Jornalismo, população em situação de rua e eventos internacionais: uma análise de reportagens do jornal O Globo em 2017 / Journalism, homeless population and international events: an analysis of reportages in O Globo newspaper in 2017 / Periodismo, población en situación de calle y eventos internacionales: un análisis de reportajes del periódico O Globo en 2017

Este artigo tem o propósito de analisar as representações das pessoas em situação de rua e da violência em quatro reportagens expressivas do jornal O Globo, a fim de identificar se elas são retratadas como responsáveis pela violência urbana ou como vítimas de grupos violentos. Serão examinadas reportagens publicadas em 2017, um ano após a cidade ter passado por transformações significativas para os Jogos Olímpicos e Paralímpicos, incluindo investimentos em segurança pública por parte dos governos federal e estadual, alterações no espaço urbano e remoção forçada de pessoas em situação de rua das áreas turísticas. Para atingir o objetivo proposto, será utilizada como metodologia a análise de narrativas conforme Bastos e Biar e Spink. Em resumo, o jornal oscilou entre a demonização dessas pessoas, reforçando preconceitos associados a elas, e a abertura, ainda que em menor medida, para a divulgação das violências enfrentadas por esse segmento da população

This article aims to analyze the representations of people experiencing homelessness and of violence in four significant reportages in O Globo newspaper in order to determine whether they are portrayed as responsible for urban violence or as victims of violent groups. The selected reportages which will be examined were published in 2017, a year after the implementation of significant transformations in the city for the Olympic and Paralympic Games, including investments in public security by the federal and state governments, changes in urban space, and removal of homeless population by force from tourist areas. To achieve the proposed objective, the narrative analysis according to the approaches of Bastos and Biar and Spink will be employed as methodology. In short, the newspaper oscillated between demonising these individuals, reinforcing prejudices associated with them, and opening up, albeit to a lesser extent, to publicise the violence faced by this segment of the population

Este artículo tiene como objetivo analizar las representaciones de las personas en situación de calle y de la violencia en cuatro reportajes significativos del periódico O Globo para determinar si él las retrata como responsables de la violencia urbana o como víctimas de grupos violentos. Serán examinados reportajes publicados en 2017, un año después de que la ciudad había pasado por transformaciones significativas debido a los Juegos Olímpicos y Paralímpicos, que incluyeron inversiones en seguridad pública por parte de los gobiernos federal y estatal, cambios en el espacio urbano y la remoción forzada de personas en situación de calle de las zonas turísticas. Para lograr el objetivo propuesto, se empleará el análisis narrativo como metodología de acuerdo con los enfoques de Bastos y Biar y Spink. En resumen, el periódico osciló entre la demonización de estas personas, reforzando los prejuicios asociados a ellas, y la apertura, aunque en menor medida, a la divulgación de las violencias enfrentadas por este segmento de la población

To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India.

BACKGROUND: In India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors. METHODS: This study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them. RESULTS: Out of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females. CONCLUSION: The occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.7 Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.

Diagnósticos e intervenções de enfermagem frente aos riscos cardiovasculares originados pelo estresse na população em situação de rua / Diagnoses and nursing interventions against cardiovascular risks caused by stress in the homeless population

ntrodução: O estresse está relacionado às doenças cardiovasculares, que são responsáveis por 27% das mortes no Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao estresse persistente e potencialmente fatal. Objetivo: Estabelecer diagnósticos e intervenções de enfermagem, relacionando estresse e DCV nesta população. Métodos e procedimento: Este é um estudo exploratório, transversal e quantitativo, realizado na área central de São Paulo com 119 voluntários selecionados por conveniência entre novembro de 2021 e julho de 2022, aprovado pelo CEP: 036417, CAAE:21519413.40000.5511. Resultado: 35% dos 119 entrevistados afirmam sentir muito estresse ou que isso afeta sua rotina. Valores de pressão arterial e frequência cardíaca estão acima do recomendado. A escala de Likert mostra 32% com proteção ineficaz, risco cardiovascular prejudicado e síndrome do estresse de realocação. Conclusão: Estratégias de saúde são cruciais para atender às necessidades humanas básicas da população em situação de rua, incluindo conscientização sobre riscos cardiovasculares e acesso a cuidados básicos de saúde. A implementação do processo de enfermagem pode ajudar a abordar essas necessidades. (AU)

