PREVALENCE OF MEDICAL CONDITIONS OF MALE INMATES WITHIN A COMMUNITY CORRECTIONS POPULATION

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1 PREVALENCE OF MEDICAL CONDITIONS OF MALE INMATES WITHIN A COMMUNITY CORRECTIONS POPULATION Presented by Jared A. Hough, PA-S Final Project for Completion Of Masters Degree in Physician Assistant Studies

2 Background At midyear 5 there were 2,186,2 prisoners. 87% were males Inmates with sentence of longer than 24 months have 7% likelihood to report a significant medical problem. Inmates greater than age 45 have appoximately a 45% chance to develop a chronic medical condition Large number of inmates being released yearly having received poor of no health care Potential for increased burden of the public health system Few inmates receive a balanced diet and adequate exercise 8% of inmate population have some form of impaired vision (double the general population). Poor oral health may lead to increased risk of vascular disease Estimated 438,486 inmates with either DM, HTN, or CAD. Rate of syphilis infections may be 11x greater in prison facilities. 62% of chlamydia infections go unrecognized Prevalence of AIDS is 5x greater than the general population Increased risk of acquiring TB or Hepatitis Aprroximatly 187, mentally inmates classified as mentally ill. Looked at the health status of male prisoners in the Washington County Corrections Hope to learn current and past state of health and make recommendations to improve access to this population.

3 Methods Data was collected at the Washington County Corrections in Hillsboro, Oregon. All participants were volunteers from the population First year students from the Pacific University Physician Assistant program administered the health questionnaires after completing an orientation to ensure that all interviews were conducted in the same manner. Interview stations were placed at an adequate distance to ensure privacy. An informed consent form was read and explained to each subject and then signed prior to the interview. There was no section of the form that contained identifiable information of the subjects. Upon completion of the interview the health history forms were given to the appropriate faculty member and taken to Pacific University for interpretation. Upon completion of the study all surveys were be destroyed.

4 Results Demographics (Figure 1) Health Poor/Fair Health Good/Excellent Other Ethnic Hispanic Health Status Ethnicity Age White/None Hispanic Age > 4 Age

5 Phys. Exam/BMI/Exercise (Figure 2) Sleep (Figure 3) Hours Per Night Abnormal Sleep Last Complete Phys. Exam BMI Phyical Activity Ideal < 2 Yrs. 2-5 Yrs. > 5 Yrs. > 5 Hrs./Wk. < 5 Hrs./Wk. Obese Overweight -5 Hrs. 6-8 Hrs. > 9 Hrs. Hyper/Hypsomnolence

6 HENMT (Figure 4) Head Ears Nose Mouth/Throat 5 GERD Bleeding Gums Allergies Hearing Difficulties Chronic HA Knocked Out

7 Vision (Figure 5) Dental Health (Figure 6) Last Complete Eye Exam Last Dental Visit Last Dental Cleaning 5 5 > 2 Yrs. Within 2 Yrs. Never 2-5 Yrs. Within 2 Yrs. 2-5 Yrs. > 5 Yrs. Never

8 Cardiopulmonary (Figure 7) Cardio Pulmonary - EKG/+Ashtma + Chest Pain/+ Hemoptysis + Tach/+ Prod. Cough + Murmur/- Breath. Difficulty - Cardiac Hx

9 Sexual Hx (Figure 8) STD's (Figure 9) Never Use Prosititute Unknown Known > 5 Condom Use Partners in Last Year Familiarity Age of Onset Chlamydia/Gonorrhea Herpes Syphillis 2 to Yrs. 5

10 Cancer Screening (Figure ) Communicable Diseases (Figure 11) Starting - Holding - Dribbling - Stream TSE Not Taught TSE Taught 8 7 Prostate/Urinary Difficulty Testicular Confirmed TB Screening CXR < 1 Yr. PPD < 1 Yr. TB Hepatitis HIV/AIDS

11 Mental Health (Figure 12) Mood Disorders Personality Disorders Suicide 15 5 Thoughts Schizophrenia Bipolar ADD/ADHD Anxiety Depression

12 Abuse (Figure 14) -15 Yrs. 5- Yrs. Before 5 Neighbor Sibling Age of Onset Offendor Type Parent Sexual Physical Mental 4

13 Discussion Interesting findings of this study: Subjects were in line with national averages of BMI. Is due to poor diet or lack of exercise and could it be improved upon with simple changes? Of the 29% of inmates who reported chronic headaches could it be solved with a simple eye exam of which 42% reported having not received in greater than 5 years or never. 34% of inmates reported bleeding gums while brushing, an early sign of gum disease. Would providing an oral cleaning and exam prevent this and possibly vascular disease in the future? Very few of the inmates were screened for communicable diseases such as Hepatitis and HIV/AIDS though most were screened for TB. Greater than ½ of the inmates had been instructed in the TSE. Greater than 6% reported sleep abnormalities, more than 4% reported depression or anxiety. Are there more with mood disorders that are undiagnosed? With the high incidence of abuse (substance, mental, physical, and sexual) very few had been offered or ever received counseling.

