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Sajadipour M, Rezaei S, Irandoost SF, Ghaumzadeh M, Salmani Nadushan M, Gholami M, Salimi Y, Jorjoran Shushtari Z. What explains gender inequality in HIV infection among high-risk people? A Blinder-Oaxaca decomposition. Arch Public Health 2022; 80:2. [PMID: 34983632 PMCID: PMC8725256 DOI: 10.1186/s13690-021-00758-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Despite clear evidence on role of gender in vulnerability and exposure to HIV infection, information on gender-related inequalities in HIV and related factors are rarely documented. The aim of this study was to measure gender inequality in HIV infection and its determinates in Tehran city, the capital of Iran. Methods The study used the data of 20,156 medical records of high-risk people who were admitted to Imam Khomeini Voluntary Counseling and Testing site in Tehran from 2004 to 2018. The Blinder-Oaxaca decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of HIV infection between female and male. Results The age-adjusted proportion of HIV infection was 9.45% (95%Cl: 9.02, 9.87). The absolute gap in the prevalence of HIV infection between male and female was 4.50% (95% CI: − 5.33, − 3.70%). The Blinder-Oaxaca decomposition indicated that most explanatory factors affecting the differences in HIV infection were job exposure, drug abuse, history of imprisonment, injection drug, heterosexual unsafe sex, and having an HIV-positive spouse. Conclusion The results can provide evidence for health policymakers to better planning and conducting gender-based preventive and screening programs. Policies aiming at promoting HIV preventive behaviors among male may reduce the gap in HIV infection between female and male in Iran.
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Affiliation(s)
- Mansour Sajadipour
- Department of Health, South Tehran health center, Tehran University of Medical Sciences, Tehran, Iran
| | - Satar Rezaei
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Seyed Fahim Irandoost
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammadreza Ghaumzadeh
- Department of Health, South Tehran health center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Gholami
- Department of Medical Microbiology, Aja University of Medical Sciences, Tehran, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Miller AC, Nelson AK, Livchits V, Greenfield SF, Yanova G, Yanov S, Connery HS, Atwood S, Lastimoso CS, Shin SS. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation. PLoS One 2016; 11:e0148910. [PMID: 26871943 PMCID: PMC4752500 DOI: 10.1371/journal.pone.0148910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/23/2016] [Indexed: 11/22/2022] Open
Abstract
Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.
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Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - A. Katrina Nelson
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Viktoria Livchits
- Partners In Health Representative Office in Russian Federation, Moscow, Russia
| | - Shelly F. Greenfield
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, United States of America
| | - Galina Yanova
- Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation
| | - Sergei Yanov
- Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation
| | - Hilary S. Connery
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Charmaine S. Lastimoso
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Sonya S. Shin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
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Trillo AD, Merchant RC, Baird JR, Ladd GT, Liu T, Nirenberg TD. Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients. BMC Emerg Med 2013; 13:9. [PMID: 23721108 PMCID: PMC3686630 DOI: 10.1186/1471-227x-13-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/03/2013] [Indexed: 01/29/2023] Open
Abstract
Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. Conclusions The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
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Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF. Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 2010; 45:2444-69. [PMID: 20536356 PMCID: PMC3169437 DOI: 10.3109/10826084.2010.490928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.
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Affiliation(s)
- Audrey Brooks
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.
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Merchant RC, Catanzaro BM, Seage GR, Mayer KH, Clark MA, Degruttola VG, Becker BM. Demographic variations in HIV testing history among emergency department patients: implications for HIV screening in US emergency departments. J Med Screen 2009; 16:60-6. [PMID: 19564517 DOI: 10.1258/jms.2009.008058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the proportion of emergency department (ED) patients who have been tested for human immunodeficiency virus (HIV) infection and assess if patient history of HIV testing varies according to patient demographic characteristics. DESIGN From July 2005-July 2006, a random sample of 18-55-year-old English-speaking patients being treated for sub-critical injury or illness at a northeastern US ED were interviewed on their history of HIV testing. Logistic regression models were created to compare patients by their history of being tested for HIV according to their demography. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS Of 2107 patients surveyed who were not known to be HIV-infected, the median age was 32 years; 54% were male, 71% were white, and 45% were single/never married; 49% had private health-care insurance and 45% had never been tested for HIV. Of the 946 never previously tested for HIV, 56.1% did not consider themselves at risk for HIV. In multivariable logistic regression analyses, those less likely to have been HIV tested were male (OR: 1.32 [1.37-2.73]), white (OR: 1.93 [1.37-2.73]), married (OR: 1.53 [1.12-2.08]), and had private health-care insurance (OR: 2.10 [1.69-2.61]). There was a U-shaped relationship between age and history of being tested for HIV; younger and older patients were less likely to have been tested. History of HIV testing and years of formal education were not related. CONCLUSION Almost half of ED patients surveyed had never been tested for HIV. Certain demographic groups are being missed though HIV diagnostic testing and screening programmes in other settings. These groups could potentially be reached through universal screening.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick Building, Providence, RI 02903, USA.
