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1.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047996

RESUMO

Objetivo: identificar as atividades de vida diárias com dependência de cuidados de enfermagem. Método: estudo exploratório com abordagem qualitativa realizado com 52 pessoas em situação de rua na cidade de Sobral, Ceará, Brasil. Utilizou-se o modelo de atividade de vida diária proposto por Roper, Logan e Tierney para nortear a coleta e análise de dados. Resultados: as atividades de vida com maior dependência de cuidados são: alimentação, devido consumo irregular de nutrientes básicos, que promove um estado de desnutrição permanente, outra atividade foi trabalho e distração, pois os mesmos não possuem remuneração fixa e vivem do que arrecadam ao realizar atividades que geram pequenas quantias monetárias, além das atividades, morte, sexualidade, sono, respiração e eliminação, as quais também se revelaram comprometidas. Conclusão: a utilização do modelo com pessoas em situação de rua proporcionou abordagem holística aos indivíduos, por favorecer a investigação dos fatores que interferem na manutenção da saúde


Objetivo: identificar las actividades de la vida cotidiana con dependencia del cuidado de enfermeira. Método: estudio exploratorio con un enfoque cualitativo realizado con 52 personas en situación de calle en Sobral, Ceará, Brasil. El modelo de actividad de la vida diaria propuesto por Ropen, Logan y Tierney se utilizó para guiar la recolección y el análisis de datos. Resultados: las actividades de vida con mayor dependencia de cuidados son: alimentación, debido consumo irregular de nutrientes básicos, que promueve un estado de desnutrición permanente, otra actividad fue trabajo y distracción, pues los mismos no poseen remuneración fija y viven de lo que recaudan al realizar actividades que generan pequeñas cantidades monetarias, además de las actividades, muerte, sexualidad, sueño, respiración y eliminación, las cuales también se revelaron comprometidas. Conclusión: la utilización del modelo con personas en situación de calle proporcionó un enfoque holístico a los individuos, por favorecer la investigación de los factores que interfieren en el mantenimiento de la salud


Objective: identify daily Activities of Daily Living with dependence on nursing care. Method: exploratory study with a qualitative approach performed with 52 people in a street situation in Sobral, Ceará, Brazil. The daily Daily Living Activity model proposed by Ropen, Logan and Tierney was used to guide the data collection and analysis. Results: the activities of life with greater dependence on care are: food, due to irregular consumption of basic nutrients, which promotes a state of permanent malnutrition; another activity was work and entertainment, because they do not have fixed remuneration and live on what they collect by performing activities that generate small amounts of Money, besides activities such as death, sex, sleep, breathing and elimination, which are also compromised. Conclusion: the use of the model with people living on the street provided a holistic view of individuals, favoring the investigation of the factors that interfere in the maintenance of health


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Pessoas em Situação de Rua , Modelos de Enfermagem , Pesquisa Qualitativa , Padrões de Prática em Enfermagem , Enfermagem de Atenção Primária/métodos , Cuidados de Enfermagem/métodos
2.
Rev. Esc. Enferm. USP ; 53: e03495, Jan.-Dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020381

RESUMO

RESUMO Objetivo Descrever o ambiente de trabalho e reconhecer os riscos ocupacionais a que a equipe do Consultório na Rua está exposta, bem como as medidas preventivas aplicáveis segundo a percepção dos profissionais integrantes da equipe. Método Pesquisa qualitativa, exploratória, descritiva, realizada com profissionais representantes das seis equipes de Consultório na Rua existentes em um estado do Nordeste brasileiro. As informações foram coletadas a partir da técnica de grupo focal, e os dados foram analisados à luz da análise temática. Resultados Participaram 14 profissionais. O ambiente de trabalho foi descrito como de tensões, dificuldades e vulnerabilidades, mas também de crescimento pessoal. Foram reconhecidos riscos ocupacionais ocasionados por fatores físicos, biológicos, químicos, de acidentes e psicossociais. As medidas de prevenção utilizadas foram predominantemente tecnologias leves. Sugeriu-se a inclusão de novos equipamentos de proteção individual. Conclusão A reflexão grupal sobre o ambiente e processo de trabalho permitiu o reconhecimento de seus riscos, dificuldades e desafios, demonstrando a necessidade de implementação de medidas de enfrentamento dos fatores identificados.


