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Individual and societal reactions to an ongoing pandemic can lead to social dilemmas: In some cases, each individual is tempted to not follow an intervention, but for the whole society, it would be best if they did. Now that in most countries, the extent of regulations to reduce SARS-CoV-2 transmission is very small, interventions are driven by individual decision-making. Assuming that individuals act in their best own interest, we propose a framework in which this situation can be quantified, depending on the protection the intervention provides to a user and to others, the risk of getting infected, and the costs of the intervention. We discuss when a tension between individual and societal benefits arises and which parameter comparisons are important to distinguish between different regimes of intervention use.
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COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Cooperative Behavior , Pandemics/prevention & control , Game Theory , SARS-CoV-2ABSTRACT
Introduction: Lyndon B. Johnson (LBJ) hospital is a part of the Harris Health System, which provides comprehensive care to the uninsured and underinsured population in Harris County, TX. LBJ serves a population with 55% unemployment and a median household income of $22000. Access to endoscopy is limited by resource availability, and the completion of scheduled endoscopies is essential for public health. We aimed to assess if insurance status was associated with no- show for scheduled endoscopic procedures at the LBJ GI Lab. Method(s): All patients scheduled for outpatient endoscopy during the year 2021 were collected. Included patients must have completed a GI clinic appointment, anesthesia screening, pre-procedural COVID test, confirmed attendance on pre-procedure call, and not showed for scheduled endoscopy (Figure 1). Patient's insurances statuses were: FAP (county payment assistance), Harris County Prisoners (no costs), Medicare/Medicaid (variable costs), Private Insurance (variable costs), Self-Pay, and Texas Family Planning/HCHD Presumed (temporary FAP) (Table 1). Result(s): Comparative analysis of insurance types demonstrated that patients who were Self-Pay were 5.96 times more likely (P< 0.002) not to show up for previously scheduled endoscopic procedures, while patients with the TFP/HCHD insurance were 10.1 times more likely (P< 0.001) to not show when compared to patients who were covered by the county's FAP. Conclusion(s): Our analysis demonstrated a statistically significant association between insurance status and the incidence of no-showing for endoscopy. Upon literature review, there was limited data on rates of endoscopy no-shows in relation to the out-of-pocket commitment for individuals. Further investigation into this topic would significantly affect both the academic and private practice of gastroenterologists. We plan to continue this quality assessment by meeting with the patient eligibility department to assess if modifications of benefit profiles could optimize procedural attendance.
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In 1990, the seroprevalence of antibody against hepatitis C virus (anti- HCV) in Taiwan was first documented to be 0.95% in volunteer blood donors, 90% in hemophiliacs, and 81% in parenteral drug abusers. The risk factors for HCV infection in Taiwan include iatrogenic transmission (medical injection, hemodialysis, acupuncture, and blood transfusion), tattooing, and sexual transmission. The long-term risk of hepatic and non-hepatic diseases has been well-documented by REVEL-HCV study. A national program of antiviral therapy for chronic viral hepatitis was launched in Taiwan in 2003. Mortality rates of end-stage liver diseases decreased continuously from 2000-2003 to 2008-2011 in all age and gender groups. When the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis in 2016, National program to eliminate hepatitis C was very carefully evaluated. It became a consensus to reach the WHO's 2030 goals in 2025. Taiwan Hepatitis C Policy Guideline 2018-2025 was approved and published at the beginning of 2019. There are triple focuses of hepatitis C elimination in Taiwan including (1) therapy spearheads prevention, (2) screening supports therapy, and (3) prevention secures outcome. A total of US$1.7 billion will be allocated from 2017 to 2025 for the elimination of HCV. The coverage of HCV screening and treatment has been increasing significantly since 2017. The HCV screening coverage was almost 100% for dialytic patients, 96% for HIV-infected patients, 65% for patients under opioid substitution treatment, 63% for patients in the pre-end-stage renal disease care program, 57% for patients in the early chronic kidney disease care program, 52% for patients in diabetes care program, 39% for prisoners, and 38% for adults aged 45-79 years old in the general population by April 30, 2020. The budget to cover the cost of DAA increased from US$101 million in 2017 to US$219 million in 2019. The number of chronic hepatitis C patients receiving DAA therapy increased from 9,538 in 2017, 19,549 in 2018, to 45,806 in 2019. However, the number of DAA-treated CHC patients reduced to 36,159 in 2020 and 20,559 in 2021 due to the COVID-19 pandemic. The cure rate based on SVR12 was 96.8% in 2017, 97.4% in 2018, over 98.6% after 2019. It is expected that Taiwan will achieve WHO's HCV elimination goal by 2025.
