Influenza control can be achieved in a custodial setting: pandemic (H1N1) 2009 and 2011 in an Australian prison.

OBJECTIVES: Information on the effectiveness of interventions regarding control in closed institutional settings, including prisons, is limited. This study gathered evidence relating to influenza control in an Australian prison. STUDY DESIGN: This study built on a 2009 H1N1 outbreak investigation at the Alexander Maconochie Centre (AMC) in the Australian Capital Territory (ACT). METHODS: Influenza surveillance data, ACT 2010 Inmate Health Survey data, New South Wales 2001 and 2009 Inmate Health Survey data, ACT Department of Corrective Services administrative data, and ACT Health clinical data were analysed. RESULTS: In 2011, the AMC was exposed to influenza virus, resulting in a single case. Public health activities included exclusion of symptomatic cases from the health facility, isolation of cases, and quarantine of contacts. Contact between prisoners and the ACT community was maintained; the AMC detainee visitor rate was one visitor per prisoner every 10 days. CONCLUSIONS: The rehabilitative benefits of human contact for AMC detainees were not compromised during the surveillance period, despite the potential that a higher visitor rate may suggest. This highlights some features of the AMC which make its operational context different from many other correctional settings, but gives some indication of how good public health practice supports human rights.

Mental illness and intellectual disability in Magistrates Courts in New South Wales, Australia.

BACKGROUND: Little is known about the prevalence of intellectual disability (ID) and/or cognitive impairment (CI) among accused persons in the Magistrates (Local) Courts, the personal, health and mental health characteristics of this cohort, and their service provision needs in the community. The study aimed to determine the prevalence of dual diagnoses of ID and/or CI and psychiatric disorder in a sample of accused persons appearing before four Magistrates Courts. Accused persons with ID and/or CI may not be identified in the Magistrates Court as having a disability and therefore may be unable to access the legal safeguards which exist for their protection within the criminal justice system and/or may fail to receive appropriate community health and welfare services. METHOD: The sample was drawn from accused persons aged over 18 years appearing before four Magistrates Courts in metropolitan and urban areas of a large city. Participants were assessed using the Kaufman Brief Intelligence Test, Second Edition (KBIT-2), Vineland Adaptive Behavior Scales, Second Edition (VABS2) and the Psychiatric Assessment Schedules for Adults with Developmental Disabilities Checklist. RESULTS: On the KBIT-2, 10% of participants achieved a standard score (SS) below 70 (mild ID range) and a further 20% were in the 70-79 (borderline) range. The VABS2 results indicated that 12% of participants had SS below 70 and a further 9% were in the 70-79 (borderline) range. The prevalence of mental illness in the group with intellectual deficits was 46%, compared with a prevalence of 36% for those without intellectual deficits. CONCLUSIONS: People with ID and/or CI were found to be over-represented in the Magistrates Court. Furthermore, results highlight the unmet mental health needs of this cohort in the criminal justice system. The results of the study have implications for the planning of services and diversionary options to facilitate better management of defendants with ID and/or CI with mental health needs.

Extreme cause-specific mortality in a cohort of adult prisoners--1988 to 2002: a data-linkage study.

