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Objective: This study aimed to assess and comparatively analyse two menus from a Young Offenders Institution (YOI). One menu from 2019, and one from 2022, with the objective of identifying any improvements in meeting dietary guidelines. Design: Cross-sectional and comparative analysis. Setting: United Kingdom, a YOI in Northern England. Participants: YOI Menus. Results: Analysis of 30 dietary components identified that 25 exceeded the dietary guidelines (P < 0.05) for the 2022 menu, with five failing to meet the guidelines (P < 0.05). When compared to the 2019 menu, the 2022 menu showed improvements in saturated fat, sodium, and vitamin D. Despite the improvement, vitamin D levels remained below dietary guidelines (P < 0.01). Salt and energy content were reduced in the 2022 menu (P < 0.05); however, they were still above the dietary guidelines (P < 0.01). Free sugars were significantly above dietary guidelines for both menus, with no significant change between the 2019 and 2022 menu (P = 0.12). Conclusion: The 2022 menu has demonstrated progress in alignment with meeting dietary guidelines, particularly in reducing calories, fat, saturated fat, salt, sodium, and chloride, as well as increasing vitamin D. Despite improvements, calories, free sugars, salt, saturated fat, sodium, and chloride are still exceeding dietary guidelines, posing as potential health risks.
One of the most pronounced features of the war in Ukraine has been the heavy reliance of the Russian forces on convict-soldiers, most notably by the private military and security company (PMSC) the Wagner Group. In this essay, I explore the ethical problems with using convict-soldiers and assess how using them compares to other military arrangements, such as conscription or an all-volunteer force. Overall, I argue that the central issue with using prisoners to fight wars is their perceived expendability. To do this, I present three arguments. First, although many prisoners have been under major duress, using convict-soldiers may be somewhat preferable to using conscripts in this regard. Second, convict-soldiers are more likely to be subject to human rights abuses than other types of soldiers and this should be seen as the main problem with their use. Third, convict-soldiers’ liability to lethal force for fighting in an unjust war does not render it permissible to treat them as expendable.
This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive–behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories.
Results
Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the ‘change work’ stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term.
Clinical implications
The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.
Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.
This article explores the turn to human rights of Tunisian Maoist activists in the late 1970s and early 1980s. Many of these Tunisians later became human rights activists. I argue against prevailing views that ideological changes toward human rights in the late 1970s were the result of paradigmatic ideological shifts or the demise of socialist, anti-imperialist thinking, or an outcome of international human rights norm diffusion. Doubt or loss of faith in some or all parts of Marxism-Leninism led to a diversity of ideological transformations that were complex and hybrid. Drawing on interviews with former Tunisian Maoists, as well as on their writings, the article outlines the political and ideological environment in which they operated. It describes their solidarity work for political prisoners and explores their encounter with Amnesty International as well as the Tunisian League for Human Rights in its first years of existence, showcasing how multiple approaches to human rights existed among the activists.
Coronavirus disease 2019 (COVID-19) may affect anybody, and prisoners are a susceptible group in terms of the risk of contracting infectious illnesses owing to a variety of situations such as overcrowding, confinement, and poor cleanliness. Therefore, this study aimed to assess prisoners’ Knowledge, Attitude, and Practice (KAP) of COVID-19 and its determinants in southern Ethiopia.
Method:
The Institutional cross-section study was conducted among 404 prisoners selected using simple random sampling obtained from the prisoner’s registration book. To collect data from prisoners, an interviewer-based face-to-face data-collecting technique was used. Multivariate ordinal logistic regression was used to identify determinants of KAP toward COVID-19.
Results and Conclusions:
The majority of the prisoners had limited understanding and poor preventive strategies application toward COVID-19. Being male, living in a rural area, having a low educational standing, and being a farmer were related to limited knowledge, negative attitude, and poor practice toward COVID-19. Furthermore, having little understanding was linked with poor practice toward COVID-19. As a result, the focus should be on convicts, creating awareness, and addressing specific socioeconomic features of prisoners, as well as boosting COVID-19 preventive activities that should get attention in the prison.
From 2000 to 2008, election overload fatigued voters when the Zimbabwe government balloted citizens in six elections – an average of one election every fourteen months. The July 2013 election was also harmonised, ending the shaky MDC–Zanu PF coalition government. The election was preceded by a generally peaceful adoption of a new constitution on 16 March 2013. The constitution was a milestone achievement but a dead letter, stipulating that all security forces and government institutions, including the state media, must be impartial and that reforms on all freedoms must be implemented. However, as in the past, Zanu PF dragged its feet on the full implementation of critical reforms needed to improve the human rights environment and create conditions for democratic elections. Such pipe dream reforms included: police training; renouncing the use of violence; ensuring that the government fully and impartially enforced domestic laws in bringing all perpetrators of politically motivated violence to justice; freedom from harassment and intimidation; the respect for the rule of law; and full realisation of the rights to freedom of association and assembly, and the promotion of freedom of expression and communication.
This chapter examines the ways in which people with mental health conditions who also belong to other excluded groups may be particularly disadvantaged, in general and by mental health services. People with mental health conditions are at risk of social exclusion, but many from certain social identity groups are particularly at risk: for example, women, people from black and minority ethnic groups, and those from sexual minorities. In addition, certain groups of people are defined by their exclusion from society, such as refugees and asylum seekers, prisoners, and the homeless. The occurrence of mental health conditions in these groups is much higher than in the general population and they will often face barriers to accessing essential material resources and adequate healthcare. The presence of mental health conditions and group characteristics intersect to exacerbate the degree of exclusion experienced by the people in these groups. Some combinations may result in particularly profound states of deprivation and destitution. These severe and multiple forms of exclusion have been named ‘deep social exclusion’ or ‘people with multiple and complex needs’, two examples of which are seen in ‘multiple exclusion homelessness’ and people with multiple diagnoses.