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The proceedings contain 159 papers. The topics discussed include: microelimination of hepatitis C among people living with diagnosed HIV in England;laboratory implementation of emergency department blood-borne virus (EDBBV) opt-out screening in a London tertiary center;a review of sexual health and blood-borne virus care provided to inmates at admission into UK prisons and secure facilities;implementation of routine opt-out blood-borne virus (BBV) screening in 34 emergency departments (EDs) in areas of extremely high HIV prevalence in England;impact and experiences of offering HIV testing across the whole city population through primary care clusters and GP surgeries in the texting 4 Testing (T4T) project;'Not PrEPared': barriers to accessing PrEP in England;HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK;clinical presentation of mpox in people with and without HIV;and 'if you don't know, how can you know?': a qualitative investigation of HIV pre-exposure prophylaxis knowledge and perceptions among women in England.
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This book interrogates Conservative government penal policy for adult and young adult offenders in England and Wales between 2015 and 2021. Government penal policy is shown to have been often ineffective and costly, and to have revived efforts to push the system towards a disastrous combination of austerity, outsourcing and punishment that has exacerbated the penal crisis. This investigation has meant touching on topical debates dealing with the impact of resource scarcity on offenders' experiences of the penal system, the impact of an increasing emphasis on punishment on offenders' sense of justice and fairness, the balance struck between infection control and offender welfare during the government handling of the SARS-CoV-2 pandemic and why successive Conservative governments have intransigently pursued a penal policy that has proved crisis-exacerbating. The overall conclusion reached is that penal policy is too important to be left to governments alone and needs to be recalibrated by a one-off inquiry, complemented by an on-going advisory body capable of requiring governments to 'explain or change'. The book is distinctive in that it provides a critical review of penal policy change, whist combining this with insights derived from the sociological analysis of penal trends. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.
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The proceedings contain 53 papers. The topics discussed include: clinical study of lurasidone combined with nutritional intervention strategy in the treatment of chronic schizophrenia;analysis of clinical medication scheme and nursing measures of acute stress disorder complicated with delirium under the COVID-19;a study on the mental state of prisoners near the end of their sentence caused by a psychological anxiety case;a clinical study on the effect of peperidone combined with cognitive behavioral therapy on symptoms of schizophrenia;the clinical effect of feedforward control nursing combined with methylphenidate sustained-release tablets on children with attention deficit hyperactivity disorder;study on the effect of community legal consciousness health management on cognitive function of senile patients;effects of special sports training on autonomic nervous regulation;a study of positive intervention of music therapy and neurofeedback on negative emotions and attention in college students;and alleviating effect of the geriatric care system integrating physical and psychological on the common mental problems of the elderly.
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This Note argues that the Model Rules of Professional Conduct require the Office of Legal Counsel to identify President Biden as its client. Had the agency done so when Biden first took office, it could have immediately implemented Biden's policy preference: keeping former prisoners home during the coronavirus pandemic.