Stress is related to cardiovascular diseases, which are responsible for 27% of deaths in Brazil. The homeless population is exposed to risk factors, requiring health evaluation and monitoring due to living conditions that lead to persistent and potentially fatal stress. Objective: To establish nursing diagnoses and interventions, relating stress and CVD in this population. Methods and procedure: This is an exploratory, cross-sectional, and quantitative study conducted in downtown São Paulo with 119 volunteers selected by convenience between November 2021 and July 2022, approved by CEP: 036417, CAAE:21519413.40000.5511. Result: 35% of 119 respondents report feeling high stress or that it affects their routine. Blood pressure and heart rate values are above recommended levels. The Likert scale shows 32% with ineffective protection, impaired cardiovascular risk, and relocation stress syndrome. Conclusion: Health strategies are crucial to meet the basic human needs of the homeless population, including awareness of cardiovascular risks and access to basic health care. The implementation of the nursing process can help address these needs.(AU)

El estrés está relacionado con las enfermedades cardiovasculares, que son responsables del 27% de las muertes en Brasil. A população em situação de rua encontra-se exposta a fatores de risco necessitando avaliação e acompanhamento de saúde devido às condições de vida que levam ao stress persistente e potencialmente fatal. Objetivo: Establecer diagnósticos e intervenciones de enfermagem, relacionando estresse e DCV nesta população. Método y procedimiento: Se trata de un estudio exploratorio, transversal y cuantitativo, realizado en el área central de São Paulo con 119 voluntarios seleccionados por conveniencia entre noviembre de 2021 y julio de 2022, aprobado por CEP: 036417, CAAE:21519413.40000.5511. Resultados: 35% de los 119 encuestados afirman sentir mucho estrés o que éste afecta su rutina. Los valores de presión arterial y frecuencia cardíaca están por encima de lo recomendado. Escala de Likert muestra 32% con protección ineficaz, riesgo cardiovascular alterado y síndrome de estrés de reubicación. Conclusión: Las estrategias de salud son cruciales para satisfacer las necesidades humanas básicas de las personas sin hogar, incluyendo la concienciación sobre los riesgos cardiovasculares y el acceso a la atención sanitaria básica. La aplicación del proceso de enfermería puede ayudar a abordar estas necesidades.(AU)

A potência dos encontros entre as fissuras da rua: cuidado, afetos e redução de danos / The power of encounters among the pavement cracks: care, affect and harm reduction / La potencia de los encuentros entre las fisuras de la calle: cuidado, afectos y reducción de daños

Resumo Este artigo apresenta as cartografias produzidas com a população de rua em Florianópolis, Brasil, e tem como objetivo dar visibilidade às estratégias de redução de danos (RD) como produção de cuidado nas ruas. As primeiras cenas partem dos debates em uma oficina de RD com a população de rua, quando se teve contato com a proposta da RD. Em seguida, as cenas cartografadas apresentam o encontro com Cigana e Alemão(c), um casal que se conheceu em cenas de uso de crack, e, a partir desse encontro, foram agenciados por afetos que os movimentaram a deixar o uso daquela substância. Essas cartografias demonstraram que a população de rua inventa outros jeitos de se encontrar, criando linhas de fuga como forma de reafirmar sua existência e utilizando estratégias de RD como produção de cuidado. (AU)

Abstract This article presents maps created with the homeless population in Florianópolis, Brazil and aims to create greater visibility for harm reduction (HR) strategies as a form of care provision on the streets. The first scenes draw on discussions during a HR workshop with homeless people, when they had their first contact with the strategy. The mapped scenes are the result of an encounter with Cigana and Alemão, a couple who met each other in the midst of scenes of crack use and, thereafter, through the agency of affect, were motivated to stop using the substance. The maps demonstrate that homeless people invent other ways to find themselves, creating lines of flight as a way of reaffirming their existence and using HR strategies as a form of care provision. (AU)

Resumen Este artículo presenta las cartografías producidas con la población sin hogar a en Florianópolis, Brasil, y su objetivo es dar visibilidad a las estrategias de reducción de daños (RD) como producción de cuidado en las calles. Las primeras escenas parten de los debates de un taller de RD con la población sin hogar, cuando se tuvo contacto con la propuesta de RD. Enseguida, las escenas cartografiadas presentan el encuentro con Gitana y Alemán, una pareja que se conoció en escenas de uso de crack y, a partir de ese encuentro, fueron agenciados por afectos que los llevaron a dejar el uso de esa substancia. Esas cartografías demostraron que la población sin hogar inventa otras formas de encontrarse, creando líneas de fuga como forma de reafirmar su existencia y utilizando estrategias de RD como producción de cuidado. (AU)

The demography and disease burden of the homeless shelter population of Tshwane during COVID-19.

