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PubMed1994

An investigation to determine the health status of institutionalised street children in a place of safety in Durban.

This study determines the health profile of institutionalized street children in a Place of Safety in Durban. Fifty black street children who had been institutionalized for a period of not more than fourteen days were interviewed and health assessments were carried out. The children's weights and heights were recorded on growth charts and structured interviews were held. Generally the children were found to be deprived, both socially and physically. Minor health problems were common and some had more serious problems. Recommendations for effective primary health care are put forward.

Adolescent↗
PubMed1992

Welcome visitors.

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Abortion, Induced↗
PubMed1992

Country watch: Brazil.

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Acquired Immunodeficiency Syndrome↗
PubMed1998

Mental health problems of homeless children and families: longitudinal study.

OBJECTIVE: To establish the mental health needs of homeless children and families before and after rehousing. DESIGN: Cross sectional, longitudinal study. SETTING: City of Birmingham. SUBJECTS: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. MAIN OUTCOME MEASURES: Children's mental health problems and level of communication; mothers' mental health problems and social support one year after rehousing. RESULTS: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P = 0.04; children 39% v 11%, P = 0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. CONCLUSIONS: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Adolescent↗
PubMed1999

Who are "the homeless"? Reconsidering the stability and composition of the homeless population.

OBJECTIVES: This study assessed the extent to which the use of point-prevalence samples biases conclusions drawn about homeless people. METHODS: Three data sets and published research were used to examine the degree to which conditions leading to point-prevalence bias (turnover in the homeless population, variability in the persistence of homelessness, and associations between personal characteristics and persistence) characterize the homeless population. Results were compared from point-prevalence studies concerning persistence of homelessness and characteristics of homeless people with those from a study of formerly homeless people. RESULTS: Conditions leading to point-prevalence bias strongly characterize the homeless population. Moreover, profiles of homeless people differed dramatically between point-prevalence studies and the study of formerly homeless people. In the former, average duration of homelessness was longer, and samples included higher proportions of men, minorities, non-high school graduates, and people with histories of psychiatric hospitalization, incarceration, and detoxification. CONCLUSIONS: Reliance on point-prevalence samples, when such samples are generalized beyond the currently homeless population, leads to overestimations of the persistence of homelessness, the demographic distinctiveness of the homeless population, and the prevalence of personal disabilities and deviant lifestyles among homeless people.

Age Distribution↗
PubMed1999

A risk-amplification model of victimization and depressive symptoms among runaway and homeless adolescents.

This report is an examination of a theoretical model of risk amplification within a sample of 255 homeless and runaway adolescents. The young people were interviewed on the streets and in shelters in urban centers of four Midwestern states. Separate models were examined for males (n = 102) and females (n = 153). Results indicated that street experiences such as affiliation with deviant peers, deviant subsistence strategies, risky sexual behaviors, and drug and/or alcohol use amplified the effects of early family abuse on victimization and depressive symptoms for young women. These street adaptations significantly increased the likelihood of serious victimization over and above the effects of early family history for both young men and women. Similarly, street behaviors and experiences increased the likelihood of depressive symptoms for young women over the effects of early family abuse, but not for young men. The risk-amplification model from the life course theoretical perspective is discussed as an example of the cumulative continuity of maladaptive behaviors.

Adolescent↗
PubMed2001

Mental health problems and social supports among homeless mothers and children victims of domestic and community violence.

