The health of detainees in Italy. The results of a multi-centric study
As a result of recent legislation on prisons, issued to address the serious problem of overcrowding in a decade characterized by profound regulatory changes, the first chapter analyzes in detail the recent international scientific studies we conducted on the prison population, and Italian.
In the second chapter it describes the study protocol adopted and the information collected through the computerized tool purpose-built for detecting. Added to this is the accurate description of the enrolled population. Altogether, about 17,086 adult inmates surveyed at the index date of 3 February 2014, surveyed 15,751 people, for a total coverage of 92.2% of the sample. The prison population, as is known, is composed primarily of men and even our cohort resulting represented for 94.2%. In agreement with previous studies, confirms the young average age of this population, which happens to be 39.6 years, with the age group between 30 and 49 years including about 60% of the total of detainees. The foreign nationality constitutes 46.3% of the sample, albeit with considerable di erences depending on the region concerned. The North African and East European population remain the most represented.
The third chapter starts with an analysis of the main risk factors involved in many chronic diseases, such as smoking and body mass index, as well as taking into account the problem of physical inactivity, of course obliged, within the detention facilities. The prevalence of smoking among prisoners is higher than 70%, considerably higher than that recorded in the general population, and the average number of cigarettes smoked per day is about 18. Also with regard to the body weight is detected slightly higher value of obese people among the detainees (+ 3%) compared to that observed in the free population. Once you described the main risk factors section in Ronta the issue of health before making a distinction between people who are at least ette from a pathological condition, although not serious, and those who are in the absence of any disturbance. The first group, which represents 67.5% of visited detainees, shows considerable di erences depending on the region concerned, the age group and nationality of the detainee. This is followed by a breakdown by large group of diseases codi ed according to the system of international classes cation of diseases - 9th revision - Clinical modi, which shows the importance that cover, in the prison population, mental disorders, diseases infectious and those of the digestive system. In addition to the diagnosis of disease, an analysis was conducted on the drugs prescribed in prisons. In this case, the data show that 52.7% of inmates enrolled in the study had at least one drug during our survey, rising to 78% if we consider people turned out to ette at least a pathological condition.
The fourth chapter discusses the group's use of disease within prisons: mental disorders. This evidence has been known for decades as part scienti c and has been widely confirmed in our work. Over 40% of the enrolled detainees was found to be a pound of at least one psychiatric disorder, with considerable di erences depending on the region concerned. The most frequently diagnosed mental disorder has been linked to substance dependence, which affected more than 57% of the total participants in ounces from at least one mental disorder. Later, they were taken into account also the other types of mental disorder, bringing the di erence in prevalence related to gender, age and ethnic group. It conducted an analysis on prescribed psychotropic drugs such as anxiolytics, antipsychotics, antiepileptics, antidepressants, sedative-hypnotics and drugs for the treatment of addictions. Particular attention was paid to the use of some pharmacological groups (benzodiazepines and drugs for the treatment of addictions) in inmates with mental disorders from substance dependence, because of the possible side-and ounces related to polypharmacy in these subjects.
In the fifth chapter analyzes trends in the prison population of gastrointestinal diseases, which rank second, after psychiatric disorders, most commonly diagnosed encountered, in icting 14.5% of all persons subjected to visit . It points out that about 40% of the disturbances of this large group of diseases is made up of the diseases of the teeth and oral cavity, historically extremely use within prison facilities because of the scant attention paid to oral hygiene by inmates and lifestyles incorrect (taking drugs and habit of smoking and alcohol), and 37.5% is represented by esophagitis, gastritis and gastro-duodenal ulcers, often related to stress, an unbalanced diet, smoking, alcohol and even excessive use of certain medications, such as anti-in ammatori non steroidal.
The sixth chapter deals with the infectious and parasitic diseases, affecting 11.5% of all prisoners subjected to visit, confirming that a group of high-prevalence disorders in the prison population. In particular, hepatitis C is the most infectious disease of uses within the prison facilities the participants in our study, with a prevalence of 7.4%, followed by hepatitis B and AIDS which affect, both, 2% of enrolled ; appear to be less frequent, however, diseases such as tuberculosis and lide, which inflict respectively 0.6% and 0.5% of the total of detainees. For all these diseases the distribution erences were analyzed with respect to gender, age group and nationality, the association with the possible presence of the disorder to substance dependence and, in it, the respective drug treatment, namely the use in prisons of anti-hepatitis drugs, anti-retroviral and anti-tubercular.
