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Coping with COVID in corrections: a qualitative study among the recently incarcerated on infection control and the acceptability of wastewater-based surveillance. 在惩教机构中应对 COVID:对新近被监禁者进行的关于感染控制和废水监测可接受性的定性研究。
IF 3 Q1 CRIMINOLOGY & PENOLOGY Pub Date : 2023-02-07 DOI: 10.1186/s40352-023-00205-0
Lindsey R Riback, Peter Dickson, Keyanna Ralph, Lindsay B Saber, Rachel Devine, Lindsay A Pett, Alyssa J Clausen, Jacob A Pluznik, Chava J Bowden, Jennifer C Sarrett, Alysse G Wurcel, Victoria L Phillips, Anne C Spaulding, Matthew J Akiyama

Background: Correctional settings are hotspots for SARS-CoV-2 transmission. Social and biological risk factors contribute to higher rates of COVID-19 morbidity and mortality among justice-involved individuals. Rapidly identifying new cases in congregate settings is essential to promote proper isolation and quarantine. We sought perspectives of individuals incarcerated during COVID-19 on how to improve carceral infection control and their perspectives on acceptability of wastewater-based surveillance (WBS) accompanying individual testing.

Methods: We conducted semi-structured interviews with 20 adults who self-reported being incarcerated throughout the United States between March 2020 and May 2021. We asked participants about facility enforcement of the Centers for Disease Control and Prevention (CDC) COVID-19 guidelines, and acceptability of integrating WBS into SARS-CoV-2 monitoring strategies at their most recent facility. We used descriptive statistics to characterize the study sample and report on acceptability of WBS. We analyzed qualitative data thematically using an iterative process.

Results: Participants were predominantly Black or multiple races (50%) and men (75%); 46 years old on average. Most received a mask during their most recent incarceration (90%), although only 40% received counseling on proper mask wearing. A quarter of participants were tested for SARS-CoV-2 at intake. Most (70%) believed they were exposed to the virus while incarcerated. Reoccurring themes included (1) Correctional facility environment leading to a sense of insecurity, (2) Perceptions that punitive conditions in correctional settings were exacerbated by the pandemic; (3) Importance of peers as a source of information about mitigation measures; (4) Perceptions that the safety of correctional environments differed from that of the community during the pandemic; and (5) WBS as a logical strategy, with most (68%) believing WBS would work in the last correctional facility they were in, and 79% preferred monitoring SARS-CoV-2 levels through WBS rather than relying on just individual testing.

Conclusion: Participants supported routine WBS to monitor for SARS-CoV-2. Integrating WBS into existing surveillance strategies at correctional facilities may minimize the impact of future COVID-19 outbreaks while conserving already constrained resources. To enhance the perception and reality that correctional systems are maximizing mitigation, future measures might include focusing on closer adherence to CDC recommendations and clarity about disease pathogenesis with residents.

