Interned in Scotland. The Stobs Camp during the First World War

After the outbreak of war, civilians of Central Power nationality were declared ‘enemy aliens’ throughout the British Empire. Scotland serves as a representative case history to analyse patterns of public Germanophobia, ethnic minority displacement, internment, and repatriation. The Stobs camp in the Scottish Borders region was one of the biggest camps in the Empire. Internees were affected by the depressive ‘barbed wire disease’ and organised a plethora of activities. Those who were repatriated faced destitution in Germany. Neither in Britain nor in Germany have they been included in remembrance cultures. Within wider debates about the totalisation of warfare during World War I, the article takes on a global perspective to argue in favour of a stronger emphasis on civilian suffering.

‘Enemy aliens’ in wartime:civilian internment in South Africa during World War I

This article explores the previously neglected history of civilian internment in South Africa during World War I. German, Austro-Hungarian and Turkish nationals were classified as ‘enemy aliens’. They included mostly male immigrants, but also several hundred women and children deported from Sub-Saharan colonial contact zones. The main camp was Fort Napier in Pietermaritzburg, holding around 2,500. Based on sources in South African, German and British archives, this multi-perspectival enquiry highlights the salience of the South African case and integrates it into wider theoretical questions and arguments. The policy of civilian internment was rolled out comprehensively throughout the British Empire. Not least lessons learnt from the South African War (1900-1902), when Britain had been widely criticised for harsh conditions in its camps, led to relatively humane prisoner treatment. Another mitigating factor were the pro-German sympathies of the Afrikaner population. Nevertheless, suffering occurred through isolation and deportation. Remembering the First World War mainly as a ‘’soldiers’ war��� on the Western Front generates too narrow a picture. Widening the lens on civilians of both sexes in overseas territories supports notions of war totalisation.

Restrictions on Aliens in the United Kingdom, 1914-1919 : a Study of the Origins and Political Background of the Aliens Restrictions Acts of 1914 and 1919.

At first glance the Aliens Restriction Act of 1914, which was introduced and passed on the first day of World War One, seems a hasty and ill-prepared piece of legislation. Actually, when examined in the light of Arthur Marwick's thesis that war is a forcing house for pre-existent social and governmental ideas, it becomes clear that the act was not after all the product of hastily formed notions. In point of fact it followed the precedent of detailed draft clauses produced in 1911 by a sub-committee of the Committee of Imperial Defence established to consider the treatment of aliens in the event of war. Indeed the draft clauses and the restrictions embodied in the 1914 act were strikingly similar to restrictions on aliens legislated in 1793. Hostility to aliens had been growing from 1905 to 1914 and this hostility blossomed into xeno-phobia on the outbreak of war, a crucial precondition for the specifically anti-enemy fears of the time. In 1919 the Aliens Restriction (Amendment) Bill was introduced into parliament to extend temporarily the provisions of the 1914 act thus permitting the Home Secretary to plan permanent, detailed legislation. Two minority groups of MPs with extreme views on the treatment of aliens were prominent in the debates on this bill. The extreme Liberal group which advocated leniency in the treatment of aliens had little effect on the final form of the bill, but the extreme Conservative group, which demanded severe restrictions on aliens, succeeded in persuading the government to include detailed restrictions. Despite its allegedly temporary nature, the Aliens Restriction (Amendment) Act of 1919 was renewed annually until 1971.

The History of Arsaces, Prince of Betlis

Recounting the eventful travels of Selim, an intrepid young Arab who runs away from his parental home to learn about the world, The History of Arsaces, Prince of Betlis (1774) by the Co. Limerick-born Charles Johnston (c.1719–c.1800) is an inventive mixture of fictional genres and styles: romance, satire, sentimental narrative and oriental fantasy. The novel appeared at a politically charged moment, on the eve of the American revolutionary war and in the aftermath of the Bengal famine of 1769–70, world events that were linked by the nefarious operations of the ubiquitous East India Company. These momentous occurrences, polarising public opinion and stimulating Irish patriot sympathies in the mid-70s, provide the undercurrent to Johnston’s thoughtful examination of war, commerce, and empire through the lens of a fictional ‘history’. Enclosing a series of tales within tales, Johnston’s oriental romance offers its readers a remarkable concoction of Gulliver-inspired fantasy, political satire and moral reflection, played out within an expansive historical and geographical setting. As the Monthly Review, or, Literary Journal commented on its first appearance in 1774, The History of Arsaces provided ‘striking intimations, of the utmost national importance, with respect to over-grown empire, and colony connexions’.

