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Shah, Kanan, Patricia Mae Garcia Santos, Justin Michael Barnes, Anna Tao, Chiaojung Jillian Tsai e Fumiko Chino. "Disparities in outcomes among hospitalized unhoused patients with cancer in the US." Journal of Clinical Oncology 41, n. 16_suppl (1 giugno 2023): 6502. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.6502.
Testo completoAbstract (sommario):
6502 Background: Cancer is the 2nd leading cause of death among death among unhoused adults in the US. Use of aggressive medical interventions and costs during hospitalizations remains unstudied in the unhoused population. Methods: All hospitalized adults age ≥18 with a principal cancer diagnosis were identified in the 2016-2020 National Inpatient Sample (NIS). Logistic regression tested associations between unhoused status and: cost of care, mortality, and receipt of invasive procedures/systemic therapy. Adjusted analysis accounted for patient demographics, socioeconomic status, comorbidities, and effect modification of housing status by length of stay (LOS). Results: A total of 9,030 unhoused and 2,758,693 housed adults with cancer were included in the study. There were significant ( p<0.01) differences in age <65 years (77% unhoused vs 41% housed), male sex (75% vs 53%), race (Black, 25% vs 13%; White, 58% vs 71%), and insurance type (Private, 6% vs 27%; Medicaid, 53% vs 11%). There were also differences by primary cancer diagnosis, with higher rates of lung (17% vs 14%) and liver (8% vs 3%) cancers. Unhoused persons received less chemotherapy inpatient (5% vs 7%) and fewer overall procedures (48% vs 58%), while experiencing longer LOS (median 6 vs 4 days). On adjusted analyses, unhoused adults were had lower odds of receiving invasive procedures (aOR [95%CI], 0.34 [0.27-0.42]) or systemic therapy (0.41 [0.20-0.85]); and were less likely to have a higher-than-median cost of stay 0.47 [0.39-0.57]). Additionally, unhoused adults were 35% and 20% less likely to have a higher-than-median cost of stay or die while hospitalized (95% CI 0.59 – 0.71 and 0.67 – 0.96, respectively). When accounting for the possibility of housing status being modified by LOS, unhoused persons remained significantly less likely than housed persons to receive inpatient procedures (aOR 0.38, 0.47, and 0.60 for short, medium, and long LOS, respectively; p<0.001 for each) or have high cost of stay (adjusted OR 0.55, 0.71, 0.70, p<.001 for each), though the differences by housing status were attenuated with longer length of stay. Conclusions: In this first nationwide analysis of hospitalizations among unhoused adults with cancer, unhoused patients remained significantly less likely to receive invasive procedures or systemic therapy. These disparities in inpatient management despite the higher prevalence of more aggressive cancers and comorbidities among the unhoused highlight missed opportunities to improve cancer care.
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Cantu, Cristina. "What can social workers do to help the growing number of people experiencing homelessness? The view from an urban hospital Emergency Department". Columbia Social Work Review 22, n. 1 (13 maggio 2024): 52–70. http://dx.doi.org/10.52214/cswr.v22i1.12208.
Testo completoAbstract (sommario):
Homelessness is a growing problem nationwide. According to the U.S. Department of Housing and Urban Development (HUD), the number of people experiencing homelessness rose 12% from 2022 to 2023 (HUD Exchange, 2024b). Low vacancy rates, increased rent costs, and income inequality all comprise difficult structural factors locking people out of the housing market. Those who most harshly bear the brunt of this crisis are people with social vulnerabilities. This paper analyzes the social problem of homelessness from the perspective of an urban hospital Emergency Department (ED), Yale New Haven Hospital (YNHH) in New Haven, Connecticut. Social workers in these settings have a dual role: working directly with individuals and families to connect them with available services and resources and advocating for structural interventions that can ultimately ease this problem. Social workers are also at the forefront of combating any stigma unhoused persons face by both approaching patients experiencing homelessness with dignity and respect while educating others that this problem is not one of the individual, but is rather a consequence of multiple other social problems we have collectively failed to address.
