Search Results (198)

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11–1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50–2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58–0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project. Full article

Background/Objectives: Incarcerated people experience high rates of trauma, psychological distress, and social marginalization. Yoga has been introduced in prisons as a trauma-sensitive mind–body practice, yet its rehabilitative contribution remains uncertain. This systematic review aimed to synthesize evidence on the feasibility and effectiveness of yoga interventions delivered in correctional settings. Methods: Following PRISMA guidelines and a preregistered PROSPERO protocol, we searched PubMed, PsycINFO, Cochrane CENTRAL, and Scopus for peer-reviewed publications from May 2012 to November 2025. Eligible studies involved structured yoga interventions for incarcerated populations and reported psychological, behavioral, or institutional outcomes. Two reviewers independently performed screening, data extraction, and quality appraisal using the Mixed-Methods Appraisal Tool (MMAT). Results: Ten studies reported in twelve publications and involving 1815 incarcerated individuals met the inclusion criteria. Interventions included Hatha-based protocols, Krimyoga, trauma-informed approaches, and multicomponent programs. Across randomized, quasi-experimental, and pre–post designs, yoga was feasible and acceptable. Reported benefits included reduced psychological distress, negative affect, anger, and trauma-related symptoms, as well as improved mood, self-regulation, and mindfulness. Evidence specific to women and girls was limited, but the available trauma-informed and gender-responsive studies suggested potential reductions in post-traumatic stress, depression, and anxiety, alongside increases in self-compassion. One large quasi-experimental cohort found lower reincarceration rates among yoga participants, although institutional outcomes were otherwise limited. Evidence was constrained by small samples, heterogeneous intervention formats, short follow-up, and variable outcome measures. Conclusions: Yoga appears to be a promising adjunct to rehabilitation in correctional settings. However, methodological limitations prevent firm conclusions. Larger, well-controlled studies with standardized outcomes and longer follow-up are needed to clarify effectiveness and support integration into correctional health and rehabilitation policy. Full article

While most prison healthcare litigation seeks individual relief, some cases lead to broader structural reform via consent decrees—court-approved “legally binding performance improvement plans” designed to improve conditions. This study systematically analyzes 121 such settlements from 1970 to 2022 to assess their policy goals and implementation strategies. We identify the substantive areas targeted—general medical care, mental health, dental services, and treatment for specialized conditions like HIV, Hepatitis C, and COVID-19—and trace trends across time and geography. These agreements span 39 states and the federal system, with most states subject to multiple cases. They frequently mandate changes to budgets, staffing, facility infrastructure, training, and patient rights, alongside monitoring for quality improvement. Our findings suggest that consent decrees function not only as judicial remedies but as tools of policy development and institutional reform, shedding light on the role of courts in shaping correctional healthcare delivery. These findings also show how institutional responses to healthcare failures in prisons shape the conditions under which serious harm—and in some cases, preventable death—occur behind bars. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

People who are incarcerated experience a high rate of hepatitis C (HCV) worldwide, and HCV micro-elimination in prisons is an effective strategy to support treatment. In Victoria, British Columbia, administrative barriers limited HCV testing and treatment at Vancouver Island Correctional Centre (VIRCC), and people who were HCV RNA+ were lost to follow up. Cool Aid Community Health Centre (CACHC) is an inner-city, primary care clinic that serves a marginalized population. The CACHC HCV nurse coordinator with the VIRCC nurse held HCV testing ‘blitzes’ at VIRCC and offered phlebotomy for screening and pre-treatment bloodwork. Clients who tested HCV RNA+ were started on HCV treatment and if discharged before completion, CACHC followed them in the community. A retrospective chart review was conducted to identify all clients who accessed HCV testing and treatment through the VIRCC partnership. To date, 230 clients were tested: 49 tested HCV antibody+, 11 tested HCV RNA+, and 10 started on treatment (6 SVR). Case management and consultation with the nurse coordinator and VIRCC nurse supported treatment starts for an additional 18 clients (14 SVR). This pragmatic and innovative approach to HCV care with people who are incarcerated demonstrated effective HCV testing and treatment. CACHC and VIRCC have established closer relationships and reduced barriers to reach and maintain continuity with this target population. Full article

