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Agha A, Hwang SW, Palepu A, Aubry T. The role of housing stability in predicting social capital: Exploring social support and psychological integration as mediators for individuals with histories of homelessness and vulnerable housing. Am J Community Psychol 2024. [PMID: 38713847 DOI: 10.1002/ajcp.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/29/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
Social capital is a collective asset important for individual and population well-being. Individuals who experience homelessness may face barriers in accessing social capital due to health challenges, small social networks, and social exclusion. Data from a 4-year longitudinal study was used to determine if housing stability predicted greater social capital and if this relationship was mediated by social support and psychological integration for a sample of 855 homeless and vulnerably housed participants living in three Canadian cities. Findings showed that housing stability was not associated with trust and linking social capital. However, higher levels of social support and psychological integration had a mediating effect on the association between housing stability and trust and linking social capital. These findings highlight the importance of social support and psychological integration as means of promoting social capital for people who experience homelessness and vulnerable housing. Social interventions for housed individuals with histories of homelessness may be an avenue to foster greater social capital by building relationships with neighbors and connections to community resources and activities.
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Affiliation(s)
- Ayda Agha
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada
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2
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Dwyer R, Palepu A, Williams C, Daly-Grafstein D, Zhao J. Unconditional cash transfers reduce homelessness. Proc Natl Acad Sci U S A 2023; 120:e2222103120. [PMID: 37643214 PMCID: PMC10483630 DOI: 10.1073/pnas.2222103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Homelessness is an economic and social crisis. In a cluster-randomized controlled trial, we address a core cause of homelessness-lack of money-by providing a one-time unconditional cash transfer of CAD$7,500 to each of 50 individuals experiencing homelessness, with another 65 as controls in Vancouver, BC. Exploratory analyses showed that over 1 y, cash recipients spent fewer days homeless, increased savings and spending with no increase in temptation goods spending, and generated societal net savings of $777 per recipient via reduced time in shelters. Additional experiments revealed public mistrust toward the ability of homeless individuals to manage money and demonstrated interventions to increase public support for a cash transfer policy using counter-stereotypical or utilitarian messaging. Together, this research offers a new approach to address homelessness and provides insights into homelessness reduction policies.
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Affiliation(s)
- Ryan Dwyer
- Department of Psychology, University of British Columbia, VancouverV6T 1Z4, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, VancouverV6T 1Z4, Canada
| | | | | | - Jiaying Zhao
- Department of Psychology, University of British Columbia, VancouverV6T 1Z4, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, VancouverV6T 1Z4, Canada
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3
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Liu M, Pridham KF, Jenkinson J, Nisenbaum R, Richard L, Pedersen C, Brown R, Virani S, Ellerington F, Ranieri A, Dada O, To M, Fabreau G, McBrien K, Stergiopoulos V, Palepu A, Hwang S. Navigator programme for hospitalised adults experiencing homelessness: protocol for a pragmatic randomised controlled trial. BMJ Open 2022; 12:e065688. [PMID: 36517099 PMCID: PMC9756200 DOI: 10.1136/bmjopen-2022-065688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION People experiencing homelessness suffer from poor outcomes after hospitalisation due to systemic barriers to care, suboptimal transitions of care, and intersecting health and social burdens. Case management programmes have been shown to improve housing stability, but their effects on broad posthospital outcomes in this population have not been rigorously evaluated. The Navigator Programme is a Critical Time Intervention case management programme that was developed to help homeless patients with their postdischarge needs and to link them with community-based health and social services. This randomised controlled trial examines the impact of the Navigator Programme on posthospital outcomes among adults experiencing homelessness. METHODS AND ANALYSIS This is a pragmatic randomised controlled trial testing the effectiveness of the Navigator Programme at an urban academic teaching hospital and an urban community teaching hospital in Toronto, Canada. Six hundred and forty adults experiencing homelessness who are admitted to the hospital will be randomised to receive support from a Homeless Outreach Counsellor for 90 days after hospital discharge or to usual care. The primary outcome is follow-up with a primary care provider (physician or nurse practitioner) within 14 days of hospital discharge. Secondary outcomes include postdischarge mortality or readmission, number of days in hospital, number of emergency department visits, self-reported care transition quality, and difficulties meeting subsistence needs. Quantitative outcomes are being collected over a 180-day period through linked patient-reported and administrative health data. A parallel mixed-methods process evaluation will be conducted to explore intervention context, implementation and mechanisms of impact. ETHICS AND DISSEMINATION Ethics approval was obtained from the Unity Health Toronto Research Ethics Board. Participants will be required to provide written informed consent. Results of the main trial and process evaluation will be reported in peer-reviewed journals and shared with hospital leadership, community partners and policy makers. TRIAL REGISTRATION NUMBER NCT04961762.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts, USA
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Jesse Jenkinson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sareeha Virani
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Fred Ellerington
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Alyssa Ranieri
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Oluwagbenga Dada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Matthew To
- Division of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Fabreau
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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4
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Czechowski K, Sylvestre J, Gogosis E, Agha A, Kerman N, Polillo A, Palepu A, Hwang SW. Cycles of instability: Proximal and distal influences on residential instability among people with histories of homelessness in three Canadian cities. J Community Psychol 2022; 50:3402-3420. [PMID: 35322426 DOI: 10.1002/jcop.22843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
People with histories of homelessness often have difficulties obtaining and maintaining adequate housing. This qualitative study examined the residential transitions of people with histories of residential instability and homelessness to understand factors contributing to the instability they experience. Interviews were conducted with 64 participants about their housing transitions, in the final year of a 4-year, prospective cohort study in three Canadian cities (Ottawa, Toronto, and Vancouver). Findings showed that participants pointed to both distal and proximal factors as affecting residential transitions, including interpersonal conflict, safety concerns, substance use, poverty, pests, and health. Many reported disconnection from their housing and a lack of improvement from one housing situation to the next, demonstrating how even when housed, instability persisted. Our study highlights the complexity associated with participants' often unplanned and abrupt residential transitions. The complex and distal issues that affect housing transitions require structural changes, in addition to individual-based interventions focused on the proximal problems.