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IRIMIEȘ, Laura Maria, Cosmin IRIMIEȘ e Emil Mihai MESAROȘ. ""Romanian Ngos’ Efforts to Advocate on Behalf of Marginalized Groups and Prevent Social Turbulence"". Transylvanian Review of Administrative Sciences, SI (20 dicembre 2023): 66–84. http://dx.doi.org/10.24193/tras.si2023.4.
Testo completoAbstract (sommario):
While Romania has undergone huge progress during the last 30 years, the situation of marginalized groups hasn’t progressed as well as the country’s rapid economic development. The plight of vulnerable groups such as unhoused people, persons with disabilities, and the LGBTQ community continues to be a source of social turbulence, as they are consistently facing exclusion. Authorities do not prioritize their integration within society and there is a lack of policies to deal with these issues, leading to the appearance of extremely polarizing movements such as the 2018 referendum initiative to ban same-sex unions. This paper aims to analyze three case studies where advocacy organizations championed the cause of the above-mentioned groups, in order to increase visibility, representation, and integration, and pinpoint best practices for organizations advocating on behalf of disadvantaged groups. The three main best practices we have learned regarding advocacy projects targeting public policy for marginalized groups are: a. always put a local group at the center of the project, b. bring outside partners or mentors who can bring advocacy skills to the project, c. look for other, supplemental, positive outcomes, that usually tend to come up in the work with marginalized groups.
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Fleming, Victoria, e Fergus Maxwell. "Expropriating Privacy". Persona Studies 8, n. 2 (3 febbraio 2023): 56–69. http://dx.doi.org/10.21153/psj2022vol8no2art1683.
Testo completoAbstract (sommario):
During the winter of 2020, Toronto resident Khaleel Seivwright, began to construct small mobile shelters to provide insulation and privacy to unhoused residents living outdoors. Conditions produced by the COVID-19 pandemic increased demand on the city’s already underfunded and strained shelter system, subsequently accelerating development of encampments in parks throughout the city. From the outset, these “tiny shelters” served as a flashpoint in public discourse on the question of the relative health, safety, and beauty of unhoused privacy. Drawing on media coverage of Seivwright’s case, we address the question of the private persona as it emerges in relation to the unhoused, and to the practices of violent expropriation which daily police their existence. By examining the news discourses produced about Sievwrights tiny shelters, we interrogate how Sievwright’s public persona came to represent encampment residents as well as himself subsequently emerging as a boundary subject mediating the contradictory relations immanent to domesticity: between public and private space and public and private identity. Our analysis asks how the limits of privacy are actively imposed and managed under capitalism: who is allowed to have domestic space, where is that domestic space allowed to exist, and crucially what public personas emerge in relation to practices departing from the normative bounds of capitalism’s public/private distinction? Using critical discourse analysis (CDA), we examine the ways in which public personas are mediated by individuals and media institutions at the same time as addressing how personas themselves intervene in this process. CDA directs us to ask how personas are constituted through language. This emphasis on persona as both outcome of relations of power and as mediator in its own right permits us to address figures who are conventionally denied personas while simultaneously complicating and challenging the meanings behind domesticity within capitalist cities.
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ODonnell, Arden. "EMERGING PALLIATIVE CARE INTERVENTIONS FOR HOMELESS ADULTS IN 10 US CITIES". Innovation in Aging 7, Supplement_1 (1 dicembre 2023): 358–59. http://dx.doi.org/10.1093/geroni/igad104.1191.
