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Konrady J, Talarska D. Factors determining the quality of life of homeless people staying in support centers for people in the crisis of homelessness. Pilot study. BMC Public Health 2024; 24:347. [PMID: 38302897 PMCID: PMC10835943 DOI: 10.1186/s12889-024-17839-w] [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: 08/06/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The aim of the study was to discuss the issues of the homelessness crisis and to present the assessment of the quality of life of people experiencing a homelessness crisis, taking into account various aspects of life and everyday functioning. METHODS This was a pilot cross- sectional study carried out using an anonymous survey. The author's questionnaire, the WHOQOL-Bref scale and the Beck depression scale were used. From among the support centers for people in the homelessness crisis operating in the city of Poznań, the 2 largest centers were selected. The obtained results were based on the statistical analysis of the collected data. RESULTS The study group consisted only of people in the crisis of homelessness staying at the support centers at the time of the study. The analysis included data from 114 people, including 28 (24.6%) women. The youngest participant was 21 and the oldest 76 years old. The average period of homelessness was 86 months. 55.3% of respondents showed symptoms of depression. The main cause of homelessness was their family situation (59.6%), financial problems (36.0%) and the need to leave the apartment (13.2%). Abuse of alcohol before the homelessness crisis was reported by 96 (84.2%) respondents. The WHOQOL- Bref questionnaire was used to assess the quality of life. The psychological domain was rated the highest (62.09 ± 16.94 points, the lowest somatic domain (53.25 ± 18.71 points). The quality of life of homeless people was positively related to their economic situation, depression and health status. It was shown that sex, age and education had no influence (p > 0.05) on the assessment of the quality of life of people experiencing the crisis of homelessness. CONCLUSIONS The economic situation is the main factor affecting the quality of life within the psychological and social domain. Health status is the main factor affecting the quality of life within the somatic and environmental domain. The biggest dream of the respondents was to have a flat and improve their financial situation.
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Affiliation(s)
- Jakub Konrady
- Department of Preventive Medicine, University of Medical Sciences, Poznan, Poland
| | - Dorota Talarska
- Department of Preventive Medicine, University of Medical Sciences, Poznan, Poland.
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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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Phiri TV, Gloeck N, Musekiwa A. Prevalence of comorbid disease and associated risk factors among homeless people living in temporary shelters during the COVID-19 lockdown in Tshwane, South Africa. S Afr Med J 2023; 113:48-52. [PMID: 37882135 DOI: 10.7196/samj.2023.v113i9.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND People experiencing homelessness are among the most socially and medically vulnerable populations. OBJECTIVES To assess the prevalence of comorbid disease and associated risk factors among homeless people admitted to temporary shelters in the City of Tshwane during levels 4 and 5 of the COVID-19 national lockdown in South Africa. METHODS A descriptive cross-sectional study design was used. The sample was drawn from secondary data on all individuals placed in temporary shelters constructed by Tshwane during levels 4 and 5 of the COVID-19 lockdown (26 March - 31 May 2020). Descriptive statistics were used to summarise data, and a multivariable logistic regression model was applied to determine factors associated with comorbid disease. RESULTS The overall prevalence of comorbid disease among homeless people in temporary shelters in Tshwane was 28.8% (95% confidence interval (CI) 26.9 - 30.8). There was no significant difference in the prevalence of comorbid disease by illicit substance use (29.9% for users v. 29.5% for non-users; p=0.871). In adjusted analyses, being South African (adjusted odds ratio (aOR) 2.06; 95% CI 1.10 - 3.88; p=0.024), being female (aOR 3.73; 95% CI 1.85 - 7.53; p<0.001), being black (aOR 3.43; 95% CI 1.12 - 10.54; p=0.031) or white (aOR 6.11; 95% CI 1.55 - 24.0; p=0.01), and injecting substances (aOR 1.68; 95% CI 1.19 - 2.37; p=0.003) were significantly associated with having comorbid disease. CONCLUSION The study found a 28.8% prevalence of comorbid disease among homeless people placed in temporary shelters in Tshwane. In adjusted analysis, being South African, being female, black and white race, and injecting substances were associated with having comorbid disease. Strengthening of public health interventions such as needle and syringe exchange programmes, family planning and access to primary care with health education could improve the healthcare of people experiencing homelessness.
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Affiliation(s)
- T V Phiri
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
| | - N Gloeck
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - A Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
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Zhao Y, Shannon K, Buxton JA, Ti L, Genovy TA, Braschel M, Pick N, Kestler M, Deering K. Precarious Housing Associated with Unsuppressed Viral load, sub-optimal Access to HIV Treatment and Unmet Health care Needs, Among Women Living with HIV in Metro Vancouver, Canada. AIDS Behav 2023; 27:2271-2284. [PMID: 36729293 PMCID: PMC10564463 DOI: 10.1007/s10461-022-03957-2] [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] [Accepted: 12/12/2022] [Indexed: 02/03/2023]
Abstract
We investigated associations between (1) housing status (four categories measuring housing stability) and outcomes along the HIV care continuum (not currently on antiretroviral therapy [ART]; sub-optimal ART adherence [< 95% in the last 3-4 weeks]; unsuppressed viral load [> 200 copies/ml], median CD4 < 200 in the last six months), and (2) housing status and unmet primary, dental and mental health care needs in the last six months among WLWH. Housing status was defined according to the Canadian Definition of Homelessness and had four categories: unsheltered (i.e., living in ≥ 1 unsheltered location [e.g., street, abandoned buildings]), unstable (i.e., living in ≥ 1 unstable location [e.g., shelter, couch surfing]), supportive housing (i.e., only living in supportive housing), and stable housing (i.e., only living in one's own housing; reference). At baseline, in the last six months, 47.3% of participants reported unstable housing, followed by 24.4% unsheltered housing, 16.4% stable housing, and 11.9% supportive housing. Overall, 19.1% of the full sample (N = 336, 2010-2019) reported not currently on ART; among participants on ART, 28.0% reported sub-optimal ART adherence. Overall, 32.1% had recent unsuppressed viral load. Among a subsample (n = 318, 2014-2019), 15.7% reported unmet primary care needs, 26.1% unmet dental care needs, and 16.4% unmet mental health care needs. In adjusted models, being unsheltered (vs. stable housing) was associated with not currently on ART, unsuppressed viral load, and unmet primary and dental care needs. Housing and health services need to be developed with and for WLWH to address structural inequities and fulfill basic rights to housing and health.
