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Gomes RS, Passoni LCDL, Sirigatti RDP, Rozin L, Sanches LDC, Cavassin FB. Saúde dos indivíduos em situação de rua. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introdução: A população em situação de rua é vulnerabilizada por diversos fatores que determinam ou condicionam sua saúde e ocasionam aumento dos índices de comorbidades clínicas, entre elas as doenças mentais, crônicas e infectocontagiosas. A marginalização dos indivíduos que se encontram em situação de rua abre uma lacuna na assistência em saúde que, por vezes, é suprida por organizações sem fins lucrativos que exercem um papel social elementar. Objetivo: Mapear o perfil clínico da população em situação de rua de Curitiba (PR) atendida por iniciativa voluntária no período de um ano. Métodos: Trata-se de um estudo observacional descritivo de base documental realizado com fichas clínicas dos 509 pacientes maiores de 18 anos e que tiveram seu primeiro atendimento médico realizado pela Associação Médicos do Mundo, filial Curitiba (PR), no ano de 2019. Resultados: Indivíduos do sexo masculino, de etnia branca, faixa etária entre 36 e 45 anos, que cursaram o ensino fundamental e que se encontravam havia menos de um ano em situação de rua foram as condições sociodemográficas predominantes. As principais queixas motivadoras da procura pelo atendimento foram dor (45,19%), lesões cutâneas (15,71%) e queixas oftalmológicas (6,68%). Parte dos indivíduos mostrou acometimento crônico por hipertensão arterial sistêmica (9,03%), HIV/AIDS (3,53%) e diabetes mellitus (3,53%). Também foi identificada quantidade significativa de relatos de histórico de traumas físicos (59%). Encontrou-se correlação estatística entre hipertensão e medicamentos de uso contínuo (p=0,001). Menos que 10% dos indivíduos procuraram atendimento médico por queixas de saúde mental. Das mulheres que fizerem parte do estudo, 70% relataram fazer uso de substâncias e aproximadamente metade delas, uso regular de medicamentos. Já o uso de anticoncepcionais foi relatado por uma minoria delas (18,57%). Conclusões: As queixas de dor, as lesões cutâneas e as demandas oftalmológicas foram os principais motivadores da procura por ajuda médica pela população em situação de rua, além da prevalência de hipertensão arterial sistêmica como doença crônica. Os achados podem auxiliar e direcionar ações em saúde voltadas para essa população marginalizada.
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Baia KLN, Cordeiro ACC, Frade PCR, Gouveia AGN, Resque RL, Pinheiro LML, Fonseca RRS, Machado LFA, Martins LC, Kupek E, Fischer B, Oliveira-Filho AB. Syphilis and Co-Infections with HIV-1, HBV, and HCV among People Who Use Crack-Cocaine in Northern Brazil. Pathogens 2022; 11:pathogens11091055. [PMID: 36145487 PMCID: PMC9502650 DOI: 10.3390/pathogens11091055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
The rates of syphilis and viral co-infections among people who use crack-cocaine (PWUCC) were assessed in this study. This cross-sectional study relied on biological and self-reported socio-behavioral data from a convenience sample of 990 PWUCC from twenty-six municipalities in the states of Amapá and Pará, northern Brazil. Blood samples were collected to assess the presence of Treponema pallidum using the Rapid Qualitative Test (RQT) and the Venereal Disease Research Laboratory (VDRL). Reactive samples by RQT were used to assess the presence of HBV, HCV, and HIV-1 using Enzyme Immunoassay (EIA) and Polymerase Chain Reaction (PCR). Logistic regression models were used to determine the association of variables assessed with syphilis. In total, 287 (29.0%) of the PWUCC sample had reactive results for syphilis. HBV (15.7%), HCV (5.9%), and HIV-1 (9.8%) were detected among PWUCC with syphilis. Young age, low monthly income and education level, long duration of crack-cocaine use, condomless sex, multiple sex partners, and exchange of sex for money/drugs were associated with syphilis. The present study provides unique insights on the epidemiological status of syphilis among PWUCC in northern Brazil, with multiple implications for improving urgent interventions for diagnosis, prevention, and treatment.
