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PubMed1998

Medical care of children who are homeless or in foster care.

The number of children who are homeless or in foster care has risen dramatically during the past two decades. Poverty, substance abuse, lack of education and employment, and the failure of the social "safety net" to catch all those in need of support and financial assistance are root causes of this increase. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, popularly know as the "welfare reform" act, will likely have a powerful impact on levels of child poverty in the future and place even greater numbers of children at risk for becoming homeless or entering foster care over the next decade. Recent studies provide increased understanding of the health care and educational needs of children who are homeless or in foster care.

Child↗
PubMed1995

HIV risk behavior among homeless adults.

Very little information is available regarding HIV risk behavior among homeless adults despite increasing evidence that HIV infection disproportionately affects inner-city residents and disadvantaged populations. In the present study, adults (N = 94) entering a storefront medical clinic for the homeless completed an AIDS risk survey. The results suggest that homeless adults are engaging in sexual and substance-use behaviors that place them at high risk for HIV infection. Sixty-nine percent of the present sample was at risk for HIV infection from either 1) unprotected intercourse with multiple partners, 2) intravenous drug use (IVDU), 3) sex with an IVDU partner, or 4) exchanging unprotected sex for money or drugs. Many persons within the sample evidenced multiple risk factors: 45% reported at least two of the risk factors described above and 26% reported three or more risk factors. The results suggest there is an urgent need to develop and evaluate AIDS-prevention strategies for homeless adults.

Adolescent↗
PubMed2002

Screening for tuberculosis: the port of arrival scheme compared with screening in general practice and the homeless.

BACKGROUND: Tuberculosis is increasing in London, especially in those recently entering the UK from an area of high incidence. Screening through the port of arrival scheme has a poor yield and has been considered discriminatory. METHODS: A study was undertaken to compare the yield and costs of screening new entrants in a hospital based new entrants' clinic (1262 referrals from the port of arrival), general practice (1311 new registrations), and centres for the homeless (267 individuals) using a symptom questionnaire and tuberculin testing if indicated. Clinical outcome measures were cases of tuberculosis, tuberculin reactors requiring chemoprophylaxis and BCG vaccinations. Cost outcomes were cost per individual screened and cost per individual per case of tuberculosis prevented. RESULTS: Verbal screening limited tuberculin testing to 16% of those in general practice; most were tested at the other two locations. Intervention (BCG vaccination, chemoprophylaxis or treatment) occurred in 27% of those who received tuberculin testing. Attendance for screening was 17% of the port of arrival notifications (63% had registered with a GP), 54% in primary care, and 67% in the homeless (42% registered with a GP). Costs for screening an individual in general practice, hostels for the homeless, and the new entrants' clinic were 1.26 pounds sterling, 13.17 pounds sterling and 96.36 pounds sterling, respectively, while the cost per person screened per case of tuberculosis prevented was 6.32 pounds sterling, 23.00 pounds sterling, and 10.00 pounds sterling, respectively. The benefit of screening was highly sensitive to the number of cases of tuberculosis identified and case holding during treatment. CONCLUSION: Screening for tuberculosis in primary care is feasible and could replace hospital screening of new arrivals for those registered with a GP.

Adolescent↗
PubMed2003

Environmental-temperature injury in a Canadian metropolis.

This study performed a preliminary investigation of the incidence and determinants of environmental-temperature injury among residents of Montreal Island, Quebec, Canada. Incidence rates, mortality rates and determinants of environmental-temperature injury were estimated for Montreal Island's 1,802,309 urban and suburban residents. Sources of information included coroner's reports, death certificates, hospital discharge summaries, and hospital chart reviews. The estimated incidence rate for environmental-temperature injury requiring hospitalization on Montreal Island was 3.1 per 100,000 person-years. The estimated mortality rate for all environmental-temperature injuries on Montreal Island was 0.3 per 100,000 person-years. The majority of hospitalizations and deaths were due to cold injury. Male gender, alcohol intoxication, psychiatric illness, older age, and homelessness were suggestive of important risk factors in cold injury. All deaths due to heat injury occurred in elderly females. Montreal Island's ambulance transport service, with its unique database, was identified as a novel surveillance design for environmental-temperature injury. Knowing more about the incidence and determinants of environmental-temperature injury may suggest priorities for interventions to decrease morbidity and mortality.

Aged↗
PubMed1991

Drug abuse control and the Salvation Army.

The Salvation Army has been involved in the control of drug abuse since it was founded over 120 years ago, when alcohol was the predominant concern. Today, alcohol is still the most commonly abused substance, but the Salvation Army is increasingly tackling other forms of substance abuse as well. High priority is given to prevention of all levels and by all means through a network of over 200 specialized rehabilitation centres throughout the world, in addition to programmes within hostels for the homeless, where there is a high proportion of alcohol and other substance abusers. The Salvation Army endeavours to help drug-dependent persons to abstain from using drugs and achieve a healthy and happy life. It is of the view that, as drug dependence is usually a manifestation of deeper needs, the spiritual component is vital in dealing with drug abuse of all types.

Charities↗
PubMed2005

Uncovering homeless African-American women's knowledge of breast cancer and their use of breast cancer screening services.

This study explored the knowledge of breast cancer and the use of breast cancer screening services by homeless African-American women in an attempt to understand their use of cancer screening services and whether they understood the information about breast cancer and breast cancer screening. A qualitative study using a focus group format was employed to obtain a deeper understanding of the participants' experiences as they related to knowledge of breast cancer and their use of breast cancer screening services. The sample consisted of 25 (N = 25) African-American women who were currently living in a transient shelter for homeless women and children. Three, one-hour focus group sessions were conducted over a three-week period. Sessions were audio taped and transcribed for analysis. Content analysis was used to analyze the data. Findings from the study revealed categories that were associated with the women's personal experiences with cancer, their knowledge of breast cancer and experiences with the use of screening services, and their motivations as they related to breast cancer screenings. These categories can be useful in providing access to care and in addressing cancer education, screening behaviors, and program planning in homeless African-American women.

Adaptation, Psychological↗
PubMed1993

Childbirth education classes in homeless shelters.

Childbirth education can have an enormous positive effect on the maternal health and birth experience of women in shelters. The childbirth educator can empower economically disadvantaged pregnant women to take personal responsibility for their childbirth outcome. The characteristics of women in shelters pose unique challenges to childbirth educators. Transient populations, different stages of pregnancy, substance abuse, nutrition deficiencies, and difficulties with the skills required for being a good parent present unusual problems and rewarding educational opportunities. With understanding, sensitivity, and commitment, the childbirth educator can prepare women in shelters to participate more actively in a healthy and informed birth experience.

Adult↗
PubMed1992

Mentally disordered offenders who push or attempt to push victims onto subway tracks in New York City.

Violent offenders who pushed or attempted to push victims onto the subway tracks in New York City during the 17-year period from 1975 through 1991 were studied. Forty-nine incidents involving 52 victims were identified during this period. Of 36 perpetrators who acted alone, 25 (69%) were referred for psychiatric evaluation and treatment, as was one member of an offending gang. Data concerning 20 of these 26 offenders and their crimes were collected. At the time of the offense, 19 (95%) of these offenders were psychotic, and 13 (65%) were homeless. Most of these offenders had extensive histories of psychiatric hospitalization and several prior arrests and convictions, often for violent crimes. The offenders had extensive mental health and criminal histories. The victims of these crimes were always strangers. Half of the offenders killed or seriously injured victims. Since 1986, the incidence of this offense has increased, and offenders accounting for the increase are mostly psychotic and homeless.

Adolescent↗