Strongyloidiasis in Allied ex-prisoners of war in south-east Asia

One hundred and sixty ex-servicemen who had been prisoners of war in south-east Asia during 1942-5 were investigated for infection with Strongyloides stercoralis. Larvae were found in 44 (27·5%) of the men, who had therefore been infected for 34-37 years. Direct microscopy of the faeces was the most successful diagnostic method, giving a positive result in 37 cases (84%); multiple examinations were often necessary. Faecal culture was positive in 30 cases (68%), but examination of duodenal fluid obtained with the string test gave a positive result in only 17 (39%). The mean blood eosinophil count and mean serum IgE concentration were higher in the infected men, though normal values were often found in individual cases. Clinical manifestations of isolated strongyloides infection were analysed by comparing the infected men with control groups of ex-prisoners in south-east Asia without proved strongyloidiasis and ex-prisoners in Europe. Twenty-nine infected men (66%) complained of non-specific urticaria, and 13 (30%) had pathognomonic larva currens. Gastrointestinal symptoms significantly more common in the infected group were diarrhoea, indigestion, lower abdominal pain, pruritus ani, and weight loss (p <0·05-p <0·0005).The study group was thought to be reasonably representative of Allied ex-servicemen imprisoned in south-east Asia during the second world war. Probably there are many thousands of infected persons in several countries. The worm has an unusual ability to multiply, and larvae may spread throughout the body in immunosuppressed subjects.     

Serum copper, zinc and selenium levels with regard to psychological stress in men.

Serum concentrations of copper (S-Cu), zinc (S-Zn) and selenium (S-Se) were measured in 34 apparently healthy male prisoners of war immediately on release from a detention camp, and 85 healthy male subjects of comparable age and body mass index who had not been in a war combat zone. The results expressed as median and range were: 1138 (877-1337) micrograms/L of S-Cu, 1087 (514-1260) micrograms/L of S-Zn and 53 (30-100) micrograms/L of S-Se in the former prisoners, and 1149 (869-1487) micrograms/L of S-Cu, 1131 (874-1351) micrograms/L of S-Zn and 65 (45-109) micrograms/L of S-Se in the reference subjects. Significantly lower S-Zn (p < 0.02) and S-Se (p < 10(-5)) were found in the former prisoners compared to the reference subjects, whereas no significant difference between the groups was found for S-Cu (p > 0.80). In the group of former prisoners, a significant positive correlation was found between the S-Zn and S-Se levels (r = 0.40, p < 0.05) and an inverse correlation between S-Zn and body mass index (r = -0.34, p < 0.05), whereas no significant correlation was found of S-Cu, S-Zn or S-Se with age (38 (19-54) years) or duration of imprisonment (130 (126-270) days). As the body mass index of 23.4 (19.7-28.1) kg/m2 and the body mass relative deviation from nomogram of 105 (89-125)% in the group of former prisoners showed no indication of malnutrition, lowered S-Zn and S-Se levels may be ascribed to increased psychological stress induced by conditions during imprisonment.     

Study of infection with HIV and related risk factors in young offenders' institution.