RESUMEN Objetivo Describir el ambiente laboral y reconocer los riesgos ocupacionales a que está expuesto el equipo del Consultorio en la Calle, así como las medidas preventivas aplicables según la percepción de los profesionales integrantes del equipo. Método Investigación cualitativa, exploratoria, descriptiva, realizada con profesionales representantes de los seis equipos del Consultorio en la Calle existentes en un Estado del Nordeste brasileño. Las informaciones fueron recogidas mediante la técnica de grupo focal, y los datos fueron analizado a la luz del análisis temático. Resultados Participaron 14 profesionales. El ambiente de trabajo fue descrito como de tensiones, dificultades y vulnerabilidades, pero también de crecimiento personal. Fueron reconocidos los riesgos ocupacionales ocasionados por factores físicos, biológicos, químicos, de accidentes y psicosociales. Las medidas de prevención utilizadas fueron predominantemente tecnologías ligeras. Se sugirió la inclusión de nuevos equipos de protección individual. Conclusión La reflexión en grupo acerca del ambiente y el proceso laboral permitió el reconocimiento de sus riesgos, dificultades y retos, demostrando la necesidad de implementación de medidas de enfrentamiento de los factores identificados.


ABSTRACT Objective To describe the work environment and recognize the occupational hazards to which Street Medical Consultation teams are exposed, as well as the applicable preventive measures according to the perception of the professionals who are part of the team. Method A qualitative, exploratory and descriptive study carried out with professionals representing the six Street Medical Consultation teams existing in a Northeast Brazilian state. The information was collected from the focus group technique, and the data were analyzed by the thematic analysis technique. Results Fourteen (14) professionals participated. The work environment was described as stressful, with difficulties and vulnerabilities, but also enabling personal growth. Occupational risks caused by physical, biological, chemical, accident and psychosocial factors were recognized. Implemented preventive measures were predominantly light technologies. New personal protective equipment was suggested to be included/used. Conclusion The group reflection on the environment and work process enabled recognizing its risks, difficulties and challenges, demonstrating the need to implement measures to address the identified factors.


Assuntos
Humanos , Ambiente de Trabalho , Pessoas em Situação de Rua , Riscos Ocupacionais , Saúde do Trabalhador , Grupos Focais/métodos , Assistência à Saúde , Pesquisa Qualitativa , Enfermagem de Atenção Primária
4.
Lancet Psychiatry ; 6(11): 915-925, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601530

RESUMO

BACKGROUND: Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. METHODS: The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. FINDINGS: Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. INTERPRETATION: Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. FUNDING: Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Habitação Popular/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Ontário , Tempo , População Urbana/estatística & dados numéricos
7.
BMC Public Health ; 19(1): 1081, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399028

RESUMO

BACKGROUND: Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. METHOD: The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. RESULTS: Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. CONCLUSIONS: These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.


Assuntos
Autoavaliação Diagnóstica , Pessoas em Situação de Rua/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Inquéritos e Questionários
9.
BMC Psychol ; 7(1): 57, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455404

RESUMO

BACKGROUND: Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence. METHODS: This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables. RESULTS: In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10-2.23) and sexual (AOR: 6.31, 95% CI = 2.78-14.31) violence. CONCLUSIONS: Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account. TRIAL REGISTRATION: This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374 ; ISRCTN57595077 ; ISRCTN66721740 .


