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PubMedDate not supplied

Incidence of sexually transmitted diseases and Pap smear results in female homeless clients from the Chicago Health Outreach Project.

Homeless persons have difficulty gaining access to health care. In 1985 the Chicago Health Outreach Project was created to improve their access to health care. Staff and client reviews indicated that female homeless clients required increased outreach efforts. Consequently, a mobile women's health unit was developed in 1990. Review of 128 records of 104 female homeless clients indicated that 30% of Pap smears done were abnormal, with atypia (14%) and inflammation (10%) the most common findings. The incidence of chlamydia, gonorrhea, and trichomoniasis was 3%, 6%, and 26%, respectively. There was a significant association between the presence of trichomoniasis and an abnormal Pap smear. These results emphasize the importance of providing regular gynecological care to homeless women. Research is needed on the implications of abnormal Pap smears and sexually transmitted diseases for this population of female homeless clients.

Adolescent↗
PubMed2002

Pharmaceutical research involving the homeless.

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature.

Biomedical Research↗
PubMed1991

The eye of the beholder: Parse's theory with homeless individuals.

This article describes how practice with homeless persons in a community setting was guided by Parse's theory of nursing. The ways in which Parse's theory differs from the traditional problem-based approach are presented. Parse's practice method as lived with homeless individuals is described as it unfolded in both group sessions and individual encounters. Experiences common to all human beings in day-to-day relating with the world are presented from the perspectives of those who are homeless. Group sessions included discussions about love, pain, beauty, and the choices in life. Encounters with individuals clarify how Parse's theory guided the nurse as the person struggled to move on. Individuals involved with the center offered their perceptions of the way nurses interrelated with them. The evaluation of Parse's theory in various practice settings is proposed, and nurses are challenged to consider this innovative approach for guiding practice with all human beings.

Empathy↗
PubMed1989

Health care history and utilization for Atlantans who died homeless.

A limited study of 18 deaths among homeless persons in Atlanta, Georgia, has shown that about two-thirds had utilized public health care facilities prior to their death, often over a period of many years. Utilization of two available, specific clinics for the homeless could not be demonstrated. The county hospital and alcoholism treatment center accounted for all documented episodes of health care. Formal, medical documentation of significant alcohol-related morbidity was shown in 50% of those who died homeless. Other common medical problems included seizure disorders, hypertension, pneumonia, chronic pulmonary disease, and non-lethal trauma. These data may be used practically during medico-legal death investigation and by public health agencies when planning policy and procedure relevant to the homeless population. Paucity of data concerning mortality in the homeless should prompt additional, region-specific studies to determine risk factors in areas where homelessness is manifest.

Adult↗
PubMed1997

Integrated treatment for dually diagnosed homeless adults.

This study examined the effects of integrating mental health, substance abuse, and housing interventions for homeless persons with co-occurring severe mental illness and substance use disorder. With the use of a quasi-experimental design, integrated treatment was compared with standard treatment for 217 homeless, dually diagnosed adults over an 18-month period. The integrated treatment group had fewer institutional days and more days in stable housing, made more progress toward recovery from substance abuse, and showed greater improvement of alcohol use disorders than the standard treatment group. Abuse of drugs other than alcohol (primarily cocaine) improved similarly for both groups. Secondary outcomes, such as psychiatric symptoms, functional status, and quality of life, also improved for both groups, with minimal group differences favoring integrated treatment.

Adolescent↗
PubMed1991

Influence of substance abuse and mental disorders on emergency room use by homeless adults.

Substance abuse and mental disorders increase the health care needs of homeless persons, whose primary source of care is often the emergency room. In this study, associations between substance abuse and mental health problems and use of emergency rooms were examined using data from a 1987 survey of 1,152 homeless adults in New York City shelters. Two-thirds (N = 767) of the sample reported using an emergency room at least once in their lives, and 27.2 percent (N = 313) reported use within the previous six months. Traumatic injury was the most frequently cited reason for the last emergency room visit. Respondents who reported psychotic ideation during the previous year or severe depressive symptoms during the previous week were much more likely to have used an emergency room within the previous six months. The preliminary findings suggest that substance abuse and mental disorders play a significant role in emergency room use by homeless adults.

Adolescent↗
PubMed1991

Homelessness and dual diagnosis.

People who are dually diagnosed with severe mental illness and substance use disorders constitute 10%-20% of homeless persons. They are a heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs. In this article recent research on the epidemiology, subject characteristics, and service needs of the dually diagnosed homeless population is reviewed. Also, the range of evolving approaches to providing social services, housing, and mental health and substance-abuse treatments; the relevant system issues and legal issues; and problems with current research, as well as future research directions, are discussed. The importance of the distinction between providing appropriate living environments and mental health treatments emerges throughout.

