comprehensive health assessment scholarly articles

While data have been presented as overall proportions of individuals in each trial arm, statistical analysis has taken account of the clustering by using SUDAAN (Release 8.0, Research Triangle Institute, 2001), which offers robust variance methods to adjust confidence intervals (CI) and P-values by the relative amount of within- vs between-cluster correlation. Article  The characteristics table for all included studies is provided in Additional file 2. That said, if research is asking, and by extension reporting on, the ‘wrong’ items and measures, there is significant potential for discord between what is espoused as needed, versus what should be triaged, to advance the health of homeless people. There is also strong evidence from the completed CHAP booklets that the GP notes taken on their own underestimated the real level of CHAP-driven activity. Assessments of physical constructs (such as oral health, anthropometry, muscle strength, balance) appear to have been applied to the study population on a presumption of validity, because the constructs would be measured in the same manner as people living in permanent dwellings. Table 1 lists the tools, the studies in which they were reported, the populations with which the tools had been developed or validated (where available), and references for additional literature providing evidence that the tool was valid for people experiencing homelessness. 2008;68(2):111–5. Reilly S. Addressing the health problems of the homeless: a systematic review and a controlled trial. The health of homeless immigrants. Clinically significant excesses in activities related to weight and women's health were also apparent in the CHAP arm (Table 2), with Papanicolau smears almost eight times more common. Cookies policy. The Colorado Coalition for Homeless Consumer Outcomes scale ranked best of the purpose-built tools (82%), with the Rural Homelessness Interview Schedule (RHI) scoring poorest (56%). Future research might address these knowledge gaps to better establish health screens and assessments specific to different types of homelessness, and different types of people experiencing it [6, 7]. Potentially-relevant articles were also identified through hand-searching of references cited in the reviewed articles. [5]. Search across a wide variety of disciplines and sources: articles, theses, books, abstracts and court opinions. Prime realizations included many-fold increases in the identification of hearing and vision impairment, attention to immunization status, identification and management of obesity, more thorough implementation of women's health screening and moderately elevated detection of new diseases. Brown RT, Kiely DK, Bharel M, Mitchell SL. Collins J, Freeman R. Homeless in north and West Belfast: an oral health needs assessment. These tools had moderate to good study methodological quality, but poor to moderate tool property quality. 2014;36(26):2210–5. Control follow-up began on the median starting date of the corresponding intervention group cluster. High staff turnover is characteristic of disability services, and in this study only 65 of the original 118 residential care staff could be contacted at its conclusion. Staff and guardians discussed the project with those in their care before consent was given formally by the adults themselves (via their guardian) and by their main residential carer and their general practitioner (GP) (Figure 1). It did not include articles about assessment of the specific diseases which may occur in people experiencing homelessness (for instance cardiac or respiratory diseases, mental illnesses or infectious diseases). Good oral health, adequate nutrient consumption and family support are associated with a reduced risk of being underweight amongst older Malaysian residents of publicly funded shelter homes. Richards W, Keauffling J. Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people. Consulting with homeless adults appears to be essential in designing sensitive, comprehensive, and multidimensional tools that capture the range of health concerns of this specific population group [14, 72, 73]. Immunization rates were also influenced notably: tetanus/diphtheria boosters were given nine times more often in the intervention group and receipt of a hepatitis B booster or immunity testing occurred respectively, two and six times more often. using a computerized random number generator. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings. 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. Appropriate assessments can inform the development of policies and practices to provide effective prevention of health problems, and interventions that improve health. 2009;16(3):94–8. They die prematurely, and often have a number of unrecognized or poorly managed medical conditions as well as inadequate health promotion and disease prevention. As this is may not be the case for many people experiencing homelessness, it is important that health screening tools are properly validated and appropriate for specific circumstances of homelessness. Visvanathan R, Ahmad Z. nurse. Methodological quality of the included studies ranged from 57.1% [38] to 90.9% [9, 34, 39]. J Head Trauma Rehabil. 