OBJECTIVES--To estimate the prevalence of infection with HIV in young offenders in Scotland and to obtain information about related risk factors and previous tests for HIV. DESIGN--Voluntary anonymous study with subjects giving saliva samples for testing for HIV and completing questionnaires about risk factors. SETTING--Polmont Young Offenders'' Institution near Falkirk, Scotland. SUBJECTS--421 of 424 available male prisoners in Polmont. The questionnaires of 17 of the prisoners were excluded because of inaccuracies. MAIN OUTCOME MEASURES--Prevalence of infection with HIV and related risk behaviour. RESULTS--68 (17%) of prisoners admitted misuse of intravenous drugs, of whom 17 (25%) admitted having injected drugs while in prison. Three subjects admitted having anal intercourse while in prison. Prevalence of misuse of intravenous drugs varied geographically: 28% (33/120) of prisoners from Glasgow compared with 9% (7/81) of those from Edinburgh and Fife. A high level of heterosexual activity was reported, with 36% (142/397) of prisoners claiming to have had six or more female sexual partners in the year before they were imprisoned. Altogether 8% (32/389) of prisoners had previously taken a personal test for HIV: 50% (9/18) of those who had started misusing intravenous drugs before 1989, 18% (9/49) of those who started misuse later, and only 4% (14/322) of those who had not misused intravenous drugs. No saliva sample tested positive for antibodies to HIV, but 96 prisoners requested a confidential personal test for HIV as a result of heightened awareness generated by the study. CONCLUSIONS--Voluntary, anonymous HIV surveys can achieve excellent compliance in prisons, and the interest generated by the study suggests that prisons may be suitable sites for providing education and drug rehabilitation for a young male population at high risk of future infection with HIV.     

Malaria and World War II: German malaria experiments 1939-45

The epidemiological and pharmacological fight against malaria and German malaria research during the Nazi dictatorship were completely under the spell of war. The Oberkommando des Heeres (German supreme command of the army) suffered the bitter experience of unexpected high losses caused by malaria especially at the Greek front (Metaxes line) but also in southern Russia and in the Ukraine. Hastily raised anti-malaria units tried to teach soldiers how to use the synthetic malaria drugs (Plasmochine, Atebrine) properly. Overdoses of these drugs were numerous during the first half of the war whereas in the second half it soon became clear that it would not be possible to support the army due to insufficient quantities of plasmochine and atebrine. During both running fights and troop withdrawals at all southern and southeastern fronts there was hardly any malaria prophylaxis or treatment. After war and captivity many soldiers returned home to endure heavy malaria attacks. In German industrial (Bayer, IG-Farben) and military malaria laboratories of the Heeres-Sanit?ts-Akademie (Army Medical Academy) the situation was characterised by a hasty search for proper dosages of anti-malaria drugs, adequate mechanical and chemical prophylaxis (Petroleum, DDT, and other insecticides) as well as an anti-malaria vaccine. Most importantly, large scale research for proper atebrine and plasmochine dosages was conducted in German concentration camps and mental homes. In Dachau Professor Claus Schilling tested synthetic malaria drugs and injected helpless prisoners with high and sometimes lethal doses. Since the 1920s he had been furiously looking for an anti-malaria vaccine in Italian mental homes and from 1939 he continued his experiments in Dachau. Similar experiments were also performed in Buchenwald and in a psychiatric clinic in Thuringia, where Professor Gerhard Rose tested malaria drugs with mentally ill Russian prisoners of war. Schilling was put to death for his criminal research in 1946, Rose was condemned to lifelong imprisonment in 1947, though, not for his malaria research but for his dreadful experiments with epidemic typhus sera which he also had performed in concentration camps and with prisoners of war in Russia.     

Parasitic Diseases as the Cause of Death of Prisoners of War during the Korean War (1950-1953)

To determine the cause of death of prisoners of war during the Korean War (1950-1953), death certificates or medical records were analyzed. Out of 7,614 deaths, 5,013 (65.8%) were due to infectious diseases. Although dysentery and tuberculosis were the most common infectious diseases, parasitic diseases had caused 14 deaths: paragonimiasis in 5, malaria in 3, amoebiasis in 2, intestinal parasitosis in 2, ascariasis in 1, and schistosomiasis in 1. These results showed that paragonimiasis, malaria, and amoebiasis were the most fatal parasitic diseases during the early 1950s in the Korean Peninsula. Since schistosomiasis is not endemic to Korea, it is likely that the infected private soldier moved from China or Japan to Korea.     