BACKGROUND:  Homeless people are a vulnerable population susceptible to physical and mental health care problems. There are, however, limited studies and information regarding the health of the homeless population. AIM:  To describe and understand the burden of disease among the homeless population in Tshwane District, Gauteng, South Africa. SETTING:  Data were collected from 15 different homeless shelters created during the South African 2020 coronavirus disease 2019 (COVID-19) lockdown in the Tshwane District, from April to July 2020. METHODS:  A cross-sectional survey was conducted among the homeless people in the shelters to provide information of self-reported conditions that the homeless populations at the shelters had during the lockdown period. The participants were also screened for medical conditions like, human immunodeficiency virus (HIV), hypertension (HPT) and diabetes mellites (DM). RESULTS:  Results showed a total of 2066 homeless population out of which 1391 took part in the survey. Most of the participants consisted of African males 93.83%, with substance use prevalence in 52.77%. The study showed that the population was very reluctant to share information and had less chronic conditions than originally thought. CONCLUSION:  Efforts should be made to improve education and research around the homeless population, by government and non-government facilities by building relationships with homeless shelters in their areas.Contribution: This study provides awareness of the homeless population's health and challenges, with the intention to attempt a better understanding of the population that may present themselves to primary healthcare (PHC) facilities and encourage future investigation into how to improve care.

Mulheres em situação de pobreza nos contextos do Programa Bolsa Família e da vida nas ruas / Women in poverty in the contexts of the Programa Bolsa Família and life on the streets / Mujeres en pobreza en los contextos del Programa Bolsa Família y la vida en la calle

Este artigo visa a compreender como as categorias gênero e pobreza se apresentam no cotidiano das mulheres beneficiárias do Programa Bolsa Família e das mulheres em situação de Rua. Considera que as opressões de gênero se apresentam de formas distintas conforme as experiências e lugares que ocupam na sociedade, assim demandam um olhar interseccional, que apreenda os marcadores identitários e modos de vida destas mulheres. Utiliza em suas análises o conceito de patriarcado como um sistema de opressões que atinge as mulheres e destaca a vivência de pobreza a partir de uma perspectiva multidimensional, que engloba várias dimensões além da renda. Evidenciaram-se processos opressivos que passam pela estigmatização e culpabilização das mulheres, assim como construção de resistências que atravessam seu cotidiano. Aponta-se a necessidade de políticas públicas que reconheçam as necessidades e singularidades das mulheres.

This article aims to understand how the categories gender and poverty are present in the daily lives of women benefiting from the Programa Bolsa Família and women living on the streets. It considers that gender oppression presents itself in different ways according to the experiences and places women occupy in society, thus demanding an intersectional look, which apprehends these women's identity markers and ways of life. It uses in its analyses the concept of patriarchy as a system of oppression that affects women and highlights the experience of poverty from a multidimensional perspective, which encompasses several dimensions beyond income. Oppressive processes were evidenced, which go through the stigmatization and blame of women, as well as the construction of resistance that crosses their daily lives. The need for public policies that recognize the needs and singularities of women is pointed out.

Este artículo tiene por objeto comprender cómo se presentan las categorías de género y pobreza están presentes en el cotidiano de las mujeres beneficiarias del Programa Bolsa Família y de las mujeres en situación de calle. Considera que la opresión de género se presenta de diferentes formas según las experiencias y los lugares que ocupan en la sociedad, exigiendo una mirada interseccional, que aprehenda los marcadores identitarios y modos de vida de estas mujeres. En sus análisis, utiliza el concepto de patriarcado como un sistema de opresión que afecta a las mujeres, y destaca la experiencia de la pobreza desde una perspectiva multidimensional, que abarca varias dimensiones más allá del ingreso. Se evidenciaron procesos de opresión que pasan por la estigmatización y la culpabilización de las mujeres, así como la construcción de resistencias que atraviesan su cotidiano. Se señala la necesidad de políticas públicas que reconozcan las necesidades y singularidades de las mujeres.

