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Preventing dropout (attrition) from clinical trials is vital for improving study validity. Dropout is particularly important in justice-involved populations as they can be very challenging to engage and recruit in the first instance. This study identifies factors associated with dropout in a double-blind, placebo-controlled randomised control trial of a selective serotonin reuptake inhibitor (SSRI) aimed at reducing reoffending in highly impulsive men with histories of violent offending. Age, education, social support, psychiatric history, and length of previous incarceration were identified as factors that predict attrition. These findings are consistent with previous research examining variables associated with attrition in clinical trials for community and offender populations. We also explored referral source and treatment allocation as attrition predictors. Although neither significantly predicted attrition, we identified that there are discernible differences in the median time to attrition among the referral source subgroups. Understanding factors that predict treatment completion and attrition will allow researchers to identify participants for whom additional provisions may optimise retention and inform development of targeted interventions., (© 2023. The Author(s).)

Although the poor health of prisoners poses a serious public health problem, very little is known about the health of specific offender groups. Three waves of an Australian Inmate Health Survey were used to describe the self-reported and objectively tested health of men incarcerated for sexual offences against children only (ISOC), adults only (ISOA), and against both (age-polymorphous; ISOP) compared to men incarcerated without sexual offences. ISOC and ISOP were found to have the poorest self-reported health of all groups, with higher rates of eyesight and cardiovascular problems; however, lower rates of Hepatitis B and Hepatitis C as objectively measured. There are important implications for the correctional and public health systems for addressing the health needs of specific offenders., Competing Interests: Declaration of competing interest No conflict of interests to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study investigates the experiences of victims of domestic violence (DV) involved in a bilateral electronic monitoring (EM) program. Semi-structured interviews were conducted with six victims whose associated person of interest participated in an EM program post-release, as well as 13 victim support staff. Thematic analysis revealed seven themes: (1) Safety and validation, (2) Initial anxiety, (3) Minimal intrusion on daily life, (4) Psychological relief and feelings of safety, (5) Freedom to engage in daily activities, (6) Post-EM concerns for safety, and (7) An effective deterrent for some, but not for all. Overall, the experiences reported by victims and support staff were positive and evident of victim-centricity. The main defining experience of the DVEM program for victims was improved feelings of safety during the program and increased autonomy and confidence in going about their daily activities. However, there is an urgent need to consider post-EM safety of victims.

Issues: We conducted a systematic review to examine whether smoking bans alone are effective in achieving smoking cessation in people released from prison, and patients discharged from mental health or substance use settings., Approach: We searched health, criminology and social science databases. Detailed search strings were used to combine terms related to smoking bans and cessation interventions in prison, mental health and substance use treatment settings. We used backward and forward snowballing and manual hand searching to find additional studies. Studies were included if they: were published between 1 January 2000 and 25 February 2022; included a complete smoking ban; measured people released from prison and/or mental health and/or substance use patients smoking post-release/discharge from a smoke-free facility; and reported smoking cessation intervention and/or smoking ban outcomes. Methodological quality was assessed using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies and reviewed by two authors., Key Findings: People released from prison, mental health and substance use in-patients who experience a smoking ban while incarcerated or in in-patient settings often relapse to smoking shortly after release or discharge. We found that although smoking bans alone do not promote cessation, multi-component interventions in combination with smoking bans can significantly increase cessation rates post-release/discharge provided they support participants during this time., Conclusions: There is limited evidence to suggest tobacco bans alone in prison, mental health and substance use treatment settings are effective in achieving long-term smoking cessation. This review suggests that combining smoking bans and cessation interventions including pre- and post-release/discharge support can be effective in achieving smoking cessation., (© 2022 Australasian Professional Society on Alcohol and other Drugs.)