Humeral cross-sectional morphology from 18th century Quebec prisoners of war: Limits to activity reconstruction

This study uses measures of cross-sectional robusticity and asymmetry (based on humeral areal and inertial cross-sectional components) to test a prediction from bone remodeling theory that a physically active 18th century Quebec prisoner of war sample (N = 25) should have more robust and asymmetrical humeri than a nonphysically active 20th century New Mexico suburbanite sample (N = 27). Narrative accounts document that prisoners of war engaged in labor-intensive activities, and these activities were confirmed by observations of osteoarthritis and other pathologies. The suburbanite sample, for the most part, did not engage in such activities. The prisoners had higher levels of pathology than the suburbanites (e.g., 80% vs. 22% osteoarthritis; F = 17.95, P < 0.01). For robusticity, the populations did not differ significantly in total area, cortical area, moment areas of inertia about the mediolateral plane, or polar moment area of inertia. The Quebec prison sample did have significantly higher values for moment areas of inertia about the anteroposterior plane. For asymmetry, the populations did not differ in any values (total area, cortical area, moment areas of inertia about the mediolateral plane, moment areas of inertia about the anteroposterior plane, or polar moment of inertia). Thus, examinations of cross-sectional robusticity and asymmetry failed to conclusively confirm the hypothesis that intensive labor leads to changes in humeral morphology. Possible explanations for the lack of differences are discussed, such as poor diet impeding bone remodeling. Nevertheless, the one significant finding suggests that cross-sectional shape is more useful in reconstructing activity patterns than amount of bone in a cross section. Results from this study join those from other recent investigations to suggest that additional controls are required before cross-sectional differences may be confidently attributed to activity patterns.     

Drug injection and HIV prevalence in inmates of Glenochil prison.

OBJECTIVE--To determine prevalence of HIV infection and drug injecting behaviour among inmates of Glenochil Prison on a specified date a year after an outbreak of hepatitis B and HIV infection. DESIGN--Cross sectional: voluntary, anonymous HIV salivary antibody surveillance and linked self completion questionnaire on risk factors. SETTING--Glenochil prison, Scotland, a year after an outbreak of hepatitis B and HIV transmission related to drug injection. SUBJECTS--352 prisoners, of whom 295 (84%) took part; 284 questionnaires (96%) passed logical checks. MAIN OUTCOME MEASURES--HIV prevalence; proportion of all inmates who had ever injected drugs, had ever injected inside prison, had started injecting drugs while inside prison. RESULTS--More than half (150/284) the current inmates were also in Glenochil Prison during the critical period of January to June 1993, when hepatitis B and HIV were transmitted. Similar proportions of current inmates and men who were also in Glenochil during the critical period were drug users (27% (75/278) v 30% (44/149)). A quarter of injecting drug users (18/72) had first injected inside prison, irrespective of whether they were in Glenochil in January to June 1993 and regardless of the calendar period when they first injected. Significantly more inmates from Glasgow (41%; 56/138) than from Edinburgh (21%; 7/34) or elsewhere (11%; 12/106) were injecting drug users. On testing for HIV, seven saliva samples out of 293 gave positive results--four were presumed to be from inmates known to be infected with HIV, and the others from injecting drug users from Glasgow, all of whom had been in Glenochil during January to June 1993, when two of the three had injected drugs and had been tested for HIV, with negative results. The ratio of overall (2.4%) to disclosed (1.4%) HIV prevalence was 1.7. For men who had injected drugs in Glenochil during January to June 1993, HIV prevalence was estimated at 29%. CONCLUSION--Between a quarter and a third of prisoners who injected drugs in Glenochil in January to June 1993 were infected with HIV. There is widespread ongoing risk of bloodborne virus infection within prisons, which is probably long standing but demands urgent attention.     

Drug-Related Disorders and the Criminal and Clinical Background of the Prison Population of S?o Paulo State,Brazil

Objective

To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil.

Method

Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category.

Results

The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5).

Conclusion

The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison populations.     

