The Effect of Place of Service on Diabetic Screening Adherence in the Homeless Population

Abstract Background Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population. Methods Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals. Results All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up. A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified. Conclusion B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis. Disclosures Jeffrey Klausner, MD, MPH, Nothing to disclose

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Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094398 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4398

Author(s):

Kiara N. Mayhand ◽

Elizabeth A. Handorf ◽

Angel G. Ortiz ◽

Evelyn T. Gonzalez ◽

Amie Devlin ◽

...

Keyword(s):

Colorectal Cancer ◽

Study Participant ◽

Socioeconomic Indicators ◽

Cross Sectional ◽

Mixed Effect ◽

Total Study Population ◽

Screening Guidelines ◽

Individual Level ◽

Crc Screening ◽

Screening Adherence

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

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The impact of the 2016 Psychoactive Substances Act on synthetic cannabinoid use within the homeless population: Markets, content and user harms

International Journal of Drug Policy ◽

10.1016/j.drugpo.2021.103305 ◽

2021 ◽

Vol 97 ◽

pp. 103305

Author(s):

Rob Ralphs ◽

Paul Gray ◽

Oliver B. Sutcliffe

Keyword(s):

Synthetic Cannabinoid ◽

Homeless Population ◽

Psychoactive Substances ◽

The Impact

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Disparities in communication among the inpatient homeless population at a safety-net hospital

Journal of the National Medical Association ◽

10.1016/j.jnma.2021.02.009 ◽

2021 ◽

Author(s):

Cristina Vellozzi-Averhoff ◽

William W. Thompson ◽

Claudia Vellozzi ◽

Ike Okosun ◽

Kathy Kinlaw ◽

...

Keyword(s):

Safety Net ◽

Homeless Population ◽

Safety Net Hospital

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Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer

Annals of Behavioral Medicine ◽

10.1093/abm/kaab010 ◽

2021 ◽

Author(s):

Salene M W Jones ◽

Tammy A Schuler ◽

Tasleem J Padamsee ◽

M Robyn Andersen

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

High Risk ◽

Pap Smear ◽

Clinical Breast Examination ◽

Lower Odds ◽

Breast Examination ◽

Clinical Breast ◽

Financial Anxiety ◽

Screening Adherence

Abstract Background Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. Purpose This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. Methods Women (n = 324) aged 30–50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. Results More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). Conclusions Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.

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Cognition, Health, and Social Support of Formerly Homeless Older Adults in Permanent Supportive Housing

Innovation in Aging ◽

10.1093/geroni/igz049 ◽

2020 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Anita M Souza ◽

Jenny Hsin-Chin Tsai ◽

Kenneth C Pike ◽

Francesca Martin ◽

Susan M McCurry

Keyword(s):

Mental Health ◽

Older Adults ◽

Cognitive Impairment ◽

Global Mental Health ◽

Case Managers ◽

Supportive Housing ◽

Homeless Population ◽

Physical And Mental Health ◽

Permanent Supportive Housing ◽

Formerly Homeless

Abstract Background and Objectives Formerly homeless older adults residing in Permanent Supportive Housing (PSH) represent an invisible subsector of two distinct, yet related populations: the homeless population and the elderly population. Little research is focused on the complex health concerns facing this aging population within the homelessness response system. Of particular concern is the identification and support of individuals with cognitive impairment and co-occurring chronic conditions. We collaborated with a leading housing services provider to develop a systematic screening system for case managers to capture the cognitive, physical, and psychosocial health of older adults served within homeless housing programs. Research Design and Methods PSH residents aged ≥50 years in four sites screened as being without cognitive impairment on the Mini-Cog were enrolled. A brief demographic survey and selected PROMIS measures were used to characterize participants’ demographics, cognition, global physical and mental health, physical functioning, self-efficacy for social interactions, and instrumental support. PSH case managers were trained to recruit participants and collect data. PROMIS scales were scored using the Health Measures Scoring Service. Descriptive statistics, correlations, and one sample t-tests were performed. Results Fifty-three residents (mean age = 60.8 years, range 50–76 years) participated. The majority self-identified as male and were military veterans; 60% reported having a history of two or more episodes of homelessness. All PROMIS scores were significantly (p < .05) lower than reference U.S. population means, with global mental health and cognition having the lowest scores. Discussion and Implications Self-reported cognitive functioning and global mental health were residents’ greatest concerns. Strengthening housing case manager capacity to assess residents’ cognitive and health status could increase support for older adults in PSH. It is feasible to train PSH staff to conduct structured interviews to identify resident cognitive and health needs to help support this “invisible” population to successfully age in place.

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