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Hutchinson JM, Tarasuk V. Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015. Appl Physiol Nutr Metab 2024; 49:1025-1034. [PMID: 38603809 DOI: 10.1139/apnm-2023-0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.
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Affiliation(s)
- Joy M Hutchinson
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Ayenew B, Belay DM, Gashaw Y, Gimja W, Gardie Y. WHO's end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022. BMC Public Health 2024; 24:961. [PMID: 38575958 PMCID: PMC10996214 DOI: 10.1186/s12889-024-18400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health challenge, despite the World Health Organization (WHO) actively working towards its eradication through various initiatives and programs. Undernutrition, forced displacement, and homelessness worsen TB's burden and challenge control efforts; however, there is still no adequate research that shows the trend of these underlying factors to attain the WHO's ambitious TB targets. So, this study aims to analyze the trend analysis of these underlying factors worldwide from 2015 to 2022 and their impact on the feasibility and implications of reaching the End TB targets by 2035. We utilized international databases, including UNHCR, FAO, and WHO reports, as secondary data sources. Data were extracted chronologically from 2015 to 2022 to illustrate trends in undernutrition, forced displacement, and homelessness on a global level.This trend analysis reveals that undernutrition, forced displacement, and homelessness have worsened over time. Undernutrition rose from 8.4 to 9.8% globally between 2015 and 2021, affecting 22.7 million additional individuals each year. In 2022, undernutrition affected 735 million people globally. Africa (21.9%) and Asia (10.6%) had the highest rates, while Western Europe and North America had lower rates than the global average: 3.4% and 2.5%, respectively.Similarly, the global rate of forced displacement increased from 65.1 million people in 2015 to 108.4 million in 2022, a 21% increase from 2021. This means that an extra 19 million people were displaced in 2021. Globally, homelessness, affecting 1.6 billion people, has worsened over time. Despite being a highly vulnerable group to TB, homeless individuals are often neglected in TB control efforts. Our findings underscore the critical importance of addressing undernutrition, forced displacement, and homelessness in achieving the World Health Organization's ambitious End TB targets by 2035, as highlighted through trend analysis from 2015 to 2022. Implementing policies focusing on nutrition, stable housing, and the challenges faced by displaced populations is imperative for progress toward a TB-free world.
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Affiliation(s)
- Birhanu Ayenew
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Dawit Misganaw Belay
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Yegoraw Gashaw
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Wondimu Gimja
- Department of Adult Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Yimenu Gardie
- Department of Pediatric and Child Health Nursing, College of Health Science, Assosa University, Assosa, Ethiopia
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3
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Adams EJ, Lu M, Duan R, Chao AK, Kessler HC, Miller CD, Richter AG, Latyshev DG, Dastoor JD, Eckburg AJ, Kadambi NS, Suresh NR, Bales CE, Green HM, Camp DM, Jara R, Flaherty JP. Nutritional needs, resources, and barriers among unhoused adults cared for by a street medicine organization in Chicago, Illinois: a cross-sectional study. BMC Public Health 2023; 23:2430. [PMID: 38057780 PMCID: PMC10698922 DOI: 10.1186/s12889-023-16790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/19/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Those experiencing houselessness rely on obtaining food from community organizers and donations. Simultaneously, the houseless face disproportionally high rates of medical conditions that may be affected by diet including diabetes, hypertension, and hyperlipidemia. There is limited literature on the resources and barriers of the houseless community regarding optimal nutrition from an actionable perspective. Further, less data is available on how street medicine organizations may best impact the nutrition of the unhoused they serve. Elucidating this information will inform how organizational efforts may best support the nutrition of the houseless community. METHODS In partnership with the medical student-run organization, Chicago Street Medicine, at Northwestern University Feinberg School of Medicine, twenty adults experiencing houselessness in Chicago, Illinois participated in the cross-sectional study. A 10-item survey was verbally administered to characterize the participants' daily food intake, food sources, barriers, resources, and nutritional preferences and needs. All data was directly transcribed into REDCap. Descriptive statistics were generated. RESULTS Individuals consumed a median of 2 snacks and meals per day (IQR: 1-3). No participant consumed adequate servings of every food group, with only one participant meeting the dietary intake requirements for one food group. Participants most often received their food from donations (n = 15), purchasing themselves (n = 11), food pantries (n = 4), and shelters (n = 3). Eleven of nineteen participants endorsed dental concerns as a major barrier to consuming certain foods. Twelve participants had access to a can opener and twelve could heat their meals on a stove or microwave. Seven had access to kitchen facilities where they may prepare a meal. Approximately half of participants had been counseled by a physician to maintain a particular diet, with most related to reducing sugar intake. CONCLUSION Most houseless participants were unable to acquire a balanced diet and often relied on organizational efforts to eat. Organizations should consider the chronic health conditions, dentition needs, and physical resources and barriers to optimal nutrition when obtaining food to distribute to the unhoused.