The Janus-faced City: A Sensory History of the London Blitz 1940–1941

The city of London was, during the years of 1940–1941, a city under fire. The metropolis seemed to have two faces, like the Roman deity Janus: the face of the daylight hours, so normal, and yet so deceiving in its false quietness – and at nightfall, the city turned, and the face of it was the face of the devil himself, transforming London into a living inferno. This thesis examines the sensescapes of the Blitz, through the diaries and memoirs written of that time. The primary sources consist of seven different diaries, two autobiographies, and four research volumes that contain multiple diary- and memoire entries, mostly from the Mass Observation Archives and from the Imperial War Museum. The sensory approach is a new orientation in the field of history – it studies the five senses in their cultural contexts, interpreting the often subtle ways in which the senses affect into society, politics, culture, and class hierarchies, to name only but few. The subject of the sensory history of war is a theme widely unexamined: this thesis contributes to this frontier field by unveiling the sensorium of the London bombings, comparing the differences between the halves of nychtemeron, and examining how the Blitz was communicated by the writers as a lived, bodily experience. This study reveals the very different sensory worlds in which the Londoners lived, during a time that is often described with the mythical solidarity that was thought to exist between the people. The reality of the homeless, working class, and poor were in the foul smelling tubes, poor law -dated rations, and in the smoking ruins of East End – the contrast was massive reflecting it to the luxury hotels and restaurants of the upper classes, opportunities for evacuation, sheltering possibilities, and overall comforts of life.

CIVIL WAR SETTLEMENTS AND COMBATANTS’ BEHAVIORS: STRATEGY, PERCEPTION, AND REPUTATION

Three projects in my dissertation focus on the termination of internal conflicts based on three critical factors: a combatant’s bargaining strategy, perceptions of relative capabilities, and reputation for toughness. My dissertation aims to provide the relevant theoretical framework to understand war termination beyond the simple two-party bargaining context. The first project focuses on the government’s strategic use of peace agreements. The first project suggests that peace can also be designed strategically to create a better bargain in the near future by changing the current power balance, and thus the timing and nature of peace is not solely a function of overcoming current barriers to successful bargaining. As long as the government has no overwhelming capability to defeat all rebel groups simultaneously, it needs to keep multiple rebel groups as divided as possible. This strategic partial peace helps to deter multiple rebel groups from collaborating in the battlefield and increases the chances of victory against non-signatories. The second project deals with combatants’ perceptions of relative capabilities. While bargaining theories of war suggest that war ends when combatants share a similar perception about their relative capabilities, combatants’ perceptions about relative capabilities are not often homogeneous. While focusing on information problems, this paper examines when a rebel group underestimates the government’s supremacy in relative capabilities and how this heterogeneous perception about the power gap influences negotiated settlements. The third project deals with the tension between different types of reputations in the context of civil wars: 1) a reputation for resolve and 2) a reputation for keeping human rights standards. In the context of civil wars, the use of indiscriminate violence by the government is costly, and as such, it signals the government’s toughness (or resolve) to rebel groups. I argue that the rebels are more likely to accept the government’s offer when the government recently engaged in indiscriminate violence against civilians during the conflict. This effect, however, is conditional on the government’s international human rights reputation; suggesting that rebel groups interpret this violence as a signal particularly when the government does not have a penchant for attacking civilians in general.

