Strategies for the Delivery of Medical Care

Brickner, Philip W.; McAdam, John M.; Vicic, William J.; Doherty, Patricia M

doi:10.1007/978-1-4899-0679-3_12

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Homelessness 1992

DOI: 10.1007/978-1-4899-0679-3_12

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Strategies for the Delivery of Medical Care

Philip W. Brickner

John M. McAdam

William J. Vicic

et al.

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1994

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Cited by 3 publications

(1 citation statement)

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“…Little is known, however, about adherence to prophylactic regimens. Studies of treatment for active TB disease found that fewer than 50% of homeless persons completed treatment (Brickner, McAdam, Vicic, & Doherty, 1992; Brudney & Dobkin, 1991; McAdam, Brickner, Scharer, Croccio, & Duff, 1990). Furthermore, there are few data on the current level of knowledge and attitudes about TB among people in the United States.…”

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confidence: 99%

HIV and TB among people who are homeless and mentally ill.

Colson¹,

Susser²,

Valencia³

1994

Psychosocial Rehabilitation Journal

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After several decades of decline, tuberculosis rates in the United States have begun to increase. Many believe that this upsurge is directly related to the HIV epidemic (U.S. Congress, 1993; Bayer, Dubler, 8c Landesman, 1993;Bloom 8c Murray, 1992). People whose immune systems are compro mised by HIV are much more likely to develop active TB disease and may be more likely to become infected with TB (Bloch,

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mentioning

confidence: 99%

HIV and TB among people who are homeless and mentally ill.

Colson¹,

Susser²,

Valencia³

1994

Psychosocial Rehabilitation Journal

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Tuberculosis Skin Testing Among Homeless Adults

Gelberg

Panarites²,

Morgenstern

et al. 1997

J Gen Intern Med

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OBJECTIVE:To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. DESIGN:Cross-sectional study. SETTING: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.PARTICIPANTS: A representative sample of 260 homeless adults. MEASUREMENTS AND MAIN RESULTS:Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. nderstanding the epidemiology of tuberculosis (TB) among the homeless, as well as other high-risk populations, is critical. Despite relatively recent predictions that TB could be eradicated in the United States by the year 2010, 1-3 we have been confronted by a sharp rise in active TB (10% increase between 1985 and 1994) 4 and an increase in multidrug-resistant TB since 1985 when reported cases of TB reached their lowest levels since national reporting began in 1953. [4][5][6][7] This increase in active TB has also led to increased numbers of individuals with newly acquired asymptomatic TB infection resulting from contact with persons with active contagious disease. Such individuals are at increased risk of developing active disease: the 1-year risk of becoming an active case is 3% within 1 year of infection and 0.5% in each subsequent year after 2 years of infection. 8 A multiplicity of factors, including the HIV/AIDS epidemic, increasing poverty and homelessness in America's cities, illicit drug use, budgetary constraints on local health departments, immigration from high-prevalence nations, and high rates of noncompliance among TB patients, have contributed to the resurgence of TB. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Previous research on homeless adults demonstrated their elevated risk of asymptomatic TB infection, active disease, and multidrug-resistant TB. [23][24][25][26][27][28] Further, reports have cited outbreaks of TB in emergency shelters for the homeless in Boston and Ohio,29,30 as well as in a neighborhood bar frequented by a homeless person with active disease. 31 Why is the risk of TB increased among homeless persons? Among the homeless, men outnumber women approximately four to one and ethnic and racial minority groups, especially African Americans, are overrepresented. [32][33][34] A disproportionate number of individuals with serious mental health problems (including previous psychiatric hospitalization), or a history of substance dependence, have been found among the homeless, and a significant number of homeless persons have dual diagnoses of mental illness and substance dependence. [35][36][37][38] Further, homeless persons have gr...

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Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis

et al. 2015

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We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980–2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97 366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval = 23.8%, 29.9%; n = 43 studies) and of diabetes was 8.0% (95% confidence interval = 6.8%, 9.2%; n = 39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.

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Strategies for the Delivery of Medical Care

Cited by 3 publications

References 24 publications

HIV and TB among people who are homeless and mentally ill.

HIV and TB among people who are homeless and mentally ill.

Tuberculosis Skin Testing Among Homeless Adults

Diabetes and Hypertension Prevalence in Homeless Adults in the United States: A Systematic Review and Meta-Analysis

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