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Merchant RC, Seage GR, Mayer KH, Clark MA, DeGruttola VG, Becker BM. Emergency department patient acceptance of opt-in, universal, rapid HIV screening. Public Health Rep 2009; 123 Suppl 3:27-40. [PMID: 19172704 DOI: 10.1177/00333549081230s305] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We assessed emergency department (ED) patient acceptance of opt-in, rapid human immunodeficiency virus (HIV) screening and identified demographic characteristics and HIV testing-history factors associated with acceptance of screening. METHODS A random sample of 18- to 55-year-old ED patients was offered rapid HIV screening. Patient acceptance or decline of screening and the reasons for acceptance or decline were analyzed with multivariable regression models. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for the logistic regression models. RESULTS Of the 2,099 participants, 39.3% accepted HIV screening. In a multinomial regression model, participants who were never married/not partnered, did not have private health insurance, and had 12 or fewer years of education were more likely to be screened due to concern about a possible HIV exposure. In a multivariable logistic regression model, the odds of accepting screening were greater among those who were younger than 40-years-old (OR=1.61, 95% CI 1.32, 2.00), nonwhite (OR=1.28, 95% CI 1.04, 1.58), not married (OR=1.82, 95% CI 1.44, 2.28), lacking private health insurance (OR=1.40, 95% CI 1.13, 1.74), and who had 12 or fewer years of education (OR=1.43, 95% CI 1.16, 1.75). Despite use of a standardized protocol, patient acceptance of screening varied by which research assistant asked them to be screened. Patients not previously tested for HIV who were white, married, and 45 years or older and who had private health insurance were more likely to decline HIV screening. CONCLUSIONS In an opt-in, universal, ED HIV screening program, patient acceptance of screening varied by demography, which indicates that the impact of such screening programs will not be universal. Future research will need to determine methods of increasing uptake of ED HIV screening that transcend patient demographic characteristics, HIV testing history, and motivation for testing.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Merchant RC, Clark MA, Mayer KH, Seage Iii GR, DeGruttola VG, Becker BM. Video as an effective method to deliver pretest information for rapid human immunodeficiency testing. Acad Emerg Med 2009; 16:124-35. [PMID: 19120050 DOI: 10.1111/j.1553-2712.2008.00326.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Video-based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video "Do you know about rapid HIV testing?" is an acceptable alternative to an in-person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information. METHODS This was a noninferiority trial of 574 participants in an ED opt-in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live-action 9.5-minute video or an in-person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in-person information session if the 95% confidence interval (CI) of the difference (Delta) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in-person information session arm's mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. RESULTS The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in-person information session arm. The difference in mean scores compared to the mean score for the in-person information session met the noninferiority criterion for this investigation (Delta = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks/African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner/marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. CONCLUSIONS In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in-person information session were less effective in providing pretest information for patients with fewer years of formal education.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Cleland CM, Des Jarlais DC, Perlis TE, Stimson G, Poznyak V. HIV risk behaviors among female IDUs in developing and transitional countries. BMC Public Health 2007; 7:271. [PMID: 17908299 PMCID: PMC2140060 DOI: 10.1186/1471-2458-7-271] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 10/01/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of studies suggest females may be more likely to engage in injection and sex risk behavior than males. Most data on gender differences come from industrialized countries, so data are needed in developing countries to determine how well gender differences generalize to these understudied regions. METHODS Between 1999 and 2003, 2512 male and 672 female current injection drug users (IDUs) were surveyed in ten sites in developing countries around the world (Nairobi, Beijing, Hanoi, Kharkiv, Minsk, St. Petersburg, Bogotá, Gran Rosario, Rio, and Santos). The survey included a variety of questions about demographics, injecting practices and sexual behavior. RESULTS Females were more likely to engage in risk behaviors in the context of a sexual relationship with a primary partner while males were more likely to engage in risk behaviors in the context of close friendships and casual sexual relationships. After controlling for injection frequency, and years injecting, these gender differences were fairly consistent across sites. CONCLUSION Gender differences in risk depend on the relational contexts in which risk behaviors occur. The fact that female and male risk behavior often occurs in different relational contexts suggests that different kinds of prevention interventions which are sensitive to these contexts may be necessary.
