Soins en prison (prise en charge de l'hépatite C)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Polyconsommation chez les détenus sous traitement de substitution aux opiacés

Nous avons réalisé chez les patients en demande d'un traitement de substitution aux opiacés arrivant en incarcération à la maison d'arrêt de Villeneuve-lès-Maguelone un dépistage urinaire de toxiques à l'entrée et à trois mois. L'objectif était d'avoir une vision globale des habitudes consommation de cette population et de voir si une évolution serait observée sous traitement suivi pendant trois mois à l'UCSA de VLM. L'étude inclut soixante-sept patients. On observe qu'à l'entrée, la polyconsommation est quasiment la règle, particulièrement représentée par le cannabis et les BZD. La cocaïne est consommée en moindre proportion mais sa consommation dépasse tout de même largement celle de la population générale. On observe à trois mois une diminution globale de la polyconsommation concernant notamment le cannabis et la cocaïne. Cependant un phénomène nouveau est mis en évidence : la consommation de BZD augmente et on observe un mésusage exacerbé concernant cette substance. Les patients recevant une prescription de BZD sont nombreux à ne pas consommer ce produit, en revanche les patients ne bénéficiant pas de prescription de BZD sont souvent consommateurs. Cela fait poser la question de l'observance des TSO, la prise en charge sociale et psychothérapique est-elle bien suivie? On peut se demander si le recrutement des patients incarcérés n'est pas un biais pour cette étude (sevrage forcé ), d'autant que l'anxiété liée à l'incarcération influe sur leurs habitudes de consommation. Comment pourrait-on optimiser les TSO ?MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Teledentistry, new oral care tool for prisoners

International audienceIn France, all incarcerated prisoners are required to undergo a dental examination (Ministère de la santé et de la protection sociale, 2004 and Ministère de la justice, 2004). However, only one in two prisoners benefits from this oral health check-up. Oral teleconsultation could improve the quality of oral care in prisons. The paper aims to discuss these issues. Design/methodology/approach The focus of this study was therefore to apply oral teleconsultation as an experiment. Using an oral teleconsultation system, a dentist and a nurse were separately asked to give patients a score, according to how urgently their dental issue needed to be treated. This score will henceforth be referred to as the "dental emergency scores given". Findings The separate dental emergency scores given by the dentist and the nurse were compared and the results demonstrate the following: - 36.7 per cent (11) of the two scores were equal - 53.3 per cent (16) of the two scores differed by 1 point - 10 per cent (3) of the two scores differed by 2 points. The average score of the nurse was 2.23 and that of the dentist was 2.13. The small disparity should not obscure the fact that 63 per cent of the diagnoses turned out to be incorrect. Practical implications Dental care could easily be improved with oral teleconsultation as a care plan could be developed for each patient. Social implications The condition of one's dental health is, of course, very important for general health, but it also affects social aspects. Good oral hygiene and health are very important when looking for a job after having been released from prison. Originality/value This is the first study on oral teleconsultation in prisons. Dental care is rarely studied on prisoners. Telemedicine in dentistry is just beginning all over the world. This study is the first step of an extensive project in the University Hospital of Montpellier and the Villeneuve-les-Maguelone prison

Applications of teledentistry in a French inmate population: A one-year observational study

International audienceTeledentistry oral examination protocol was evaluated for one year at the Villeneuve-lès-Maguelone Correctional Facility. The aim of the study was to simplify the obligatory dental consultation protocol at the entrance visit for new detainees. 1051 detainees were enrolled and 651 of them (58.9%) accepted an oral examination by teledentistry throughout the entire year of 2018. Only 1 inmate did not need treatment and 88.06% of those who have been examined had at least one untreated cavitated carious lesion. Forty-four percent of people who received a teledentistry check-up were referred to a dentist with a dental emergency. The use of teledentistry at the entry visit in a detention facility may facilitate the oral health screening without wasting the dentist’s time, and may allow an optimization of the inmate’s oral healthcare

Factors of Interest in Extended-Release Buprenorphine: Comparisons Between Incarcerated and Non-Incarcerated Patients with Opioid Use Disorder

