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. . 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  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%  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  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 , drug and alcohol use , infectious diseases, including influenza, tuberculosis, human immunodeficiency virus (HIV), hepatitis, and sexually transmitted infections , oral cancer and other dental problems [7, 8], injury and assault and skin problems (often related to cold exposure) . 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  (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 , and that the scores compare with other similar measures . 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)  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. 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