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Affiliation(s)
- Konrad Czechowski
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sylvestre
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ayda Agha
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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McDonald EG, Wu PE, Rashidi B, Wilson MG, Bortolussi-Courval É, Atique A, Battu K, Bonnici A, Elsayed S, Wilson AG, Papillon-Ferland L, Pilote L, Porter S, Murphy J, Ross SB, Shiu J, Tamblyn R, Whitty R, Xu J, Fabreau G, Haddad T, Palepu A, Khan N, McAlister FA, Downar J, Huang AR, MacMillan TE, Cavalcanti RB, Lee TC. The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med 2022; 182:265-273. [PMID: 35040926 PMCID: PMC8767487 DOI: 10.1001/jamainternmed.2021.7429] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs). OBJECTIVE To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy. DESIGN, SETTING, AND PARTICIPANTS This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020. At admission, participants were taking 5 or more medications per day. Data analyses were performed from January 3, 2021, to September 23, 2021. INTERVENTIONS Personalized reports of deprescribing opportunities generated by MedSafer software to address usual home medications and measures of prognosis and frailty. Deprescribing reports provided to the treating team were compared with usual care (medication reconciliation). MAIN OUTCOMES AND MEASURES The primary outcome was a reduction of ADEs within the first 30 days postdischarge (including adverse drug withdrawal events) captured through structured telephone surveys and adjudicated blinded to intervention status. Secondary outcomes were the proportion of patients with 1 or more PIMs deprescribed at discharge and the proportion of patients with an adverse drug withdrawal event (ADWE). RESULTS A total of 5698 participants (median [range] age, 78 [72-85] years; 2858 [50.2%] women; race and ethnicity data were not collected) were enrolled in 3 clusters and were adjudicated for the primary outcome (control, 3204; intervention, 2494). Despite cluster randomization, there were group imbalances, eg, the participants in the intervention arm were older and had more PIMS prescribed at baseline. After hospital discharge, 4989 (87.6%) participants completed an ADE interview. There was no significant difference in ADEs within 30 days of discharge (138 [5.0%] of 2742 control vs 111 [4.9%] of 2247 intervention participants; adjusted risk difference [aRD] -0.8%; 95% CI, -2.9% to 1.3%). Deprescribing increased from 795 (29.8%) of 2667 control to 1249 (55.4%) of 2256 intervention participants [aRD, 22.2%; 95% CI, 16.9% to 27.4%]. There was no difference in ADWEs between groups. Several post hoc sensitivity analyses, including the use of a nonparametric test to address the low cluster number, group imbalances, and potential biases, did not alter study conclusions. CONCLUSIONS AND RELEVANCE This cluster randomized clinical trial showed that providing deprescribing clinical decision support during acute hospitalization had no demonstrable impact on ADEs, although the intervention was safe and led to improvements in deprescribing. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03272607.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Peter E Wu
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, University of Toronto; Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada
| | - Babak Rashidi
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Marnie Goodwin Wilson
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Émilie Bortolussi-Courval
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anika Atique
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Kiran Battu
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andre Bonnici
- Department of Pharmacy, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sarah Elsayed
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Allison Goodwin Wilson
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise Papillon-Ferland
- Department of Pharmacy, Institut Universitaire de Geriatrie de Montreal, University of Montreal, Montreal, Quebec, Canada
| | - Louise Pilote
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Sandra Porter
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Johanna Murphy
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sydney B Ross
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - Robyn Tamblyn
- Division of Epidemiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Rachel Whitty
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jieqing Xu
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Fabreau
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taleen Haddad
- Division of Geriatric Medicine, Queens University, Kingston, Ontario, Canada
| | - Anita Palepu
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Finlay A McAlister
- Division of General Internal Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - James Downar
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Allen R Huang
- Division of Geriatric Medicine, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Thomas E MacMillan
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo B Cavalcanti
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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6
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Gadermann AM, Hubley AM, Russell LB, Thomson KC, Norena M, Rossa-Roccor V, Hwang SW, Aubry T, Karim ME, Farrell S, Palepu A. Understanding subjective quality of life in homeless and vulnerably housed individuals: The role of housing, health, substance use, and social support. SSM - Mental Health 2021. [DOI: 10.1016/j.ssmmh.2021.100021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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7
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Nasmith TE, Gadermann A, Jaworsky D, Norena M, To MJ, Hwang SW, Palepu A. Clinically significant substance use and residential stability among homeless or vulnerably housed persons in Canada: a longitudinal cohort study. J Public Health (Oxf) 2021; 43:532-540. [PMID: 32076717 DOI: 10.1093/pubmed/fdaa018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined clinically significant substance use among homeless or vulnerably housed persons in three Canadian cities and its association with residential stability over time using data from the Health and Housing in Transition study. METHODS In 2009, 1190 homeless or vulnerably housed individuals were recruited in three Canadian cities and followed for 4 years. We collected information on housing and incarceration history, drug and alcohol use, having a primary care provider at baseline and annually for 4 years. Participants who screened positive for substance use at baseline were included in the analyses. We used a generalized logistic mixed effect regression model to examine the association between clinically significant substance use and residential stability, adjusting for confounders. RESULTS Initially, 437 participants met the criteria for clinically significant substance use. The proportion of clinically significant substance use declined, while the proportion of participants who achieved residential stability increased over time. Clinically significant substance use was negatively associated with achieving residential stability over the 4-year period (AOR 0.7; 95% CI 0.57, 0.86). CONCLUSIONS In this cohort of homeless or vulnerably housed individuals, clinically significant substance use was negatively associated with achieving residential stability over time, highlighting the need to better address substance use in this population.
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Affiliation(s)
- Trudy E Nasmith
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Denise Jaworsky
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew J To
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.,Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
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8
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Khan N, Palepu A, Dodek P, Salmon A, Leitch H, Ruzycki S, Townson A, Lacaille D. Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation. BMJ Open 2021; 11:e050380. [PMID: 33972345 PMCID: PMC8111871 DOI: 10.1136/bmjopen-2021-050380] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation. DESIGN, SETTING AND PARTICIPANTS We conducted a cross-sectional survey (August-October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada. PRIMARY AND SECONDARY OUTCOMES Physician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory. RESULTS The response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009). CONCLUSION Burnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.
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Affiliation(s)
- Nadia Khan
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita Palepu
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Dodek
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Amy Salmon
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Leitch
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shannon Ruzycki
- Department of Medicine, Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Townson
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Department of Medicine, Arthritis Research Canada, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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9
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Wiens K, Nisenbaum R, Sucha E, Aubry T, Farrell S, Palepu A, Duhoux A, Gadermann A, Hwang SW. Does Housing Improve Health Care Utilization and Costs? A Longitudinal Analysis of Health Administrative Data Linked to a Cohort of Individuals With a History of Homelessness. Med Care 2021; 59:S110-S116. [PMID: 33710082 DOI: 10.1097/mlr.0000000000001379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario. METHODS Survey data from a 4-year prospective cohort study were linked with administrative health records in Ontario. Annual rates of health encounters and mean costs were compared across housing categories (homeless, inconsistently housed, housed), which were based on the percentage of time an individual was housed. Generalized estimating equations were applied to estimate the average annual effect of housing status on health care utilization and costs. RESULTS Over the study period, the proportion of individuals who were housed increased from 37% to 69%. The unadjusted rates of ambulatory care visits, prescription medications, and laboratory tests were highest during person-years spent housed or inconsistently housed and the rate of emergency department visits was lowest during person-years spent housed. Following adjustment, the rate of prescription claims remained higher during person-years spent housed or inconsistently housed compared with the homeless. Rate ratios for other health care encounters were not significant (P>0.05). An interaction between time and housing status was observed for total health care costs; as the percentage of days housed increased, the average costs increased in year 1 and decreased in years 2-4. CONCLUSIONS These findings highlight the effects of housing on health care encounters and costs over a 4-year study period. The rate of prescription medications was higher during person-years spent housed or inconsistently housed compared with the homeless. The cost analysis suggests that housing may reduce health care costs over time; however, future work is needed to confirm the reason for the reduction in total costs observed in later years.
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Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences
| | - Tim Aubry
- School of Psychology
- Centre for Research on Educational and Community Services, University of Ottawa
| | | | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- Division of General Internal Medicine, University of British Colombia, Vancouver, BC
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, QC
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital
- School of Population and Public Health, University of British Colombia, Vancouver, BC
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
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10
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Gadermann AM, Karim ME, Norena M, Emerson SD, Hubley AM, Russell LB, Nisenbaum R, Hwang SW, Aubry T, Palepu A. The Association of Residential Instability and Hospitalizations among Homeless and Vulnerably Housed Individuals: Results from a Prospective Cohort Study. J Urban Health 2020; 97:239-249. [PMID: 32078728 PMCID: PMC7101457 DOI: 10.1007/s11524-019-00406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study examined the association of residential instability with hospitalizations among homeless and vulnerably housed individuals over a 4-year time period. Survey data were linked to administrative records on hospitalizations. Specifically, we used data from the Health and Housing in Transition study, a prospective cohort study that tracked the health and housing status of homeless and vulnerably housed individuals in Canada. Responses from Vancouver-based participants (n = 378) from baseline and 3 follow-ups were linked to their administrative health records on hospitalizations (Discharge Abstract Database - Hospital Separation Files; 2008-2012). A generalized estimating equations model was used to examine associations between the number of residential moves and any hospitalizations during each year (none versus ≥ 1 hospitalizations). Analyses included demographic and health variables. Survey data were collected via structured interviews. Hospitalizations were derived from provincial administrative health records. A higher number of residential moves were associated with hospitalization over the study period (adjusted odds ratio: 1.14; 95% confidence interval: 1.01, 1.28). Transgender, female gender, perceived social support, better self-reported mental health, and having ≥ 3 chronic health conditions also predicted having been hospitalized over the study period, whereas high school/higher education was negatively associated with hospitalizations. Our results indicate that residential instability is associated with increased risk of hospitalization, illustrating the importance of addressing housing as a social determinant of health.
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Affiliation(s)
- Anne M Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Mohammad Ehsanul Karim
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | | | - Anita M Hubley
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, Canada
| | - Lara B Russell
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
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11
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Magee C, Norena M, Hubley AM, Palepu A, Hwang SW, Nisenbaum R, Karim ME, Gadermann A. Longitudinal Associations between Perceived Quality of Living Spaces and Health-Related Quality of Life among Homeless and Vulnerably Housed Individuals Living in Three Canadian Cities. Int J Environ Res Public Health 2019; 16:ijerph16234808. [PMID: 31795464 PMCID: PMC6926800 DOI: 10.3390/ijerph16234808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/15/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
The objective of this study was to examine longitudinal associations between perceived quality of living spaces and mental and physical health-related quality of life (HRQoL) among homeless and vulnerably housed individuals living in three Canadian cities. The Health and Housing in Transition (HHiT) study was a prospective cohort study conducted between 2009 and 2013 of N = 1190 individuals who were homeless and vulnerably housed at baseline. Perceived quality of living spaces (based on rated comfort, safety, spaciousness, privacy, friendliness and overall quality) and both mental and physical HRQoL were assessed at baseline and at four annual follow up points. Generalized estimating equation (GEE) analyses were used to examine associations between perceived quality of living spaces and both mental and physical HRQoL over the four-year study period, controlling for time-varying housing status, health and socio-demographic variables. The results showed that higher perceived quality of living spaces was positively associated with mental (b = 0.42; 95% CI 0.38—0.47) and physical (b = 0.11; 95% CI 0.07—0.15) HRQoL over the four-year study period. Findings indicate that policies aimed at increasing HRQoL in this population should prioritize improving their experienced quality of living spaces.
