Homeless Population Research Articles

Associations of Homelessness With Primary Care and Acute Care Utilization Among Medicaid-Enrolled Youth.

Youth comprise one-third of the US homeless population. However, little is known about how homelessness affects health care utilization. Examine associations of homelessness with hospitalization, primary care, and ED visits, varying by race/ethnicity, among Medicaid-enrolled youth. A cross-sectional analysis was conducted using California Medicaid claims data on youth beneficiaries with complex needs. We examined the number of hospitalizations, preventable and nonpreventable ED, and primary care visits using a multivariate regression. We further explored the differential associations by race/ethnicity. Approximately 17% of our sampled youth experienced homelessness in 2018 (N=90,202). Compared with their housed counterparts, youth experiencing homelessness had a 1.9 percentage point (pp) higher likelihood of frequent ED visits (95% CI: 1.7-2.2) but a 2.9 pp lower probability of any primary care visits (95% CI: -3.9 to -1.9). Homelessness was associated with 221 more ED visits (95% CI: 182-260), 100 more preventable ED visits (95% CI: 84-116), 19.9 more hospitalizations (95% CI: 12-27), but 56 fewer primary care visits (95% CI: -104 to -7), per 1000 youth. The associations of homelessness with total ED visits, preventable ED visits, and needed and nonpreventable ED visits were all higher among Whites and, particularly, Blacks than for Hispanics and Asians. Medicaid-enrolled youth who experienced homelessness had more overall ED, preventable ED, and hospital visits, but fewer primary care visits than their housed peers. Our results suggest promoting primary care use should be considered among strategies to improve health and reduce costs.

COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States.

People experiencing homelessness are at greater risk of exposure and poor health outcomes from COVID-19. However, little data exist on the prevalence and correlates of COVID-19 among homeless populations. To mitigate the spread and severity, uptake of the COVID-19 vaccine is needed. This can be challenging among youth experiencing homelessness who are more likely to be unvaccinated when compared to stably housed youth. We conducted this study to determine the prevalence and correlates of COVID-19 among youth experiencing homelessness. We examined experiences of COVID-19 symptoms, self-report of infection, and rates of COVID-19 antibodies and distinguished between natural and vaccinated immunity among youth experiencing homelessness ( N = 265) recruited in one large metropolitan area in the south. Based on self-report, very few participants experienced any symptoms, and 80% had never been diagnosed with COVID-19. Of those with COVID-19 antibodies (68%), the proportion with antibodies resulting from natural infection was 44%. The vaccination rate was 42%. Younger and vaccinated participants and those in shelters were likelier to have COVID-19 antibodies. Black and Hispanic youth were more likely than White youth to have had COVID-19. Those who adopted only one or two prevention behaviors were more likely to acquire a natural infection than those who adopted three or more prevention behaviors. Youth experiencing homelessness report low vaccination rates, disrupted access to healthcare and social supports, and underlying chronic conditions, which may explain why they face poorer outcomes when infected with COVID-19. Vaccination and risk mitigation strategies to combat the high prevalence of COVID-19 are especially needed for sheltered youth who are at high risk yet are often asymptomatic.

Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study.

Although the effects of digital health are receiving wide scientific attention, very little is known about the characteristics of digitally engaged people experiencing homelessness, especially in Central and Eastern Europe. Our previous research revealed a considerable level of internet use in the homeless population of Budapest, Hungary, for general purposes (350/662, 52.9%) and medical purposes (229/664, 34.6%). Moreover, a digitally engaged subgroup was identified (129/662, 19.5%). The aim of this exploratory study was to map out the resources, attitudes, and behaviors of digitally engaged homeless individuals in relation to digital technology to set the basis for potential health policy interventions, which will enable better access to health services through strengthening of the digital components of the existing health care system. Between August 18, 2022, and October 27, 2022, a total of 12 in-depth semistructured interviews were conducted in 4 homeless shelters in Budapest, Hungary. Upon analysis by 3 independent evaluators, 2 interviews were excluded. The interviewees were chosen based on purposive sampling with predefined inclusion criteria. Thematic analysis of the transcripts was conducted. In the thematic analysis, 4 main themes (attitude, access, usage patterns, and solutions for usage problems) emerged. Health-related technology use mostly appeared in health information-seeking behavior. Online search for prescribed medications (5 interviews), active ingredients of medications (4 interviews), medicinal herbs believed to replace certain pills (2 interviews) or foods, and natural materials (1 interview) were mentioned. Moreover, mobile health app use (3 interviews) was reported. The intention to circumvent or check on mainstream health care solutions was mainly associated with previous negative experiences in the health care system. Several gaps in the daily use of technology were identified by the interviewees; however, more than half of the interviewees (6/10) turned out to be contact points for their peers for digital problem-solving or basic digital literacy skill enhancement in the homeless shelters. Furthermore, a lack of institutional support or special programs targeting senior clients was noted. Digitally engaged homeless individuals might become mediators between their peers and comprehensive digital health programs. They have the trust of their peers, can recognize and harness the benefits of digital technology, and are able to provide meaningful help in technology- and usage-related issues through experience. Digital health services have great promise in community shelters for managing and preventing health issues, and digitally engaged individuals might be important for the success of such services.