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Affiliation(s)
- Yinong Zhao
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jane A Buxton
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Theresa Anne Genovy
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Mary Kestler
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020. BMC Public Health 2022; 22:1597. [PMID: 35996145 PMCID: PMC9395771 DOI: 10.1186/s12889-022-14023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. Methods Study participants were adults who sought medical care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. Results Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35–49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68–3.24; AOR = 3.57, 95% CI = 2.55–5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. Conclusions Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.
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Che X, Sohn M, Moon S, Park HJ. Unmet dental care needs of homeless adults in South Korea: Findings from a national survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1134-e1142. [PMID: 34291516 DOI: 10.1111/hsc.13521] [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: 09/28/2020] [Revised: 05/13/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
This study identifies the key factors underlying the unmet dental care needs of South Korean homeless adults that obstructed their dental service access. We analysed data from 551 Korea Homeless Survey respondents (17 years and older) who reported having an oral disease in the previous 12 months. We conducted multiple logistic regression analyses to examine the factors associated with homeless individuals' unmet dental care needs, using weights to make the data nationally representative. Approximately 43% of the homeless people reported having unmet dental care needs. Housing type (living in the street) was significantly associated with an increased odds ratio of unmet dental care needs. However, when social protection programs (housing benefits and Medical Aid [MA]) were included in the model, the statistical significance of the housing type disappeared. Homeless MA recipients were less likely to have unmet needs than those not covered by MA. On the other hand, homeless people who received housing benefits were more likely to receive dental care than people who do not receive these benefits. Consequently, policy makers should develop social protection programs influencing homeless individuals' access to dental care and ensure the sustainable implementation of integrated community-based dental services for homeless adults.
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Affiliation(s)
- Xianhua Che
- Department of Health Policy Research, Daejeon Public Health Policy Institute, Daejeon, Republic of Korea
| | - Minsung Sohn
- Department of Health and Care Administration, The Cyber University of Korea, Seoul, Republic of Korea
| | - Sungje Moon
- Research Institute for Healthcare Policy, Korean Medical Association, Seoul, Republic of Korea
| | - Hee-Jung Park
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok, Republic of Korea
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Machado TGDO, Lawder JAC, Souza JBD, Matos MAD, Freire MDCM. [Periodontal status of temporarily institutionalized homeless adults and associated factors]. CIENCIA & SAUDE COLETIVA 2022; 27:1347-1358. [PMID: 35475817 DOI: 10.1590/1413-81232022274.04172021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 03/27/2021] [Indexed: 11/22/2022] Open
Abstract
The scope of this cross-sectional study was to describe the periodontal status and its association with sociodemographic, oral-health related behaviors and use of drugs among temporarily institutionalized homeless adults. The data were collected through oral clinical examination and a questionnaire with 102 adults attending the only public institution for this group in Goiânia, Goiás, Brazil. The periodontal condition was measured by the presence of bleeding on probing, dental calculus and pockets, according to the Community Periodontal Index (CPI). Chi-square test and Poisson regressions with robust variance were performed. The prevalence of CPI>1 was 83.3%. Approximately 68% of the sample had bleeding, 82.4% had calculus and 9.8% had periodontal pockets. In the bivariate analyses, those who reported having used illicit drugs had a higher prevalence of calculus; males and unmarried adults had a higher prevalence of pockets. In the adjusted analysis, individuals who used dental floss had a lower prevalence of bleeding (PR=0.58; 95%CI=0.35-0.96). The remaining covariates were not associated with the outcomes. It was concluded that the prevalence of periodontal alteration was high, the most frequent condition was calculus and the only independent association was between bleeding and the use of dental floss.
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Affiliation(s)
- Tamires Gomes de Oliveira Machado
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG). Av. Universitária Esquina com 1ª Avenida s/n, Setor Leste Universitário. 74605-220 Goiânia GO Brasil.
| | - Juliana Aparecida Campos Lawder
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG). Av. Universitária Esquina com 1ª Avenida s/n, Setor Leste Universitário. 74605-220 Goiânia GO Brasil.
| | - João Batista de Souza
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG). Av. Universitária Esquina com 1ª Avenida s/n, Setor Leste Universitário. 74605-220 Goiânia GO Brasil.
| | | | - Maria do Carmo Matias Freire
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG). Av. Universitária Esquina com 1ª Avenida s/n, Setor Leste Universitário. 74605-220 Goiânia GO Brasil.
