Health and healthcare access among Zambia's female prisoners: a health systems analysis.

BackgroundResearch exploring the drivers of health outcomes of women who are in prison in low- and middle-income settings is largely absent. This study aimed to identify and examine the interaction between structural, organisational and relational factors influencing Zambian women prisoners' health and healthcare access.MethodsWe conducted in-depth interviews of 23 female prisoners across four prisons, as well as 21 prison officers and health care workers. The prisoners were selected in a multi-stage sampling design with a purposive selection of prisons followed by a random sampling of cells and of female inmates within cells. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems.ResultsWe identified compounding and generally negative effects on health and access to healthcare from three factors: i) systemic health resource shortfalls, ii) an implicit prioritization of male prisoners' health needs, and iii) chronic and unchecked patterns of both officer- and inmate-led victimisation. Specifically, women's access to health services was shaped by the interactions between lack of in-house clinics, privileged male prisoner access to limited transport options, and weak responsiveness by female officers to prisoner requests for healthcare. Further intensifying these interactions were prisoners' differential wealth and access to family support, and appointments of senior 'special stage' prisoners which enabled chronic victimisation of less wealthy or less powerful individuals.ConclusionsThis systems-oriented analysis revealed how Zambian women's prisoners' health and access to healthcare is influenced by weak resourcing for prisoner health, administrative biases, and a prevailing organisational and inmate culture. Findings highlight the urgent need for investment in structural improvements in health service availability but also interventions to reform the organisational culture which shapes officers' understanding and responsiveness to women prisoners' health needs

Elastic response of [111]-tunneling impurities

We study the dynamic response of a [111] quantum impurity, such as lithium or cyanide in alkali halides, with respect to an external field coupling to the elastic quadrupole moment. Because of the particular level structure of a eight-state system on a cubic site, the elastic response function shows a biexponential relaxation feature and a van Vleck type contribution with a resonance frequency that is twice the tunnel frequency $\Delta/\hbar$. This basically differs from the dielectric response that does not show relaxation. Moreover, we show that the elastic response of a [111] impurity cannot be reduced to that of a two-level system. In the experimental part, we report on recent sound velocity and internal friction measurements on KCl doped with cyanide at various concentrations. At low doping (45 ppm) we find the dynamics of a single [111] impurity, whereas at higher concentrations (4700 ppm) the elastic response rather indicates strongly correlated defects. Our theoretical model provides a good description of the temperature dependence of $\delta v/v$ and $Q^{-1}$ at low doping, in particular the relaxation peaks, the absolute values of the amplitude, and the resonant contributions. From our fits we obtain the value of the elastic deformation potential $\gamma_t=0.192$ eV.Comment: 19 pages, 5 figure

The challenge of modelling nitrogen management at the field scale : simulation and sensitivity analysis of N2O fluxes across nine experimental sites using DailyDayCent

Peer reviewedPublisher PD

Beyond behaviour as individual choice: a call to expand understandings around social science in health research

The focus of behavioural sciences in shaping behaviour of individuals and populations is well documented. Research and practice insights from behavioural sciences improve our understanding of how people make choices that in turn determine their health, and in turn the health of the population. However, we argue that an isolated focus on behaviour - which is one link in a chain from macro to the micro interventions - is not in sync with the public health approach which per force includes a multi-level interest. The exclusive focus on behaviour manipulation then becomes a temporary solution at best and facilitator of reproduction of harmful structures at worst. Several researchers and policymakers have begun integrating insights from behavioural economics and related disciplines that explain individual choice, for example, by the establishment of Behavioural Insight Teams, or nudge units to inform the design and implementation of public health programs. In order to comprehensively improve public health, we discuss the limitations of an exclusive focus on behaviour change for public health advancement and call for an explicit integration of broader structural and population-level contexts, processes and factors that shape the lives of individuals and groups, health systems and differential health outcomes

Soft Interaction Between Dissolved Dendrimers: Theory and Experiment

Using small-angle neutron scattering and liquid integral equation theory, we relate the structure factor of flexible dendrimers of 4th generation to their average shape. The shape is measured as a radial density profile of monomers belonging to a single dendrimer. From that, we derive an effective interaction of Gaussian form between pairs of dendrimers and compute the structure factor using the hypernetted chain approximation. Excellent agreement with the corresponding experimental results is obtained, without the use of adjustable parameters. The present analysis thus strongly supports the previous finding that flexible dendrimers of low generation present fluctuating structures akin to star polymers.Comment: 20 pages, 4 figures, submitted to Macromolecules on July 24, 200

Modelling spatial and inter-annual variations of nitrous oxide emissions from UK cropland and grasslands using DailyDayCent

This work contributes to the Defra funded projects AC0116: ‘Improving the nitrous oxide inventory’, and AC0114: ‘Data Synthesis, Management and Modelling’. Funding for this work was provided by the UK Department for Environment, Food and Rural Affairs (Defra) AC0116 and AC0114, the Department of Agriculture, Environment and Rural Affairs for Northern Ireland, the Scottish Government and the Welsh Government. Rothamsted Research receives strategic funding from the Biotechnology and Biological Sciences Research Council. This study also contributes to the projects: N-Circle (BB/N013484/1), U-GRASS (NE/M016900/1) and GREENHOUSE (NE/K002589/1).Peer reviewedPublisher PD

Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

Background: Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. Methods: We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 34 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. Results: A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. Conclusions: This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems and more comprehensive pre-service health education for prison officers