背景:劳教场所是 SARS-CoV-2 传播的热点地区。社会和生物风险因素导致司法人员中 COVID-19 的发病率和死亡率较高。快速识别集中场所的新病例对于促进适当的隔离和检疫至关重要。我们征求了 COVID-19 期间被监禁人员对如何改善狱中感染控制的看法,以及他们对废水监测(WBS)伴随个人检测的可接受性的看法:我们对 2020 年 3 月至 2021 年 5 月期间在美国各地自称被监禁的 20 名成年人进行了半结构化访谈。我们询问了参与者有关设施执行美国疾病控制和预防中心(CDC)COVID-19 指南的情况,以及在其最近的设施中将 WBS 纳入 SARS-CoV-2 监测策略的可接受性。我们使用描述性统计来描述研究样本的特征,并报告 WBS 的可接受性。我们采用迭代过程对定性数据进行了专题分析:参与者主要是黑人或多种族人(50%)和男性(75%);平均年龄 46 岁。大多数人在最近一次入狱时都佩戴了口罩(90%),但只有 40% 的人接受了正确佩戴口罩的辅导。四分之一的参与者在入院时接受了 SARS-CoV-2 检测。大多数人(70%)认为他们在监禁期间接触过病毒。重复出现的主题包括:(1) 矫正设施环境导致不安全感;(2) 认为大流行加剧了矫正环境中的惩罚性条件;(3) 同伴作为缓解措施信息来源的重要性;(4) 认为在大流行病期间,惩教环境的安全性与社区环境不同;以及 (5) 将 WBS 作为一种合理的策略,大多数人(68%)认为 WBS 可以在他们所在的上一个惩教所发挥作用,79%的人倾向于通过 WBS 监测 SARS-CoV-2 的水平,而不是仅仅依靠个人检测。结论:参与者支持通过常规 WBS 监测 SARS-CoV-2 水平。将 WBS 纳入惩教机构现有的监测策略可最大限度地减少未来 COVID-19 爆发的影响,同时节约本已紧张的资源。为了让人们更好地认识到惩教系统正在最大限度地减轻疫情影响,未来的措施可能包括更严格地遵守疾病预防控制中心的建议,并向居民说明疾病的发病机理。
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引用次数: 0
"It was really poor prior to the pandemic. It got really bad after": A qualitative study of the impact of COVID-19 on prison healthcare in England. "大流行之前情况很糟糕。大流行之后就变得非常糟糕":关于 COVID-19 对英格兰监狱医疗保健影响的定性研究。
IF 3 Q1 CRIMINOLOGY & PENOLOGY Pub Date : 2023-02-07 DOI: 10.1186/s40352-023-00212-1
Lucy Wainwright, Sarah Senker, Krysia Canvin, Laura Sheard

Background: The impact of COVID-19 has been exceptional, particularly on the National Health Service which has juggled COVID affected patients alongside related staff shortages and the existing (and growing) health needs of the population. In prisons too, healthcare teams have been balancing patient needs against staffing shortfalls, but with additional strains unique to the prison population. Such strains include drastic lockdown regimes and prolonged isolation, the need to consider health alongside security, known health inequalities within prisoner groups, and an ageing and ethnically diverse population (both groups disproportionately affected by COVID). The aim of this paper is to contribute to emerging research on the impact of COVID-19 on prison healthcare.

Methods: We conducted 44 in depth interviews (over phone or video) across three groups: prison leavers, healthcare staff and decision makers, between July and December 2021. Framework analysis was undertaken.

Results: Three themes were found. First, we found that Covid-19 had a significant impact on prison healthcare which involved reduced access and changes to how healthcare was delivered. This affected the health of prisoners by exacerbating existing conditions, new conditions being undiagnosed and mental health needs increasing. Second, the pandemic impacted on healthcare staff through creation of stress, frustration and exhaustion due to minimal staffing levels in an already under-resourced system. Third, an emerging conflict was witnessed. People in prison felt neglected regarding their healthcare needs but staff reported doing the best they could in an unprecedented situation. Healthcare staff and decision makers felt that prison healthcare was seen as a poor relation when compared with healthcare in the community, with no extra resource or staffing for Covid-19 testing or vaccinations.

Conclusion: The Covid-19 pandemic has significantly impacted almost all aspects of prison healthcare in the UK. This includes delivery of healthcare by staff, receipt of it by people in prison and the management, planning and commissioning of it by decision makers. These three groups of people were all affected detrimentally but in vastly different ways, with some participants describing a sense of trauma. Health needs that were exacerbated or went unmet during Covid urgently need to be addressed in order to reduce health inequalities. In order for welfare and wellbeing to be maintained, and in some cases repaired, both prisoners and staff need to feel heard and recognised.