National Overview of Nonprofit Hospitals' Community Benefit Programs to Address Housing.

Housing is a critical social determinant of health that can be addressed through hospital-supported community benefit programming. To explore the prevalence of hospital-based programs that address housing-related needs, categorize the specific actions taken to address housing, and determine organizational and community-level factors associated with investing in housing. This retrospective, cross-sectional study examined a nationally representative dataset of administrative documents from nonprofit hospitals that addressed social determinants of health in their federally mandated community benefit implementation plans. We conducted descriptive statistics and bivariate analyses to examine hospital and community characteristics associated with whether a hospital invested in housing programs. Using an inductive approach, we categorized housing investments into distinct categories. The main outcome measure was a dichotomous variable representing whether a hospital invested in one or more housing programs in their community. Twenty percent of hospitals invested in one or more housing programs. Hospitals that addressed housing in their implementation strategies were larger on average, less likely to be in rural communities, and more likely to be serving populations with greater housing needs. Housing programs fell into 1 of 7 categories: community partner collaboration (34%), social determinants of health screening (9%), medical respite centers (4%), community social determinants of health liaison (11%), addressing specific needs of homeless populations (16%), financial assistance (21%), and targeting high-risk populations (5%). Currently, a small subset of hospitals nationally are addressing housing. Hospitals may need additional policy support, external partnerships, and technical assistance to address housing in their communities.

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper

Background Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. Methods The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.

Immunity against measles, mumps, rubella, and varicella among homeless individuals in Germany - A nationwide multi-center cross-sectional study.

Homeless individuals suffer a high burden of vaccine-preventable infectious diseases. Moreover, they are particularly susceptible to adverse infection outcomes with limited access to the health care system. Data on the seroprevalence of measles, mumps, rubella, and varicella within this cohort are missing. The seroprevalence of measles, mumps, rubella, and varicella was determined within the homeless population in Germany. Predictors of lacking immune protection were determined using multivariable logistic regression analysis. Homeless individuals in Germany (n = 611) showed a seroprevalence of 88.5% (95% CI: 85.8-91.0) for measles, 83.8% (95% CI: 80.6-86.6) for mumps, 86.1% (95% CI: 83.1-88.7) for rubella, and 95.7% (95% CI 93.8-97.2) for varicella. Measles seroprevalences declined from individuals born in 1965 to individuals born in 1993, with seroprevalences not compatible with a 95% threshold in individuals born after 1980. For mumps, seroprevalences declined from individuals born in 1950 to individuals born in 1984. Here, seroprevalences were not compatible with a 92% threshold for individuals born after 1975. Seronegativity for measles, mumps and rubella was associated with age but not with gender or country of origin. Herd immunity for measles and mumps is not achieved in this homeless cohort, while there was sufficient immune protection for rubella and varicella. Declining immune protection rates in younger individuals warrant immunization campaigns also targeting marginalized groups such as homeless individuals. Given that herd immunity thresholds are not reached for individuals born after 1980 for measles, and after 1975 for mumps, vaccination campaigns should prioritize individuals within these age groups.

Homeless people: a review of personality disorders.