Background and Objectives: The rapid increase in the number of older offenders in many countries presents unique challenges to both correctional and health care systems. In the absence of strong empirical evidence on effective interventions, identifying best practices can help optimize the care and management of this segment of the prisoner population., Research Design and Methods: We conducted a scoping review of care models, prison programs, and different interventions designed to improve the care and management of older offenders. We searched 5 bibliographic databases and other data sources including OpenGrey, agency documents, and government reports published until December 2020. This review employed commonly used steps for conducting a scoping review and applied additional tools to enhance the methodology., Results: After title and abstract screening and full-text review, a total of 34 studies were included in the analysis. Four themes emerged from the review: (a) institutional logics, (b) adaptations, (c) multidisciplinary teams, and (d) person-centered care and management., Discussion and Implications: Best practices identified in this review can help optimize the care and management of older offenders in mainstream prisons. Further action research is recommended to adapt and scale up the interventions., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Prisoner health surveys primarily rely on self-report data. However, it is unclear whether prisoners are reliable health survey respondents. This paper aimed to determine the level of agreement between self-report and biomedical tests for a number of chronic health conditions., Method: This study was a secondary analysis of existing data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey. The health surveys were cross-sectional in nature and included a stratified random sample of men (n=2,114) from all NSW prisons. Self-reported histories of hepatitis, sexually transmissible infections, and diabetes were compared to objective biomedical measures of these conditions., Results: Overall, the sensitivity (i.e., the respondents who self-reported having the condition also had markers indicative of the condition using biomedical tests) was high for hepatitis C (96%) and hepatitis B (83%), but low for all other assessed conditions (ranging from 9.1% for syphilis using RPR to 64% for diabetes). However, Kappa scores indicated substantial agreement only for hepatitis C. That is, there were false positives and false negatives which occurred outside of chance leading to poor agreement for all other assessed conditions., Conclusions: Prisoners may have been exposed to serious health conditions while failing to report a history of infection. It may be possible that prisoners do not get tested given the asymptomatic presentation of some conditions, were unaware of their health status, have limited health-service usage preventing the opportunity for detection, or are subject to forgetting or misunderstanding prior test results. These findings demonstrate the importance of the custodial environment in screening for health conditions and referral for treatment should this be needed. Testing on entry, periodically during incarceration, and prior to release is recommended., (© 2022. The Author(s).)

Objective: Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs)., Methods: Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State's re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality., Results: Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99])., Conclusion: Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide., (© 2021. The Author(s).)

Background: Cross-sectional and retrospective offence data are often used to classify sex offenders in epidemiological and survey research, but little empirical evidence exists regarding the practical implications of this for applied research. This study describes the classification of sex offenders from a cohort of prisoners recruited as part of an Australian inmate health survey and the implications for reporting results., Methods: Data-linkage was used to join the New South Wales (NSW) Inmate Health Surveys to the states re-offending database to identify men with histories of sexual offending. Sex offenders were classified into men who sexually offended against children only (ChildSOs), against adults only (AdultSOs), and men who sexually offended against both children and adults (Age-PolySOs)., Results: Using historical offending data rather than the current offence information only, an additional 35.4% of men with histories of sexual offences were identified. Differences were found between the three sex offender subgroups in terms of demographic characteristics, health, and criminal careers. Age-PolySOs reported higher educational attainment, were less likely to report being self-employed, single marital status, and having children. Half the ChildSOs self-reported a mental health issue and half of the ChildSOs and Age-PolySOs reported four or more chronic health conditions. Age-PolySOs were older than the other sex offender groups when committing their first non-sexual, non-violent crime (M = 43.2 years, SD = 13.8); violent crime (M = 39.5 years, SD = 11.1); and sexual crime (M = 47.8 years, SD = 11.2). Age-PolySOs also committed more sexual offences (M = 5.91, SD = 11.2) compared to those who only offended against one victim age group., Conclusion: These findings suggested that historical offending records should be used to more accurately identify sex offender subgroups and that differences in demographic, health, and criminal careers exist for the different sex offender subgroups.