背景:COVID-19 的影响非同一般,尤其是对国家卫生服务部门的影响,该部门在处理 COVID 患者问题的同时,还要应对相关的人员短缺问题以及人口现有的(和不断增长的)健康需求。在监狱中,医疗团队也一直在平衡患者需求与人员短缺之间的关系,但同时也面临着监狱人口特有的额外压力。这些压力包括严格的禁闭制度和长期隔离、需要在考虑安全的同时考虑健康、囚犯群体内部已知的健康不平等、人口老龄化和种族多样化(这两个群体受 COVID 的影响尤为严重)。本文旨在为有关 COVID-19 对监狱医疗保健影响的新兴研究做出贡献:我们在 2021 年 7 月至 12 月期间对三个群体进行了 44 次深度访谈(通过电话或视频),这三个群体分别是:离监人员、医疗保健人员和决策者。结果:我们发现了三个主题:结果:发现了三个主题。首先,我们发现 Covid-19 对监狱医疗保健产生了重大影响,这涉及到医疗保健服务的减少和提供方式的改变。这对囚犯的健康产生了影响,因为现有病情加重,新的病情得不到诊断,心理健康需求增加。其次,大流行病对医护人员产生了影响,在本已资源不足的系统中,由于人员配备水平极低,医护人员产生了压力、挫折感和疲惫感。第三,出现了新的冲突。监狱中的囚犯感到他们的医疗保健需求被忽视,但工作人员表示,在前所未有的情况下,他们已经尽了最大努力。医疗保健人员和决策者认为,与社区医疗保健相比,监狱医疗保健被认为是差强人意的,在 Covid-19 检测或疫苗接种方面没有额外的资源或人员配备:Covid-19 大流行对英国监狱医疗保健的几乎所有方面都产生了重大影响。这包括工作人员提供的医疗服务、囚犯接受的医疗服务以及决策者对医疗服务的管理、规划和委托。这三类人都受到了不利影响,但影响的方式却大相径庭,一些参与者描述了一种创伤感。科维德期间加剧或未得到满足的健康需求亟待解决,以减少健康不平等现象。为了保持福利和福祉,甚至在某些情况下修复福利和福祉,囚犯和工作人员都需要感受到倾听和认可。
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引用次数: 0
Medications for opioid use disorder during incarceration and post-release outcomes. 监禁期间阿片类药物使用障碍的药物治疗和释放后的结果。
IF 3.5 Q1 Social Sciences Pub Date : 2023-02-04 DOI: 10.1186/s40352-023-00209-w
Lara Cates, Aaron R Brown

Background: Continuation or initiation of MOUDs during incarceration could improve post-release outcomes by preventing return to opioid use and reducing risk of overdose. People with OUD involved in the criminal legal system are a vulnerable population, yet little research has comprehensively examined post-release outcomes associated with receiving MOUDs in jail and prison settings.

Methods: The authors conducted a review of published peer-reviewed literature on post-release outcomes associated with the use of MOUDs in correctional settings to determine implications for further research and policy.

Results: Results showed compelling evidence supporting the use of MOUDs for currently incarcerated populations, with almost all studies showing that MOUDs provided during incarceration increased community-based treatment engagement post-release. There is also evidence that initiating or continuing MOUDs during incarceration is associated with decreased opioid use and overdoses post-release, without increasing criminal involvement.

Conclusions: Findings indicate that forcing tapering and withdrawal during incarceration can have dire consequences upon release into the community. Initiating or continuing MOUDs during incarceration reduces the risk for opioid use and overdose upon release by maintaining opioid tolerance and increasing community treatment engagement.

背景:在监禁期间继续或开始使用mods可以通过防止阿片类药物的重新使用和降低过量的风险来改善释放后的结果。涉及刑事法律体系的OUD患者是弱势群体,但很少有研究全面调查在监狱和监狱环境中接受OUD的释放后结果。方法:作者对已发表的同行评议文献进行了回顾,以确定在惩教环境中使用MOUDs的释放后结果,以确定进一步研究和政策的意义。结果:结果显示了令人信服的证据,支持目前被监禁的人群使用MOUDs,几乎所有的研究都表明,在监禁期间提供的MOUDs增加了释放后社区治疗的参与。也有证据表明,在监禁期间开始或持续使用mods与释放后阿片类药物使用和过量使用有关,而不会增加犯罪参与。结论:研究结果表明,在监禁期间强迫逐渐减少和戒断可能会在释放到社区后产生可怕的后果。通过维持阿片类药物耐受性和增加社区治疗参与,在监禁期间开始或继续使用mods可降低阿片类药物使用和释放后过量使用的风险。
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引用次数: 2
A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes. 基于社区的阿片类药物过量后干预方案的范围审查:方案结构和结果的含义。
IF 3.5 Q1 Social Sciences Pub Date : 2023-01-28 DOI: 10.1186/s40352-022-00201-w
Amelia Bailey, Calla Harrington, Elizabeth A Evans

