Of 2122 identified studies, 37 were identified as potentially-relevant (Table 1). Included articles also explicitly described the study sample as experiencing homelessness as per those proposed by the Australian Bureau of Statistics’ (ABS) definition of homelessness and provided in the introduction of this paper [5]. This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness. cWomen only (intervention n = 93, control n = 107). The recent Rough Sleeping Statistics (Autumn 2017) for England [6] counts: People sleeping, about to bed down (sitting on/in or standing next to their bedding) or actually bedded down in the open air (such as on the streets, in tents, doorways, parks, bus shelters or encampments), and. 11), or. CAS Br J Nutr. Consequently, the demand for emergency and critical care services has increased. Cognitive functioning in a homeless population: the relationship of multiple traumatic brain injuries to neuropsychological test scores. Conclusions The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs’ attention to the health needs of adults with intellectual disability with concomitantly more disease detection. J Hum Nutr Diet. Few studies have reported on validated and reliable health screening and assessment tools, informed by input from people experiencing homelessness. Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people. Full details of participant flow are shown in Figure 1. It prompted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. 1989;262(14):1973–9. A preliminary database search identified common key words and MeSH terms that were then applied to the main search. Homelessness is a serious global problem [1] that affects adults of all ages [2]. These were then screened according to the review method. Both tools captured information leading to homelessness, employment options, education, children, housing options, and access to benefits. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. More than 2400 years ago the Athenians offered their capacity of assessing risk before making decisions (Bernstein, 1996).However, risk assessment and risk management as a scientific field is young, not more than 30–40 years old. Hwang SW, Colantonio A, Chiu S, Tolomiczenko G, Kiss A, Cowan L, et al. 1992;30(6):473–83. A holistic health assessment goes beyond focusing solely on physical health. Although we aimed to blind data collection, 70% of CHAP reviews were noted in GP consultation records making it possible those abstractors scrutinized these more closely. Luder E, Ceysens-Okada E, Koren-Roth A, Martinez-Weber C. Health and nutrition survey in a group of urban homeless adults. 1990;152(1):5–9. AB, TD, SG, NB, MK, TB, CH, MS, TM were responsible for dual critical appraisal and data extraction. Background: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. I. Whilst none had been validated with people experiencing homelessness, two warrant further development in this population; the Shortened Oral Health Impact Profile (OHIP-14 tool incorporating oral health-related quality of life interview) [22] and the Geriatric Oral Health Assessment Index (GOHAI) [27]. The McMaster critical appraisal tool provided a standardised way of comparing methodological quality across diverse research designs. All investigators had access to all study data and hold final responsibility for the decision to submit the manuscript for publication. Potentially-relevant articles were also identified through hand-searching of references cited in the reviewed articles. Consequently, many people experiencing homelessness also present with age-related declining physical and cognitive functions [4, 9, 10]. The comparison group received usual care only. Ware JE Jr, Kosinski M, Keller SD. Br Dent J. Sfeatcu R, Dumitrache A, Dumitrascu L, Lambescu D, Funieru C, Lupusoru M. Aspects of oral and general health among a community center for the underserved. 1996;34:220–33. Other aspects which assessors may need to consider are whether the tool is freely available and whether there are population norms for comparison. The National Health and Medical Research Council of Australia funded the study. However, it is important to view testing in terms of the real world experienced by the target population, as findings may be constrained by the capacity of individuals to interpret and complete assessments. Correspondence to 2004;192(7):471–8. dWhere clinically indicated and according to national guidelines. It is based on the CEBM hierarchy model in which the hierarchy of evidence for diverse research questions contains different types of research designs (fit for purpose). Rates of identification of new disease, investigations performed and medical services used. Public Health Nutr. The funding bodies had no influence on the design of the study, or collection, analysis, and interpretation of data or in writing the manuscript. 