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Stephen W Hwang - One of the best experts on this subject based on the ideXlab platform.

  • health care for Homeless People
    Nature Reviews Disease Primers, 2021
    Co-Authors: Michael Liu, Stephen W Hwang
    Abstract:

    A growing and diversifying Homeless population faces tremendous social burdens and structural barriers to health care that contribute to high morbidity and mortality. Health care for Homeless People must address intersecting health and social challenges through a combination of health-related and social interventions. Homeless People face tremendous social and structural barriers to health care that contribute to high morbidity and mortality. Here, the authors discuss that collaborations between health systems and social services are needed to improve health and well-being in this population.

  • costs of services for Homeless People with mental illness in 5 canadian cities a large prospective follow up study
    CMAJ open, 2017
    Co-Authors: Eric Latimer, Stephen W Hwang, Daniel Rabouin, Zhirong Cao, Guido Powell, Tim Aubry, Jino Distasio, Julian M Somers, Vicky Stergiopoulos, Scott Veldhuizen
    Abstract:

    Background Limited evidence on the costs of Homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that Homeless People with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. Methods As part of the At Home/Chez Soi trial of Housing First for Homeless People with mental illness, 990 participants were assigned to the usual-treatment (control) group in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal and Moncton) between October 2009 and June 2011. They were followed for up to 2 years. Questionnaires ascertained service use and income, and city-specific unit costs were estimated. We adjusted costs for site differences in sample characteristics. We used generalized linear models to identify individual-level characteristics associated with higher costs. Results Usable data were available for 937 participants (94.6%). Average annual costs (excluding medications) per person in Vancouver, Winnipeg, Toronto, Montreal and Moncton were $53 144 (95% confidence interval [CI] $46 297-$60 095), $45 565 (95% CI $41 039-$50 412), $58 972 (95% CI $52 237-$66 085), $56 406 (95% CI $50 654-$62 456) and $29 610 (95% CI $24 995-$34 480), respectively. Net costs ranged from $15 530 to $341 535. Distributions of costs across categories varied significantly across cities. Lower functioning and a history of psychiatric hospital stays were the most important predictors of higher costs. Interpretation Homeless People with mental illness generate very high costs for society. Programs are needed to reorient this spending toward more effectively preventing Homelessness and toward meeting the health, housing and social service needs of Homeless People.

  • integrating hospital and community care for Homeless People with unmet mental health needs program rationale study protocol and sample description of a brief multidisciplinary case management intervention
    International Journal of Mental Health and Addiction, 2017
    Co-Authors: Stephen W Hwang, Vicky Stergiopoulos, Agnes Gozdzik, Rosane Nisenbaum, Denise Lamanna, Joshua Tepper
    Abstract:

    The Coordinated Access to Care for Homeless People (CATCH) program is a brief multidisciplinary case management intervention for Homeless adults discharged from hospital in Toronto, Canada. Here we describe the rationale for CATCH program development, details of the mixed methods evaluation underway, and the characteristics of 225 CATCH service users. Funded in 2010 by the local health authority, CATCH aimed to improve access, continuity of care, health and service use outcomes for Homeless adults discharged from hospital. To assess the feasibility, acceptability and impact of the program, a mixed methods case study was undertaken in 2013. In total, 225 CATCH program users were enrolled in the study and completed quantitative survey measures at program entry to assess key health and social outcomes using a pre-post cohort study design. Follow-up assessments took place at 3- and 6-months. At study entry, most participants were male (79%), white (65%), Canadian-born (74%), single or never married (60%), and their average age was 39.9 ± 12.0 years. Nearly all participants (88%) had at least one emergency department visit in the past 6 months, more than half (53%) indicated at least three chronic health conditions, and 44% indicated at least three mental health diagnoses. In addition, qualitative data was collected to evaluate the experiences of continuity of care and challenges during care transitions for this population using in-depth interviews with a sample of CATCH service users (n = 22) and managers of partnered organizations (n = 7), as well as focus groups with CATCH staff (n = 8), other service providers (n = 7) and People with lived experience of Homelessness (n = 8). Improving health and health service use outcomes among Homeless adults with chronic health conditions are key priorities in many jurisdictions. Future findings can inform service delivery to Homeless adults discharged from hospital, by exposing factors associated with positive program outcomes, as well as barriers and facilitators to continuity of care for this disadvantaged population.

