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These studies reported on 73 health screening or health assessment tools, across 11 domains: oral health [22,23,24,25,26,27,28,29,30,31,32]; health related quality of life, and health status [9, 33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]; nutrition [49,50,51,52,53,54,55,56]; psychological and cognitive function [9, 22, 34, 35, 41, 42, 44, 56,57,58,59]; substance use [28, 33,34,35,36, 51, 57]; injury [29, 30, 36, 58]; chronic conditions [33, 44, 45, 60, 57]; demography and anthropometry [34,35,36,37,38,39,40, 44, 49, 51,52,53,54,55, 60]; functional decline and frailty [9, 37, 38, 54]; hearing and vision [9, 36, 61]; and pelvic floor health . The MOS 36-item short-form health survey (SF-36). 2016;87(4):376–81. 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. Chronic pain among homeless persons: characteristics, treatment, and barriers to management. The findings have not been differentiated by age group, sex, location or geography (which limits comparative insights into variability by sex, and among homeless populations globally). Search across a wide variety of disciplines and sources: articles, theses, books, abstracts and court opinions. 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. J Rehabil Res Dev. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. Eleven assessment tools (reported in 13 articles) had been developed for, and/or validated in people experiencing homelessness. 1994;11(4):359–65. Google Scholar. Previous research from North America suggests that the majority of … Human health research must align with the ethical principles of beneficence, non-maleficence, health maximization, efficiency, and respect for autonomy, justice and proportionality . 1). Google Scholar provides a simple way to broadly search for scholarly literature. Duplicate articles were removed, and remaining articles were independently screened by title and abstract (AB and TD). This will ensure that valid data is available to inform health policies and healthcare initiatives that are likely to be effective. 1. Google Scholar. Lancet. Soc Indic Res. Not only could concerns be raised about the capacity and willingness of homeless people to complete written self-reports (because of literacy, vision or trust) but also question relevance to their circumstances. One third of this licencing fee is paid to N.L. A preliminary database search identified common key words and MeSH terms that were then applied to the main search. Further, additional clinical data from the CHAP booklet suggests an even stronger effect. We hypothesized that this would encourage beneficial patterns of general practice-driven activities, in particular increases in health promotion, disease prevention and case-finding activities, as well as appropriate management of these previously unmet health needs. AB, TD, SG, NB, MK, TB, CH, MS, TM were responsible for dual critical appraisal and data extraction. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations. This left 34 clusters (17 pairs) with 234 intervention adults and 219 control adults of whom 430 participants (95% of those recruited) were successfully followed up at 1-year. 2008;45(4):619–26. Int J Public Health. PubMed The information accessed and included in this systematic review is available via the references provided. G Parsons, N Lennox and D Rice performed the recruitment of participants and N Lennox, T Rey-Conde, M Green, D Rice, C Bain, R Bush and D Purdie designed the tools. It requires reviewers to identify the developmental literature on assessment instruments, and extract information on what psychometric properties were tested (and how), and what information is provided on utility. Few studies have reported on validated and reliable health screening and assessment tools, informed by input from people experiencing homelessness. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. BMC Public Health 19, 994 (2019). JAMA. 2004;125(5):1719–25. Control follow-up began on the median starting date of the corresponding intervention group cluster. This is the definitive research tool for nursing and allied health professionals. Baseline characteristics of adults with intellectual disability in the intervention and control arms of the CHAP trial. Indeed, a recent matched study reports benefits from a nurse-directed approach in the UK healthcare setting.10, To explore other ways to further enhance the healthcare of adults with intellectual disability we have developed a more complex health advocacy, education and record-keeping tool and are currently completing an RCT of its use in combination with the CHAP.22 This approach seeks to further enhance communication and knowledge retention and transfer especially in the long term. 2001;62(3-B):1586. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved. dWhere clinically indicated and according to national guidelines. Assessment is the foundation of health care. The search was restricted to human studies published in English, and was not limited by date or type of article. We thank the adults with intellectual disability, their families, carers and GPs, and the Endeavour Foundation. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined. The health assessment provides a wealth of data cost-effectively that can be used to tailor the wellness experience to each individual. Thus, tool utility for the target population also needs to be considered in terms of its language and literacy levels, how long it takes to complete the items, and how many items the tool includes. Australian Bureau of Statistics. Moher D, Liberati A, Tetzlaff J, Altman DG. Follow-up was for 1 year post intervention, with outcomes extracted from GPs’ clinical records. © 2020 BioMed Central Ltd unless otherwise stated. Aust Dent J. 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. 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). Int J Food Sci Nutr. A comprehensive health assessment gives nurses insight into a patient's physical status through observation, the measurement of vital signs and self-reported symptoms. It also includes finding out about diseases that run in the patient's family. Lancet. This review did not include research about children and adolescents (younger than 18 years) experiencing homelessness, or studies that assessed health services for people experiencing homelessness, or studies that described tools that aimed to diagnose health conditions. PubMed Homelessness is increasing globally. These definitions do not include people in hostels or shelters, people in campsites or other sites used for recreational purposes or organised protest, squatters or travellers . . Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. It also addresses emotional, mental and spiritual health. aFrom Endeavour Foundation unless otherwise stated. J Nurs Meas. Family/household structure 2. The McMaster critical appraisal instruments (designed for quantitative and qualitative designs) provided a ubiquitous approach to scoring methodological quality, without the need to use different tools for different designs (for instance the CASP suite). Homelessness is a serious global problem  that affects adults of all ages . Dams-O’Connor K, Cantor JB, Brown M, Dijkers MP, Spielman LA, Gordon WA. This study employs a participation and empowerment plan in order to conduct community assessment. These studies are highlighted for ease of identification. PLoS Med. 2006;21(1):61–4. The values themselves are not reported in the Reckoner, as the Reckoner is simply a way of summarising the amount and type of testing to which an instrument has been subjected during developmental phases. The effect of traumatic brain injury on the health of homeless people. 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. This overall aim of this review was to identify health screening and assessment tools that have been developed for, or used with adults experiencing homelessness. 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. 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. However, absolute frequencies were still fairly low, and the rate of cervical screening in the CHAP arm was actually little changed, so the excess over control rate may be artefactual. 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. 2006;26(4):150–4. McLellan AT, Luborsky L, O’Brien CP, Woody GE. Figueiredo RL, Lars SW, Quinonez C. Dental health of homeless adults in Toronto, Canada. 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)  and the Geriatric Oral Health Assessment Index (GOHAI) . Privacy People in buildings or other places not designed for habitation (such as stairwells, barns, sheds, car parks, cars, derelict boats, stations, or “bashes” which are makeshift shelters, often comprised of cardboard boxes). 1990;90(10):1387–92. Cook PF, Farrell E, Perlman J. Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. They included PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC. described the psychometric properties and utility of those tools. Ocular telehealth screenings in an urban community. Darnton-Hill I, Truswell AS. Med Care. 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. Identifying nutritionally vulnerable groups in case of emergencies: experience from the Athens 1999 earthquake. 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). The database search and screening process is summarized in the PRISMA flow diagram (Fig. cSummation of disease diagnosed excluding challenging behaviour and analysis by individual result in the loss of new diagnosis in four adults with intellectual disability who had two new diagnoses—three intervention and one control. The McMaster critical appraisal tool provided a standardised way of comparing methodological quality across diverse research designs. This is particularly problematic in dietary intake tools where the types of foods used to prompt memory may be inappropriate to circumstances of homelessness, and frequency and location of eating may be variable [50, 56, 60]. The psychometric properties and utility of the validated tools are summarized in Table 2. 2017;29(1):54–62. I. Premature mortality in homeless populations: a review of the literature. Background People with intellectual disability constitute ∼ 2% of the population. Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. There were no prospective stopping rules, nor any contact between researchers and participants during follow-up. PubMed Central Oxford: Oxford University Press; 2008. The best performing tool for the target population was the WHOQoL 100 or WHOQoL BREF (scoring 100%), followed by BDI II, SF-12 and SF-36, and then the ASI (all scoring 94%). 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%). Addressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. The results may be less applicable to adults with intellectual disability living in different circumstances, e.g. The intervention took place between August 1999 and March 2000. West J Nurs Res. 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. 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). Reliability and validity of the World Health Organization quality of life: brief version (WHOQOL-BREF) in a homeless substance dependent veteran population. (17) This new benefit supple-ments the “Welcome to Medicare” preventive visit, a one-time, comprehensive assessment offered to beneficiaries within the first 12 The whole condition of the patient is taken into consideration for ongoing wellness across the lifespan. Note: Values are percentages (numbers) unless stated otherwise. using a computerized random number generator. People ‘living rough’ have been shown to have symptoms of aging much earlier than the general population [4, 7, 9, 10]. Homeless who accessed a healthy living Centre in Swansea, South Wales: an assessment of the impact of oral ill-health. Heterogeneity of people experiencing homelessness supports the need for validated tools appropriate to specific subgroups, for example; different sex-age groups, or people with varying language and reading capabilities. Traumatic brain injury and cognitive impairment in men who are homeless. Magkos F, Arvaniti F, Piperkou I, Katsigaraki S, Stamatelopoulos K, Sitara M, et al. 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. Percentages and risk ratios (with 95% CIs) were used to summarise and compare rates of health-related events in the two arms of the trial as randomized. Luo Y, McGrath C. Oral health and its impact on the life quality of homeless people in Hong Kong. bOccurrence in previous year unless otherwise stated. 2009;63(11):943–8. Disabil Rehabil. Data from the CHAP tool itself were reviewed for purposes of validation and additional assessment of the process. Cookies policy. Two uncontrolled studies have evaluated general practice-based health assessments in this population and a further small matched study has demonstrated benefits using a nurse-driven approach.4,6,10 All reported increased disease prevention, identification and treatment among over half their participants. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. 2012;27(1):16–22. Reliability is about understanding variability and error in repeated measurement . Effects on assessing sensory impairment were especially striking (e.g. Spec Care Dentist. The authors declare that they have no competing interests. Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. Non-participants were very similar to those enrolled in their distributions by age, sex and IQ. 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. Richards W, Keauffling J. Longer follow-up studies are warranted to elucidate natural trajectories and to find predictors of complicated long-term trajectories of recovery. a 30-fold increase in hearing tests), and 22 new cases of sensory loss were detected compared with one among controls. Community Dent Health. We sought evidence of health promotion, disease prevention and case-finding activities and of appropriate interventions (as shown in Box 1) in both arms of the trial. Levorato S, Bocci G, Troiano G, Messina G, Nante N. Health status of homeless persons: a pilot study in the Padua municipal dorm. 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). 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). https://doi.org/10.1371/journal.pmed1000097. statement and Br Dent J. 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