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1.
CJEM ; 23(1): 111-122, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33683611

RESUMO

BACKGROUND: The social determinants of health are economic and social conditions that contribute to health. Access to housing is a major social determinant of health and homeless patients often rely on emergency departments (EDs) for their healthcare. These patients are frequently discharged back to the street which further perpetuates the cycle of homelessness and negatively affects their health. Previous work has described the financial and systems implications of ED-housed interventions for homeless patients; this review summarizes ED-based interventions that seek to improve the social determinants of health of homeless patients. METHODS: We conducted a search of multiple databases and gray literature for studies investigating interventions for homelessness that were initiated in the ED. Studies had to use a control group or use a pre/post-intervention design and measure outcomes that demonstrate an effect on health or the social determinants of health. RESULTS: Thirteen studies were identified that met the inclusion criteria. Two studies were housing first interventions and were effective in providing housing and improving health. Seven studies used variations of case management and were able to address many of the social needs of people who are homeless. CONCLUSION: This review demonstrated that ED interventions can be effective in improving the social determinants of health of homeless individuals and can be the place to initiate housing interventions. ED providers must advocate for the resources necessary to properly address the social needs of this marginalized population. Equipped with the proper resources, EDs can be one place where the cycle of homelessness is broken.


RéSUMé: CONTEXTE: Les déterminants sociaux de la santé font référence aux conditions sociales et économiques qui ont une incidence sur l'état de santé. Ainsi, l'accès au logement représente un important et les patients sans abri comptent souvent sur les services des urgences (SU) pour obtenir des soins de santé. Qui plus est, après avoir obtenu leur congé de l'hôpital, ces patients retournent la plupart du temps à la rue, ce qui a pour effet d'entretenir le cercle vicieux de l'itinérance et d'avoir une influence défavorable sur leur santé. La portée financière des interventions amorcées au SU pour les patients sans abri et leurs retombées sur les systèmes de soins de santé ont déjà fait l'objet d'études. La revue systématique avait donc pour but de présenter un résumé des interventions visant à améliorer les des patients sans abri, mises en œuvre au SU. MéTHODE: La revue consistait en une recherche d'études dans de nombreuses bases de données et dans la documentation parallèle portant sur des interventions amorcées au SU pour les sans-abris. Les études sélectionnées devaient s'appuyer sur un groupe témoin ou sur une démarche de type avant-après ainsi que sur des mesures de résultats démontrant une influence des interventions sur l'état de santé ou sur les. RéSULTATS: Treize études satisfaisaient aux critères de sélection. Deux d'entre elles portaient sur des interventions accordant la priorité au logement et ces dernières se sont révélées efficaces dans l'accès au logement et dans l'amélioration de l'état de santé. Dans sept autres études, on avait appliqué diverses variantes de la prise en charge de cas, qui se sont montrées efficaces dans la satisfaction de nombreux besoins sociaux des sans-abris. INTERPRéTATION: Les résultats de cette revue systématique ont démontré que les interventions amorcées au SU peuvent améliorer efficacement les des sans-abris et que les SU peuvent certes être le lieu de mise en œuvre d'interventions accordant la priorité au logement. Aussi les fournisseurs de soins au SU doivent-ils réclamer les ressources nécessaires pour répondre adéquatement aux besoins sociaux de cette population marginalisée. Ainsi dotés des ressources appropriées, les SU peuvent devenir l'un des points de rupture du cercle vicieux de l'itinérance.


Assuntos
Pessoas Mal Alojadas , Serviço Hospitalar de Emergência , Habitação , Humanos , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente
2.
Am J Physiol Regul Integr Comp Physiol ; 314(5): R647-R654, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29351419

RESUMO

We determined the impact of moderate maternal nutrient restriction (MNR) in guinea pigs with fetal growth restriction (FGR) on offspring body and organ weights, hypothesizing that FGR-MNR animals will show catch-up growth but with organ-specific differences. Guinea pig sows were fed ad libitum (Control) or 70% of the control diet from 4 weeks preconception, switching to 90% at midpregnancy (MNR). Control newborns >95 g [appropriate for gestational age (AGA); n = 37] and MNR newborns <85 g (FGR; n = 37) were monitored until neonatal (~25 days) or adult (~110 days) necropsy. Birth weights and body/organ weights at necropsy were used to calculate absolute and fractional growth rates (FRs). FGR-MNR birth weights were decreased ~32% compared with the AGA-Controls. FGR-MNR neonatal whole body FRs were increased ~36% compared with Controls indicating catch-up growth, with values negatively correlated to birth weights indicating the degree of FGR leads to greater catch-up growth. However, the increase in organ FRs in the FGR-MNR neonates compared with Controls was variable, being similar for the brain and kidneys indicating comparable catch-up growth to that of the whole body and twofold increased for the liver but negligible for the heart indicating markedly increased and absent catch-up growth, respectively. While FGR-MNR body and organ weights were unchanged from the AGA-Controls by adulthood, whole body growth rates were increased. These findings confirm early catch-up growth in FGR-MNR guinea pigs but with organ-specific differences and enhanced growth rates by adulthood, which are likely to have implications for structural alterations and disease risk in later life.


Assuntos
Fenômenos Fisiológicos da Nutrição Animal , Peso ao Nascer , Restrição Calórica , Retardo do Crescimento Fetal/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Aumento de Peso , Fatores Etários , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Cobaias , Masculino , Estado Nutricional , Tamanho do Órgão , Gravidez , Fatores de Tempo
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