ABSTRACT
Introduction The WHO Prison Health Framework was developed to assess prison health system performance and support Member States (MS) in improving their prison health systems. Moreover, it shall enhance MS capacity to evaluate: the impact of changes in governance models, progress in service provision and improvements of the health status of people in prison (PiP). Methods The framework informed the 2021 data collection round of the Health In Prisons European Database Survey. Invitations were sent to all 53 MS of the WHO European Region. Those MS nominating a focal point and providing valid answers were included in the analysis. Results Answers were obtained from 36 MS, representing a total of 613,497 PiP. Access to immunization was very good across all MS, with the highest for COVID-19 (90% of MS provide it in all prisons). Vaccination against HBV was only available in all prisons of 25 MS. Access in all prisons to HIV post and PrEP were reported, respectively, by 78% and 58% of MS. Screening for diseases at entrance was common for HIV, HCV and HBV. In all prisons of 35 MS soap was provided for free, while needles & syringes and lubricants were only provided free of charge, respectively, in 3 and 4 MS. 5 MS did not have therapeutic spaces to tackle drug problems in any prison, in 73% of those having, accessibility was restricted to some prisons. HIV prevalence ranged from 0-16% and treatment was accessible to 55-100% of those diagnosed. Prevalence of HCV ranged from 0-34%, with access to treatment ranging from 0-91%. The most common format of health records in European prisons was paper based (44%). Conclusions Prison-based data collection systems resulted in limited capacity for extraction so that some countries were unable to provide any data on disease prevalence or treatments offered. Given the scarcity of data on this topic obtained from real-world and not from ad-hoc studies, this snapshot provides an important contribution to public health.
ABSTRACT
Introduction WHO-HIPP rapidly implemented measures to assess the situation and address the spread of COVID-19 inside European prisons. Specific tools included preparedness guidance to support Member States (MS) in, preventing and controlling COVID-19, factsheets directed at people living in prison (PiP) and at their visitors, checklists directed at prison administrators to self-assess their compliance with recommendations and a surveillance dataset. Methods The WHO-HIPP Surveillance Dataset comprises variables enabling the extraction of epidemiological indicators. This data has been collected weekly since May 2020. Results and discussion Data from 21 MS or regions has been obtained, 14 of which submitted national data regularly, enabling the observation of time trends. Ten MS experienced outbreaks at some moment, during which the ration of infection rate in PiP/general population varied widely (Median=1.58 {1.01-4.09}), highlighting the effect of congregate living on amplified transmission. Prevention and control measures in prisons were implemented in several MS. Eleven MS decreased occupancy rate to varying degrees (0.1-7.3%), while three increased population. Baseline occupancy rate of countries experiencing outbreaks was considerably higher than of those remaining controlled during all period. Among recent measures, seven MS have an established testing strategy, varying in methods, including rapid, polymerase-chain reaction (PCR) and sewage testing. While some MS have not been yet able to include PiP in the national COVID-19 vaccination roll-outs, seven are progressing, albeit coverage is highly heterogenous (0.1-34.5%). Conclusions Even though our data represents a self-selected sample, it suggests the level of infections in prison is, in some cases and periods, double of that observed in the general population. Strategies adopted to prevent and control the spread of infections vary widely in Europe.
ABSTRACT
Due to the current pandemic, the importance of health management increases, especially in the management of chronic pain syndromes and those in need in primary care periodic evaluations. In this scenario, we aim to assess the factors involved in this new interaction of Covid-19 in the various aspects that contribute to the patient with chronic pain. Essential data from global recommendations that arise based on hospital experiences that treat and support patients infected with the new coronavirus are reported. The risks of patients with previous chronic pain syndromes and comorbidities in patients with Covid-19 infection are analyzed. Medication treatments and the pathophysiological pathways involved are discussed, as well as factors that could put the patient at risk of developing or maintaining chronic pain syndrome after hospitalization with Covid-19. Additionally, ways of rehabilitation using telemedicine were illustrated. Chronic pain causes a significant increase in suffering for patients with Covid-19, therefore, logistical strategies and identification of risk factors for these patients are useful, containing a global assessment of associated comorbidities, in maintaining or including appropriate therapy. The use of telemedicine provides a way to alleviate acute health resource needs, as well as to monitor psychological aspects and post-event trauma associated with chronic pain. The policies to be adopted must be adapted to each location for good management of resources and good rehabilitation after the event. © 2020 Academia Nacional de Medicina. All rights reserved.