Warfare in the West Highlands and Isles of Scotland, c. 1544-1615

Warfare has long been associated with Scottish Highlanders and Islanders, especially in the period known in Gaelic tradition as ‘Linn nan Creach’ (the ‘Age of Forays’), which followed the forfeiture of the Lordship of the Isles in 1493. The sixteenth century in general is remembered as a particularly tumultuous time within the West Highlands and Isles, characterised by armed conflict on a seemingly unprecedented scale. Relatively little research has been conducted into the nature of warfare however, a gap filled by this thesis through its focus on a series of interconnected themes and in-depth case studies spanning the period c. 1544-1615. It challenges the idea that the sixteenth century and early seventeenth century was a time of endless bloodshed, and explores the rationale behind the distinctive mode of warfare practised in the West Highlands and Isles. The first part of the thesis traces the overall ‘Process of War���. Chapter 1 focuses on the mentality of the social elite in the West Highlands and Isles and demonstrates that warfare was not their raison d'être, but was tied inextricably to chiefs’ prime responsibility of protecting their lands and tenants. Chapter 2 assesses the causation of warfare and reveals that a recurrent catalyst for armed conflict was the assertion of rights to land and inheritance. There were other important causes however, including clan expectation, honour culture, punitive government policies, and the use of proxy warfare by prominent magnates. Chapter 3 takes a fresh approach to the military capacity of the region through analysis of armies and soldiers, and the final thematic chapter tackles the conduct of warfare in the West Highlands and Isles, with analysis of the tactics and strategy of militarised personnel. The second part of this thesis comprises five case studies: the Clanranald, 1544-77; the Colquhouns of Luss and the Lennox, 1592-1603; the MacLeods of Harris and MacDonalds of Sleat, 1594-1601; the Camerons, 1569-1614; and the ‘Islay Rising’, 1614-15. This thesis adopts a unique approach by contextualising the political background of warfare in order to instil a deeper understanding of why early modern Gaelic Scots resorted to bloodshed. Overall, this period was defined by a sharp rise in military activity, followed by an even sharper decline, a trajectory that will be evidenced vividly in the final case study on the ‘Islay Rising’. Although warfare was widespread, it was not unrestrained or continuous, and the traditional image of a region riven by perpetual bloodshed has been greatly exaggerated.

Clouds of Suspicion: Airspace Arrangements, Escalation, and Discord in U.S./NATO-Russian Relations

How have cooperative airspace arrangements contributed to cooperation and discord in the Euro-Atlantic region? This study analyzes the role of three sets of airspace arrangements developed by Euro-Atlantic states since the end of the Cold War���(1) cooperative aerial surveillance of military activity, (2) exchange of air situational data, and (3) joint engagement of theater air and missile threats—in political-military relations among neighbors and within the region. These arrangements provide insights into the integration of Central and Eastern European states into Western security institutions, and the current discord that centers on the conflict in Ukraine and Russia’s place in regional security. The study highlights the role of airspace incidents as contributors to conflict escalation and identifies opportunities for transparency- and confidence-building measures to improve U.S./NATO-Russian relations. The study recommends strengthening the Open Skies Treaty in order to facilitate the resolution of conflicts and improve region-wide military transparency. It notes that political-military arrangements for engaging theater air and missile threats created by NATO and Russia over the last twenty years are currently postured in a way that divides the region and inhibits mutual security. In turn, the U.S.-led Regional Airspace Initiatives that facilitated the exchange of air situational data between NATO and then-NATO-aspirants such as Poland and the Baltic states, offer a useful precedent for improving air sovereignty and promoting information sharing to reduce the fear of war among participating states. Thus, projects like NATO’s Air Situational Data Exchange and the NATO-Russia Council Cooperative Airspace Initiative—if extended to the exchange of data about military aircraft—have the potential to buttress deterrence and contribute to conflict prevention. The study concludes that documenting the evolution of airspace arrangements since the end of the Cold War contributes to understanding of the conflicting narratives put forward by Russia, the West, and the states “in-between” with respect to reasons for the current state of regional security. The long-term project of developing a zone of stable peace in the Euro-Atlantic must begin with the difficult task of building inclusive security institutions to accommodate the concerns of all regional actors.

