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This study sought to evaluate the association of a solitary confinement ban with self-harm among adolescents in New York City's jail system. Data were extracted from medical records on 5,038 adolescent incarcerations from October 1, 2013, through July 12, 2016, and compared incarcerations before the ban (February 20, 2015) with those after the ban. Of the 2,503 adolescent incarcerations pre-ban, there were 171 self-harm gestures among 106 incarcerations (4.2% of incarcerations). Post-ban, there were 2,100 adolescent incarcerations and 105 self-harm gestures among 71 incarcerations (3.4% of incarcerations

New York City's (NYC) Correctional Health Services has introduced specialized treatment units for patients with serious mental illness in the NYC jail system. With multidisciplinary mental health staffing and a coordinated approach with NYC's Department of Correction, these units expand therapeutic options for patients vulnerable to clinical instability and physical harm, including those at high risk of psychiatric medication nonadherence and those returning to jail from psychiatric hospitalization. This study evaluated the extent to which these units improve clinical outcomes for this population.This retrospective, observational cohort study included adult males with serious mental illness with a length of jail stay of ≥14 days between January 1, 2016, and March 31, 2018. Patients on treatment units were matched with patients of similar characteristics (control group) by using propensity score matching (N=302 pairs). Rates of self-injury, injury due to violence, and psychiatric medication adherence were analyzed.Most patients on treatment units had diagnoses of schizophrenia spectrum and other psychotic disorders (81%), and most had a violent felony as their most severe charge (68%). Compared with patients in a control group, those on the treatment units had lower rates per 100 person-days of injury due to violence at 30 and 60 days (0.04, 95% confidence interval [CI]=0.02-0.07, and 0.03, 95% CI=0.02-0.06, respectively) and higher mean medication adherence (77% versus 55%, p0.001). They also experienced lower rates of self-injury, although the difference was not statistically significant.Initial outcomes indicate substantial benefits to patients, demonstrating the value of a rehabilitative approach to psychiatric care in jail.

There is an integral research gap regarding whether there is a relationship between pain levels and low physical activity among older women. This is a secondary analysis of a longitudinal cohort study, the Women’s Health and Aging Study (WHAS) II. Our analyses included 436 community-dwelling women between the ages of 70 and 79, who were followed for 10.5 years. We employed marginal structural modeling, which controls for time-dependent confounding, with the aim of assessing the potential direct association between pain levels and low physical activity and assess a graded relationship. Compared to women with no pain, those with widespread pain were nearly half as likely to be moderately active versus low active (aOR: 0.46, 95% confidence interval (CI): 0.22, 0.96). A graded association was observed across the four pain levels (no pain or mild pain, other pain, moderate or severe lower extremity pain, and widespread pain) on low physical activity. Our findings indicate that reducing chronic widespread pain in older women may increase moderate physical activity, and therefore reduce the downstream health risks of low physical activity, including morbidity and mortality risk.

ObjectiveCentral obesity has been associated with several adverse health events, but little research exists about the longitudinal effects of central obesity on multisite pain. The purpose of this study was to assess if central obesity, as measured by waist circumference measurement, was associated with an increased rate of having multisite pain among older adults aged 65 years and older.DesignThe National Health and Aging Trends Study is a longitudinal cohort study initiated in 2011 and intended to be representative of Medicare beneficiaries in the contiguous United States.MethodsThere were 7,145 community-dwelling participants included in this study. Data for this study were collected annually between 2011 and 2018. Researchers assessed if waist circumference risk level was associated with an increased rate ratio of multisite pain. Weighted data were used in a multivariable generalized estimating equation model that used a log link specified with a Poisson distribution.ResultsParticipants with high-risk waist circumferences (98 cm or greater for women and 109 cm or greater for men) had a 11% higher rate of multisite pain than those with low-risk waist circumferences [rate ratio (RR) 1.11, 95% CI: 1.07–1.15] adjusting for gender, age, race, education, probable major depression, arthritis, and multimorbidity count.ConclusionAs measured by waist circumference, central adiposity is associated with multisite pain in older adults. While more research is needed, reducing waist circumference may prove beneficial in reducing the burden of multisite pain.

Lower extremity functioning in older adults provides a measure of poor physical performance and can predict negative health outcomes. The consequences of reduced lower extremity functioning on cognitive decline, measured as time-varying variables, have not been well documented in previous studies. We aimed to evaluate whether lower extremity functioning is associated with an increased incidence rate of probable dementia among older adults using data from the National Health and Aging Trends Study (NHATS). Participants (n = 6457) were followed for 8 years to examine the relationship between lower extremity functioning, as measured by the Short Physical Performance Battery (SPPB), and incident probable dementia. Using weighted data, a multivariable Poisson regression with generalized estimating equations (GEE) was used to calculate incidence rate ratios (IRR), adjusting for covariates and clustering. Participants with low SPPB scores (0–5) had a 5% increase in incident probable dementia when compared with those who had good SPPB scores (10–12) in the adjusted model (IRR = 1.05, 95% CI = 1.04–1.07). Lower extremity functioning is associated with a modest increase in incident probable dementia. The SPPB score may be helpful in identifying subjects at risk of dementia. Efforts aimed at improving physical functioning may lead to better cognitive outcomes.