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PubMed2005

An outbreak of hepatitis A among homeless drug users in Rotterdam, The Netherlands.

From the end of January to mid-June 2004 (weeks 5-24) a hepatitis A virus (HAV) outbreak occurred among a homeless and drug user community in Rotterdam, The Netherlands. To prevent further spread of the virus within this group and to the general population, the Municipal Health Service of Rotterdam organized a mass vaccination campaign during which 83% (1,515/1,800) of the homeless people were vaccinated. As part of a national HAV typing study, blood and/or fecal samples of 30 Rotterdam HAV IgM+ patients who fell ill during the period of 1 September 2003-1 December 2004 were tested. The tests included RT-PCR and sequencing at the VP3-VP1 and VP1-P2a regions of the HAV genome. It was found that 12 homeless people, one family member of a homeless person and two people without a known risk were infected with a unique subtype 3a strain. Four of the homeless patients became ill after vaccination and were probably infected at the time. This study shows that Dutch homeless people and drug users involved in HAV outbreaks should be offered HAV vaccine actively to prevent further spread of the infection. Furthermore, it was shown by molecular techniques that the unique subtype 3a strain was not found before the Rotterdam outbreak or afterwards, indicating that the mass vaccination campaign was successful.

Disease Outbreaks↗

PubMed1993

Lessons from a clinic for the homeless. The Camillus Health Concern.

OBJECTIVE: To present the educational opportunities provided by a model clinic for homeless persons. DESIGN: Descriptive. PATIENTS OR OTHER PARTICIPANTS: Patients are those who are cared for at Camillus Health Concern clinic for the homeless in Miami, Fla. Other participants include students, residents, and faculty affiliated with the University of Miami (Fla) School of Medicine. INTERVENTION: Affiliation of the clinic with the medical school has shifted the clinic from a pure service model to an education and service model. MAIN OUTCOME MEASURES: Numbers of patients and encounters are presented, as well as student and resident rotations, numbers, and hours. RESULTS: Shifting to an education and service model has increased productivity of the clinic while providing a unique, multifaceted educational experience to students, residents, and faculty. CONCLUSIONS: Those factors that contribute to the success of this education and service model include the professional satisfaction that results from providing care to patients who previously have not had access to health care; a team approach that includes faculty, students, nurses, and social workers; an environment that fosters clinical judgment rather than expensive tests; and the opportunity to teach social responsibility in the process of providing health care. We encourage other schools to consider the development of clinics for the homeless as alternative ambulatory training sites.

Clinical Clerkship↗

PubMed1996

Evaluation in the Substance Abuse and Mental Health Services Administration.

The evaluation policy of the Substance Abuse and Mental Health Services Administration (SAMHSA) is described in this article. Three studies are presented that exemplify SAMHSA's evaluations. These include evaluations of a program to prevent substance abuse among pregnant and postpartum women and their infants; a Job Corps treatment enrichment program; and the McKinney program for homeless persons with severe mental illnesses. Each of these evaluations demonstrated the effectiveness of the programs in reducing substance abuse or homelessness and in improving the health and well-being of the consumers served. SAMHSA will use the results of these and similar evaluations to guide policy and program development. Through its evaluations, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. By using its evaluation results to guide policy and program development, SAMHSA aims to improve the quality of the public system of substance abuse and mental health services.

Adolescent↗

PubMed2005

Housing preferences of homeless veterans with dual diagnoses.

Previous research indicates that most homeless persons with mental illness prefer independent living, while most clinicians recommend group housing. This study compared residential preferences of 141 homeless veterans with dual diagnoses with those of 62 homeless nonveterans with dual diagnoses. Clinicians rated both groups while they were in transitional shelters before they were placed in housing. Both samples strongly rejected group home living, but a majority of nonveterans desired staff support. Clinicians recommended staffed group homes for most veterans and nonveterans. This survey underscores the disjuncture between consumers' and clinicians' preferences as well as the need to provide a range of housing options to accommodate varied preferences.