2009;6(7):e1000097. Hill KB, Rimington D. Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham. Google Scholar. Homeless who accessed a healthy living Centre in Swansea, South Wales: an assessment of the impact of oral ill-health. PubMed Google Scholar. Thiamin status of a sample of homeless clinic attenders in Sydney. Methodological quality of the included studies ranged from 57.1% [38] to 90.9% [9, 34, 39]. Of course, many of these changes are only intermediary steps in the pathway to clinically significant benefit, so we are unable to say with assurance that adults with intellectual disability will have achieved markedly better health because of this programme. The randomization procedure worked well in practice despite the relatively small numbers of clusters, and follow-up was virtually complete; thus, confounding and selection bias are unlikely to have affected the findings. A large number of assessment and screening tools for issues potentially related to the complex and varied health needs of people suffering homelessness was identified in this review. The definitions thus reflect the variability and changing circumstances of people who experience homelessness. aPerformed by the GP, optometrist or ophthalmologist. 2004;125(5):1719–25. Longer term studies with larger samples will be needed to demonstrate with surety that the anticipated reductions in morbidity and premature mortality do actually occur. For example, issues concerning literacy and memory recall (due to substance abuse, illness or dementia) may affect acceptability of the tool and the quality of data collected with it. Soc Sci Med. J Gen Intern Med. 2010;38(2):136–44. Visvanathan R, Ahmad Z. E-mail: Search for other works by this author on: The influence of intellectual disability on life expectancy, Series A, Biological sciences and medical sciences J Gerontol, Medical disorders of adults with mental retardation: a population study, Letter: only one quarter of women with learning disability in Exeter have cervical screening, Health screening for people with intellectual disability: the New Zealand experience, Audit and comprehensive health assessment programmeme in the primary healthcare of adults with intellectual disability: a pilot study. They comprised: Brain Injury Screening Questionnaire (BISQ) [58], Colorado Coalition for Homelessness Consumer Outcome Scale [34], Delighted-Terrible Faces Scale (DTFS) [40], Rural Homelessness Interview Schedule [35], Short Form Survey-12 (SF-12) and/or Short Form Survey-36 (SF-36) [39, 60, 41], World Health Organization Quality of Life 100 (WHOQoL 100) and/or World Health Organization Quality of Life BREF (WHOQoL-BREF) [26, 42, 43]. For the NHMRC III-1 studies the median quality score was 72.7% (25th % 64.9-75th % 81.8), whilst for the NHMRC III-2 studies the median quality score was 81.8% (25th % 72.7- 75th % 90.9). J Gen Intern Med. For instance, many validated tools are available to evaluate sleep quality, nutrition and hygiene in the general population. Accurate information on health needs can only be obtained by the use of psychometrically-sound tools applicable to this population. PubMed While 73 health screening and assessment tools were reported as having been used to collect information on a range of issues in people experiencing homelessness, only 11 had published evidence of psychometric testing applicable to this target population. 2009;301(17):1771–8. Longer follow-up studies are warranted to elucidate natural trajectories and to find predictors of complicated long-term trajectories of recovery. Diss Abstr Int. Gelberg L, Linn LS. JAMA. The funding source had no role in the study design. A comprehensive health assessment usually begins with a health history, which includes information about the patient's past illnesses or injuries (including childhood illnesses and immunizations), hospitalizations, surgeries, allergies and chronic illnesses. The usefulness of health screening and assessment tools to collect relevant information on particular individuals, and/or a specific target population is typically expressed in terms of validity, reliability and utility of application. Previous research from North America suggests that the majority of … The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined. While improvements in measures of healthcare practitioner cultural competency … They die prematurely, and often have a number of unrecognized or poorly managed medical conditions as well as inadequate health promotion and disease prevention. Merlin T, Weston A, Tooher R. Extending an evidence hierarchy to include topics other than treatment: revising the Australian ‘levels of evidence’. Human health research must align with the ethical principles of beneficence, non-maleficence, health maximization, efficiency, and respect for autonomy, justice and proportionality [72].
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