Publications by authors named "Tony Butler"

119 Publications

Identifying research priorities to improve the health of incarcerated populations: results of citizens' juries in Australian prisons.

Lancet Public Health 2021 Jun 8. Epub 2021 Jun 8.

School of Population Health, University of New South Wales (UNSW Sydney), Sydney, NSW, Australia.

Health disparities in incarcerated populations should guide investment in the health care and research of these communities. Although users of health-care services are important in providing input into decisions about research, the voices of people in prison are absent regarding research into their health. In this Health Policy paper, we present priorities for research into the health of people in prison according to people in prison themselves. By use of a deliberative research approach, citizens' juries were conducted in six prisons (three men's and three women's prisons) in Australia. Participants were selected following submissions of expression of interest forms that were distributed within the prisons. Prerecorded information by experts in the health of incarcerated people was shown to participants. Participants deliberated for up to 4 h before agreeing on five research priorities. All citizens' juries endorsed mental health as a number one research priority. Prison health-care services, alcohol and other drug use, education, and infectious diseases were identified as research priorities by most citizens' juries. Focal points within priorities included serious mental illness; grief and trauma; medication management; health-care service access, quality, and resources; drug withdrawal and peer support; prison-based needle and syringe programmes; and health and life skills education. If endeavours in research priority setting are to consider health equity goals, the views of our most health affected citizens need to be included.
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http://dx.doi.org/10.1016/S2468-2667(21)00050-5DOI Listing
June 2021

Domestic Violence in Residential Care Facilities in New South Wales, Australia: A Text Mining Study.

Gerontologist 2021 May 23. Epub 2021 May 23.

School of Population Health, Faculty of Medicine, University of New South Wales, Kensington, Sydney, New South Wales, Australia.

Background And Objectives: The police are often the first to attend domestic violence events in New South Wales (NSW), Australia, recording related details as structured information (e.g., date of the event, type of incident, premises type) and as text narratives which contain important information (e.g., mental health status, abuse types) for victims and perpetrators. This study examined the characteristics of victims and persons of interest (POIs) suspected and/or charged with perpetrating a domestic violence related crime in residential care facilities.

Research Design And Methods: The study employed a text mining method that extracted key information from 700 police recorded domestic violence events in NSW residential care facilities.

Results: Victims were mostly female (65.4%) and older adults (median age 80.3). POIs were predominantly male (67.0%) and were younger than the victims (median age 57.0). While low rates of mental illnesses were recorded (29.1% in victims; 17.4% in POIs), 'dementia' was the most common condition among POIs (55.7%) and victims (73.0%). 'Physical abuse' was the most common abuse type (80.2%) with 'bruising' the most common injury (36.8%). The most common relationship between perpetrator and victim was 'carer' (76.6%).

Discussion And Implications: These findings highlight the opportunity provided by police text-based data to provide insights into elder abuse within residential care facilities.
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http://dx.doi.org/10.1093/geront/gnab068DOI Listing
May 2021

COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia.

Int J Prison Health 2021 05;ahead-of-print(ahead-of-print)

School of Population Health, University of New South Wales, Sydney, Australia.

Purpose: The purpose of this commentary is to draw upon available literature and practices related to COVID-19 and management of older incarcerated adults in Australia to highlight key matters for better risk management and care of this population during this and future infectious disease pan/epidemics.

Design/methodology/approach: The present commentary draws on current policies, practices and literature regarding the health, needs and management of older incarcerated adults in Australia to discuss risk, care and early release for this population during the COVID-19 pandemic.

Findings: Incarcerated persons experience poorer health and accelerated age-related decline compared to those in the general community. The present situation offers the opportunity to fill knowledge and practice gaps, including policies for staff training, identification of dementia and cognitive decline, assessment of mobility issues, addressing barriers to health-seeking, possibilities of medical or compassionate release, risk assessment and release protocols and post-release needs.

Practical Implications: While Australian prisons have acknowledged the vulnerability of older persons, more focused adaptation of COVID-19-related policies to consider adults as young as 45 years are needed. Appropriate ethical identification and management of cases in this population is needed, as is discussion on issues of decarceration and medical release. Re-conceptualisation of incarcerated adults as "citizens in need of care", rather than as "offenders to be secured", will be beneficial. Robust, local evidence is needed to assist decision-making.

Originality/value: This is a comprehensive, focused review of relevant evidence, policies and practices for a growing subpopulation of prisoners worldwide with complex needs and particular vulnerability to the COVID-19.
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http://dx.doi.org/10.1108/IJPH-10-2020-0078DOI Listing
May 2021

Evaluation of hepatitis C treatment-as-prevention within Australian prisons (SToP-C): a prospective cohort study.