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Affiliation(s)
- Elizabeth J Adams
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA.
| | - Michelle Lu
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Richard Duan
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Alyssa K Chao
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Helen C Kessler
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Charles D Miller
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Adam G Richter
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Daniel G Latyshev
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Jehannaz D Dastoor
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Adam J Eckburg
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Namrata S Kadambi
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Nila R Suresh
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Cayla E Bales
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Hannah M Green
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Daniel M Camp
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - Rolando Jara
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
| | - John P Flaherty
- Chicago Street Medicine, 1074 W. Taylor St #381, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair St Ste 940, Chicago, IL, USA
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Seeman MV. Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review. Behav Sci (Basel) 2023; 13:967. [PMID: 38131823 PMCID: PMC10740554 DOI: 10.3390/bs13120967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G4, Canada
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Wetherill MS, Caywood LT, Hollman N, Carter VP, Gentges J, Sims A, Henderson CV. Food Is Medicine for Individuals Affected by Homelessness: Findings from a Participatory Soup Kitchen Menu Redesign. Nutrients 2023; 15:4417. [PMID: 37892492 PMCID: PMC10609710 DOI: 10.3390/nu15204417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Health disparities among people experiencing homelessness are likely exacerbated by limited access to healthy, fresh, and minimally processed foods. Soup kitchens and shelters serve as essential food safety nets for preventing hunger in this population, and community interest is growing in the potential of "food is medicine" interventions to improve the mental and physical wellbeing of people who receive meals from these providers. This study describes our two-phase approach to first identify and prioritize nutrition needs within an urban soup kitchen community and then test and implement new recipes and menu guidelines to help the standard soup kitchen menu better align with those priorities. We began by first conducting a nutrition needs assessment, including a collection of intercept surveys from a convenience sample of soup kitchen guests to better understand their nutrition-related health needs, dental issues, food preferences, and menu satisfaction (n = 112), as well as a nutrition analysis of the standard menu based on seven randomly selected meals. Most respondents reported at least one chronic health condition, with depressive disorders (50.9%) and cardiovascular diseases (49.1%) being the most common. Nearly all guests requested more fruits and vegetables at mealtimes, and results from the menu analysis revealed opportunities to lower meal contents of sodium, saturated fat, and added sugars and to raise micronutrient, fiber, and omega-3 content. We then applied these nutrition needs assessment findings to inform the second phase of the project. This phase included the identification of new food inventory items to help support cardiovascular and mental health-related nutrition needs, taste test sampling of new healthy menu items with soup kitchen guests, and hands-on culinary medicine training to kitchen staff on newly-developed "food is medicine" guidelines to support menu transformation. All taste tests of new menu items received over 75% approval, which exceeded satisfaction ratings of the standard menu collected during the phase 1 needs assessment. Findings from this community-based participatory research project confirm the great potential for hunger safety net providers to support critical nutrition needs within this vulnerable population through strategic menu changes. However, more research is needed on the longitudinal impacts of such changes on health indicators over time.
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Affiliation(s)
- Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Tulsa Schusterman Center, Tulsa, OK 74135, USA
- Department of Family and Community Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA
- OU Culinary Medicine Program, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA;
| | - Lacey T. Caywood
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Tulsa Schusterman Center, Tulsa, OK 74135, USA
| | - Nicholas Hollman
- Office of Research Development and Scholarly Activity, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA;
| | - Valarie P. Carter
- OU Culinary Medicine Program, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA;
| | - Joshua Gentges
- Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK 74135, USA;
| | - Ashli Sims
- Iron Gate, Tulsa, OK 74103, USA; (A.S.); (C.V.H.)