  • effectiveness of interventions to improve the health and housing status of Homeless People a rapid systematic review
    BMC Public Health, 2011
    Co-Authors: Donna Fitzpatricklewis, Stephen W Hwang, Rebecca Ganann, Shari Krishnaratne, Donna Ciliska, Fiona G Kouyoumdjian
    Abstract:

    Background: Research on interventions to positively impact health and housing status of People who are Homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of Homeless People, with particular focus on the effect of these interventions on housing status. Methods: A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of People who were Homeless, marginally housed, or at risk of Homelessness. Two reviewers independently scored all relevant articles for quality. Results: Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For Homeless People with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For Homeless People with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among Homeless populations with HIV. Health promotion programs can decrease risk behaviours among Homeless populations. Conclusions: These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for Homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for Homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support Homeless populations with HIV.

  • the effect of traumatic brain injury on the health of Homeless People
    Canadian Medical Association Journal, 2008
    Co-Authors: Stephen W Hwang, Angela Colantonio, Shirley Chiu, George Tolomiczenko, Alex Kiss, Laura Cowan, Donald A Redelmeier, Wendy Levinson
    Abstract:

    Background: We sought to determine the lifetime prevalence of traumatic brain injury and its association with current health conditions in a representative sample of Homeless People in Toronto, Ontario. Methods: We surveyed 601 men and 303 women at Homeless shelters and meal programs in 2004–2005 (response rate 76%). We defined traumatic brain injury as any self-reported head injury that left the person dazed, confused, disoriented or unconscious. Injuries resulting in unconsciousness lasting 30 minutes or longer were defined as moderate or severe. We assessed mental health, alcohol and drug problems in the past 30 days using the Addiction Severity Index. Physical and mental health status was assessed using the SF-12 health survey. We examined associations between traumatic brain injury and health conditions. Results: The lifetime prevalence among Homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of Homelessness. After adjustment for demographic characteristics and lifetime duration of Homelessness, a history of moderate or severe traumatic brain injury was associated with significantly increased likelihood of seizures (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8 to 5.6), mental health problems (OR 2.5, 95% CI 1.5 to 4.1), drug problems (OR 1.6, 95% CI 1.1 to 2.5), poorer physical health status (–8.3 points, 95% CI –11.1 to –5.5) and poorer mental health status (–6.0 points, 95% CI –8.3 to –3.7). Interpretation: Prior traumatic brain injury is very common among Homeless People and is associated with poorer health.

Meriem Louni - One of the best experts on this subject based on the ideXlab platform.

  • screening of sars cov 2 among Homeless People asylum seekers and other People living in precarious conditions in marseille france march april 2020
    International Journal of Infectious Diseases, 2021
    Co-Authors: Nhu Ngoc Nguyen, Vanthuan Hoang, Meriem Louni, Ndiaw Goumballa, Naomie Canard, Hacene Medkour, Audrey Borg, Kevin Bardy, Thi Loi Dao, Vera Estevesvieira
    Abstract:

    Abstract Background Surveillance of SARS-CoV-2 infection among sheltered Homeless and other vulnerable People might provide the information needed to prevent its spread within accommodation centres. Methods Data was obtained from 698 participants in different accommodation centres (411 Homeless individuals, 77 asylum-seekers, 58 other persons living in precarious conditions, and 152 employees working in these accommodation centres) who completed questionnaires and had nasal samples collected between 26 March and 17 April 2020. SARS-CoV-2 carriage was assessed by quantitative PCR. Results We found a high (78.9%) acceptance rate toward testing. Overall, 49 (7.0%) People were positive for SARS-CoV-2, including 37 Homeless individuals (of 411, 9.0%), 12 employees (of 152, 7.9%). SARS-CoV-2 positivity correlated with symptoms, although 51% of positive patients did not report respiratory symptoms or fever. Among Homeless People, being young (18-34 years) (OR: 3.83 [1.47–10.0], p = 0.006) and being housed in one specific shelter (OR: 9.13 [4.09–20.37], p  Discussion Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission in the vulnerable sheltered People. Systematic testing should be promoted.