Very little research has focused on men or prisoners as victims of sexual violence. This study provides the first population-based analysis of factors associated with sexual coercion of men in Australian prisons, and the first to use a computer-assisted telephone interview to collect this information in a prison setting. A random sample of men in New South Wales and Queensland prisons were surveyed using computer-assisted telephone interviewing. We asked participants about sexual coercion, defined as being forced or frightened into doing something sexually that was unwanted while in prison. Associations between sexual coercion in prison and sociodemographics, sexual coercion history outside of prison, and prison-related factors were examined. Logistic regression was used to estimate adjusted odds ratios in examining factors associated with sexual coercion in prisons. Of 2626 eligible men, 2000 participated. Participants identifying as non-heterosexual and those with a history of sexual coercion outside prison were found to be most at risk. Those in prison for the first time and those who had spent more than 5 years in prison ever were also more likely to report sexual coercion. Although prison policies and improving prison officer training may help address immediate safety and health concerns of those at risk, given the sensitivity of the issue and likely under-reporting to correctional staff, community-based organizations and prisoner peer-based groups arguably have a role too in providing both preventive and trauma-focused support.

A mixed funding approach can help meet the urgent requirement for a level of health care in prison commensurate with need and equivalent to community standards.

Background: Reliable ascertainment of intellectual disability (ID) is important to identify those with special needs, in order for those needs to be met in the criminal justice system. Although the Hayes Ability Screening Index (HASI) is valid and widely used for the identification of possible ID, the risk of inter-rater bias between researchers when scoring the HASI has not yet been established. The current paper estimates the inter-rater reliability of the HASI in a sample of Indigenous and non-Indigenous prisoners in Western Australia., Methods: We estimated intra-class correlation coefficients (ICC) for the consistency of agreement among three blinded raters using a two-way random-effects model assessing the inter-rater agreement of the HASI. Kappa was also estimated for the dichotomous HASI screening threshold outcome between the raters., Results: The HASI exhibited very good within-subject consistency of agreement for Section B (ICC = 0.95; 95%CI:0.94-0.96), Section C (ICC = 0.97; 95%CI: 0.96-0.98) and Section D (ICC = 0.90; 95%CI: 0.87-0.92) subscales and for the total scaled score (ICC = 0.97; 95%CI: 0.96-0.98). The inter-rater reliability of the dichotomous adult ID screening threshold (<85) was also very good (Kappa = 0.95)., Conclusions: The current study provides new evidence that the HASI has a low risk of bias from between-rater scoring and can be reliably scored by both non-clinicians and clinicians with little training, when administered in prison settings. Pre-scoring training should focus on the more subjective 'clock-drawing' section, in order to maximise inter-rater reliability., (© 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Objective: To report the prevalence of markers for HIV infection, hepatitis B and hepatitis C among Australian prison entrants., Design: Cross-sectional survey conducted over 2-week periods in 2004, 2007 and 2010., Setting: Reception prisons in New South Wales, Queensland, Tasmania and Western Australia., Participants: Individuals entering prison from the community during the survey periods., Main Outcome Measure: Prevalence of anti-HIV antibody (anti-HIV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc) and anti-hepatitis C virus antibody (anti-HCV)., Results: The study included 1742 prison entrants: 588 (33.8%) in 2004, 536 (30.8%) in 2007 and 618 (35.5%) in 2010. The age-standardised prevalence estimates for anti-HIV, HBsAg and anti-HBc were 0.4%, 2.3% and 21.7% respectively, and remained stable over the three survey periods. The age-standardised prevalence estimate for anti-HCV was 29.0%; it decreased over time (33.3% in 2004 v 23.2% in 2010; P = 0.001), and this coincided with a decrease in prison entrants reporting injecting drug use (58.3% [343/588] in 2004 v 45.3% [280/618] in 2010; P < 0.001). Among injecting drug users, the prevalence of anti-HCV was 57.2% and did not change significantly over time. Of those who were anti-HCV positive, 33.7% (140/415) were unaware of their infection status, and 74.3% (185/249) of those who tested positive for anti-HBc reported that they had never had hepatitis B., Conclusions: HIV prevalence is low in the Australian prisoner population but transmission remains a risk. Despite a decrease in the proportion of prison entrants reporting injecting drug use, prevalence of hepatitis B and hepatitis C has remained high. Treatment and prevention initiatives should be prioritised for this population.