Pytanie o pamięć. Relacje autobiograficzne więźniów obozów koncentracyjnych

This book consists of two main parts. The first part offers a basic methodological introduction, presenting a concise but multifaceted overview of current problems of collective memory. The second part contains a set of interviews with former prisoners of concentration camps carried out by the authors. The research was conducted by Paweł Greń and Łukasz Posłuszny and focuses on issues of collective and cultural memory illustrated by individual life experiences of concentration camps prisoners. The field of oral history serves as the framework of analysis and narrative inquiry as its research tool. Interviews and additional research materials were collected by the authors and are not available in previous publications, making this work a precious supplement to the current scholarly body of knowledge and achievements in the discipline of memory studies. According to the authors, current historical and literary publications provide an incomplete picture of the WWII and its aftermaths for survivors, because descriptions of the war and imprisonment in the camp play still a dominate role in narratives. The importance of these issues in autobiographies is unquestionable and highly needed to create a common identity among generation of prisoners, though authors often wanted to perceive the fate of individuals in a broader perspective – including the periods before and after the war. Hence, interviews stressed personal experiences and their understanding over time by former prisoners. The interviews covered many topics on life before, during and after the camp – among them daily and neutral routines, but also difficult matters. The latter were connected on the one hand with traumatic events or harsh memories and emotions, and on the other hand with less extensively highlighted threads of prisoners’ lives - such as issues of the body and sexuality – and their dependence on particular representation or narrative. The authors are convinced that the book serves not only as a record of past remembered by eyewitnesses, but it also depicts their accounts in wider contexts and discourses, which expose specific dimensions of told and written stories. In the book Questions for Memory one examine the approach proposed by young scholars. Interviews were conducted from 2009-2011, seventy years after the end of the second world war, and this initiative was the result of questions and doubts of the authors from the existing literature. They also wanted to use the unique opportunity to meet with eyewitnesses and record their stories, because when they pass away we will irretrievably lose the possibility to listen to them and to pose sensitive questions. The majority of the interviewees were prisoners of KL Auschwitz-Birkenau, and their experiences differed greatly from each other based on social background and specific experience in the camps as well as their post-camp and postwar life. Aside from persons whose stories are already well known and open, readers will hear the stories of those who spoke only reluctantly and very rarely, or who had remained silent until the present author’s research. Qualitative differences between interviews occurred on the level of established relationship and atmosphere of trust, which varied according to circumstances and individual character and personality. For P. Greń and Ł. Posłuszny, each interviewed person is equally and highly valued due to the collected material and the personal experience of the meetings. Among the ten interviews placed in the book, seven of them are the stories told by women. Their testimonies exemplify realities of everyday prisoners’ existence and gravitate towards mirroring specifically feminine perspectives of imprisonment. For women, crucial problems stemmed from experiences of body that intertwine with suffering, feeling of shame and humiliation. Early discussions on holocaust literature and issues of representation that shaped the Polish narrative and collective memory imposed imperatives of silence on certain topics. A solution for reconciling heroic and inhuman deeds in stories with completely human physiology was impossible and improper for many years. There were also questions about life after, ways of dealing with a trauma or reflections on the present time. During conversations the authors attempted to come closer to something distant and incomprehensible for their generation and for people who did not experience the camps. Despite the fact that there have been seventy years of dealing with these events in literature, art, drama, film, memoirs and scientific works, the past still breeds more questions than answers. The book Questions for Memory serves as an example of this phenomenon.

The symbolic, socio-economic and exchange value of Imperial German and National Socialist medals and badges, 1701 to the present