As ruas e provocações à transcendência: espiritualidade na produção imanente de comuns / The streets and provocations to transcendence: spirituality in the immanent production of commons / Las calles y las provocaciones a la transcendência: espiritulidad en la produción inmanente de comunes

Trata-se de uma pesquisa-intervenção desenvolvida entre o final de 2013 e 2016, referente à caracterização das condições de vida, das histórias de vida e das violações de direitos contra a população em situação de rua. Foram realizadas 159 entrevistas semiestruturadas e narrativas de histórias de vida, com registro em diários de campos e análise de documentos políticos institucionais. Esse trabalho focalizou a temática da espiritualidade, religiosidade e religião nesses contextos. Nas narrativas se utilizou a própria linguagem do campo de pesquisa, conforme as influências etnográficas. Essa produção textual se limitou a conectar os fenômenos ditos transcendentes com aspectos imanentes das vidas dessas pessoas. Valeu-se, também, do conceito de espiritualidade nesse ancoramento, procurando produzir um discurso que facilitasse o encontro dos contextos das ruas dos sujeitos com diferentes aproximações: religiosas ou não religiosas, espirituais ou não espirituais, colaborando na produção de comuns nas diferenças.

This is an intervention research developed between the end of 2013 and 2016, referring to the characterization of living conditions, life stories and human rights violations against the homeless population. During this investigation, 159 semi-structured interviews and life story narratives were carried out, with records in field diaries and analysis of institucional policy documents. This work focuses on the theme of spirituality, religiosity and religion in these contexts. In the narratives, the language of the research field was used, according to ethnographic influences. This textual production was limited to connecting the so-called transcendent phenomena with the immanent aspects of these people's lives. The concept of spirituality was also used in this anchoring, seeking to produce a discourse that facilitated the encounter of the subjects's contexts through different approaches: religious or non-religious, spiritual or non-spiritual, collaborating in the production of commonalities in differences.

Esta investigación-intervención desarrollada entre finales de 2013 y 2016, se refiere a la caracterización de las condiciones de vida, histórias de vida y violaciones de derechos de la población sin hogar. Se llevaron 159 entrevistas semiestructuradas y narrativas de vida, con registros en diarios de campo y análise de documentos políticos institucionales. Este trabajo se centró en el tema de la espiritualidad, la religiosidad y la religión en estos contextos. En las narrativas se utilizó el linguaje própria del campo de investigación, conforme las influencias etnográficas. Esta produción textual se limitó a conectar los llamados fenómenos trascendentes con aspectos inmanentes de las vidas de estas personas. También utilizó el concepto de espiritualidad en este anclaje, buscando producir un discurso que facilitara el encuentro de los contextos de las calles con diferentes enfoques: religiosos o no religiosos, espirituales o no espirituales, colaborando en la producción de comunes en las diferencias.

Resistências na vida comezinha: sentidos do #elenao e #elenunca / Resistances in everyday life: senses of #elenao and #elenunca / Resistencias en la vida cotidiana: sentidos del #elenao y del #elenunca

Trata-se de uma pesquisa-intervenção desenvolvida entre o final de 2013 e 2016, referente à caracterização das condições de vida, das histórias de vida e das violações de direitos contra a população em situação de rua. Foram realizadas 159 entrevistas semiestruturadas e narrativas de histórias de vida, com registro em diários de campos e análise de documentos políticos institucionais. Esse trabalho focalizou a temática da espiritualidade, religiosidade e religião nesses contextos. Nas narrativas se utilizou a própria linguagem do campo de pesquisa, conforme as influências etnográficas. Essa produção textual se limitou a conectar os fenômenos ditos transcendentes com aspectos imanentes das vidas dessas pessoas. Valeu-se, também, do conceito de espiritualidade nesse ancoramento, procurando produzir um discurso que facilitasse o encontro dos contextos das ruas dos sujeitos com diferentes aproximações: religiosas ou não religiosas, espirituais ou não espirituais, colaborando na produção de comuns nas diferenças.

The aim of this work is to investigate the movement of the hashtags #elenão (#nothim) and #elenunca (#neverhim), which circulated in cyberspace through a cybermilitancy of women in the Brazilian 2018 presidential elections and which were replicated in urban space. In view of this, affiliated with French-based Discourse Analysis, founded by Michel Pêcheux, the authors intend to identify the effects of senses of resistance in this relationship between digital and urban, that is, a movement that inscribes network and street in a relationship of continuity. Our corpus of analysis, therefore, was composed of materials collected on digital social networks, in order to undertake a reading gesture that makes it possible to verify the meanings of resistance that such hashtags produce in ordinary life, in other words, they affect and materialize in the ordinary, simple and homely life.

