1,721,081 research outputs found
Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysis
No full textBackground and objectives: imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population.Methods: we systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group.Findings: a total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes.Conclusion: imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended.Prospero registration number: CRD42014009690.</p
The health needs of imprisoned female juvenile offenders: the views of the young women prisoners and youth justice professionals
No full textLittle is known about the health needs of detained juvenile females, yet there is emerging concern regarding substance misuse, mental health problems, poor sexual health and poorer general physical health on a range of indicators. This study sought to identify health needs from the perspective of imprisoned young women themselves and key professionals working with them to inform healthcare provision. We conducted semi-structured interviews and focus groups with detained juvenile women and adult professionals in four specialist female young offender institutions. The study presents new qualitative findings on the profound impact of social exclusion and multiple forms of abuse and victimisation on the health of juvenile women prisoners. Concerns regarding substance misuse, mental health problems, self-harm and poor sexual health are reinforced by this study. Young women tended to focus on their immediate health needs in contrast to the professionals who emphasised longer-term issues. The study identified the need for priority interventions in relation to mental health, substance misuse, self-harm and sexual health and tentatively suggests that 'compensatory care' may offer some scope to redress health inequalities experienced by these young women.</p
Oxford graduates' perceptions of a global health master's degree: a case study
No full textIntroduction: low and middle-income countries suffer an ongoing deficit of trained public health workers, yet optimizing postgraduate education to best address these training needs remains a challenge. Much international public health education literature has focused on global capacity building and/or the description of innovative programmes, but less on quality and appropriateness.Case description: the MSc in Global Health Science at the University of Oxford is a relatively new, full-time one year master's degree in international public health. The programme is intended for individuals with significant evidence of commitment to health in low and middle income countries. The intake is small, with only about 25 students each year, but they are from diverse professional and geographical backgrounds. Given the diversity of their backgrounds, we wanted to determine the extent to which student background influenced their perceptions of the quality of their learning experience and their learning outcomes. We conducted virtual or face-to-face semi-structured individual interviews with students who had graduated from the course at least one year previously. Of the 2005 to 2007 intake years, 52 of 63 graduates (83%) were interviewed. We used thematic analysis to analyze the data, then linked results to student characteristics.Discussion: the findings from the evaluation suggested that all MSc GHS graduates who spoke with us, irrespective of background, appreciated the curriculum structure drawing on the strengths of a small, diverse student group, and the contribution the programme had made to their breadth of understanding and their careers. This evaluation also demonstrated the feasibility of an educational evaluation conducted several years after programme completion and when graduates were 'in the field'. This is important in ensuring international public health programmes are relevant to the day-to-day work of public health practitioners and researchers in low and middle-income countries.Conclusions: feedback from students, when they had either resumed their positions 'in the field' or pursued further training, was useful in identifying valuable and positive aspects of the programme and also in identifying areas for further action and development by the programme's management and by individual teaching staff.</p
Assessing the health of women in prison: a study from the United Kingdom
No full textThe number of women imprisoned in the United Kingdom is rising rapidly, but there is little research on their health and well-being. We could find no studies in which the researchers had used measures of subjective health status to gain a picture of the health of imprisoned women. This self-completed questionnaire study aimed to explore the usefulness of the Short Form 36 (SF-36) in a general female prison population. The scores of imprisoned women for all but 3 of the 8 dimensions were significantly lower than those for women in the social class with the worst health in the United Kingdom, confirming the very poor mental and physical health of this population.</p
Immunisation coverage in rural-urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis
No full textBackground: the majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural-urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural-urban migrant (RUM) children being less likely to be immunised.Objectives: to examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children.Methods: a multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis.Results: eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates.Conclusions: this review indicates that there is an association between rural-urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.</p
Delivering primary care in prison: the need to improve health information
No full textBackground: electronic patient records and access to electronic information resources are the cornerstones of delivery of modern primary care, and they will be necessary to deliver effective evidence-based patient care, provide needs-driven health care, assist research and improve quality of services. However, prison health needs assessments carried out in the South East region suggested that modern information technology was lacking in prison primary care. This is despite the fact that the principle of 'equivalence of care' has been guiding the recent prison healthcare reforms in response to concerns about quality of prison healthcare services.Methods: we visited all four male adult prisons in the Thames Valley area and conducted one-to-one semi-structured interviews with healthcare staff to investigate the information available to them, the quality and uses of the data, and their current information systems. We also ran a workshop with prison healthcare managers and other healthcare staff from prisons in the Thames Valley area.Results: primary care staff in prisons record almost all clinical data on paper and do not have access to electronic clinical records nor to the internet. The main perceived barriers to implementing health information technology in prisons were concerns about potential breaches of security and discipline in prisons, anxiety about data security and a culture that gives low priority to health in prisons.Conclusions: to provide 'equivalence of care' for prisoners, primary care trusts need to implement full electronic clinical records in prisons and ensure staff have access to resources on the internet.</p
Changes in health-related quality of life following imprisonment in 92 women in England: a three month follow-up study
No full textBackground: despite the considerable changes in the provision of health care to prisoners in the UK there is little published literature that attempts to examine broader aspects of health and the impact of imprisonment on these, focusing instead on disease specific areas. This is surprising given that one of the main drivers behind the changes was the need for improvements in the quality of care; examining changes in health outcomes should be an important part of monitoring service developments. This study assessed the health-related quality of life of women on entry into prison and examined changes during a period of three months imprisonment.Methods: this was a prospective longitudinal study involving 505 women prisoners in England. The SF-36 was contained within a questionnaire designed to examine many aspects of imprisoned women's health. Participants completed this questionnaire within 72 hours of entering prison. The researchers followed up all participants who were still imprisoned three months later.Results: the study achieved good response rates: 82% of women agreed to participate initially (n = 505), and 93% of those still imprisoned participating three months later (n = 112). At prison entry, women prisoners have lower mental component summary score (MCS) and physical component summary score (PCS) compared to women within the general population. The mental well-being of those 112 women still imprisoned after three months improved over this period of imprisonment, although remained poorer than that of the general population. The PCS did not improve significantly and remained significantly lower than that of the general population. Multivariate analyses showed that the only independent predictor of change in component score was the score at baseline.Conclusions: the results highlight the poor health-related quality of life of women prisoners and highlight the scale of the challenge faced by those providing health care to prisoners. They also draw attention to the major health disadvantages of women offenders compared to women in general. While recent reforms may improve health services for prisoners, broader inequalities in the health of women are a more complex challenge.</p
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