International audiencePurpose: Extended-release buprenorphine (XR-BUP) covers a range of formulations of buprenorphine-based treatments for opioid use disorder (OUD) that release the medication over a period of one week, one month, or six months. OUD is particularly prevalent among incarcerated populations, and previous findings have shown that incarcerated subjects were not less interested in XR-BUP than non-incarcerated subjects. However, no study has ever investigated whether the factors of interest in XR-BUP were similar in incarcerated and non-incarcerated populations.Patients and methods: We carried out post-hoc analyses using data from the "AMBRE" survey, which was conducted among 366 individuals with OUD, that were recruited in 68 French addiction settings, including six prison medical centers. The reasons for interest in XR-BUP were compared between incarcerated and non-incarcerated interviewees, using logistic regressions models, which provided raw and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Adjustment variables were gender, age category, level of education, and type of current medication for OUD, respectively.Results: Data from 317 participants (ie, 221 non-incarcerated, and 96 incarcerated individuals) were included in the analyses. Adjusted comparisons found that "no longer taking a daily treatment" (aOR= 2.91; 95% CI= 1.21-6.98) and "having a more discreet medication" (aOR= 1.76; 95% CI= 1.01-3.10) were reasons that appealed more to incarcerated participants than to non-incarcerated ones. On the other hand, the potential reduction of withdrawal symptoms (aOR= 0.54; 95% CI= 0.29-0.99) or the risk of misuse (aOR= 0.56; 95% CI= 0.34-0.94) associated with XR-BUP treatment were considered more important by non-incarcerated individuals than by incarcerated ones.Conclusion: Incarcerated interviewees were interested in XR-BUP for different reasons than those outside prison. In particular, incarcerated patients were more interested in practicability and discretion features, and less in improving recovery or reducing misuse than non-incarcerated patients

Determinants of interest in extended-released buprenorphine: A survey among 366 French patients treated with buprenorphine or methadone

International audienceAim: To explore the factors determining the interest in extended-release buprenorphine (XR-BUP) injections among patients receiving opioid agonist treatment (OAT) in France.Methods: 366 patients receiving OAT for opioid use disorder, recruited in 66 French centers, were interviewed from 12/2018 to 05/2019. A structured questionnaire assessed their interest in XR-BUP using a [1-10] Likert scale. 'More' vs. 'less' interested groups were defined using the median score of interest, and their characteristics were explored using adjusted odds ratios (aORs) and 95 % confidence interval (95 %CI). Independent variables were as follows: sociodemographic characteristics, OAT-related features (e.g., type of OAT and prescriber, dosing, or duration of treatment), OAT representations, and personal objectives of treatment.Results: The median interest in XR-BUP was 7 (interquartile range: 3-9) out of 10. The participants who were 'more interested' (i.e. those scoring ≥7) showed no substantial difference in sociodemographic characteristics, relative to the 'less interested' participants. However, they more frequently reported forgetting to take their OAT (OR = 1.81; CI95 % = 1.06-3.10) or reported experiencing situations where taking their OAT was impractical (aOR = 1.69; CI95 % = 1.05-2.73). Their treatment objective was more focused on stopping illicit drugs (aOR = 1.67; 95 %CI = 1.02-2.70), reducing health risks (aOR = 3.57; 95 %CI = 1.67-7.69) and craving (aOR = 2.38; 95 %CI = 1.39-4.02) or improving family (aOR = 1.81; 95 %CI = 1.03-3.13) or professional (aOR = 2.22; 95 %CI = 1.43-3.85) recovery.Conclusions: In France, where the access to OAT is relatively unrestricted, the majority of participants were interested in XR-BUP formulations. Being interested was associated with treatment objectives focused on abstinence and recovery, and with experiencing constraints in taking a daily oral OAT

RISE-Vac-co-production of vaccine education materials with persons living in prison

Increasing vaccination knowledge is effective in addressing hesitancy and is particularly important in populations deprived of liberty who may not routinely have access to health information, ensuring health equity. RISE-Vac is a European Union–funded project aiming to promote vaccine literacy, offer, and uptake in prisons in Europe. We consulted persons living in prisons in the United Kingdom (through the Prisoner Policy Network), France, and Moldova to determine their vaccination knowledge gaps, the information they would like to receive, and how they would like to receive it. We received 344 responses: 224 from the United Kingdom, 70 from France, and 50 from Moldova. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their responses guided the development of educational materials, including a brochure that will be piloted in prisons in Europe. Persons with experience of imprisonment were involved at every stage of this project

Cancer-preventing vaccination programs in prison: promoting health equity in Europe

The most important human oncogenic viruses are hepatitis B virus (HBV) and human papillomavirus (HPV). The roll-out of vaccinations against HPV and HBV is a significant public health initiative with robust evidence of impact on the prevention of infection and neoplastic disease sequelae. Incarcerated individuals frequently have suboptimal immunisation levels for a wide variety of vaccine-preventable diseases, including HBV and HPV, and a high burden of disease for HBV/HPV-related cancers. In this Personal View, we analyse evidence regarding HBV and HPV vaccination in prison settings in 20 European countries and integrate it with existing scientific literature to discuss the rationale and possible strategies to expand cancer-preventing vaccination in prison populations. Enhancing HBV/HPV vaccination offer and uptake of HBV/HPV vaccination for this population would not only contribute to reducing the derived burden among the European population, but would also foster health equity and boost efforts towards the attainment of global and regional public health targets