Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

The cornerstones of the World Health Organization's strategy to eliminate HIV, hepatitis B and C, and sexually transmitted infections by 2030 are target-group-specific prevention, testing, and treatment. The microelimination of hepatitis C is a practical approach that breaks down national elimination targets into smaller, more approachable goals for key populations (e.g., prisoners). From a public health perspective, the prison healthcare systems play an important role in achieving these goals. Based on data and experiences collected in Berlin prisons over two years, this article demonstrates that treatment models for hepatitis C in prison exist and discusses how these models can be successfully implemented.

Incarceration is associated with significant health burdens. Prisoners suffer disproportionately from chronic diseases, mental disorders, and substance use disorders. While primary care in prisons is usually provided regularly and sometimes even faster than outside, care for more complex treatment needs is often limited to few facilities. Structural deficits include restricted freedom of physician choice, limited specialist access, separation from the regular health system, and gaps at the transitions from incarceration to release.Despite the principle of equivalence, prison healthcare often fails to meet the standards of the statutory health insurance (in German: Krankenversicherung [GKV]). International recommendations call for the inclusion of prisoners in the GKV as well as for a transfer of healthcare responsibility from ministries of justice to ministries of health.Particularly challenging is the treatment of individuals with substance use disorders: access to evidence-based therapies is inconsistent and varies greatly from region to region. Smoking cessation and psychosocial support are also inadequate. Nutrition is also often unbalanced, while sports and physical activities are often inadequately implemented.To date, a comprehensive interdisciplinary healthcare strategy aligned with the "Healthy Prisons" approach is largely absent in Germany. The Baden-Württemberg model featuring health reporting, telemedicine approaches, age-appropriate care, and quality circles, could serve as a nationwide example. A paradigm shift is required from institution-centered care toward participatory, preventive health promotion that involves both prisoners and staff.

In Germany, there are approximately 70,000 prison spaces (criminal and pre-trial detention), which are currently over 90% full. Medical care is organized by the judicial administration. Section 63 of the Bremen Prison Act (BremStVollzG) regulates medical care. It stipulates that prisoners are entitled to "necessary, sufficient, and appropriate medical services, observing the principle of cost-effectiveness and taking into account the general standards of statutory health insurance."The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) identifies important principles for prison medicine: unhindered access to a physician, equivalent healthcare to that provided in freedom, patient self-determination and physician confidentiality/discretion, preventive healthcare, humanitarian assistance, professional independence, and sufficient medical competence.This article first outlines the requirements for prison medicine based on these principles. The author then reports on his own professional experiences as a prison physician at the Bremen Correctional Facility, including the challenges posed by the widespread prevalence of mental disorders, substance use, infectious diseases, and physical violence in prisons. Adequate training of medical staff is essential to meeting these unique requirements.

Linking different health data at the personal level (record linkage, RL) allows answering scientific questions that could otherwise not be answered by a single data source. Linked data therefore offer great potential for health research to improve prevention, treatment, and care at the population level. Personal health data are protected by strict legal regulations. Its use requires balancing legitimate interests in protecting personal data and health benefits. However, current laws and their interpretations in Germany place severe restrictions on health data RL such that its potential for improving health outcomes is still to be leveraged. In Germany, RL is also hindered by the lack of a unique identifier that enables error-free merging across different data sources. Overall, there is a lack of interoperable solutions to perform comprehensive RL across studies and data sources in a secure environment.In this article, we propose solutions for the linkage of personal health data from different sources based on the White Paper - Verbesserung des Record Linkage für die Gesundheitsforschung in Deutschland. Our proposed solutions include, among others, the establishment of a health ID and the creation of a decentralized federated research data infrastructure with central components. Although these proposals are in line with the General Data Protection Regulation, there is a need for further legal regulation in specific cases.

Due to the special conditions that prevail in prisons, there are specific health risks. Drug use and poor hygiene are widespread. Typical illnesses in prisons include skin diseases, infectious diseases such as HIV and hepatitis, and nutritional deficiencies. Mental disorders, self-harm, and harm to others are also common. Medical services in prisons-known as prison medicine-therefore face particular challenges compared to regular medical care outside prisons, especially in the area of diagnosis. This concerns, among other things, the assessment of fitness for detention, the indication of specific therapies (e.g., social therapy, addiction therapy, suicide prevention), and prognostic issues, for example in connection with the relaxation of prison rules and the associated risk of abuse by the prisoner. From a medical point of view, it must also be taken into account that aggravation, that is, the deliberate exaggeration of actual symptoms, and the simulation of illness can play a certain role. The article provides an overview of the diagnostic challenges, particularly from a legal perspective.

Sexual offenses cause significant individual and societal harm. Psychosocial and psychotherapeutic interventions are considered central components of relapse prevention. However, international evidence on the effectiveness of approaches for treating individuals incarcerated for sexual offenses is inconsistent and marked by methodological limitations. This review examines the current state of research in Germany. For this purpose, the literature was systematically reviewed. The aim is to summarize the evidence on the effectiveness of treatment approaches over the past 25 years and to assess it with particular attention to methodological aspects.Empirical studies indicate that treatment can have positive effects on general recidivism (i.e., reoffending after release). However, there is no clear evidence for a reduction in sexual reoffending. Treatment dropout was associated with higher recidivism rates. Studies examining changes in risk-relevant factors report some favorable developments, but the highly heterogeneous quality and methodology of these studies limit the strength of the conclusions that can be drawn.Overall, it is currently not possible to make a definitive judgment about the effectiveness of inpatient treatment programs for sexual offenders in Germany. There is a clear need for larger, methodologically robust studies with equivalent comparison groups and detailed documentation of treatment content in order to generate reliable evidence on the effectiveness of these interventions.

Compared to their peers, young people in prison show a marked accumulation of biographical and psychosocial stressors, in particular a low level of education and multiple experiences of violence. These stressors are reflected not only in sometimes serious criminal offences, but also in above-average substance use and a significantly increased prevalence of mental health issues and disorders. The article first outlines psychosocial stress factors in connection with physical and mental health problems and then describes healthcare in the juvenile justice system.There are hardly any systematic and up-to-date studies on the physical and mental illnesses of incarcerated young people in Germany. The areas of substance abuse and suicidality are exceptions. There is also a lack of large-scale studies on medical and psychological-psychiatric care in juvenile detention. This results in a considerable need for research on the health situation of young prisoners and their care practices. Studies suggest that adequate medical and psychological-psychiatric care in juvenile detention needs more resources.