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Crane M, Joly L, Daly BJ, Gage H, Manthorpe J, Cetrano G, Ford C, Williams P. Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-217. [PMID: 37839804 DOI: 10.3310/wxuw5103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services. Objectives This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants' use of health care and social care services over 12 months, and costs were calculated. Design and setting The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model. Participants People who had been homeless during the previous 12 months were recruited as 'case study participants'; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders. Results The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services. Limitations There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model. Conclusions Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, 'drop-in' services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (HSDR 13/156/03) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maureen Crane
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Louise Joly
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Blánaid Jm Daly
- Special Care Dentistry, Division of Population and Patient Health, King's College London, London, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Jill Manthorpe
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | - Gaia Cetrano
- National Institute for Health and Care Research Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
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Ravikumar-Grant D, Kelly C, Gabhainn SN. The determinants of the nutritional quality of food provided to the homeless population: a mixed methods systematic review protocol. Syst Rev 2023; 12:118. [PMID: 37430337 DOI: 10.1186/s13643-023-02286-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Studies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population. METHODS This mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed. DISCUSSION Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector. SYSTEMATIC REVIEW REGISTRATION This mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.
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Affiliation(s)
- Divya Ravikumar-Grant
- Health Promotion Department, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Colette Kelly
- Health Promotion Department, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Saoirse Nic Gabhainn
- Health Promotion Department, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
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O'Leary C, Teixeira L, Coren E, Kiss Z, Roberts A, Amitage H. PROTOCOL: The effectiveness of psychosocial interventions for reducing problematic substance use, improving mental health, and improving housing stability for adults experiencing homelessness: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1290. [PMID: 36908838 PMCID: PMC9695752 DOI: 10.1002/cl2.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This systematic review is part of a broader evidence synthesis which aims to produce two systematic reviews to address a significant gap in the evidence base identified by Luchenski et al. (2018) and by (White, 2018). The first review (which is the subject of this protocol) will use meta-analysis to examine the effectiveness of different psychosocial interventions in (1) reducing problematic substance use; (2) improving mental health; and (3) improving housing stability for adults experiencing homelessness. The second review (which is covered by a separate title registration and protocol) will be of the experiences of adults experiencing homelessness when accessing or using psychosocial interventions, and will be a qualitative evidence synthesis using thematic synthesis (Thomas & Harden, 2008).
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Affiliation(s)
- Chris O'Leary
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
| | | | | | | | - Anton Roberts
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
| | - Harry Amitage
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
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9
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O'Leary C, Roberts A, Teixeira L, Coren E. PROTOCOL: The experiences of adults experiencing homelessness when accessing and using psychosocial interventions: A systematic review and qualitative evidence synthesis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1289. [PMID: 36908840 PMCID: PMC9683077 DOI: 10.1002/cl2.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 06/18/2023]
Abstract
The systematic review set out in this protocol is part of a broader evidence synthesis which intends to produce two systematic reviews to address a significant gap in the evidence base identified by Luchenski et al. (2018) and by White and Narayanan (2021). This review (the focus of this protocol) will be of the experiences of adults experiencing homelessness when accessing and using psychosocial interventions. This review of qualitative data will use thematic synthesis to analyse these experiences as faced by this population when accessing and using psychosocial interventions.
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Affiliation(s)
- Chris O'Leary
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
| | - Anton Roberts
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
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Easton C, Oudshoorn A, Smith-Carrier T, Forchuk C, Marshall CA. The experience of food insecurity during and following homelessness in high-income countries: A systematic review and meta-aggregation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3384-e3405. [PMID: 35869792 DOI: 10.1111/hsc.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Homelessness is a pervasive challenge caused by poverty which continues to grow in economically developed countries, posing significant health impacts (Fazel et al., Lancet, 384: 1529-1540, 2014). While food security related to poverty and low income has been investigated, this review specifically explores the experience of food security during and following homelessness. Given the fact that the health of individuals who experience homelessness is known to be poor and the importance of nutrition, this is a necessary contribution. Informed by a health equity lens, this review synthesises the findings and quality of the literature regarding experiences of food security during and following homelessness in high-income countries. We used the Joanna Briggs Institute methodology, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Qualitative studies published to date were obtained from six databases. We conducted a meta-aggregation of existing qualitative findings. Twenty-four studies on 462 participants were included in the review. Through meta-aggregation four themes were created: (1) imposed food options as a determinant of health out of my control; (2) obtaining food for survival despite stigma or other consequences; (3) situated within a system that maintains food insecurity; and (4) surviving hardships. Persons during and following homelessness in high-income countries face multiple challenges when securing food while situated in an oppressive system that lacks choice. Despite this, persons who have experienced homelessness demonstrate resilience by finding ways to meet their basic needs in the face of imposed barriers. Implications for research, policy and practice are offered.