  • screening of sars cov 2 among Homeless People asylum seekers and other People living in precarious conditions in marseille france march april 2020
    International Journal of Infectious Diseases, 2021
    Co-Authors: Nhu Ngoc Nguyen, Vanthuan Hoang, Meriem Louni, Ndiaw Goumballa, Naomie Canard, Hacene Medkour, Audrey Borg, Thi Loi Dao, Kevin Bardy
    Abstract:

    BACKGROUND Surveillance of SARS-CoV-2 infection among sheltered Homeless and other vulnerable People might provide the information needed to prevent its spread within accommodation centres. METHODS Data was obtained from 698 participants in different accommodation centres (411 Homeless individuals, 77 asylum-seekers, 58 other persons living in precarious conditions, and 152 employees working in these accommodation centres) who completed questionnaires and had nasal samples collected between 26 March and 17 April 2020. SARS-CoV-2 carriage was assessed by quantitative PCR. RESULTS We found a high (78.9%) acceptance rate toward testing. Overall, 49 (7.0%) People were positive for SARS-CoV-2, including 37 Homeless individuals (of 411, 9.0%), 12 employees (of 152, 7.9%). SARS-CoV-2 positivity correlated with symptoms, although 51% of positive patients did not report respiratory symptoms or fever. Among Homeless People, being young (18-34 years) (OR: 3.83 [1.47-10.0], p = 0.006) and being housed in one specific shelter (OR: 9.13 [4.09-20.37], p < 0.001) were independent factors associated with the SARS-CoV-2 positivity rates (11.4% and 20.6%, respectively). DISCUSSION Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission in the vulnerable sheltered People. Systematic testing should be promoted.

  • screening of sars cov 2 among Homeless People asylum seekers and other People living in precarious conditions in marseille france march april 2020
    International Journal of Infectious Diseases, 2021
    Co-Authors: Nhu Ngoc Nguyen, Vanthuan Hoang, Meriem Louni, Ndiaw Goumballa, Naomie Canard, Hacene Medkour, Audrey Borg, Kevin Bardy, Thi Loi Dao, Vera Estevesvieira
    Abstract:

    Abstract Background Surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among sheltered Homeless and other vulnerable People might provide the information needed to prevent its spread within accommodation centres. Methods Data were obtained from 698 participants in different accommodation centres (411 Homeless individuals, 77 asylum-seekers, 58 other People living in precarious conditions and 152 employees working in these accommodation centres) who completed questionnaires and had nasal samples collected between 26 March and 17 April 2020. SARS-CoV-2 carriage was assessed by quantitative PCR. Results We found a high acceptance rate (78.9%) for testing. Overall, 49 People (7.0%) were positive for SARS-CoV-2, including 37 Homeless individuals (of 411, 9.0%) and 12 employees (of 152, 7.9%). SARS-CoV-2 positivity correlated with symptoms, although 51% of patients who tested positive did not report respiratory symptoms or fever. Among Homeless People, being young (18–34 years) (odds ratio 3.83, 95% confidence interval 1.47–10.0, p = 0.006) and being housed in one specific shelter (odds ratio 9.13, 95% confidence interval 4.09–20.37, p Discussion Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission in vulnerable sheltered People. Systematic testing should be promoted.