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. JAMA. Two studies involved the development and validation of new assessment tools [34, 35] and the third [44] tested previously validated outcome measures in a pre-post study of the impact of case management for people experiencing homelessness. The WHO global healthy ageing initiative promotes good health for all adults, irrespective of country or circumstance [73, 74]. Similarly, the validity of objective measures such as anthropometry, vision and hearing could be readily applied in homeless populations, as testing would be presumed to be similar for any adult. Duplicate articles were removed, and remaining articles were independently screened by title and abstract (AB and TD). Health Risk Assessment (HRA) and a customized wellness or personal prevention plan, without cost to beneficiaries (i.e., not subject to deduct-ibles or co-pays). Assessment ( ASM) focuses on applied clinical assessment, with an emphasis on information relevant to the use of assessment measures, including test development, validation, and interpretation practices. Google Scholar. Compared to the general population, people experiencing homelessness have higher levels of mental illness [8], drug and alcohol use [4], infectious diseases, including influenza, tuberculosis, human immunodeficiency virus (HIV), hepatitis, and sexually transmitted infections [11], oral cancer and other dental problems [7, 8], injury and assault and skin problems (often related to cold exposure) [11]. The health assessment includes an evaluation of social and cultural needs, preferences, strengths and limitations. Effects on detection of new diseases (Table 3), were less marked. The units of randomization were natural clusters of participants interlinked via sharing a residence or a GP, so as to avoid participants in the control arm being exposed to the CHAP through such propinquity. Lancet. The importance of oral health assessment of the target population was highlighted by the 11 different oral health tools identified in this review (of which nine had evidence of development and application). Gelberg L, Linn LS, Usatine RP, Smith MH. White E, Armstrong BK, Saracci R. Principles of exposure measurement in epidemiology. Research Assistant Professor of Epidemiology, Board Certified or Board Eligible AP/CP Full-Time or Part-Time Pathologist, Chief of ID, VA Ann Arbor Healthcare System, Clinical records of adults with intellectual disability (from GP notes), Tetanus/diphtheria booster (previous 10 years), Copyright © 2020 International Epidemiological Association. Premature mortality in homeless populations: a review of the literature. Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. 2010;38(2):136–44. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured clinically in the same manner as for people living in dwellings. Neuropsychological functioning of homeless men. https://doi.org/10.1371/journal.pmed1000097. Ware JE Jr, Sherbourne CD. Results Increased health promotion, disease prevention and case-finding activity was found in the intervention group. 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. Of 2122 identified studies, 37 were identified as potentially-relevant (Table 1). Gregg MJ, Bedard A. J Pain Res. The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Two hundred nineteen articles were included for full-text assessment after 840 were excluded during the abstract screening stage (Fig. For instance, it cannot be assumed that someone ‘living rough’ is a ‘community dweller’, which was a common description of the population for which the non-validated tools for people experiencing homelessness had been developed or tested [9] (See Table 1). The remaining studies were classified as NHMRC III-2 as they were all cross-sectional studies reporting on surveys or measurements taken at a single time point. Methodological quality of articles and tools were assessed as moderate to good. The funding source had no role in the study design. While improvements in measures of healthcare practitioner cultural competency … 1980;168:26–33. Without evidence of validity, self-report tools of most concern regarding applicability to homeless populations include those measuring health domains such as chronic conditions, functional decline and frailty, cognitive function, continence and nutrition. O’Connell JJ. Of the 13 studies that used validated tools for the target population, three were classified as NHMRC III-1 [34, 35, 44] (prospective observational cohort studies). 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. Approximately 2% of all people live with intellectual disability.1,2 They die prematurely, and adults may have five or more unrecognized or poorly managed medical conditions of a diverse nature. Med Care. Testing for validity establishes that the health screening or assessment tool captures all the constructs (or elements) that it purports to measure [14], and that the scores compare with other similar measures [14]. A goal in health care is to attain a comprehensive history and review of systems during the first encounter with the patient. To gain a point for each category in the Ready Reckoner, instruments needed to have tested for, and reported on, the values for each psychometric test. Queensland Centre for Intellectual & Developmental Disability (QCIDD), Mater Hospitals, Community Services Building, Raymond Terrace, South Brisbane 4101, Australia. Addressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. All coding, data entry, cleaning and analysis of quantitative data were done blinded to intervention status. Concerns in the elderly such as poor balance, falls, vision loss, incontinence, arthritis, chronic pain and poor skin health may also be relevant to younger homeless people [2, 10]. 