Personality disorders in homeless people pose a challenge to the medical community and society, requiring specialized approaches for these super-difficult patients. The prevalence of personality disorders is higher in homeless populations than in the general population. However, there is a knowledge gap regarding personality disorders among people experiencing homelessness, and the implications of this lack of recognition are substantial. This paper provides a brief narrative review of personality disorders among homeless individuals. The primary importance and specificity of these disorders in this population remain unexplored. We searched PubMed and Web of Science databases in February and November 2023 using the keywords 'homeless' and 'personality disorder', and selected fifty-eight studies to be included in this literature review. The main themes of the results were personality disorders in homeless individuals and comorbid psychiatric disorders; risk factors and other psychological and behavioral data; clinical and intervention outcomes; and challenges linked to assessment, treatment, and intervention. The homeless population experiences significant diagnostic variability and the diagnosis of personality disorders is still evolving, contributing to difficulties in diagnosis, assessment, and treatment. A future challenge is to raise clinical awareness and optimize research knowledge, assessment, and intervention in personality disorders among homeless individuals with comorbid psychiatric disorders.

Prevalence and Characteristics of Tuberculosis in the Korean Homeless Population Based on Nationwide Tuberculosis Screening.

The government of Korea implemented a strategy of prevention and early diagnosis in high-risk groups to reduce the tuberculosis (TB) burden. This study aims to investigate the TB epidemiology and gap in understanding of TB prevalence among homeless individuals by analyzing active TB chest X-ray (CXR) screening results in Korea. The Korean National Tuberculosis Association conducted active TB screening with CXR for homeless groups from January 1 to December 31, 2021. Sputum acid-fast bacilli smear and culture were performed for the subjects suggestive of TB on CXR. We performed a cross-sectional analysis of the data in comparison with the national health screening results from the general population. Among 17,713 homeless persons, 40 (0.23%), 3,077 (17.37%), and 79 (0.45%) were categorized as suggested TB, inactive TB, and observation required, respectively. Prevalence of suggested TB in the homeless was significantly higher (3-5 fold) than in Univerthe national general health screening based on age category (p<0.005). Twenty-nine cases were confirmed as TB, yielding a prevalence of 164 cases per 100,000 individuals; 19 of these 29 cases showed inactive TB on CXR. Body mass index (p=0.0478) and CXR result (p<0.001) significantly correlated with confirmed TB based on multivariable analysis. Nutrition status and CXR results, especially that of inactive TB, should be considered in active TB screening of the homeless population, where TB prevalence is higher than the general population.

Meaningful Healthcare and Social Service Access for Homeless Populations: Generating Alliances Through Theories of Therapeutic Landscape

ABSTRACT Poor health can both facilitate and be facilitated by homelessness. The desire for serious illness care to occur at home and increased attention to home-and-community-based health services prompts consideration of how the therapeutic nature of place can shape patient-centered care for those who live outside of traditional housing. Three key concepts from therapeutic landscape are illustrated by findings from an empirical, grounded theory study (RASCAL-UP) of a mobile palliative care provider for the homeless: (1) healing pilgrimages and migrations; (2) place-based therapeutic networks; (3) spaces of care and control. Through application of therapeutic landscape theory, health workers can better comprehend the healthcare decisions and goals of people experiencing homelessness. Applications of therapeutic landscape theory can guide healthcare professionals toward equitable care planning and support programming and policy to enhance care options for homeless populations.

Estimating the population size of persons contending with homelessness using electronic health records

Abstract The majority of attempts to enumerate the homeless population rely on point-in-time or shelter counts, which can be costly and inaccurate. As an alternative, we use electronic health records from the Vancouver Island Health Authority, British Columbia, Canada from 2013 to 2022 to identify adults contending with homelessness based on their self-reported housing status. We estimate the annual population size of this population using a flexible open-population capture–recapture model that takes into account (1) the age and gender structure of the population, including aging across detection occasions, (2) annual recruitment into the population, (3) behavioural-response, and (4) apparent survival in the population, including emigration and incorporating known deaths. With this model, we demonstrate how to perform model selection for the inclusion of covariates. We then compare our estimates of annual population size with reported point-in-time counts of homeless populations on Vancouver Island over the same time period, and find that using data extracts from electronic health records gives comparable estimates. We find similarly comparable results using only a subset of interaction data, when using only ER interactions, suggesting that even if cross-continuum data is not available, reasonable estimates of population size can still be found using our method.