Testo completoAbstract (sommario):
Abstract America’s adult homeless population is growing older; its median age is now 50 years of age. Due to harsh living conditions of chronic homelessness, these individuals often experience geriatric conditions in their 50s and 60s and face premature mortality. Yet, little is known about palliative care for this population. A 2017 systematic review of scientific journals revealed only six palliative care intervention studies for homeless adults. Anecdotal evidence, however, suggests community responses are emerging. Focusing on the 10 U.S. cities with the largest adult homeless populations, this exploratory study had two objectives: 1) through a web-based search of the “grey literature,” the identification of organizations developing or adapting programs to serve the palliative care needs of homeless adults; and 2) through in-depth zoom interviews with directors, gaining an understanding of the programs’ core aspects as well as their successes and challenges in development, implementation, and sustainability. The 18 interviewed agencies fell into two distinct service categories, healthcare/palliative organizations and homelessness/housing organizations. Identified modifications included targeted advanced care planning (ACP) groups, the development of an ACP repository for unhoused persons, rapid re-housing for terminally ill patients, harm reduction strategies, and hospice options in shelters. Common themes were the challenges of working across multiple systems and the lack of dedicated resources and funding for initiatives to support the population’s multiple and complex needs. The discussion highlights the need for greater organizational resources and flexibility in both the healthcare and homeless systems to promote value-based-goal concordant care for homeless adults.
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Iwamoto, Satori, Leilani Hernandez, Harrison Chu, Hillary Chu e Mason Johnstone. "2022 Monkeypox Case Report: Beyond Borders and Expectations". Asploro Journal of Biomedical and Clinical Case Reports 5, n. 3 (24 settembre 2022): 140–45. http://dx.doi.org/10.36502/2022/asjbccr.6277.
Testo completoAbstract (sommario):
Monkeypox is a zoonotic virus that is in the same family as smallpox. It is primarily spread through various forms of close contact with an infected individual, including direct contact with an infected person’s bodily fluids or surfaces and fabrics that have been contaminated. Its symptoms are generally characterized by rashes or lesions that are firm or supple, restricted to its area, and raised in its center. Vaccines for this disease were actually developed for smallpox. There are two main types of vaccinations: ACAM2000 and 0Jynneos. ACAM2000 uses a live vaccine virus while Jynneos uses a non-replicating virus. Due to the similarity between smallpox and monkeypox, Tpoxx is being researched as a potential treatment. FDA approved Tpoxx – or Tecovirimat – in 2018 as an effective treatment for smallpox after extensive animal trials and safety studies. Currently, the drug is not FDA-approved for monkeypox; however, under an expanded access protocol, it is clinically available. There are two cases presented in this article. The first case was a heterosexual male in his 30s who contracted monkeypox while having multiple sexual encounters with women while moving from tent to tent as an unhoused resident. He also shared pipes with others for recreational marijuana use. This case illustrates that monkeypox is a virus that isn’t restricted to sexuality, especially that of the LGBTQ+ community. To clarify, this virus is not an STI/STD, it’s spread by skin-to-skin contact, contact with an object that was in contact with an infected individual, or contact with respiratory secretions. However, there are fears of singling out the LGBTQ+ community and using the monkeypox virus to stigmatize these communities, much like the AIDS pandemic in the 1980s. In this case, a large proportion of those infected identifies as non-heterosexual, which may just be a result of the nature of a viral illness. Tightly knit groups and communities that spend a lot of time with each other create many opportunities for contact and facilitate disease spread. Second case is a homosexual male in his 60s who received childhood vaccination for smallpox, and yet contracted the monkeyvirus during his travels to Germany and Switzerland, where he had encountered multiple sex partners. This case presents how previous vaccination for smallpox may not be effective against monkeypox virus. Thus, prior smallpox vaccines in the distant past offered no protection against monkeypox and are capable of spreading to people outside of the borders of LGBTQ+ community.
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Lahue, Katie. "Unhoused Persons: Perspectives on Perceived Benefits of Music Therapy". Music Therapy Perspectives, 20 dicembre 2021. http://dx.doi.org/10.1093/mtp/miab025.
