Reaching out to the forgotten: providing access to medical care for the homeless in Italy

Prevalence of Otolaryngology Diseases in an Urban Homeless Population

OBJECTIVE

Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population.

STUDY DESIGN

Retrospective study.

SETTING

Primary health care facility.

METHODS

The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study.

RESULTS

A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported.

CONCLUSIONS

Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.

Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review

BACKGROUND

Developing essential health services through non-governmental organisations (NGOs) is an important strategy for progressing towards Universal Health Coverage (UHC), especially in low- and middle-income countries. It is crucial to understand NGOs' role in reaching UHC and the best way to engage them.

OBJECTIVE

This study reviewed the role of NGOs and their engagement strategies in progress toward UHC.

METHOD

We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed.

FINDINGS

Seventy-eight studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to progress towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. Most studies were conducted in middle-income countries. Overall, the quality of the reported evidence was good. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors.

CONCLUSION

NGOs can play a significant role in the country's progress towards UHC along with the government and other key health players. The government should use strategies and interventions in supporting NGOs, accelerating their movement toward UHC.

Assessment of SARS-CoV-2 infection through rapid serology testing in the homeless population in the City of Rome, Italy. Preliminary results

Background: The development of COVID-19 pandemic has affected all segments of the population; however, it had a significant impact on vulnerable subjects, such as in people experiencing homelessness. The aim of this study was to evaluate the prevalence of COVID-19 spread in homeless persons in the city of Rome, Italy.

Design and Methods: Patients included in the study underwent a clinical evaluation and rapid antibody analysis on capillary blood for the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to SARS-CoV-2 virus. Symptomatic patients were not included in the screening and immediately referred to local hospitals for further evaluation.

Results: One-hundred seventy-three patients of both sexes were tested for SARS-CoV-2 infection through rapid serological test. Age range was 10-80 years; people came from 35 different countries of origin and 4 continents. Test results were negative for most patients (170-98.2%); two patients had positive IgM (1.2%) and one patient had positive IgG (0.6%).

Conclusions: Our study is the first to evaluate the prevalence of SARS-CoV-2 infection in people experiencing homelessness in the city of Rome, Italy. Most patients were negative for COVID- 19, although several factors may have had an impact on this result, such as the exclusion of symptomatic patients, the limited sensitivity of rapid serological tests in the initial stage of infection and the prevention measures adopted in these populations. Larger studies on fragile populations are needed to prevent and intercept new clusters of infection in the upcoming months.

Social Nurses’ Descriptions of Nursing: A Qualitative Study of What Social Nursing is and Does?

Background:

In the meeting between socially marginalised patients and somatic hospitals, healthcare systems often encounter complex challenges related to health inequalities that are difficult to resolve. To help reduce these challenges, a nursing approach employing a nurse (RN) with in-depth knowledge of socially marginalised patients and competences in rehabilitation (“social nurse”) has contributed to diminish health inequalities. However, further insight into the potential benefits of social nursing is required.

Aim:

To examine how social nurses describe and experience the social nursing approach situated at somatic hospitals.

Methods:

A qualitative study of social nurses’ descriptions and experiences with a social nurse approach included eight Danish hospitals. One male and 12 female nurses (n=13) employed as social nurses at somatic hospitals participated. Thirteen semi structured interviews were conducted using the methodological frameworks of phenomenology and hermeneutics. The interviews were analysed employing a method inspired by the French philosopher Paul Ricoeur’s theory of interpretation.

Results:

Four themes emerged from the analysis: 1) A unique expertise encompassing experience and evidence-based knowledge 2) coordination towards a common goal to reduce patients’ vulnerability, 3) to see and understand patients as whole persons, thereby assuring successful treatment and 4) working with the system to avoid losing the patients.

The themes describe a unique expertise emerging from focusing healthcare efforts on the socially marginalised patients and the system in charge.

Conclusion:

The study indicated that the social nurse approach is a holistic nursing approach. Applying this approach allows for optimised treatment that fosters a more equal outcome across the spectrum of socially marginalised patients. The social nurse approach may contribute to diminishing health inequalities.