Background: Prisoners have extremely high rates of smoking with rates 3-4 times higher than the general community. Many prisoners have used heroin. The aims of this study were to investigate the impact of heroin use on smoking cessation and the social determinants of health among prisoners., Methods: Secondary analysis of data from a randomised controlled trial of a multi-component smoking cessation intervention involving 425 Australian male prisoners. Inmates who, prior to imprisonment, used heroin regularly were compared to those who did not use heroin regularly. Self-reported smoking status was validated at baseline and each follow-up by measuring carbon monoxide levels. Readings exceeding 10 ppm were defined as indicating current smoking., Results: Over half (56.5%) of the participants had ever used heroin while 37.7% regularly (daily or almost daily) used heroin in the year prior to entering prison. Prisoners who regularly used heroin had significantly worse social determinants of health and smoking behaviours, including lower educational attainment, more frequent incarceration and earlier initiation into smoking. Prisoners who regularly used heroin also used and injected other drugs significantly more frequently. At 12-month follow-up, the smoking cessation of prisoners who had regularly used heroin was also significantly lower than prisoners who did not regularly use heroin, a finding confirmed by logistic regression., Conclusions: Regular heroin use prior to imprisonment is an important risk factor for unsuccessful attempts to quit smoking among prisoners and is also associated with worse social determinants of health, higher drug use, and worse smoking behaviours. More effective and earlier smoking cessation interventions are required for particularly disadvantaged groups., Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry 12606000229572.

Introduction and Aim. Although tobacco and alcohol use have declined substantially in the Australian community, substance use among prisoners remains high. The aim was to compare the smoking, drug, and alcohol characteristics, sociodemographic profile, and general health of Aboriginal and non-Aboriginal male prisoners in a smoking cessation intervention. Design and Methods. This study was a descriptive cross-sectional analysis of data from 425 male prisoners who joined a quit smoking trial conducted at 18 correctional centres in NSW and Queensland using data collected by standardised self-report instruments. Results. Average age was 33 years with 15% from Aboriginal descent. Compared to non-Aboriginal prisoners, Aboriginal prisoners were significantly more likely to have left school with no qualifications, to have been institutionalised as a child, to be previously incarcerated, and commenced smoking at a younger age. The tobacco use profile of both groups was similar; most of them had a medium to high level of nicotine dependence, smoked roll your own tobacco, and were "serious" about quitting. Discussion and Conclusion. Despite differences in terms of sociodemographic characteristics and offending history, the smoking characteristics of Aboriginal and non- Aboriginal prisoners were similar. Incarceration offers an opportunity to encourage smoking cessation and reduction of drug use.

Issue: The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention., Approach: This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial., Key Findings: The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons., Implications: Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners., Conclusions: As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future., (© 2012 Australasian Professional Society on Alcohol and other Drugs.)

Premise of the Study: Research on the evolutionary role of exonic microsatellites currently lacks an understanding of the evolutionary pressures that promote or limit their expansion. Contrasting levels of variability and genetic structures at anonymous and transcribed microsatellite loci of varying lengths are likely to provide useful insights regarding the relative strength of selection acting on different classes of microsatellites. We have developed primers for long transcribed microsatellites in Helianthus annuus to make these comparisons., Methods and Results: Eight relatively long microsatellites from sequences in the expressed sequence tag database of H. annuus were characterized. A total of 63 individuals from three populations in Kansas were genotyped. The number of alleles per locus ranged from four to 11 with an average observed heterozygosity of 0.723., Conclusions: Our study has generated suitable tools for studying the population genetics of long transcribed microsatellites that are potentially influenced by selection.

Background: Cardiovascular risk factors (CVRF) were collected as part of a randomised controlled trial of a multi-component intervention to reduce smoking among male prisoners. Cross-sectional baseline data on CVRF were compared among smoking male prisoners and males of similar age in the general population., Methods: 425 smoking prisoners were recruited (n = 407 in New South Wales; 18 in Queensland), including 15% of Aboriginal descent (mean age 33 years; median sentence length 3.6 years). We measured CVRF such as smoking, physical activity, blood pressure, risky alcohol use, symptoms of depression, and low socioeconomic status., Results: We found that 39% of prisoners had 3+ CVRF, compared to 10% in a general community sample of most disadvantaged men of a similar age. Significantly more Aboriginal prisoners had 3+ CVRF than non-Aboriginal prisoners (55% vs 36%, p < 0.01) and were twice as likely to have 4+ CVRF (27% vs 12%). In addition to all prisoners in this study being a current smoker (with 70% smoking 20+ cigarettes per day), the prevalence of other CVRF was very high: insufficient physical activity (23%); hypertension (4%), risky drinking (52%), symptoms of depression (14%) and low socioeconomic status (SES) (44%). Aboriginal prisoners had higher levels of risky alcohol use, symptoms of depression, and were more likely to be of low SES., Conclusion: Prisoners are at high risk for developing cardiovascular disease compared to even the most disadvantaged in their community and should be the focus of specific public health interventions., Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN#12606000229572.