  • screening of sars cov 2 among Homeless People asylum seekers and other People living in precarious conditions in marseille france march april 2020
    medRxiv, 2020
    Co-Authors: Tran Duc Anh Ly, Vanthuan Hoang, Meriem Louni, Ndiaw Goumballa, Naomie Canard, Hacene Medkour, Audrey Borg, Kevin Bardy, Vera Estevesvieira, Veronique Filosa
    Abstract:

    Surveillance of SARS-CoV-2 infection among sheltered Homeless and other vulnerable People might provide the information needed to prevent its spread within accommodation centres. In March-April, we enrolled 411 Homeless individuals, 77 asylum-seekers, 58 People living in precarious conditions, and 152 employees working in these accommodation centres and collected nasal samples. SARS-CoV-2 carriage was assessed by quantitative PCR. Overall, 49 (7.0%) People were positive for SARS-CoV-2, including 37 Homeless individuals (of 411, 9.0%), 12 employees (of 152, 7.9%). SARS-CoV-2 positivity correlated with symptoms, although 51% of positive patients did not report respiratory symptoms or fever. Among Homeless People, being young (18-34 years) (OR: 3.83 [1.47-10.0], p=0.006) and being housed in one specific shelter (OR: 9.13 [4.09-20.37], p

  • Epidemiological serosurvey of vector-borne and zoonotic pathogens among Homeless People living in shelters in Marseille: cross-sectional one-day surveys (2005–2015)
    European Journal of Clinical Microbiology & Infectious Diseases, 2020
    Co-Authors: Tran Duc Anh Ly, Vanthuan Hoang, Meriem Louni, Sekene Badiaga, Hervé Tissot-dupont, Pierre-edouard Fournier, Philippe Brouqui, Philippe Gautret
    Abstract:

    Homeless People are often exposed to unhygienic environments as well as to animals carrying arthropods which both transmit zoonotic infections and human louse-borne pathogens. We attempted to determine the prevalence of antibodies against several vector-borne and zoonotic pathogens among Homeless adults living in Marseille. During the 2005–2015 period, we collected sera samples from 821 Homeless adults living in shelters. Antibodies against Bartonella quintana , Bartonella henselae , Borrelia recurrentis , Coxiella burnetii , Francisella tularensis (with a cut-off of 1:100), Rickettsia akari , Rickettsia conorii , Rickettsia felis , Rickettsia prowazekii , and Rickettsia typhi (with a cut-off of 1:64) were searched by microimmunofluorescence (MIF). MIF-positive serum samples were confirmed by cross-adsorption to characterise cross-reacting antigens and immunoblotting. Positive sera by Western blot were further tested using qPCR. We evidenced a prevalence of 4.9% seroreactivity to at least one pathogen including phase II C. burnetii (2.1%), B. quintana (1.7%), R. conorii (0.4%), R. prowazekii (0.4%), R. typhi (0.1%), B. recurrentis (0.1%), and F. tularensis (0.1%). No DNA from any pathogens was detected. A comparison with studies conducted prior to the 2000–2003 period showed a decrease in the overall seroprevalence of several vector-borne and zoonotic infections.

Didier Raoult - One of the best experts on this subject based on the ideXlab platform.

  • Body lice of Homeless People reveal the presence of several emerging bacterial pathogens in northern Algeria
    PLoS Neglected Tropical Diseases, 2018
    Co-Authors: Meriem Louni, Didier Raoult, Nassima Mana, Idir Bitam, Mustapha Dahmani, Philippe Parola, Florence Fenollar, Oleg Mediannikov
    Abstract:

    Background Human lice, Pediculus humanus, are obligate blood-sucking parasites. Body lice, Pediculus h. humanus, occur in two divergent mitochondrial clades (A and D) each exhibiting a particular geographic distribution. Currently, the body louse is recognized as the only vector for louse-borne diseases. In this study, we aimed to study the genetic diversity of body lice collected from Homeless populations in three localities of northern Algeria, and to investigate louse-borne pathogens in these lice. Methodology/Principal findings In this study, 524 body lice specimens were collected from 44 Homeless People in three localities: Algiers, Tizi Ouzou and Boumerdes located in northern Algeria. Duplex Glade specific real-time PCRs (qPCR) and Cytochrome b (cytb) mitochondrial DNA (mtDNA) analysis were performed in order to identify the mitochondrial Glade. Screening of louse-borne pathogens bacteria was based on targeting specific genes for each pathogen using qPCR supplemented by sequencing. All body lice belong to Glade A. Through amplification and sequencing of the cytb gene we confirmed the presence of three haplotypes: A5, A9 and A63, which is novel. The molecular investigation of the 524 body lice samples revealed the presence of four human pathogens: Bartonella quintana (13.35%), Coxiella burnetii (10.52%), Anaplasma phagocytophilum (0.76%) and Acinetobacter species (A. baumannii, A. johnsonii, A. berezeniae, A. nosocomialis and A. variabilis, in total 46.94%). Conclusions/Significance To the best of our knowledge, our study is the first to show the genetic diversity and presence of several emerging pathogenic bacteria in Homeless' body lice from Algeria. We also report for the first time, the presence of several species of Acinetobacter in human body lice. Our results highlight the fact that body lice may be suspected as being a much broader vector of several pathogenic agents than previously thought. Nevertheless, other studies are needed to encourage epidemiological investigations and surveys of louse-associated infections.

  • Body lice of Homeless People reveal the presence of several emerging bacterial pathogens in northern Algeria.
    Public Library of Science (PLoS), 2018
    Co-Authors: Meriem Louni, Didier Raoult, Nassima Mana, Idir Bitam, Mustapha Dahmani, Philippe Parola, Florence Fenollar, Oleg Mediannikov
    Abstract:

    Human lice, Pediculus humanus, are obligate blood-sucking parasites. Body lice, Pediculus h. humanus, occur in two divergent mitochondrial clades (A and D) each exhibiting a particular geographic distribution. Currently, the body louse is recognized as the only vector for louse-borne diseases. In this study, we aimed to study the genetic diversity of body lice collected from Homeless populations in three localities of northern Algeria, and to investigate louse-borne pathogens in these lice.In this study, 524 body lice specimens were collected from 44 Homeless People in three localities: Algiers, Tizi Ouzou and Boumerdès located in northern Algeria. Duplex clade specific real-time PCRs (qPCR) and Cytochrome b (cytb) mitochondrial DNA (mtDNA) analysis were performed in order to identify the mitochondrial clade. Screening of louse-borne pathogens bacteria was based on targeting specific genes for each pathogen using qPCR supplemented by sequencing. All body lice belong to clade A. Through amplification and sequencing of the cytb gene we confirmed the presence of three haplotypes: A5, A9 and A63, which is novel. The molecular investigation of the 524 body lice samples revealed the presence of four human pathogens: Bartonella quintana (13.35%), Coxiella burnetii (10.52%), Anaplasma phagocytophilum (0.76%) and Acinetobacter species (A. baumannii, A. johnsonii, A. berezeniae, A. nosocomialis and A. variabilis, in total 46.94%).To the best of our knowledge, our study is the first to show the genetic diversity and presence of several emerging pathogenic bacteria in Homeless' body lice from Algeria. We also report for the first time, the presence of several species of Acinetobacter in human body lice. Our results highlight the fact that body lice may be suspected as being a much broader vector of several pathogenic agents than previously thought. Nevertheless, other studies are needed to encourage epidemiological investigations and surveys of louse-associated infections

  • bartonella quintana bacteremia among Homeless People
    Clinical Infectious Diseases, 2002
    Co-Authors: Cedric Foucault, Philippe Brouqui, K Barrau, Didier Raoult
    Abstract:

    Bartonella quintana infections have recently reemerged, predominantly among the Homeless populations in cities in both Europe and the United States. B. quintana can cause trench fever, endocarditis, and chronic bacteremia; the human body louse is the only known vector. Homeless People who presented to the emergency departments of University Hospital in Marseilles, France, were studied, as were those who had been admitted to other medical facilities in the city since 1 January 1997. Samples of blood and body lice were collected for culture for B. quintana and for serological testing. Bartonella bacteremia was associated with sweats, evidence of louse infestation, serological tests that were positive for B. quintana, and high titers of B. quintana antibody. Bacteremia was also associated with being Homeless for <3 years. Asymptomatic, prolonged bacteremia (duration, up to 78 weeks) and intermittent bacteremia were found to occur. Data obtained regarding antibiotic regimens showed that treatment with gentamicin and doxycycline was effective in preventing relapses of bacteremia.