Objectives: This cross-sectional observational and epidemiological study aimed to collect data on the oral health conditions of the prison population in Rio de Janeiro, Brazil. Methods: The Penitentiary Moniz Sodré, part of the Penitentiary Complex of Bangu, houses 1385 male inmates of different nationalities. They were divided into groups according to age: Group 1, prisoners aged 18 to 27 years; Group 2, from 28 to 37 years; Group 3, from 38 to 47 years; and Group 4, from 48 and older. A survey was performed, and the Decayed, Missing, Filled Teeth (DMFT) index was applied. A statistical analysis was conducted, considering a p-value of less than 0.05 as significant. Then, multiple linear regression was implemented to verify correlations among the studied parameters, to adjust for confounders, and to examine predictors of DMFT scores. Results: The average age was 26.95 ± 6.72 years, with 57.7% smokers (n = 720) and 7.7% (n = 96) former smokers. Lung diseases were also relatively common (20.9%). The most frequently reported oral issue was bleeding on probing (37.7%, n = 470), with 100% presenting visible dental plaque and 71.3% dental calculus. Oral hygiene habits showed moderate adherence, with 20.1% brushing their teeth at least once daily and 20.3% flossing; however, only 10.3% reported using fluoride mouthwash. The average DMFT score progressively increased across age groups: Group 1 (age: 18–27): 6.89; Group 2 (age: 28–37): 10.87; Group 3 (age: 38–47): 16; and Group 4 (age ≥ 48): 22.5 (p < 0.0001). Decayed (D) teeth scores showed a moderate increase: Group 1: 2.94 ± 2.74; Group 2: 3.38 ± 2.65; Group 3: 3.11 ± 2.56; Group 4: 3.75 ± 3.1 (p = 0.0029). Missing (M) teeth scores demonstrated a significant increase with age, from 2.74 (±2.84) in group 1 to 18.12 (±7.71) in group 4 (p < 0.0001), whereas Filled (F) teeth scores were highest in group 3 (mean 1.92 ± 4.13), followed by a decline in the oldest group (mean 0.62 ± 1.18) (p < 0.0001). These findings indicate a strong age-related increase in the total DMFT score, primarily driven by the number of missing teeth. Conclusions: High levels of caries and its sequelae exist, demonstrating a correlation with age, as well as a low level of previous periodontal treatment or intervention. As the treatments performed did not manage to reduce the incidence of caries and periodontal diseases, a high number of extractions were observed in patients in confinement. Full article

Mental health problems are widespread in prison populations and can negatively affect inmates’ well-being. Although physical activity (PA) is known to benefit mental health in the general population, less is known about this relationship in correctional settings. This study examined the association between PA levels, symptoms of anxiety and depression, as well as coping strategies among 130 male prisoners at Prison No. 1 in Wroclaw, Poland. Data were collected using validated self-report tools: the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the Mini-COPE inventory. Inmates who met the criteria for Health-Enhancing Physical Activity (HEPA) reported fewer symptoms of anxiety and depression than less active participants. Individuals showing signs of mental health difficulties were also more likely to rely on avoidant coping strategies, though no clear link was found between coping style and activity level. Cluster analysis further supported the observed association between low PA and higher psychological distress. These findings suggest a potential role for PA in supporting mental health in prison settings. They also highlight the importance of identifying individuals who may be at risk due to maladaptive coping strategies. Given its exploratory nature, the study’s findings should be interpreted with caution and verified in future research with larger and more diverse samples. Full article

Mycobacterium tuberculosis (TB) antigen-based skin tests, known as TB-specific skin tests (TBSTs), have been recommended by the World Health Organization (WHO) to test for TB infection (TBI). In light of these new recommendations, we conducted a situational analysis and market assessment to evaluate the utility of testing for TBI in general and of the new TBSTs in South Africa. We found the following barriers to acceptability of testing for TBI overall, regardless of the test: the perceived high prevalence of TBI; prior experiences of poor TB preventive treatment (TPT) uptake, which has led to the removal of TBI tests from the current TPT guidelines; and a poor sensitivity of previous TBI tests in people living with HIV (PLHIV). In addition, further barriers to the new TBSTs in particular were as follows: patient level barriers linked to repeat visits; the need for cold chains; and the need for a strong laboratory system, which reduces the need for point-of-care options. TBI testing was thought to be potentially useful to determine the eligibility for TPT in these use cases: healthcare workers, pregnant women living with HIV and prisoners. One other use case was in the TB diagnoses of children, where it was thought that a positive immunological test (TST/IgRA/TBST) could indicate a TB contact and serve as a ‘rule in’ test to strengthen the evidence for TB disease as a cause. Full article