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Affiliation(s)
- Carly Magee
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
| | - Anita M. Hubley
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1A6, Canada; (S.W.H.); (R.N.)
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1A6, Canada; (S.W.H.); (R.N.)
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
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12
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Shankar S, Gogosis E, Palepu A, Gadermann AM, Hwang SW. "I Haven't Given Up and I'm Not Gonna": A Phenomenographic Exploration of Resilience Among Individuals Experiencing Homelessness. Qual Health Res 2019; 29:1850-1861. [PMID: 30253692 DOI: 10.1177/1049732318798353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Resilience is a factor related to positive health outcomes. Exploring this concept among adults experiencing homelessness can inform interventions while subsequently considering individuals' strengths. A phenomenographic approach was applied to examine this concept among a sample of 22 individuals involved in qualitative interviews. The phenomenographic inquiry identified eight conceptions and found resilience is captured in both positive and negative ways. Conceptions are summarized by two categories, situated in an outcome space which describes the overall resilience experience and the different ways these conceptions are understood and experienced. Categories summarize conceptions as Staying Strong and Sustaining Positive Beliefs, which highlight the construct as being captured by a persistent positive aspect; however, the findings also uniquely describe the influence of negative conceptions toward the overall phenomenon. The findings suggest resilience is recognizable during adversity, and it is a phenomenon that has the potential to be strengthened.
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Affiliation(s)
- Sneha Shankar
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Evie Gogosis
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Stephen W Hwang
- St. Michael's Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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13
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Walsh C, Hubley AM, To MJ, Norena M, Gadermann A, Farrell S, Hwang SW, Palepu A. The effect of forensic events on health status and housing stability among homeless and vulnerably housed individuals: A cohort study. PLoS One 2019; 14:e0211704. [PMID: 30730929 PMCID: PMC6366888 DOI: 10.1371/journal.pone.0211704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022] Open
Abstract
We sought to characterize the association between a forensic event (arrest or incarceration) with housing vulnerability and mental and physical health status over a four-year follow-up among a cohort of homeless and vulnerably housed individuals in Vancouver, Toronto and Ottawa. Data were obtained from the Health and Housing in Transition Study, a prospective cohort study of homeless and vulnerably housed individuals between 2009 and 2012. Participants were interviewed in-person at baseline (N = 1190) and at four annual follow-up time points. We used generalized estimating equations to characterize the independent associations between a forensic event and the number of residential moves and SF-12 physical and mental health component scores over the four-year follow-up period. We analyzed data from 1173 homeless and vulnerably housed participants. Forensic events were reported by 446 participants at baseline. In multivariate analyses, a history of forensic event in the preceding twelve months was independently associated with an increased number of residential moves over the four-year follow-up period (ARR 1.24; 95% CI 1.19–1.3). It was not, however, independently associated with a change in physical or mental health status (respective ß-estimates; 95% CI: -0.34; -1.02, 0.34, and -0.69; -1.5, 0.2). Female gender and a history of problematic substance use were significantly associated with all three primary outcomes. This suggests arrest or incarceration is associated with increased housing vulnerability. The results underline the importance of supporting individuals experiencing arrest or incarceration with post-release planning in order to obtain stable housing after discharge.
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Affiliation(s)
- Charles Walsh
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anita M. Hubley
- Department of Education Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J. To
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Stephen W. Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
| | - Anita Palepu
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
- * E-mail:
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14
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Palepu A, Premanathan S, Azhar F, Vendrame M, Loddenkemper T, Reinsberger C, Kreiman G, Parkerson KA, Sarma S, Anderson WS. Automating Interictal Spike Detection: Revisiting A Simple Threshold Rule. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:299-302. [PMID: 30440397 DOI: 10.1109/embc.2018.8512244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Interictal spikes (IIS) are bursts of neuronal depolarization observed electrographically between periods of seizure activity in epilepsy patients. However, IISs are difficult to characterize morphologically and their effects on neurophysiology and cognitive function are poorly understood. Currently, IIS detection requires laborious manual assessment and marking of electroencephalography (EEG/iEEG) data. This practice is also subjective as the clinician has to select the mental threshold that EEG activity must exceed in order to be considered a spike. The work presented here details the development and implementation of a simple automated IIS detection algorithm. This preliminary study utilized intracranial EEG recordings collected from 7 epilepsy patients, and IISs were marked by a single physician for a total of 1339 IISs across 68 active electrodes. The proposed algorithm implements a simple threshold rule that scans through iEEG data and identifies IISs using various normalization techniques that eliminate the need for a more complex detector. The efficacy of the algorithm was determined by evaluating the sensitivity and specificity of the detector across a range of thresholds, and an approximate optimal threshold was determined using these results. With an average true positive rate of over 98% and a false positive rate of below 2%, the accuracy of this algorithm speaks to its use as a reliable diagnostic tool to detect IISs, which has direct applications in localizing where seizures start, detecting when seizures start, and in understanding cognitive impairment due to IISs. Furthermore, due to its speed and simplicity, this algorithm can be used for real-time detection of IIS that will ultimately allow physicians to study their clinical implications with high temporal resolution and individual adaptation.
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Sylvestre J, Klodawsky F, Gogosis E, Ecker J, Polillo A, Czechowski K, Agha A, Shankar S, To M, Gadermann A, Palepu A, Hwang S. Perceptions of Housing and Shelter among People with Histories of Unstable Housing in three Cities in Canada: A Qualitative Study. Am J Community Psychol 2018; 61:445-458. [PMID: 29577343 DOI: 10.1002/ajcp.12243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Housing is a key social determinant of health that contributes to the well-documented relationship between socioeconomic status and health. This study explored how individuals with histories of unstable and precarious housing perceive their housing or shelter situations, and the impact of these settings on their health and well-being. Participants were recruited from the Health and Housing in Transition study (HHiT), a longitudinal, multi-city study that tracked the health and housing status of people with unstable housing histories over a 5-year period. For the current study, one-time semi-structured interviews were conducted with a subset of HHiT study participants (n = 64), living in three cities across Canada: Ottawa, Toronto, and Vancouver. The findings from an analysis of the interview transcripts suggested that for many individuals changes in housing status are not associated with significant changes in health due to the poor quality and precarious nature of the housing that was obtained. Whether housed or living in shelters, participants continued to face barriers of poverty, social marginalization, inadequate and unaffordable housing, violence, and lack of access to services to meet their personal needs.
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Affiliation(s)
- John Sylvestre
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fran Klodawsky
- Department of Geography and Environmental Studies, Faculty of Arts and Social Sciences, Carleton University, Ottawa, ON, Canada
| | - Evie Gogosis
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - John Ecker
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- Canadian Observatory on Homelessness, York University, Toronto, ON, Canada
| | - Alexia Polillo
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Konrad Czechowski
- Centre for Research on Educational and Community Services, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ayda Agha
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sneha Shankar
- Department of Education and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Matthew To
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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16
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Zhang L, Norena M, Gadermann A, Hubley A, Russell L, Aubry T, To MJ, Farrell S, Hwang S, Palepu A. Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. J Dual Diagn 2018; 14:21-31. [PMID: 29494795 DOI: 10.1080/15504263.2017.1392055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. METHODS In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. RESULTS Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. CONCLUSIONS Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.