Testo completoAbstract (sommario):
Abstract There is limited literature to support the use of music therapy with unhoused persons and more research is needed to deepen the understanding of music therapy with this population. This researcher aimed to gather information from music therapists who work with unhoused persons to gain more perspective on the perceived benefits of the music therapy treatment process. Three music therapists were interviewed; interviews were then transcribed and coded to find themes regarding perceived benefits of music therapy with unhoused persons. The four themes derived from the data were increased resilience factors, facilitating connections, creating a safe space, and increased expression. Findings support music therapy attending to many levels of human need for unhoused individuals. These findings can be used as recommendation for practice and program development for the use of music therapy with unhoused persons and also point to a need for more research to understand the benefits of specific music therapy techniques and treatment methods with unhoused persons and subgroups of the unhoused community.
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Miller, Timothy Isaac, Stephanie Banning e Joshua A. Lieberman. "Risk factors and provider awareness of sexually transmitted enteric pathogens among men who have sex with men". Microbiology Spectrum, 23 febbraio 2024. http://dx.doi.org/10.1128/spectrum.03577-23.
Testo completoAbstract (sommario):
ABSTRACT Sexual transmission of enteric pathogens among men who have sex with men (MSM) is well documented, although whether providers are cognizant of this risk when MSM patients present with gastrointestinal symptoms has not been studied. Over 34 months at a major tertiary metropolitan medical system, this study retrospectively analyzed 436 BioFire FilmArray Gastrointestinal results from 361 patients documented as MSM. An extensive chart review was performed, including specific sexual behaviors, socioeconomic risk factors, and whether providers charted a sexual history when a patient presented for care. Overall BioFire positivity rate was 62% with no significant difference in positivity between persons living with HIV and those without. Patients charted as sexually active had a significantly increased odds ratio (OR) of a positive result compared to those who were not. Anilingus had the highest OR. Providers charted any type of sexual history in 40.6% of cases, and HIV/infectious disease providers were significantly more likely to do this compared to other subspecialties. Sexual transmission of enteric pathogens within MSM is ongoing, and patients are at risk regardless of living with HIV. Not all sexual behaviors have the same associated risk, highlighting opportunities to decrease transmission. Increased provider vigilance and better patient education on sexual transmission of enteric pathogens are needed to reduce the disease burden. IMPORTANCE Our work adds several key findings to the growing body of literature describing the epidemiology of enteric pathogens as sexually transmitted infections among men who have sex with men (MSM). We analyzed clinical test results, housing status, provider awareness, sexual behaviors, and symptoms for 361 patients. We found that any sexual activity was associated with an increased risk of diarrheal pathogen detection, whereas being unhoused was not a risk factor. These findings suggest separate transmission networks between unhoused persons, who are also at risk of infectious diarrhea, and MSM. Moreover, our study suggested low awareness among patient-facing clinicians that diarrheal pathogens can be sexually transmitted. Together, our findings indicate an important opportunity to disrupt transmission cycles by educating clinicians on how to assess and counsel MSM patients.
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Mercado, Micaela, Lara Law, Kristin Ferguson-Colvin e Wendy Wolfersteig. "Intersectional Structural Stigma: A Qualitative Study With Persons Experiencing Homelessness in the Southwest United States". Qualitative Health Research, 20 giugno 2024. http://dx.doi.org/10.1177/10497323241239209.
Testo completoAbstract (sommario):
This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12–17), young adults (ages 18–24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups ( n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers.
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T. Schneider, Luisa. "Let me take a vacation in prison before the streets kill me! Rough sleepers’ longing for prison and the reversal of less eligibility in neoliberal carceral continuums". Punishment & Society, 7 maggio 2021, 146247452110102. http://dx.doi.org/10.1177/14624745211010222.