Lancet Gastroenterol Hepatol 2021 Jul 7;6(7):533-546. Epub 2021 May 7.

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. Electronic address:

Background: Limited empirical evidence exists for the effectiveness of hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study aimed to assess the effect of HCV treatment-as-prevention in the prison setting.

Methods: SToP-C was a prospective study, including a before-and-after analysis, within a cohort of people incarcerated in two maximum-security prisons (male) and two medium-security prisons (one male, one female) in New South Wales, Australia. All prison inmates aged at least 18 years were eligible for enrolment. After HCV testing, participants were monitored for risk behaviours and HCV infection, among three sub-populations: uninfected (HCV antibody-negative); previously infected (HCV antibody-positive, HCV RNA-negative); and infected (HCV antibody and HCV RNA-positive). Uninfected participants were followed up every 3-6 months to detect HCV primary infection and previously infected participants were followed up every 3-6 months to detect re-infection. Participants with HCV infection were assessed for treatment, initially standard-of-care treatment (administered by prison health services) from 2014 to mid-2017, then direct-acting antiviral (DAA) treatment scale-up from mid-2017 onwards (12 weeks of sofosbuvir plus velpatasvir, administered through SToP-C). Participants were followed up until study closure in November, 2019. The primary study outcome was HCV incidence before and after DAA treatment scale-up among participants at risk of HCV primary infection or re-infection. This study is registered with ClinicalTrials.gov, NCT02064049.

Findings: Between Oct 30, 2014, and Sept 30, 2019, 3691 participants were enrolled in the SToP-C study. 719 (19%) participants had detectable HCV RNA, 2240 (61%) were at risk of primary HCV infection, and 725 (20%) were at risk of re-infection at baseline. DAA treatment was initiated in 349 (70%) of 499 eligible participants during the treatment scale-up period. The HCV incidence analysis comprised 1643 participants at risk of HCV infection or re-infection during longitudinal follow-up (median age 33 years [IQR 27-42]; 1350 [82%] male). 487 (30%) of 1643 participants reported injecting drugs in prison. HCV incidence decreased from 8·31 per 100 person-years in the pre-treatment scale-up period to 4·35 per 100 person-years in the post-treatment scale-up period (incidence rate ratio [IRR] 0·52 [95% CI 0·36-0·78]; p=0·0007). The incidence of primary infection decreased from 6·64 per 100 person-years in the pre-treatment scale-up period to 2·85 per 100 person-years in the post-treatment scale-up period (IRR 0·43 [95% CI 0·25-0·74]; p=0·0019), whereas the incidence of re-infection decreased from 12·36 per 100 person-years to 7·27 per 100 person-years (0·59 [0·35-1·00]; p=0·050). Among participants reporting injecting drugs during their current imprisonment, the incidence of primary infection decreased from 39·08 per 100 person-years in the pre-treatment scale-up period to 14·03 per 100 person-years in the post-treatment scale-up period (IRR 0·36 [95% CI 0·16-0·80]; p=0·0091), and the incidence of re-infection decreased from 15·26 per 100 person-years to 9·34 per 100 person-years (0·61 [0·34-1·09]; p=0·093). The adjusted analysis (adjusted for age, Indigenous Australian ethnicity, duration of stay in prison, previous imprisonment, injecting drug use status, and prison site) indicated a significant reduction in the risk of HCV infection between the pre-DAA treatment scale-up and post-DAA treatment scale-up periods (adjusted hazard ratio 0·50 [95% CI 0·33-0·76]; p=0·0014).

Interpretation: DAA treatment scale-up was associated with reduced HCV incidence in prison, indicative of a beneficial effect of HCV treatment-as-prevention in this setting. These findings support broad DAA treatment scale-up within incarcerated populations.

Funding: Australian National Health and Medical Research Council Partnership Project Grant and Gilead Sciences.
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http://dx.doi.org/10.1016/S2468-1253(21)00077-7DOI Listing
July 2021

The effect of omega-3 long chain polyunsaturated fatty acids on aggressive behaviour in adult male prisoners: a structured study protocol for a multi-centre, double-blind, randomised placebo-controlled trial and translation into policy and practice.

Trials 2021 May 2;22(1):318. Epub 2021 May 2.

Corrective Services NSW, 20 Lee St, Haymarket, NSW, 2000, Australia.

Background: Interventions to better manage aggressive behaviour and reduce recidivism are a primary concern for corrective services. Nutritional interventions to correct prisoner behaviour have been largely overlooked in the literature. Emerging evidence suggests that dietary intake influences aggressive behaviours and that nutritional supplementation with omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) could attenuate both the severity and frequency of aggressive behaviour.