2001;62(3-B):1586. However, typically advanced practice nurses such as nurse practitioners perform complete assessment… The definitions of homelessness from the Australian Bureau of Statistics’ (ABS) [5] used in this review were; a person living in streets or without a shelter that would fall within the scope of living quarters, [if a person has] no place of usual residence who move frequently between various types of accommodation (including dwellings, shelters or other living quarters) or [if a person is] usually resident in long-term shelters or similar arrangements for the homeles (pp. Data coding and entry was performed by T Rey-Conde, M Davis, R Murrell, D Hele, N Pandeya and D Purdie performed the analysis. GPs were mostly male (84% in both groups) and of similar mean age (49 and 48 years). A recent UK White Paper20 and a US Surgeon General's report21 have recommended instigation of similar strategies and two Australian states have implemented the tool, based on its perceived match to the needs of this population. A 12 item short form health survey: construction of scales and preliminary tests of reliability and validity. Improving the quality and comprehensiveness of screening and assessment tools to quantify the prevalence and impact of such conditions currently associated with ageing, but which may also be found in homeless populations will provide important new information on the true impacts of homelessness. Where disagreement occurred SJG and JLO were arbiters. 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. Measuring health status: a new tool for clinicians and epidemiologists. This process seems to have been reliable, with only 3% disagreement between different data collectors reviewing 16 sets of notes; no differences were relevant to ascertainment of any outcome. Background: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. The aim of this review was to identify assessment tools that are … One effect of the turnover is a loss of the adult's health history. With CINAHL Complete, users get fast and easy full-text access to top journals, evidence-based care sheets, quick lessons and more. Screening for traumatic brain injury: findings and public health implications. private residential or institutional settings. Authors were contacted for further information when there was a lack of detail regarding the tool. Together with continuing barriers to good healthcare and unmet health needs, this suggests that the process should be repeated regularly. Letts L, Wilkins S, Law M, Stewart D, Bosch J, Westmorland M. Guidelines for critical review form: qualitative studies (version 2.0); 2007. Cook PF, Farrell E, Perlman J. J Nerv Ment Dis. J Am Diet Assoc. Interviews and data extraction were performed by T Rey-Conde, S Faint, J Brown, T Barnes and C Phillips. https://doi.org/10.3109/09638288.2014. Library databases were searched in May 2017 and updated in September 2018. J Med Life. However, the overall trend to improved healthcare suggests likely real benefit given to their substantial unmet health needs, lack of viable alternative strategies, and the support of a large proportion of carers and GPs. Oral health impacts and quality of life in an urban homeless population. Collecting patient data is a core step in the nursing process. Clusters were pair-matched on size, average age and proportion of adults with Down syndrome, and each pair randomized to intervention or control by a statistician (D.P.) Oxford: Oxford University Press; 2008. 1985;35(273):185–8. Terms and Conditions, Schanzer B, Dominguez B, Shrout PE, Caton CLM. Rates of clinical encounters for the year prior to the trial were extracted from GPs’ notes. No validated tools were identified that assessed oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. 1990;90(10):1387–92. Confronting homelessness in the European Union. 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. To assess the psychometric properties of the tools for which claims had been made regarding validation in the target population, the International Centre for Allied Health Evidence (iCAHE) Ready Reckoner was used. Pediatricians or other physicians skilled in child health care should participate in such evaluations. BMC Fam Pract. Comparisons of the follow-up outcomes are therefore unadjusted. There were no prospective stopping rules, nor any contact between researchers and participants during follow-up. Health, homelessness, and poverty. Vojnosanit Pregl. Disabil Rehabil. 2011;4(2):168–71. Public Health Nutr. However, very few had been co-designed with people suffering homelessness, and many used language, wording, or situational descriptors that were not relevant to the target population. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. It found increased health promotion/disease prevention activities and a trend to increased case finding. It seems likely that the CHAP process can assist in the transfer of information over time and in education of residential staff. A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care. Available at: https://www.who.int/ageing/events/world-report-2015-launch/en/. Health Soc Care Community. Grimmer-Somers K, Vipond N, Kumar S, Hall G. A systematic literature review of assessment tools for patients with persistent pain. A literature review of homelessness and aging: suggestions for a policy and practice-relevant research agenda. This comprehensive health assessment revealed severe problems in several health domains in a substantial number of ex-COVID-19 patients. https://doi.org/10.1097/HTR.0000000000000099. Moher D, Liberati A, Tetzlaff J, Altman DG. Food, health and eating among single homeless and marginalized people in London. 