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Affiliation(s)
- Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Tracy Smith-Carrier
- School of Humanitarian Studies, Royal Roads University, Victoria, British Columbia, Canada
| | - Cheryl Forchuk
- School of Nursing, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
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11
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Huang C, Foster H, Paudyal V, Ward M, Lowrie R. A systematic review of the nutritional status of adults experiencing homelessness. Public Health 2022; 208:59-67. [PMID: 35716429 DOI: 10.1016/j.puhe.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify, appraise, and describe studies focussing on the nutritional characteristics of people experiencing homelessness (PEH). STUDY DESIGN Systematic (narrative) review. METHODS We identified full-text studies of any design and in the English language of adults (≥18 years) fulfilling the European Typology criteria for homelessness, based in community or hospital settings, and which report nutritional measures. Five electronic databases, 13 grey literature sources, reference lists, and forward citations were searched. Data on study characteristics and nutrition measures were collected and synthesised narratively. Risk of bias was assessed using relevant checklists for each study type. RESULTS A total of 1130 studies were identified and retrieved. After screening, six studies were included for review: three cross-sectional studies; two case-control studies; and one randomised control trial, involving a total of 1561 participants from various settings including shelters, drop-in centres, hospitals, and hostels. All included studies were from high-income countries. Studies reported a range of nutrition measures including anthropometry (e.g., body mass index (BMI)), serum micronutrients and biomarkers, and dietary intake. Between 33.3% and 68.3% of participants were overweight or obese; 3.5%-17% were underweight; and low blood levels of iron, folate, vitamins C, D, and B12, and haemoglobin were prevalent. PEH consumed high amounts of dietary fats and alcohol, and low amounts of fruits and vegetables compared with national guidelines and housed individuals. There was moderate to high risk of selection and measurement bias and confounding in included studies. CONCLUSIONS A majority of PEH are within unhealthy BMI ranges and are deficient in serum micronutrients and nutritional biomarkers. Studies using large data sets that examine multiple aspects of nutrition are needed to describe the nutritional characteristics of PEH. REGISTRATION This systematic review is based on a prespecified protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42021218900).
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Affiliation(s)
- C Huang
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, UK.
| | - H Foster
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK.
| | - V Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, UK.
| | - M Ward
- Marianne Ward, Homelessness Dietitian, Dietetics, Glasgow City HSCP, Shettleston Health Centre, 420 Old Shettleston Road, Glasgow G32 7JZ, UK.
| | - R Lowrie
- PHOENIx Team, Pharmacy Services, NHS Greater Glasgow and Clyde, UK.
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Kaltsidis G, Grenier G, Cao Z, Bertrand K, Fleury MJ. Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:631-643. [PMID: 32985755 DOI: 10.1111/hsc.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12 months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12 months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12 months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Karine Bertrand
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
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13
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Donesky D, Norton L, Fisher E, Bunker-Alberts M. Health services and the Project RoomKey COVID-19 initiative for the unhoused: A university and community partnership. J Prof Nurs 2021; 37:1175-1179. [PMID: 34887037 PMCID: PMC8552694 DOI: 10.1016/j.profnurs.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Indexed: 11/29/2022]
Abstract
A hotel-based clinic to serve Project RoomKey residents is a model for meeting the health care needs of an unhoused population. The purpose of this paper is to describe the health services provided by students and licensed clinicians at a hotel that was designed to allow unhoused community residents to shelter in place during the early stages of the Covid pandemic (May 1–June 30, 2020). Documents developed for the project may be useful to others who are setting up similar services for unhoused residents in their own communities.