Alcoholism↗
PubMed2000

Helping the urban poor stay with antiretroviral HIV drug therapy.

Recent studies have documented dramatic decreases in opportunistic infections, hospitalizations, and mortality among HIV-infected persons, owing primarily to the advent of highly active antiretroviral medications. Unfortunately, not all segments of the population living with HIV benefit equally from treatment. In San Francisco, only about 30% of the HIV-infected urban poor take combination highly active antiretroviral medications, as compared with 88% of HIV-infected gay men. Practitioners who care for the urban poor are reluctant to prescribe these medications, fearing inadequate or inconsistent adherence to the complicated medical regimen. Persons typically must take 2 to 15 pills at a time, 2 to 3 times a day. Some of the medications require refrigeration, which may not be available to the homeless poor. Most homeless persons do not have food available to them on a consistent schedule. Therefore, they may have difficulty adhering to instructions to take medications only on an empty stomach or with food. Lack of a safe place to store medications may be an issue for some. In addition, many urban poor live with drug, alcohol, or mental health problems, which can interfere with taking medications as prescribed. Inconsistent adherence to medication regimens has serious consequences. Patients do not benefit fully from treatments, and they will become resistant to the medications in their regimen as well as to other medications in the same classes as those in their regimen. Development of resistance has implications for the broader public health, because inadvertent transmission of multidrug-resistant strains of HIV has been demonstrated. Concern that the urban poor will not adhere to highly active antiretroviral medication regimens has led to debate on the role of clinicians and public health officials in determining who can comply with these regimens. Rather than define the characteristics that would predict adherence to these regimens, the San Francisco Department of Public Health created a program to support adherence among those who may have the greatest difficulty complying with complicated highly active antiretroviral medication regimens. The program, dubbed the Action Point Adherence Project, was conceived through a community planning process in preparation for a city-wide summit on HIV/AIDS that took place in January 1998. Action Point is funded by the city and the county of San Francisco. Now in its 10th month, the program continues to show promising evidence of improving clients' biological and social indicators.

Adult↗
PubMed1990

Substance abuse and mental health status of homeless and domiciled low-income users of a medical clinic.

Data were collected on indicators of mental health status and substance abuse among 214 homeless and 250 domiciled but impoverished patients who sought care in a community medical clinic in a California beach community. Although both groups had a high prevalence of problems, homeless patients were significantly more likely to have been hospitalized for alcohol or mental problems, to have been arrested because of drinking, and to have experienced delirium tremens. Homeless persons were also more likely to have made a suicide attempt, to have experienced recent psychotic symptoms, and to be dissatisfied with life. The findings suggest that primary medical care settings serving the poor and homeless may present an excellent opportunity for delivering mental health services and that psychiatrists should expand their involvement in such settings.

Adult↗
PubMed1993

A systematic study of mental health services utilization by homeless men and women.

Psychiatric illness is overrepresented among the homeless, but mental health services are underutilized in this population in proportion to their needs. The current study was concerned with 900 homeless men and women randomly sampled and systematically interviewed with the Diagnostic Interview Schedule; it focuses on psychiatric and substance abuse rehabilitation service patterns and stated needs of this population in relation to specific psychiatric disorders. Although rates of lifetime treatment utilization were fairly high in comparison with general population utilization patterns, rates of treatment in the current year were low. In particular, outpatient services have been neglected for reliance upon inpatient services. Although the major reason cited for not obtaining treatment by homeless persons with mental illness was lack of insurance and inability to pay for it, having health insurance was not associated with mental health services utilization, nor were other important predictors apparent. Mental health professionals serving mentally ill homeless populations would best serve them by focusing on creative and innovative ways to improve the availability and attractiveness of ambulatory care services.

Adolescent↗
PubMed1998

Health problems of sheltered homeless men using a mobile health van: a 4-year study.

The number of homeless persons in the United States is increasing on an annual basis, with men accounting for the greatest number. Accessing health care for this group is difficult for many reasons, particularly those related to finances, transportation, lack of insurance, and transiency of lifestyle. Consequently, data regarding homeless men's health problems/concerns are difficult to obtain, and often the information reported is only for acute care services provided by emergency rooms and clinics. The purpose of this study was to determine the demographic characteristics and health problems/concerns of sheltered homeless men using the services of a mobile van for health care over a 4-year period. A total of 2,086 records, representing 1,171 men aged 19 and over, were retrospectively reviewed to determine demographic and health characteristics (age, sex, self-reported medical and addiction histories, and self-reported medication use). Data on presenting concerns, diagnoses, visit patterns, treatments, medications and teaching provided were also collected and analyzed. Recommendations to improve the quality, continuity, and follow-up of care for homeless men are included.

