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The 6 dimensions of promising practice for case managed supports to end homelessness: part 2: the 6 dimensions of quality.

https://arctichealth.org/en/permalink/ahliterature129049
Source
Prof Case Manag. 2012 Jan-Feb;17(1):4-12; quiz 13-4
Publication Type
Article
Author
Katrina Milaney
Author Affiliation
Calgary Homeless Foundation, Calgary, Alberta, Canada. kmilaney@calgaryhomeless.com
Source
Prof Case Manag. 2012 Jan-Feb;17(1):4-12; quiz 13-4
Language
English
Publication Type
Article
Keywords
Canada
Case Management - standards - statistics & numerical data
Cooperative Behavior
Delivery of Health Care - organization & administration - standards
Health Services Accessibility
Health services needs and demand
Homeless Persons - statistics & numerical data
Humans
Models, Theoretical
Patient care team
Patient-Centered Care - methods
Physician's Practice Patterns - standards - statistics & numerical data
Professional Competence
Quality of Health Care - standards - statistics & numerical data
Abstract
Homelessness is a social condition increasing in frequency and severity across Canada. Interventions to end and prevent homelessness include effective case management in addition to an affordable housing provision. Little standardization exists for service providers to guide their decision making in developing and maintaining effective case management programs. The purpose of this 2-part article is to articulate dimensions of promising practice for case managers working in a "Housing First" context. Part 1 discusses research processes and findings and Part 2 articulates the 6 dimensions of quality.
Practice settings include community-based organizations that employ and support case managers whose primary role is moving people from homelessness into permanent supportive housing.
Six dimensions of promising practice are critically important to reducing barriers, improving sector collaboration, and ensuring that case managers have appropriate and effective training and support. Dimensions of promising practice are (1) collaboration and cooperation-a true team approach; (2) right matching of services-person-centered; (3) contextual case management-culture and flexibility; (4) the right kind of engagement-relationships and advocacy; (5) coordinated and well-managed system-ethics and communication; and (6) evaluation for success-support and training.
Effective, coordinated case management, in addition to permanent affordable housing has the potential to reduce a person's or family's homelessness permanently. Organizations and professionals working in this context have the opportunity to improve processes, reduce burnout, collaborate and standardize, and, most importantly, efficiently and permanently end someone's homelessness with the help of dimensions of quality for case management.
PubMed ID
22146635 View in PubMed
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10 year follow up study of mortality among users of hostels for homeless people in Copenhagen.

https://arctichealth.org/en/permalink/ahliterature9689
Source
BMJ. 2003 Jul 12;327(7406):81
Publication Type
Article
Date
Jul-12-2003
Author
Merete Nordentoft
Nina Wandall-Holm
Author Affiliation
Department of Psychiatry, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. merete.nordentoft@dadlnet.dk
Source
BMJ. 2003 Jul 12;327(7406):81
Date
Jul-12-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Cause of Death
Denmark - epidemiology
Female
Follow-Up Studies
Homeless Persons - statistics & numerical data
Humans
Male
Middle Aged
Mortality - trends
Registries
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Sex Distribution
Abstract
OBJECTIVES: To investigate mortality among users of hostels for homeless people in Copenhagen, and to identify predictors of death such as conditions during upbringing, mental illness, and misuse of alcohol and drugs. DESIGN: Register based follow up study. SETTING: Two hostels for homeless people in Copenhagen, Denmark PARTICIPANTS: 579 people who stayed in one hostel in Copenhagen in 1991, and a representative sample of 185 people who stayed in the original hostel and one other in Copenhagen. MAIN OUTCOME MEASURE: Cause specific mortality. RESULTS: The age and sex standardised mortality ratio for both sexes was 3.8 (95% confidence interval 3.5 to 4.1); 2.8 (2.6 to 3.1) for men and 5.6 (4.3 to 6.9) for women. The age and sex standardised mortality ratio for suicide for both sexes was 6.0 (3.9 to 8.1), for death from natural causes 2.6 (2.3 to 2.9), for unintentional injuries 14.6 (11.4 to 17.8), and for unknown cause of death 62.9 (52.7 to 73.2). Mortality was comparatively higher in the younger age groups. It was also significantly higher among homeless people who had stayed in a hostel more than once and stayed fewer than 11 days, compared with the rest of the study group. Risk factors for early death were premature death of the father and misuse of alcohol and sedatives. CONCLUSION: Homeless people staying in hostels, particularly young women, are more likely to die early than the general population. Other predictors of early death include adverse experiences in childhood, such as death of the father, and misuse of alcohol and sedatives.
PubMed ID
12855527 View in PubMed
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[10-year follow-up study of mortality among users of hostels for homeless people in Copenhagen].

https://arctichealth.org/en/permalink/ahliterature179879
Source
Ugeskr Laeger. 2004 Apr 26;166(18):1679-81
Publication Type
Article
Date
Apr-26-2004

