H omeless and vulnerably housed populations are heterogeneous 1 and continue to grow in numbers in urban and rural settings as forces of urbanization collide with gentrification and austerity policies. 2 Collectively, they face dangerous living conditions and marginalization within health care systems. 3 However, providers can improve the health of people who are homeless or vulnerably housed, most powerfully by following evidence-based initial steps, and working with communities and adopting anti-oppressive practices. 1,4,5 Broadly speaking, "homelessness" encompasses all individuals without stable, permanent and acceptable housing, or lacking the immediate prospect, means and ability of acquiring it. 6 Under such conditions, individuals and families face intersecting social, mental and physical health risks that significantly increase morbidity and mortality. 7,8 For example, people who are homeless and vulnerably housed experience a significantly higher prevalence of trauma, mental health conditions and substance use disorders than the general population. 7,9 Canadian research reports that people who experience homelessness face life expectancies as low as 42 years for men and 52 years for women. 7 A generation ago, homeless Canadians were largely middleaged, single men in large urban settings. 10 Today, the epidemiology has shifted to include higher proportions of women, youth, Indigenous people (Box 1), immigrants, older adults and people from rural communities. 13,14 For example, family homelessness (and therefore homelessness among dependent children and youth) is a substantial, yet hidden, part of the crisis. 15 In 2014, of the estimated 235 000 homeless people in Canada, 27.3% were women, 18.7% were youth, 6% were recent immigrants or migrants, and a growing number were veterans and seniors. 10

Background: A growing number of migrants experience precarious housing situations worldwide, but little is known about their health and housing experiences. The objective of this study was to understand the enablers and barriers of accessing fundamental health and social services for migrants in precarious housing situations. Methods:We conducted a systematic review of qualitative studies. We searched the databases of MEDLINE, PsycINFO, CINAHL, Scopus, Web of Science, Social Sciences, Canadian Business & Current Affairs and Sociological Abstracts for articles published between Jan. 1, 2007, and Feb. 9, 2020. We selected studies and extracted data in duplicate, and used a framework synthesis approach, the Bierman model for migration, to guide our analysis of the experiences of migrant populations experiencing homelessness or vulnerable housing in high-income countries. We critically appraised the quality of included studies using the Critical Appraisal Skills Programme checklist and assessed confidence in key findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Results:We identified 1039 articles, and 18 met our inclusion criteria. The studies focused on migrants from Asia and Africa who resettled in Canada, Australia, the United States, the United Kingdom and other European countries. Poor access to housing services was related to unsafe housing, facing a family separation, insufficient income assistance, immigration status, limited employment opportunities and lack of language skills. Enablers to accessing appropriate housing services included finding an advocate and adopting survival and coping strategies.Interpretation: Migrants experiencing homelessness and vulnerable housing often struggle to access health and social services; migrants may have limited proficiency with the local language, limited access to safe housing and income support, and ongoing family insecurities. Public health leaders could develop outreach programs that address access and discrimination barriers. PROSPERO Registration: CRD42018071568

Summary :Setting: A key recommendation of the National TB Strategy for England is testing and treatment of latent Tuberculosis infection (LTBI) among new migrants. Programmatic testing is based in primary care; however, this may be inaccessible to some individuals. Current strategies therefore could be complemented with screening in other settings.Objective: To investigate the feasibility and effectiveness of LTBI screening in a community college.Design: We performed a cohort study, based on observational data collected during and after the pilot project. Eligible language students from high TB incidence countries were consented and tested with a single-step Interferon Gamma Release Assay (IGRA) and enrolled in the cohort. We used single and multivariable analyses to estimate effectiveness of LTBI screening and to explore effectiveness in different sub-groups.Results: Screening uptake was 75% and the treatment completion rate was 85%. 71/440 students (16%) were LTBI positive and two had active TB. There was an association of positivity with age and TB incidence in the country of origin. We included costs from a UK National Health Service perspective. Three potential TB incidence thresholds met our cost effectiveness criteria for screening: countries with incidences of more than 40, more than 100 and more than 200 per 100,000 plus students from sub-Saharan Africa. Conclusion:We found that LTBI screening can be offered effectively in a community college setting, and could be a feasible complement to primary care-based programmes in low-incidence countries.