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Affiliation(s)
- Charles M Cleland
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
| | - Don C Des Jarlais
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th Floor, New York, NY 10038, USA
| | - Theresa E Perlis
- Center for Drug Use and HIV Research, National Development and Research Institutes Inc. 71 West 23rd Street, New York, NY 10010, USA
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th Floor, New York, NY 10038, USA
| | - Gerry Stimson
- International Harm Reduction Association; The Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, UK
| | - Vladimir Poznyak
- Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland
| | - the WHO Phase II Drug Injection Collaborative Study Group
- Professor Moruf Adelekan and Dr Rahim Lawal, University of Ilorin Teaching Hospital, Ilorin – Kwara State, Nigeria; Dr Francisco Inacio Bastos, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Dr Nguyen Tran Hien and Dr Dao Thi Minh An, Hanoi Medical University, Hanoi, Viet Nam; Dr Sylvia Inchaurraga, Universidad Nacional de Rosario, Rosario, Argentina; Dr Don Des Jarlais and Dr Theresa Perlis, National Development and Research Institutes, Inc., New York, USA; Dr Maristela Monteiro, World Health Organization, Geneva, Switzerland; Prof. V. Navaratnam and B. Vicknasingam, Centre for Drug Research, University Sains Malaysia, Malaysia; Dr Augusto Perez Gomez and Dr Ines Elvira Mejia, Programa RUMBOS, Bogotá, Colombia; Dr Fabio Mesquita, Faculdade de Medicina da USP, Santos, Brazil; Dr Sergey Molochko, Minsk City Narcological Dispensary, Minsk, Belarus; Dr Maurice Odek-Ogunde, United States International University, Nairobi, Kenya; Mr Dimitry Ostrovsky, Foundation Vozvrastcheniye, St. Petersburg, Russia; Dr Vladimir Poznyak, World Health Organization, Geneva, Switzerland; Dr Emran Razzaghi and Dr Afarin Rahimi, Iranian Welfare Organization, Teheran, Iran; Professor Gerry Stimson and Mr Chris Fitch, formerly at Imperial College School of Medicine, London, United Kingdom; Dr Olga Balakireva and Dr Marina Varban, Ukrainian Institute for Social Research, Kiev, Ukraine; Prof. Zunyou Wu and Dr Lorraine Yap, Chinese Academy of Preventive Medicine, Beijing, China
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Morris DM, Gordon JA. The role of the emergency department in the care of homeless and disadvantaged populations. Emerg Med Clin North Am 2006; 24:839-48. [PMID: 16982342 DOI: 10.1016/j.emc.2006.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article provides an overview of the role of the emergency department (ED) in the care of homeless and disadvantaged populations. It suggests that organized emergency medicine can have a significant impact on total community health by maintaining a universal "safety net" for the delivery of integrated health and human services. The epidemiology of social deprivation among ED patients is examined, with a particular focus on homelessness. Current research on the value of socio-medical integration in the ED setting is discussed, with emphasis on selected initiatives that have demonstrated feasibility, cost-effectiveness, and impact.
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Affiliation(s)
- David M Morris
- Department of Emergency Medicine, MetroWest Medical Center, Framingham Union Hospital, Framingham, MA 01702, USA.
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Gender Differences in HIV Risk Behavior of Intravenous Drug Users Who Are Not Prostitutes. Women Health 2001. [DOI: 10.1300/j013v34n02_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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