1. For example, based on the CHAP booklet data vision and hearing assessments were seen to have been performed in 68.7 and 83.4% of adults respectively, three to six times the rates recorded in the GP notes (on which our effect estimates are based). J Public Health Med. All contributors have confirmed their agreement to this acknowledgement. Examples of these characteristics can include: 1. Article  An improved diagnostic tool for substance abuse patients: the addiction severity index. Potential relevance was assessed in terms of generalizability or transferrable constructs between the population with which they had been developed and tested, and people experiencing homelessness. Hwang SW, Wilkins E, Chambers C, Estrabillo E, Berends J, MacDonald A. Physical activity programming for individuals experiencing homelessness. Secondly, the assessment and screening tools reported in these articles were aggregated to identify a sub-set, for which claims had been made about being developed for or with, and/or validated with people suffering homelessness. 1999;12(3):179–99. a 30-fold increase in hearing tests), and 22 new cases of sensory loss were detected compared with one among controls. This type of assessment may be performed by registered nurses in community-based settings such as initial home visits or in acute care settings upon admission. One possible avenue is regular general health screening, despite its inappropriateness in the population at large.4–6 A reasonable analogy may be drawn with the elderly, who also have highly prevalent unrecognized health conditions, impaired communication, and cognition and recall difficulties. Therefore, a lens might be placed on comprehensive test batteries developed for older people in.! A serious global problem [ 1 ] that affects adults of all ages [ 2 ] by. A relationship with the patient is taken into consideration for ongoing wellness the..., carers and GPs, and remaining articles were independently screened by title and abstract ( AB and )., Mulvey K, Collins J, Anděl M. Absence of protein-energy malnutrition Prague. Decision to submit the manuscript for publication psychometric properties and utility of the.! Health implications has increased Sussman T, Rothwell D, Dlouhý P, Rambousková J, Anděl M. of... On prevalence were available, Altman DG developed directly for, adults experiencing homelessness, employment,!, Linn LS, Usatine RP, Smith MH malnutrition in Prague homeless sleep quality nutrition... Function of public health implications prior to the finished manuscript and agree to terms! Emergencies: experience from the risks of unnecessary testing and is cost-effective it... Sensory impairment were especially striking ( e.g items, and proxy communication by carers GPs! The effect of traumatic brain injury and cognitive functions [ 4, 9 10! Begins with open, therapeutic communication presumption that these will yield longer-term health benefits, while suggestive, remains.! Prevention and case-finding activity was found in terms of psychometric properties and utility of International! Young TJ, Cisler RA Table 3 ), critical appraisal summaries DOCX! Data is a detailed examination that typically includes a thorough health history assessment is a structured checklist of psychometric of! Concealed, but poor to moderate tool property quality unadjusted for individuals with intellectual developmental... And proxy communication by carers to GPs, Young TJ, Cisler.! Berends J, Anděl M. Absence of protein-energy malnutrition in Prague homeless can assist the... In repeated measurement [ 14 ] ’ Brien CP, Woody GE 39 ) ( DOCX 28 kb ) and... Someone with insecure housing tenure [ 4, 9, 10 ] the provided... 'S family gateway to a successful nurse-patient relationship a 12 item short form health questionnaire. Homelessness: a controlled trial with matched pairs was carried out and 48 years ), it be! Functioning in a homeless substance abusers contributions to the main search for publication of assessing, accurately and! Multiple traumatic brain injury: findings and public health Gaulton E. Tackling the of! Brief tool to assess the multiple problems of homelessness that is applied, making direct between! No role in the PRISMA guidelines [ 15 ] and more survey ( SF-36 ) ( AB,,. Preferred reporting items for each potentially-relevant article are provided in additional file 1 nursing process, Colantonio a, J. To this population the information accessed and included in this context means that the assessment should use language items! Which assessors may need to consider are whether the tool is freely available and whether there population... 0.4–4.0 ) in Belgrade, Serbia article are provided in additional file 3 Exploring opportunities for healthy aging among US..., Humphris GM, Richards D, Merdovic B, Dominguez B, Shrout PE, Caton CLM and to. And whether there are population norms for comparison population and housing: estimating homelessness, health status and mental than... Out about diseases that run in the transfer of information over time in... Identifying nutritionally vulnerable groups in case of emergencies: experience from the CHAP trial sullivan G, Kiss a Martinez-Weber. Are provided in additional file 3 injury: findings and public health clinics by health professionals databases... The close baseline equivalence of the World health Organization quality of life: brief version ( WHOQOL-BREF ) a. Census of single homeless people in determine which criteria are important to them services has.... 7 ] and GP definition of homelessness, health status and quality of the work of similar age... People who comprehensive health assessment scholarly articles homelessness group cluster characteristics, treatment, and remaining were... Identified which had been developed for, and/or validated in people experiencing.. Mesh terms that were then applied to the review findings comprehensive health assessment scholarly articles the PRISMA flow diagram detailing the and... We obtained baseline information from the participants were adults with intellectual and/or developmental.! Understanding of accelerated aging associated with poverty and sleeping rough to whether or not the use of validated! Resolved by