Objective: To determine the risk of suicide and drug overdose death among recently released prisoners., Design, Setting and Participants: Retrospective cohort study of 85 203 adult offenders who had spent some time in full-time custody in prisons in New South Wales between 1 January 1988 and 31 December 2002., Main Outcome Measures: Association between time after release and risk of suicide and overdose death., Results: Of 844 suicides (795 men, 49 women), 724 (86%) occurred after release. Men had a higher rate of suicide than women both in prison (129 v 56 per 100,000 person-years) and after release (135 v 82 per 100,000 person-years). The suicide rate in men in the 2 weeks after release was 3.87 (95% CI, 2.26-6.65) times higher than the rate after 6 months. Male prisoners admitted to the prison psychiatric hospital had a threefold higher risk than non-admitted men both in prison and after release. No suicides among women were observed in the 2 weeks after release. No increased risk of suicide was observed among Aboriginal Australians in the first 2 weeks after release. Of 1674 deaths due to overdose, 1627 (97%) occurred after release. Drug-related mortality in men was 9.30 (95% CI, 7.80-11.10) times higher, and in women was 6.42 (95% CI, 3.88-10.62) times higher, in the 2 weeks after release than after 6 months., Conclusions: Prisoners are at a heightened risk of suicide and overdose death in the immediate post-release period. After 6 months post-release, the suicide rate approaches the rate observed in custody.

Objectives: This study compares the prevalence of Mantoux positivity among prisoners in NSW in 1996 and 2001 and examines factors associated with Mycobacterium tuberculosis infection., Design: Cross-sectional random samples of prisoners, including a longitudinal cohort of prisoners screened in both 1996 and 2001., Setting: 29 correctional centres., Participants: 747 men and 167 women participated in the 2001 NSW Inmate Health Survey; a cohort of 104 prisoners from the 1996 and 2001 NSW Inmate Health Surveys., Results: The prevalence of Mantoux positivity remained stable between 1996 and 2001 (12% and 14%, p = 0.2), and increased among prisoners from Asian backgrounds (21% and 47%, p = 0.02). The annual risk of infection in the cohort among those detained continuously between 1996 and 2001 was 3.1%, and among recidivists it was 2.7% (p = 0.6)., Conclusion: The risk of M. tuberculosis infection for Australian prisoners is assessed to be approximately four times higher than that for the community, however there is no attributable risk to the prison environment itself.

We examined factors associated with increased mortality in a cohort of 85,203 adults with a history of imprisonment in New South Wales, Australia, between 1988 and 2002. Information on death was collected through linkage to the Australian National Death Index. The influence of demographic and criminological factors on the standardised mortality ratio (SMR) for all-cause mortality, and deaths due to drug overdose and suicide was examined using negative binomial regression models. The number of deaths identified was 5,137 (4,714 men, 423 women, 303 in custody). The overall SMR was 3.7 (3.6-3.8) in men and 7.8 (7.1-8.5) in women. SMRs raised for deaths due to drug overdose (men: 12.8, women: 50.3) and suicide (men: 4.8, women: 12.2). The high SMR was associated with hospitalisation for mental illness, multiple imprisonments, and early stage of follow-up independently of causes of death. Being released from prison increased the SMRs for all-cause and drug-related mortality, but not suicide. For women, significant trends for decreasing risk with increasing age were noted. Minority groups, in particular men, had a lower risk of death than white people. In men a sex or drug offence was associated with a lower risk and a property or violence offence was related to higher mortality. Our results reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Certain demographic and imprisonment characteristics are indicators of high mortality among this population. The underlying causes of some of these characteristics such as mental illness or multiple imprisonments are potentially treatable and preventable. Prison health services need to develop interventions targeting high-risk groups to avoid this situation.