Adult↗
PubMed2001

[Existing and possible working areas for social workers in the public health service of Berlin and Brandenburg].

Standardised questionnaires were used to examine in which Public Health Service areas of Berlin and Brandenburg (Germany) social workers are currently active. The main goal was to ascertain the working approaches and primary areas of their activities. Another aim was to look into the co-operation between public health service and resident doctors, mutual aid groups, out-patient services and social services in other institutions (hospitals, health insurance, services for disabled persons and nursing homes). It was also examined whether current social and economical changes raise a need for new counselling offers from the public health service for other target groups (unemployed, women and homeless persons).

Berlin↗
PubMed2004

Smoking behavior and interest in quitting among homeless smokers.

OBJECTIVES: To examine smoking behavior in homeless persons, including the impact of self-reported tobacco-related health problems and drug and alcohol abuse on readiness to quit and interest in smoking cessation counseling. METHODS: Cross-sectional survey of outpatients and inpatients on the homeless service at Massachusetts General Hospital. RESULTS: Among 98 homeless smokers with a mean age of 44 years, tobacco-related medical diagnoses and symptoms and psychiatric illnesses were common, as were drug and alcohol abuse. One third of the smokers in this sample intended to quit smoking within the next 6 months, including 19% who planned to quit in the next 1 month. Forty-four percent of the participants were somewhat or very interested in smoking cessation counseling. In multivariate analyses, significant (P < .05) predictors of readiness to quit smoking were greater confidence in one's ability to quit (self-efficacy) and more social support for quitting. Multivariate predictors of interest in smoking cessation counseling were smoking-related symptoms and higher self-efficacy for quitting. CONCLUSIONS: Homeless smokers recruited from the inpatient and outpatient services of a large, urban teaching hospital reported interest in both stopping tobacco use and receiving assistance to quit smoking. Having an illness that a smoker believes is tobacco-related, having greater confidence in the ability to quit, and having more social support for quitting were associated with greater readiness to quit and more interest in smoking cessation counseling. Alcohol and drug abuse were not associated with reduced interest in quitting smoking. These findings suggest that homeless smokers may benefit from smoking cessation programs that are colocated in medical or drug treatment settings.

Adult↗
PubMed2003

Use of faith-based social service providers in a representative sample of urban homeless women.

There are few quantitative studies on the characteristics of homeless persons who use faith-based social service providers. To help address the lack of information in this area, we analyzed survey data on 974 participants in the University of California at Los Angeles (UCLA) Homeless Women's Health Study, a representative sample of homeless women at shelters and meal programs in Los Angeles County. The primary objective of this analysis was to estimate the association of religious affiliation, race/ethnicity, income, and other client characteristics with the use of faith-based programs. In interviews at 78 homeless shelters and meal programs, study respondents provided information about their religious affiliation and other social and demographic characteristics. The names of the organizations were examined, and those with names that referenced specific religions or contained words connoting religiosity were designated as "faith based." At the time they were selected for study participation, 52% of respondents were using the services of faith-based providers. In multivariate logistic regression analysis, lower odds of using these providers were estimated for participants with no religious affiliation (compared with Christian respondents) and for African Americans and Latinas (compared with whites). There is evidence of systematic differences between the clients of faith-based and secular social service providers. The benefits of increased funding through a federal faith-based policy initiative may accrue primarily to subgroups of clients already using faith-based programs.

Adolescent↗
PubMedDate not supplied

Demographic differences in health status of homeless adults.

OBJECTIVE: To determine how the physical health of homeless adults varies by the demographic characteristics of age, gender, ethnicity, lifetime length of homelessness, and work status. PARTICIPANTS: A community-based sample of 529 homeless adults. STUDY DESIGN: In multivariate analyses, the authors studied the independent contributions of five demographic groups to variations in 12 physical health measures (based on self-reports from face-to-face interviews, screening physical examinations, and venous blood samples). MEASUREMENTS AND MAIN RESULTS: Older persons were more likely to have a functional disability (p < 0.001), chronic disease (p < 0.001), and greater risk of dying (p < 0.001), but less likely to abuse substances (p < 0.001). Men were more likely than women to be substance users (p < 0.001) and to have a greater risk of dying (p < 0.001). Whites and blacks were less likely than respondents in other ethnic groups to have an abnormal blood test (p < 0.001). Persons homeless longer were more likely to be substance users (p < 0.001) and to have experienced trauma (p < 0.001). Working for pay was not related to any of our health measures. CONCLUSIONS: Age and gender contributed most to the understanding of differences in health status among homeless adults. Since the homeless have a wide variety of physical, mental, social, and substance-abuse problems, primary care providers are in the best position to provide the broad-based care needed by such persons.