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Paiva KDC, Lima LSD, Leite ICG. Self-Declared Oral Health Conditions and Oral Health-Related Quality of Life of the Brazilian Homeless Population: A Cross-Sectional Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Bernardino RMP, Silva AM, Costa JF, Silva MVB, Santos ITD, Dantas Neta NB, Prado Júnior RR, Mendes RF. Factors associated with oral health-related quality of life in homeless persons: a cross-sectional study. Braz Oral Res 2021; 35:e107. [PMID: 34816895 DOI: 10.1590/1807-3107bor-2021.vol35.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/23/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the clinical and sociodemographic factors associated with the oral health-related quality of life (OHRQoL) of homeless persons. A cross-sectional study was conducted, with participants (n = 176) attending a Specialized Reference Center for the Homeless Population in Teresina, Brazil. Dental caries (DMFT index, WHO criteria), periodontal disease (CPI index), and the consequences of untreated caries (PUFA index) were measured by a single calibrated examiner (Kappa ≥0.83). Sociodemographic, oral health, and OHRQoL (OHIP-14) data were obtained through interviews. Data analysis included descriptive statistics and Poisson regression, with a significance level of 5%. Most of the participants were male (86.4%) and from the age group of 30 to 43 years (52.2%). Mean DMFT was 11 (SD ± 6.9) and mean total PUFA score was 1.2 (SD ± 2.2). Most of the participants (88.6%) had dental calculus and 8.5% and 1.7% of the sample had gingival bleeding and periodontal pocket > 3.5mm, respectively. The highest prevalence of negative impact in the OHRQoL was associated with females (1.4 (95%CI 1.1-1.7)), low educational level (2.0 (95%CI 1.3-3.0)), caries (1.6 (95%CI 1.1-2.6)), fistulas (1.9 (95%CI 1.3-3.1)), gingival bleeding (1.7 (95%CI 1.1- 2.7)), dental calculus (1.8 (95% CI 1.3-2.5)), periodontal pockets > 3 mm (1.5 (95%CI 1.1-2.0)), and need for extraction (2.3 (95%CI 1.1-5.0)). In conclusion, the negative impact on the OHRQoL of homeless persons was associated with low educational level, presence of decayed teeth, gingival bleeding, and dental calculus.
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Affiliation(s)
| | - Aryvelto Miranda Silva
- Universidade Federal do Piauí - UFPI, Postgraduation Program in Dentistry, Teresina, PI, Brazil
| | - Jonathan Ferreira Costa
- Universidade Federal do Piauí - UFPI, Department of Restorative Dentistry, Teresina, PI, Brazil
| | | | - Isaac Torres Dos Santos
- Universidade Federal do Piauí - UFPI, Postgraduation Program in Dentistry, Teresina, PI, Brazil
| | | | | | - Regina Ferraz Mendes
- Universidade Federal do Piauí - UFPI, Postgraduation Program in Dentistry, Teresina, PI, Brazil
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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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11
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do Carmo Matias Freire M, de Campos Lawder JA, de Souza JB, de Matos MA. Dental pain in adult and elderly homeless people: Prevalence, associated factors, and impact on the quality of life in Midwest Brazil. J Public Health Dent 2021; 82:211-219. [PMID: 33782969 DOI: 10.1111/jphd.12452] [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: 05/01/2020] [Revised: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the prevalence and factors associated with dental pain and its impact on the quality of life of adult and elderly homeless people in Midwest Brazil. METHODS A cross-sectional study was conducted with 353 individuals aged ≥18 attending a public homeless shelter in a Brazilian state capital (Goiânia). Data on sociodemographic, psychosocial, drug use and oral health-related factors, and quality of life [Oral Impact on Daily Performance scale (OIDP)] were collected through interviews. Pearson's Chi-square tests and robust Poisson regression were used for statistical analysis. RESULTS The prevalence of dental pain in the past 6 months was 50 percent. Most of the respondents reported very severe pain and self-management including medication and tooth extraction. In the adjusted regression, the prevalence of pain was 1.48 times higher among individuals who last visited the dentist within the past 2 years, compared to those who had visited more than 2 years ago; and nearly five times higher among those with a perceived need for dental treatment, compared to those with no need. The prevalence of oral impact on daily performance was 80.1 percent and the most affected activities were "difficulty eating" and "feeling ashamed to smile or speak." The adjusted prevalence of impact was higher among individuals who had dental pain, regardless of their sociodemographic characteristics. CONCLUSIONS The prevalence, intensity, and self-management of dental pain were high among the Brazilian homeless people studied. Reporting of pain was associated with factors related to dental care and negatively affected their quality of life.
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Comassetto MO, Hugo FN, Neves M, Hilgert JB. Dental Pain in Homeless Adults in Porto Alegre, Brazil. Int Dent J 2021; 71:206-213. [PMID: 34024330 PMCID: PMC9275110 DOI: 10.1111/idj.12626] [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] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. Methods A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. Results A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). Conclusions Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.