This thesis examines the manufacture, use, exchange (including gift exchange), collecting and commodification of German medals and badges from the early 18th century until the present-day, with particular attention being given to the symbols that were deployed by the National Socialist German Workers’ Party (NSDAP) between 1919 and 1945. It does so by focusing in particular on the construction of value through insignia, and how such badges and their symbolic and monetary value changed over time. In order to achieve this, the thesis adopts a chronological structure, which encompasses the creation of Prussia in 1701, the Napoleonic wars and the increased democratisation of military awards such as the Iron Cross during the Great War. The collapse of the Kaiserreich in 1918 was the major factor that led to the creation of the NSDAP under the eventual strangle-hold of Hitler, a fundamentally racist and anti-Semitic movement that continued the German tradition of awarding and wearing badges. The traditional symbols of Imperial Germany, such as the eagle, were then infused with the swastika, an emblem that was meant to signify anti-Semitism, thus creating a hybrid identity. This combination was then replicated en-masse, and eventually eclipsed all the symbols that had possessed symbolic significance in Germany’s past. After Hitler was appointed Chancellor in 1933, millions of medals and badges were produced in an effort to create a racially based “People’s Community”, but the steel and iron that were required for munitions eventually led to substitute materials being utilised and developed in order to manufacture millions of politically oriented badges. The Second World War unleashed Nazi terror across Europe, and the conscripts and volunteers who took part in this fight for living-space were rewarded with medals that were modelled on those that had been instituted during Imperial times. The colonial conquest and occupation of the East by the Wehrmacht, the Order Police and the Waffen-SS surpassed the brutality of former wars that finally culminated in the Holocaust, and some of these horrific crimes and the perpetrators of them were perversely rewarded with medals and badges. Despite Nazism being thoroughly discredited, many of the Allied soldiers who occupied Germany took part in the age-old practice of obtaining trophies of war, which reconfigured the meaning of Nazi badges as souvenirs, and began the process of their increased commodification on an emerging secondary collectors’ market. In order to analyse the dynamics of this market, a “basket” of badges is examined that enables a discussion of the role that aesthetics, scarcity and authenticity have in determining the price of the artefacts. In summary, this thesis demonstrates how the symbolic, socio-economic and exchange value of German military and political medals and badges has changed substantially over time, provides a stimulus for scholars to conduct research in this under-developed area, and encourages collectors to investigate the artefacts that they collect in a more historically contextualised manner.

Veteranness : Representations of Combat-related PTSD in U.S. Popular Visual Media

Posttraumatic stress and PTSD are becoming familiar terms to refer to what we often call the invisible wounds of war, yet these are recent additions to a popular discourse in which images of and ideas about combat-affected veterans have long circulated. A legacy of ideas about combat veterans and war trauma thus intersects with more recent clinical information about PTSD to become part of a discourse of visual media that has defined and continues to redefine veteran for popular audiences. In this dissertation I examine realist combat veteran representations in selected films and other visual media from three periods: during and after World Wars I and II (James Allen from I Am a Fugitive from a Chain Gang, Fred Derry and Al Stephenson from The Best Years of Our Lives); after the Vietnam War (Michael from The Deer Hunter, Eriksson from Casualties of War), and post 9/11 (Will James from The Hurt Locker, a collection of veterans from Wartorn: 1861-2010.) Employing a theoretical framework informed by visual media studies, Barthes’ concept of myth, and Foucault’s concept ofdiscursive unity, I analyze how these veteran representations are endowed with PTSD symptom-like behaviors and responses that seem reasonable and natural within the narrative arc. I contend that veteran myths appear through each veteran representation as the narrative develops and resolves. I argue that these veteran myths are many and varied but that they crystallize in a dominant veteran discourse, a discursive unity that I term veteranness. I further argue that veteranness entangles discrete categories such as veteran, combat veteran, and PTSD with veteran myths, often tying dominant discourse about combat-related PTSD to outdated or outmoded notions that significantly affect our attitudes about and treatment of veterans. A basic premise of my research is that unless and until we learn about the lasting effects of the trauma inherent to combat, we hinder our ability to fulfill our responsibilities to war veterans. A society that limits its understanding of posttraumatic stress, PTSD and post-war experiences of actual veterans affected by war trauma to veteranness or veteran myths risks normalizing or naturalizing an unexamined set of sociocultural expectations of all veterans, rendering them voice-less, invisible, and, ultimately disposable.

"To Hold the World in Contempt": The British Empire, War, and the Irish and Indian Nationalist Press, 1899-1914