Assuntos
Identidade de Gênero , Pessoas em Situação de Rua/psicologia , Índios Norte-Americanos , Transtornos Mentais/psicologia , Adulto , Canadá , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Relacionados ao Uso de Substâncias
10.
BMC Public Health ; 19(1): 1154, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438912

RESUMO

BACKGROUND: The paper presents two-year findings from a study investigating the effectiveness of Housing First (HF) with assertive community treatment (ACT) in helping individuals with serious mental illness, who are homeless or precariously housed and living in a small city, to become stably housed. METHODS: The research design was a parallel group non-blinded RCT with participants randomly assigned after the baseline interview to receive HF with ACT (N = 100) or treatment as usual (TAU; N = 101). Participants were interviewed every 3 months over 21/24 months to investigate changes on a range of housing and psychosocial outcomes. The primary outcomes were housing stability (as defined by a joint function of number of days housed and number of moves) and improvement in community functioning. Secondary predicted outcomes were improvements in self-rated physical and mental health status, substance use problems, quality of life, community integration, and recovery. RESULTS: An intent-to-treat analysis was conducted. Compared to TAU participants, HF participants who entered housing did so more quickly (23.30 versus 88.25 days, d = 1.02, 95% CI [0.50-1.53], p < 0.001), spent a greater proportion of time stably housed (Z = 5.30, p < 0.001, OR = 3.12, 95% CI [1.96-4.27]), and rated the quality of their housing more positively (Z = 4.59, p < 0.001, d = 0.43, 95% CI [0.25-0.62]). HF participants were also more likely to be housed continually in the final 6 months (i.e., 79.57% vs. 55.47%), χ2 (2, n = 170) = 11.46, p = .003, Cramer's V = 0.26, 95% CI [0.14-0.42]). HF participants showed greater gains in quality of life, (Z = 3.83, p < 0.001, ASMD = 0.50, 95% CI [0.24-0.75]), psychological integration (Z = 12.89, p < 0.001, pooled ASMD = 0.91, 95% CI [0.77-1.05]), and perceived recovery (Z = 2.26, p = 0.03, ASMD = 0.39, 95% CI [0.05-0.74]) than TAU participants. CONCLUSIONS: The study indicates that HF ends homelessness significantly more rapidly than TAU for a majority of individuals with serious mental illness who have a history of homelessness and live in a small city. In addition, compared to TAU, HF produces psychosocial benefits for its recipients that include an enhanced quality of life, a greater sense of belonging in the community, and greater improvements in perceived recovery from mental illness. TRIAL REGISTRATION: International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009.


Assuntos
Serviços Comunitários de Saúde Mental , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Transtornos Mentais/reabilitação , Adolescente , Adulto , Canadá , Cidades , Integração Comunitária , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Índice de Gravidade de Doença , Adulto Jovem
13.
BMC Public Health ; 19(1): 994, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340786

RESUMO

BACKGROUND: Homelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations. The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless. METHODS: Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner. RESULTS: Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings. CONCLUSIONS: This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.


Assuntos
Programas de Triagem Diagnóstica , Pessoas em Situação de Rua/psicologia , Programas de Rastreamento/métodos , Adulto , Austrália , Feminino , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Psicometria , Adulto Jovem
14.
Int J Equity Health ; 18(1): 113, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337407

RESUMO

BACKGROUND: Homeless people have poor health and mortality indices. Despite this they make poor usage of health services. This study sought to understand why they use health services differently from the domiciled population. METHODS: Ethnographic observations were conducted at several homeless services, in Dublin. This was supplemented with 47 semi-structured interviews with homeless people and two focus groups of homeless people and hospital doctors. A critical-realist approach was adopted for interpretation of the data. RESULTS: Homeless people tended to present late in their illness; default early from treatment; have low usage of primary-care, preventative and outpatient services; have high usage of Emergency and Inpatient services; and poor compliance with medication. They tended to avoid psychiatric services. A number of external barriers were identified. These were classified as physical (distance) administrative (application process for medical care; appointments; queues; the management of addiction in hospital; rules of service; and information providing processes); and attitudinal (stigma; differing attitudes as to appropriate use of services. A new form of barrier, Conversations of Exclusion was identified and described. Internalised barriers were identified which were in nature, either cognitive (fatalistic, denial, deferral to future, presumption of poor treatment or discrimination, self blame and survival cognitions) or emotional (fear; embarrassment, hopelessness and poor self-esteem). Generative mechanisms for these factors were identified which either affected participants prior to homelessness (marginalization causing hopelessness, familial dysfunction, substance misuse, fear of authority, illiteracy; mental health; and poor English) or after becoming homeless (homelessness; ubiquity of premature death; substance misuse; prioritization of survival over health; threat of violence; chaotic nature of homelessness; negative experiences of authority; and stigma. CONCLUSIONS: An explanatory critical realist model integrating the identified generative mechanisms, external and internalised barriers was developed to explain why the Health service Utilization of homeless people differs from the domiciled populations. This new model has implications for health service policy makers and providers in how they design and deliver accessible health services to homeless people.