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Affiliation(s)
- DorAnne Donesky
- University of California San Francisco, United States of America.
| | - Lisa Norton
- Touro University of California, United States of America
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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15
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Miyawaki A, Khullar D, Tsugawa Y. Processes of care and outcomes for homeless patients hospitalised for cardiovascular conditions at safety-net versus non-safety-net hospitals: cross-sectional study. BMJ Open 2021; 11:e046959. [PMID: 36107751 PMCID: PMC8039275 DOI: 10.1136/bmjopen-2020-046959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Evidence suggests that homeless patients experience worse quality of care and poorer health outcomes across a range of medical conditions. It remains unclear, however, whether differences in care delivery at safety-net versus non-safety-net hospitals explain these disparities. We aimed to investigate whether homeless versus non-homeless adults hospitalised for cardiovascular conditions (acute myocardial infarction (AMI) and stroke) experience differences in care delivery and health outcomes at safety-net versus non-safety-net hospitals. DESIGN Cross-sectional study. SETTING Data including all hospital admissions in four states (Florida, Massachusetts, Maryland, and New York) in 2014. PARTICIPANTS We analysed 167 105 adults aged 18 years or older hospitalised for cardiovascular conditions (age mean=64.5 years; 75 361 (45.1%) women; 2123 (1.3%) homeless hospitalisations) discharged from 348 hospitals. OUTCOME MEASURES Risk-adjusted diagnostic and therapeutic procedure and in-hospital mortality, after adjusting for patient characteristics and state and quarter fixed effects. RESULTS At safety-net hospitals, homeless adults hospitalised for AMI were less likely to receive coronary angiogram (adjusted OR (aOR), 0.42; 95% CI, 0.36 to 0.50; p<0.001), percutaneous coronary intervention (aOR, 0.52; 95% CI, 0.44 to 0.62; p<0.001) and coronary artery bypass graft (aOR, 0.43; 95% CI, 0.26 to 0.71; p<0.01) compared with non-homeless adults. Homeless patients treated for strokes at safety-net hospitals were less likely to receive cerebral arteriography (aOR, 0.23; 95% CI, 0.16 to 0.34; p<0.001), but were as likely to receive thrombolysis therapy. At non-safety-net hospitals, we found no evidence that the probability of receiving these procedures differed between homeless and non-homeless adults hospitalised for AMI or stroke. Finally, there were no differences in in-hospital mortality rates for homeless versus non-homeless patients at either safety-net or non-safety-net hospitals. CONCLUSION Disparities in receipt of diagnostic and therapeutic procedures for homeless patients with cardiovascular conditions were observed only at safety-net hospitals. However, we found no evidence that these differences influenced in-hospital mortality markedly.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Dhruv Khullar
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Fleury MJ, Grenier G, Sabetti J, Bertrand K, Clément M, Brochu S. Met and unmet needs of homeless individuals at different stages of housing reintegration: A mixed-method investigation. PLoS One 2021; 16:e0245088. [PMID: 33444366 PMCID: PMC7808646 DOI: 10.1371/journal.pone.0245088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to identify and compare major areas of met and unmet needs reported by 455 homeless or recently housed individuals recruited from emergency shelters, temporary housing, and permanent housing in Quebec (Canada). Mixed methods, guided by the Maslow framework, were used. Basic needs were the strongest needs category identified, followed by health and social services (an emergent category), and safety; very few participants expressed needs in the higher-order categories of love and belonging, self-esteem, and self-actualization. The only significant differences between the three housing groups occurred in basic needs met, which favored permanent housing residents. Safety was the only category where individuals reported more unmet than met needs. The study results suggested that increased overall access to and continuity of care with family physicians, MD or SUD clinicians and community organizations for social integration should be provided to help better these individuals. Case management, stigma prevention, supported employment programs, peer support and day centers should particularly be more widely implemented as interventions that may promote a higher incidence of met needs in specific needs categories.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
- * E-mail:
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
- McGill University School of Social Work, Montreal, Quebec, Canada
| | - Karine Bertrand
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michèle Clément
- Département de Médecine Sociale et Préventive, Université Laval, Quebec City, Quebec, Canada
| | - Serge Brochu
- Département de Criminologie, Université de Montréal, Montreal, Canada
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17