Methods: Adult male prisoners who have a history of aggressive behaviour (n = 600) will be recruited from at least 6 Correctional Centres and randomised to receive either n-3 LCPUFA or placebo supplementation for a 16-week duration. Treatment will be with either 1 g/day of n-3 LCPUFA (694 mg DHA and 397 mg EPA) or placebo capsules, which are a corn/soy oil blend and are identical in size and colour. The primary outcome measure is the Inmate Behavioural Observation Scale (IBOS): an objective measure of aggressive behaviour. Secondary outcome measures include questionnaires (including aggression, attention deficit disorder, impulsivity, depression/anxiety/stress scales), engagement in programmes, recidivism and quality of life. Baseline and post-intervention assessments include the IBOS, questionnaires and blood to measure the levels of n-3 LCPUFA.

Discussion: To conclusively test the potential that increasing n-3 LCPUFA intakes can improve rates of prisoner aggression and associated mental health and violence-related social system management costs, we propose an adequately powered multi-centre, double-blind, randomised controlled trial, examining the effects of n-3 LCPUFA supplementation on aggressive behaviour in adult male prisoners. If successful, this study will inform prisoner policy with respect to nutrition and by inference contribute to a broader community approach to preventative mental health practices.

Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12618001665224 . Registered on 10 October 2018.
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http://dx.doi.org/10.1186/s13063-021-05252-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088826PMC
May 2021

Incarcerated people should be prioritised for covid-19 vaccination.

BMJ 2021 04 7;373:n859. Epub 2021 Apr 7.

School of Population Health, University of New South Wales, Sydney (UNSW Sydney), New South Wales, Australia.

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http://dx.doi.org/10.1136/bmj.n859DOI Listing
April 2021

Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis.

PLoS One 2021 11;16(2):e0245896. Epub 2021 Feb 11.

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016-2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016-2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9-33% (2-months LOS), 26-65% (6-months LOS), 37-70% (24-months LOS), and 35-65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280-$323 (6-months LOS), -$432-$426 (24-months LOS), and -$245-$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245896PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877645PMC
February 2021

Substance use and help-seeking among justice-involved young people in Queensland and Western Australia: A cross-sectional survey of 14-17-year-olds.

Drug Alcohol Rev 2021 May 2;40(4):617-626. Epub 2021 Feb 2.

Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Australia.

Introduction: This study investigated substance use and help-seeking among justice-involved young people to inform and improve service provision during and after contact with the justice system.

Methods: Young people (14-17 years) in the community with current or prior contact with the justice system were recruited in Queensland and Western Australia, Australia using purposive sampling between 2016 and 2018. A cross-sectional survey was delivered by computer-assisted telephone interview. Information was collected on sociodemographic and health factors; lifetime and frequency of use of alcohol, tobacco and other drugs; and use of health services related to substance use and mental health.

Results: Of the 465 justice-involved young people surveyed, most had used alcohol (89%), tobacco (86%) or other drugs (81%). Of the latter, cannabis use was most prevalent (79%), followed by ecstasy (26%) and amphetamine (22%). Young people engaging in higher risk drug use (daily use, injecting use) were more likely to also have an alcohol use disorder, be disengaged from education, unemployed, have attempted suicide and experienced incarceration. Of the cohort, 24% had received treatment at an alcohol and drug service in the past year and 30% had seen a health professional about emotional/behavioural problems. Males and Aboriginal and Torres Strait Islander young people were less likely to have sought professional help.

Conclusion: The high levels of substance use and disproportionate levels of help-seeking observed in this study illustrate the importance of delivering tailored, comprehensive and coordinated trauma-informed and culturally safe alcohol and drug services to justice-involved young people.
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http://dx.doi.org/10.1111/dar.13238DOI Listing
May 2021

The sexual behaviours of adolescents aged between 14 and 17 years involved with the juvenile justice system in Australia: A community-based survey.

PLoS One 2020 28;15(12):e0243633. Epub 2020 Dec 28.

School of Population Health, The University of New South Wales, Sydney, Australia.

Objectives: To overcome key knowledge gaps in relation to justice involved and vulnerable young people and their sexual health and to compare this group with their peers from other youth health surveys in Australia to determine the extent of the issues.

Methods: Young people, aged between 14 and 17 years, who had ever been or were currently involved with the criminal justice system were purposively sampled. The survey was anonymous and delivered using Computer Assisted Telephone Interview (CATI).

Results: A total of 465 justice involved MeH-JOSH young people, aged between 14 and 17 years, participated in the study: 44% Aboriginal and/or Torres Strait Islander (Indigenous) and 37% not attending school. Of the total valid responses, 76% (n = 348) reported having ever had sex, with sexual initiation at a median age of 14 years. We compared these data with their peers in other Australian surveys and found that young people in our study had a higher engagement in sex and start having sex at a younger age, reporting more sexual partners at all ages.