OBJECTIVES: Describe the standardized mortality ratio (SMR) and its trend in adults who have served time in prison. DESIGN: A retrospective cohort study of 85,203 adults imprisoned in New South Wales (NSW), Australia, between 1 January 1988 and 31 December 2002. METHODS: We obtained information on deaths by record linkage with the Australian National Death Index (NDI). Mortality rates were estimated using the person-time method. SMRs were calculated using sex, age, and calendar-specific death rates from the NSW population. Time trends in SMRs were assessed using the test for linear trends. RESULTS: The median overall follow-up of the cohort was 7.7 years. We identified 5137 deaths (4714 men, 423 women) among the cohort of which the vast majority (4834, 94%) occurred following release from custody. All-cause SMR was 3.7 (95% CI: 3.6-3.8) in men and 7.8 (95% CI: 7.1-8.5) in women. SMRs were substantially raised for deaths due to mental and behavioural disorders (men: 13.2, 95% CI: 12.3-14.0; women: 62.8, 95% CI: 52.7-74.9) and drug-related deaths (men: 12.8, 95% CI: 12.2-13.5; women: 50.3, 95% CI: 43.7-57.8). The SMR for death by homicide was 10.2 (95% CI: 8.9-11.7) in men and 26.3 (95% CI: 17.8-39.0) in women. Aboriginal men were 4.8 times, and Aboriginal women 12.6 times, more likely to die than the general NSW population. Over the study period on average all-cause SMR decreased significantly in men (p = 0.003) and women (p = 0.05) largely due to the decline in SMRs for drug-related deaths and suicide. CONCLUSION: In the largest study so far reported, mortality of male and female offenders was far greater than expected for all major causes, especially deaths caused by drug overdose. Despite some indication of a reduction in excess mortality in recent years, there remains an overwhelming need for enhanced responses to mental health and drug problems for people who have been in prison.

Summer outbreak of respiratory disease in an Australian prison due to an influenza A/Fujian/411/2002(H3N2)-like virus.

An outbreak of influenza A occurred in a prison system in New South Wales, Australia in January 2003 during the southern hemisphere summer. This report documents only the third confirmed outbreak of influenza in a prison environment. The outbreak investigation included case ascertainment, state-wide surveillance, a case-control study and interventions to limit the outbreak such as infection control, quarantine, cohorting of cases, and the use of antiviral medication for prophylaxis. A total of 37 clinical cases were identified. Influenza A virus was detected in 11 of the 22 respiratory tract specimens collected. The virus was typed as an influenza A/Fujian/411/2002 (H3N2)-like virus. This strain subsequently became the predominant virus strain during the northern hemisphere winter and the following 2003 Australian southern hemisphere winter influenza season.

Advancement of opioid analgesia with controlled-release oxycodone.

Optimal pharmacologic management of pain requires selection of the appropriate analgesic drug, prescription of the appropriate dose, administration of the analgesic by the appropriate route, scheduling of the appropriate dosing interval, prevention of persistent pain and relief of breakthrough pain, aggressive titration of the dose of the analgesic, prevention, anticipation, and management of analgesic side-effects, use of appropriate co-analgesic drugs, and consideration of sequential trials of opioid analgesics. Controlled-release oxycodone (CRO) has the characteristics of an 'ideal' opioid analgesic drug: short half-life, long duration of action, predictable pharmacokinetics, absence of clinically active metabolites, rapid onset of action, easy titration, no ceiling dose, minimal adverse effects, and minimal associated stigma. CRO has been shown to be effective in the control of pain caused by cancer, osteoarthritis, post-herpetic neuralgia, major surgery, and degenerative spine disease.

NCCN Practice Guidelines for Cancer Pain.

The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.

Therapeutic benefits of infrared (810-nm) diode laser macular grid photocoagulation in prophylactic treatment of nonexudative age-related macular degeneration: two-year results of a randomized pilot study.