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Objective assessment of dietary exposure and cardiometabolic risk in homeless adults. Proc Nutr Soc 2021. [DOI: 10.1017/s0029665121000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Al-Shakarchi NJ, Evans H, Luchenski SA, Story A, Banerjee A. Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies. Heart 2020; 106:1483-1488. [PMID: 32665359 PMCID: PMC7509384 DOI: 10.1136/heartjnl-2020-316706] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify: (i) risk of cardiovascular disease (CVD) in homeless versus housed individuals and (ii) interventions for CVD in homeless populations. METHODS We conducted a systematic literature review in EMBASE until December 2018 using a search strategy for observational and interventional studies without restriction regarding languages or countries. Meta-analyses were conducted, where appropriate and possible. Outcome measures were all-cause and CVD mortality, and morbidity. RESULTS Our search identified 17 articles (6 case-control, 11 cohort) concerning risk of CVD and none regarding specific interventions. Nine were included to perform a meta-analysis. The majority (13/17, 76.4%) were high quality and all were based in Europe or North America, including 765 459 individuals, of whom 32 721 were homeless. 12/17 studies were pre-2011. Homeless individuals were more likely to have CVD than non-homeless individuals (pooled OR 2.96; 95% CI 2.80 to 3.13; p<0.0001; heterogeneity p<0.0001; I2=99.1%) and had increased CVD mortality (age-standardised mortality ratio range: 2.6-6.4). Compared with non-homeless individuals, hypertension was more likely in homeless people (pooled OR 1.38-1.75, p=0.0070; heterogeneity p=0.935; I2=0.0%). CONCLUSIONS Homeless people have an approximately three times greater risk of CVD and an increased CVD mortality. However, there are no studies of specific pathways/interventions for CVD in this population. Future research should consider design and evaluation of tailored interventions or integrating CVD into existing interventions.
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Affiliation(s)
| | - Hannah Evans
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Serena A Luchenski
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Alistair Story
- Institute of Health Informatics, University College London, London, United Kingdom.,Find and Treat Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom .,Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.,Department of Cardiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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19
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Paudyal V, MacLure K, Forbes-McKay K, McKenzie M, MacLeod J, Smith A, Stewart D. 'If I die, I die, I don't care about my health': Perspectives on self-care of people experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:160-172. [PMID: 31490598 DOI: 10.1111/hsc.12850] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Self-care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self-care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi-structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio-recorded and transcribed verbatim. Six aspects of self-care were explored, including (a) self-awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self-care. Most of the barriers to engagement in self-care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health-related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was 'nothing' they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self-care. The theme of 'social circle' held examples of both enabler and barriers in participants' uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi-morbidity, health literacy and self-efficacy.
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Affiliation(s)
- Vibhu Paudyal
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Katie MacLure
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | | | - Myra McKenzie
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | - Joan MacLeod
- NHS Grampian (South Cluster), Aberdeen City Community Health Partnership, Aberdeen, UK
| | - Ann Smith
- NHS Grampian (North Cluster), Aberdeen City Community Health Partnership, Aberdeen, UK
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20
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Lee HJ, Shin J, You KM. High-Prevalence Vitamin D Deficiency among Korean Emergency Department Homeless, with a Comparison to a Healthy Korean Population. Nutrients 2019; 11:nu11040763. [PMID: 30939796 PMCID: PMC6521275 DOI: 10.3390/nu11040763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/23/2022] Open
Abstract
Although nutritional problems are a major concern for the homeless, their vitamin D status has not yet been widely evaluated. This study was a retrospective chart review conducted at a single academic, urban public hospital’s emergency department (ED). Patients whose serum 25-hydroxyvitamin D [25(OH)D] levels had been checked in the ED from July 2014 to June 2015 were reviewed and enrolled. For a healthy settled civilian control, 2011 and 2012 data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES) were used. A total of 179 patients were enrolled. Vitamin D deficiency was observed in 133 patients (73.7%). The vitamin D deficiency group showed a lower hemoglobin level than that of non-vitamin D deficiency group (p = 0.02). Winter visits were more common among the deficiency group (p = 0.048). Rhabdomyolysis was observed only in the deficiency homeless group (p = 0.03). When using age and sex as covariates of propensity score matching 25(OH)D levels were lower in the homeless than in the healthy control (15.7 ± 7.4 ng/mL vs. 18.2 ± 5.5 ng/mL, p < 0.001). Moreover, when the controls were limited to residents of the same city, the serum 25(OH)D level also was lower in the homeless than in the control (15.7 ± 7.4 ng/mL vs. 17.1 ± 5.4 ng/mL, p = 0.03). In summary, vitamin D deficiency was common and more frequent among homeless patients.