BACKGROUND: Children and mothers who have suffered domestic or neighbourhood violence constitute a high risk group, although it has not been clear whether their mental health needs are specifically related to the type of violence. This paper reports on the prevalence of mental health problems in homeless parents and children who have experienced domestic and neighbourhood violence and their access to social support networks. METHODS: Three groups of families who had become homeless were compared: those experiencing domestic violence (48 with 75 children), victims of neighbourhood violence (14 with 29 children), and those who became homeless for other reasons (31 with 54 children). Mothers completed a service use semi-structured interview, the Strengths and Difficulties Questionnaire, the General Health Questionnaire, the Family Support Scales, and the SF-36 Health Status Questionnaire. RESULTS: Levels of psychiatric morbidity were high in the group experiencing domestic violence (35.7% in children and 21.9% in mothers) and higher still in those who were victims of neighbourhood violence (52.2% in children and 50% in mothers). Levels of social support were found to be an important factor, particularly in relation to professional support and support from other family members, as they predicted both child and maternal psychopathology. CONCLUSIONS: Mental health interventions for victims of domestic and neighbourhood violence should be integrated with community programmes of social reintegration. Mental health professionals should work in close collaboration with Housing Departments, Social Services, Education and the Police.

Adolescent↗
PubMedDate not supplied

Tuberculosis screening and anergy in a homeless population.

BACKGROUND: Tuberculosis has again emerged as a growing public health concern in the United States. Among the homeless population, increased risk factors contribute to immunodeficiency, which can cause false-negative results on purified protein derivative (tuberculin) (PPD) skin testing, the standard screening procedure for tuberculosis in individuals. We evaluated the accuracy of PPD skin test results by determining anergy status of patients when offering the PPD test. METHODS: A consecutive convenience sample of 105 underserved men and women were tested at a health clinic located in a homeless shelter in Yonkers, NY. These persons were currently homeless, living in a shelter, or formerly homeless and using the soup kitchen at the shelter. Three antigens, candidin, mumps, and trichophytin, in addition to PPD, were administered intradermally using the Mantoux method, and results were read 48 to 72 hours later on the 100 (95 percent) who returned. An individual was considered to be anergic if the delayed-type hypersensitivity reactions were less than or equal to 2 mm for each of the four antigens. RESULTS: Of the 100 persons who returned for follow-up, 5 (5 percent) were found to be anergic. Of these 5, all were previously known to be positive for human immunodeficiency virus (HIV). CONCLUSIONS: PPD testing alone was found to be an accurate screening test in this population except in those who were HIV positive.

AIDS-Related Opportunistic Infections↗
PubMed1999

Housing placement and subsequent days homeless among formerly homeless adults with mental illness.

OBJECTIVE: The study examined the influence of group or individual housing placement and consumer characteristics on the number of days subsequently homeless among formerly homeless mentally ill persons. METHODS: A total of 303 homeless shelter residents with severe mental illness were screened for dangerousness, 118 were randomly assigned to either independent apartment or staffed group living sites, and 110 were followed for 18 months. Study participants' sociodemographic characteristics, diagnosis, and residential preferences and the residential recommendations made by clinicians were measured at baseline. RESULTS: Overall, 76 percent of the study participants were housed at the end of the 18-month follow-up period, although 27 percent had experienced at least one episode of homelessness during the period. The number of days homeless was greater for individuals assigned to independent apartments than for those placed in staffed group homes, but only for members of minority groups. Substance abuse was the strongest individual-level predictor of days homeless. Individuals whom clinicians identified as needing group living experienced more days homeless, irrespective of the type of housing they received. Consumers who stated a strong preference for independent living had more days homeless than those who were amenable to staffed group homes. CONCLUSIONS: Although consumers more frequently prefer independent living, placement in staffed group housing resulted in somewhat fewer days homeless for some groups of consumers. Further experience of homelessness by formerly homeless mentally ill individuals may be reduced by providing effective substance abuse treatment and by paying special attention to consumers identified by clinicians to be at particular risk for housing loss.

Adult↗
PubMed2004

Mental health status of runaway adolescents.

UNLABELLED: There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences. OBJECTIVE: (1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors. METHODS: This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems. RESULTS: 20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated. CONCLUSION: Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Adolescent↗
PubMed2006

Health services utilization for people with HIV infection: comparison of a population targeted for outreach with the U.S. population in care.