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Affiliation(s)
- Linda Zhang
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Monica Norena
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Anne Gadermann
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - Anita Hubley
- d Department of Education Counselling Psychology and Special Education , University of British Columbia , Vancouver , British Columbia , Canada
| | - Lara Russell
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Tim Aubry
- e School of Psychology, University of Ottawa , Ottawa , Ontario , Canada
| | - Matthew J To
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
| | - Susan Farrell
- g Royal Ottawa Health Care Group , Ottawa , Ontario , Canada
| | - Stephen Hwang
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada.,h Division of General Internal Medicine, Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Anita Palepu
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada.,b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
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Khan NA, McAlister FA, Pilote L, Palepu A, Quan H, Hill MD, Fang J, Kapral MK. Secondary prevention treatment after acute stroke in older South Asian, Chinese and other Canadians: a retrospective data analysis. CMAJ Open 2017; 5:E702-E709. [PMID: 28899946 PMCID: PMC5621941 DOI: 10.9778/cmajo.20160147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke. METHODS Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009). We compared prescriptions filled for statins, warfarin, any antihypertensive agent, the recommended combination of angiotensin-converting-enzyme (ACE) inhibitor and diuretic, and the combination of ACE inhibitor, diuretic and statin within 1 year after ischemic or primary intracerebral hemorrhagic stroke. RESULTS There were 118 362 patients with acute stroke (3430 Chinese, 2075 South Asian and 112 857 other Canadians). Among those with ischemic stroke (n = 108 699), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor, diuretic and statin (adjusted odds ratio [OR] 0.64 [95% confidence interval (CI) 0.55-0.74]) and, in those with atrial fibrillation, for warfarin (adjusted OR 0.75 [95% CI 0.59-0.95]). There were no differences in filling of prescriptions for antihypertensive therapy overall between the 3 groups. Among patients with intracerebral hemorrhagic stroke (n = 9663), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor and diuretic (adjusted OR 0.51 [95% CI 0.38-0.69]), and South Asians were more likely than other Canadian patients to fill prescriptions for any antihypertensive agent (adjusted OR 1.73 [95% CI 1.21-2.49]). INTERPRETATION We identified ethnic differences in filling of prescriptions for several secondary prevention medications after acute stroke. The reasons underlying these differences need to be investigated.
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Affiliation(s)
- Nadia A Khan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Finlay A McAlister
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Louise Pilote
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Anita Palepu
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Hude Quan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Michael D Hill
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Jiming Fang
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Moira K Kapral
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
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To MJ, Palepu A, Matheson FI, Ecker J, Farrell S, Hwang SW, Werb D. The effect of incarceration on housing stability among homeless and vulnerably housed individuals in three Canadian cities: A prospective cohort study. Can J Public Health 2017; 107:e550-e555. [PMID: 28252374 DOI: 10.17269/cjph.107.5607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 12/29/2016] [Accepted: 09/02/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of the study is to characterize the associations between a history of incarceration and subsequent housing stability over a two-year follow-up period among a sample of homeless and vulnerably housed individuals. METHODS The study was a prospective cohort study of homeless and vulnerably housed adults in three Canadian cities. Between 2009 and 2012, data were collected using structured, in-person interviews at baseline and two follow-up interviews. Generalized estimating equations were employed to determine the association between reported incarceration within the past 12 months and being housed during the subsequent year over a two-year follow-up period. RESULTS Baseline data were available for 1,189 homeless and vulnerably housed adults. Recent incarceration was reported by 337 (29%) individuals at baseline. In adjusted analyses, incarceration in the past 12 months was independently associated with a decreased likelihood of being housed during the subsequent year over the two-year follow-up period (adjusted odds ratio = 0.67, 95% confidence interval: 0.50-0.90). CONCLUSION Homeless and vulnerably housed individuals reporting recent incarceration were less likely to be housed over a two-year follow-up period. These findings highlight the importance of assisting individuals experiencing incarceration with securing stable housing during discharge and post-release planning.
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Affiliation(s)
- Matthew J To
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON.
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Somers JM, Moniruzzaman A, Patterson M, Currie L, Rezansoff SN, Palepu A, Fryer K. A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats. PLoS One 2017; 12:e0168745. [PMID: 28076358 PMCID: PMC5226665 DOI: 10.1371/journal.pone.0168745] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 12/07/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE No previous experimental trials have investigated Housing First (HF) in both scattered site (SHF) and congregate (CHF) formats. We hypothesized that CHF and SHF would be associated with a greater percentage of time stably housed as well as superior health and psychosocial outcomes over 24 months compared to treatment as usual (TAU). METHODS Inclusion criteria were homelessness, mental illness, and high need for support. Participants were randomised to SHF, CHF, or TAU. SHF consisted of market rental apartments with support provided by Assertive Community Treatment (ACT). CHF consisted of a single building with supports equivalent to ACT. TAU included existing services and supports. RESULTS Of 800 people screened, 297 were randomly assigned to CHF (107), SHF (90), or TAU (100). The percentage of time in stable housing over 24 months was 26.3% in TAU (reference; 95% confidence interval (CI) = 20.5, 32.0), compared to 74.3% in CHF (95% CI = 69.3, 79.3, p<0.001) and 74.5% in SHF (95% CI = 69.2, 79.7, p<0.001). Secondary outcomes favoured CHF but not SHF compared to TAU. CONCLUSION HF in scattered and congregate formats is capable of achieving housing stability among people experiencing major mental illness and chronic homelessness. Only CHF was associated with improvement on select secondary outcomes. REGISTRATION Current Controlled Trials: ISRCTN57595077.
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Affiliation(s)
- Julian M. Somers
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
- * E-mail:
| | - Akm Moniruzzaman
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
| | - Michelle Patterson
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
| | - Lauren Currie
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
| | - Stefanie N. Rezansoff
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
| | - Anita Palepu
- School of Population and Public Health University of British Columbia Vancouver, Canada
| | - Karen Fryer
- Somers Research Group Faculty of Health Sciences Simon Fraser University Burnaby, Canada
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Gadermann AM, Sawatzky R, Palepu A, Hubley AM, Zumbo BD, Aubry T, Farrell S, Hwang SW. Minimal impact of response shift for SF-12 mental and physical health status in homeless and vulnerably housed individuals: an item-level multi-group analysis. Qual Life Res 2016; 26:1463-1472. [DOI: 10.1007/s11136-016-1464-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 02/06/2023]
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To MJ, Palepu A, Aubry T, Nisenbaum R, Gogosis E, Gadermann A, Cherner R, Farrell S, Misir V, Hwang SW. Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study. BMC Public Health 2016; 16:1041. [PMID: 27716129 PMCID: PMC5048475 DOI: 10.1186/s12889-016-3711-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Background Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Methods Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Results Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14–2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22–3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33–0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97–1.00) were protective against homelessness. Conclusions Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
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Affiliation(s)
- Matthew J To
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim Aubry
- University of Ottawa, Ottawa, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Evie Gogosis
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Vachan Misir
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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22
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Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to an Explosive HIV Epidemic Driven by Frequent Cocaine Injection: Is There a Role for Safe Injecting Facilities? Journal of Drug Issues 2016. [DOI: 10.1177/002204260303300303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of SIF utilization, and methods of maximizing use among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety.
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Affiliation(s)
- Thomas Kerr
- Canadian HIV/AIDS Legal Network and Research Associate at the BC Centre for Excellence in HIV/AIDS
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS and coprincipal investigator of the Vancouver Injection Drug Users Study (VIDUS)
| | - Anita Palepu
- Internal medicine specialist and an assistant professor on the Faculty of Medicine at the University of British Columbia
| | - Dean Wilson
- Healthcare advocate and past president of the Vancouver Area Network of Drug Users (VANDU)
| | - Martin T. Schechter
- Department of Healthcare and Epidemiology at the University of British Columbia
| | - Mark W. Tyndall
- Faculty of Medicine at the University of British Columbia, and a research associate at the BC Centre for Excellence in HIV/AIDS
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Jaworsky D, Gadermann A, Duhoux A, Naismith TE, Norena M, To MJ, Hwang SW, Palepu A. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada. J Urban Health 2016; 93:666-81. [PMID: 27457795 PMCID: PMC4987593 DOI: 10.1007/s11524-016-0065-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Trudy E Naismith
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Matthew J To
- Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Research in Inner City Health, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Somers JM, Moniruzzaman A, Palepu A. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction 2015; 110:1605-14. [PMID: 26052657 DOI: 10.1111/add.13011] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/05/2014] [Accepted: 06/01/2015] [Indexed: 11/27/2022]
Abstract
AIMS Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU). DESIGN Two concurrent randomized controlled trials with 24-month follow-up. SETTING Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on-site supports (CONG); TAU in Vancouver, Canada. PARTICIPANTS Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either 'high needs' (HN; n = 297) or 'moderate needs' (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN-TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN-TAU (n = 100). INTERVENTIONS AND COMPARATORS All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness. MEASUREMENTS DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing. FINDINGS Compared with HN-TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39-1.37] nor ACT (AOR = 1.22, 95% CI = 0.61-2.45) differed on DSU at 24 months, and MN-TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37-1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing. CONCLUSIONS Housing First, an intervention to support recovery for homeless people who have co-occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.