Background: An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions.

Results: A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners.

Conclusions: Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.

背景:解决阿片类药物流行的紧急干预措施是使用多学科外展小组,在阿片类药物过量后将社区中的个人与医疗资源联系起来。虽然这些干预措施正在获得联邦资助,但对未来干预措施的经验了解却很少。了解这些干预措施的过程和结果是可取的,因为公共卫生和执法机构之间的新型伙伴关系有时目标不同。本综述的目的是描述以社区为基础的药物过量后干预的项目结构和评估结果。结果:检索PubMed、PsycInfo和Web of Science,得出5篇同行评议的文章,详细介绍了2001年至2021年7月在美国发表的干预措施的实施和结果。大多数干预措施使用多学科外展小组,并参考第一响应者的数据与最近在其住所经历过量用药的个人联系。提供的服务通常包括转诊到药物使用治疗、康复教练和社会服务。外展方法、评估措施和结果各不相同。从现有文献来看,项目参与的促进因素包括多学科合作伙伴之间的沟通、信息共享和领导力认同。结论:未来的研究可以从探索农村地区、受药物过量影响的家庭和少数群体的服务提供中受益。利用执法伙伴关系的以社区为基础的过量后干预措施正在涌现,经验文献中有希望但有限的例子。
{"title":"A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes.","authors":"Amelia Bailey,&nbsp;Calla Harrington,&nbsp;Elizabeth A Evans","doi":"10.1186/s40352-022-00201-w","DOIUrl":"https://doi.org/10.1186/s40352-022-00201-w","url":null,"abstract":"<p><strong>Background: </strong>An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions.</p><p><strong>Results: </strong>A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners.</p><p><strong>Conclusions: </strong>Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2023-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9188771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Assessing Road to Mental Readiness (R2MR) training among correctional workers in Canada. 评估加拿大惩教人员的心理准备之路(R2MR)培训。
IF 3 Q1 CRIMINOLOGY & PENOLOGY Pub Date : 2023-01-23 DOI: 10.1186/s40352-023-00206-z
Matthew S Johnston, Rosemary Ricciardelli, Maryam Ghodrati, Stephen Czarnuch

Background: Mental health frameworks, best practices, and the well-being of public safety personnel in Canada are topics of increasing interest to both researchers and organizations. To protect and improve worker mental health, different training programs have been implemented to serve this population. The Road to Mental Readiness (R2MR) training regimen is one such program specialized to build cultural awareness of mental health, reduce stigma, and mitigate the cumulative impacts of exposures to potentially psychologically traumatic events among public safety personnel. However, limited research has been conducted to evaluate the effectiveness of R2MR, especially among correctional workers.

Methods: The current study analyzed 307 open-ended survey responses to four (4) questions about R2MR garnered from 124 Canadian provincial and territorial correctional workers between 2018-2020 to reveal their understandings and perceptions of R2MR training, and to identify what learned skills they found challenging or easy to implement.

Results: The results suggest that R2MR training plays a significant role in decreasing stigma and increasing mental health awareness. Across jurisdictions, R2MR creates a supportive space for open dialogue around mental health meant to shift cultural and individual barriers that often hinder treatment-seeking. Some respondents also indicated that R2MR was a starting point for intervention.

Conclusions: Further research is necessary to understand how R2MR and other programs could support the mental health and well-being of correctional workers.