Esta investigación-intervención desarrollada entre finales de 2013 y 2016, se refiere a la caracterización de las condiciones de vida, histórias de vida y violaciones de derechos de la población sin hogar. Se llevaron 159 entrevistas semiestructuradas y narrativas de vida, con registros en diarios de campo y análise de documentos políticos institucionales. Este trabajo se centró en el tema de la espiritualidad, la religiosidad y la religión en estos contextos. En las narrativas se utilizó el linguaje própria del campo de investigación, conforme las influencias etnográficas. Esta produción textual se limitó a conectar los llamados fenómenos trascendentes con aspectos inmanentes de las vidas de estas personas. También utilizó el concepto de espiritualidad en este anclaje, buscando producir un discurso que facilitara el encuentro de los contextos de las calles con diferentes enfoques: religiosos o no religiosos, espirituales o no espirituales, colaborando en la producción de comunes en las diferencias.

Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study.

(1) Background: homeless people are characterized by serious social vulnerability and difficulty in accessing health services worldwide. In Brazil, this population is supported by the Street Clinic teams who are challenged to establish intersectoral networks to expand access and promote unique and humanized care from the perspective of harm reduction. The study aimed to analyze the practices of professionals working at the Street Clinic in a city in the interior of São Paulo, Brazil, to tackle the vulnerabilities of the homeless population and expand access to the health care network. (2) Methods: a qualitative study was conducted with a social approach in which we interviewed eight workers from the Street Clinic. Data were analyzed using the thematic content analysis tool. (3) Results: three nuclei of meaning were built: stigma and prejudice as the main barriers to accessing services, harm reduction as a humanized care practice and valuing autonomy, and Street Clinic as a gateway to the health system and main interlocutor with other services. (4) Conclusions: the articulation with network services is marked by contradictory relationships, of conflict and trust, signaling the need for greater investment in educational qualifications and working conditions for professionals at all levels of care to expand access to health care.

COVID-19 and the Well-Being of the Homeless Population.

A previous editorial by the Editor-in-Chief discusses public health and steps towards recovery from the COVID-19 disaster. In addition to the current public health disasters, and multiple disasters such as earthquakes, typhoons and hurricanes, worldwide recession, and global morbidity and mortality, the authors would like to highlight the need for responses to deal with the well-being of the homeless population due to their condition and vulnerability in the society. People who are experiencing homelessness are considered vulnerable and "preferential options for the homeless" must be considered.

População em situação de rua e Rede de Atenção Psicossocial: na corda bamba do cuidado / The homeless population and a psychosocial care network: walking on the tightrope of care

Resumo A interface rua e saúde mental adensa vulnerabilidades, o que dificulta a garantia do direito à saúde. Obetivou-se analisar como se dá a atenção à saúde da População em Situação de Rua no âmbito da Rede de Atenção Psicossocial em Natal-RN. Pesquisa de campo, qualitativa descritivo-exploratória. Realizou-se grupo focal com 10 profissionais dessa rede e entrevista semiestruturada com 13 pessoas em situação de rua. Os resultados foram submetidos à análise de conteúdo temática, sistematizados em duas categorias: 1) A vida nua da População em Situação de Rua; 2) Os nós da rede e os fluxos de vida da População em Situação de Rua. Tem-se uma invisibilização da população em situação de rua ou uma associação a estigmas e rótulos. Delineia-se o espaço da rua de exceção, vida nua. Nessa condição, essas pessoas enfrentam inúmeras barreiras no acesso à rede no cenário estudado. Destacam-se inúmeros desafios da rede frente às dissonâncias de uma política que ao mesmo tempo que cuida, segrega, isola, tutela, cerca. Identificaram-se entraves que caminham na contramão da Reforma Psiquiátrica brasileira e potencialidades que favorecem sua efetivação resistindo na "corda bamba".