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Affiliation(s)
- Julian M Somers
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Akm Moniruzzaman
- Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anita Palepu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Cheung A, Somers JM, Moniruzzaman A, Patterson M, Frankish CJ, Krausz M, Palepu A. Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders. Addict Sci Clin Pract 2015; 10:17. [PMID: 26242968 PMCID: PMC4636835 DOI: 10.1186/s13722-015-0038-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 07/16/2015] [Indexed: 11/14/2022] Open
Abstract
Background Homelessness, substance use, and mental disorders each have been associated with higher rates of emergency department (ED) use and hospitalization. We sought to understand the correlation between ED use, hospital admission, and substance dependence among homeless individuals with concurrent mental illness who participated in a ‘Housing First’ (HF) intervention trial. Methods The Vancouver At Home study consisted of two randomized controlled trials addressing homeless individuals with mental disorders who have “high” or “moderate” levels of need. Substance dependence was determined at baseline prior to randomization, using the Mini International Neuropsychiatric Interview diagnostic tool, version 6.0. To assess health service use, we reviewed the number of ED visits and the number of hospital admissions based on administrative data for six urban hospitals. Negative binomial regression modeling was used to test the independent association between substance dependence and health service use (ED use and hospitalization), adjusting for HF intervention, age, gender, ethnicity, education, duration of lifetime homelessness, mental disorders, chronic health conditions, and other variables that were selected a priori to be potentially associated with use of ED services and hospital admission. Results Of the 497 homeless adults with mental disorders who were recruited, we included 381 participants in our analyses who had at least 1 year of follow-up and had a personal health number that could be linked to administrative health data. Of this group, 59% (n = 223) met criteria for substance dependence. We found no independent association between substance dependence and ED visits or hospital admissions [rate ratio (RR) = 0.85; 95% CI 0.62–1.17 and RR = 1.21; 95% CI 0.83–1.77, respectively]. The most responsible diagnoses (defined as the diagnosis that accounts for the length of stay) for hospital admissions were schizo-affective disorder, schizophrenia-related disorder, or bipolar affective disorder; collectively reported in 48% (n = 263) of admissions. Fifteen percent (n = 84) of hospital admissions listed substance dependence as the most responsible diagnosis. Conclusions Substance dependence was not independently associated with ED use or hospital admission among homeless adults with mental disorders participating in an HF trial. Hospital admissions among this cohort were primarily associated with severe mental disorders. Trial registration: ISRCTN57595077 and ISRCTN66721740
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Affiliation(s)
- Adrienne Cheung
- Department of Medicine, Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Julian M Somers
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
| | | | | | - Michael Krausz
- School of Population and Public Health, Vancouver, Canada. .,Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Anita Palepu
- Department of Medicine, Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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26
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You JJ, Downar J, Fowler RA, Lamontagne F, Ma IWY, Jayaraman D, Kryworuchko J, Strachan PH, Ilan R, Nijjar AP, Neary J, Shik J, Brazil K, Patel A, Wiebe K, Albert M, Palepu A, Nouvet E, des Ordons AR, Sharma N, Abdul-Razzak A, Jiang X, Day A, Heyland DK. Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA Intern Med 2015; 175:549-56. [PMID: 25642797 DOI: 10.1001/jamainternmed.2014.7732] [Citation(s) in RCA: 267] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers. OBJECTIVE To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process. DESIGN, SETTING, AND PARTICIPANTS Multicenter survey of medical teaching units of nurses, internal medicine residents, and staff physicians from participating units at 13 university-based hospitals from 5 Canadian provinces. MAIN OUTCOMES AND MEASURES Importance of 21 barriers to goals of care discussions rated on a 7-point scale (1 = extremely unimportant; 7 = extremely important). RESULTS Between September 2012 and March 2013, questionnaires were returned by 1256 of 1617 eligible clinicians, for an overall response rate of 77.7% (512 of 646 nurses [79.3%], 484 of 634 residents [76.3%], 260 of 337 staff physicians [77.2%]). The following family member-related and patient-related factors were consistently identified by all 3 clinician groups as the most important barriers to goals of care discussions: family members' or patients' difficulty accepting a poor prognosis (mean [SD] score, 5.8 [1.2] and 5.6 [1.3], respectively), family members' or patients' difficulty understanding the limitations and complications of life-sustaining treatments (5.8 [1.2] for both groups), disagreement among family members about goals of care (5.8 [1.2]), and patients' incapacity to make goals of care decisions (5.6 [1.2]). Clinicians perceived their own skills and system factors as less important barriers. Participants viewed it as acceptable for all clinician groups to engage in goals of care discussions-including a role for advance practice nurses, nurses, and social workers to initiate goals of care discussions and be a decision coach. CONCLUSIONS AND RELEVANCE Hospital-based clinicians perceive family member-related and patient-related factors as the most important barriers to goals of care discussions. All health care professionals were viewed as playing important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication and decision making about goals of care.
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Affiliation(s)
- John J You
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - James Downar
- Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada4Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada6Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - François Lamontagne
- Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dev Jayaraman
- Department of Internal Medicine, McGill University, Montreal, Québec, Canada
| | | | | | - Roy Ilan
- Department of Medicine, Queen's University, Kingston, Ontario, Canada13Critical Care Program, Queen's University, Kingston, Ontario, Canada
| | - Aman P Nijjar
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Neary
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Shik
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Amen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kim Wiebe
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Albert
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Département de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Anita Palepu
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elysée Nouvet
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Nishan Sharma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amane Abdul-Razzak
- Division of Palliative Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrew Day
- Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada22Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Hunter CE, Palepu A, Farrell S, Gogosis E, O’Brien K, Hwang SW. Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities. J Prim Care Community Health 2014; 6:154-61. [DOI: 10.1177/2150131914560610] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Methods: Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Results: Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Conclusion: Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
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Affiliation(s)
- Charlotte E. Hunter
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Farrell
- University of Ottawa, Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Evie Gogosis
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kristen O’Brien
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Galipeau J, Moher D, Campbell C, Hendry P, Cameron DW, Palepu A, Hébert PC. A systematic review highlights a knowledge gap regarding the effectiveness of health-related training programs in journalology. J Clin Epidemiol 2014; 68:257-65. [PMID: 25510373 DOI: 10.1016/j.jclinepi.2014.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/16/2014] [Accepted: 09/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate whether training in writing for scholarly publication, journal editing, or manuscript peer review effectively improves educational outcomes related to the quality of health research reporting. STUDY DESIGN AND SETTING We searched MEDLINE, Embase, ERIC, PsycINFO, and the Cochrane Library for comparative studies of formalized, a priori-developed training programs in writing for scholarly publication, journal editing, or manuscript peer review. Comparators included the following: (1) before and after administration of a training program, (2) between two or more training programs, or (3) between a training program and any other (or no) intervention(s). Outcomes included any measure of effectiveness of training. RESULTS Eighteen reports of 17 studies were included. Twelve studies focused on writing for publication, five on peer review, and none fit our criteria for journal editing. CONCLUSION Included studies were generally small and inconclusive regarding the effects of training of authors, peer reviewers, and editors on educational outcomes related to improving the quality of health research. Studies were also of questionable validity and susceptible to misinterpretation because of their risk of bias. This review highlights the gaps in our knowledge of how to enhance and ensure the scientific quality of research output for authors, peer reviewers, and journal editors.
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Affiliation(s)
- James Galipeau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice Changing Research Building (CPCR 1) The Ottawa Hospital - General Campus 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada, K1H 8L6.