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Background: There has been a rampant increase in substance abuse in Kashmir valley for the last few years. Department of Psychiatry SKIMS Medical College Srinagar has extended its services to cater to the needs of the substance users in the valley even during the COVID -19 pandemic. In 2021, de-addiction services were also started among prison inmates of central jail Srinagar. This was the first of its kind of services provided in the valley. The management of substance users with Hepatitis infections had also been challenging. Purpose(s): To describe the management of substance users under special circumstances(COVID-19), special settings(Central Jail Srinagar), high-risk groups(substance users with blood-borne infections). Method(s): Semi-structured proformas were used to collect data from special groups of participants a) those who were seeking treatment during COVID-19 times from the De-addiction center, SKIMS Medical College b) Prison in-mates on treatment for substance-use disorders c) substance users who are hepatitis B and/or positive. This included Socio-demographic details, clinical profile, the pattern of substance use, coping strategies, and treatment seeking. Preliminary Findings: More than 25 percent of the prison in-mates are substance dependent and relapse rate is very high. Psychiatric comorbidity like mood disorders and or personality disorders are present among most of the prison-inmates. During COVID-19 times, 90% patients reported average to very high level of importance and value given to their own health and health of family and friends and focussed on treatment of their illness(85%). Substance users with blood-borne infections were associated with highrisk behavior in the form of needle-sharing. Conclusion(s): The findings provide a voice that there is a need for backup plans that cater to the needs of substance users during in-evitable circumstances like the COVID-19 pandemic. Policymakers should focus on prison mental health for the functioning of a better society. Substance users with blood-borne infections should be rigorously treated to prevent them from taking the shape of an epidemic.
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Mass incarceration, which caused the sharp increase in the American prison population over the last five decades, explains why America today comprises five percent of the world's population but houses twenty-five percent of the world's prisoners. This widespread issue has led to many others, including prison overcrowding. American prisons are dramatically overcrowded, with 2,068,000 prisoners as of 2019. Of the fifty states and the District of Columbia, twelve of them have a prison population that is more than fifty percent Black, even though only 13.4% of the US population is Black. Although many incarcerated people are in jail awaiting trial, the majority are incarcerated because they were sentenced there. Therefore, sentencing reform must be part of the solution. This Note will argue that prosecutors should have a duty to recommend non-custodial sentencing whenever feasible, and to otherwise pursue the lowest prison sentence available, because of 1) current overcrowding in prisons, 2) the impact of current COVID-19 protocols, and 3) the societal impact of incarceration.
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Ethics in research and how it is translated into practice is fundamental to rule out any potential misconduct either with the scientific method or the way results are presented to the world, thus impacting patients outcomes. The last two years of the Covid-19 pandemic were prolific in exposing the scientific community and healthcare professionals to the many flaws regarding the different studies either with promising simple treatments or sophisticated medications. Supposedly high-profile papers with the antimalarial medication hydroxychloroquine either favoring its use or indicating the risk of death were retracted from very prestigious journals such as the Lancet and the New England Journal of Medicine. Ethics in research became fundamental in reaction to abuses practiced against people as the Nazi studies on concentration camp prisoners or the syphilis study with American prisoners or the US governments radiation experiment. Copyright © 2023 The Author(s)
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Ethics in research and how it is translated into practice is fundamental to rule out any potential misconduct either with the scientific method or the way results are presented to the world, thus impacting patients outcomes. The last two years of the Covid-19 pandemic were prolific in exposing the scientific community and healthcare professionals to the many flaws regarding the different studies either with promising simple treatments or sophisticated medications. Supposedly high-profile papers with the antimalarial medication hydroxychloroquine either favoring its use or indicating the risk of death were retracted from very prestigious journals such as the Lancet and the New England Journal of Medicine. Ethics in research became fundamental in reaction to abuses practiced against people as the Nazi studies on concentration camp prisoners or the syphilis study with American prisoners or the US governments radiation experiment. Copyright © 2023 The Author(s)
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The current COVID-19 pandemic challenges require collective actions aiming at ensuring the preservation of human health by developing a social and an economic resilience. Moreover, experiences show that cooperative and civic behaviours are so credible in a context of solidarity and reciprocity according to a win-win cooperation among all social stakeholders and countries from a micro to a macro – analysis level. The present study explores the choices and decisions made by Moroccan firms through the lens of the game theory and investigates cooperative behaviours occurring during 2020 within social dilemmas. It contributes for a better formalisation of social and behavioural compliance to public policies in times of coronavirus crisis. This research provides then an enhanced understanding of gender differences related to people's behavioural responses to the COVID-19 pandemic and emphasises the importance of adopting individual and collective behaviours required for the coordination of separate actions. Copyright © 2022 Inderscience Enterprises Ltd.