The era between the close of the nineteenth century and the onset of the First World War witnessed a marked increase in radical agitation among Indian and Irish nationalists. The most outspoken political leaders of the day founded a series of widely circulated newspapers in India and Ireland, placing these editors in the enviable position of both reporting and creating the news. Nationalist journalists were in the vanguard of those pressing vocally for an independent India and Ireland, and together constituted an increasingly problematic contingent for the British Empire. The advanced-nationalist press in Ireland and the nationalist press in India took the lead in facilitating the exchange of provocative ideas—raising awareness of perceived imperial injustices, offering strategic advice, and cementing international solidarity. Irish and Indian press coverage of Britain’s imperial wars constituted one of the premier weapons in the nationalists’ arsenal, permitting them to build support for their ideology and forward their agenda in a manner both rapid and definitive. Directing their readers’ attention to conflicts overseas proved instructive in how the Empire dealt with those who resisted its policies, and also showcased how it conducted its affairs with its allies. As such, critical press coverage of the Boxer Rebellion, Boer War, Russo-Japanese War, and World War I bred disaffection for the Empire, while attempts by the Empire to suppress the critiques further alienated the public. This dissertation offers the first comparative analysis of the major nationalist press organs in India and Ireland, using the prism of war to illustrate the increasingly persuasive role of the press in promoting resistance to the Empire. It focuses on how the leading Indian and Irish editors not only fostered a nationalist agenda within their own countries, but also worked in concert to construct a global anti-imperialist platform. By highlighting the anti-imperial rhetoric of the nationalist press in India and Ireland and illuminating their strategies for attaining self-government, this study deepens understanding of the seeds of nationalism, making a contribution to comparative imperial scholarship, and demonstrating the power of the media to alter imperial dynamics and effect political change.

The birth of a tragic hero(ine) On tragic excess in contemporary theatre

The idea of the tragic is unthinkable. It is precisely within the moment in which an ordinary human being, a heroine or a hero – incapable of scrutinizing fully their own position within the whole – is invited to respond, to accept or refuse it all, that the tragic unfolds, changing their life irremediably. What are the causes and the consequences of "god’s arrival", as in case of Dionysus who visits Pentheus’ home in Euripides’ "The Bacchae"? Through episodes in the stories of characters from Ancient Greek dramas – such as Oedipus, Antigone, Ajax, Io, through Dostoevsky’s or Kafka’s imagery, in Prince Myshkin’s, the Ridiculous Man’s or Gregor Samsa’s experiences, this doctoral research proposes to examine the aspects which compete in the creation of a tragic hero. Theatrical performances – such as Jan Fabre’s "Mount Olympus: To Glorify the Cult of Tragedy, a 24-Hour Performance", immersed in a cycle of life, death and re-birth; Oliver Frljić’s "Trilogija o hrvatskom fašizmu", in its careful analysis of the wounds of a heritage of war; and Cristian Ceresoli’s and Silvia Gallerano’s tragic testimony of an estranged, almost soulless body in "La Merda" – open up the dialogue on our contemporary idea of the tragic. This doctoral work chooses excess as its privileged channel through which to approach the concept of the tragic – by its nature elusive, hostile to any definition, strictly personal and, thus, visible only through one’s own lens. In an excess of pain, devotion, desire, rage, arrogance or beauty, opposites collide, time concentrates into a moment and the hero is invited to choose, to live or die, to transform.

Entre mortificações e resistências : a saúde e o psicotrópico no sistema prisional

A saúde e o uso do psicotrópico no sistema prisional habitam um paradoxo. O sistema penitenciário, nas últimas décadas, passou por algumas transformações. No mundo, as estatísticas apontam crescimento populacional carcerário e prisões superlotadas, em condições precárias. No Brasil, a situação não é diferente: em 10 anos a população prisional brasileira duplicou e as condições de confinamento são paupérrimas, o que acaba contribuindo para a prevalência de doenças infectocontagiosas. Diante desta realidade, em 2003 homologou-se o Plano Nacional de Saúde no Sistema Penitenciário (PNSSP) que, em consonância com os princípios do Sistema Único de Saúde, visa garantir a integralidade e a universalidade de acesso aos serviços de saúde para a população penitenciária. O estado do Espírito Santo aderiu ao PNSSP e formulou o Plano Operativo Estadual de Atenção Integral à Saúde da População Prisional (2004), contudo, foi a partir de 2010 que se efetivou o acesso aos serviços de saúde prisional capixaba. Neste contexto, a pesquisa de mestrado buscou investigar as práticas de saúde no sistema prisional e as formas de usos do psicotrópico por presos da Penitenciária de Segurança Máxima II (PSMA II), localizada no Complexo Penitenciário de Viana, Espírito Santo. Para tanto, foi necessário habitar o sistema penitenciário capixaba e realizar entrevistas semiestruturadas com profissionais da gestão de saúde prisional da Secretaria Estadual de Justiça do Espírito Santo, com profissional da área da medicina psiquiátrica e com presos da PSMA II. Dessa forma, foi possível observar que a saúde no sistema penitenciário, bem como os usos do psicotrópico, encontram-se em um espaço poroso. As práticas de saúde podem fortalecer estratégias de controle e produzir mortificação, como podem escapar dos investimentos biopolíticos e produzir resistência. O uso do medicamento psicotrópico por sujeitos privados de liberdade encontra-se nessa mesma ambivalência: podem servir como instrumentos regularizadores de captura, como podem produzir autonomia nas suas formas de uso pelos presos. Por fim, entre mortificações e resistências, afirma-se que é o próprio preso que administrará os tensionamentos desse paradoxo e irá produzir vida, potência de vida.