Background: Carbapenem-resistant Enterobacterales and difficult-to-treat resistance (DTR) Pseudomonas aeruginosa are a growing public health issue. Cefiderocol demonstrated activity against β-lactamase-producing Gram-negative bacteria (GNB). However, bone PharmacoKinetics (PK) data is lacking. Here, we report a case of post-traumatic chronic osteomyelitis caused by extensively drug-resistant (XDR) Pseudomonas aeruginosa which was successfully treated with cefiderocol. Moreover, we conducted a non-systematic review of the available literature. Case Report: We described the case of a 64-year-old man who was admitted to a traumatology ward after a work accident caused crushing of his left foot. Microbiological tests on intraoperative biopsies demonstrated XDR P. aeruginosa and K. oxytoca. Despite the administrations of different antibiotics regimens and multiple surgical revisions, the patient developed chronic osteomyelitis. To prevent amputation, cefiderocol was prescribed for six weeks, resulting in a complete clinical resolution of osteomyelitis. Review of the Literature: We performed a non-systematic review of the literature searching the public databases PubMed and Google Scholar. We identified nine case reports. In most patients (60%) the cause of osteomyelitis was post-surgical, and all the reported cases were healthcare associated. Osteomyelitis treatment required both antimicrobial therapy and surgery in all the cases described. Cefiderocol was often prescribed in association with other antibiotics (70%). Clinical cure was described in all the reported cases. Conclusions: This study highlights that cefiderocol is safe and efficacious to treat osteomyelitis caused by carbapenem-resistant GNB. However, evidence is limited to a few case reports. Full article

Occupational therapy (OT) advocates for rehabilitation and social reintegration within prison systems, yet its integration must consider the ethical and institutional constraints of incarceration. This paper critically examines the Spanish penitentiary system to explore the tensions between the punitive logic of imprisonment and the rehabilitative values of OT. The aim is to assess whether the current institutional structure enables socio-health professionals—particularly occupational therapists—to act coherently with their humanistic and ethical principles. A detailed documentary review was conducted using the Triangular Method of Ontologically Grounded Personalism (Sgreccia), which integrates biological/situational, anthropological, and ethical dimensions. Legislative documents, institutional reports, and academic literature were systematically analyzed to identify ethical challenges affecting professional practice within Spanish prisons. Findings reveal a paradoxical reality: Spain maintains one of the lowest crime rates in the EU yet exhibits a high incarceration rate, reflecting a punitive penal culture. The prison population, mostly adult males convicted of property and public health offenses, experiences significant occupational deprivation, mental illness, and social vulnerability. Ethical dilemmas include dual loyalty, loss of autonomy, and institutional priorities that undermine person-centered rehabilitation. The study underscores profound ethical tensions limiting OT practice in prisons. Addressing these challenges requires institutional and professional transformation toward more participatory and dignity-centered correctional models. Future research should incorporate empirical and qualitative approaches to design ethical frameworks that promote occupational justice and sustainable reintegration. Full article

Background/Objectives: The prison environment presents a unique context for examining the impact of addiction on physical and psychological functioning. Individuals with substance use disorders (SUDs) are overrepresented in correctional facilities and often experience greater emotional difficulties and impaired physical capacity. This study aimed to conduct a comparative analysis of psychological and functional profiles between addicted and non-addicted male inmates in a semi-open correctional facility. Methods: The study included 47 male prisoners (19 addicted, 28 non-addicted). Physical performance was assessed using the Countermovement Jump (CMJ), handgrip strength, the Functional Movement Screen (FMS), and the FitLight reaction time test. Psychological functioning was evaluated using six standardized questionnaires: problem-focused, emotion-focused, and avoidant coping strategies, depression (PHQ-9), perceived stress (PSS-10), and self-compassion (SCS). Results: No statistically significant differences (p > 0.05) were found between addicted and non-addicted inmates in physical performance parameters. Addicted individuals demonstrated slightly higher handgrip strength with lower variability, while non-addicted inmates showed slightly better lower-body power in the CMJ test. Functional movement quality and reaction speed were similar between groups. Psychological assessments also revealed no significant differences between the groups. Coping styles, depressive symptoms, perceived stress levels, and self-criticism scores were comparable in both populations. In the addicted group, deeper squats correlated with lower stress (rho = −0.46, p = 0.047), and better hurdle step performance correlated with emotion-focused coping (rho = 0.46, p = 0.048). Conclusions: Although no statistically significant differences were found between addicted and non-addicted male inmates in the assessed physical and psychological outcomes, the limited sample size and context-specific nature of this pilot study suggest that these findings should be viewed as preliminary and interpreted with caution. Nonetheless, the observed associations between physical performance and psychological variables indicate subtle interconnections between motor capacity, stress perception, and coping mechanisms that merit further investigation in larger, longitudinal studies. Full article