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Background. Tuberculosis in prisons was reported to be 100 times higher than the normal population. Late diagnosis, overcrowding, and poor ventilation encourage the transmission of tuberculosis. Five percent of new tuberculosis infections turn into active disease within two years. This study was conducted to determine the incidence of tuberculosis infection among new prisoners in southern Thailand. Methods. A prospective cohort study was planned for January 2020-December 2021 at Songkhla Provincial Prison. However, due to the emerging COVID-19 pandemic, the study was terminated early in February 2021. All new prisoners aged >=15 years were included. Subjects were excluded if they had any history of a previous diagnosis of tuberculosis, household contact with a tuberculosis patient, or a history of repeated imprisonment. Chest radiography together with a 2-step tuberculin skin test (TST) was done within 2 weeks after imprisonment and at 6 months using the onestep TST. A positive TST was defined by a skin reaction >=1.5 cm. Prisoners with negative TST had a repeat TST at 6 months. New tuberculosis infection was defined by conversion of TST to positive after 6 months of imprisonment without evidence of active tuberculosis from chest radiography. Results. The number of new prisoners during the study period was 602. All prisoners were men with an average age of 31.11 (range 18-75) years Fifty-one prisoners were excluded. Three hundred and eighty-five prisoners completed the 2-step TST. A total of 11.07% (61/551) of subjects had initially tested positive. Three hundred and seventy prisoners were followed. The COVID-19 pandemic caused a total shutdown of the study because access to the prison was blocked. Therefore, only 53 (9.6%) prisoners completed the study protocol at 6 months. Five prisoners (9.4%) were tuberculin converters with no evidence of active tuberculosis from chest radiography Conclusion. The incidence of tuberculosis infection in new prisoners was 9.4%. This study has limitations. Due to the emerging COVID-19 pandemic, 90.4% of subjects were lost to follow-up and some prisoners were released before 6 months, which caused low power of the study. Further studies are needed to identify the incidence of new tuberculosis infection in new prisoners.
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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.
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Background: The National Crime Record Bureau and the Prison Statistics India, 2020 report on the overcrowding and occupancy in jails has ripple effect on the spread of the COVID-19.The protection to health freedoms of detainees and prisoners reflected in the World Health Organization (WHO) Guidance on COVID-19 for Prisons and Detention, 2020. The Indian jails have congestion and inhabitance and prone to contagion disease. The COVID-19 has an expanding transmission among detainees in prisons, jails and detention homes. Objectives: The WHO Guidance on COVID-19 for Prisons and Detention, 2020 standardizes the essential instrument to manage the COVID-19 difficulties in penitentiaries and confinement homes. The direction secures the strength of detainees and convicts living in encased conditions. The ostensible purpose is to contain the COVID-19 disease from spreading to general population and release the under trials for the safe healthy conditions. Methodology: The methodology applied the canons of statutory interpretation of United Nations Principles of the Protection of Prisoners, 1982 and Basic Principles for the Treatment of Prisoners, 1990 alongside the Moscow Declaration on Prisons and Health, 2003 and Nelson Mandela Rules, 2015 in fostering the health equity and criminal justice during COVID-19 pandemic. The mandate of the WHO Interim Guidance on COVID-19 in Prisons and Other Places of Detention, 2020 is straight out in preventive and medicinal measures for the penitentiaries and confinement homes in the virus of COVID-19. Results: The paper tracks the salubrious results of the international legal norms and national precedents of High Courts and Supreme Court in heralding systemic prison reform. The compliance of WHO Interim Guidance on Preparedness, Prevention and Control of COVID-19 In Prisons and Other Places of Detention, 2020 cultivated robust criminal administration during COVID-19 pandemic and the lockdown in India.Conclusion: The judgment of High Courts and Supreme Court on prison reform during the COVID-19 pandemic in India has resulted in Health Rights of Prisoners and Prison Law Reforms during COVID-19 Pandemic in India. It also refurbished the medical services in correctional facilities and confinement homes in criminal justice system.