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice Changing Research Building (CPCR 1) The Ottawa Hospital - General Campus 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada, K1H 8L6; Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, 451, Smyth Rd., Ottawa, Ontario, Canada, K1H 8M5
| | - Craig Campbell
- Office of Professional Affairs, The Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario, Canada, K1S 5N8
| | - Paul Hendry
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, 451, Smyth Rd., Ottawa, Ontario, Canada, K1H 8M5
| | - D William Cameron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice Changing Research Building (CPCR 1) The Ottawa Hospital - General Campus 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada, K1H 8L6; Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, 451, Smyth Rd., Ottawa, Ontario, Canada, K1H 8M5
| | - Anita Palepu
- Department of Medicine, Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y6
| | - Paul C Hébert
- Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Québec, Canada, H2L 4M1
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Kendall C, Maskalyk J, Palepu A. Closing Open Medicine. Open Med 2014; 8:e147-9. [PMID: 25426183 PMCID: PMC4242792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Claire Kendall
- Claire Kendall, MD, is Deputy Editor at Open Medicine; an Associate Professor with the Department of Family Medicine, University of Ottawa; Clinician Investigator at the C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute; and a practising family physician with the Riverside Campus Family Health Team, Ottawa, Ontario
| | - James Maskalyk
- James Maskalyk, MD, is an Associate Editor at Open Medicine, an emergency physician at St. Michael's Hospital, and an Assistant Professor in the Department of Medicine at the University of Toronto, Toronto, Ontario
| | - Anita Palepu
- Anita Palepu, Department of Medicine, University of British Columbia, 588B-1081 Burrard Street, Vancouver, BC V6Z 1H6;
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Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, Altman DG, Hirst A, Hoey J, Palepu A, Schulz KF, Moher D. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ 2014; 348:g3804. [PMID: 24965222 PMCID: PMC4070413 DOI: 10.1136/bmj.g3804] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the completeness of reporting of health research is related to journals' endorsement of reporting guidelines. DESIGN Systematic review. DATA SOURCES Reporting guidelines from a published systematic review and the EQUATOR Network (October 2011). Studies assessing the completeness of reporting by using an included reporting guideline (termed "evaluations") (1990 to October 2011; addendum searches in January 2012) from searches of either Medline, Embase, and the Cochrane Methodology Register or Scopus, depending on reporting guideline name. STUDY SELECTION English language reporting guidelines that provided explicit guidance for reporting, described the guidance development process, and indicated use of a consensus development process were included. The CONSORT statement was excluded, as evaluations of adherence to CONSORT had previously been reviewed. English or French language evaluations of included reporting guidelines were eligible if they assessed the completeness of reporting of studies as a primary intent and those included studies enabled the comparisons of interest (that is, after versus before journal endorsement and/or endorsing versus non-endorsing journals). DATA EXTRACTION Potentially eligible evaluations of included guidelines were screened initially by title and abstract and then as full text reports. If eligibility was unclear, authors of evaluations were contacted; journals' websites were consulted for endorsement information where needed. The completeness of reporting of reporting guidelines was analyzed in relation to endorsement by item and, where consistent with the authors' analysis, a mean summed score. RESULTS 101 reporting guidelines were included. Of 15,249 records retrieved from the search for evaluations, 26 evaluations that assessed completeness of reporting in relation to endorsement for nine reporting guidelines were identified. Of those, 13 evaluations assessing seven reporting guidelines (BMJ economic checklist, CONSORT for harms, PRISMA, QUOROM, STARD, STRICTA, and STROBE) could be analyzed. Reporting guideline items were assessed by few evaluations. CONCLUSIONS The completeness of reporting of only nine of 101 health research reporting guidelines (excluding CONSORT) has been evaluated in relation to journals' endorsement. Items from seven reporting guidelines were quantitatively analyzed, by few evaluations each. Insufficient evidence exists to determine the relation between journals' endorsement of reporting guidelines and the completeness of reporting of published health research reports. Journal editors and researchers should consider collaborative prospectively designed, controlled studies to provide more robust evidence. SYSTEMATIC REVIEW REGISTRATION Not registered; no known register currently accepts protocols for methodology systematic reviews.
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Affiliation(s)
- Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
| | - Erica Weinstein
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
| | - Fatemeh Yazdi
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Justin Thielman
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, UK
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - John Hoey
- Population and Public Health Initiative, Queen's University, Kingston, ON, Canada, K7L 3N6
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y9 Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Kenneth F Schulz
- International Clinical Sciences Support Center, FHI 360, Durham, NC 27713, USA
| | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
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Somers JM, Patterson ML, Moniruzzaman A, Currie L, Rezansoff SN, Palepu A, Fryer K. Vancouver At Home: pragmatic randomized trials investigating Housing First for homeless and mentally ill adults. Trials 2013; 14:365. [PMID: 24176253 PMCID: PMC4228396 DOI: 10.1186/1745-6215-14-365] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mental illnesses are overrepresented among the homeless. Housing First (HF) has been shown to promote positive outcomes in this population. However, key questions remain unresolved, including: how to match support services to client needs, the benefits of housing in scattered sites versus single congregate building, and the effectiveness of HF with individuals actively using substances. The present study aimed to recruit two samples of homeless mentally ill participants who differed in the complexity of their needs. Study details, including recruitment, randomization, and follow-up, are presented. METHODS Eligibility was based on homeless status and current mental disorder. Participants were classified as either moderate needs (MN) or high needs (HN). Those with MN were randomized to HF with Intensive Case Management (HF-ICM) or usual care. Those with HN were randomized to HF with Assertive Community Treatment (HF-ACT), congregate housing with support, or usual care. Participants were interviewed every 3 months for 2 years. Separate consent was sought to access administrative data. RESULTS Participants met eligibility for either MN (n = 200) or HN (n = 297) and were randomized accordingly. Both samples were primarily male and white. Compared to participants designated MN, HN participants had higher rates of hospitalization for psychiatric reasons prior to randomization, were younger at the time of recruitment, younger when first homeless, more likely to meet criteria for substance dependence, and less likely to have completed high school. Across all study arms, between 92% and 100% of participants were followed over 24 months post-randomization. Minimal significant differences were found between study arms following randomization. 438 participants (88%) provided consent to access administrative data. CONCLUSION The study successfully recruited participants meeting criteria for homelessness and current mental disorder. Both MN and HN groups had high rates of substance dependence, suicidality, and physical illness. Randomization resulted in no meaningful detectable differences between study arms. TRIAL REGISTRATION Current Controlled Trials: ISRCTN57595077 (Vancouver at Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing First plus Intensive Case Management versus treatment as usual).
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Affiliation(s)
- Julian M Somers
- Somers Research Group, Faculty of Health Sciences Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, Canada.
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Palepu A, Patterson ML, Moniruzzaman A, Frankish CJ, Somers J. Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders. Am J Public Health 2013; 103 Suppl 2:e30-6. [PMID: 24148035 DOI: 10.2105/ajph.2013.301628] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between substance dependence and residential stability in homeless adults with current mental disorders 12 months after randomization to Housing First programs or treatment as usual (no housing or support through the study). METHODS The Vancouver At Home study in Canada included 2 randomized controlled trials of Housing First interventions. Eligible participants met the criteria for homelessness or precarious housing, as well as a current mental disorder. Residential stability was defined as the number of days in stable residences 12 months after randomization. We used negative binomial regression modeling to examine the independent association between residential stability and substance dependence. RESULTS We recruited 497 participants, and 58% (n = 288) met the criteria for substance dependence. We found no significant association between substance dependence and residential stability (adjusted incidence rate ratio = 0.97; 95% confidence interval = 0.69, 1.35) after adjusting for housing intervention, employment, sociodemographics, chronic health conditions, mental disorder severity, psychiatric symptoms, and lifetime duration of homelessness. CONCLUSIONS People with mental disorders might achieve similar levels of housing stability from Housing First regardless of whether they experience concurrent substance dependence.
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Affiliation(s)
- Anita Palepu
- Anita Palepu is with the Department of Medicine, University of British Columbia, Vancouver, British Columbia. Michelle L. Patterson, Akm Moniruzzaman, and Julian Somers are with the Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia. C. James Frankish is with the School of Public and Population Health, University of British Columbia, Vancouver
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Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, Hwang SW. Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities. PLoS One 2013; 8:e75133. [PMID: 24124470 PMCID: PMC3790780 DOI: 10.1371/journal.pone.0075133] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/07/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction We examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study. Methods In 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment. Results Substance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54). Conclusions Problematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anita M. Hubley
- Department of Education and Counseling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Susan Farrell
- Department of Psychiatry, Royal Ottawa Health Care Group, University of Ottawa, Ottawa, ON, Canada
| | - Evie Gogosis
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Somers JM, Rezansoff SN, Moniruzzaman A, Palepu A, Patterson M. Housing first reduces re-offending among formerly homeless adults with mental disorders: results of a randomized controlled trial. PLoS One 2013; 8:e72946. [PMID: 24023796 PMCID: PMC3762899 DOI: 10.1371/journal.pone.0072946] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Homelessness and mental illness have a strong association with public disorder and criminality. Experimental evidence indicates that Housing First (HF) increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders. HF is also associated with lower residential costs than common alternative approaches. Few studies have examined the effect of HF on criminal behavior. METHODS Individuals meeting criteria for homelessness and a current mental disorder were randomized to one of three conditions treatment as usual (reference); scattered site HF; and congregate HF. Administrative data concerning justice system events were linked in order to study prior histories of offending and to test the relationship between housing status and offending following randomization for up to two years. RESULTS The majority of the sample (67%) was involved with the justice system, with a mean of 8.07 convictions per person in the ten years prior to recruitment. The most common category of crime was "property offences" (mean=4.09). Following randomization, the scattered site HF condition was associated with significantly lower numbers of sentences than treatment as usual (Adjusted IRR=0.29; 95% CI 0.12-0.72). Congregate HF was associated with a marginally significant reduction in sentences compared to treatment as usual (Adjusted IRR=0.55; 95% CI: 0.26-1.14). CONCLUSIONS This study is the first randomized controlled trial to demonstrate benefits of HF among a homeless sample with mental illness in the domain of public safety and crime. Our sample was frequently involved with the justice system, with great personal and societal costs. Further implementation of HF is strongly indicated, particularly in the scattered site format. Research examining interdependencies between housing, health, and the justice system is indicated. TRIAL REGISTRATION ISRCTN57595077.