Conclusions: The sexual behaviours of young people involved in the justice system in this study suggest they may be at a greater risk for sexually transmissible infections than their age-matched peers in the general population. Policymakers should elevate them to a priority population for targeting sexual health services and health promotion.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243633PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769256PMC
February 2021

Prevalence of Mental Illnesses in Domestic Violence Police Records: Text Mining Study.

J Med Internet Res 2020 12 24;22(12):e23725. Epub 2020 Dec 24.

School of Population Health, University of New South Wales, Sydney, Australia.

Background: The New South Wales Police Force (NSWPF) records details of significant numbers of domestic violence (DV) events they attend each year as both structured quantitative data and unstructured free text. Accessing information contained in the free text such as the victim's and persons of interest (POI's) mental health status could be useful in the better management of DV events attended by the police and thus improve health, justice, and social outcomes.

Objective: The aim of this study is to present the prevalence of extracted mental illness mentions for POIs and victims in police-recorded DV events.

Methods: We applied a knowledge-driven text mining method to recognize mental illness mentions for victims and POIs from police-recorded DV events.

Results: In 416,441 police-recorded DV events with single POIs and single victims, we identified 64,587 events (15.51%) with at least one mental illness mention versus 4295 (1.03%) recorded in the structured fixed fields. Two-thirds (67,582/85,880, 78.69%) of mental illnesses were associated with POIs versus 21.30% (18,298/85,880) with victims; depression was the most common condition in both victims (2822/12,589, 22.42%) and POIs (7496/39,269, 19.01%). Mental illnesses were most common among POIs aged 0-14 years (623/1612, 38.65%) and in victims aged over 65 years (1227/22,873, 5.36%).

Conclusions: A wealth of mental illness information exists within police-recorded DV events that can be extracted using text mining. The results showed mood-related illnesses were the most common in both victims and POIs. Further investigation is required to determine the reliability of the mental illness mentions against sources of diagnostic information.
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http://dx.doi.org/10.2196/23725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790609PMC
December 2020

Risky alcohol consumption prior to incarceration: A cross-sectional study of drinking patterns among Australian prison entrants.

Drug Alcohol Rev 2020 09 23;39(6):694-703. Epub 2020 Aug 23.

Justice Health Research Program, Kirby Institute, UNSW Sydney, Sydney, Australia.

Introduction And Aims: Risky alcohol consumption is linked to poor health and criminal justice outcomes. This study aims to assess the prevalence and correlates of risky drinking in a sample of recently incarcerated Australians.

Design And Methods: Consecutive cross-sectional data were collected from prisoners residing in 19 correctional facilities in six Australian states and territories as part of the National Prison Entrants' Bloodborne Virus and Risk Behaviour Survey Report. The sample consisted of 389 prisoners (339 men, 50 women). Risky alcohol consumption was estimated using the Alcohol Use Disorders Identification Test-Condensed questionnaire, with a cut-off score of ≥6. Potential correlates of risky alcohol consumption were assessed utilising univariate and multivariate analyses.

Results: Over one-third (34.5%) of prisoners who were screened met the criteria for risky alcohol consumption. The five factors found to be independently and positively associated with risky alcohol consumption were Aboriginal and Torres Strait Islander (Indigenous) status, incarceration in prison in the Northern Territory, heavy tobacco use, cannabis use and abstinence from drugs in the 4 weeks prior to incarceration. Additionally, risky alcohol consumption was associated with current or past hepatitis B or hepatitis C infection.

Discussion And Conclusions: The findings highlight that risky alcohol consumption is common among prisoners across Australia. This is known to be associated with adverse health outcomes and re-offending, suggesting a need for alcohol interventions targeting prisoners.
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http://dx.doi.org/10.1111/dar.13127DOI Listing
September 2020

Onset and trajectory of alcohol and other drug use among Aboriginal men entering a prison treatment program: A qualitative study.

Drug Alcohol Rev 2020 09 3;39(6):704-712. Epub 2020 Aug 3.

National Centre for Cultural Competence and Sydney Institute of Criminology, The University of Sydney, Sydney, Australia.

Introduction: Aboriginal and Torres Strait Islander people are vastly over-represented in Australian prisons. Many people in prison attribute in some way their offences to alcohol and/or other drug (AOD) use. This paper aims to understand AOD use before first and between terms in prison, among a group of Aboriginal men enrolled in a prison-based AOD treatment program. It examines opportunities for prevention or treatment that might interrupt the cycle of alcohol consumption, offending and imprisonment.

Methods: A thematic analysis of in-depth interviews with 14 Aboriginal men in an urban prison.

