provided at the jail. However, many said they would hesitate to use these services themselves. Reservations were caused in part by women's negative views of health care services at the jail. Fears about the safety of birth control, difficulties associated with follow-up in the community, and desire for pregnancy were other factors that influenced interest in accepting contraception.

CONCLUSIONS

Contraception at the jail must be provided by trusted medical providers delivering high quality care with the goal of allowing women to control their own fertility; this would ensure that women could access birth control and cease using birth control when desired.

A review of primary care training programs in correctional health for physicians

BACKGROUND

Despite the health consequences of incarceration, there are no national standards for teaching physicians about correctional health. The purpose of this study was to survey existing correctional health training programs for primary care physicians.

SUMMARY

Programs were identified through literature and Web search, snowballing, and professional meetings. Programs were contacted and asked to complete a survey. Correctional health programs exist in a variety of disciplines. We identified 22 in primary care. Programs seek to improve public health, reduce stigma, and recruit physicians to correctional health. Curricula covered specific health problems as well as the impact of incarceration on families and communities. Relationships between the academic center and the correctional facilities were varied. Barriers include issues of security, time, financial resources, and stigma. Programs evaluate their learners, as well as educational and clinical outcomes.

CONCLUSIONS

A variety of correctional health programs currently exist. A national model curriculum could strengthen teaching in correctional health.

Energy production, intracellular amino acid pools, and protein synthesis in chronic renal disease

Intracellular glycolytic regulating enzyme activities, pyruvate kinase (PK) and phosphofructokinase (PFK), adenylate kinase (AK), energy charge (Ech), free amino acids (ICAA), and protein synthesis (PS) were measured in polymorphonuclear leukocytes--used as a cell model--in 62 adults and 12 children with chronic renal failure, and 66 normal adults and 21 children as comparison controls. In normal subjects, children had significantly lower enzyme activities and cell amino acid levels but similar Ech and higher PS than adults. ICAA concentrations were significantly higher than plasma amino acid concentrations (PAA) in both groups, and the PAA were not correlated with, nor indicative of, the ICAA concentrations. The variance (R2) in PS could be largely accounted for by a combination ("set") of six ICAA, as determined by multivariate analysis. The sets differed in children vs adults, suggesting that different proteins were being synthesized. In the uremic patients, reduced PF, PFK, Ech, most ICAAs and PS were indicative of cellular malnutrition. For the uremic adults, the abnormalities in cell metabolism were modified by therapy--nondialyzed uremics being worst, CAPD patients best and approximately normal, and hemodialyzed intermediate. The uremic CAPD children had reduced, PK, PFK, AK, most ICAA, and PS. Ech was increased. Cellular malnutrition in children with chronic renal failure may contribute to their poor growth.