BACKGROUND: Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services. OBJECTIVE: This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a nationally representative cohort of persons with HIV infection who were receiving care from known HIV providers in the United States and examined whether the independent correlates of low ambulatory utilization differed between the 2 samples. METHODS: We compared sociodemographic, clinical, and health care utilization characteristics in 2 samples of adults with HIV infection: 1286 persons from 16 sites across the United States interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach), a study of underserved persons targeted for supportive outreach services; and 2267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. We conducted logistic regression analyses to identify differences between the 2 samples in sociodemographic and clinical associations with ambulatory medical visits. RESULTS: Compared with the HCSUS sample, the Outreach sample had notably greater proportions of black respondents (59% vs. 32%, P = 0.0001), Hispanics (20% vs. 16%), Spanish-speakers (9% vs. 2%, P = 0.02), those with low socioeconomic status (annual income < Dollars 10,000 75% vs. 45%, P = 0.0001), the unemployed, and persons with homelessness, no insurance, and heroin or cocaine use (58% vs. 47%, P = 0.05). They also were more likely to have fewer than 2 ambulatory visits (26% vs. 16%, P = 0.0001), more likely to have emergency room visits or hospitalizations in the prior 6 months, and less likely to be on antiretroviral treatment (82% vs. 58%, P = 0.0001). Nearly all these differences persisted after stratifying for level of ambulatory utilization (fewer than 2 vs. 2 or more in the last 6 months). In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95% confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.35-0.88], HCSUS 1.17 [0.65-2.11)], P = 0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P = 0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P = 0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45], HCSUS 1.00 [0.73-1.37], P = 0.02). Having CD4 count less than 50 was associated with elevated odds of low ambulatory medical visits in the Outreach sample (1.53 [1.00-2.36], P = 0.05). CONCLUSIONS: Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.

Adolescent↗
PubMed1997

Homelessness: care, prevention, and public policy.

Homeless men, women, and children make up a growing population that is vulnerable to preventable disease, progressive morbidity, and premature death. Homelessness and poverty are inextricably linked, and subgroups of persons who live in poverty have a particularly high risk for becoming homeless. Providing effective primary care for homeless persons is a formidable task because of many internal and external barriers to care. Targeted care strategies and new approaches to primary care are required to lower these barriers. Effective disease prevention in the homeless requires effective programs and policies to prevent homelessness. It is imperative that health professionals, the societies to which they belong, and academic health systems reaffirm their social responsibility, commit to changing public policies that perpetuate homelessness, and assist in the development and provision of primary health care services for persons who are homeless or on the brink of homelessness.

Adult↗
PubMed1997

A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland.

Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.

Activities of Daily Living↗
PubMed1994

Prevalence and risk factors for HBV infection among street youth in central Brazil.

PURPOSE: A seroprevalence survey was carried out among 496 street adolescents from 9 to 20 years old in central Brazil to determine the prevalence of hepatitis B (HBV) markers, as well as to assess the role of potential risk factors. RESULTS: The findings reveal that 20.4% of the participants were homeless adolescents without family links, living and/or working on the streets. The age at first sexual intercourse was as low as 9 years old, and approximately 60% of this population had had at least one sexual relationship by the age of thirteen, indicating prepubertal initiation of sexual experiences among street adolescents. 13.5% were HBV marker-positive (anti-HBc) and 2.0% had antigenemia. Street-based youth had a higher HBV marker-positive rate when compared to home-based teens (OR = 4.1, 95% CI: 2.1-8.5) and, similarly, higher HBV prevalence was obtained for those reporting sexual activity versus the group without sexual activity (OR = 2.1, 95% CI: 1.1-3.9), even after adjusting for potential confounders. CONCLUSIONS: We have found that street youth, particularly street-based adolescents, should be considered at-risk group for hepatitis B infection in our region. These findings may be used as a baseline information for policy changes not only in hepatitis B prevention but also to reverse the scenario of adolescents sexual abuse.

Adolescent↗