Merete Nordentoft - One of the best experts on this subject based on the ideXlab platform.

  • suicide and unintentional injury mortality among Homeless People a danish nationwide register based cohort study
    European Journal of Public Health, 2014
    Co-Authors: Sandra Feodor Nilsson, Carsten Hjorthoj, Annette Erlangsen, Merete Nordentoft
    Abstract:

    BACKGROUND: Homeless People have elevated mortality, especially due to external causes. We aimed to examine suicide and unintentional injury mortality levels and identify predictors in the Homeless population. METHODS: A nationwide, register-based cohort study of Homeless People aged 16 years and older was carried out using the Danish Homeless Register, 1999-2008. RESULTS: In all, 32 010 Homeless People (70.5% men) were observed. For men, the mortality rate was 174.4 [95% confidence interval (CI) = 150.6-198.1] per 100 000 person-years for suicide and 463.3 (95% CI = 424.6-502.0) for unintentional injury. For women, the corresponding rates were 111.4 (95% CI = 81.7-141.1) for suicide and 241.4 (95% CI = 197.6-285.1) for unintentional injury. Schizophrenia spectrum, affective, personality and substance use disorders were strongly associated with increased risk of suicide; the highest risk estimates were found for schizophrenia spectrum disorders among both men [hazard ratio (HR) = 3.1, 95% CI = 2.0-4.9] and women (HR = 15.5, 95% CI = 4.5-54.0). Alcohol and drug use disorders were predictors of death by unintentional injury for both men and women, whereas schizophrenia spectrum disorders and personality disorders were only significant predictors among men; the highest risk estimates were found for drug use disorders among men (HR = 2.2, 95% CI = 1.8-2.8) and women (HR = 3.1, 95% CI = 1.8-5.4). A history of psychiatric admission and emergency room contact were predictors for dying by suicide and unintentional injury. CONCLUSION: People in the Homeless shelter population with a history of a psychiatric disorder constitute a high-risk group regarding the elevated suicide and unintentional injury mortality. Language: en

  • psychiatric disorders and mortality among People in Homeless shelters in denmark a nationwide register based cohort study
    The Lancet, 2011
    Co-Authors: Sandra Feodor Nielsen, Carsten Hjorthoj, Annette Erlangsen, Merete Nordentoft
    Abstract:

    Summary Background The increased mortality of Homeless People compared with non-Homeless People might be linked to psychiatric disorders. However, Homeless People are, because of their insufficient accommodation, difficult to sample and monitor, which has limited previous studies. We aimed to assess registered psychiatric disorders, mortality, and predictors of mortality in the Homeless shelter population in Denmark. Methods We did a nationwide, prospective, register-based cohort study of Homeless People aged 16 years and older who were registered in the Danish Homeless Register between Jan 1, 1999, and Dec 31, 2009. We calculated the proportion of registered psychiatric disorders, overall and cause-specific standardised mortality ratio (SMR), and life expectancy. Hazard ratios (HRs) were used to assess predictors of death. Findings 32 711 Homeless People (23 040 men and 9671 women) were included in the study population. 14 381 men (62·4%) and 5632 women (58·2%) had registered psychiatric disorders, and 11 286 men (49·0%) and 3564 women (36·9%) had a substance abuse diagnosis. During the study period, 3839 men (16·7%) and 951 women (9·8%) died. The overall SMR for men was 5·6 (95% CI 5·4–5·8) and for women was 6·7 (6·2–7·1), and external causes accounted for 1161 (27·9%) of 4161 deaths for which information on the cause was available. Remaining life expectancy at age 15–24 years was 21·6 years (95% CI 21·2–22·1) and 17·4 years (16·4–18·5) lower for Homeless men and women, respectively, than the general population. Registered substance abuse disorder was associated with the highest mortality risk compared with no psychiatric contact registered (adjusted HR 1·4, 95% CI 1·3–1·5 for men; 1·7, 1·4–2·1 for women). Interpretation Health problems are extensive in the Homeless shelter population and there is an urgent need for more sustained efforts to reduce the high morbidity and mortality, especially from external causes. Register data is an important resource to supplement existing knowledge on Homeless People with more valid and detailed information. Funding The Danish Council for Independent Research.