Adult↗

PubMed2006

Health care needs of homeless adults at a nurse-managed clinic.

Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the homeless. The purpose of this study was to establish baseline health data on homeless persons prior to attending a nurse-managed clinic.(1) This study was a cross-sectional, retrospective health survey of homeless clients at a nurse-managed clinic. A total of 110 participants completed a baseline health survey. Of these, 61% reported that prior to coming to the clinic, they used the ED as a source of health care. The most frequent medical diagnoses reported were substance use disorders, depression, back pain, hypertension, and asthma. Providing care for chronic conditions at a nurse-managed clinic has the potential to improve health and reduce use of the ED.

Adult↗

PubMed2007

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

OBJECTIVE: To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. DESIGN: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. MAIN OUTCOME MEASURES: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. RESULTS: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). CONCLUSION: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.

Adolescent↗

PubMed1997

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: physical and mental health, substance use, and health services utilization.

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed.

Adult↗

PubMed2000

Antecedents of physical and sexual victimization among homeless women: a comparison to homeless men.

Homeless women experience extensive health risks including physical and sexual victimization. Few studies that have gathered information on homeless persons have reported results separately for women or have compared them directly with men. Research that both investigates antecedents of victimization among homeless women and compares them to those for men is necessary to determine whether prevention efforts must be different for each group. We investigated potential antecedents of recent (past 30 days) physical and sexual victimization in a probability sample of 394 homeless women and compared findings to those for 1159 homeless men. As hypothesized, mental disorder, substance dependence, and engaging in economic survival strategies significantly predicted victimization among homeless women. With few dissimilarities, these characteristics also predicted victimization among homeless men. Although differences in the needs and experiences of homeless women and men must be recognized, both women and men require assistance to establish and maintain safe residences, treatment of any substance use and mental disorder, and alternatives to economic survival strategies that place them at risk for victimization.

Adolescent↗

PubMed2003

Case management and access to services for homeless women.

Previous research on case management for homeless persons has not sufficiently addressed access to services for women of reproductive age. This cross-sectional study estimates the proportion of homeless women with case managers and the associations of case management with access to shelter; food stamps; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and general medical care. Nine hundred seventy-four homeless women were sampled in Los Angeles County in 1997 and asked about their use of services and whether they had case managers. Approximately 56 percent of respondents had case managers. Having a case manager was associated with greater odds of using food stamps and of finding shelter without difficulty in the previous 30 days, but not with use of WIC or with unmet needs for medical care. More assertive forms of outreach may be necessary to link this population to case managers and a broader range of services.

Adolescent↗

PubMed1989

Assessing the physical health of homeless adults.

Information on the physical health of homeless adults is potentially biased either by sampling strategy or by measurement of physical health. Studies that used comprehensive health measures (self-reported and objective measures) relied on samples from shelters or hotels. However, more representative community-based studies relied on self-reports or ratings. We conducted the first study to use both a community-based sample (N = 529) and comprehensive measures of health (an interview, a limited physical examination, and blood testing). Shelter dwellers compared with homeless persons sampled elsewhere were less likely to have used illegal drugs, to have been victimized, to have injured skin, and to have elevated aspartate aminotransferase levels and mean corpuscular volumes. Sixty-two percent of persons observed to have high blood pressure were unaware of their condition. Sampling only shelter dwellers, or relying only on reports of illness by homeless adults, may mask or underestimate existent health problems that are revealed by community-based sampling techniques and more objective measures.

Adult↗

PubMed1995

High-risk vulnerable populations and volunteers: a model of education and service collaboration.

Extending our earlier work (Hutchison & Quartaro, 1993) describing a training program for volunteers caring for high-risk vulnerable populations, we identify and explicate factors contributing to the successful collaboration of education and service organizations. Addressing the management of linkages essential to mutual goal setting and shared responsibility for planning, implementation, and evaluation of patient/client outcomes, each factor is discussed with specific reference to improving caregiving to persons with AIDS and their families through well-trained volunteer services. The model has been applied to training for service to homeless persons and to the frail elderly and may be more broadly applicable to other high-risk vulnerable populations.