The Effect of Homelessness on Management of Menstruation and Dysmenorrhea in Pomona, California [ID 2683481

INTRODUCTION: Given the challenges to menstrual hygiene many women face and the high rate of homelessness in Pomona, California, we suspected women without housing would have increased difficulty managing their menstrual hygiene and dysmenorrhea primarily due to resource inaccessibility. METHODS: After IRB approval and beta testing, we partnered with local homeless shelters and a student-run clinic to screen for eligible participants, obtain verbal consent, and conduct anonymous interviews. Each interview lasted 15 minutes with 26 questions spanning demographics, menstrual hygiene and dysmenorrhea management, and history of homelessness. RESULTS: Analysis of 50 surveys (96% response rate) revealed that 37% of participants reportedly relied on shelter pantries for access to menstrual hygiene products, 27% of participants admitted to stealing their preferred products, and almost 10% of participants reported resorting to using alternate methods such as free bleeding and old clothes to catch their menstrual flow. For management of dysmenorrhea-associated painful cramping, 96% of participants reported preferring medication management but not having access to it when homeless so instead their only option was to “just deal with it” (60%). CONCLUSION: The results of this study illuminate the gap in existing literature regarding the specific struggles that homeless people face when managing their menstrual hygiene and dysmenorrhea. The discrepancies in management of hygiene and pain when housed versus unhoused come down to lack of access to essential resources. Shelter pantries do not have enough funding to effectively support the size and demand of the growing menstruating homeless population.

A Framework for Healthcare Services Affordability for the Homeless in Malaysia: Addressing Inequalities

The issue of homelessness is a worldwide problem that necessitates attention from all stakeholders. The major concerns are around inadequate legislation safeguarding the rights of the homeless and their financial ability to seek medical care. This study aims to assess the feasibility of establishing a healthcare framework specifically tailored for the homeless population in Malaysia. Semi-structured interviews were carried out with individuals aged 18 years and older who are currently residing in homeless-related facilities in Malaysia. A total of 57 participants from three distinct sites were questioned. Based on the input from these participants, this study discovered that homelessness can be attributed to a range of factors, such as unemployment, familial issues, criminal histories, and even personal choice. When questioned about their primary necessities when experiencing homelessness, the majority expressed apprehension regarding access to sustenance and housing, while a few also voiced concerns about receiving medical care. Although many individuals disregard the importance of seeking medical care, a portion of the homeless population experiences severe ailments. The report presents preventive and sustainable ways to address the issues of homelessness and suggests improvements to legislation.

“Access to healthcare is a human right”: a constructivist study exploring the impact and potential of a hospital-community partnered COVID-19 community response team for Toronto homeless services and congregate living settings

BackgroundIndividuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women’s College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women’s College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships.MethodsConstructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical.ResultsData analysis revealed five main categories, 16 subcategories, and one core category. The core category “access to healthcare is a human right; understand our communities” emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building.ConclusionHospital-community programs can alleviate some of the ongoing health concerns faced by shelters – during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.

Physical therapy interventions for people experiencing homelessness to improve pain and self-perceived health status

BackgroundHomeless shelters have emerged as components of the social services network, playing an important role in providing health care to the homeless population. The aim of this study was to evaluate an individualized physical therapy intervention for people experiencing homelessness and to determine the relationship between self-perceived variables.MethodsPre and post study, setting at the “Santa y Real Hermandad de Nuestra Señora del Refugio y Piedad” homeless shelter in Zaragoza, Spain. Participants were people experiencing homelessness with musculoskeletal disorders who attended a physical therapy service at shelter facilities. A physical therapy program was implemented including health education, exercise and manual therapy, electrotherapy, thermotherapy and bandaging. Demographic variables (age and gender), nationality, employment situation, educational level, pain location, number of painful areas, feeling of loneliness (3-Item Loneliness Scale; values from 3 to 9), pain intensity (Numerical Pain Rating Scale [NPRS]; from 0 to 10) and self-perceived health (Clinical Global Impression [CGI]; from 1 to 7).ResultsSixty-four homeless people (age of 46.4 ± 10.9 years) participated in the study. Musculoskeletal pain was reported by 98.4% of subjects, with moderate pain intensities (6.1), and 48.4% presenting with pain at multiple sites. Perceptions of loneliness were low (3.7 ± 2.5) and self-perceived health status was moderately ill (3.5 ± 1.7). Positive significant correlations were identified between pain intensity and self-perceived health. The average number of sessions was 1.5 (± 0.8), with manual therapy (35.6%) followed by health education (23.5%) being the most frequently used techniques. Both pain and self-perceived health improved after treatment, even following a brief intervention.ConclusionsThis study demonstrates the potentially negative impact of untreated pain on the self-perceived health of homeless individuals with musculoskeletal disorders that should be targeted for consideration. The findings suggest that a paradigm shift in pain management, including a physical therapy service in shelters, is needed to address the rehabilitation demands of these individuals in a real-life context. This study was approved by the Aragon Ethics Committee (PI19/438) and performed according to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.