Active tuberculosis among homeless persons, Toronto, Ontario, Canada, 1998-2007.

https://arctichealth.org/en/permalink/ahliterature136298
Source
Emerg Infect Dis. 2011 Mar;17(3):357-65
Publication Type
Article
Date
Mar-2011
Author
Kamran Khan
Elizabeth Rea
Cameron McDermaid
Rebecca Stuart
Catharine Chambers
Jun Wang
Angie Chan
Michael Gardam
Frances Jamieson
Jae Yang
Stephen W Hwang
Author Affiliation
St. Michael's Hospital, Toronto, Ontario, Canada. khank@smh.ca
Source
Emerg Infect Dis. 2011 Mar;17(3):357-65
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Emigrants and Immigrants - statistics & numerical data
Female
Homeless Persons - statistics & numerical data
Humans
Male
Middle Aged
Ontario - epidemiology
Risk factors
Tuberculosis - diagnosis - epidemiology - mortality
Abstract
While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998-2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998-2002 to 39% in 2003-2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.
Notes
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PubMed ID
21392424 View in PubMed
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[Alarming figures on homelessness. Are the positive trends changing?].

https://arctichealth.org/en/permalink/ahliterature221645
Source
Lakartidningen. 1993 Feb 17;90(7):593-4
Publication Type
Article
Date
Feb-17-1993
Author
G. Agren
Author Affiliation
Forsknings- och utvecklingsbyrån, Socialtjänsten, Stockholm.
Source
Lakartidningen. 1993 Feb 17;90(7):593-4
Date
Feb-17-1993
Language
Swedish
Publication Type
Article
Keywords
Female
Homeless Persons - statistics & numerical data
Humans
Male
Substance-Related Disorders - epidemiology
Sweden - epidemiology
PubMed ID
8437473 View in PubMed
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An investigation of the growing number of deaths of unidentified people in Russia.

https://arctichealth.org/en/permalink/ahliterature159626
Source
Eur J Public Health. 2008 Jun;18(3):252-7
Publication Type
Article
Date
Jun-2008
Author
Evgueni Andreev
William Alex Pridemore
Vladimir M Shkolnikov
Olga I Antonova
Author Affiliation
Max Planck Institute for Demographic Research, Konrad Zuse Strasse 1, Rostock 18057, Germany.
Source
Eur J Public Health. 2008 Jun;18(3):252-7
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adult
Alcohol-Related Disorders - mortality
Case-Control Studies
Homeless Persons - statistics & numerical data
Humans
Life Expectancy - trends
Logistic Models
Male
Middle Aged
Mortality - trends
Russia - epidemiology
Social Isolation
Abstract
We examined mortality among working-age Russian men whose identity could not be determined, focusing on where and how they died.
Employing micro-data from deaths that occurred in Izhevsk (Ural region) between June 2004 and September 2005, we analysed the characteristics of decedent men aged 25-54 (n = 2158). Differences between completely identified (n = 1699) and unidentified deaths (n = 282) were compared via logistic regression. Data on all deaths in Russia in 2002 were used for supplemental comparisons.
We found that relative to identified men, unidentified men were at a higher risk of death from exposure to natural cold, violence, alcoholic cardiomyopathy, acute respiratory infections and poisonings. Our results also revealed that alcohol played an important role in the mortality of unidentified men. The places and causes of death among these unidentified men provide substantial evidence of their homelessness and social isolation.
The increase in deaths among unidentified men of working-age indicates the emergence of a health threat associated with homelessness and social marginalization. This vulnerable group is exposed to different levels and causes of mortality compared with the larger population and represent a new challenge that requires serious and immediate scholarly attention and policy responses.
Notes
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PubMed ID
18160388 View in PubMed
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Bacteremic pneumococcal pneumonia: a prospective study in Edmonton and neighboring municipalities.