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Introduction/ Background: During September-October 2020, an outbreak of COVID-19 occurred at Masaka Ssaza, a COVID-19 quarantine prison (holding center for newlysentenced persons before transit to their host prison) in Central Uganda. We investigated to identify factors associated with introduction and spread of infection in Masaka Ssaza prison. Methods: We defined a case as PCR-confirmed SARS-CoV-2 infection in a prisoner/staff at Masaka Ssaza prison during September- October 2020. A control was defined as a prisoner or staff at Masaka Ssaza with a negative test during the same timeframe. We reviewed prison medical records to identify casepatients and interviewed prison staff to understand possible avenues of introduction of infection and opportunities for spread. We conducted a casecontrol study interviewing prisoners and staff to determine factors associated with spread of the infection. Logistic regression was used to assess factors associated with infection. Results: The index case was Inmate A, a 33-year-old male who entered the prison on September 16, 2020. On September 23, Inmate A learned that a colleague with whom he had close contact before imprisonment had died of COVID-19 which he reported to the warden leading to mass testing. The overall attack rate was 40/100. Ward-specific prisoner density ranged from 0.3-2.1 prisoners/square meter. Face mask ownership among case-patients was 35%. Using a face mask all the time was protective (aOR= 0.03: 95% CI 0.01- 0.09). Residing in Ward 6 was associated with increased odds of infection (aOR=7.4;95% CI 1.6- 3.4). Impact: Consistent use of face masks was protective. Unrestricted access to handwashing facilities, facemask use, and strict adherence to 'do not enter another ward' rules could mitigate risk of future outbreaks. Conclusion: COVID-19 was likely introduced into Masaka Ssaza prison by an infected incoming prisoner. The outbreak may have been amplified by congestion in wards and at mealtimes and low use of preventive measures.
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CASE: A 75-year-old incarcerated man presented to the ED with one week of chills, body aches, dry cough, and dyspnea. His past medical history was significant for hypertension, type II diabetes, and obesity. He had been incarcerated for 18 years and was looking forward to his release in five months. He was identified as African-American in his chart. On initial evaluation, his oxygen saturation was 87% on room air with otherwise normal vitals. His breathing was labored with crackles in the lung bases. His chest x-ray showed multifocal opacities. He tested positive for SARS-CoV- 19 and was admitted on high-flow nasal cannula. In the following week, his oxygen needs escalated and he was transferred to the Medical ICU. Multiple requests for medical clearance to contact family were declined by the correctional facility. On day 8, he was intubated, paralyzed, and proned. He remained shackled to his bed with two correctional officers posted outside his door. On day 14, he suffered a PEA arrest with return of spontaneous circulation following ACLS. Attempts to contact family are approved and his care plan is changed to comfort measures only. He was terminally extubated and passed away soon after. Throughout the hospitalization, including during his cardiac arrest, the patient remained shackled to his hospital bed by the left ankle. Two correctional officers were stationed outside his hospital room 24 hours per day. The medical team had been unable to contact the patient's next of kin until the day he arrested, at which time they opted to pursue comfort measures. Months later, a medical resident who had cared for him shared the following words during a reflective writing session: “Nobody should die in handcuffs.” IMPACT/DISCUSSION: End-of-life care for incarcerated people is a pressing issue in the United States, where approximately 2.4 million individuals are held within the prison system. Due to an aging prison population, more incarcerated patients are dying than ever before. It is predicted that by 2030, the number of elderly prisoners is expected to reach 400,000 - an increase of 4,400% since 1981, according to a 2012 report from the ACLU. Most jurisdictions in the United States require shackling of the hands or feet when inmates are transported outside the prison setting. For patients with debilitating illness, shackling in the medical setting violates the principles of beneficence, non-maleficence, and autonomy essential to the practice of medicine. The COVID-19 pandemic has further underscored the ethical, legal, and moral dilemmas which clinicians face in preserving the dignity of the dying patient. CONCLUSION: Given the expected changes in demographics within the US correctional system, clinicians must advocate for compassionate policies such as the removal of shackles at the end of life. Potential avenues for change in practice can involve increased medical-legal dialogue and partnerships with correctional officers and other stakeholders within medical and correctional institutions.