背景:加拿大公共安全人员的心理健康框架、最佳实践和福祉是研究人员和组织机构日益关注的话题。为了保护和改善工作人员的心理健康,针对这一人群实施了不同的培训计划。心理准备之路(R2MR)培训计划就是其中之一,该计划旨在培养公共安全人员的心理健康文化意识,减少耻辱感,并减轻潜在心理创伤事件的累积影响。然而,对 R2MR 的有效性进行评估的研究非常有限,尤其是在惩教人员中:本研究分析了 2018-2020 年间从 124 名加拿大各省和地区惩教人员中收集到的 307 份针对四(4)个有关 R2MR 问题的开放式调查回复,以揭示他们对 R2MR 培训的理解和看法,并确定他们认为哪些学习技能具有挑战性或易于实施:结果表明,R2MR 培训在减少污名化和提高心理健康意识方面发挥了重要作用。在各个辖区,R2MR 为围绕心理健康的公开对话创造了一个支持性的空间,意在改变往往阻碍寻求治疗的文化和个人障碍。一些受访者还表示,R2MR 是干预的起点:有必要开展进一步的研究,以了解 R2MR 和其他项目如何能够为劳教人员的心理健康和福祉提供支持。
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引用次数: 0
Interventions to improve the implementation of evidence-based healthcare in prisons: a scoping review. 改善监狱循证医疗实施的干预措施:范围界定综述。
IF 3 Q1 CRIMINOLOGY & PENOLOGY Pub Date : 2023-01-03 DOI: 10.1186/s40352-022-00200-x
Jenna Blackaby, Jordan Byrne, Sue Bellass, Krysia Canvin, Robbie Foy

Background: There are challenges to delivering high quality primary care within prison settings and well-recognised gaps between evidence and practice. There is a growing body of literature evaluating interventions to implement evidence-based practice in the general population, yet the extent and rigour of such evaluations in incarcerated populations are unknown. We therefore conducted a scoping literature review to identify and describe evaluations of implementation interventions in the prison setting.

Methods: We searched EMBASE, MEDLINE, CINAHL Plus, Scopus, and grey literature up to August 2021, supplemented by hand searching. Search terms included prisons, evidence-based practice, and implementation science with relevant synonyms. Two reviewers independently selected studies for inclusion. Data extraction included study populations, study design, outcomes, and author conclusions. We took a narrative approach to data synthesis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for scoping reviews.

Results: Fifteen studies reported in 17 papers comprised one randomised controlled trial, one controlled interrupted time series analysis and 13 uncontrolled before and after studies. Eight studies took place in the US and four in the UK. Ten studies evaluated combined (multifaceted) interventions, typically including education for staff or patients. Interventions most commonly targeted communicable diseases, mental health and screening uptake. Thirteen studies reported adherence to processes of care, mainly testing, prescribing and referrals. Fourteen studies concluded that interventions had positive impacts.

Conclusions: There is a paucity of high-quality evidence to inform strategies to implement evidence-based health care in prisons, and an over-reliance on weak evaluation designs which may over-estimate effectiveness. Whilst most evaluations have focused on recognised priorities for the incarcerated population, relatively little attention has been paid to long-term conditions core to primary care delivery. Initiatives to close the gaps between evidence and practice in prison primary care need a stronger evidence base.