Results: Participants had low levels of formal education, none having completed high school and had spent limited or no time in the workforce. All 14 spoke of being negatively affected by AOD use within their families. First alcohol and cannabis use were around age 12-14 years, first amphetamines and/or heroin use was around age 15. As adults, they had unstable accommodation and when released from prison returned to the same situation they had been in previously. Most believed they would not have offended and subsequently imprisoned if they did not have a substance use disorder.

Discussion And Conclusion: Without further support post-prison, the men in this study are likely to return to the same situation and continue their AOD use. Further efforts are needed to support families with substance use disorders and to give young Aboriginal and Torres Strait Islander people better education and training opportunities.
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http://dx.doi.org/10.1111/dar.13123DOI Listing
September 2020

Identifying significant contributors for smoking cessation among male prisoners in Australia: results from a randomised clinical trial.

BMJ Open 2020 07 20;10(7):e034046. Epub 2020 Jul 20.

Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia

Introduction: In Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers.

Aims: To identify factors and their relative contributions to smoking cessation among male prisoners.

Methods: A total of 425 male tobacco smokers with a median age of 32 years in Australian prisons. The primary outcome was continuous abstinence at 3, 6 and 12 months. We measured various sociodemographic characteristics, drug use, psychological distress and the mental and physical health status of the participants. Multivariate logistic regression models and population attributable risks (PAR%) were used to identify the significant factors and their contributions to smoking cessation rates.

Results: The median age of participants was 32 years (IQR 25-41 years). High smoking cessation rates were collectively associated with not using drugs, lower psychological distress, good mental health scores and better physical health (PAR%: 93%, 98% and 88% at 3, 6 and 12 months).

Conclusion: Our study suggests that not using drugs and being in good mental/physical health are the important contributors to continuous abstinence among prisoners. Thus, effective smoking cessation programmes require a multicomponent approach that includes addressing drug problems and mental health functioning.

Trial Registration Number: 12606000229572.
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http://dx.doi.org/10.1136/bmjopen-2019-034046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375500PMC
July 2020

Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis.

JAMA Psychiatry 2020 Nov;77(11):1137-1146

Kirby Institute, University of New South Wales, Sydney, Australia.

Importance: Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending.

Objective: To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis.

Design, Setting, And Participants: In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020.

Exposures: Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis.

Main Outcomes And Measures: Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders.

Results: Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]).

Conclusions And Relevance: In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.1255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364339PMC
November 2020

Authors' response to "Australian first in Aboriginal and Torres Strait Islander prisoner health care in the Australian Capital Territory".

Aust N Z J Public Health 2020 08 6;44(4):325. Epub 2020 Jul 6.

Kirby Institute, University of New South Wales.

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http://dx.doi.org/10.1111/1753-6405.13008DOI Listing
August 2020

Disengagement from mental health treatment and re-offending in those with psychosis: a multi-state model of linked data.

Soc Psychiatry Psychiatr Epidemiol 2020 Dec 10;55(12):1639-1648. Epub 2020 May 10.

Kirby Institute, University of New South Wales, Sydney, Australia.

Background And Aims: Individuals with psychosis are over-represented in the criminal justice system and, as a group, are at elevated risk of re-offending. Recent studies have observed an association between increased contacts with mental health services and reduced re-offending, as well as reduced risk of re-offending in those who are ordered to mental health treatment rather than punitive sanctions. In furthering this work, this study examines the effect of disengagement from mental health treatment on probability of re-offence in offenders with psychosis over time.

Methods: Data linkage was conducted with judicial, health and mortality datasets from New South Wales, Australia (2001-2015). The study population included 4960 offenders with psychosis who received non-custodial sentences and engaged with community-based mental health treatment. Risk factors for leaving treatment and/or reconviction were examined using multivariate cox regression. Further, a multi-state model was used to observe the probabilities associated with individuals moving between three states: conviction, disengagement from mental health treatment and subsequent re-conviction.

Results: A threefold increase was observed in the risk of re-offending for those who disengaged from treatment compared to those who did not (aHR = 2.76, 95% CI 1.65-4.62, p < 0.001). The median time until re-offence was 195 days, with the majority (67%) being convicted within one year of leaving treatment. A higher risk of leaving treatment was found for those born outside of Australia, with substance-related psychosis, and a history of violent offence.

Conclusions: The findings argue for an emphasis on continued engagement with mental health services following release for offenders with psychosis and identify subgroups within this population for whom concentrated efforts regarding treatment retention should be targeted.
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http://dx.doi.org/10.1007/s00127-020-01873-1DOI Listing
December 2020

Implications of sex offender classification on reporting demographic characteristics, health, and criminal careers: results from an Australian jurisdiction.

BMC Med Res Methodol 2020 04 28;20(1):97. Epub 2020 Apr 28.

Kirby Institute, University of New South Wales, Sydney, Australia.

