Nutritional deficiencies in homeless persons with problematic drinking: a systematic review.

BACKGROUND: A significant proportion of homeless people drink alcohol excessively and this can lead to malnutrition and consequent medical problems. The aim of this review was to assess the evidence on the range of nutritional deficiencies in the homeless problem-drinking populations. METHODS: We conducted a comprehensive search of nine scientific literature databases and 13 grey literature sources. We included studies of any design that included homeless population with problem-drinking and reported measures of nutritional deficiencies in urine or blood. Study selection and data extraction was done by one reviewer and checked by another. Data on malnutrition profile were summarized narratively. RESULTS: We found nine studies reporting nutritional deficiencies in homeless populations with problem-drinking. The oldest study was from the 1950s and the most recent from 2013. The following nutrients were reported across studies: vitamins B1, B2, B6, B9, B12, C, A, and E; haemoglobin; and albumin. The most common deficiencies reported were of vitamin B1 (prevalence of deficiency was 0, 2, 6, 45, and 51% in five studies) and vitamin C (29, 84, and 95% in three studies). None of the studies were assessed to be at a low risk of bias. CONCLUSIONS: The limited, low quality and relatively old evidence suggests that homeless people who drink heavily may be deficient in vitamin C, thiamine, and other nutrients. New, well conducted studies are needed in order to optimally inform public health interventions aimed at improving deficiencies in this population. TRIAL REGISTRATION: PROSPERO CRD42015024247.

A novel HPLC method for the concurrent analysis and quantitation of seven water-soluble vitamins in biological fluids (plasma and urine): a validation study and application.

An HPLC method was developed and validated for the concurrent detection and quantitation of seven water-soluble vitamins (C, B(1), B(2), B(5), B(6), B(9), B(12)) in biological matrices (plasma and urine). Separation was achieved at 30°C on a reversed-phase C18-A column using combined isocratic and linear gradient elution with a mobile phase consisting of 0.01% TFA aqueous and 100% methanol. Total run time was 35 minutes. Detection was performed with diode array set at 280 nm. Each vitamin was quantitatively determined at its maximum wavelength. Spectral comparison was used for peak identification in real samples (24 plasma and urine samples from abstinent alcohol-dependent males). Interday and intraday precision were <4% and <7%, respectively, for all vitamins. Recovery percentages ranged from 93% to 100%.

Simulator assessment of innovative intersection designs on driver speeds and trajectories.

Intersections are over-represented in crash statistics internationally, suggesting that treatments targeting intersections could substantially improve road safety. Aligning with a Safe Systems approach, several innovative intersection configurations have been proposed. We evaluated the effectiveness of five designs on reducing speed and modifying conflict angles using a driving simulator. The designs were 1) cut-through, 2) modified restricted squircle, 3) unrestricted squircle, 4) raised approach, and 5) raised intersection. For the higher speed green light condition, speed reductions for vehicles travelling straight through the intersection were seen for all five innovative designs on approach to the intersection and at critical conflict points within the intersection. Within the intersection specifically, speed reductions ranged from 1) 7-8 km/h for the modified restricted squircle, 2) 12.5-16.5 km/h for the unrestricted squircle, raised approach, and raised intersection, and 3) 15-19 km/h for the cut-through. In contrast, speeds for drivers turning right were either not substantially reduced (modified restricted squircle, unrestricted squircle, and raised intersection) or were increased (raised approach and cut-through). Beneficial modification of conflict angles were also observed at conflict points for three of the five designs: cut-through, and two variations of the squircle design. Innovative intersection designs may be effective in reducing intersection crash risk by reducing speeds and conflict angles.

Chronic alcohol feeding and its influence on c-Fos and heat shock protein-70 gene expression in different brain regions of male and female rats.

Excessive ingestion of the macronutrient, alcohol, causes devastating complications in the brain leading to atrophy and impaired cognitive function with corresponding increases in morbidity and mortality and, consequently, reduced quality of life measures. The pathogenic mechanisms are unknown, but various studies have shown that the immediate early genes and heat shock (ie, stress or chaperone) proteins are increased in alcohol-exposed tissue. However, many of these studies have been performed in vitro or have failed to consider either the nutritional elements in the experimental design by appropriate use of pair-feeding or whether there are regional and/or gender differences. We hypothesized that (1) increased expression of heat shock proteins and/or oncogenes occur as a consequence of alcohol-feeding in vivo, and sensitivities are related to different (2) gender and (3) brain regions. To test this, we fed male and female rats nutritionally complete diets containing ethanol as 35% of total calories (treated) or isocaloric amounts of the same diet in which ethanol was replaced by isocaloric glucose (controls). At the end of 6 weeks, rats were killed and c-Fos and heat shock protein-70 (HSP70) mRNA analyzed in midbrain, cortex, brainstem, and cerebellum by reverse transcription-polymerase chain reaction (RT-PCR) with an endogenous internal standard, beta-actin. The results showed that there were distinct regional differences (P at least <.05) in both c-Fos (cerebellum > cortex > midbrain and brainstem) and HSP70 (brainstem and cerebellum > cortex and midbrain). However, the only significant effect of alcohol feeding occurred in the HSP70 mRNA in midbrain of male rats, which was reduced by approximately 50% (P <.01). In contrast, no corresponding effect of alcohol feeding was observed in c-Fos mRNA levels in either midbrain or other regions of female rats. These data show that chronic ethanol feeding has no demonstrable effect on c-Fos mRNA expression in the brain when using nutritionally complete liquid diet regimens with concomitant pair-feeding. HSP70 mRNA, in contrast, is reduced by alcohol feeding and appears to be regional and gender dependent.