背景:在监狱环境中提供高质量的初级保健服务面临挑战,证据与实践之间存在公认的差距。有越来越多的文献对在普通人群中实施循证实践的干预措施进行了评估,但在被监禁人群中进行此类评估的程度和严谨性尚不得而知。因此,我们进行了一次范围广泛的文献综述,以确定并描述在监狱环境中实施干预措施的评估情况:我们检索了 EMBASE、MEDLINE、CINAHL Plus、Scopus 和截至 2021 年 8 月的灰色文献,并辅以人工检索。检索词包括监狱、循证实践和实施科学及相关同义词。两名审稿人独立选择纳入研究。数据提取包括研究人群、研究设计、结果和作者结论。我们采用叙事方法进行数据综合。我们遵循系统综述和元分析首选报告项目(PRISMA)指南进行范围界定综述:17 篇论文中报告的 15 项研究包括一项随机对照试验、一项对照中断时间序列分析和 13 项非对照前后研究。八项研究在美国进行,四项在英国进行。10 项研究评估了综合(多方面)干预措施,通常包括对员工或患者的教育。最常见的干预措施是针对传染病、心理健康和筛查。13 项研究报告了对护理流程的遵守情况,主要是检测、处方和转诊。14 项研究认为干预措施产生了积极影响:缺乏高质量的证据为在监狱中实施循证医疗保健的策略提供依据,而且过度依赖于薄弱的评估设计,这可能会高估有效性。虽然大多数评估都集中在公认的被监禁人口的优先事项上,但对初级医疗服务核心的长期条件关注相对较少。为缩小监狱初级保健中证据与实践之间的差距而采取的举措需要更强大的证据基础。
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引用次数: 0
CPR in correctional facilities: a missed opportunity? 惩教设施的心肺复苏术:错失良机?
IF 3.5 Q1 Social Sciences Pub Date : 2022-12-27 DOI: 10.1186/s40352-022-00202-9
Christopher Scott Sampson, Julie A W Stilley, Elizabeth Kendrick, Kayla Riel

In the incarcerated population, the largest ethnic and racial group is Black people. Heart disease is known as the leading causes of death in the United States which can lead to cardiac arrest. Layperson cardiopulmonary resuscitation (CPR) has been shown to provide a benefit and increase likelihood of return of spontaneous circulation (ROSC). Recent research shows that in witnessed out of hospital cardiac arrests, the likelihood of receiving bystander CPR was found to be less among Black or Hispanic people when compared to White persons. One neglected area for layperson CPR training are these correctional facilities. This population is known to have higher rates of diabetes, high blood pressure and coronary artery disease, all of which contribute to an increased risk of acute coronary syndrome.A search was performed of the NEMSIS database. When comparing witnessed cardiac arrest, incidents without bystander interventions occurred more frequently than expected if the arrest was witnessed by a family member or other lay person. These interventions included bystander CPR or AED placement with or without defibrillation.The data presented shows that there is an unmet need of additional lay person CPR training in correctional facilities which could be implemented for little cost.

在被监禁的人口中,最大的民族和种族群体是黑人。在美国,心脏病被认为是导致心脏骤停的主要死因。外行人心肺复苏术(CPR)已被证明是有益的,并增加了自然循环(ROSC)恢复的可能性。最近的研究表明,与白人相比,在目睹院外心脏骤停的情况下,黑人或西班牙裔接受旁观者心肺复苏的可能性更低。一个外行心肺复苏培训被忽视的领域是这些惩教设施。众所周知,这一人群患糖尿病、高血压和冠状动脉疾病的几率更高,所有这些都增加了患急性冠状动脉综合征的风险。对NEMSIS数据库进行了检索。当比较目睹的心脏骤停时,如果有家庭成员或其他非专业人员目睹心脏骤停,没有旁观者干预的事件发生的频率比预期的要高。这些干预措施包括旁观者CPR或AED放置,伴有或不伴有除颤。所提供的数据表明,在惩教设施中,对额外的非专业人员心肺复苏培训的需求尚未得到满足,这些培训可以以很少的成本实施。
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引用次数: 0
Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. 监狱中阿片类药物使用障碍的最佳做法的可得性以及相关的培训和资源需求:对美国受影响严重的县的监狱进行的全国访谈研究的结果
IF 3.5 Q1 Social Sciences Pub Date : 2022-12-20 DOI: 10.1186/s40352-022-00197-3
Christy K Scott, Christine E Grella, Michael L Dennis, John Carnevale, Robin LaVallee

Background: Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD "best practices" in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources.

Results: Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff.

Conclusions: Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release.