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Affiliation(s)
- Marcela Obst Comassetto
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernando Neves Hugo
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Matheus Neves
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Hawkesford JL, Lette H, Saunders J, Slack-Smith L. Oral health perceptions and client satisfaction among homeless adults attending a community-centred dental clinic. Aust Dent J 2020; 66:67-76. [PMID: 33226637 DOI: 10.1111/adj.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The homeless face significant barriers accessing dental care. Community-centred dental clinics might provide more accessible care to this group. This descriptive epidemiological study aimed to measure oral health perceptions and client satisfaction among homeless and similarly disadvantaged adults receiving community-centred dental care. METHODS A sample of 79 clients attending St Patrick's Oral Health Clinic completed Locker's Global Oral Health Item, the Oral Health Impact Profile 14 and the Client Satisfaction Questionnaire 4. RESULTS High levels of satisfaction with St Patrick's Oral Health Clinic were based on positive staff attitudes, low cost, time effectiveness and staff sensitivity to anxiety. Ideas for improvement included shorter treatment waiting lists, offering additional treatment types and better communication and advertisement of the service. Compared to the general Australian population, participants reported a relatively poor self-perception of oral health and a high prevalence and severity of oral health impacts. CONCLUSIONS Participants experienced significant personal and social impacts due to their oral conditions. High levels of client satisfaction reflect the value of community-centred dental care for this group. An understanding of factors influencing satisfaction might be useful for similar services providing oral care to homeless and similarly disadvantaged groups.
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Affiliation(s)
- J L Hawkesford
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - H Lette
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - J Saunders
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - L Slack-Smith
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
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Yokota K, Yu SW, Tan T, Anderson J, Stormon N. The extent and nature of dental anxiety in Australians experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2352-2361. [PMID: 32511864 DOI: 10.1111/hsc.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
High dental anxiety is a major barrier to accessing dental care and has been found to be experienced to a greater extent in the homeless population. No studies have investigated the extent and nature of dental anxiety in Australians experiencing homelessness and was the aim of this study. Participants were recruited from four not-for-profit organisations in inner Brisbane using convenience and snowball sampling. The Dental Anxiety Questionnaire (DAQ) and the Index of Dental Anxiety and Fear (IDAF-4C+ ) questionnaire and oral health screening were completed by people experiencing homelessness in Brisbane, Australia, and compared to population norms. Descriptive statistics were calculated, and non-overlapping confidence intervals considered significantly different. The majority of the participants (n = 66) were male, a current smoker, unemployed and living in government supported housing. Most of the participants rated their oral health as poor/fair (n = 46, 71.9%) and their oral function as good or higher (n = 34, 53.1%). Using the single-item DAQ, 28.2% (n = 19) of people experiencing homelessness had high dental anxiety, compared to 16% of the general Australian population. The mean summed IDAF-4C+ fear module score was 18.02 (CI 15.60-20.43), which was significantly higher than the Australian population (µ = 14.40, CI 13.93-14.86). The highest mean score in the IDAF-4C+ stimulus module was feeling embarrassed or ashamed as anxiety inducing (µ = 2.27, CI 1.89-2.64) and was significantly different from the general Australian population (µ = 1.40, CI 1.33-1.47). The poorer overall self-rated oral health by the homeless population may induce feelings of embarrassment or shame, highlighting the differing psychosocial aspect to dental anxiety experienced by this population. Managing dental anxiety is needed to improve accessing to dental care for this population. Multidisciplinary care from social workers, mental health workers and dental practitioners may be beneficial in managing fear.
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Affiliation(s)
- Kumiko Yokota
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Sheng Wey Yu
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Tara Tan
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Jan Anderson
- Queensland Health, Oral Health Services, Community and Oral Health Directorate, Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - Nicole Stormon
- School of Dentistry, Oral Health Centre, The University of Queensland, Brisbane, Qld, Australia
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Stormon N, Sowa PM, Anderson J, Ford PJ. Facilitating Access to Dental Care for People Experiencing Homelessness. JDR Clin Trans Res 2020; 6:420-429. [PMID: 32853528 DOI: 10.1177/2380084420952350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Fear, lack of information, and lower health literacy are prominent barriers preventing people experiencing homelessness from accessing dental services. Most of this population are eligible for free dental treatment in Australia, yet few access care. This study evaluated 3 models for facilitating access to dental services for people experiencing homelessness. METHODS Three facilitated access models were developed and implemented at 4 community organizations. In model 1, dental appointments were booked on the spot after a screening by dental practitioners. Model 2 also involved dental screenings followed by appointments made via phone call from the service. In model 3, the community organizations referred clients directly to the service where appointments were made via a phone call to the client. The models were trialed with community organizations between 2017 and 2019. For each model, participant demographic information, attendance at subsequent dental appointments, and program operation resource use were collected. Cost-effectiveness was assessed as an incremental cost per additional person attending a dental appointment. RESULTS A total of 76 people participated in model 1, 66 in model 2, and 43 in model 3. Model 1 was the most effective, leading to 84.2 (confidence interval, 75.8-92.7) of every 100 participants attending a dental appointment. Model 2 had a lower effectiveness of 56.1 (44.6-67.6), and model 3 was the least effective, with a mean of 29.3 (15.0-43.6) per 100 participants attending. Incremental cost-effectiveness ratios were $51 per additional person attending a dental appointment for model 3 (compared to no strategy) and $173 per additional person attending for model 1 (compared to model 3). CONCLUSIONS Model 3 was the most cost-effective strategy of increasing access to dental care for people experiencing homelessness. Decision makers who find the effectiveness of model 3 insufficient should look instead to employ model 1 or a combination of these 2 models. The importance of face-to-face engagement to foster trust between the individual and health care practitioner was evident. KNOWLEDGE TRANSFER STATEMENT This study provides a range of models for dental and community services to facilitate access to dental care for people experiencing homelessness. Decision makers should consider the needs of vulnerable populations, alternative model designs, and their cost-effectiveness when implementing models of facilitated access to dental care. Face-to-face engagement between clients and dental practitioners by inclusion of a screening stage appears to be instrumental in overcoming barriers to access clinical care.
