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      Homeless population: characterization and contextualization by census research Translated title: Población en situación de calle: caracterización y contextualización por investigación censal Translated title: Pessoas em situação de rua: caracterização e contextualização por pesquisa censitária

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          Abstract

          ABSTRACT Objectives: to analyze characteristics of homeless people and factors associated with living on the streets. Methods: a census-type sectional survey carried out between 2015 and 2018, in the municipality of Maringá-Paraná. A total of 701 homeless answered a structured questionnaire with sociodemographic data, living conditions, and drug use. We used Pearson’s correlation test for the association analysis of the variables at a 95% confidence level. Results: men (90.7%) the average age of 37.7 years had been homeless for an average of 5.39 years. Most had little education (54.2%), and homelessness was due to drug use (47.2%) and family disagreements (38.9%). Conclusions: drug use and family disagreements were the main reasons for homelessness. Time on the street, gender, and drugs were associated with a negative correlation to be homeless; and age, mean daily income, the number of daily meals, having been in prison, and having an income source were associated with positive correlation.

          Translated abstract

          RESUMEN Objetivos: analizar las características de las personas en situación de calle y factores asociados a la vida en las calles. Métodos: investigación seccional del tipo censal, realizada entre 2015 y 2018, en el municipio de Maringá-Paraná. Un total de 701 personas en situación de calle ha respondido a un cuestionario estructurado con datos sociodemográficos y condiciones de vida y uso de drogas. El test de correlación de Pearson ha sido utilizado para el análisis de asociación de las variables con nivel de confianza de 95%. Resultados: hombres (90,7%), con edad media de 37,7 años, estaban en situación de calle hace 5,39 años. La mayoría tenía escasa escolaridad (54,2%), y la situación de calle se debía al uso de drogas (47,2%) y a los desentendimientos familiares (38,9%). Conclusiones: el uso de drogas y los desentendimientos familiares han sido los principales motivos para la situación de calle. El tiempo en la calle, sexo y drogas han sido asociados a una correlación negativa para la situación de calle; y edad, renta media diaria, número de comidas diarias, tener sido preso y tener una fuente de renta han sido asociados a la correlación positiva.

          Translated abstract

          RESUMO Objetivos: analisar características das pessoas em situação de rua e fatores associados à vida nas ruas. Métodos: pesquisa seccional do tipo censitário, realizada entre 2015 e 2018, no município de Maringá-Paraná. Um total de 701 pessoas em situação de rua respondeu a um questionário estruturado com dados sociodemográficos e condições de vida e uso de drogas. O teste de correlação de Pearson foi utilizado para a análise de associação das variáveis com nível de confiança de 95%. Resultados: homens (90,7%), com idade média de 37,7 anos, estavam em situação de rua há 5,39 anos. A maioria possuía pouca escolaridade (54,2%), e a situação de rua se devia ao uso de drogas (47,2%) e a desentendimentos familiares (38,9%). Conclusões: o uso de drogas e os desentendimentos familiares foram os principais motivos para a situação de rua. O tempo na rua, sexo e drogas foram associados a uma correlação negativa para a situação de rua; e idade, renda média diária, número de refeições diárias, ter sido preso e ter uma fonte de renda foram associados a correlação positiva.

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          Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis

          Summary Background Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. Findings Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42–13·30; I 2=94·1%) in female individuals and 7·88 (7·03–8·74; I 2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40–9·37; I 2=98·1%) and women (18·72; 13·73–23·71; I 2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). Interpretation Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. Funding Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.
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            Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes.

            This study examines the prevalence of alcohol and drug disorders among homeless veterans entering the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program and its association with both housing and clinical outcomes. A total of 29,143 homeless veterans were categorized as either having: no substance use disorder, only an alcohol use disorder, only a drug use disorder, or both alcohol and drug use disorders. Veterans were compared on housing and clinical status prior to admission to HUD-VASH and a smaller sample of 14,086 HUD-VASH clients were compared on their outcomes 6 months after program entry. Prior to HUD-VASH, 60% of program entrants had a substance use disorder and 54% of those with a substance use disorder had both alcohol and drug use disorders. Homeless veterans with both alcohol and drug use disorders had more extensive homeless histories than others, and those with any substance use disorder stayed more nights in transitional housing or residential treatment in the previous month. After six months in HUD-VASH, clients with substance use disorders continued to report more problems with substance use, even after adjusting for baseline differences, but there were no differences in housing outcomes. These findings suggest that despite strong associations between substance use disorders and homelessness, the HUD-VASH program is able to successfully house homeless veterans with substance use disorders although additional services may be needed to address their substance abuse after they become housed.
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              Prevalence and Correlates of Substance Use in Homeless Youth and Young Adults

              Substance use is higher among homeless youth than among the general population. Although substance use has been well studied, little is known about the risk factors associated with specific substances used by homeless youth, particularly in the Houston, Texas, area. Therefore, we conducted this study to examine the rates of lifetime and past-month substance use in a sample of homeless youth in Harris County, Texas, and examine the relations between substance type and race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma history. Participants were recruited during October and November 2014 as part of the study YouthCount 2.0! and completed a survey to assess demographics, stress, abuse, substance use, and risk behaviors. The sample (N = 416) was predominantly young adult (13-17 years old: 55 and 18-24 years old: 361), African American (54.5%), and male (55.9%). Nearly one quarter identified as lesbian, gay, bisexual, or questioning (n = 102). Over a third of youth had used alcohol (38%) or marijuana (36%) in the past month, and 36% had ever used synthetic marijuana. Bivariate analyses showed that substance use was significantly associated with race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma scores. Youth in this study had lower rates of alcohol and some substance use than other samples of homeless youth, although use still exceeded national rates for housed youth. Substance use prevention interventions for homeless youth should be trauma informed and include housing navigation and stress management strategies. The most at-risk subgroups included street-dwelling and lesbian, gay, bisexual, or questioning youth.
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                Author and article information

                Journal
                reben
                Revista Brasileira de Enfermagem
                Rev. Bras. Enferm.
                Associação Brasileira de Enfermagem (Brasília, DF, Brazil )
                0034-7167
                1984-0446
                2020
                : 73
                : 5
                : e20190236
                Affiliations
                [2] Maringá Paraná orgnameUniversidade Estadual de Maringá orgdiv1Observatório das Metrópoles Brazil
                [1] Maringá Paraná orgnameUniversidade Estadual de Maringá Brazil
                Article
                S0034-71672020000500163 S0034-7167(20)07300500163
                10.1590/0034-7167-2019-0236
                32609214
                3a850528-b143-45fa-8765-1b03b9cae5a6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 November 2019
                : 31 March 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 0
                Categories
                Original Article

                Censuses,Drogas Ilícitas,Vulnerable Populations,Censos,Public Health Nursing,Street Drugs,Enfermería en Salud Pública,Personas en Situación de Calle,Homeless Persons,Pessoas em Situação de Rua,Enfermagem em Saúde Pública,Populações Vulneráveis,Poblaciones Vulnerables

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