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.
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http://dx.doi.org/10.1186/s12874-020-00960-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189498PMC
April 2020

Covid-19, prison crowding, and release policies.

BMJ 2020 04 20;369:m1551. Epub 2020 Apr 20.

Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1136/bmj.m1551DOI Listing
April 2020

Incident hepatitis B virus infection and immunisation uptake in Australian prison inmates.

Vaccine 2020 04 6;38(16):3255-3260. Epub 2020 Mar 6.

The Kirby Institute, University of New South Wales, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia.

Introduction: Despite an effective vaccine, hepatitis B virus (HBV) infection continues to impose a large burden of disease globally. Until childhood immunisation achieves high adult population coverage, people who inject drugs (PWID), including prison inmates remain at risk. PWID have a higher prevalence of HBV than the wider population, and lower rates of vaccine-conferred immunity. This study sought to identify the incidence and predictors of HBV transmission and uptake of immunisation in PWID prisoners in Australia.

Methods: Longitudinally collected, stored sera from subjects previously enrolled in a prospective study of hepatitis C in recently incarcerated PWID prisoners (n = 590) were serologically tested for HBV. Interviews recording demographic and behavioural risks were analysed. Multivariate statistical analyses were applied to identify associations of incident infection or immunisation.

Results: Upon imprisonment there were n = 373 (63%) individuals who were HBV susceptible, of whom 140 remained susceptible at the subsequent enrolment into the cohort, and had one or more follow-up visits (a total of 406.73 person years [p.y.]), and so were included in this analysis. There were 7 incident cases of HBV infection (1.7 per 100 p.y.) in this group, with transmission being associated with injecting drug use daily or more often. There were 48 individuals who were successfully immunised (11.8 per 100 p.y.) with younger age and continuous imprisonment predicting this outcome.

Conclusions: The Australian prison environment poses a high risk for HBV infection, and also provides an opportunity for immunisation for PWID. Further efforts are required to improve coverage and prevent ongoing transmissions.
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http://dx.doi.org/10.1016/j.vaccine.2020.02.076DOI Listing
April 2020

A rule-based approach to identify patient eligibility criteria for clinical trials from narrative longitudinal records.

JAMIA Open 2019 Dec 20;2(4):521-527. Epub 2019 Aug 20.

School of Computer Science, University of Manchester, Manchester, UK.

Objective: Achieving unbiased recognition of eligible patients for clinical trials from their narrative longitudinal clinical records can be time consuming. We describe and evaluate a knowledge-driven method that identifies whether a patient meets a selected set of 13 eligibility clinical trial criteria from their longitudinal clinical records, which was one of the tasks of the 2018 National NLP Clinical Challenges.

Materials And Methods: The approach developed uses rules combined with manually crafted dictionaries that characterize the domain. The rules are based on common syntactical patterns observed in text indicating or describing explicitly a criterion. Certain criteria were classified as "met" only when they occurred within a designated time period prior to the most recent narrative of a patient record and were dealt through their position in text.

Results: The system was applied to an evaluation set of 86 unseen clinical records and achieved a microaverage F1-score of 89.1% (with a micro F1-score of 87.0% and 91.2% for the patients that met and did not meet the criteria, respectively). Most criteria returned reliable results (drug abuse, 92.5%; Hba1c, 91.3%) while few (eg, advanced coronary artery disease, 72.0%; myocardial infarction within 6 months of the most recent narrative, 47.5%) proved challenging enough.

Conclusion: Overall, the results are encouraging and indicate that automated text mining methods can be used to process clinical records to recognize whether a patient meets a set of clinical trial criteria and could be leveraged to reduce the workload of humans screening patients for trials.
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http://dx.doi.org/10.1093/jamiaopen/ooz041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993990PMC
December 2019

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations.

Aust N Z J Public Health 2019 Dec 30;43(6):538-543. Epub 2019 Oct 30.

The Kirby Institute, University of New South Wales.

Objective: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison.

Methods: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken.

Results: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery.

Conclusion: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.
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http://dx.doi.org/10.1111/1753-6405.12941DOI Listing
December 2019

First diagnosis of psychosis in the prison: results from a data-linkage study.

BJPsych Open 2019 Oct 14;5(6):e89. Epub 2019 Oct 14.

Program Head, Justice Health Research Program, Kirby Institute, University of New South Wales, Australia.

Background: Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed.

Aims: Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison.

Method: This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison.

Results: Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception.

Conclusions: Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release.

Declaration Of Interest: None.
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http://dx.doi.org/10.1192/bjo.2019.74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854362PMC
October 2019

Disclosing sexuality: Gay and bisexual men's experiences of coming out, forced out, going back in and staying out of the 'closet' in prison.

Cult Health Sex 2020 11 9;22(11):1222-1234. Epub 2019 Oct 9.