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Affiliation(s)
- N Stormon
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
| | - P M Sowa
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - J Anderson
- Queensland Health, Oral Health Services, Community and Oral Health Directorate, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - P J Ford
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
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Differences in Utilization of Medical and Dental Services among Homeless People in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155304. [PMID: 32717950 PMCID: PMC7432539 DOI: 10.3390/ijerph17155304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: Homelessness contributes to both needs for care and barriers to access. This study aimed to explore the utilization of medical or dental services using Andersen's model for a vulnerable population of homeless in South Korea. (2) Methods: The data were applied from the first national survey for homeless people in South Korea, 2016. Totally 2032 persons participated in the interview survey. This study team requested the raw data through the public portal and analyzed them. (3) Results: The participants who were homeless for more than ten years, staying in small rooming house or shelter, non-employed, earning less than 500,000 won per month, and having a medical condition showed a significantly higher chance of using Medicaid. The use of outreach programs had a significant relationship with gender, duration of homelessness, and monthly income. Among dental patients, the homeless who did not consume alcohol, stayed in a shelter, and were employed had higher chances of using dental service. (4) Conclusions: Medicaid service was strongly related to enabling factors but outreach programs with predisposing factors. Dental service showed strong relationships with the enabling domain, but the pattern was opposite: the jobless had less chance to avail it. The policymakers need to consider these domains of service utilization to provide equitable access to healthcare services.
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Shukla N, Pradhan B, Dikshit A, Chakraborty S, Alamri AM. A Review of Models Used for Investigating Barriers to Healthcare Access in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4087. [PMID: 32521710 PMCID: PMC7312585 DOI: 10.3390/ijerph17114087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Understanding barriers to healthcare access is a multifaceted challenge, which is often highly diverse depending on location and the prevalent surroundings. The barriers can range from transport accessibility to socio-economic conditions, ethnicity and various patient characteristics. Australia has one of the best healthcare systems in the world; however, there are several concerns surrounding its accessibility, primarily due to the vast geographical area it encompasses. This review study is an attempt to understand the various modeling approaches used by researchers to analyze diverse barriers related to specific disease types and the various areal distributions in the country. In terms of barriers, the most affected people are those living in rural and remote parts, and the situation is even worse for indigenous people. These models have mostly focused on the use of statistical models and spatial modeling. The review reveals that most of the focus has been on cancer-related studies and understanding accessibility among the rural and urban population. Future work should focus on further categorizing the population based on indigeneity, migration status and the use of advanced computational models. This article should not be considered an exhaustive review of every aspect as each section deserves a separate review of its own. However, it highlights all the key points, covered under several facets which can be used by researchers and policymakers to understand the current limitations and the steps that need to be taken to improve health accessibility.
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Affiliation(s)
- Nagesh Shukla
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
- Department of Energy and Mineral Resources Engineering, Sejong University, Choongmu-gwan, 209 Neungdong-ro, Gwangjin-gu, Seoul 05006, Korea
| | - Abhirup Dikshit
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), University of Technology Sydney, 2007 NSW, Australia; (N.S.); (A.D.); (S.C.)
| | - Abdullah M. Alamri
- Department of Geology & Geophysics, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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Ferreira DC, Gonçalves TR, Celeste RK, Olinto MTA, Pattussi MP. Aspectos psicossociais e percepção de impacto da saúde bucal na qualidade de vida em adultos do Sul do Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200049. [DOI: 10.1590/1980-549720200049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/18/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: A pesquisa objetivou investigar a associação entre os aspectos psicossociais e o impacto das condições bucais sobre a qualidade de vida de adultos, escopo ainda pouco explorado em pesquisas nacionais. Método: Um estudo transversal de base populacional foi realizado com 1.100 adultos de 20 anos de idade ou mais, em uma cidade de médio porte do Rio Grande do Sul. O desfecho foi avaliado por meio do Oral Health Impact Profile (OHIP-14) enquanto as exposições incluíram medidas de apoio social, resiliência, senso de coerência, espiritualidade, qualidade de vida e estresse. Foram calculadas as razões de chances brutas e ajustadas, bem como seus intervalos de confiança de 95% utilizando-se regressão logística ordinal. Resultados: Após o ajuste para variáveis demográficas, socioeconômicas e comportamentais, indivíduos com baixo apoio social, baixo senso de coerência, baixa qualidade de vida e alto nível de estresse possuíam respectivamente 2,16; 2,90; 2,94; 1,50 vezes mais chance de relatar um pior impacto da condição na qualidade de vida quando comparados aos indivíduos com estas características favoráveis. Conclusões: Os achados sugerem que os aspectos psicossociais podem influenciar a avaliação que as pessoas fazem do impacto da condição bucal sobre a qualidade de vida. É importante que políticas, programas e serviços de saúde reconheçam a relação mútua entre os indicadores de saúde bucal e os aspectos psicossociais de adultos.
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Gordon SJ, Grimmer K, Bradley A, Direen T, Baker N, Marin T, Kelly MT, Gardner S, Steffens M, Burgess T, Hume C, Oliffe JL. Health assessments and screening tools for adults experiencing homelessness: a systematic review. BMC Public Health 2019; 19:994. [PMID: 31340786 PMCID: PMC6657068 DOI: 10.1186/s12889-019-7234-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Homelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations. The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless. METHODS Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner. RESULTS Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings. CONCLUSIONS This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.