OBJECTIVE: This pilot study collected preliminary information on the effectiveness and safety of infrared (810-nm) diode laser macular grid photocoagulation in patients with nonexudative age-related macular degeneration (AMD). Results from this pilot study were used in designing a larger, multicenter, randomized clinical trial. DESIGN: A multicenter, randomized, controlled, clinical trial. PARTICIPANTS: A total of 229 eyes of 152 patients with AMD were enrolled in the pilot study. Seventy-five patients with 1 eye eligible (75 eyes) were enrolled in the unilateral arm of the study; 77 patients with both eyes eligible (154 eyes) were enrolled in the bilateral arm of the study. In the unilateral study arm, 32 eyes were randomized to the observation group, 27 eyes were treated with visible endpoint burns, and 16 eyes were treated with invisible endpoint (subthreshold) lesions. In the bilateral study arm, 77 eyes were in the observation group, 36 eyes were treated with visible burns, and 41 eyes were treated with subthreshold (invisible) lesions. INTERVENTION: Eyes were treated with infrared (810-nm) diode laser macular grid photocoagulation using either visible burns or subthreshold (invisible) lesions and compared to eyes receiving no treatment. MAIN OUTCOME MEASURES: Reduction of drusen, change in visual acuity, and rate of choroidal neovascularization (CNV) membrane formation. RESULTS: At 12 months after treatment, 62% of eyes treated with visible burns had a clinically significant reduction in drusen, whereas this proportion (65%) was reached in 18 months for eyes treated with subthreshold lesions. At 24 months' follow-up, treated eyes had a significant reduction in drusen compared to observation eyes (P < 0.0001). Visual acuity was significantly improved in treated eyes at 12, 18, and 24 months compared to observation eyes (P < 0.001). Choroidal neovascularization formation was similar in treated and observation eyes through 24 months' follow-up. Complications included CNV associated with six eyes treated with visible burns and a juxtafoveal laser scar in one eye treated with visible burns. CONCLUSIONS: Infrared (810-nm) diode laser macular grid photocoagulation in patients with nonexudative AMD significantly reduces drusen levels (P < 0.0001) and significantly improves visual acuity (P < 0.001) when either visible endpoint burns or subthreshold endpoint lesions are used. Complications were fewer using subthreshold endpoint lesions. A larger, multicenter, prospective clinical trial with longer follow-up is needed to determine the efficacy of treatment in reducing the rate of CNV formation. Data from this clinical pilot study have been used to design the Prophylactic Treatment of AMD Trial (PTAMD), a multicenter, randomized, prospective clinical trial currently in progress comparing subthreshold (invisible) treatment to observation in eyes with nonexudative AMD.

Tuberculosis control practices in some prison systems of the Asia-Pacific Region, 1997.

SETTING: Prison health services of Member States of the Western-Pacific Region (WPR) of the World Health Organization (WHO). OBJECTIVE: To assess tuberculosis control activities in prisons. DESIGN: Self-reporting questionnaire. RESULTS: A total of 15 responses out of a possible 26 (57%) were received from WPR countries. The estimated population for the respondent countries was 65 154 000 out of a possible 1 580 000 000 (4%); 69% of respondents stated that the prison health service was independent of the custodial service, 86% notified tuberculosis cases to national health authorities, and 84% of respondents applied directly observed therapy to tuberculosis cases. Only 76% of respondents reported that patients were transferred on release to community treatment services. CONCLUSIONS: Tuberculosis control practices in prisons are inconsistent, and do not conform to guidelines now promoted by the WHO. Emphasis on the diagnosis and treatment of infectious cases, improved surveillance of tuberculosis, and the integration of prison programmes into the National Tuberculosis Programmes (NTP) will improve the current epidemic behind prison walls.

Overwhelming consumption in prisons: human rights and tuberculosis control.

Tuberculosis is thought to be the single biggest cause of death among the world's prisoners, but a human rights approach to tuberculosis control has not yet been applied. We propose that existing guidelines for the control of HIV be adapted and applied to tuberculosis. Tuberculosis control in prisons provides a platform to develop these concepts.

Pain control in patients with cancer.

Pain is the most common symptom of advanced cancer. For most cancer patients, pain can be controlled with systemic analgesic and coanalgesic therapy in concert with treatment of their underlying cancer. Analgesic therapy for pain involves choosing the right drug and giving it at the proper dose and interval via the best route of administration. The goal of pain prevention requires around-the-clock dosing and aggressive titration of long-acting opioids with as--needed supplements of short-acting opioids for breakthrough pain. Sequential trials of alternative opioids plus the early use of pain-specific coanalgesics can further optimize patient comfort and function. Most clinicians should be able to control most of the pain in most of their cancer patients. Collaboration with pain and palliative care experts can help the rest. No cancer patient should live or die with unrelieved pain.