This Week in BMJ | Editor's Choice | Press releases

1 Guidelines for managing HIV infection
Kevin M De Cock

2 Bringing epilepsy out of the shadows
Rajendra Kale

3 Five years down the road from Rio
Michael McCally

4 Making the diagnosis of asthma
D Robin Taylor

6 Career guidance for doctors
Douglas Carnall

7 UK proposes health action zones
Liver cancer falls after hepatitis B vaccination
Hong Kong bans tobacco advertising
NHS trusts to be more open
Inquiry backs decision not to resuscitate baby
US rules against physician assisted suicide
Technique defines spread of breast cancer
Internet images attract trainees to Wales
Registrar's criticism ruled as misconduct
BMA urges co-ordinated drug misuse strategy
Mother sues trust after murder
US considers testing all over-45s for diabetes
Germany passes new transplant law
Flying doctor's hopes for Africa

13 Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and the Netherlands: longitudinal cohort study
Patricia Huijbregts, Edith Feskens, Leena Räsänen, Flaminio Fidanza, Aulikki Nissinen, Alessandro Menotti, Daan Kromhout

18 Substance use in remand prisoners: a consecutive case study
Debbie Mason, Luke Birmingham, Don Grubin

21 Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey
A Graham Bird, Sheila M Gore, Sharon J Hutchinson, Stephanie C Lewis, Sheila Cameron, Sheila Burns on behalf of the European Commission Network on HIV infection and hepatitis in prison

25 Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials
Geert J M G van der Heijden, Daniëlle A W M van der Windt, Andrea F de Winter

30 Prevalence of HIV and injecting drug use in men entering Liverpool prison
Mark A Bellis, Andrew R Weild, Nick J Beeching, Ken J Mutton, Qutub Syed

31 Drug points: Severe hypotension associated with netilmicin treatment
T Rygnestad

Simvastatin and impotence
G Jackson

32 Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice
Christopher Everett

34 Predicting stress in general practitioners: 10 year follow up postal survey
Jenny Firth-Cozens

35 A randomised controlled trial of feedback to general practitioners of their prophylactic aspirin prescribing
Peter McCartney, Wendy Macdowall, Margaret Thorogood

37 Fortnightly review: Management of abnormal bleeding in women receiving hormone replacement therapy
C P Spencer, A J Cooper, M I Whitehead

43 ABC of mental health: Depression
Anthony S Hale

42 Correction: Fortnightly review: Seasonal allergic rhinitis
Abhi Parikh, Glenis K Scadding

47 Personal paper: how to get the best health outcome for a given amount of money
Matthew Sutton

50 Managed care: Disease management
David J Hunter, Gillian Fairfield

54 Britain's first minister of public health
J Powles and others; J Crown and M Clarke; S Griffiths

55 No consensus seems to exist about when caesarean section is medically indicated
M H Hall

55 Fatal methadone overdose
T Carnwath; M Gabbay and M Perry; E W Benbow and others

56 Patients receive an inadequate dose of antidepressants for an inadequate period
T M MacDonald and others

56 Advice on long term corticosteroid treatment may be misleading
G J Gibson and K Prowse

57 Is it time to stop searching for MRSA?
R Philp and others; J K Torrens; R D Jefferson and J Harrison; G Cattermole; R K Peel and others; P Wilson and L J Dunn; K Loudon and J P Burnie; R P D Cooke and others; D A B Dance and others

60 Should oral contraceptive users be screened for factor V Leiden?
T Ward; J P Vandenbroucke

60 Benefit of using polymerase chain reaction to test blood donations will be considerable
J Barbara

60 Local research ethics committees
P V Scott and C A Pinnock; P G Stone and C E Blogg

61 Three quarters of one French prison population needed immunisation against hepatitis B
M Rotily and others

61 Mistake in report: hepatitis B vaccination for drug misusers is recommended
J Polkinghorne and others

61 GPs need training in care programme approach more than in supervised discharge
J Bindman and others

62 Book reviewers reviewed
A Bond; D F Levine

62 Children have rights to medicines
C Essex and G Rylance

63 A G MacIver, J N Parker, M McLean Poston, P W Ruggles, D Rumney, E Samuel

64 BMA chairman calls for health strategy
Consultants advised against BUPA partnership
Review of London's health care
Private finance initiative

Soundings

65 Unlikely scenarios of 1997 Liam Farrell

65 Should prisoners have a say in prison health care?
Luke Birmingham

Dealing with loss of fertility
Dani Singer and Myra S Hunter

67 Sexually Transmitted Infections: Guidelines for Prevention and Treatment
Michael Adler, Susan Foster, John Richens, Hazel Slavin
Charles F Gilks

Heart Disease in Pregnancy
Ed Celia Oakley
Kassam Mahomed

68

Editor's choice

Prisoners' health: a test for civilisation

Prisons are dreadful places because nobody cares about prisoners - until they become a threat. Concern about the health of prisoners grew in the 19th century because of fears about typhus spreading out from the prisons. Now history might be about to repeat itself because prisons are being recognised as places where blood borne viral diseases flourish - because of the concentration of drug misusers.

A study of 548 adult male remand prisoners admitted consecutively to Durham prison showed that almost two thirds were using illicit drugs (p 18). A quarter had injected drugs, and a third of them had shared needles. Only a small proportion of those misusing drugs were detected by prison doctors, and only 5% who needed a detoxification regimen were actually given it. A study from Liverpool showed that a third of new prisoners had injected drugs and that 16% of them had injected in prison (p 30). Some injected drugs for the first time while in prison.

A study from Scotland, confirming that many prisoners had injected drugs in prison (p 21), found that only 4% had been offered vaccination against hepatitis B, although most used sterilising tablets when injecting. Most are denied methadone, and all are denied needle exchange. The authors observe that the "limited access to harm reduction ... represents a serious gulf between the standards of health care and public health available to the same individuals in prison and outside." Data from Marseilles found that more than a quarter of prisoners were positive for hepatitis B and that vaccination against the disease is possible in prison (p 61).

The picture in Britain is of a serious health problem and an inadequate response. Luke Birmingham offers an explanation of why (p 65). Many prisoners see prison doctors as "them" and are reluctant to disclose information. One prisoner described how he reported that he felt suicidal after the death of his brother: "... they put me in strips. You wouldn't treat a dog like that. I won't tell them anything now." Birmingham argues that those developing health services for prisoners must listen to them.

Finally, Douglas Carnall celebrates a year of Career Focus (p 6). He thinks that medicine needs both a good appraisal system and a means to provide career counselling. All Career Focus articles are available on the BMJ's website.