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Affiliation(s)
- S. J. Gordon
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
| | - K. Grimmer
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
- Division of Physiotherapy, Faculty of Medicine and Health Science, Stellenbosch Uni, Cape Town, South Africa
| | - A. Bradley
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
| | - T. Direen
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
| | - N. Baker
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
| | - T. Marin
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia 5042
| | - M. T. Kelly
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - S. Gardner
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia 5000
| | - M. Steffens
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia 5000
| | - T. Burgess
- School of Public Health, University of Adelaide, Adelaide, South Australia 5000
| | - C. Hume
- School of Public Health, University of Adelaide, Adelaide, South Australia 5000
| | - J. L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
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Goode J, Hoang H, Crocombe L. Strategies to improve access to and uptake of dental care by people experiencing homelessness in Australia: a grey literature review. AUST HEALTH REV 2019; 44:297-303. [PMID: 31262395 DOI: 10.1071/ah18187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/25/2019] [Indexed: 11/23/2022]
Abstract
Objectives The poor oral health of Australians experiencing homelessness negatively affects their quality of life. Better oral health is associated with having annual dental check-ups. Because there is limited peer-reviewed literature describing strategies that improve access to and uptake of dental care by homeless people, in this study we searched the grey literature to discover what strategies are used. Methods The Informit database and Google and Bing search engines were searched using the keywords 'homeless and oral and dental services'. Bing and Google were searched unrestricted by site and Google was searched for sites ending in 'org.au'. Searches were restricted to Australia from June 2008 to June 2018. The first 300 websites were read, and those describing or linking to pages describing a strategy that improved access to or uptake of dental care were included in the study. The content of the webpages was evaluated and summarised, with common strategies reported as a narrative description. Results Nineteen programs were described. Common strategies were providing free care, in-reach care, outreach care and the need to work closely with support organisations. Conclusions To improve access to and uptake of dental care by people experiencing homelessness, dental services need to be free and organised in collaboration with support organisations. What is known about the topic? The peer-reviewed literature describing strategies used to improve access to and uptake of dental care by people experiencing homelessness in Australia is limited. The authors could only locate two such studies, one based in Melbourne and one in Brisbane. Both programs had a similar aim, but used different strategies to achieve it, suggesting a lack of consensus about the best way to encourage dental visiting by people experiencing homelessness. What does this paper add? This paper used the grey literature to describe common strategies used in Australia to improve access to and uptake of dental care by people experiencing homelessness. What are the implications for practitioners? Dental service providers aiming to increase access to and uptake of dental care by people experiencing homelessness need to work collaboratively with support organisations and provide care free of charge.
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Affiliation(s)
- Jacqueline Goode
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia. ; and Department of Dentistry and Oral Health, Rural Health School, La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia; and Corresponding author.
| | - Ha Hoang
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tas. 7250, Australia.
| | - Leonard Crocombe
- Centre for Rural Health, School of Health Sciences, University of Tasmania, ABC Building, 1 Liverpool Street, Hobart, Tas. 7000, Australia.
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Tong M, Tieu L, Lee CT, Ponath C, Guzman D, Kushel M. Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study. J Public Health (Oxf) 2019; 41:240-249. [PMID: 29617886 PMCID: PMC6636692 DOI: 10.1093/pubmed/fdy063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. METHODS We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security. RESULTS The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22-0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69-5.38), oral pain (AOR = 2.15, 1.24-3.74) and cognitive impairment (AOR = 2.21, 1.12-4.35) were associated with increased odds of very low food security. CONCLUSIONS Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.
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Affiliation(s)
- M Tong
- School of Public Health, University of California, Berkeley, USA
| | - L Tieu
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - C T Lee
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
| | - C Ponath
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - D Guzman
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - M Kushel
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
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Lawder JADC, Matos MAD, Souza JBD, Freire MDCM. Impact of oral condition on the quality of life of homeless people. Rev Saude Publica 2019; 53:22. [PMID: 30810659 PMCID: PMC6390670 DOI: 10.11606/s1518-8787.2019053000718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE: To describe the prevalence of oral health impact on quality of life and its association with the dental condition and sociodemographic factors of homeless people. METHODS: The sample was composed of 116 adults, temporarily attended by a public institution in the municipality of Goiânia, state of Goiás. Interviews were carried out including the Oral Impact on Daily Performance instrument and sociodemographic aspects. Clinical examinations were done by a trained examiner considering criteria of the World Health Organization. We evaluated dental caries (DMFT index) and use or need to use some type of prosthesis. For the statistical analysis of data, we used Pearson's Chi-square and Fisher's exact tests and Poisson regression with robust variance. RESULTS: Of the total respondents, 81.9% had at least one daily performance affected by dental problems in the six months prior the survey. The most prevalent dental conditions were: need for lower arch (76.7%) and upper arch prosthesis (69.0%); untreated caries (75.9%); and high DMFT (57.8%). In bivariate analysis, only the need for upper prosthesis variable was associated with the impact (high Oral Impact on Daily Performance). In the regression model, adjusted for time in the institution, age, and sex, this association remained significant (p = 0.015). Individuals without need for upper prosthesis had prevalence of high impact on daily performance 55% lower than those in need of this type of prosthesis (p = 0.018). CONCLUSIONS: The prevalence of oral health impact on quality of life of homeless people was high and higher than that verified in the overall Brazilian population. The impact was associated with the need for upper prosthesis, regardless of sociodemographic characteristics of the individuals.