14 Limitations Number of volunteers (89) may not have been an adequate sample size. Had to assume the information we received was accurate as we had no way to verify it. The general nature of the questions of the health history survey made for broad assumptions on the investigators part. Limited time of the students to conduct the interviews due to other commitments in regards to academic careers.

15 Recommendations More detailed questionnaire to focus in the findings of the research especially in regards to cardiovascular health, specific drug use, and mental health. Look for greater correlation between abuse and all of the other variables. Look at putting together a cooperative team with the Pacific University College of Health Sciences, Washington County Public Health and Virginia Garcia to provide expanded health care to this population to include: Physical Exam by the Physician Assistant program Vision screening by the College of Optometry Dental cleaning by the Dental Science Program Counseling by the College of Professional Psychology

16 References Harrison, P. M., Beck, A. J. Prison and Jail Inmates at Midyear 5. Bureau of Justice Statistics; May 6, NCJ Maruschak, L. M., Beck, A. J. Medical Problems of Inmates, Bureau of Justice Statistics; January 1, NCJ Ditton, P. M. Mental Health and Treatment of Inmates and Probationers. Bureau of Justice Statistics; July 1999, NCJ Moynihan, P. J. The Role of Diet and Nutrition in the Etiology and Prevention of Oral Disease. Bulletin of the World Health Organization; September 5, 83(9). Amtmann, J. Physical Activity and Inmate Health. Corrections Compendium; November 1, Vol. 26, Issue 11. pp Magnitude and Causes of Visual Impairment. World Health Organization; Petersen, P. E., Bourgeois, D., Ogawa, H., Estupinan-Day, S., Ndiaye, C. The Global Burden of Oral Diseases and Risks to Oral Health. Bulletin of the World Health Organization; September 5, 83(9). Meurman, J. H., Sanz, M., Janket, S. Oral Health, Atherosclerosis, and Cardiovascular Disease. Crit Rev Oral Biol Med; 4, 15(6), pp Amar, S., Han, X. The Impact of Periodontal Infection on Systemic Diseases. Med Sci Monit; 3, 9(12), pp Maruschak, L. M. HIV in Prisons, 3. Bureau of Justice Statistics; September 5, NCJ Hornung, C. A., Greifinger, R. B., Gadre, S. A Projection Model of the Prevalence of Selected Chronic Diseases in the Inmate Population. National Commission on Correctional Health Care, 5. Kraut, J. R., Haddix, A. C., Carande-Kulis, V., Greifinger, R. B. Cost-Effectiveness of Routine Screening of Sexually Transmitted Diseases Among Inmates in United States Prisons and Jails. National Commission on Correctional Health Care, 5. Vasudev, N. S., Joffe, J. K., Cooke, C., Richards, F., Jones, W. G. Delay in the Diagnosis of Testicular Tumors-Changes Over the Past 18 Years. British Journal of General Practice; August 4, 54, pp Smith, R. A., Cokkinides, V., von Eschenbach, A. C., Levin, B., Cohen, C., Runowicz, C. D., Sener, S., Saslow, D., Eyre, H. American Cancer Society Guidelines for the Early Detection of Cancer. A Cancer Journal for Clinicians, June 6; http//caonline.amcancersoc.org/cgi/content/full/52/1/8. Anonymous. Survey Summary: Communicable Diseases. Corrections Compendium; October 2, 27(), pp. 8, 18 pgs. Strickland, T. Prison Bars Cannot Stop Disease. Corrections Today; August 2, 64(5), pg 8, 3 pgs. Beck, A., Maruschak, L. M. Hepatitis Testing and Treatment in State Prisons. Bureau of Justice Statistic; April 4, NCJ C. Varghese, B., Peterman, T. A. Cost Effectiveness of HIV Counseling and Testing in U.S. Prisons. National Commission on Correctional Health Care, 5. Taylor, Z., Nguyen, C. Cost-Effectiveness of Preventing Tuberculosis in Prison Populations. National Commission on Correctional Health Care, 5. Conklin, T. J. A Public Health Model of Care for Corrections. Corrections Today; October 4.