Adolescent↗
PubMed1992

Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project.

OBJECTIVE: To determine the rate and estimate the cost of hospitalization in a defined urban homeless population. DESIGN: Retrospective chart review. SETTING: Kalihi-Palama Health Clinic Health Care for the Homeless Project, Hawaii State Hospital and seven acute care hospitals in Honolulu, Hawaii. PATIENTS: A total of 1751 homeless clients contacted between 1 December 1988 and 30 November 1990. MEASUREMENTS AND MAIN RESULTS: A total of 1751 individuals were studied for an aggregate of 871.3 person-years. Five hundred sixty-four hospitalizations were identified: ninety-two to the state psychiatric hospital and 472 to acute care hospitals. The age- and sex-adjusted hospitalization rate for acute care hospitals was 542/1000 person-years (compared with the state rate of 96/1000 person-years). Homeless persons were admitted to acute care hospitals for 4766 days compared with a predicted 640 days. The age- and sex-adjusted rate of admission to the state psychiatric hospital was 105/1000 person-years (compared with the state rate of 0.8/1000 person-years). Homeless persons were admitted to the state psychiatric hospital for 3837 days compared with a predicted 139 days. CONCLUSIONS: Homeless individuals in this study were hospitalized in acute care and psychiatric hospitals far more frequently than were members of the general population.

Adult↗
PubMed2005

[Organization of detection of patients with tuberculosis in Moscow].

The authors studied the X-ray detection of patients with tuberculosis in Moscow over 5 years (1997-2001). The subject of the study was the Moscow population numbering about 7 million people to undergo fluorographic examinations and a group of new cases (more than 12,000) of pulmonary tuberculosis. The study has provided the following data: The most patients with pulmonary tuberculosis are detected in the polyclinics, general somatic and mental hospitals, and psychoneurological nursing homes; they amount to 74.8, 22, and 3.2%, respectively. The leading detection method among Moscow adults and adolescents is currently fluorography that detects 83.7% of the patients. The highest proportion in the structure of clinical forms is infiltrative pulmonary tuberculosis that amounts to 52.6%. Next is focal tuberculosis (14.9%); then in the descending order: disseminated tuberculosis (14.6%); tuberculosis of intrathoracic lymph nodes (4.1%); tuberculoma (3.9%), pleuritis (3.3%), caseous pneumonia (2.9%), cavernous and fibrocavernous tuberculosis (1.8%), and cirrhotic tuberculosis (0.5%). There are 69.3 of males and 30.7% of females in the structure of new cases of pulmonary tuberculosis. The unemployed able-bodied persons account for 34.5%, workers, 14.7%, disabled, 12.7%, and pensioners, 10.8%. Patients with pulmonary tuberculosis are most frequently detected in social risk groups. With this, the highest detection rate per 1000 examinees is 29.1% in homeless persons and 26.9% in migrants. In medical risk groups, tuberculosis is more frequently identified in patients with mental diseases, chronic nonspecific respiratory diseases, and alcohol and drug users (8.7, 5.3, and 2.5, respectively per 1000). In an epidemiological risk group, the highest detection rate is noted among persons who are in contact with patients with tuberculosis (5.4 per 1000). Examination of risk-group patients who amounted to 32.2% of those undergone fluorography detects 62.9% of patients with tuberculosis.

Adolescent↗
PubMed1994

[Homeless on the streets of Copenhagen].

A group of homeless people living in the streets is described with the purpose of gaining the knowledge necessary to prevent development of homelessness and establishing programmes for the homeless. Out-reach work in the streets and cooperation with private and religious organisations was conducted during a two-year period and 59 homeless persons were interviewed. Fifteen were women and 44 were men. Upbringing, social conditions, daily living, physical and mental health and contact with health services, social security and private organisations were highlighted in a structured and semistructured interview. Compared with the background population the homeless had much more frequently childhood experience of parents' divorce or death of one of the parents. The women were significantly older than the men and the majority of the women were suffering from schizophrenia and had very little contact with network and public services. The majority of the men were abusing alcohol or drugs, many had had a troublesome childhood with stays in institutions. Many had had many contacts with different social institutions and a criminal record. Among the homeless in the streets of Copenhagen, the prevalence of mental illness, especially schizophrenia, is high. It is recommended that homelessness among the mentally ill is prevented by a special effort directed towards the patient group at risk of becoming homeless and through establishing different housing facilities with varying degrees of professional support. Out-reach work towards the homeless mentally ill should be carried out with the purpose of establishing contact with psychiatric services and securing the possibility of compulsory admission.

Adolescent↗