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Affiliation(s)
- Julian M. Somers
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
| | - Stefanie N. Rezansoff
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Anita Palepu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Patterson M, Moniruzzaman A, Palepu A, Zabkiewicz D, Frankish CJ, Krausz M, Somers JM. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1245-59. [PMID: 23748928 DOI: 10.1007/s00127-013-0719-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants' level of need. METHODS Participants (n = 497) were stratified by level of need ("high" or "moderate") and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level. RESULTS Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU. CONCLUSIONS Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.
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Affiliation(s)
- Michelle Patterson
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.
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Palepu A, Patterson M, Strehlau V, Moniruzzamen A, Tan de Bibiana J, Frankish J, Krausz M, Somers J. Daily substance use and mental health symptoms among a cohort of homeless adults in Vancouver, British Columbia. J Urban Health 2013; 90:740-6. [PMID: 23099626 PMCID: PMC3732679 DOI: 10.1007/s11524-012-9775-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Substance use can be a barrier to stable housing for homeless persons with mental disorders. We examined DSM-IV symptoms among homeless adults (N = 497), comparing those who reported daily substance use (DSU) with non-daily substance users. Multivariable linear regression modeling was used to test the independent association between DSU and symptoms using the Colorado Symptom Index total score. DSU was independently associated with higher symptoms (beta = 3.67, 95 % CI 1.55-5.77) adjusting for homelessness history, age, gender, ethnicity, education, marital status, and mental disorder sub-type (adjusted R (2) = 0.24). We observed a higher prevalence of DSU in our sample than has been previously reported in a Housing First intervention. DSU was also independently associated with more DSM-IV symptomatology. We have an opportunity to observe this cohort longitudinally and examine if there are changes in substance use based on treatment assignment and commensurate changes in housing stability, community integration, health status, and quality of life.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, 588B-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Khan NA, Quan H, Hill MD, Pilote L, McAlister FA, Palepu A, Shah BR, Zhou L, Zhen H, Kapral MK. Risk factors, quality of care and prognosis in South Asian, East Asian and White patients with stroke. BMC Neurol 2013; 13:74. [PMID: 23829874 PMCID: PMC3726470 DOI: 10.1186/1471-2377-13-74] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background Stroke has emerged as a significant and escalating health problem for Asian populations. We compared risk factors, quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke. Methods Retrospective analysis was performed on consecutive patients with ischemic stroke or intracerebral hemorrhage admitted to 12 stroke centers in Ontario, Canada (July 2003-March 2008) and included in the Registry of the Canadian Stroke Network database. The database was linked to population-based administrative databases to determine one-year risk of death or recurrent stroke. Results The study included 253 South Asian, 513 East Asian and 8231 White patients. East Asian patients were more likely to present with intracerebral hemorrhage (30%) compared to South Asian (17%) or White patients (15%) (p<0.001). Time from stroke to hospital arrival was similarly poor with delays >2 hours for more than two thirds of patients in all ethnic groups. Processes of stroke care, including thrombolysis, diagnostic imaging, antithrombotic medications, and rehabilitation services were similar among ethnic groups. Risk of death or recurrent stroke at one year after ischemic stroke was similar for patients who were White (27.6%), East Asian (24.7%, aHR 0.97, 95% CI 0.78-1.21 vs. White), or South Asian (21.9%, aHR 0.91, 95% CI 0.67-1.24 vs. White). Although risk of death or recurrent stroke at one year after intracerebral hemorrhage was higher in East Asian (35.5%) and White patients (47.9%) compared to South Asian patients (30.2%) (p=0.002), these differences disappeared after adjustment for age, sex, stroke severity and comorbid conditions (aHR 0.89 [0.67-1.19] for East Asian vs White and 0.99 [0.54-1.81] for South Asian vs. White). Conclusion After stratification by stroke type, stroke care and outcomes are similar across ethnic groups in Ontario. Enhanced health promotion is needed to reduce delays to hospital for all ethnic groups.
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Affiliation(s)
- Nadia A Khan
- Department of Medicine, University of British Columbia, 620 B, 1081 Burrard Street, St, Paul's Hospita, Vancouver, BC V6Z 1Y6, Canada.
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Galipeau J, Moher D, Skidmore B, Campbell C, Hendry P, Cameron DW, Hébert PC, Palepu A. Systematic review of the effectiveness of training programs in writing for scholarly publication, journal editing, and manuscript peer review (protocol). Syst Rev 2013; 2:41. [PMID: 23773340 PMCID: PMC3691595 DOI: 10.1186/2046-4053-2-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/28/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An estimated $100 billion is lost to 'waste' in biomedical research globally, annually, much of which comes from the poor quality of published research. One area of waste involves bias in reporting research, which compromises the usability of published reports. In response, there has been an upsurge in interest and research in the scientific process of writing, editing, peer reviewing, and publishing (that is, journalology) of biomedical research. One reason for bias in reporting and the problem of unusable reports could be due to authors lacking knowledge or engaging in questionable practices while designing, conducting, or reporting their research. Another might be that the peer review process for journal publication has serious flaws, including possibly being ineffective, and having poorly trained and poorly motivated reviewers. Similarly, many journal editors have limited knowledge related to publication ethics. This can ultimately have a negative impact on the healthcare system. There have been repeated calls for better, more numerous training opportunities in writing for publication, peer review, and publishing. However, little research has taken stock of journalology training opportunities or evaluations of their effectiveness. METHODS We will conduct a systematic review to synthesize studies that evaluate the effectiveness of training programs in journalology. A comprehensive three-phase search approach will be employed to identify evaluations of training opportunities, involving: 1) forward-searching using the Scopus citation database, 2) a search of the MEDLINE In-Process and Non-Indexed Citations, MEDLINE, Embase, ERIC, and PsycINFO databases, as well as the databases of the Cochrane Library, and 3) a grey literature search. DISCUSSION This project aims to provide evidence to help guide the journalological training of authors, peer reviewers, and editors. While there is ample evidence that many members of these groups are not getting the necessary training needed to excel at their respective journalology-related tasks, little is known about the characteristics of existing training opportunities, including their effectiveness. The proposed systematic review will provide evidence regarding the effectiveness of training, therefore giving potential trainees, course designers, and decision-makers evidence to help inform their choices and policies regarding the merits of specific training opportunities or types of training.
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Affiliation(s)
- James Galipeau
- Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, K1H 8L6, Canada.
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Argintaru N, Chambers C, Gogosis E, Farrell S, Palepu A, Klodawsky F, Hwang SW. A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities. BMC Public Health 2013; 13:577. [PMID: 23764199 PMCID: PMC3691921 DOI: 10.1186/1471-2458-13-577] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 05/28/2013] [Indexed: 11/11/2022] Open
Abstract
Background Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system. Methods Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months. Results Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03–1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24–3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09–0.53), improved mental (AOR = 0.97, 95% CI = 0.96–0.98) or physical health (AOR = 0.98, 95% CI = 0.96–0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46–0.85) decreased the odds of reporting unmet needs. Conclusions Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.
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Affiliation(s)
- Niran Argintaru
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St, Michael's Hospital, Toronto, ON, Canada.