Acquired Immunodeficiency Syndrome↗

PubMed1999

[Homeless and mentally ill. Review of recent research and results on a doubly disadvantaged minority].

There are about 200,000 homeless persons in Germany, 35,000 of them living on the streets. They suffer from unemployment, poverty, social isolation and physical impairments. More than two-thirds of them suffer from mental illness as well. Substance abuse predominates, but also schizophrenic and affective disorders and personality disorders show a higher prevalence than among the general population. Comorbidity is found frequently. However, mental disorders are just one of several factors contributing to the process of becoming homeless. Due to the complex combination of mental, physical, social and economic problems of the homeless mentally ill psychiatric care is not sufficient. Yet recent US studies show that a combination of multimodal clinical measures and a network of outpatient assistance can improve both physical and mental health and the social situation. Having established reliable epidemiological data, future research should concentrate on analysing the influence of homelessness on mental health, and on planning and evaluating specific programmes for the homeless mentally ill.

Ill-Housed Persons↗

PubMed2005

Using cost and health impacts to prioritize the targeted testing of tuberculosis in the United States.

PURPOSE: Evaluation improves efficiency and effectiveness. Current U.S. tuberculosis (TB) control policies emphasize the treatment of latent TB infection (LTBI). However, this policy, if not targeted, may be inefficient. We determined the efficiency of a state-law mandated TB screening program and a non state-law mandated one in terms of cost, morbidity, treatment, and disease averted. METHODS: We evaluated two publicly funded metropolitan TB prevention and control programs through retrospective analyses and modeling. Main outcomes measured were TB incidence and prevalence, TB cases averted, and cost. RESULTS: A non state-law mandated TB program for homeless persons in Tarrant County screened 4.5 persons to identify one with LTBI and 82 persons to identify one with TB. A state-law mandated TB program for jail inmates screened 109 persons to identify one with LTBI and 3274 persons to identify one with TB. The number of patients with LTBI treated to prevent one TB case was 12.1 and 15.3 for the homeless and jail inmate TB programs, respectively. Treatment of LTBI by the homeless and jail inmate TB screening programs will avert 11.9 and 7.9 TB cases at a cost of 14,350 US dollars and 34,761 US dollars per TB case, respectively. CONCLUSIONS: Mandated TB screening programs should be risk-based, not population-based. Non mandated targeted testing for TB in congregate settings for the homeless was more efficient than state-law mandated targeted testing for TB among jailed inmates.

Costs and Cost Analysis↗

PubMedDate not supplied

Homeless patients with hepatocellular carcinoma in Osaka City, Japan.

BACKGROUND/AIMS: Although the number of homeless persons is increasing worldwide, studies delineating the health status of these persons according to various medical perspectives, including hepatology, are limited. However, such studies are important for understanding the pathogenesis of diseases and their prevention. METHODOLOGY: Thirty homeless patients with hepatocellular carcinoma (HCC) and 15 with liver cirrhosis (LC) who were admitted to the Osaka Socio Medical center Hospital during the past 6 years were analyzed clinicopathologically. All were from the Airin district of Osaka City. RESULTS: The patients with HCC had a history of long stay (mean: 25 years) in the district and many infectious opportunities and most of them were malnourished. The main causes of liver disease in the patients with HCC were hepatitis C virus (HCV) (77%), alcohol abuse (73%), and the combination of HCV and alcohol abuse (50%). Serum HCV RNA concentration was 10(5.8 +/- 0.9) copies/50 microliters in the 21 HCC patients and 10(6.5 +/- 0.7) copies/50 microliters in the 14 LC patients (p < 0.02). Six HCC patients (20%) were positive for the GB virus C/Hepatitis G virus (GBV-C/HGV) RNA in association with HCV or hepatitis B virus (HBV). Only 2 patients with HCC underwent the curative operations and most of the HCC cases were in progressed stages. CONCLUSIONS: A long stay in a hygiene-poor environment increases the opportunity for infection in homeless people. The causative agents in the HCC and LC patients were mostly HCV, alcohol abuse, and a combination of the two. Since the quantification of HCV-RNA in the HCC patients was lower, the high level of HCV-RNA may not be a risk factor for the development of HCC. GBV-C/HGV may not also. The reversion to former healthy living conditions and reduction in alcohol consumption as soon as possible may contribute to low incidence of HCC and save the tax dollar expenditures among homeless people.