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Affiliation(s)
| | - Marcos André de Matos
- Universidade Federal de Goiás. Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Goiânia, GO, Brasil
| | - João Batista de Souza
- Universidade Federal de Goiás. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil
| | - Maria do Carmo Matias Freire
- Universidade Federal de Goiás. Faculdade de Odontologia. Programa de Pós-Graduação em Odontologia. Goiânia, GO, Brasil
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Stormon N, Pateman K, Smith P, Callander A, Ford PJ. Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:241-248. [PMID: 30152168 DOI: 10.1111/hsc.12644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 06/10/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.
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Affiliation(s)
- Nicole Stormon
- UQ Oral Health Centre, School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelsey Pateman
- UQ Oral Health Centre, School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Phil Smith
- Brisbane Youth Services, Brisbane, Queensland, Australia
| | | | - Pauline J Ford
- UQ Oral Health Centre, School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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Stormon N, Pradhan A, McAuliffe A, Ford PJ. Does a facilitated pathway improve access to dental services for homeless and disadvantaged adults? EVALUATION AND PROGRAM PLANNING 2018; 71:46-50. [PMID: 30114615 DOI: 10.1016/j.evalprogplan.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
Access to dental care is poorer for people experiencing homelessness and disadvantage due to barriers such as lengthy waiting lists, lack of transport, lack of information and fear of authorities and treatment. This study aimed to evaluate a system integration model for oral health care for clients of homeless services in Brisbane, Australia. This model aimed to provide a facilitated access pathway between homeless community organisations and a public dental service to improve access to dental care. Participants were adult (≥18 years) clients Brisbane homeless community organisations. Those who participated in the intervention evaluation completed a questionnaire, had their oral health screened and followed up for feedback at their dental appointment. Seventy-six clients of community organisations in Brisbane participated in the intervention and its evaluation. Fear was a barrier to accessing dental services for 23% (n = 18). Attendance to the subsequent appointments at the public dental clinic was high, with 85% (n = 64) attending their first appointment. A higher proportion of participants who had surgical and prosthodontic treatment needs at the screening did not attend their appointment compared to those with other needs. Overall the model piloted in this study had positive outcomes; with high attendance rates to the dental facility and positive experiences by participants.
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Affiliation(s)
- N Stormon
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston Rd, Brisbane, QLD 4006, Australia.
| | - A Pradhan
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston Rd, Brisbane, QLD 4006, Australia
| | - A McAuliffe
- Oral Health Service, Metro North Hospital and Health Service, Herston, QLD 4029, Australia
| | - P J Ford
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston Rd, Brisbane, QLD 4006, Australia
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25
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Goode J, Hoang H, Crocombe L. Homeless adults' access to dental services and strategies to improve their oral health: a systematic literature review. Aust J Prim Health 2018; 24:PY17178. [PMID: 29983138 DOI: 10.1071/py17178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
Abstract
Homeless people have poor oral health and high treatment needs, yet tend to make problem-based dental visits. This review aimed to determine how and where homeless adults receive oral health care, the barriers that prevent homeless adults accessing dental care and find strategies to promote oral health to homeless adults. The databases MEDLINE via OvidSP, PubMed, CINAHL and Scopus were searched using the keywords: homeless, roofless, houseless, rough sleeper, couch surfer, shelter, hostel, dental and oral health. The inclusion criteria were: participants over the age of 17 years, studies written in English, based in developed countries and published after 2003. Selected articles were assessed using the Mixed Methods Appraisal Tool and data extracted were thematically analysed. Twenty-two studies met the inclusion criteria. Five main themes were found: how homeless people accessed dental care; factors affecting the uptake of care; strategies used to improve access to care; the effect of non-dental staff on dental care; and challenges with providing care to homeless people. Dental care for homeless adults was affected by numerous factors. Improving their access to dental services requires collaboration between support service providers, dental care to be near homeless populations and flexibility by dental services.
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Cockburn N, Pradhan A, Taing MW, Kisely S, Ford PJ. Oral health impacts of medications used to treat mental illness. J Affect Disord 2017; 223:184-193. [PMID: 28759866 DOI: 10.1016/j.jad.2017.07.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many psychotropic medications affect oral health. This review identified oral side effects for antidepressant, antipsychotic, anticonvulsant, antianxiety and sedative drugs that are recommended in Australia for the management of common mental illnesses and provides recommendations to manage these side-effects. METHODS The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat common mental health conditions. For each medication, the generic name, class, and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (eMIMs) and UpToDate databases. Meyler's Side Effect of Drugs Encyclopaedia was used to identify additional oral adverse reactions to these medications. RESULTS Fifty-seven drugs were identified: 23 antidepressants, 22 antipsychotics or mood stabilisers, and 12 anxiolytic or sedative medications. Xerostomia (91%) the most commonly reported side effect among all classes of medications of the 28 identified symptoms. Other commonly reported adverse effects included dysguesia (65%) for antidepressants, and tardive dyskinesia (94%) or increased salivation (78%) for antipsychotic medications. CONCLUSIONS While xerostomia has often been reported as a common adverse effect of psychotropic drugs, this review has identified additional side effects including dysguesia from antidepressants and tardive dyskinesia and increased salivation from antipsychotics. Clinicians should consider oral consequences of psychotropic medication in addition to other side-effects when prescribing. For antidepressants, this would mean choosing duloxetine, agomelatine and any of the serotonin re-uptake inhibitors except sertraline. In the case of antipsychotics and mood stabilisers, atypical agents have less oral side effects than older alternatives.