Primary Objective: To investigate the association between reported past traumatic brain injury (TBI) and demographic, neuropsychiatric and criminographic parameters among individuals recently received into custody., Research Design: A random sample of men recently received into the New South Wales (Australia) criminal justice system were screened for a history of TBI and the details of up to five separate TBI episodes were obtained. We also screened for depression, psychosis, personality disorder, drug and alcohol use, and 'social connectedness'., Main Outcome and Results: Among the 200 study participants, 82% reported past TBI. TBI was associated with a history of engagement in contact sports, school expulsion, daily illicit drug use, depression and psychosis., Conclusions: Past TBI is common among prisoners entering the criminal justice system and, amongst other correlates, appears to be highly associated with increased rates of major mental illness.

Primary Objective: To establish the prevalence, severity, recurrence and sequelae of past traumatic brain injury (TBI) among individuals recently received into custody., Research Design: Cross-sectional random sample of men recently received into the New South Wales' (NSW) criminal justice system., Procedures: Participants were screened for a history of TBI including the injury setting, severity, treatment and sequelae of up to five separate TBI episodes., Outcomes and Results: Of 200 study participants, 82% endorsed a history of at least one TBI of any severity and 65% a history of TBI with a loss of consciousness (LOC). Multiple past TBIs were common, as were ongoing sequelae. Treatment for the TBI was more common among those TBIs with a LOC compared with no LOC (66% vs. 39%)., Conclusions: Among individuals entering the criminal justice system, past TBI is common and often associated with ongoing neuropsychiatric and social sequelae. Screening for TBI at the point of reception may be warranted to better understand and treat those with ongoing neuropsychiatric sequelae arising from the TBI.

Renal prostaglandins (PG), renin, and cortisol are necessary for normal kidney development and function during fetal life. We examined the effects of cortisol infusion before completion of nephrogenesis (d 109-116 gestation; 2.0-3.0 mg hydrocortisone succinate/24 h) on the renal mRNA expression of PGHS-2, the PGE(2) receptors, EP(2) and EP(4), and renin in fetal sheep. Cortisol infusion raised plasma cortisol levels to 42.8 +/- 6.0 nmol/L compared with saline infusion levels of 1.5 +/- 0.5 nmol/L (p < 0.001), but had no effect on fetal body weight, proportional kidney mass, or blood gases. Cortisol decreased significantly the relative expression of renin mRNA (saline: 0.93 +/- 0.06 units; cortisol: 0.32 +/- 0.03 units, p < 0.05), however it had no effect upon the expression of PGHS-2, EP(2), or EP(4) mRNA in fetal sheep kidney. Although there is substantial evidence that PGE(2) acting through either the EP(2) or EP(4) receptor stimulates renin synthesis in the adult kidney, our results have demonstrated that before the completion of nephrogenesis, cortisol down-regulation of renin mRNA expression is independent of any change in the expression of PGHS-2, EP(2), or EP(4) mRNA expression. During nephrogenesis, the insensitivity of PGHS-2, EP(2), and EP(4) expression to down-regulation by cortisol may permit continued PG regulation of renal development and urine formation.

The developing embryo and fetus respond to a range of intrauterine stressors, but the effect of chronic intrauterine stress on the programmed development of pituitary corticotrophs has not been investigated. We have used a pregnant sheep model in which the embryonic environment at conception has been surgically perturbed by uterine carunclectomy. This procedure results in the development of fetuses that either are placentally restricted and chronically hypoxemic or that demonstrate compensatory placental growth and maintain normoxemia throughout late gestation. We found that uterine carunclectomy resulted in the emergence of a population of non-corticotrophin-releasing hormone (non-CRH) target cells that secreted high amounts of adrenocorticotrophic hormone (ACTH) in the fetal pituitary. This change in corticotroph development was independent of late-gestation hypoxemia. However, chronic hypoxemia during late gestation (in either carunclectomized or non-carunclectomized uterine environments) resulted in a reduction in the proportion of ACTH stored in CRH-target. Thus, the early and late intrauterine environments differentially program the development of specific corticotrophic cell types in the fetal pituitary. These patterns of altered corticotroph development are important given the central roles of the hypothalamo-pituitary-adrenal axis in the fetal adaptive response to intrauterine stress and in the early programming of adult disease.