Low prevalence of resistance genes in sheltered homeless population in Marseille, France, 2014-2018

Objectives: The present study has explored the prevalence and potential factors contributing to the presence of nasal/pharyngeal resistant genes in homeless people. Methods: During the winters 2014-2018, we enrolled sheltered homeless adults and controls and collected nasal/pharyngeal samples. Sixteen antibiotic resistance genes (ARGs), including genes encoding for beta-lactamases and colistin-resistance genes, were searched by real-time polymerase chain reaction (qPCR) performed directly on respiratory samples and followed by conventional PCR and sequencing. Results: Over a 5-year period, using qPCR, we identified in homeless group (n=715) the presence of bla _TEM (396/710, 54.7%), bla_SHV (27/708, 3.6%), bla _OXA-23 (1/708, 0.1%), while other genes including colistin-resistance genes (mcr-1 to mcr-5) were absent. We found a significantly higher proportion of ARG carriage among controls (74.1%) compared to homeless population (57.1%), p=0.038. Tobacco smoking (OR=4.72, p<0.0001) and respiratory clinical signs (OR=4.03, p=0.002) were most prevalent in homeless people, while vaccination against influenza (OR=0.31, p=0.016) was lower compared to controls. Among homeless people, type of housing (shelter A versus B, OR=1.59, p=0.006) and smoking tobacco (smoker versus non-smoker, OR=0.55, p=0.001) were independent factors associated with ARG carriage. By sequencing, we obtained a high diversity of bla _TEM and bla_SHV in both populations. Conclusion: The lower risk for ARGs in the homeless population could be explained by limited access to health care and subsequently reduced exposure to antibiotics.

The Medical Treatment of Homeless People

BACKGROUND

The homeless are often in poor health, and their risk of premature death is three to four times that of the general population. This article is intended to provide an overview of the medical care of the homeless in Germany.

METHODS

We selectively reviewed pertinent scientific and non-scientific publications from the years 2000-2017 that were retrieved from PubMed, from the reports of the German Homeless Aid Society (Bundesarbeitsgemeinschaft Wohnungslosenhilfe), from the websites of homeless aid organizations, and from Google Scholar.

RESULTS

At least 75% of the homeless currently suffer from a mental illness requiring treatment. Common somatic problems include respiratory (6-14%) and cardiovascular disorders (7-20%), injuries and intoxications (5-15%), and infectious and parasitic diseases (10-16%). To circumvent the multiple barriers impeding homeless people's access to standard medical care (lack of health insurance, a feeling of being unwelcome, lack of disease awareness, impaired capacity for compliance), medical help is offered to them outside the system in a number of ways, embedded in an overall scheme of social and practical assistance with daily living. These medical resources differ from region to region. They are often underfinanced and tend to focus on acute general medical care, with limited access to specialists.

CONCLUSION

More heath care resources need to be made available to the homeless beyond standard medical care. Concrete suggestions are discussed in the text.

Epidemiology of respiratory pathogen carriage in the homeless population within two shelters in Marseille, France, 2015-2017: cross sectional 1-day surveys

Objectives

To assess risk factors for respiratory tract infection symptoms and signs in sheltered homeless people in Marseille during the winter season, including pathogen carriage.

Methods

Data on 479 male participants within two shelters who completed questionnaires and a total of 950 nasal and pharyngeal samples were collected during the winters of 2015–2017. Respiratory pathogen carriage including seven viruses and four bacteria was assessed by quantitative PCR.

Results

The homeless population was characterized by a majority of individuals of North African origin (300/479, 62.6%) with a relatively high prevalence of chronic homelessness (175/465, 37.6%). We found a high prevalence of respiratory symptoms and signs (168/476, 35.3%), a very high prevalence of bacterial carriage (313/477, 65.6%), especially Haemophilus influenzae (280/477, 58.7%), and a lower prevalence of virus carriage (51/473, 10.8%) with human rhinovirus being the most frequent (25/473, 5.3%). Differences were observed between the microbial communities of the nose and throat. Duration of homelessness (odds ratio (OR) 1.77, p 0.017), chronic respiratory diseases (OR 5.27, p <0.0001) and visiting countries of origin for migrants (OR 1.68, p 0.035) were identified as independent risk factors for respiratory symptoms and signs. A strong association between virus (OR 2.40, p 0.012) or Streptococcus pneumoniae (OR 2.32, p 0.014) carriage and respiratory symptoms and signs was also found.

Conclusions

These findings allowed identification of the individuals at higher risk for contracting respiratory tract infections to better target preventive measures aimed at limiting the transmission of these diseases in this setting.