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The SARS-CoV-2 pandemic poses new challenges and requires new solutions for problems previously not faced by our generation. This particularly applies to the field of opioid dependence therapy due to the physical and psychological vulnerability of patients and the treatment model that often requires daily attendance. An overview is given of the responses of the physicians and the recommendations of medical societies in Germany during the year 2020 with a special focus on the lockdown periods and the challenges and guidelines for the patients, patient organizations and physicians, both outpatient and in prison. Reduced travel and empty inner cities led to reduced patient income combined with closed patient organizations during lockdown, leading to a temporary increase of patients in opioid dependence therapy. New hygiene procedures had to be implemented. A temporary change in the German Narcotics Prescription Ordinance, including longer periods for take-home prescriptions, allowed for ongoing supply with improved social distancing. Depot buprenorphine significantly reduces the risk of infection by avoiding the daily commute and presence at the practice with many other patients. This is even more favourable in prison settings by greatly reducing the movement of prisoners and diversion of drugs.
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Background: Among the more than 10 million people imprisoned around the world, the rate of mental illness is higher than among the general population for various reasons. Although rates of mental illnesses such as depression and anxiety in this population may have changed as a response to the coronavirus disease (COVID-19) outbreak and other factors, to our knowledge, no related studies have been conducted related to depression and anxiety in this population during the pandemic. Therefore, this study aimed to assess depression, anxiety, and associated factors among Dessie City prisoners during the 2020 COVID-19 outbreak. Methods: An institution-based cross-sectional survey was conducted in October 2020. A total of 420 prisoners were selected via a systematic sampling technique. PHQ-9 depression scale, generalized anxiety disorder-7 questionnaire, Oslo 3-item social support scale, insomnia severity index, and Brief COPE scale were used. Data were entered by using Epi-Data version 3.1 and finally exported to Statistical Package for Social Science Software version 21 for analysis. We fitted a multiple binary logistic regression model. Finally, an adjusted odds ratio with 95% confidence interval was reported and factors with a p-value < 0.05 were considered as significant for depression and anxiety. Results: This study showed that 279 (66.4%) of imprisoned people had major depressive disorder with 95% CI of (61.4, 70.6), while 281 (66.9) had generalized anxiety disorder with 95% CI of (61.9, 71.9). Conclusion: In this study, the overall prevalence of depression and anxiety was significantly high, and was related to a number of factors including COVID-19. Therefore, designing and implementing strategies for COVID-19 prevention and control in prisons is highly recommended to reduce mental health problems among prisoners.
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Background: The impact of the Covid-19 pandemic on prisons across the world has been of much concern due to the increased risk of virus spread among a particularly vulnerable population. Efforts made to prevent spread of the virus have resulted in a range of restrictive measures with the aim of reducing contact between prisoners and staff. Unfortunately, restrictions have also resulted in increased time confined to cells, reduced occupation, and restricted access to services. The potential impact of this on a population that already presents with high rates of mental health difficulties requires consideration. Male prisoners may be at particularly high risk of experiencing negative outcomes. Methods: This study evaluated the impact of the pandemic and related changes upon the mental health of prisoners and staff within a male urban prison in the United Kingdom. A mixed methods approach with a convergent parallel design was used. Correlational and feature selection analysis was conducted on quantitative data. Qualitative data were subject to a thematic analysis. Findings were integrated at the point of summary and interpretation. Results: Prisoners and staff reported finding it hard to cope with changes and stressors associated with the pandemic. For prisoners, time spent locked in one???s cell with limited access to activities and support was associated with poor mental health outcomes, and salient themes emerged of feeling trapped, isolated and neglected. For staff, concerns about prisoner welfare and worry about catching the virus was associated with increased anxiety and worry. Additionally finding it hard to cope with constant changes at work and reduced staffing resulted in unhealthy coping behaviours such as drinking and smoking. Conclusions: Findings suggest that the implementation of additional restrictions, within the already restricted prison environment, has had a significant negative impact on the mental health of both prisoners and staff. The potential long-term mental health difficulties resulting from this require further investigation, as does the likely negative impact on staff wellbeing and staff turnover. The effects of the pandemic appear to have heightened an already desperate need to consider the mental health and wellbeing of prisoners and prison