The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

Many papers have been written on the process of coming out by individuals with predominantly same-sex sexual orientation but few of these papers have explored the concept of how people negotiate the idea of coming out in prison. We conducted in-depth interviews with 13 prisoners and one ex-prisoner in New South Wales, Australia, who self-identified as gay, homosexual or bisexual men. Data was collected and analysed using an inductive or grounded theory framework since very little was known on the sexual behaviours and identities of Australian prisoners prior to the study and elsewhere. We examined and discussed the lived experiences of prisoners whose disclosure stories were seen to fall under four thematic categories: 'coming out', 'forced out', 'going back in' and 'staying out of the closet' on entering prison. Respondents were required continuously and contextually to manage their sexual identities and disclosure to different audiences while incarcerated. Findings suggest that the prison environment and its attendant heteronormative values and hyper-masculine culture, apply significant pressure on gay and bisexual men on how to manage their sexual identities and disclose their sexuality in prison.
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http://dx.doi.org/10.1080/13691058.2019.1668963DOI Listing
November 2020

Best care options for older prisoners with dementia: a scoping review.

Int Psychogeriatr 2019 08;31(8):1081-1097

Centre for Dementia Research, Leeds Beckett University, Leeds, UK.

Introduction: The prisoner population is ageing, and consideration is needed for how to best support those with age-related health conditions in the system. Existing work practices and organizational structures often fail to meet the needs of prisoners with dementia, and prison staff experience high levels of burden because of the increased needs of these prisoners. Little is known about the best method of responding to the needs of this growing subpopulation of prisoners.

Method: A scoping review was conducted to answer the question: what are the perceived best care options for prisoners with dementia? To be included, publications had to be publicly available, reported on research findings, or viewed opinions and commentaries on care practices relevant to older prisoners with dementia. Searches were conducted in 11 databases to identify relevant publications. Data from the included publications were extracted and summarized into themes.

Results: Eight themes were identified that could support better care practices for prisoners with dementia: (1) early and ongoing screening for older prisoners; (2) specialized services; (3) specialized units; (4) programs or activities; (5) adaptations to current contexts; (6) early release or parole for older prisoners with dementia deemed at low risk of reoffending; and (7) training younger prisoners (8) as well as staff to assist older prisoners with dementia. Besides practical strategies improving care practice, costs, prison-specific resources, and staff skills were highlighted as care barriers across all themes. A lack of empirical evidence supported these findings.

Conclusion: One of the implications of the international ageing prison population is the higher number of people living with dementia being incarcerated. Suggestions for best care approaches for prisoners with dementia now need to move from opinion to empirical approaches to guide practice.
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http://dx.doi.org/10.1017/S1041610219000681DOI Listing
August 2019

Prison cell spatial density and infectious and communicable diseases: a systematic review.

BMJ Open 2019 07 23;9(7):e026806. Epub 2019 Jul 23.

Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

Objective: To summarise the extent and quality of evidence on the association between prison cell spatial density (a measure of crowding) and infectious and communicable diseases transmission among prisoners.

Design: Systematic review.

Data Sources: Embase, PubMed, Medline, Scopus, Web of Science, PsycINFO, PsycExtra, ProQuest Databases, ProQuest Dissertations and Theses Global, Index to Legal Periodicals, InformitOnline, Cochrane Library, Criminal Justice Abstracts and ICONDA were searched to 31 December 2018.

Eligibility Criteria: Studies that reported on the association between prison cell spatial density (measured in square feet or square metres of cell floor area per person) and infectious and communicable diseases in juvenile and adult populations incarcerated in a correctional facility.

Data Extraction And Synthesis: A review protocol was developed in consultation with an advisory panel. Two reviewers independently extracted data and used the Australian National Health and Medical Research Council's (NHMRC) checklist to critically appraise individual studies. An assessment of the overall body of the evidence was conducted using the NHMRC's Evidence Scale and Statement Form.

Results: A total of 5126 articles were initially identified with seven included in the review from Pakistan (2003), Chile (2016), Nigeria (2012, 2013) and the USA (1980s). Infectious and communicable disease outcomes included pneumococcal disease/acute pneumonia, , latent tuberculosis infection, infectious skin conditions and contagious disease reporting to the prison clinic. Five articles reported statistically significant positive associations but were countered by associations possibly being explained by chance, bias or confounding factors. Heterogeneity prevented meta-analysis.

Conclusion: Overall, the body of evidence provides some support for an association between prison cell special density and infectious and communicable diseases, but care should be taken in the interpretation and transferability of the findings. Future research and policy responses should adequately consider prospective mediating factors implicated in associations between cell spatial density and health effects.
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http://dx.doi.org/10.1136/bmjopen-2018-026806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661645PMC
July 2019

Developing Attributes and Attribute-Levels for a Discrete-Choice Experiment: An Example for Interventions of Impulsive Violent Offenders.