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Affiliation(s)
- Karen Lorena N. Baia
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
| | - Ana Caroline C. Cordeiro
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
| | - Paula Cristina R. Frade
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
| | - Alanna Gabrielly N. Gouveia
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
| | - Rafael Lima Resque
- Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68903-419, Brazil
| | - Luiz Marcelo L. Pinheiro
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Faculdade de Ciências Biológicas, Campus do Marajó, Universidade Federal do Pará, Soure 68870-000, Brazil
| | - Ricardo Roberto S. Fonseca
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66077-830, Brazil
| | - Luiz Fernando A. Machado
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66077-830, Brazil
| | - Luisa C. Martins
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Laboratório de Patologia Clínica de Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém 66055-240, Brazil
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil
| | - Aldemir B. Oliveira-Filho
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém 66075-110, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança 68600-000, Brazil
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68600-000, Brazil
- Correspondence:
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Vélez-Gómez DE, Torres-Vellojín N, Grajales-Zapata JC, McEwen-Ochoa JG, Martínez A, Ramírez-Lopera V, Villegas-Castaño A. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the homeless population of Medellín, Colombia: a cross-sectional study. BMJ Open 2022; 12:e054966. [PMID: 35232786 PMCID: PMC8889321 DOI: 10.1136/bmjopen-2021-054966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in the homeless population in Medellín, Colombia, using molecular diagnostic methods. It also intended to develop a demographic profile, exploring associated factors and the dynamics of the social and sexual interactions of this community. DESIGN Cross-sectional study. SETTING Two homeless care centres in Medellín, Colombia. PARTICIPANTS Homeless individuals that assisted to the main homeless care centres of Medellín, Colombia from 2017 to 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The prevalence of CT and NG in this population using qPCR detection, factors associated with CT and NG infection, and the sociodemographic profile of the community. RESULTS The prevalence of CT infection was 19.2%, while that of NG was 22.6%. Furthermore, being a female was significantly correlated to CT infection p<0.05 (adjusted OR, AOR 2.42, 95% CI 1.31 to 4.47). NG infection was significantly associated with factors such as: sexual intercourse while having a sexually transmitted infection p<0.05 (AOR 3.19, 95% CI 1.48 to 6.85), having more than 11 sexual partners in the last 6 months p=0.04 (AOR 2.91, 95% CI 1.04 to 8.09) and having daily intercourse p=0.05 (AOR 3.15, 95% CI 1.02 to 9.74). CONCLUSIONS The prevalence of CT and NG was higher than that reported in the general population. Additionally, females had a higher percentage of infection compared with males.
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Affiliation(s)
- Diego Enrique Vélez-Gómez
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
| | - Natalia Torres-Vellojín
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
| | - Juan Camilo Grajales-Zapata
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
| | - Juan Guillermo McEwen-Ochoa
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
- Cellular and Molecular Biology Unit, Corporacion para Investigaciones Biologicas, Medellin, Colombia
| | - Alonso Martínez
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
| | - Verónica Ramírez-Lopera
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
| | - Aracelly Villegas-Castaño
- Microbiology and Parasitology Department, Bacteria & Cancer group, Universidad de Antioquia - Facultad de Medicina, Medellin, Colombia
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Fisher DG, Reynolds GL, Khoiny N, Huckabay L, Rannalli D. Application of the Frailty Framework among Vulnerable Populations to Hospitalization Outcomes of Individuals Experiencing Homelessness in Long Beach, California. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2021; 31:163-171. [PMID: 36439946 PMCID: PMC9697922 DOI: 10.1080/10530789.2021.1908487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/07/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Individuals experiencing homelessness have a high prevalence of infectious diseases that may result in hospitalization. However, low ability to navigate the healthcare system and lack of health insurance may mean that those who are experiencing homelessness may not receive the healthcare that they need. OBJECTIVES This study uses risk factors at baseline to predict hospitalization at follow-up. This paper also presents the associations between reporting homelessness and selected infectious diseases. RESEARCH DESIGN Longitudinal study of baseline and follow-up conducted August 2000 through July 2014. SUBJECTS 4916 Not experiencing homelessness mean age 37.9 years, 29% female, and 2692 experiencing homelessness age 42.1 years, 29% female received services from a research/service center in a low-income, high-crime area of Long Beach, CA. MEASURES Risk Behavior Assessment, Risk Behavior Follow-up Assessment, laboratory testing for hepatitis A, hepatitis B, hepatitis C, syphilis, chlamydia, and gonorrhea. RESULTS Predictors of hospitalization at follow-up were ever use of crack cocaine, income from Social Security or disability, reporting homelessness, female, and those who identify as Black compared to White race/ethnicity. CONCLUSIONS Income from the safety net of Social Security or disability appears to provide the participant with experience that transfers to being able to obtain healthcare. A higher proportion of those experiencing homelessness, compared to those not experiencing homelessness, appear to be hospitalized at follow-up. Women, those who identified as Black, and those who used crack at baseline are more likely to be hospitalized at follow-up whether or not they were experiencing homelessness. We recommend coordination with substance abuse treatment programs for discharge planning for homeless patients. Our findings support use of the Frailty Framework when working with individuals experiencing both homelessness and hospitalization.
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Affiliation(s)
- Dennis G Fisher
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Grace L Reynolds
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Noushin Khoiny
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Loucine Huckabay
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
| | - Debby Rannalli
- California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840
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