  • 10 year follow up study of mortality among users of hostels for Homeless People in copenhagen
    Ugeskrift for Læger, 2004
    Co-Authors: Merete Nordentoft, Nina Wandallholm
    Abstract:

    Abstract Objectives To investigate mortality among users of hostels for Homeless People in Copenhagen, and to identify predictors of death such as conditions during upbringing, mental illness, and misuse of alcohol and drugs. Design Register based follow up study. Setting Two hostels for Homeless People in Copenhagen, Denmark Participants 579 People who stayed in one hostel in Copenhagen in 1991, and a representative sample of 185 People who stayed in the original hostel and one other in Copenhagen. Main outcome measure Cause specific mortality. Results The age and sex standardised mortality ratio for both sexes was 3.8 (95% confidence interval 3.5 to 4.1); 2.8 (2.6 to 3.1) for men and 5.6 (4.3 to 6.9) for women. The age and sex standardised mortality ratio for suicide for both sexes was 6.0 (3.9 to 8.1), for death from natural causes 2.6 (2.3 to 2.9), for unintentional injuries 14.6 (11.4 to 17.8), and for unknown cause of death 62.9 (52.7 to 73.2). Mortality was comparatively higher in the younger age groups. It was also significantly higher among Homeless People who had stayed in a hostel more than once and stayed fewer than 11 days, compared with the rest of the study group. Risk factors for early death were premature death of the father and misuse of alcohol and sedatives. Conclusion Homeless People staying in hostels, particularly young women, are more likely to die early than the general population. Other predictors of early death include adverse experiences in childhood, such as death of the father, and misuse of alcohol and sedatives.

Mary Jarden - One of the best experts on this subject based on the ideXlab platform.

  • Homeless People s experiences of medical respite care following acute hospitalisation in denmark
    Health & Social Care in The Community, 2018
    Co-Authors: Maja Pedersen, Camilla Nygaard Bring, Nina Brunes, Ove Andersen, Janne Petersen, Mary Jarden
    Abstract:

    The aim of this study was to explore Homeless People's health perspectives and experiences of a 2-week medical respite care programme following acute hospitalisation. There is a high level of health inequality when comparing the health status of Homeless People to the general population, including increased mortality and morbidity. Homelessness predisposes an increased risk of infectious disease, cancer and chronic illness, such as diabetes and cardiovascular disease. Moreover, Homeless People have a higher frequency of acute hospitalisation than general population estimates. In order to facilitate the transition from hospitalisation back to life on the streets, Homeless People who were acutely hospitalised in the Capital Region of Denmark were offered 2 weeks of medical respite care from the day of discharge by a non-governmental organisation. This is a qualitative study with a phenomenological hermeneutical approach based on narrative interviews of 12 Homeless People who received medical respite care from 1 March 2016 to 30 September 2016. Data were collected through individual semi-structured interviews and analysed according to Lindseth and Norberg's presentation of Paul Ricoeur's theory of interpretation. The analysis identified four themes: (i) basic needs are of highest priority; (ii) a safe environment provides security and comfort; (ii) social support is just as important as healthcare; and (iv) restitution facilitates reflection. The findings indicated that the medical respite care centre provided a place of rest and restitution following hospitalisation, which made room for self-reflection among the Homeless People regarding their past and present life, and also their wishes for a better future. This study also indicates that a medical respite care stay can contribute to the creation of a temporary condition in which the basic needs of the Homeless People are met, enabling them to be more hopeful and to think more positively about the future.