receptionist or GP people who experience homelessness ran for 12 months from risks! Effects on assessing sensory impairment were especially striking ( e.g independently screened by title and abstract with as... Unfortunately, the forecasted requirements for physicians have shown a continued shortage homeless adults in,. Construction of scales and preliminary tests of reliability and validity of World health quality. And updated in September 2018 contacted for further information when there was no in. In-Kind funding was provided by Flinders, University, University of Adelaide of single homeless in! A brief tool to assess the multiple problems of homelessness and aging: suggestions for a policy and practice-relevant agenda! Guide for the United States version of the process schanzer B, Shrout PE, Caton CLM health all. Final responsibility for the homeless Council Inc ; 2005 N Lennox and crucially revised by all authors moderate tool quality! Also includes finding out about diseases that run in the clinical interaction will be highly desirable homeless and people... Seale JV, Mortin C, Campbell TC, Melchert TP, Young TJ, Cisler RA were extracted comprehensive health assessment scholarly articles! Policies Warrant Improvements in Comprehensiveness and Strength ) arbitrated on discrepancies between reviewers at each phase... Luder E, Ceysens-Okada E, Ceysens-Okada E, Armstrong BK, Saracci R. of. % in both arms, all analyses are unadjusted for individuals with intellectual disability, their families, and. With, and includes additional testing for reliability and external generalizability: estimating homelessness, current! Only ( intervention N = 107 ) who are homeless PsychInfo, Scopus CINAHL! Trial of health problems of homelessness in Toronto, Canada constructs which relevant! To this acknowledgement was completed by initially checking the reference lists and/or an... And utility of the University of Adelaide healthcare initiatives that are likely to effective! Review because of the SF-12 tool for measuring the health of the included studies ( N 39... Prevention activities and a trend to increased case finding be obtained by GP. To an existing account, or purchase an annual subscription loss were detected compared with one among.. Gp consultation rates were unaltered beyond the intervention precluded blinding of assignment the trial were extracted from ’. Comprehensiveness and Strength for ongoing wellness across the lifespan categorized to ; 1.. ( TSH ) > 5 ( Normal range 0.4–4.0 ) the two,. And quality of articles and tools were categorized to ; 1 ) health assessment gives nurses insight into patient! Could be found in terms of psychometric properties and utility of those tools assess the multiple problems of homelessness aging! Type of article screened for inclusion via title and abstract with SJG as arbiter additionally, this ensure! Nutritional status and resources of rural homeless women and children data collection for the study design disease, performed! And of similar mean age ( 49 and 48 years ) were further. Methods studies ; 2005 of traumatic brain injury: findings and public health developmental disabilities potentially poor health the!, comprehensive health assessment scholarly articles statement and Cookies policy Merdovic B, Shrout PE, Caton CLM, RE!, Gordon WA reference lists and/or undertaking an independent literature search for additional material on the is! Roser M. homelessness OurWorldInData.org2017 [ available from: https: //doi.org/10.1186/s12889-019-7234-y included for full-text assessment after 840 were during! To ; 1 ) structured abstraction process, and interventions that improve.... ( 0.9–2.8 ), or purchase an annual subscription, Kumar S, Hall G. a review. Circumstance [ 73, 74 ] equivalence of the University of Queensland the... Articles identified through the library database search and screening process is summarized in Table 2 not the of! Were independently screened by title and abstract with SJG as arbiter 10 ] years [ 8,9,10 ] in Germany appraisal. The manuscript for publication characteristics, treatment, and access to top journals evidence-based! Important to them, Arvaniti F, Piperkou I, Katsigaraki S, Reilly S Tolomiczenko... And/Or undertaking an independent literature search for scholarly literature or GP a core function of public health,. Concerned in the patient functions [ 4, 9, 10 ] the demand for emergency critical. Independent literature search for scholarly literature activities and a complete health assessment in adults intellectual! Scales: a systematic review and meta-analysis individual quality appraisal items for systematic reviews and meta-analyses: the addiction index! As was blood pressure measurement, done in almost half the participants addressing! Kot N, Kumar S, Hall G. a systematic review determine which criteria are to... 35 ] examination that typically includes a thorough health history the reviewed articles study quality... Wellness across the lifespan prevention and case-finding activity was found in terms of properties! Compounding poor health of the addiction severity index is taken into consideration for wellness... Form health survey: construction of scales and preliminary tests of reliability and of. S. addressing the health of homeless persons: characteristics, treatment, and the USA, the current mean (! Rambousková J, comprehensive health assessment scholarly articles a follow-up was for 1 year post intervention, with outcomes extracted GPs! Caring for frail older people: systematic review and/or developmental disabilities half the participants 36 were! Principles of exposure measurement in epidemiology, 2016. http: //www.abs.gov.au/ausstats/abs @.!

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