Appl Health Econ Health Policy 2019 10;17(5):683-705

National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women's and Children's, Health University of New South Wales Sydney, Level 1, AGSM Building, Botany Street, Randwick, Sydney, NSW, 2052, Australia.

Background: Discrete-Choice Experiments (DCEs) are used to assess the strength of preferences and value of interventions, but researchers using the method have been criticised for failing to either undertake or publish the rigorous research for selecting the necessary attributes and levels. The aim of this study was to elicit attributes to inform a DCE to assess societal and offenders' preferences for, and value of, treatment of impulsive-violent offenders. In doing so, this paper thoroughly describes the process and methods used in developing the DCE attributes and levels.

Methods: Four techniques were used to derive the final list of attributes and levels: (1) a narrative literature review to derive conceptual attributes; (2) seven focus group discussions (FGDs) comprising 25 participants including offenders and the general public and one in-depth interview with an offender's family member to generate contextual attributes; (3) priority-setting methods of voting and ranking to indicate participants' attributes of preference; (4) a Delphi method consensus exercise with 13 experts from the justice health space to generate the final list of attributes.

Results: Following the literature review and qualitative data collection, 23 attributes were refined to eight using the Delphi method. These were: treatment effectiveness, location and continuity of treatment, treatment type, treatment provider, voluntary participation, flexibility of appointments, treatment of co-morbidities and cost.

Conclusion: Society and offenders identified similar characteristics of treatment programs as being important. The mixed methods approach described in this manuscript contributes to the existing limited methodological literature in DCE attribute development.
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http://dx.doi.org/10.1007/s40258-019-00484-5DOI Listing
October 2019

Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing.

Aust N Z J Public Health 2019 Jun 17;43(3):241-247. Epub 2019 Apr 17.

Faculty of Medicine and Health, The University of Sydney, New South Wales.

Objective: To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison.

Methods: Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers.

Results: Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1).

Conclusions: Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.
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http://dx.doi.org/10.1111/1753-6405.12892DOI Listing
June 2019

The Prison and Transition Health (PATH) Cohort Study: Study Protocol and Baseline Characteristics of a Cohort of Men with a History of Injecting Drug Use Leaving Prison in Australia.

J Urban Health 2019 06;96(3):400-410

Behaviours and Health Risks Program, Public Health Discipline, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.

People who inject drugs (PWID) are disproportionately represented among individuals who experience imprisonment and often have more complex physical and mental health needs than people in prison without injecting histories. The trajectories of PWID after prison release are poorly understood, hampering the development of effective strategies to address their distinct health needs. The Prison and Transition Health (PATH) Cohort Study is characterising the post-release trajectories of incarcerated male PWID in Victoria, Australia. We outline study methodology and baseline characteristics of participants prior to their release. Four hundred participants were recruited from three prisons and completed researcher-administered baseline interviews covering socio-demographics, social supports, physical health, mental health, alcohol and other drug use, and pre-release and transitional service utilisation. The median age among participants was 36 years (IQR 30-42), and they reported a median of five (IQR 3-9) previous adult incarcerations. Almost half (49%) were reliant on government payments prior to incarceration. One quarter (25%) of participants reported removal from their parents' care as children and 64% reported being a parent or primary caregiver to children. Most participants (81%) reported a previous mental health diagnosis and 44% reported three or more diagnoses. The most common drugs injected prior to incarceration were crystal methamphetamine (80%) and heroin (62%), and most (85%) reported being under the influence of drugs at the time of committing offences for which they were currently incarcerated. Injecting drug use during their current sentence was reported by 40% of participants, and 48% reported engaging with some form of drug treatment during their current sentence. Study participants are characterised by significant mental health and substance use morbidities, social disadvantage and criminogenic histories that present challenges for the provision of post-release support services. Data from the PATH Cohort Study will help inform strategies to improve the health and social outcomes of this population.
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http://dx.doi.org/10.1007/s11524-019-00353-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565648PMC
June 2019

Justice targets in Closing the Gap: let's get them right.

Aust N Z J Public Health 2019 Jun 8;43(3):201-203. Epub 2019 Apr 8.

Griffith Criminology Institute, Griffith University, Queensland.

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http://dx.doi.org/10.1111/1753-6405.12896DOI Listing
June 2019

Correction: Automatic Extraction of Mental Health Disorders From Domestic Violence Police Narratives: Text Mining Study.

J Med Internet Res 2019 Apr 5;21(4):e13007. Epub 2019 Apr 5.

Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia.

[This corrects the article DOI: 10.2196/11548.].
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http://dx.doi.org/10.2196/13007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473208PMC
April 2019