Biopsy, Needle↗

PubMed2005

Homeless, mentally ill and addicted: the need for abuse and trauma services.

This paper examines an empirical investigation of the lifetime prevalence of trauma (defined as sexual and/or physical abuse) in a cohort of adults enrolled in a federally funded initiative that provides treatment for homeless persons suffering the effects of comorbid substance use and serious mental illness, and considers the impact of this information on clinical programming. Data collected from homeless individuals with co-occurring disorders admitted to the Seeking Treatment and Recovery (STAR) Program during a one year period (n=78) were analyzed for a history of trauma events. Of those individuals evaluated, 79.5% (62/78) acknowledged a history of either physical and/or sexual abuse at some time in their lifetimes. Of this population, 100% of the homeless women (27/27) with co-occurring disorders had experienced a life-altering traumatic event while 68.6% (35/51) of the homeless men also reported trauma histories. We describe the trauma-based interventions made in the STAR Program that have the potential for replication in other initiatives committed to serving homeless individuals with co-occurring disorders.

Adolescent↗

PubMed1994

Health care for the homeless: a family medicine perspective.

Many factors contribute to the health problems of homeless persons, including exposure to adverse weather, trauma and crime, overcrowding in shelters, unusual sleeping accommodations, poor hygiene and nutritional status, alcoholism, drug abuse and psychiatric illness. It is common for homeless adults to have skin ailments, respiratory infections, traumatic injuries and chronic gastrointestinal, vascular, dental and neurologic disorders. Homeless children may have respiratory, ear and skin diseases, as well as special problems, including failure to thrive, developmental delay, neglect and abuse. Important questions to ask during history-taking include questions about sleeping conditions, sources of food, past psychiatric problems and substance abuse, and sources of social support. Special attention should be given to examination of the skin, teeth and feet. Supplemental food, immunizations, psychologic counseling and social service referrals should be considered for homeless pediatric patients.

Adult↗

PubMed1984

The mentally ill homeless: isolation and adaptation.

Project HELP was established in New York City in 1982 as a mobile outreach unit providing crisis medical and psychiatric services to impaired homeless persons. The authors describe the demographic characteristics of the population served, the disposition of patients accepting treatment or shelter services, and the adaptation of the homeless to weather extremes. They discuss the difficulties in providing services to a population whose members are distrustful of authority and are unwilling to provide information about themselves. They conclude that the more disaffiliated members of the homeless population, such as those served by Project HELP, need even more extensive services than the homeless who use some kind of existing sheltered care, and they suggest various kinds of services to meet their needs.

Adaptation, Psychological↗

PubMed1989

Factors affecting prescribed medication compliance of the urban homeless adult.

Compliance with medical treatment may constitute an impenetrable barrier to homeless persons experiencing significant physiological and psychosocial limitations. The purpose of this study was to describe the perceived factors that enhance or diminish prescribed medication compliance of homeless adults. A retrospective descriptive study of 61 urban homeless adults sheltered at the Union Rescue Mission in downtown Los Angeles were interviewed with a compliance questionnaire. Findings revealed that more than two-thirds of the sample reported their health status to be fair to poor. Nearly one-third reported compliance rates ranging from none of the time to half of the time. Deterrents to compliance included structural variables such as availability of drugs and lack of privacy and storage space. Factors enhancing compliance included carrying the medications, being close to the health clinic and understanding the need for the medication. Many of the factors reported to enhance or diminish compliance are within the realm of professional practice.

Adult↗