Tuberculose na população privada de liberdade: características clínicas e epidemiológicas relacionadas à doença

Introdução: Há cerca de duas décadas, a tuberculose (TB) foi considerada pela Organização Mundial de Saúde (OMS) como uma doença em estado de emergência em todo o mundo. Atualmente, apesar de todas as ações de controle da doença, ainda trata-se de um importante problema de saúde pública, apresentando forte relação com questões socioeconômicas, o que acarreta no maior adoecimento em grupos específicos, tais como a população privada de liberdade. Os dados de tuberculose em populações vulneráveis podem atingir índices ainda mais altos e por isso preocupante. Objetivos: Analisar as características clínicas e epidemiológicas associadas com os desfechos do tratamento da tuberculose na população privada de liberdade do Brasil, registrado no Sistema de Informação de Agravos de Notificação (SINAN), de 2007 a 2011; conhecer a taxa de incidência e de mortalidade por tuberculose na população privada de liberdade do Espírito Santo, de julho de 2009 a julho de 2010; e identificar as características clínicas e epidemiológicas dos casos diagnosticados de tuberculose na população privada de liberdade do Espírito Santo, de julho de 2009 a julho de 2010. Métodos: A população do estudo consistiu em presos diagnosticados com tuberculose identificados através do SINAN, entre janeiro de 2007 e dezembro de 2011 e dos casos diagnosticados de tuberculose na população prisional do Espírito Santo no período de 1º de julho de 2009 a 30 de junho de 2010. O teste de qui-quadrado de Pearson e o modelo de regressão polinomial foram utilizados na analise, além de estatística descritiva, por meio de tabelas e gráficos. Resultados: Em relação pacientes com TB na população privada de liberdade do Brasil, nota-se que os presos que abandonaram o tratamento eram mais jovens (P <0,001), com menor escolaridade (P <0,001) e maior probabilidade de alcoolismo (P < 0,001), eram mais propensos a ter TB recorrente ou recidiva (P < 0,001) e eles não estavam sob tratamento diretamente observado (TDO) (P < 0,001), comparados com aqueles que completaram o tratamento da tuberculose. Aqueles que morreram de tuberculose tendem a ter idade ⩾ 43 anos (P < 0,001) e alcoolistas (P < 0,001), também eram mais propensos a tipo de tratamento desconhecido (P <0,001) e apresentar tuberculose pulmonar e tuberculose extrapulmonar (TBEP). Presos que desenvolveram tuberculose multidroga resistente (TB-MDR) foram mais propensos a 9 experiência de recorrência de TB, retorno após abandono e transferência de local de tratamento. Além disso, observou-se 167 casos de tuberculose (taxa de incidência de 1962,6 por 100 mil presos) no Espírito Santo. O sexo masculino apresentou maior número de pacientes, assim como a faixa etária de 25 a 36 anos e a forma clínica pulmonar. Destaca-se que 109 (65,3%) pacientes tiveram alta por cura, ocorrendo dois óbitos durante o período, sendo a taxa de mortalidade por tuberculose de 11,7 por 100 mil presos. A maior incidência da tuberculose foi em pacientes localizados nas unidades prisionais da Região Metropolitana e um pequeno número de casos ocorreu em outros locais externos às unidades prisionais. Conclusão: Nossos resultados destacam a necessidade de melhorar as políticas de controle da TB nas penitenciárias, bem como os desfechos do tratamento de presos a fim de impedir a transmissão para outros presos, seus familiares e profissionais de saúde.