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In a steadily expanding carceral landscape, rough sleepers are using prisons in unforeseen ways: namely to escape violence, for survival, to access social or medical care, enhance their prospects or regain housing. Like most neoliberal welfare states, the German aid system is dispersed and based on individual responsibility, but in prison it concentrates due to the prison’s duty to rehabilitate which translates into care for the subject position ‘inmate’ but holds politically unwanted unhoused persons responsible to change their fates. Poor and disenfranchised people who use prisons as lifelines turn the carceral grip into an embrace. Their tactics reveal a reverse cycle of carcerality where the streets are the space of detriment and the prison, trough harnessing the productivity of penal power, offers a break or potential escape from carceral livelihoods. Rough sleepers who seek imprisonment to escape the hardship and confinement of the streets challenge the concept of less eligibility and offer new ways to theorise the carceral and to think through prisons and the iron rules of punishment.
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Amato, Heather K., Douglas Martin, Christopher M. Hoover e Jay P. Graham. "Somewhere to go: assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020". BMC Public Health 22, n. 1 (4 settembre 2022). http://dx.doi.org/10.1186/s12889-022-13904-4.
Testo completoAbstract (sommario):
Abstract Background Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco’s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. Methods We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions at 27 locations across 10 San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. Results Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). In the same restrooms, the rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change = -0.024 [95% CI = -0.033, -0.014]). In a subset of restrooms, where new installations were made (Mission and Golden Gate Park), and in another subset of restrooms where restroom attendants were provided (Mission, Castro/Upper Market, and Financial District/South Beach), feces reports also declined. Conclusions Increased access to public toilets reduced feces reports in San Francisco, especially in neighborhoods with people experiencing homelessness. The addition of restroom attendants also appeared to have reduced feces reports in some neighborhoods with PEH. These interventions should be audited for implementation quality, observed utilization data, and user experience at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.
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McMullen, Timothy P., Mahan Naeim, Carol Newark, Haden Oliphant, Jeffrey Suchard e Faried Banimahd. "Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition". Substance Abuse Treatment, Prevention, and Policy 16, n. 1 (24 marzo 2021). http://dx.doi.org/10.1186/s13011-021-00362-1.
Testo completoAbstract (sommario):
Abstract Background For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation. Commentary In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access – thereby hindering access to healthcare for thousands of predominantly unhoused individuals. The county was previously served by the Orange County Needle Exchange Program from 2016 until 2018 when a civil suit brought by the Orange County Board of Supervisors resulted in the closure of the program. For more than 2 years, persons who inject drugs in Orange County lacked reliable access to clean syringes, placing them at increased risk for contracting HIV and Hepatitis C. Here, we comment on the ongoing effort to restore syringe access in Orange County. This collaborative physician-directed endeavor has brought together students and community volunteers to provide vital harm reduction services to a remarkably underserved population. Since the reestablishment of syringe access in Orange County by the Harm Reduction Institute, new legal barriers have arisen including the passage of new municipal legislation banning the operation of syringe exchanges. We are well-equipped to overcome these obstacles. This work serves as an affirmation of assertions made by previous authors regarding the unique qualifications of medical & graduate students as effective harm reductionists. Conclusion Harm reduction services are vital to the health and well-being of people who use drugs. The provision of these services should not be impeded by legislative interference by municipal, county, or state governments.
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Sartirano, Daniele, Kyriaki Kalimeri, Ciro Cattuto, Enrique Delamónica, Manuel Garcia-Herranz, Anthony Mockler, Daniela Paolotti e Rossano Schifanella. "Strengths and limitations of relative wealth indices derived from big data in Indonesia". Frontiers in Big Data 6 (21 febbraio 2023). http://dx.doi.org/10.3389/fdata.2023.1054156.