背景:监狱是筛选阿片类药物使用障碍(OUD)个体并提供所需服务,特别是OUD药物治疗的最佳场所。本研究旨在评估在美国受阿片类药物过量严重影响的县的监狱中OUD“最佳做法”的可用性及其相关的培训和资源需求。使用OUD严重程度的两个指标(阿片类药物过量死亡的绝对数量和人口比率)选择县纳入研究。对目标县185/244(76%)和目标县185/250(74%)监狱的代表进行了结构化访谈。根据目前的治疗和实践指南确定了10个OUD最佳做法。这些措施包括:OUD筛查;临床评估;医疗管理戒断;MOUD管理;孕妇服;咨询和综合服务;与社区提供者合作;医疗补助/保险援助;返回服务;预防用药过量。描述性分析审查了所有服务的提供情况和在最佳做法类别内认可的服务的平均百分比,最佳做法与社区和监狱特点的联系,以及对培训和资源的相关需求。结果:超过70%的监狱答复者表示,在他们的监狱中可以获得10种OUD最佳做法中的每一种的某些方面,从71%使用临床评估到96%提供过量预防。然而,在每个最佳做法类别内核准的项目的平均百分比有很大差异,从涉及重返社会服务的项目的38%到涉及医疗管理戒断的项目的88%不等。监狱中OUD最佳做法的可用性也因社区和监狱的特点而异。据报告,监狱对药品和临床工作人员的资金需求最大。结论:需要制定政策,以解决监狱内OUD最佳做法可获得性方面存在的差距。需要培训、技术援助和资金,以提高监狱管理阿片类药物的临床能力,并确保从监狱到社区的护理的连续性,这对于减少释放后阿片类药物过量的风险至关重要。
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引用次数: 5
The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study. COVID-19对狱中阿片类药物使用障碍治疗的影响:一项横断面研究。
IF 3.5 Q1 Social Sciences Pub Date : 2022-12-19 DOI: 10.1186/s40352-022-00199-1
Elizabeth C Saunders, Milan F Satcher, Laura B Monico, Ryan D McDonald, Sandra A Springer, David Farabee, Jan Gryczynski, Amesika Nyaku, Donald Reeves, Lynn E Kunkel, Alysse M Schultheis, Robert P Schwartz, Joshua D Lee, Lisa A Marsch, Elizabeth Needham Waddell

While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.

虽然 COVID-19 大流行扰乱了各地的医疗保健服务,但有监狱系统参与和阿片类药物使用障碍 (OUD) 的人受到的影响更大,更容易患上严重的 COVID 相关疾病。殡葬机构和社区治疗项目(CTPs)迅速制定了协议,以维持医疗服务的提供,同时降低 COVID-19 传播的风险。这项调查研究评估了参与美国国家药物滥用研究所(NIDA)资助的 "刑事司法系统涉案成年人长效丁丙诺啡与纳曲酮阿片类药物治疗"(EXIT-CJS)研究的收容所和社区治疗计划在 OUD 治疗、远程医疗使用和重返社会支持服务方面的变化。2020 年 12 月,参与 EXIT-CJS 研究的监禁场所(n = 6;COVID 2020 前每月人口普查中位数 = 3468 人)和 CTP(n = 7;COVID 2020 前每月人口普查中位数 = 550 名患者)完成了一项横断面网络调查。该调查评估了 COVID-19 前(2020 年 1 月至 3 月)和 COVID-19 后(2020 年 4 月至 9 月)在 OUD 治疗、远程医疗使用、重返支持和转介实践方面的变化。与 2020 年 1 月至 3 月相比,一半的监禁点(n = 3)在 2020 年 4 月至 9 月期间增加了开始接受阿片类药物使用障碍(MOUD)药物治疗的总人数,而三分之一的监禁点(n = 2)减少了开始接受药物治疗的人数。大多数社区治疗点(n = 4)报告称,2020 年 4 月至 9 月期间,新入院人数有所减少,其中有两个项目因 COVID-19 而停止或暂停了 MOUD 项目。所有在 COVID 前使用远程医疗的囚禁场所(n = 5)都增加或保持了远程医疗的使用,所有提供 MOUD 的 CTP(n = 6)都增加了远程医疗的使用。虽然远程医疗服务的扩展支持了 MOUD 服务的提供,但大多数站点在提供释放后社区支持(包括住房、就业和交通服务转介)方面遇到了挑战。在 COVID-19 大流行期间,这一小部分囚禁场所和社区治疗点进行了创新,以继续提供对 OUD 的治疗。扩大远程医疗服务对于支持 MOUD 服务的提供至关重要。尽管进行了这些创新,但这些机构在为社区中的患者提供重返社会支持方面仍面临挑战。自大流行病发生以来,COVID 之前用于识别被监禁者并使其参与其中的策略可能就不那么有效了。除了扩大对监禁环境中最有效的远程医疗实践的研究外,探索在重返社会期间扩大住房和就业支持战略的研究也至关重要。
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引用次数: 0
Psychometric evaluation of an Adverse Childhood Experiences (ACEs) measurement tool: an equitable assessment or reinforcing biases? 不良童年经历(ace)测量工具的心理测量评估:公平评估还是强化偏见?
IF 3.5 Q1 Social Sciences Pub Date : 2022-11-29 DOI: 10.1186/s40352-022-00198-2
Xiaohan Mei, Jiayu Li, Zhi-Shu Li, Shun Huang, Li-Li Li, Yang-Hong Huang, Jianhong Liu