Background The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and feasibly collect pain-related data from patients in both clinical and research settings. Objective The aim of this study was to conduct a systematic review and meta-analysis to compare electronic and conventional pain-related data collection methods with respect to pain score equivalence, data completeness, ease of use, efficiency, and acceptability between methods. Methods We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception until November 2019. We included all peer-reviewed studies that compared electronic (any modality) and conventional (paper-, telephone-, or in-person–based) data capture methods for patient-reported pain data on one of the following outcomes: pain score equivalence, data completeness, ease of use, efficiency, and acceptability. We used random effects models to combine score equivalence data across studies that reported correlations or measures of agreement between electronic and conventional pain assessment methods. Results A total of 53 unique studies were included in this systematic review, of which 21 were included in the meta-analysis. Overall, the pain scores reported electronically were congruent with those reported using conventional modalities, with the majority of studies (36/44, 82%) that reported on pain scores demonstrating this relationship. The weighted summary correlation coefficient of pain score equivalence from our meta-analysis was 0.92 (95% CI 0.88-0.95). Studies on data completeness, patient- or provider-reported ease of use, and efficiency generally indicated that electronic data capture methods were equivalent or superior to conventional methods. Most (19/23, 83%) studies that directly surveyed patients reported that the electronic format was the preferred data collection method. Conclusions Electronic pain-related data capture methods are comparable with conventional methods in terms of score equivalence, data completeness, ease, efficiency, and acceptability and, if the appropriate psychometric evaluations are in place, are a feasible means to collect pain data in clinical and research settings.

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Introduction Diabetic retinopathy (DR) screening relies on adherence to follow-up eye care. This article assesses if a model of patient education and tele-retina screening among high-risk patients with DR can achieve increased rates of compliance within a one-year follow-up. Methods Between May 2014 and May 2016, DR screening was conducted in a cohort of 101 patients with diabetes in Southern Ontario. Optical coherence tomography and fundus photography images were used to visualize the retina remotely. Enrolled patients participated in an educational seminar at the screening site with the expressed purpose of enhancing patient understanding of DR. A chi-squared test was used to assess patient compliance to follow-up examinations within 6–12 months, while pre-to post-screening HbA1c levels were compared using a dependent t-test. Results Of 101 patients who completed the study, 33 patients (32.6%) have never previously been screened for DR. Baseline compliance to annual screening increased from 36 patients (35.6%) to 51 patients (50.5%) after the tele-retina programme ( p = 0.03). Eighty-nine patients (88%) were referred to an optometrist for ongoing care compared with 12 patients (11.9%) to an ophthalmologist for management of DR. Overall, 100 patients (99.0%) were satisfied with the tele-retina screening. There was no significant change in pre- to-post screening HbA1c levels ( p = 0.91). Discussion Patient education-focused tele-retina screening for DR significantly increased compliance to follow-up in a high-risk, non-compliant patient population. Management of diabetes as captured by HbA1c levels remain unchanged in the cohort indicating a need for ongoing inter-professional collaboration in education and vision screening.

In the EU/EEA, subgroups of international migrants have an increased prevalence of certain infectious diseases. The objective of this study was to examine migrants’ acceptability, value placed on outcomes, and accessibility of infectious disease interventions. We conducted a systematic review of qualitative reviews adhering to the PRISMA reporting guidelines. We searched MEDLINE, EMBASE, CINAHL, DARE, and CDSR, and assessed review quality using AMSTAR. We conducted a framework analysis based on the Health Beliefs Model, which was used to organize our preliminary findings with respect to the beliefs that underlie preventive health behavior, including knowledge of risk factors, perceived susceptibility, severity and barriers, and cues to action. We assessed confidence in findings using an adapted GRADE CERQual tool. We included 11 qualitative systematic reviews from 2111 articles. In these studies, migrants report several facilitators to public health interventions. Acceptability depended on migrants’ relationship with healthcare practitioners, knowledge of the disease, and degree of disease-related stigma. Facilitators to public health interventions relevant for migrant populations may provide clues for implementation. Trust, cultural sensitivity, and communication skills also have implications for linkage to care and public health practitioner education. Recommendations from practitioners continue to play a key role in the acceptance of infectious disease interventions.

Objective: To evaluate the pharmacogenetic relationship between CFH haplotypes and single nucleotide polymorphisms (SNPs) with response to ranibizumab treatment for neovascular age-related macular degeneration (nAMD). Patients and Methods: This was a prospective cohort study involving 70 treatment-naive nAMD patients. Patients were genotyped for CFH haplotypes and SNPs in the C3, ARMS2, and mtDNA genes. Visual acuity and central macular thickness were assessed at baseline and during 6 monthly follow-up visits. Multivariate logistic regression was used to determine the association between genotypes and a gain of ≥15 letters at the 6-month endpoint after adjusting for potential confounders. Results:CFH haplotypes were associated with a gain of ≥15 letters at the 6-month endpoint (p = 0.046). Patients expressing protective haplotypes were more likely to achieve a gain of ≥15 letters relative to the greatly increased risk haplotypes [OR 6.58 (95% CI: 1.37, 31.59)]. Conclusion:CFH is implicated in nAMD patient treatment response to ranibizumab.