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The United States has a rapidly aging prison population with complex medical comorbidities. Medical parole has been proposed as a mechanism to address the heavy medical burden posed by the aging and chronically ill prison population. Current studies demonstrate medical parole is underutilized, but little is known about the factors considered when rendering a medical parole decision. The aim of this study was to describe the characteristics of medical parole applications in Massachusetts and identify predictors of the final parole decision. We conducted a retrospective review of 31 applications submitted by a non-profit legal services organization between 2022 and 2023. Univariate analysis demonstrated that a supportive superintendent recommendation and prison-contracted clinician assessment that an applicant could not perform ADLs independently were statistically significant factors in approval of medical parole. Unexpectedly, a history of disciplinary action while incarcerated was also associated with a higher likelihood of application approval, suggesting prior disciplinary action does not decrease the chances of a successful parole application. Our study suggests the superintendent and prison medical clinicians are key stakeholders with influence on the likelihood of approval of a medical parole application. Further work is needed to assess parole board decision-making when evaluating applications.

Background There are roughly 6,000 individuals incarcerated in the Massachusetts Department of Corrections (MADOC), and in 2025, 32% of these individuals were age 50 and older. Older incarcerated individuals have a higher burden of chronic disease, and caring for them is associated with higher healthcare costs. In 2018, Massachusetts passed legislation enabling medical parole, a process by which an individual can be released due to terminal illness or permanent incapacitation. Existing literature suggests medical parole is underutilized. The aim of this study was to characterize the cause of death of individuals in MADOC custody to determine potential medical parole eligibility and gaps in referrals. Methods We conducted a retrospective analysis of deaths of individuals in MADOC custody between 2021 and 2023 using death records obtained from MADOC and death certificates from the Massachusetts Vital Statistics Program. Cause of death was categorized through structured review of death certificates and supplemental MADOC medical documentation. Results Between January 1, 2021 and December 31, 2023, 87 individuals died in MADOC custody. The primary disease processes leading to death involved infection (28%), complications of chronic disease (25%), and cancer (22%). Nearly half (41.7%) of infection-related deaths were due to COVID-19. The most common causes of death categorized by primary organ system were cardiovascular conditions (26%) and respiratory conditions (25%). The majority of deaths were attributed to acute causes (58%). Conclusions In our study, nearly half of the population died in custody from a chronic condition or complications related to a chronic condition and could have been identified for medical parole eligibility. The majority of individuals died from acute causes, suggesting the need for an expedited review process and expanded eligibility criteria. A small number of correctional facilities and hospitals saw the majority of deaths, and these locations may be ideal targets for future interventions. Further work is needed to compare death data before and after the COVID-19 pandemic, assess barriers to utilization of medical parole, and explore other interventions to decrease the number of deaths in MADOC custody.

As of March 2021, coronavirus disease (COVID-19) had led to >500,000 deaths in the United States, and the state of Tennessee had the fifth highest number of cases per capita. We reviewed the Tennessee Department of Health COVID-19 surveillance and chart-abstraction data during March 15‒August 15, 2020. Patients who died from COVID-19 were more likely to be older, male, and Black and to have underlying conditions (hereafter comorbidities) than case-patients who survived. We found 30.4% of surviving case-patients and 20.3% of deceased patients had no comorbidity information recorded. Chart-abstraction captured a higher proportion of deceased case-patients with >1 comorbidity (96.3%) compared with standard surveillance deaths (79.0%). Chart-abstraction detected higher rates of each comorbidity except for diabetes, which had similar rates among standard surveillance and chart-abstraction. Investing in public health data collection infrastructure will be beneficial for the COVID-19 pandemic and future disease outbreaks.

AbstractPatients in custody due to arrest or incarceration are a vulnerable population that present a unique ethical and logistical challenge for emergency physicians (EPs). People incarcerated in the United States have a constitutional right to health care. When caring for these patients, EPs must balance their ethical obligations to the patient with security and safety concerns. They should refer to their institutional policy for guidance and their local, state, and federal laws, when applicable. Hospital legal counsel and risk management also can be helpful resources. EPs should communicate early and openly with law enforcement personnel to ensure security and emergency department staff safety is maintained while meeting the patient's medical needs. Physicians should consider the least restrictive restraints necessary to ensure security while allowing for medical evaluation and treatment. They should also protect patient privacy as much as possible within departmental constraints, promote the patient's autonomous medical decision‐making, and be mindful of ways that medical information could interact with the legal system.

[This corrects the article DOI: 10.1002/emp2.13143.].

BackgroundPrevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in China; however, awareness and knowledge of NAFLD is lacking among the Chinese public.AimsWe investigated knowledge about NAFLD and the impact of a brief educational seminar among office employees in Beijing.MethodsEducational seminar on knowledge about NAFLD and recommendations on diet and physical activity and a pre- and a post-survey in 8 offices in Beijing.ResultsA total of 420 participants (24.7% with a diagnosis of NAFLD) completed both the pre- and post-surveys. Median age was 42, 39.1% were men, 93.9% participants had some college education, 50.5% were overweight/obese, and 74.9% were inactive/minimally active. Only 31.2% had awareness of NAFLD. Median baseline knowledge score (of a total of 25) was 17 in participants with and 16 in those without a diagnosis of NAFLD. After the seminar, 30.9% of participants with and 50.8% without a diagnosis of NAFLD increased their knowledge score by ≥ 3 points, and 92.9% indicated they will improve their diet and physical activity. Multivariate logistic regression analyses found baseline knowledge score was associated with personal diagnosis of NAFLD and family history of dyslipidemia while improvement in knowledge was associated with lower baseline knowledge score and absence of a personal diagnosis of NAFLD.ConclusionWe found a high prevalence but a low awareness of NAFLD among office employees in Beijing. A brief educational seminar improved knowledge about NAFLD and motivated lifestyle changes. More educational efforts are needed to decrease the burden of NAFLD in China.

The purpose of the current study was to determine if Dallas-Fort Worth Chinese heritage church congregants preferred particular servant leadership dimensions based on their generation and cultural backgrounds. The current study was a non-experimental quantitative design utilizing convenience sampling with 289 participants. A modified version of the Servant Leadership Questionnaire was used to measure Chinese heritage church congregants’ preference for servant leadership, while the perception of and preference for power distance and collectivism were measured with the GLOBE survey. ANOVA tests looking at servant leadership based on generations found Generation Z had a significantly higher preference than Generation X and millennials for Creating Value for the Community, and Generation Z had a significantly higher preference than Generation X for Helping Followers Grow and Succeed. Generation Z had a lower preference for institutional collectivism than boomers. ANOVAs examining culture found that American-raised Chinese had a higher preference than overseas-born Chinese from China for Behaving Ethically, while American-born Chinese had a lower mean perception of power distance than overseas-born Chinese from China. Pearson’s r correlations indicated significant negative relationships between preference for the servant leadership dimensions Creating Value for the Community and Conceptual Skills and preference for power distance. Significant positive relationships were found between the preference for institutional collectivism and preference for the servant leadership dimension Putting Followers First, and the perception of and preference for in-group collectivism and preference for the servant leadership dimensions of Emotional Healing, Conceptual Skills, Helping Followers Grow and Succeed, Putting Followers First, Behaving Ethically, and overall servant leadership. The results suggest that preference for collectivism is the best predictor of how Chinese heritage church congregants prefer the servant leadership dimensions instead of generation or cultural background.

BackgroundDespite high prevalence of nonalcoholic fatty liver disease in China, understanding of the disease appears to be low.AimsWe assessed the knowledge of NAFLD among the public in Beijing, China, as well as diet and physical activity patterns, which may provide information useful for NAFLD prevention and management.MethodsWe surveyed adult patients and family members in the Peking University Health Science Center (PUHSC) ultrasound clinic and office staff in Beijing, China. Participants provided demographic and medical history data. NAFLD-related knowledge and diet and physical activity were assessed.ResultsA total of 1296 participants at the PUHSC clinic (51% female, median age 35, 61% college-educated) and 494 participants in offices (61% female, median age 43, 74% college-educated) completed the survey. Response rate was 68.4% and 96.7%, respectively. In clinic and offices, 44% versus 48% were overweight/obese, 5% had a history of diabetes in both groups, and 14% versus 23% had a personal history of NAFLD. Median knowledge score was 15 out of 25 in clinic versus 16 in offices. 44.9% reported minimal physical activity. Factors associated with higher NAFLD knowledge scores (> 16) on multivariate analysis included college education or higher (OR 1.7, p = 0.01), family history of hyperlipidemia (OR 1.96, p < 0.001), and number of sugary drinks per week (OR 0.74, p = 0.006). No factors were significantly associated with physical activity levels.ConclusionsAdults in Beijing had low knowledge about NAFLD, and most were not physically active. Programs to increase public awareness of NAFLD and promote physical activity are critical to curb this growing epidemic.