Abstract The interface connecting street and mental health increases vulnerabilities, hardening the guarantee of the right to health. The objective was to analyze how the health care of the Homeless Population is provided within the scope of the Psychosocial Care Network in Natal/RN. It is qualitative descriptive-exploratory field research. A focus group with 10 professionals from this network was created, and a semi-structured interview with 13 homeless people. The results were submitted to thematic content analysis, systematized into two categories: 1) The bare life of the Homeless Population; 2) The hindrances of the care network and the life flows of the Homeless Population. There is an invisibility of this population or an association with stigmas and labels. A street that segregates and a bare life are outlined. In this condition, these people face numerous impediments in accessing the health network in this scenario. There are numerous challenges faced by this network against the dissonances of a policy that, at the same time, cares for, segregates, isolates, protects, and surrounds. Obstacles going against the Brazilian Psychiatric Reform and potentialities that favor its realization were identified, while it finds a way "on the tightrope".

The role played by family physicians in providing health services for the sheltered homeless populations during COVID-19 lockdown in the Tshwane district.

This short report describes the role that family physicians (FPs) (and family medicine registrars) played to provide care for the homeless people in shelters (both temporary and permanent) during the coronavirus disease 2019 (COVID-19) lockdown in the City of Tshwane, South Africa. The lockdown resulted in the establishment of a large number of temporary shelters. The FPs took on the task to provide comprehensive and coordinated primary care, whilst extending their activities in terms of data management, quality improvement, capacity building and research. The FPs worked in teams with other healthcare providers and contributed a unique set of skills to the process. This report demonstrates the value of responding quickly and appropriately through communication, cooperation and innovation. It also demonstrates the large number of areas in which FPs can make a difference when engaged appropriately, with the necessary support and collaboration, thus making a positive impact in the already overburdened health services.

Comparison of COVID-19 mitigation and decompression strategies among homeless shelters: a prospective cohort study.

PURPOSE: To compare the effectiveness of COVID-19 mitigation strategies in two homeless shelters in Massachusetts during the pandemic. METHODS: We conducted a prospective cohort study that followed guests in two Massachusetts homeless shelters between March 30 and May 13, 2020, which adopted different depopulation strategies. One set up temporary tents in its parking lot, while the other decompressed its guests to a gym and a hotel. The outcome was assessed by comparing the odds ratios of positive SARS-CoV-2 RT-PCR assays. RESULTS: Guests residing at the shelter that used temporary tents had 6.21 times (95% CI = 1.86, 20.77) higher odds of testing positive for SARS-CoV-2 at follow-up after adjusting for loss to follow up, age, gender, and race. The daily COVID-19 symptoms checklist performed poorly in detecting positive infection. CONCLUSIONS: The study highlights the importance of depopulating shelter guests with stable and adequate indoor space to prevent SARS-CoV-2 transmission. Daily temperature and symptom checks should be combined with routine testing. With the rising homelessness due to mass unemployment and eviction crisis, our study supports further governmental assistance in decompressing homeless shelters during this pandemic.

Perfil da tuberculose em populações vulneráveis: pessoas privadas de liberdade e em situação de rua / Tuberculosis profile in vulnerable people: people deprived of liberty and homeless population

Objetivo: descrever o perfil sociodemográfico e epidemiológico das pessoas privadas de liberdade e da população em situação de rua com tuberculose em Belo Horizonte. Metodologia: estudo ecológico descritivo. A fonte de dados foi o Sistema de Informação de Agravos de Notificação do município de Belo Horizonte-MG, de 2015 a 2017. Resultados: observou-se 43 casos de tuberculose em pessoas privadas de liberdade e 188 na população em situação de rua, sendo a maioria do sexo masculino, raça preta ou parda e com idade média de 38 e 40 anos, respectivamente. Nos dois públicos a escolaridade foi inferior a 12 anos e a maioria não era beneficiária de auxílio financeiro. Como comorbidades destaca-se a coinfecção HIV/TB, o alcoolismo e o tabagismo. A ocorrência de tuberculose multidrogarresistente foi de 5% entre os privados de liberdade. Destaca-se a baixa realização do teste rápido molecular. O tratamento diretamente observado foi pouco implementado nos dois grupos e o abandono foi a principal situação de encerramento na população de rua. Conclusões: o perfil sociodemográfico identificado apresenta características de grupos em situação de vulnerabilidade, com menos acesso a diagnóstico e tratamento de qualidade e desfechos mais desfavoráveis na tuberculose. Espera-se mais atuação das autoridades sobre os determinantes sociais de vulnerabilidade, visando sucesso na cura e controle da tuberculose.