Oral health behind bars: a study of oral disease and its impact on the life quality of an older prison population

Objective: The principal aims of this study were to report on the prevalence of oral disease and its impact on the life quality of older (aged 60 and above) prisoners at Hong Kong SAR's elderly detention centre, China. Design: A cross‐sectional epidemiological survey involving clinical oral examinations and face‐to‐face interviews with 64 older prisoners at the centre. Clinical oral examinations were carried out following WHO criteria. The impact of oral health on life quality was assessed using the 14‐item Oral Health Impact Profile measure, OHIP‐14 Results: The prevalence of oral disease was high, the mean DMFT was 22.5 (SD 10.6) and 40% (18) of the dentate prisoners had shallow or deep periodontal pockets. Most (75%, 48) were in need of prosthetic treatment. Over half the prisoners experienced one or more oral health impacts on life quality during the previous year. This was associated with socio‐demographic factors: employment status prior to incarceration (P<0.01), oral health behaviour: smoking habits (P<0.01) and clinical oral health status: DMFT (P<0.05) and prosthetic need (P<0.05). Conclusion: Among inmates at Hong Kong's elderly detention centre, the prevalence of oral disease was high and the impact of oral health on their life quality was substantial. The impact of oral health on the life quality of the older prisoners was associated with prisoners socio‐demographic background, oral health behaviour and oral health status.     

Point prevalence of mental disorder in unconvicted male prisoners in England and Wales.

OBJECTIVES: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. DESIGN: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. SETTING: Three young offenders'' institutions and 13 adult men''s prisons. SUBJECTS: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. MAIN OUTCOME MEASURES: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. RESULTS: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). CONCLUSIONS: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness.     

Molecular investigation into outbreak of HIV in a Scottish prison.

OBJECTIVES: To support already established epidemiological links between inmates of Glenochil prison positive for HIV infection by using molecular techniques and thus provide evidence of the extent of acquisition during a recent outbreak of the disease resulting from needle sharing. To identify possible sources of the outbreak, and to demonstrate the ability of the methodology to make further links beyond the original outbreak. DESIGN: Viral sequences obtained from the blood of HIV positive prisoners previously identified by standard epidemiological methods were compared with each other and with sequences from other Scottish patients. SETTING: Glenochil prison for men, central Scotland. SUBJECTS: Adult inmates and their possible contacts. RESULTS: Phylogenetic analysis of viral sequences in two different genomic regions showed that 13 of the 14 HIV positive prisoners had been infected from a common source. Previous research had shown that six of these had acquired their infection in Glenochil; molecular evidence suggests that more than double this number were infected while incarcerated. Virus from two long term HIV positive patients who were in the prison at the time of the outbreak but who were not identified in the original or subsequent surveys was sufficiently different to make it unlikely that they were the source. A viral sequence from heterosexual transmission from one inmate showed the ability of these techniques to follow the infection through different routes of infection. CONCLUSION: The number of prisoners infected with HIV during the 1993 outbreak within Glenochil prison was more than twice that previously shown. This shows the potential for the spread of bloodborne diseases within prisons by injecting drugs.     

The results of a joint project of the State Department of Ukraine on the Implementation of Punishments and UNAIDS to decrease the risk of the spread of HIV in the prisons of Ukraine

During the period of 1987-1999 altogether 7,800 cases of HIV infection were detected among the prisoners of the penitentiary institutions of the Ukraine. In 1997 the penitentiary system of the Ukraine abolished the mandatory testing and isolation of HIV-positive persons. In April 1998 the realization of measures aimed at reducing the spread of HIV infection started in the penitentiary system. The main trends in the activities aimed at the realization of the Project were information and educational work among prisoners both during investigative detention and after conviction, as well as among the personnel of penitentiary institutions; availability of condoms and disinfectants; ensuring the possibilities of voluntary testing for HIV, as well as pre- and post-test counselling.     

THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non‐therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military‐civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency.     

Substance use in remand prisoners: a consecutive case study.