Central noradrenergic blockade prevents autotomy in rat: implication for pharmacological prevention of postdenervation pain syndrome.

Following transection of peripheral nerve, rats exhibit autotomy, which is considered to be the animal model of postdenervation pain syndrome. It has been suggested that phantom limb pain is a result of peripheral denervation leading to reorganization of somatosensory pathways, particularly in the cerebral cortex, which is shown to depend upon central noradrenergic activity. In this study, sciatic and saphenous nerves were sectioned in the left hindpaw of 30 adult rats resulting in complete loss of pain sensation in the hindpaw. A group of rats received normal saline, compared to another group which received N-(2-) Chloroethyl-N-ethyl-2-bromobenzylamine (DSP4) injection 24 h prior to transection. The latter group was also compared to a third group whose central noradrenergic system were also blocked by bilateral injection of 6-OHDA into the ascending noradrenergic bundle 1 week prior to transection. A fourth group received contralateral cortical ablation in addition to peripheral nerve transection and was compared to the first group whose cortex remained intact. The animals were observed daily for 60 days and autotomy was scored in accordance to the system of Wall et al. After 1 week, control animals began to exhibit autotomy. In contrast, autotomy was absent in rats treated with DSP4, similar to rats which received 6-OHDA. Rats which had contralateral cortical ablation showed a considerably delayed onset of autotomy and a reduction in final autotomy scores. We conclude that autotomy, as a model of postdenervation pain syndrome, can be prevented by blockade of noradrenergically mediated cortical reorganization. The clinical implications of this finding are discussed.

Risk factors for homelessness: evidence from a population-based study.

OBJECTIVE: This study examined factors associated with lifetime experience of homelessness among young adults. METHODS: Data were analyzed for 14,888 young adults (mean+/-SD age 21.97+/-1.77; 7,037 men and 7,851 women) who participated in the National Longitudinal Study of Adolescent Health (Add Health), a U.S. nationally representative, population-based sample. Data were collected from young adults through computer-assisted interviews six years after they had enrolled in the study as adolescents. Variables that have been associated with lifetime homelessness in at least one service sample were mapped to Add Health survey items. Data were analyzed by logistic regression. RESULTS: A total of 682 respondents (4.6%) were classified as ever being homeless. Several factors related to childhood experiences of poor family functioning, socioeconomic disadvantage, and separation from parents or caregivers were independently associated with ever being homeless. Other significant independent factors included current socioeconomic difficulty, mental health problems, and addiction problems. Indicators of involvement in crime and addiction problems with gambling and alcohol were not independently associated with homelessness. CONCLUSIONS: The findings underscore the relationship between specific indicators of adversity in childhood and risk of homelessness and point to the importance of early intervention efforts. Consistent with the extant research literature, mental health problems also appear to be associated with homelessness, highlighting the potentially complex service needs of this population.

A longitudinal population-based study of factors in adolescence predicting homelessness in young adulthood.

PURPOSE: Almost everything known about risk factors for homelessness is based on cross-sectional studies of non-random samples. Furthermore, most studies have focused on a small number of risk factors and have not evaluated their relative importance. Our aim was to examine which factors, in a population-based sample of adolescents, independently predict homelessness in young adults. METHODS: Participants (n = 10,433) in the US National Longitudinal Study of Adolescent Health (Add Health) were initially selected through systematic random sampling of US high schools. Interviews were conducted at home in 1994-1995 when the participants were 11-18 years of age and again in 2001 when participants were 18-28 years of age. We examined the relationships between a range of risk factors reported in adolescence (mood-related problems, substance involvement, delinquency, personality, quality of family relations, neighborhood quality, school adjustment, religious affiliation, perpetration of violence, and experiences of victimization) and experiences of homelessness reported in young adulthood, using regression analysis. RESULTS: Each risk factor predicted homelessness. However, only family relationship quality (odds ratio [OR] = .79, 95% confidence interval [CI] = .69-.90), school adjustment problems (OR = 1.57, 95% CI = 1.35-1.82), and experiences of victimization (OR = 1.27, 95% CI = 1.11-1.45) were found to independently predict homelessness. CONCLUSIONS: Among a range of well-established risk factors, a troubled family background, school adjustment problems and experiences of victimization were found to be the strongest predictors of homelessness in a general population of young people. Our findings suggest possibilities for the early identification of young persons at risk for homelessness through schools, agencies offering family-based support, and clinical services.

Factor structure and use of the hospital anxiety and depression scale in the homeless and socially marginalized.

The homeless have been identified as a group at risk of significant anxiety and depression and screening is therefore highly desirable to identify those needing psychological and psychiatric support. However, the psychometric properties of routine screening instruments have yet to be established in this group. This study sought to determine the psychometric properties of the widely used Hospital Anxiety and Depression Scale in this group. Using a cross-sectional design, 314 clients presenting at homelessness units (shelters) supported by The Salvation Army were administered the HADS. Confirmatory factor analysis revealed three-factor models offered the best fit to the data (best-fit model CFI = .98, RMSEA = .06, WRMR = .87). This investigation confirms contemporary research findings that the HADS comprises an underlying tri-dimensional factor structure. However, the internal consistency of the HADS anxiety (alpha = .81) and depression (alpha = .90) sub-scales was excellent. The findings of the current study suggest that the HADS is a suitable screening tool in this group.