“The Longest Day in Graignes,” recounts the three German assaults on the village on 11–12 June. The paratroopers rebuffed the numerically superior enemy, until they ran out of ammunition. The 17th SS Panzergrenadier Division also employed heavy guns, including artillery, against the village. The Germans damaged the twelfth-century Romanesque Church. Once they seized the center of the village, the SS troops proceeded to murder the village priest, Father Albert Le Blastier, and his aides for tending to wounded Americans. The Nazi troops terrorized other villagers. The Nazis also executed nineteen US prisoners, many of whom had been wounded in action. The length of the battle held the 17th SS Panzergrenadier Division back from its central mission, namely the recapture of the strategically vital port town of Carentan.
Malingering, the practice of feigning medical conditions for specific purposes, became a pressing concern for many practitioners of legal medicine following the introduction of conscription during the Revolutionary and Napoleonic Wars. A burgeoning medicolegal literature on malingering revealed that some doctors went to great lengths to detect and expose malingerers by using deceit, coercion, painful procedures, and altered states of consciousness as diagnostic tools. Doctors justified the far-reaching tactics used in adversarial contests with suspected malingerers in the name of the public good. Acting on behalf of the state to expose them, doctors engaged in adversarial relationships with suspected malingerers. These encounters also provided an impetus for debates about medical ethics; however, ethical concerns about doctors’ methods of detecting malingering were rarely raised and debated until the end of the nineteenth century.
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.
Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.
Objectives
In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.
Methods
Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.
Results
Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.
Conclusions
Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.
The campaign songs of Abraham Lincoln help to carry a working-class hero into the White House, while no songs are sung about his background as a wealthy corporate lawyer. Lincoln’s love of opera is only one further dimension to the music of the Civil War era; the sides are drawn in the popular music of the Union and the Confederacy, while the songs of the newly emancipated Black soldiers herald the turn of the tide toward Union victory. The Irish contribution is also charted musically, as are such contentious subjects as the New York Draft Riots and the fate of the war’s prisoners and its disabled veterans. The hope of emancipated Black Americans in the wake of Sherman’s March through Georgia is sung to the skies, before the assassination of Lincoln paves the way for Andrew Johnson and the betrayal of Reconstruction.
Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.
Aims
To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.
Method
We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.
Results
In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.
Conclusions
ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
Using recently published general population studies, this chapter updates an earlier Moran review on the epidemiology of ASPD. It examines the prevalence, comorbidity, psychosocial functioning, impact on health services and cultural differences of those with ASPD and, to a lesser extent, of those with psychopathy and on prisoners. It finds that the prevalence of ASPD ranges between 0.6% and 4.3% in men (which is significantly higher than in women). It has multiple comorbidities – both with other mental disorders (especially with substance misuse and affective disorder) together with other Cluster B PDs. Despite significant mental health and psychosocial impairment, those with ASPD rarely seek treatment for their disorder. There are marked cultural differences in the prevalence of ASPD with studies in the United States showing significantly higher rates than in Europe or in Asia. The prevalence of ASPD among prisoners is c. 55% among men and 31% among women with community prevalence rates for psychopathy ranging from 0.6% in the United Kingdom and 1.0% in the United States. Both ASPD and psychopathy have a positive association with both increased mortality and suicidality, suggesting that, together with their other impairments, they are a group that require mental health interventions.
There is growing interest in the relationship between head injury, offending and recidivism and in developments in the criminal justice and forensic health systems to assess and manage the impact of associated brain injury. This chapter summarises evidence indicating that the head injury is particularly prevalent in offenders, and that it is likely to be a causative factor that increases the risk of criminal behaviour. This is explained in relation to the neurobehavioural effects of head injury and characteristics of offenders with head injury, the impact of brain damage early in life and the high risk of multiple head injuries. The need to assess head injury at key points in the criminal justice system and means of doing so is given, together with a context of interventions, service need and directions for future research.
This paper examines the presence of lonely, isolated and impoverished older citizens in Japan's prison population, many of whom have turned to petty crime only recently and arguably lack a genuine need for corrective services. The paper offers empirical evidence drawn from a mixed-methods study that appears to confirm their compliant, ‘law-abiding’ attributes. It argues that their influx into prisons can be seen, at least in part, as citizens who are already socially excluded and stigmatised leveraging law to assert an additional risk-laden and stigmatised identity, which provides protection. The outcome is the subversion of prisons as de facto aged-care communities. This analysis resonates with an emerging body of literature that Chua and Engel (2018; 2019) have described as the ‘Identity’ school of legal-consciousness scholarship. This literature centres on empirical studies of marginalised cohorts who leverage legal structures to embrace an identity that complicates their stigma while providing desired protections.
Paraguay is a landlocked country in South America. It is a democratic low-middle-income nation, and the Ministry of Public Health and Social Welfare is responsible for its healthcare system. Mental health services receive just 1–2% of healthcare budgets, and there are only 1.6 psychiatrists per 100 000 inhabitants. There are insufficient resources to adequately assess and treat mental disorders in high-risk populations such as children, adolescents and prisoners. Despite several improvements to mental health policies within the past two decades, the nation still lacks a Mental Health Act and specific policies required to optimise the mental health of the population.