Objective: to describe the sociodemographic and epidemiological profile of people deprived of their liberty and the homeless population with tuberculosis in Belo Horizonte. Methodology: descriptive ecological study. The data source was the Information System for Notifiable Diseases in the city of Belo Horizonte-MG, from 2015 to 2017. Results: 43 cases of tuberculosis in people deprived of their liberty and 188 in the homeless population, being the majority male, black or brown and with an average age of 38 and 40 years, respectively. In both publics, schooling was less than 12 years and most were not beneficiaries of financial aid. As comorbidities, HIV/ TB co-infection, alcoholism and smoking stand out. The occurrence of multidrug-resistant tuberculosis was 5% among those deprived of their liberty. The low performance of the rapid molecular test stands out. The directly observed treatment was poorly implemented in both groups and abandonment was the main situation of closure in the homeless population. Conclusion: the sociodemographic profile identified presents characteristics of groups in situations of vulnerability, with less access to quality diagnosis and treatment and more unfavorable outcomes in tuberculosis. It is expected more work of authorities on the social determinants of vulnerability, aiming at success in healing and control of tuberculosis.

População em situação de rua: representações sociais sobre o comer e a comida / Homeless: social representations of eating and food / Personas sin hogar: representaciones sociales sobre el comer yla comida

Este artigo, parte de uma pesquisa de dissertação, pretende compreender as Representações Sociais sobre o comer e a comida para a População em Situação de Rua de um município do interior paulista. Participaram da pesquisa dezesseis sujeitos adultos em situação de rua. Para coleta de dados utilizou-se entrevista semiestruturada. A análise dos dados foi realizada por meio da análise de conteúdo e discutida à luz da teoria das representações sociais. O objeto social deste estudo - a comida - representa a sobrevivência na condição atual de vida e preserva a sua história nas recordações afetivas no passado. Os achados retratam o sofrimento de já ter tido que recorrer ao lixo para saciar a fome e revelam que apesar do avanço na criação de políticas públicas para este grupo ainda não é suficiente para contemplar seus direitos no que tange à alimentação (AU)

Perceptions of nonopioid treatment for pain in a homeless population.

CONTEXT: Opioid abuse has developed into a public health emergency within the last decade because opioid medications, while addictive, are effective and commonly used for pain management. In 2016, over 42,000 deaths were attributed to opioids. Chronic pain affects about 50% of people experiencing homelessness in the US, and they have a higher overall rate of chronic pain than the general population; opioids are among the methods they might use to manage that pain. Complementary and alternative therapies for pain management have largely gone unexplored in the homeless population. OBJECTIVES: To determine, among people experiencing homelessness, the willingness to use and current use of complementary and alternative treatments (physical and massage therapy, chiropractic treatments). A secondary objective was to investigate awareness and perception of osteopathic manipulative treatment (OMT) as a complementary treatment for chronic pain among the homeless population. METHODS: A 32 question survey was administered verbally to guests of True Worth Place Homeless Shelter in Fort Worth, Texas in three 4 hour sessions from February 2019 to April 2019. If participants gave verbal consent, a researcher read the questionnaire, one question at a time, and recorded the participant's responses. The survey included queries for opioid and nonopioid treatment modalities (physical and massage therapy, chiropractic, and OMT) to assess the perception of and current use of each among the population. Appropriate nonparametric statistical analysis was conducted to assess significance and correlations among the treatment groups. RESULTS: Of the 200 survey participants, 126 (91.3%) reported a history of opiate use for pain, but 136 (68.0%) believed that a nondrug pain intervention could better treat their pain. Additionally, 150 participants (75.0%) believed that regular manipulation, including OMT, would decrease their need for pain medications. Participants with a history of opioid use for pain were more likely to believe that the availability of regular manipulation, including OMT, at True Worth Place could decrease their need for pain medication (odds ratio=3.7143; 95% confidence interval=1.6122-8.5572; p=0.0009). Moreover, some participants (141; 70.5%) were already pursuing nondrug pain management modalities such as PT, massage therapy, and chiropractic care. The greatest barriers to receiving OMT were transportation and cost. CONCLUSIONS: This survey study was conducted to determine whether a homeless population would be willing to use nonopioid treatment, particularly OMT, for chronic pain management. Results revealed both a willingness to use and a previous use of nonopioid treatments for pain, along with a high prevalence of opiate use. Despite limited exposure to OMT, this population reported being potentially willing to pursue manipulation, including OMT, as a complementary treatment for pain relief alongside opioids if readily available.