OBJECTIVES: To determine the prevalence of drug and alcohol use among newly remanded prisoners, assess the effectiveness of prison reception screening, and examine the clinical management of substance misusers among remand prisoners. DESIGN: A consecutive case study of remand prisoners screened at reception for substance misuse and treatment needs and comparison of findings with those of prison reception screening and treatment provision. SETTING: A large adult male remand prison (Durham). SUBJECTS: 548 men aged 21 and over awaiting trial. MAIN OUTCOME MEASURES: Prevalence of substance misuse; treatment needs of substance misusers; effectiveness of prison reception screening for substance misuse; provision of detoxification programmes. RESULTS: Before remand 312 (57%) men were using illicit drugs and 181 (33%) met DSM-IV drug misuse or dependence criteria; 177 (32%) men met misuse or dependence criteria for alcohol. 391 (71%) men were judged to require help directed at their drug or alcohol use and 197 (36%) were judged to require a detoxification programme. The prison reception screen identified recent illicit drug use in 131 (24%) of 536 men and problem drinking in 103 (19%). Drug use was more likely to be identified by prison screening if an inmate was using multiple substances, using opiates, or had a diagnosis of abuse or dependence. 47 (9%) of 536 inmates were prescribed treatment to ease the symptoms of substance withdrawal. CONCLUSIONS: The prevalence of substance misuse in newly remanded prisoners is high. Prison reception health screening consistently underestimated drug and alcohol use. In many cases in which substance use is identified the quantities and numbers of different substances being used are underestimated. Initial management of inmates identified by prison screening as having problems with dependence producing substances is poor. Few receive a detoxification programme, so that many are left with the option of continuing to use drugs in prison or facing untreated withdrawal.     

Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison.

OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector inmates'' harm reduction needs.     

Prevalence of adult ADHD in an all-female prison unit

There is increasing evidence suggesting a link between ADHD and criminality, including a strong association between ADHD symptoms and the likelihood of being on probation or in prison. Most studies investigating the prevalence of ADHD in prison populations have focused on adult male offenders. In the current study, 69 female prisoners were screened for both childhood and adult ADHD symptoms using the Barkley Adult ADHD Rating Scale-IV. The results indicate that 41 % of the prisoners met the diagnostic criteria for ADHD in childhood and continued to meet criteria for ADHD as adults. More importantly, young female prisoners (aged 18–25) were significantly more likely to report symptoms of ADHD than older prisoners. Prisoners who reported symptoms of ADHD also reported high levels of impairment associated with these symptoms. A better understanding of the prevalence of ADHD in female prison units can highlight specific areas for intervention during rehabilitation, as well as the management of serious incidents within prison.     

Outbreak of HIV infection in a Scottish prison.

OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.     

High Tuberculosis Prevalence in a South African Prison: The Need for Routine Tuberculosis Screening

Background

Tuberculosis is a major health concern in prisons, particularly where HIV prevalence is high. Our objective was to determine the undiagnosed pulmonary tuberculosis (“undiagnosed tuberculosis”) prevalence in a representative sample of prisoners in a South African prison. In addition we investigated risk factors for undiagnosed tuberculosis, to explore if screening strategies could be targeted to high risk groups, and, the performance of screening tools for tuberculosis.

