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PubMed2000

[Homeless men in inpatient psychiatric treatment--a controlled study. 1: Health status and self assessment at intake].

OBJECTIVE: This study examines the objective and the subjectively reported state of health, the social network and the utilisation of mental health services in a representative group of homeless men (n = 50) at time of admission to a psychiatric hospital and compares these results with a control group (matched by diagnosis) of non-homeless men. METHOD AND PATIENTS: The BPRS, the SF-12 Health Survey and a neglection index were administered. The main psychiatric diagnosis (ICD-10) were alcohol addiction (n = 29), drug addiction (n = 13), schizophrenia (n = 7) or personality disorder (n = 1). RESULTS: No differences were found according to sociodemographic basis data, but the homeless group had a smaller social network and less financial resources. There was a higher rate of involuntary admission in the homeless group, less contact to mental health services in the weeks before admission, more psychopathological symptoms and more physical neglection. Self-rating of mental and physical health, however, did not differ significantly. There was a positive correlation between thought disturbance and positive self-rating of mental health. CONCLUSION: The mental and physical health of the homeless patients was markedly worse. Beneath structural barriers symptoms, the extreme distress of their living situation and the decreased insight and motivation for treatment are characteristics of this group of patients which make them difficult to treat.

Adolescent↗
PubMed1992

Substance misuse, emotional disturbance, and dual diagnosis in a meal-line population of mixed ethnicity.

This study investigated the rates of severe substance misuse, severe emotional disturbance, and dual diagnosis in a meal-line population of mixed ethnicity, 75% of whom were homeless and the remainder near-homeless. Alcohol and/or drug use was reported by 93% and severe substance misuse was found in 39% of the population. Severe mental illness was found in 54% of the population. Both conditions, dual diagnosis, was found in 29% of the cases. A cluster analysis of the total population found three types: those with dual diagnosis (24.27%), those with serious substance misuse and personality disorder (39.3%), and those with neither severe disorder (37.3%). The ethnicity of the homeless individual was very weakly, if at all, associated with the disorders.

Adolescent↗
PubMed1993

Social research in health and the American sociopolitical context: the changing fortunes of medical sociology.

The fortunes of medical sociology, like other public policy-relevant disciplines, are shaped by political dynamics and prevailing values and attitudes. In the 1980s the field, which views disease and disability as consequences to a substantial degree of material conditions, social stratification, and inequalities among varying strata, lost ground to economics as societal attention focused on cost containment issues. Sociological concern with social structures clashed with dominant conservative and individualistic perspectives and the increased focus on personal responsibility and market strategies. There was decreasing tolerance in policy circles for the view that health, and the problems affecting disenfranchised groups such as the poor, the homeless, the uninsured and people with disabilities, were more due to our politics and social arrangements than the personal characteristics of those affected. Thus, little attention has been given in public health discourse to how life imperatives and social opportunities and constraints shape behavior. The paper documents the important role of the social sciences in health services research with special attention to examining the social context of the RAND Health Insurance Experiment. Although many of the questions medical sociology address sit on the periphery of policy-makers' concerns, a strong case is made for the revitalization of a critical scholarly role in medical sociology. I conclude, given the short and longterm problems we face in medicine and health, that we would have to invent a vigorous critical medical sociological enterprise if we did not already have one.

Forecasting↗
PubMed2004

Patients' perspectives on noncompliance with diabetic retinopathy standard of care guidelines.

BACKGROUND: Periodic dilated eye examinations are recommended by the American Optometric Association, American Academy of Ophthalmology, and American Diabetes Association to detect sight-threatening conditions in diabetic patients. However, many patients with diabetes do not receive this recommended eye care and there is limited research to explain why. The objective of this study was to determine reasons some diabetic patients do not receive a dilated eye examination at least every year. METHODS: A chart review identified patients at The Ohio State University College of Optometry who had not been examined for more than a year, but less than two years. A telephone interview was attempted for all subjects. RESULTS: Of 100 eligible subjects, 43 completed the telephone interview. The reasons patients with diabetes did not return for a recommended dilated eye examination included transfer of care to another eye doctor, limited personal mobility due to poor overall health, last examination at a homeless clinic, self-reported lack of insurance, and self-reported apathy. CONCLUSIONS: Strategies to improve compliance of patients with diabetes should include reaching patients of low socioeconomic status and those institutionalized for poor overall health. Improved compliance may also come by encouraging patients to use medical insurance for eye examinations and using patient recall systems.

Adolescent↗
PubMed1999

Adolescents' explanations for political issues: concordance with their views of self and society.

The relationships between adolescents' explanations for unemployment, poverty, and homelessness and their beliefs about opportunity, reports of family values, and personal aspirations were tested for 434 teenagers (mean age = 16 years 4 months). Explanations were coded for references to individual causes, societal causes, or both. Higher maternal education and average household income in the adolescent's school district were positively related to the likelihood of attributing all three problems to societal causes. When explaining unemployment, older adolescents noted both causes, and boys mentioned individual factors whereas girls mentioned societal factors. After adjustment for background factors, those endorsing individual causes were more likely to believe that all Americans enjoyed equal opportunity and that government support encouraged dependency, and they were more committed to materialist goals. In contrast, youth endorsing societal or situational causes had more altruistic life goals and reported that compassion was emphasized in their families.

Adolescent↗
PubMed1995

Tuberculosis in the 1990s.

The steady decline in tuberculosis case rate reversed in the mid-1980s, and tuberculosis cases have increased dramatically since that time. Important factors contributing to this increase are the human immunodeficiency virus (HIV) epidemic and tuberculosis occurring in foreign-born persons. Tuberculosis outbreaks have occurred in HIV clinics and wards, prisons, homeless shelters, nursing homes, and health care facilities. Some of the outbreaks have involved strains of tuberculosis resistant to multiple antituberculosis drugs. Recent recommendations for initial therapy of tuberculosis include the use of four drugs and directly observed therapy in an effort to prevent the emergence of further drug resistance.

AIDS-Related Opportunistic Infections↗