Objective: The primary goals of this systematic review were to assess studies of homeless adults and cognitive functioning, and to explore the clinical implications and potential impacts on social functioning of these cognitive deficits. Method:The MEDLINE, CINAHL, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, ERIC, Social Sciences Abstracts, Social Sciences Citation Index, Social Services Abstracts, and Sociological Abstracts databases were searched from 1970 (or their inception) to October 2007. Abstracts from 582 studies were screened and 22 studies were found to meet inclusion criteria (published in the English language, reported results of neuropsychological tests, or screening tests for cognitive dysfunction in homeless people aged 18 years or older). Two investigators independently reviewed each study and rated its quality based on well-defined criteria.Results: Ten studies were of good or fair quality. Studies that administered the Mini Mental State Examination indicate about 4% to 7% of homeless people exhibit global cognitive deficits. Focal deficits in verbal and visual memory, attention, speed of cognitive processing, and executive function were also apparent. No studies of the functional implications of cognitive deficits were found.

The authors' objectives of this research were: (1) to assess levels of selfreported antidepressant adherence and reasons for nonadherence and (2) to investigate determinants of nonadherence. A group of general hospital and community psychiatry practice mood disorder outpatients (n=80) took a self-report questionnaire that assessed beliefs about antidepressants, self-efficacy, and reasons for nonadherence. High levels of adherence were reported: 58 patients (73%) indicated they took their medication as directed more than 80% of the time. Practical issues (e.g., simply forgetting or a change in routine) were the most frequently identified reasons for nonadherence. Patients were more likely to report nonadherence if they experienced a sexual side effect, had lower self-efficacy, were female, and had not completed post-secondary education. Clinicians should be cognizant of this complexity and address not only issues related to medication efficacy and tolerability, but also social mediators and health beliefs when prescribing antidepressants.

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The Canadian Geographer / Le Geographe canadien 46, no 2 (2002) 160-1 71 0 / Canadian Association of Geographers / CAssociation canadienne des geographes Conceptual and practical issues in the detection of local disease clusters: a study of mortality in Hamilton, Ontario 16 1 Q J C Wj (dj/ nj) CMF= F1 Dl J

This study compared the functional capacity and neurocognitive status of homeless and housed adults with schizophrenia or schizoaffective disorder and examined whether housing status is an independent predictor of functional capacity. We examined 30 homeless individuals and 21 housed controls and matched for diagnosis, sex, and age. The participants, recruited from an acute psychiatric inpatient unit, completed a measure of psychiatric symptom severity, a neuropsychological test battery, and a measure of functional capacity, the University of California-San Diego performance-based skills assessment (UPSA). There were no significant differences in performance on the neuropsychological test battery or the UPSA between housed and homeless participants. In a multivariate model, however, cognitive status and housing status were independent predictors of functional capacity, and homelessness was associated with an approximately 9-point lower score on the UPSA. This finding highlights the importance of neuropsychological screening and interventions that promote housing stability for patients with schizophrenia.

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The Sydney Tar Ponds in Sydney, Nova Scotia, Canada, have been referred to as the most contaminated industrial site in the country. Area residents, aware of the contamination for close to 25 years, are very concerned about their health: past, present and future. In particular, they are concerned about cancer; this is followed closely by reproductive health concerns. The objective of this study was to assess the prevalence and determinants of birth weight and preterm birth among residents living in proximity to an industrial site contaminated with a mix of industrial wastes arising from a former steel mill and coking works (the Tar Ponds) in Sydney, Nova Scotia, Canada. A telephone survey was administered to 500 randomly selected women living in proximity to the site to document reproductive histories. The respondents reported 904 live birth pregnancies occurring in Sydney. The mean birth weight reported for live birth pregnancies was 3,391 g (standard deviation: 570). The reported prevalence of preterm births was 7 percent. Linear regression analyses showed a reduction in birth weight of approximately 85 g among residents in a zone estimated to have higher levels of deposition of airborne effluent from the site. Multivariate logistic regression analyses showed a decrease in the risk of preterm birth as residential distance from the site increased (odds ratio 0.65, 95 percent confidence interval 0.42, 0.98). These data suggest that community exposure to industrial contaminants had some, but little, impact on reported birth weights in this sample of respondents. The apparent increase in risk for preterm births suggests further investigation may be warranted, particularly in light of community concerns. Follow‐up investigations using validated birth records and more sensitive measures of environmental exposure could be used to confirm the findings and further explore the intra‐urban variation in health outcomes. These findings underscore the importance of ongoing clean‐up efforts in Sydney.

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