In the seventh chapter we consider other chronic diseases, such as those of the circulatory system, the respiratory system and the endocrine and metabolism, all diseases which are often associated with raging.
Altogether, these morbid conditions turn out to be less than use in the prison population than in the general population, because of the young age found in the detainees. However, there was a prevalence quite high, for an essentially young population like the one held, for diseases such as hypertension (7% of the enrolled), dyslipidemia (3.7%) and diabetes mellitus type II (3.1 %). This phenomenon, coupled with the fact that some risk factors for chronic diseases (habit of tobacco smoking, sedentary lifestyle and unbalanced diet) are extremely frequent in the prison population, warns the real risk of being, in the very near future, with a great deal of chronic conditions within detention facilities.
In the eighth chapter in Ronta the theme of suicide risk in prisons that now represents a genuine emergency health, so much so that in 2007 the World Health Organization has produced a speci c reports in which the main factors were presented risk and possible actions to be activated to combat the phenomenon. In our study, in addition to detecting information regarding the attempts of suicide and self-harm acts made in the last year of detention, he was and ETTU screening speci c availing ourselves of a tool widely used in this area (of Blaauw scale) . Screening, which included the implementation of a speci c protocol of multidisciplinary activities, was activated on all detainees "by the new freedom" joints with or without previous imprisonment, which accessed in 6 detention facilities (one per participating region) characterized by 'high number of external inputs. About 53% of new recruits arrived and evaluated for suicide risk was positive: especially women showed a higher risk (77% of them tested positive) while, regardless of nationality, the population at greatest risk was be that Italian with 62% of new joints positive results. About 44% of the positive inmates at Blaauw scale has at least one disease and 56% of diagnoses detected in these subjects was represented by mental disorders, especially from substance dependence disorder.
The ninth chapter examines the state of health of people who log on for the first time in prison, taking into account the first access visits carried out on the subjects who for the first time came into the detention and about which the prison environment variable could not He has played a role on the possible disease condition. Despite the small number of the sample (N = 41), the results were quite interesting and showed that the new joints are on average younger than the prison population (35.4 years vs. 39.6 years), the most of Italian nationality and have less habit to tobacco smoke, so as to record a smoking prevalence of 59.3%, compared to that of 71% of the prison population enrolled in our study. As regards the conditions of health, only 23.6% of people were found to ette from at least one disease, compared to the value of 67.5% detected in the inmates of the cohort. To take the lion's share even mental disorders, with approximately 56% of total diagnosis of the disease found represented, mainly, by neurotic disorders or substance dependence.
In the tenth chapter we discuss the results obtained on the detained juvenile population. In our study we were involved 6 detention facilities for minors, for a total of 86 juvenile detainees (65% boys and 35% girls). The average age of this population is about 17 years and the most represented ethnic group is the one coming from Eastern Europe (about 45%, with a percentage that s now 80% as regards the females). The educational level was found to be very low, with 20% of boys who did not achieve any degree, suggesting that most of these guys eludes society's control, often living in a serious state of neglect not only familiar but also institutional. About 40% of the total of children enrolled had at least a disease, especially were found to be the most frequent psychiatric disorders, involving 18.6% of juvenile prisoners. To underline how real markets are 10 gestures self-harm and suicide attempts in this second group of people, a phenomenon that highlights the need to take action, even more than in the adult prison population, with actions to promote the social rehabilitation of these subjects.
It should be noted, in them, and in-depth chapters of large groups of (mental disorders diseases, gastrointestinal diseases, infectious and parasitic diseases, circulatory system diseases, endocrine and metabolic diseases, respiratory diseases) are reported tables for each participating region to the study, of the prevalence of these diseases in inmates, the distribution of the diagnosis and the prescription of drugs associated with them.
Source: Regional Health Agency of Tuscany. Italy