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      Migrants Versus Homeless Population in Rehabilitation

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          Abstract

          Background Long term Rehabilitation, Chronic Care, Palliative Dept. Physiotherapy Units accumulate elderly debilitated polymorbide sometimes homeless patients and hypomobile individuals with different levels of personal hygiene. Ectoparasites increase suffering from long term care and social services. Patients and Methods The aim of this study was to compare the incidence of scabies among different types of hypomobile  and vulnerable populations and compare homeless and elderly to refugees and migrants containing of hypermobile and wounded populations. Results Among 22 homeless elderly, Group A; 42 homeless non-elderly high threshold Group B; 55 hypermobile migrants visiting a Rehabilitation and Physiotherapy Center, scabies was massively present in Group C. Among the first two Groups, Homeless A and Homeless B was rare. Increasing personal hygiene in stationary versus mobile Units, better Social Services and hygiene for homeless versus migrants, may be responsible for these unexpected findings. Conclusion Scabies has to be considered as the commonest ectoparasite followed by louse and mice among physiotherapy and rehabilitation dependent hypomobile elderly homeless clients. However, its incidence among homeless in CEE among migrants via the Balkan Route is incomparably low.

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          Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

          Summary Background Scabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015. Methods We did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate. Findings 230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5–92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38–4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people. Interpretation Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia. Funding Public Health England and British Skin Foundation.
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            Author and article information

            Journal
            Clinical Social Work and Health Intervention
            CSWHI
            Journal of Clinical Social Work and Health Intervention
            2222386X
            20769741
            October 31 2018
            October 27 2018
            October 31 2018
            October 27 2018
            : 9
            : 3
            : 67-70
            Article
            10.22359/cswhi_9_3_09
            © 2018

            This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

            Psychology, Social & Behavioral Sciences

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