Methods and Findings

In this cross-sectional survey, male prisoners were screened for tuberculosis using symptoms, chest radiograph (CXR) and two spot sputum specimens for microscopy and culture. Anonymised HIV antibody testing was performed on urine specimens. The sensitivity, specificity and predictive values of symptoms and investigations were calculated, using Mycobacterium tuberculosis isolated on sputum culture as the gold standard.From September 2009 to October 2010, 1046 male prisoners were offered enrolment to the study. A total of 981 (93.8%) consented (median age was 32 years; interquartile range [IQR] 27–37 years) and were screened for tuberculosis. Among 968 not taking tuberculosis treatment and with sputum culture results, 34 (3.5%; 95% confidence interval [CI] 2.4–4.9%) were culture positive for Mycobacterium tuberculosis. HIV prevalence was 25.3% (242/957; 95% CI 22.6–28.2%). Positive HIV status (adjusted odds ratio [aOR] 2.0; 95% CI 1.0–4.2) and being an ex-smoker (aOR 2.6; 95% CI 1.2–5.9) were independently associated with undiagnosed tuberculosis. Compared to the gold standard of positive sputum culture, cough of any duration had a sensitivity of 35.3% and specificity of 79.6%. CXR was the most sensitive single screening modality (sensitivity 70.6%, specificity 92.2%). Adding CXR to cough of any duration gave a tool with sensitivity of 79.4% and specificity of 73.8%.

Conclusions

Undiagnosed tuberculosis and HIV prevalence was high in this prison, justifying routine screening for tuberculosis at entry into the prison, and intensified case finding among existing prisoners.     

Comparison of medical care in prison and in general practice.

The medical care of prisoners "declaring sick" to the medical officer and hospital officers in Bedford Prison was surveyed and compared with the medical care given to the medical officer''s patients in general practice. The consultation rate of prisoners was higher than that of patients in the practice. Part of this increase was because household remedies were not available to prisoners except through the prison medical service and part may also have been due to the stresses of life in prison. Few psychoactive drugs were prescribed in prison. The problems that prisoners presented reflected the problems of violence and poor hygiene in prison. Some problems that more commonly present in prison than in general practice may be related to stress.     

The electron microscopic observation of haustoria of Erysiphe graminis hordei

The fine structure of haustoria ofErysiphe graminis hordei was studied using samples fixed with 3 per cent KMnO₄ or 2 per cent OsO₄. The cell wall of the infected leaves of barley seedlings was extremely electron-dense around the penetration point of this fungus. This may be due to chemical change of components in cell wall by the enzymatic action of the fungus. The cell wall was invaginated towards the cytoplasm at the point of penetration and formed a sheath around the infection hypha. Unknown electron-dense substances were accumulated around the infection hypha outside the sheath. The haustorial cell wall was surrounded with encapsulation and distinguished clearly from the cytoplasm of epidermal cell. The cell wall of the haustorium was very thin and electron-transparent, when compared with that of conidia and hyphae. A septum with a septal pore was observed between the infection hypha and the haustorium. Besides the nucleus, mitochondria, endoplasmic reticula and the like, many kinds of vesicles and specific coiled membraneous structure were found in the haustorium. The origin and the function of the encapsulation remain obscure.

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Zusammenfassung Die Feinstruktur von Haustorien vonErysiphe graminis hordei war untersucht, indem Stücke mit 3 % KMnO₄ oder 2 % OsO₄ fixiert worden sind. Die Zellwand der infizierten Blätter der Gerstenkeimlinge war elektron-dicht um die Eindringungsstelle des Pilzes. Dies mag die Folge der chemischen Veränderung der Komponenten in der Zellwand durch die enzymatische Wirkung des Pilzes sein. Die Zellwand war an der Eindringungsstelle zum Zytoplasma gebogen und hat eine Hülle um die Infektionshyphe gebildet. Unbekannte, elektron-dichte Substanzen waren um die Infektionshyphe außerhalb der Hülle angesammelt. Die Haustorialzellwand war abgegrenzt und war vom Zytoplasma der Epidermalzelle unterscheidbar. Die Zellwand des Haustoriums war dünn und elektron-durchsichtig im Vergleich mit denen der Konidien und Hyphen. Ein Septum mit einer Septalpore war zwischen der Infektionshyphe und dem Haustorium beobachtet. Neben dem Nucleus, Mitochondrien, endoplasmatischen Netz sind mancherlei Blister, spezifische, eingerollte Membranstruktur im Haustorium gefunden worden. Die Herkunft und die Funktion dieser Strukturen blieb ungeklärt.

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Contribution No. 232