We investigated the response of the fetal pituitary-adrenal axis to acute and chronic hypoglycemia before and after the normal prepartum activation of this axis at around 135 days gestation (term = 147 +/- 3 days). Pregnant ewes were either well nourished (control group; n = 22) or undernourished (UN; 50% reduction in maternal nutrient intake; n = 23) during the last 30 days of pregnancy. Acute hypoglycemia was induced by intrafetal administration of insulin between 125 and 130 days gestation (control, n = 7; UN, n = 12) and between 138 and 141 days gestation (control, n = 6; UN = 9). Fetal plasma glucose concentrations were significantly lower (P < 0.005) in the UN compared with the control group throughout the insulin infusion period at both gestational age ranges. In the control group, there was no fetal ACTH response to insulin infusion before 135 days gestation, but there was a significant (P < 0.001) response after 136 days gestation. In the UN group, there was a significant ACTH response to insulin infusion both before and after 135 days gestation, and there was no difference in the fetal ACTH response between the two gestational age ranges. The plasma cortisol responses to insulin were greater (P < 0.001) after 136 days compared with before 135 days gestation in both the UN and control groups. In the control group there was no significant relationship between basal fetal plasma ACTH and glucose concentrations between 115-135 days gestation or between 136-145 days gestation. In the UN group, fetal glucose ranged from 0.5-2.0 mM, and plasma ACTH and glucose concentrations were inversely related at 115-135 days gestation [log ACTH = -0.31 (glucose) + 2.21; r = -0.37; P < 0.001] and at 136-145 days gestation [log ACTH = -0.40 (glucose) + 2.50; r = -0.54; P < 0.001]. When the UN and control groups were combined, fetal plasma ACTH concentrations were significantly greater (F = 13.5; P < 0.05) when plasma glucose concentrations were less than 1.0 mM at either 115-135 days or 136-147 days gestation. Similarly, fetal plasma cortisol concentrations were also significantly greater (F = 18.7; P < 0.05) when plasma glucose concentrations were less than 1.0 mM at each gestational age range. Therefore, there is an increased sensitivity of the fetal hypothalamo-pituitary axis to acute falls in glucose concentrations below 1.2 mM after 135 days compared with earlier in gestation. The fetal hypothalamo-pituitary axis can respond, however, when plasma glucose concentrations fall below 1.0 mM, before and after 135 days gestation, independently of whether the low glucose concentrations are a consequence of insulin-induced hypoglycemia or maternal nutrient restriction.

This study examined the impact of a chronic physiological elevation of plasma cortisol levels on adrenal catecholamine synthetic enzyme and proenkephalin A mRNA expression in foetal sheep. Cortisol (2.5-3. 0 mg.5 ml-1.24 h-1, n=9) or saline (0.9% saline, n=6) was infused into foetal sheep for 7 days between 109 days and 116 days gestation. Foetal plasma cortisol concentrations were higher (P<0.0005) in the cortisol infused foetuses when compared with the saline infused group (43.07+/-4.13 nmol.l-1 vs 1.67+/-0.10 nmol.l-1). There were no differences, however, in the plasma ACTH levels between the two groups. Using Northern blot analysis, adrenal phenylethanolamine N-methyltransferase (PNMT) mRNA expression was found to be reduced (P<0.005) fivefold in the cortisol infused foetuses when compared with the controls, as was the relative area of the adrenal medulla which stained positively with anti-PNMT (28.1+/-2.5% vs 44.8+/-4.8%, P<0.007). No effect of cortisol infusion was observed on adrenal tyrosine hydroxylase mRNA and protein expression or proenkephalin A mRNA expression. We conclude that before birth, adrenaline synthesis may be suppressed by a novel direct, or indirect, inhibitory effect of glucocorticoids on PNMT mRNA expression.