RESUMO
Several recent studies have shown that the racial disparities in U.S. mortality nearly disappear in prisons. We review the social determinants of the recent epidemic of incarceration, especially the war on drugs, and describe inmate morbidity and mortality within the context of U.S. health disparities. Incarceration provides an important public health opportunity to address health disparities by accessing a high-need, medically-underserved, largely non-White population, but it has also been associated with poor long-term health outcomes. Viewing incarceration within the context of community health and community life shows that the more equitable mortality rates among inmates are not evidence of the beneficial effects of incarceration so much as an indictment of disparities in the community at large. Because people of color are incarcerated far more frequently than Whites, the experience may ultimately exacerbate rather than mitigate health disparities.
Assuntos
Disparidades nos Níveis de Saúde , Prisioneiros/estatística & dados numéricos , Adulto , População Negra/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Grupos Raciais/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto JovemAssuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Notificação de Doenças/métodos , Infecções por HIV/transmissão , Humanos , Epidemiologia Molecular , Rhode Island/epidemiologia , Infecções Sexualmente Transmissíveis/transmissão , Sífilis/prevenção & controle , Sífilis/transmissãoAssuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis , Gonorreia/diagnóstico , Infecções por Chlamydia/epidemiologia , Feminino , Gonorreia/epidemiologia , Humanos , Técnicas de Amplificação de Ácido Nucleico , Doença Inflamatória Pélvica/microbiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Rhode Island/epidemiologiaAssuntos
Sorodiagnóstico da AIDS , Centers for Disease Control and Prevention, U.S. , Infecções por HIV/diagnóstico , Sorodiagnóstico da AIDS/legislação & jurisprudência , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Hospitais Universitários , Humanos , Recém-Nascido , Consentimento Livre e Esclarecido/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Gravidez , Preconceito , Rhode Island , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: We investigated an outbreak of severe neurologic disease and pneumonia that occurred among students at 4 schools in Rhode Island. METHODS: We identified cases of encephalitis, encephalomyelitis, and pneumonia that occurred among schoolchildren from 1 September 2006 through 9 February 2007, and we performed serologic tests, polymerase chain reaction (PCR) analysis, and culture for the detection of multiple pathogens in oropharyngeal and nasopharyngeal specimens. Students with positive results of M. pneumoniae IgM serologic testing and no alternative diagnosis were considered to be infected with M. pneumoniae. At school A, we used questionnaires to identify students and their household contacts who made visits to physicians for pneumonia and cough. We compared observed and expected rates of pneumonia. RESULTS: Rates of pneumonia among elementary students (122 cases/1000 student-years) were > 5-fold higher than expected. Three students had encephalitis or encephalomyelitis, and 76 had pneumonia. Of these 2 groups of students, 2 (66%) and 57 students (75%), respectively, had M. pneumoniae infection. M. pneumoniae was detected by PCR in 10 students with pneumonia; 5 of these specimens were cultured, and M. pneumoniae was isolated in 4. Of 202 households of students attending school A, 20 (10%) accounted for 61% of visits to physicians for pneumonia or cough. Of 19 household contacts of students with pneumonia, 8 (42%) developed pneumonia and 6 (32%) reported visits for cough. CONCLUSIONS: M. pneumoniae caused a community-wide outbreak of cough illness and pneumonia and was associated with the development of life-threatening neurologic disease. Although M. pneumoniae was detected in schools, its transmission in households amplified the outbreak. Interrupting household transmission should be a priority during future outbreaks.