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Affiliation(s)
- N Cockburn
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia.
| | - A Pradhan
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia
| | - M W Taing
- The University of Queensland, School of Pharmacy, Pharmacy Australia Centre of Excellence, Woolloongabba, Brisbane 4102 QLD, Australia
| | - S Kisely
- The University of Queensland, School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102 QLD, Australia; Dalhouise University, Departments of Psychiatry, Community Health and Epidemiology, Halifax, Nova Scotia, Canada
| | - P J Ford
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Herston, Brisbane 4006 QLD, Australia
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Cheah ALS, Pandey R, Daglish M, Ford PJ, Patterson S. A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1209-1217. [PMID: 28105790 DOI: 10.1111/hsc.12423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
Social factors, health behaviours and the direct effects of substances contribute to the poor oral health and restricted access to dental services experienced by people who are dependent on drugs and/or alcohol. Admission for inpatient withdrawal management provides an opportunity for intervention to promote oral health but to be effective it must be acceptable to patients. To support intervention design, we examined patients' views about oral health, practices and treatment access, and appropriateness of health-promoting intervention in this context. Given paucity of knowledge in the area we employed a qualitative approach, data were collected in semi-structured interviews with inpatients of a public specialist alcohol and drug unit in Australia in September 2014. Analysis employed the framework approach. All 14 participants wanted 'good teeth' but few diligently attended to oral healthcare; most sought assistance only in emergencies. Participants' knowledge of services was limited and practical and affective barriers hindered access. With none recalling attention to oral health during admission, support was strong for incorporation of oral health in inpatient assessments. Participants wanted information about the impact of substances on oral health and oral hygiene practices provided in various formats, and facilitated referral to non-judgemental, affordable treatment. Patients regarded promotion of oral health in the inpatient context as important, relevant and acceptable. Support should respect the different knowledge, practices and motivations for oral health and recovery, of patients. Addressing practical and affective barriers to dental services will require collaboration between drug and alcohol and dental services, and this should be the focus of further research.
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Affiliation(s)
- Alison Li Sun Cheah
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Ram Pandey
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Mark Daglish
- FRANZCP Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Pauline J Ford
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Sue Patterson
- Metro North Mental Health, Metro North Hospital and Health Service and Griffith University, Herston, Queensland, Australia
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Brown LF, Ford PJ, Symons AL. Periodontal disease and the special needs patient. Periodontol 2000 2017; 74:182-193. [DOI: 10.1111/prd.12198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
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Pradhan A, Keuskamp D, Brennan D. Oral health-related quality of life improves in employees with disabilities following a workplace dental intervention. EVALUATION AND PROGRAM PLANNING 2016; 59:1-6. [PMID: 27497877 DOI: 10.1016/j.evalprogplan.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
This pilot study evaluated a dental intervention for employees with disabilities by measuring changes in self-rated oral health, dental behaviours and oral health-related quality of life (OHRQol). Consenting employees with disabilities (≥18years) at two worksites in South Australia underwent dental examinations at baseline, three and six months. Referrals were arranged as needed to public dental clinics. At one and two months a dental hygienist provided group oral health education to the employees. Employees' demographics, self-rated oral health, dental behaviours and OHRQol were collected via face-to-face interviews. Of the 39 referred employees, 28 (72%) of them completed the recommended treatment. Self-rated oral health improved and there were significant reductions in the prevalence of oral health impact on quality of life (percentage of employees reporting 1+ items fairly/very often) from 27% to 11% (McNemar's test, p<0.05); the extent of impact (mean number of items reported fairly/very often) from 1.3 to 0.6 and the severity of impact (mean of summed OHIP item scores) from 3.6 to 1.8 (paired t-tests, p<0.01). As this pilot study indicates that enabling urgent referral for treatment and regular oral health education can improve OHRQol and self-rated oral health among employees with disabilities, a larger study with a control group should be undertaken.
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Affiliation(s)
- Archana Pradhan
- School of Dentistry, University of Queensland, 288 Herston Road, Herston, Queensland, 4006, Australia; Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, ARCPOH Level 1, 122 Frome Street, 5005, Australia.
| | - Dominic Keuskamp
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, ARCPOH Level 1, 122 Frome Street, 5005, Australia.
| | - David Brennan
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, ARCPOH Level 1, 122 Frome Street, 5005, Australia.
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Hsieh E. Voices of the Homeless: An Emic Approach to the Experiences of Health Disparities Faced by People Who Are Homeless. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:328-340. [PMID: 27093127 DOI: 10.1080/19371918.2015.1137512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
People who are homeless are particularly vulnerable to health disparities. Rather than using population statistics to highlight the prevalence or severity of the suffering of people who are homeless, 28 undergraduate students each conducted an in-depth interview with an individual who relied on a local homeless shelter to cope with everyday life. The interview explored the participants' health concerns and strategies for health management. Due to equipment failure and incomplete recording, only 16 interviews are included in this study. The author adopted thematic analysis while focused on preserving the richness of the interactions between the participants who are homeless and the undergraduate students. The author's goal is to provide emic, intimate insights about the struggles and challenges faced by the people who are homeless. The author concluded the study by situating the findings in the larger literature of health disparities experienced by people who are homeless.
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Affiliation(s)
- Elaine Hsieh
- a Department of Communication , University of Oklahoma , Norman , Oklahoma, USA
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