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Affiliation(s)
- Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
- Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
| | - Kyoung Min You
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea.
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21
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Ijaz S, Thorley H, Porter K, Fleming C, Jones T, Kesten J, Mamluk L, Richards A, Marques EMR, Savović J. Interventions for preventing or treating malnutrition in homeless problem-drinkers: a systematic review. Int J Equity Health 2018; 17:8. [PMID: 29338739 PMCID: PMC5771104 DOI: 10.1186/s12939-018-0722-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Excessive drinking leads to poor absorption of nutrients and homeless problem-drinkers often have nutritionally inadequate diets. Depletion of nutrients such as vitamin B1 can lead to cognitive impairment, which can hinder efforts to reduce drinking or engage with services. This review aimed to assess effectiveness of interventions designed to prevent or treat malnutrition in homeless problem-drinkers. METHODS We systematically searched nine electronic databases and 13 grey literature sources for studies evaluating interventions to improve nutrition in homeless populations, without regional or language restrictions. Screening for inclusion was done in duplicate. One reviewer extracted data and assessed risk of bias, and another checked the extractions. Primary outcomes were nutrition status/deficiency, liver damage, and cognitive function. Secondary outcomes included abstinence, comorbidities, resource use, acceptability and engagement with intervention. Results were synthesised narratively. RESULTS We included 25 studies (2 Randomised Controlled Trials; 15 uncontrolled before and after; 7 surveys; 1 case-control). Nine studies evaluated educational and support interventions, five food provision, and three supplement provision. Eight studies evaluated a combination of these interventions. No two interventions were the same, and all studies were at high risk of bias. Nutritional status (intake/ deficiency) were reported in 11 studies and liver function in one. Fruit and vegetable intake improved with some education and support interventions (n = 4 studies) but not others (n = 2). Vitamin supplements appeared to improve vitamin deficiency levels in the blood (n = 2). Free or subsidised meals (n = 4) and food packs (n = 1) did not always fulfil dietary needs, but were usually considered acceptable by users. Some multicomponent interventions improved nutrition (n = 3) but acceptability varied (n = 3). No study reported cost effectiveness. CONCLUSIONS The evidence for any one intervention for improving malnutrition in homeless problem-drinkers was based on single studies at high risk of bias. Various food and supplement provision interventions appear effective in changing nutritional status in single studies. Educational and multicomponent interventions show improved nutritional behaviour in some studies but not others. Further better quality evidence is required before these interventions can be recommended for implementation. Any future studies should seek the end user input in their design and conduct. TRIAL REGISTRATION Registered with PROSPERO: CRD42015024247 .
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Affiliation(s)
- Sharea Ijaz
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Helen Thorley
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Clare Fleming
- Compass Health, The Compass Centre, 1 Jamaica Street, Bristol, BS2 8JP UK
| | - Tim Jones
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna Kesten
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, London, UK
| | - Loubaba Mamluk
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Elsa M. R. Marques
- Bristol Medical School, Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Jelena Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Knight R, Fast D, DeBeck K, Shoveller J, Small W. "Getting out of downtown": a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene. BMC Public Health 2017; 17:376. [PMID: 28464942 PMCID: PMC5414159 DOI: 10.1186/s12889-017-4313-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban drug "scenes" have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths' drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner-city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences. METHODS Between 2008 and 2016, we draw on 150 semi-structured interviews with 75 street-entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between. RESULTS Youth described that, in order to successfully exit Vancouver's inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves - both physically and socially - from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth's capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low-threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption. CONCLUSIONS Policies and programming interventions that can facilitate young people's efforts to reduce engagement with Vancouver's inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, 'low threshold' addiction treatment services, as well as access to supportive housing outside of the scene.
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Affiliation(s)
- Rod Knight
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada. .,British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada.,British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Public Policy, Simon Fraser University at Harbour Centre, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.,British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jean Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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