Assuntos
Atitude Frente a Saúde , Pessoas em Situação de Rua/psicologia , Atenção Primária à Saúde/organização & administração , Autoimagem , Populações Vulneráveis/psicologia , Adulto , Feminino , Grupos Focais , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Irlanda , Masculino , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários
15.
AIDS Behav ; 23(9): 2326-2336, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31324996

RESUMO

While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Pessoas em Situação de Rua/psicologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Razão de Chances , Pobreza , São Francisco/epidemiologia , Testes Sorológicos , Adulto Jovem
16.
Int J Equity Health ; 18(1): 101, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262310

RESUMO

BACKGROUND: People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. METHODS: Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. RESULTS: Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. CONCLUSIONS: The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Grupos Focais , Humanos , Ontário , Inquéritos e Questionários
17.
BMC Health Serv Res ; 19(1): 482, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300051

RESUMO

BACKGROUND: Health utility assessments are important for economic evaluations but few instruments have been validated in homeless people with mental illness. We examined the convergent validity of the EuroQol-5 Dimension 3-level questionnaire (EQ-5D-3L) as a measure of quality of life in homeless adults with mental illness. METHODS: Data were from Toronto participants in At Home/Chez Soi, a 24-month randomized controlled trial of Housing First (immediate access to scattered site housing and mental health support services) compared to treatment as usual for homeless adults with a mental disorder (n = 575). Participants completed the EQ-5D-3L at 6 month intervals. We tested convergent validity, hypothesizing strong correlation (r > 0.6) with the Lehman Quality of Life Interview 20 (QOLI-20) index and moderate correlations (r > 0.3) with the Colorado Symptom Index (CSI), Recovery Assessment Scale (RAS), and number of comorbidities. We also examined correlations between EQ-5D-3L scores and the QOLI-20 over time using a linear mixed-effects model. RESULTS: The EQ-5D-3L was not strongly correlated with the QOLI-20 (r ranged from 0.31-0.52 at various time points). The EQ-5D-3L was moderately correlated with the CSI, RAS, and number of comorbidities. The Snijders/Bosker r2 for longitudinal validity between the EQ-5D-3L and QOLI-20 within subjects over time was 0.2094 (square-root r = 0.4576). CONCLUSIONS: The EQ-5D-3L did not demonstrate strong convergent validity in homeless people with mental illness but was moderately correlated with several instruments. Further research is warranted to determine the optimal method for measuring health utilities in this population. TRIAL REGISTRATION: International Standard Randomised Control Trial Registry ISRCTN42520374 assigned on August 18, 2009.


Assuntos
Pessoas em Situação de Rua/psicologia , Transtornos Mentais/epidemiologia , Qualidade de Vida , Inquéritos e Questionários , Adulto , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
18.
BMC Public Health ; 19(1): 789, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221113