Estigma hacia habitantes de calle, consumo de drogas y género. Consecuencias en derechos humanos y salud pública

Objective: comprehend the stigmatization of the homeless population, its relationship with drug use, gender and its consequences from the perspective of the assistance personnel in Medellin. Methods: qualitative research with a descriptive-interpretative scope. Data were generated through focus groups. The information was analyzed with grounded theory techniques and contrasted with the scientific literature on the subject. Results: two conceptions of the homeless person emerged: disposable and citizen. About gender, the multiple stigmas towards women and the LGBTI population living on the streets were highlighted, and the consequences of stigmatization were described. Conclusion: Living on the street and having a lifestyle contrary to the dominant values, makes homeless people to be discriminated, dehumanized and corrected by society, which is worse when belong to non-hegemonic genders, this situation limits the guarantee of fundamental human rights, especially the right to health.

Interventions to improve the mental health of women experiencing homelessness: A systematic review of the literature.

Homelessness is a growing public health challenge in the United Kingdom and internationally, with major consequences for physical and mental health. Women represent a particularly vulnerable subgroup of the homeless population, with some evidence suggesting that they suffer worse mental health outcomes than their male counterparts. Interventions aimed at improving the lives of homeless women have the potential to enhance mental health and reduce the burden of mental illness in this population. This review synthesised the evidence on the effectiveness and acceptability of interventions which aim to improve mental health outcomes in homeless women. Five electronic bibliographic databases: MEDLINE, PsycInfo, CINAHL, ASSIA and EMBASE, were searched. Studies were included if they measured the effectiveness or acceptability of any intervention in improving mental health outcomes in homeless women. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. A narrative summary of the study findings in relation to the research questions was produced. Thirty-nine studies met inclusion criteria. Overall, there was moderate evidence of the effectiveness of interventions in improving mental health outcomes in homeless women, both immediately post-intervention and at later follow-up. The strongest evidence was for the effectiveness of psychotherapy interventions. There was also evidence that homeless women find interventions aimed at improving mental health outcomes acceptable and helpful. Heterogeneity in intervention and study methodology limits the ability to draw definitive conclusions about the extent to which different categories of intervention improve mental health outcomes in homeless women. Future research should focus on lesser-studied intervention categories, subgroups of homeless women and mental health outcomes. More in-depth qualitative research of factors that enhance or diminish the acceptability of mental health interventions to homeless women is also required.

IJCM_174A: Lifestyle risk factors among homeless adults in Chennai- A Cross Sectional Study

Background: India defines ‘homeless’ as those who do not live in Census houses, but rather stay on pavements, roadsides, railway platforms, staircases, temples, streets, in pipes, or other open spaces. According to 2018 GCC enumeration of urban homeless, there are 3764 men and 2962 women, in total 6726 adult population. As they have a relatively different lifestyle, it is essential to know about their lifestyle risk factors and their accessibility to healthcare. In order to attain our Sustainable Development goals, in particular SDG 3- it is essential to target the well being of the homeless population. Objective: To estimate the lifestyle risk factors among homeless population in Chennai. Methodology: All adults who were 18 years and above and who fit in the criteria for homeless where taken for the study and an Interviewer administered pre-designed questionnaire, under the following Socio Demographic Details, Behavioural Measurements which included tobacco use, alcohol consumption, diet, lifestyle advice and physical activity was used to ascertain the lifestyle risk factors among the homeless. Data was entered in MS excel and analyzed using SPSS-21. Results: Out of 341 participants, 70.7% were females,27.3% males and 2.1% transgender. 27.6% had a habit of smoking daily and among that 24.9% were using smokeless tobacco. 15% had a habit of drinking alcohol. In the past one year 57.2% had visited the hospital and 44% had visited a government facility. 27.3% did moderate work and 14.4% vigorious work. 1.5% had a habit of doing moderate exercise on a daily basis.76.8% and 54.8% had undergone screening for hypertension and diabetes mellitus respectively. Conclusion: Spreading awareness to the homeless population on lifestyle risk factors is essential to ensure their healthy living.