Testo completoAbstract (sommario):
Accurate relative wealth estimates in Low and Middle-Income Countries (LMICS) are crucial to help policymakers address socio-demographic inequalities under the guidance of the Sustainable Development Goals set by the United Nations. Survey-based approaches have traditionally been employed to collect highly granular data about income, consumption, or household material goods to create index-based poverty estimates. However, these methods are only capture persons in households (i.e., in the household sample framework) and they do not include migrant populations or unhoused citizens. Novel approaches combining frontier data, computer vision, and machine learning have been proposed to complement these existing approaches. However, the strengths and limitations of these big-data-derived indices have yet to be sufficiently studied. In this paper, we focus on the case of Indonesia and examine one frontier-data derived Relative Wealth Index (RWI), created by the Facebook Data for Good initiative, that utilizes connectivity data from the Facebook Platform and satellite imagery data to produce a high-resolution estimate of relative wealth for 135 countries. We examine it concerning asset-based relative wealth indices estimated from existing high-quality national-level traditional survey instruments, the USAID-developed Demographic Health Survey (DHS), and the Indonesian National Socio-economic survey (SUSENAS). In this work, we aim to understand how the frontier-data derived index can be used to inform anti-poverty programs in Indonesia and the Asia Pacific region. First, we unveil key features that affect the comparison between the traditional and non-traditional sources, such as the publishing time and authority and the granularity of the spatial aggregation of the data. Second, to provide operational input, we hypothesize how a re-distribution of resources based on the RWI map would impact a current social program, the Social Protection Card (KPS) of Indonesia and assess impact. In this hypothetical scenario, we estimate the percentage of Indonesians eligible for the program, which would have been incorrectly excluded from a social protection payment had the RWI been used in place of the survey-based wealth index. The exclusion error in that case would be 32.82%. Within the context of the KPS program targeting, we noted significant differences between the RWI map's predictions and the SUSENAS ground truth index estimates.
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Erath, Tyler G., Rosalie LaCroix, Erin O’Keefe, Stephen T. Higgins e Richard A. Rawson. "Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont". Harm Reduction Journal 21, n. 1 (5 aprile 2024). http://dx.doi.org/10.1186/s12954-024-00995-y.
Testo completoAbstract (sommario):
Abstract Background Understanding current substance use practices is critical to reduce and prevent overdose deaths among individuals at increased risk including persons who use and inject drugs. Because individuals participating in harm reduction and syringe service programs are actively using drugs and vary in treatment participation, information on their current drug use and preferred drugs provides a unique window into the drug use ecology of communities that can inform future intervention services and treatment provision. Methods Between March and June 2023, 150 participants in a harm reduction program in Burlington, Vermont completed a survey examining sociodemographics; treatment and medication for opioid use disorder (MOUD) status; substance use; injection information; overdose information; and mental health, medical, and health information. Descriptive analyses assessed overall findings. Comparisons between primary drug subgroups (stimulants, opioids, stimulants-opioids) of past-three-month drug use and treatment participation were analyzed using chi-square and Fisher’s exact test. Results Most participants reported being unhoused or unstable housing (80.7%) and unemployed (64.0%) or on disability (21.3%). The drug with the greatest proportion of participants reporting past three-month use was crack cocaine (83.3%). Fentanyl use was reported by 69.3% of participants and xylazine by 38.0% of participants. High rates of stimulant use were reported across all participants independent of whether stimulants were a participant’s primary drug. Fentanyl, heroin, and xylazine use was less common in the stimulants subgroup compared to opioid-containing subgroups (p < .001). Current- and past-year MOUD treatment was reported by 58.0% and 77.3% of participants. Emergency rooms were the most common past-year medical treatment location (48.7%; M = 2.72 visits). Conclusions Findings indicate high rates of polysubstance use and the underrecognized effects of stimulant use among people who use drugs—including its notable and increasing role in drug-overdose deaths. Crack cocaine was the most used stimulant, a geographical difference from much of the US where methamphetamine is most common. With the increasing prevalence of fentanyl-adulterated stimulants and differences in opioid use observed between subgroups, these findings highlight the importance and necessity of harm reduction interventions (e.g., drug checking services, fentanyl test strips) and effective treatment for individuals using stimulants alongside MOUD treatment.
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Swamy, Shriya, Shaya Khorsandi, Sarina Attri, Renae Nichols e Ben King. "Abstract P451: Clinical, Demographic, and Geographic Trends in Cardiovascular Causes of Deaths Associated With Homelessness". Circulation 149, Suppl_1 (19 marzo 2024). http://dx.doi.org/10.1161/circ.149.suppl_1.p451.