Invited Commentary: Data Sources for Estimating Numbers of People Experiencing Homelessness in the United States-Strengths and Limitations.

In the accompanying article, Mosites et al. (Am J Epidemiol. 2021;190(11):2432-2436) evaluate data sources that enumerate people experiencing homelessness in the United States with respect to their strengths and limitations for conducting epidemiologic research in homeless populations. We largely agree with their key arguments, yet offer additional points that provide important context about these data for researchers and other stakeholders. Overall, we believe that it is possible to address many of the noted shortcomings of these data, and once addressed, the data could be more effectively leveraged to improve the health, housing stability, and quality of life of people experiencing homelessness.

Detection of Bartonella quintana Infection among the Homeless Population in Tokyo, Japan, from 2013-2015.

Several outbreaks of trench fever caused by Bartonella quintana occurred in soldiers during World Wars I and II. Although trench fever cases have been decreasing worldwide, the disease was reported among the homeless population in developing and developed countries. The current prevalence of B. quintana infection in Japan is unclear. Blood and body louse (Pediculus humanus humanus) samples were obtained from homeless inpatients with body lice during emergency hospitalization in Tokyo from January 2013 to March 2015. Patients were tested for B. quintana infections using the culture method, polymerase chain reaction, and indirect immunofluorescence assay (IFA). Among the 29 patients tested, the presence of Bartonella spp. was confirmed by genomic sequencing of DNA extracted from two samples from blood culture performed for 15 out of 29 patients and from body louse samples of 20 patients (69%). Immunoglobulin G against B. quintana was detected in 10 patients (34.5%) at a cut-off titer of 1:256 in IFA. B. quintana infection was detected in samples obtained between 2013 and 2015 in Tokyo and needs to be on the list of differential diagnoses performed for febrile homeless individuals.

The Effect of Homelessness on Patient Wait Times in the Emergency Department.

BACKGROUND: Prolonged emergency department (ED) wait times could potentially lead to increased morbidity and mortality. While previous work has demonstrated disparities in wait times associated with race, information about the relationship between experiencing homelessness and ED wait times is lacking. OBJECTIVES: The purpose of this study was to explore the relationship between residence status (undomiciled vs. domiciled) and ED wait times. We hypothesized that being undomiciled would be associated with longer wait times. METHODS: We obtained data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2017. We compared wait times in each triage category using t tests. We used multivariate linear regression to explore associations between residence status and wait times while controlling for other patient- and hospital-level variables. RESULTS: On average, undomiciled patients experienced significantly longer mean ED wait times than domiciled patients (53.4 vs. 38.9 min; p < 0.0001). In the multivariate model, undomiciled patients experienced significantly different wait times by 15.5 min (p = 0.0002). Undomiciled patients experienced increasingly longer waits vs. domiciled patients for the emergent and urgent triage categories (+33.5 min, p < 0.0001, and +22.7 min, p < 0.0001, respectively). CONCLUSIONS: Undomiciled patients experience longer ED wait times when compared with domiciled patients. This disparity is not explained by undomiciled patients seeking care in the ED for minor illness, because the disparity is more pronounced for urgent and emergent triage categories.

Asymptomatic patients as a source of transmission of COVID-19 in homeless shelters.

OBJECTIVES: Asymptomatic carriers account for over a third of all Coronavirus Disease 19 (COVID-19) cases and are characterized by the absence of symptoms but the same infectivity as symptomatic infections. The high percentage of asymptomatic COVID-19 patients is significant in settings with specific vulnerabilities, such as homeless shelters, where the consequences of an outbreak may be dramatic. In this work, we briefly report our experience on residents and staff of homeless shelters in the City of Rome, Italy, with a particular focus on asymptomatic transmission, and compare it with the available evidence. METHODS: We performed routine Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) nasopharyngeal swab tests in all residents and staff of homeless shelters managed by the Eleemosynaria Apostolica of the Vatican City State in the city of Rome, Italy, in addition to daily symptom screening, body temperature monitoring, and application of other prevention measures. RESULTS: We evaluated 298 persons and identified twelve positive cases (4%). Most of the positive cases (75%) were asymptomatic, while only three patients reported symptoms that included fever, diarrhea, and cough. CONCLUSIONS: Our data confirm the importance of early identification of asymptomatic carriers that could, in vulnerable conditions such as homeless shelters, spread the infection and cause outbreaks with severe consequences on individual and public health.