https://arctichealth.org/en/permalink/ahliterature174912
Source
Medicine (Baltimore). 2005 May;84(3):147-61
Publication Type
Article
Date
May-2005
Author
Mohammed Reza Shariatzadeh
Jane Q Huang
Gregory J Tyrrell
Marcia M Johnson
Thomas J Marrie
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Source
Medicine (Baltimore). 2005 May;84(3):147-61
Date
May-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Bacteremia - epidemiology
Canada - epidemiology
Female
Homeless Persons - statistics & numerical data
Humans
Male
Middle Aged
Pneumonia, Pneumococcal - epidemiology
Pregnancy
Pregnancy Complications, Infectious - epidemiology
Prisoners - statistics & numerical data
Prospective Studies
Risk factors
Smoking - epidemiology
Abstract
Bacteremic pneumococcal pneumonia (BPP) is an important disease that should be frequently re-evaluated due to changes in demographics and recommended treatment. We conducted a prospective study from 2000 to 2002 in adults aged 17 years and over who presented to any of 6 hospitals and 1 freestanding emergency room in Edmonton, Alberta, with signs and symptoms compatible with pneumonia, a chest radiograph interpreted as pneumonia by the attending physician, and a positive blood culture for Streptococcus pneumoniae. We identified 129 patients with BPP, for an overall incidence of 9.7/100,000 person years. The rate was markedly higher among pregnant women, homeless persons, and those in prison. Sixteen percent were managed as outpatients, 61.2% as ward patients, and 22.5% required admission to the intensive care unit (ICU). Tobacco smoking was predictive of BPP, and antibiotic therapy before presentation was protective. According to pneumonia severity index, 47.3% were in low-risk classes I-III, 31.0% were in class IV, and 21.7% were in class V. Twelve (9.3%) patients died. Four died within 24 hours of arrival at hospital, and 2 had end-stage lung disease that resulted in a decision to discontinue therapy. Of the S. pneumoniae isolates, 12.5% were not susceptible to penicillin. The overall rate of BPP appears to be decreasing, although the rate is markedly increased in certain populations, which now should be targeted for vaccination. We identified 3 subsets of patients with BPP according to the site of care (ambulatory, ward, and ICU), with different outcomes.
PubMed ID
15879905 View in PubMed
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A community-based intervention to increase screening mammography among disadvantaged women at an inner-city drop-in center.

https://arctichealth.org/en/permalink/ahliterature173606
Source
Women Health. 2005;41(1):21-31
Publication Type
Article
Date
2005
Author
Robert K Heyding
Angela M Cheung
Eva J M Mocarski
Rahim Moineddin
Stephen W Hwang
Author Affiliation
Leaside Health Centre and the Department of Family and Community Medicine, Toronto, ON, M4G 4E4, Canada.
Source
Women Health. 2005;41(1):21-31
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Breast Neoplasms - prevention & control - radiography
Community Health Centers - statistics & numerical data - utilization
Female
Homeless Persons - statistics & numerical data
Humans
Mammography - utilization
Mass Screening - utilization
Middle Aged
Ontario - epidemiology
Outcome Assessment (Health Care)
Patient Acceptance of Health Care - statistics & numerical data
Poverty - statistics & numerical data
Preventive Health Services - standards
Retrospective Studies
Urban Health Services - statistics & numerical data - utilization
Urban Population - statistics & numerical data
Women's health
Women's Health Services - statistics & numerical data - utilization
Abstract
To determine the effectiveness of a community- based intervention to increase the use of screening mammography among disadvantaged women at an inner-city drop-in center.
This study involved women 50 to 70 years old who were clients of an inner-city drop-in center in Toronto, Canada, during the years 1995-2002 (N = 158 in 1995-2001 and N = 89 in 2002). In 2002, the drop-in center and a nearby hospital initiated a collaborative breast cancer screening project in which a staff member of the drop-in center accompanied small groups of women for mammography visits at a weekly pre-arranged time. Interrupted time series analysis was used to examine the effect of this intervention on the annual rate of screening mammography, as determined by review of medical records.
More than half of the women 50 to 70 years old who used the drop-in center in 2002 had been diagnosed with a major mental illness, and one-third were either homeless or living in supportive housing. In the 7 years before the introduction of the intervention, annual mammography rates among women using the drop-in center averaged 4.7%. During the intervention year, 26 (29.2%) of 89 women underwent mammography (p = 0.0001 for the change from pre-to post-intervention).
The introduction of accompanied small-group visits was associated with significantly increased use of mammography in a group of disadvantaged women who were clients of an inner-city drop-in center. This approach may be useful to promote breast cancer screening among women affected by mental illness or homelessness who have contact with community-based agencies.
PubMed ID
16048866 View in PubMed
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A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance.

https://arctichealth.org/en/permalink/ahliterature106553
Source
Am J Public Health. 2013 Dec;103 Suppl 2:S294-301
Publication Type
Article
Date
Dec-2013
Author
Stephen W Hwang
Catharine Chambers
Shirley Chiu
Marko Katic
Alex Kiss
Donald A Redelmeier
Wendy Levinson
Author Affiliation
Stephen W. Hwang, Catharine Chambers, and Shirley Chiu are with the Centre for Research on Inner City Health, part of the Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario. Marko Katic and Alex Kiss are with the Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto. Donald A. Redelmeier is with the Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto. Wendy Levinson is with the Department of Medicine, University of Toronto.
Source
Am J Public Health. 2013 Dec;103 Suppl 2:S294-301
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - utilization
Canada - epidemiology
Cohort Studies
Emergency Service, Hospital - utilization
Female
Health Services - utilization
Homeless Persons - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Socioeconomic Factors
United States - epidemiology
Universal Coverage
Abstract
We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system.
We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs).
Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical-surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical-surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations.
In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
PubMed ID
24148051 View in PubMed
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