Background: Utilizing Adverse Childhood Experiences (ACEs) measurement scales to assess youths' adversities has expanded exponentially in health and justice studies. However, most of the ACEs assessment scales have yet to meet critical psychometric standards, especially for key demographic and minority groups. It is critical that any assessment or screening tool is not reinforcing bias, warranting the need for validating ACEs tools that are equitable, reliable and accurate. The current study aimed to examine the structural validity of an ACEs scale. Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), which collected of 97,314 responses collected from adults across sixteen states. This study assessed the psychometric properties and measurement invariance of the ACEs tool under the structural equation modeling framework.

Results: We found the 11-item ACEs screening tool as a second-order factor with three subscales, all of which passed the measurement invariance tests at metric and scalar levels across age, race, sex, socioeconomic status, gender identity, and sexual orientation. We also found that minority groups experienced more childhood adversity with small effect size, with the exception of the gender identity.

Conclusion: The ACEs measurement scale from the BRFSS is equitable and free from measurement bias regardless of one's age, race, sex, socioeconomic status, gender identity, and sexual orientation, and thus is valid to be used to compare group mean differences within these groups. The scale is a potentially valid, viable, and predictive risk assessment in health and justice and research settings to identify high-risk groups or individuals for treatments.

背景:利用不良童年经历(ace)量表评估青少年逆境在健康和司法研究中呈指数级增长。然而,大多数ace评估量表尚未达到关键的心理测量标准,特别是针对关键人口和少数群体。至关重要的是,任何评估或筛选工具都不会加剧偏见,因此需要验证公平、可靠和准确的ace工具。本研究旨在检验ace量表的结构效度。使用2019年行为风险因素监测系统(BRFSS)的数据,该系统收集了从16个州的成年人收集的97,314份回复。本研究在结构方程模型框架下评估了ace工具的心理测量特性和测量不变性。结果:我们发现11项ace筛选工具作为二阶因子,具有3个子量表,所有子量表在度量和标量水平上通过了年龄、种族、性别、社会经济地位、性别认同和性取向的测量不变性检验。我们还发现,除了性别认同外,少数群体经历了更多的童年逆境,但效应量较小。结论:BRFSS的ace量表是公平的,不存在年龄、种族、性别、社会经济地位、性别认同和性取向的测量偏差,可以有效地用于比较这些群体内的群体平均差异。该量表在卫生、司法和研究环境中是一种潜在有效、可行和可预测的风险评估,用于确定需要治疗的高危人群或个人。
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引用次数: 5
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