336 Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

INTRODUCTION: Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night. METHODS: Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, inhospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. RESULTS: Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]). CONCLUSIONS: Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.

Suicidal behavior in homeless population and its relationship with experienced aggressions: A seven-year longitudinal study.

IntroductionSuicide is a serious and complex public health issue that affects millions of people worldwide. Among the most vulnerable populations are homeless individuals (HIs), whose suicide rate is significantly higher than that of the general population.ObjectivesThe aim of this study was to analyze mortality and suicidal behavior in a cohort of HIs during a seven-year follow-up. Additionally, the study sought to identify variables linked to mortality in this population.MethodsThe study was conducted in the province of Girona, Spain, and included 154 HIs who were literally experiencing homelessness. Self-report questionnaires were used to gather sociodemographic data, assess suicide risk, and measure the severity of substance dependence. The follow-up was carried out between 2015 and 2022, collecting data on mortality, suicide attempts, episodes of overdose, and violence experienced from public health services (psychiatric and primary health care services).Results During the seven-year follow-up, 23 individuals (14.3% of the sample) passed away, with an average age at the time of death of 52.6 years. The main causes of death were cancer, suicide (excluding overdose), and accidental overdose. Methods used for suicide included drug overdose, jumping, and vein slashing. All deceased individuals had scores above the threshold on the Plutchik Suicide Risk Scale and had reported previous suicide attempts.Individuals who experienced violence during the follow-up period exhibited more severe suicidal ideation, more suicide attempts, and more non-lethal overdose episodes. Substance dependence, particularly cocaine dependence and dual pathology, was significantly associated with higher mortality.ConclusionsThis study reveals a high mortality rate among HIs, especially due to suicide and accidental overdose. The most significant variables related to mortality were suicidal ideation, the number of previous non-lethal overdoses, and substance use disorders, with cocaine dependence being prominent. The results underscore the need for specific prevention and treatment programs to address suicide risk factors and improve the mental health of homeless individuals. The importance of conducting interventions in specialized centers that detect and address suicide risk in this vulnerable population is also emphasized.Disclosure of InterestNone Declared

IJCM_87A: Immunization status among children living in streets of Chennai - A cross sectional study

Background: The homeless population of Chennai is the people who are living in the platforms, bus stands and other unused buildings in Chennai for more than three generations. Many of them lack basic amenities for their living, which makes them a vulnerable population especially the women and children. The children especially are prone to many communicable diseases as a result of their way of living Objective: To estimate the immunization status among the children of homeless population in Chennai. Methodology: The information about the clusters of homeless population is obtained from the Greater Chennai Corporation enumeration. Individual clusters are mapped in Zone 5 of Greater Chennai Corporation. Almost all the mothers of children of age up to 5 years are interviewed. Data collected using Epicollect5 data collection software. Results: The mean age of the children was 34.59 + 17.73 months. 45.4% were male children and 54.6% were female children.98.9% of the mothers registered their pregnancy and 100% delivered in the public facility. 93.4% registered their birth. 87.4 % of the children got enrolled in Anganwadis. 90.5% of the children were immunized up to age. Only one child (0.4%) didn’t get the birth dose of BCG. 18 children (6.6%) didn’t get their Measles Rubella vaccine not even once. 28 children (10.3%) didn’t get their second dose of Measles Rubella vaccine and Diptheria Pertussis Tetanus vaccine. Conclusion: The immunization coverage among homeless children upto 5 years is 90.5%. The coverage has to be strengthened in order to improve their quality of life