Testo completoAbstract (sommario):
Background: Cardiovascular disease (CVD) remains the leading cause of death in the United States, accounting for a staggering 928,741 fatalities in 2020. Persons experiencing homelessness (PEH) have a 3- to 5-fold excess risk of mortality from CVD, which ranks as a predominant cause of mortality in this setting, second only to overdose deaths. The elevated incidence of CVD mortality for PEH may be attributable to complex interactions between social determinants and risk factors that include delayed diagnosis, limited healthcare access, heightened smoking rates, and the increased incidence of diabetes and hypertension among other factors. Methods: This study utilized records from the county medical examiner in the third most populous county in the US from 2021-2022, focusing exclusively on CVD mortality in medicolegal cases to analyze the impact of specific risk factors for PEH. All medicolegal deaths involving CVD were analyzed to determine relative frequencies of associated or secondary causes between housed and PEH deaths along with insights into the influence of age, race, and gender. Results: The examination of the CVD mortality in PEH cases in 2021 (n=52) and 2022 (n=71) revealed important trends, yielding an estimated, unadjusted mortality rate of 23 deaths per 1,000 person-years-exposed-to-homelessness (compared to around 2 per 1,000 person-years in population). The mean age for CVD deaths in PEH was 58.6 and 60.6 years in 2021 and 2022 respectively (males increased 57.8 to 61.3 years; females increased 58.8 to 60.6 years), while the proportion of CVD deaths increased among males (30-32%) but decreased for females (29-22%). This widening gap in the percent of CVD deaths occurring among male PEH and female PEH is evident where the gap stood at 1% in 2021 but expanded to 10% in 2022 (p=n.s.). Racial disparities show a rapid increase in CVD deaths for Black/African American PEH (26.1-33.7%). Top conditions associated with CVD deaths were hypertension and atherosclerosis, regardless of housing status at death. Diabetes mellitus (25%), obesity (22%), and chronic ethanolism (16%) round out the top 5 conditions for housed decedents, while among the unhoused COPD (19.7%), CHF (12.7%), and diabetes mellitus (11.3%) were the most common. Conclusion: Exposure to homelessness and housing instability is a major driver of cardiovascular mortality. These findings suggest that PEH face ongoing challenges in the management and prevention of CVD. Additionally, CVD deaths associated with homelessness often point foremost to hypertensive and atherosclerotic vascular changes, contributing to natural deaths. These conditions point to persistent risk factors such as limited healthcare access, high smoking rates (contributing to COPD), and higher incidences of diabetes and hypertension. Additional research is needed on underlying causes of the identified gender disparities.
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Gross, E. B. "How to Get to Where They Are: Notes From an Open Group With Unhoused LGBTQIA2S+ Youth". Health Promotion Practice, 17 gennaio 2023, 152483992211507. http://dx.doi.org/10.1177/15248399221150784.
Testo completoAbstract (sommario):
Mental health professionals aim to engage our clients with “accurate empathy”: a nonjudgmental understanding of each person’s starting point and experiences that is in tune with their perspective. This article explores the challenges and importance of developing this type of engagement in complex contexts, using the lens of group work with a disparate set of LGBTQIA2S+ young adults whose identities, backgrounds, and experiences differed from one another and from the facilitator. The author reflects on experiences from a grant-based position creating and running a trauma-informed support group in an emergency shelter for unhoused LGBTQIA2S+ young adults in a major U.S. city, including the impact of common issues in the field such as staff turnover, confusion about roles and needs, and support. The article describes lessons learned about the importance of language choice, self-reflection, and the need to confront and build on differences to create a shared process of support.
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Jenkins, Danisha, Laura Chechel e Brian Jenkins. "Nursing in deathworlds: Necropolitics of the life, dying and death of an unhoused person in the United States healthcare industrial complex". Nursing Philosophy, 18 giugno 2023. http://dx.doi.org/10.1111/nup.12458.
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