Objectives: Tobacco-related habits, including both smoked and smokeless forms, remain a public health concern among incarcerated populations, where stress, stigma, and limited healthcare access contribute to high prevalence rates. This cross-sectional study was conducted among inmates in a central prison in Navi Mumbai, India and aimed to evaluate tobacco-use patterns, cessation motivation, and oral health outcomes among prison inmates in Navi Mumbai. Methods: A total population sampling technique was employed, which included 3321 out of 3333 inmates with varying durations of incarceration. Data were collected using a novel TRACE (Tobacco Use, Risk Factors, Assessment, Cessation, and Effects through Epidemiology) framework, incorporating the MTSS (Motivation to Stop Scale) and clinical assessments using the DMFT (Decayed, Missing, and Filled Teeth) index and OHI-S (Oral Hygiene Index-Simplified). Statistical analysis was performed using SPSS version 21 to explore associations between tobacco use and oral health outcomes in this vulnerable population. Results: Tobacco use was reported by 53.1% of inmates, with 39.5% using smokeless forms. Dental caries affected 43% and periodontal disease 46.0% of participants, both significantly associated with tobacco use (p < 0.001). Oral mucosal lesions were observed in 2.6% of inmates. While 76.3% of tobacco users expressed willingness to quit, access to cessation support remained minimal. Conclusion: These findings underscore the need for targeted interventions, such as in-house tobacco cessation programs and oral health services, in correctional facilities. Integrating cessation counseling into prison healthcare policies could improve outcomes among incarcerated populations. Full article

The communities that develop in prison are often small, insular, and central to the experience of incarceration. In these carceral communities, the deaths of individuals—especially those integral to these groups—can echo heavily within a housing unit, and even an entire institution, resulting in a collective experience of grief. While grief is experienced universally, it manifests in unique ways in the carceral context. The shared sorrow, loss, and sadness characterizing the experiences of those left behind are central to this form of mourning, and among imprisoned communities, grief is experienced uniquely. This paper draws on semi-structured interviews with 58 men imprisoned during the COVID-19 pandemic in an institution where over a dozen men died in a relatively short time. Their experiences suggest that, while grieving in prison is often complicated and may be repressed by both the individual and the carceral institution, bereavement may take a different form when experienced collectively and broadly within the carceral context. We develop the concept of mass carceral grief to explain this phenomenon. While unique in many ways, the lessons on carceral grief from this public health crisis can inform our broader understanding of how loss impacts those incarcerated. Full article

Impulsivity and compulsivity are key transdiagnostic constructs implicated in addictive and criminal behaviors, often overlapping under the broader concept of behavioral dysregulation. While impulsivity has been widely assessed using experimental tasks and self-report measures, few tools specifically target compulsivity in forensic populations. This study aimed to adapt and validate the Spanish version of the Impulsive-Compulsive Behaviours Checklist (ICB) in a prison sample. The ICB was administered to 700 incarcerated men (mean age = 37.33 years) following a rigorous translation and back-translation procedure, along with pilot testing for clarity. Exploratory and confirmatory factor analyses revealed a stable two-factor structure consistent with theoretical expectations. Internal consistency was satisfactory (McDonald’s omega and Cronbach’s alpha = 0.79–0.80), and convergent validity was supported by significant correlations with the UPPS-P Impulsive Behavior Scale, the Obsessive Beliefs Questionnaire (OBQ-44), the European Addiction Severity Index (EuropASI), and the Symptom Checklist-90-Revised (SCL-90-R). These findings support the Spanish ICB as a valid and reliable tool for assessing impulsive and compulsive traits in forensic contexts. Its use may enhance the identification of differentiated clinical profiles and inform targeted interventions for mental health and reintegration in prison populations. Full article

Background/Objectives: Suicide in prison is a significant medico-legal and public health concern, with rates several times higher than in the general population. Vulnerability is heightened by psychiatric disorders, substance use, and custodial stressors such as isolation, overcrowding, and restricted healthcare access. This study examines custodial suicides to identify diagnostic complexities, systemic shortcomings, and possible prevention strategies, including technological innovations. Methods: We conducted a retrospective forensic investigation of sixteen confirmed custodial suicides between 2022 and 2024. Each underwent a standardized protocol comprising crime scene inspection, complete autopsy, histopathology, toxicology, and review of prison medical and psychiatric records. Data on suicide methods, psychiatric comorbidities, and substance use were analyzed. Results: Hanging was the predominant method (12/16), displaying classical forensic signs such as pale, oblique ligature marks and petechial hemorrhages. Four cases involved acute intoxication, often with non-prescribed drugs. Psychiatric disorders were identified in 14 cases, including major depressive disorder, bipolar disorder, and substance use disorder. Toxicological analyses revealed both prescribed and illicit substances, highlighting unauthorized exchanges within facilities. Autopsy findings consistently excluded homicide or natural causes, confirming the vitality of lesions and the mechanism of death. Conclusions: Custodial suicides are strongly associated with untreated or inadequately managed psychiatric conditions, compounded by restrictive prison environments. Comprehensive forensic autopsies are essential for accurate cause-of-death determination and institutional accountability. Preventive strategies should combine psychiatric care, architectural modifications to reduce ligature points, and ethical integration of AI-based surveillance for early detection of suicidal behavior. A multidisciplinary, rights-based approach is crucial to reduce suicide rates and safeguard the dignity and life of incarcerated individuals. Full article