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Palepu A, Hubley AM, Russell LB, Gadermann AM, Chinni M. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: a multi-site focus group study. Health Qual Life Outcomes 2012; 10:93. [PMID: 22894551 PMCID: PMC3462681 DOI: 10.1186/1477-7525-10-93] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons. METHODS Focus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data. RESULTS Six major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society. CONCLUSIONS These findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St, Paul's Hospital & University of British Columbia, 620B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Shamseer L, Stevens A, Skidmore B, Turner L, Altman DG, Hirst A, Hoey J, Palepu A, Simera I, Schulz K, Moher D. Does journal endorsement of reporting guidelines influence the completeness of reporting of health research? A systematic review protocol. Syst Rev 2012; 1:24. [PMID: 22626029 PMCID: PMC3482392 DOI: 10.1186/2046-4053-1-24] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/10/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Reporting of health research is often inadequate and incomplete. Complete and transparent reporting is imperative to enable readers to assess the validity of research findings for use in healthcare and policy decision-making. To this end, many guidelines, aimed at improving the quality of health research reports, have been developed for reporting a variety of research types. Despite efforts, many reporting guidelines are underused. In order to increase their uptake, evidence of their effectiveness is important and will provide authors, peer reviewers and editors with an important resource for use and implementation of pertinent guidance. The objective of this study was to assess whether endorsement of reporting guidelines by journals influences the completeness of reporting of health studies. METHODS Guidelines providing a minimum set of items to guide authors in reporting a specific type of research, developed with explicit methodology, and using a consensus process will be identified from an earlier systematic review and from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network's reporting guidelines library. MEDLINE, EMBASE, the Cochrane Methodology Register and Scopus will be searched for evaluations of those reporting guidelines; relevant evaluations from the recently conducted CONSORT systematic review will also be included. Single data extraction with 10% verification of study characteristics, 20% of outcomes and complete verification of aspects of study validity will be carried out. We will include evaluations of reporting guidelines that assess the completeness of reporting: (1) before and after journal endorsement, and/or (2) between endorsing and non-endorsing journals. For a given guideline, analyses will be conducted for individual and the total sum of items. When possible, standard, pooled effects with 99% confidence intervals using random effects models will be calculated. DISCUSSION Evidence on which guidelines have been evaluated and which are associated with improved completeness of reporting is important for various stakeholders, including editors who consider which guidelines to endorse in their journal editorial policies.
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Affiliation(s)
- Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Independent Research and Information Consultant, Ottawa, ON, Canada
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Allison Hirst
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - John Hoey
- Queen’s University, Kingston, ON, Canada
| | | | - Iveta Simera
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
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Kendall C, Palepu A, Khatter K, Murray S, Willinsky J, Turner L, Todkill AM. Open Medicine at five years. Open Med 2012; 6:e59-61. [PMID: 23696770 PMCID: PMC3659215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 10/25/2022]
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Lai EJ, Grubisic M, Palepu A, Quan H, King KM, Khan NA. Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients. BMC Cardiovasc Disord 2011; 11:56. [PMID: 21923931 PMCID: PMC3189887 DOI: 10.1186/1471-2261-11-56] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/18/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Failure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients. METHODS Retrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics. RESULTS There were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities. CONCLUSION Despite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.
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Affiliation(s)
- Emily J Lai
- Department of Medicine, University of British Columbia, 10th floor - 2775rel S Laut., Vancouver, BC V5Z 1M9, Canada
| | - Maja Grubisic
- Center for Health Evaluation and Outcomes Sciences, St. Paul's Hospital, 620B - 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, 10th floor - 2775rel S Laut., Vancouver, BC V5Z 1M9, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, TRW Bldg 3rd floor - 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Kathryn M King
- Department of Community Health Sciences, University of Calgary, TRW Bldg 3rd floor - 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, 10th floor - 2775rel S Laut., Vancouver, BC V5Z 1M9, Canada
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Abstract
Objective We compared the readmission rates and the pattern of readmission among patients discharged against medical advice (AMA) to control patients discharged with approval over a one-year follow-up period. Methods A retrospective matched-cohort study of 656 patients(328 were discharged AMA) who were followed for one year after their initial hospitalization at an urban university-affiliated teaching hospital in Vancouver, Canada that serves a population with high prevalence of addiction and psychiatric disorders. Multivariate conditional logistic regression was used to examine the independent association of discharge AMA on 14-day related diagnosis hospital readmission. We fit a multivariate conditional negative binomial regression model to examine the readmission frequency ratio between the AMA and non-AMA group. Principal Findings AMA patients were more likely to be homeless (32.3% vs. 11%) and have co-morbid conditions such as psychiatric illnesses, injection drug use, HIV, hepatitis C and previous gastrointestinal bleeding. Patients discharged AMA were more likely to be readmitted: 25.6% vs. 3.4%, p<0.001 by day 14. The AMA group were more likely to be readmitted within 14 days with a related diagnosis than the non-AMA group (Adjusted Odds Ratio 12.0; 95% Confidence Interval [CI]: 3.7–38.9). Patients who left AMA were more likely to be readmitted multiple times at one year compared to the non-AMA group (adjusted frequency ratio 1.6; 95% CI: 1.3–2.0). There was also higher all-cause in-hospital mortality during the 12-month follow-up in the AMA group compared to non-AMA group (6.7% vs. 2.4%, p = 0.01). Conclusions Patients discharged AMA were more likely to be homeless and have multiple co-morbid conditions. At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality. Interventions to reduce discharges AMA in high-risk groups need to be developed and tested.
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Affiliation(s)
- Mark Choi
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Haerin Kim
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, British Columbia, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, British Columbia, Canada
- * E-mail:
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Cowan-Dewar J, Kendall C, Palepu A. Prisons and public health. Open Med 2011; 5:e132-3. [PMID: 22046225 PMCID: PMC3205828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 11/06/2022]
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Abstract
Homelessness is prevalent among HIV-infected injection drug users (IDU) and may adversely affect access and adherence to antiretroviral therapy (ART). There are limited descriptions of the effect of homelessness on adherence to ART in long-term cohorts of HIV-infected IDU. We used data from a community-recruited prospective cohort of HIV-infected IDU, including comprehensive ART dispensation records, in a setting where HIV care is free. We examined the relationship between the homelessness measured longitudinally, and the odds of ≥95% adherence to ART using generalized estimating equations logistic regression modeling adjusting for sociodemographics, drug use, and clinical variables. Between May 1996 and September 2008, 545 HIV-infected IDU were recruited and eligible for the present study. The median follow-up duration was 23.8 months (IQR 8.5-91.6 months) contributing 2,197 person-years of follow-up. At baseline, homeless participants were slightly younger (35.8 vs. 37.9 years, p = 0.01) and more likely to inject heroin at least daily (37.1% vs. 24.6%. p = 0.004) than participants who had housing. The multivariate model revealed that homelessness (adjusted odds ratio [AOR] 0.66; 95% CI: 0.53-0.84) and frequent heroin use (AOR 0.40; 95% CI: 0.30-0.53) were significantly and negatively associated with ART adherence, whereas methadone maintenance was positively associated (AOR 2.33; 95% CI: 1.86-2.92). Sub-optimal ART adherence was associated with homelessness and daily injection heroin use among HIV-infected IDU. Given the survival benefit of ART, it is critical to develop and evaluate innovative strategies such as supportive housing and methadone maintenance to address these risk factors to improve adherence.
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Affiliation(s)
- Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Palepu A, Kendall C, Moher D. Open Medicine endorses PROSPERO. Open Med 2011; 5:e65-6. [PMID: 22046223 PMCID: PMC3205808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 11/13/2022]
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Morales-Manrique CC, Palepu A, Castellano-Gomez M, Aleixandre-Benavent R, Valderrama-Zurián JC. Quality of life, needs, and interest among cocaine users: differences by cocaine use intensity and lifetime severity of addiction to cocaine. Subst Use Misuse 2011; 46:390-7. [PMID: 20735213 DOI: 10.3109/10826084.2010.501675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined the quality of life (QoL) of 149 patients who were recruited in 2005 at outpatient treatment centers for cocaine dependence in Spain. Important life areas and life areas with potential need and interest to change in order to improve the QoL were analyzed in terms of patients? cocaine use intensity within the previous six months and lifetime severity addiction to cocaine. The Spanish versions of the Drug User Quality of Life Scale and the Lifetime Severity Index for Cocaine were used to measure QoL, needs and interest, and severity addiction to cocaine. The data analysis employed t-tests, linear regression, Mann?Whitney U tests, multivariate regression, and chi-square tests. Tailoring treatment programs to address the life areas that are considered relevant to cocaine users considering their intensity of consumption and lifetime severity addiction to cocaine may improve retention and treatment outcomes. Further research needs to consider patients of different ethnic backgrounds and cultural contexts. The study's limitations are noted.
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Affiliation(s)
- C C Morales-Manrique
- Unidad de Información e Investigación Social y Sanitaria (UISYS) (Universitat de València-CSIC), Valencia, Spain
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Murray S, Brophy J, Palepu A. Open Medicine's ghost and guest authorship policy. Open Med 2010; 4:e11-2. [PMID: 21686286 PMCID: PMC3116667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/21/2009] [Indexed: 10/27/2022]
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Murray S, Giustini D, Loubani T, Choi S, Palepu A. Medical research and social media: Can wikis be used as a publishing platform in medicine? Open Med 2009; 3:e121-2. [PMID: 21603044 PMCID: PMC3090116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 06/06/2009] [Indexed: 11/18/2022]
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