RESUMO

BACKGROUND: Socially disadvantaged groups, such as drug users, sex workers and homeless individuals, are labelled as "hard-to-reach" (HTR) in public health and medical research. HIV disproportionately impacts these populations, but data on how the HTR status could affect antiretroviral therapy (ART) adherence among HIV-positive people are limited and have not been previously synthesized in a systematic manner. We performed a meta-analysis to explore the association between HTR status and optimal antiretroviral therapy adherence in the HIV-infected population to provide evidence and recommendations regarding ART adherence improvement and HIV infection control and prevention among HTR people. METHODS: The PubMed, EMBASE, and Cochrance Library databases and the bibliographies of relevant studies were systematically searched up to December 2018. Full-text studies published in English were included, and no geographic or race restrictions were applied. Studies that quantitatively assessed the association between HTR status and optimal ART adherence among HIV-infected populations with a status of homelessness, sex work, or drug use were eligible for inclusion. We estimated the pooled odds ratios (ORs) of HTR characteristics related to ART adherence from each eligible study using a random effects model. The sensitivity, heterogeneity and publication bias were assessed. RESULTS: Our search identified 593 articles, of which 29 studies were eligible and included in this meta-analysis. The studies were carried out between 1993 and 2017 and reported between 1999 and 2018. The results showed that HTR status resulted in a 45% reduction in the odds of achieving optimal ART adherence compared to odds in the general population (OR = 0.55, 95% confidential intervals (CIs) 0.49-0.62), and this significant inverse association was consistently found regardless of study design, exposure measurement, adherence cut-off points, etc. Subgroup analyses revealed that the HTRs tend to be suboptimal adhering during a longer observational period. CONCLUSIONS: HIV treatment adherence is extremely negatively affected by HTR status. It is crucial to develop appropriate interventions to improve ART adherence and health outcomes among HTR people who are HIV-infected.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Pessoas em Situação de Rua/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Humanos , Estudos Observacionais como Assunto
19.
Soins ; 64(836): 45-48, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208583

RESUMO

Maternity professionals are sometimes required to provide care to migrant women in precarious circumstances. Decisions regarding the future and the social and medical support provided to these mothers and their babies must be made quickly and be efficient and effective, despite having to contend with a lack of resources. A qualitative study focused on professionals' emotional reactions in these contexts combining pregnancy, vulnerability, migration and perinatal care. It enabled an original research protocol to be established favouring professionals' reflexivity.


Assuntos
Pessoal de Saúde/psicologia , Pessoas em Situação de Rua , Serviços de Saúde Materna , Migrantes , Emoções , Feminino , Humanos , Gravidez , Pesquisa Qualitativa
20.
BMC Public Health ; 19(Suppl 4): 548, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196020

RESUMO

BACKGROUND: The presence of homelessness in Malaysia is not a new issue. The existence of homeless population is growing, along with the development of this country. With the increasing number of homelessness, the range of issues, such as health services financier among them, has surfaced. However, there was limited study conducted on this subject. The main objective of this study was thus, to identify the financier of health services among the homelessness in Kuala Lumpur and factors associated with it. METHODS: In this cross-sectional study, we include 196 homeless people aged above 18 years, Malaysian who were able to communicate with interviewers, and respondents who were not aggressive. These respondents were transits at Pusat Transit Gelandangan Kuala Lumpur and Anjung Singgah Kuala Lumpur and were available during interview sessions. They were selected via simple random sampling and were interviewed via face to face guided interviews using a validated structured questionnaire. Data were analysed descriptively, as well as using bivariate and multivariate analysis to explore the associated factors. RESULTS: The study showed that 57.7% homeless utilized the health services with only 37.8% assessed government health services. Only 42.5% of the respondents use their own money and 46.9% received aids to finance their health. Major influencing factors that influence homeless people to use their own money for health services were education level, income and disability, with adjusted OR (95% CI) of 3.15 (1.07-9.25), 0.08 (0.029-3.07) and 0.05 (0.003-0.88) while p value was 0.037, < 0.001 and 0.041 respectively. The influencing factors for receiving aid for health services were income and those who took drugs with adjusted OR (95% CI) of 6.50 (2.30-18.39), and 0.33 (0.11-0.95) while p value was < 0.001 and 0.041 respectively. CONCLUSION: There is low healthcare services utilization and affordability among homelessness. All parties should play a role in ensuring that homeless people are not left behind in the health care accessibility in Malaysia.


Assuntos
Acesso aos Serviços de Saúde/economia , Serviços de Saúde/economia , Financiamento da Assistência à Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
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