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Botija M, Vázquez-Cañete AI, Esteban-Romaní L. [Homelessness as a determinant of health and its impact on quality of life]. GACETA SANITARIA 2024; 38:102388. [PMID: 38608386 DOI: 10.1016/j.gaceta.2024.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources. METHOD A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain. RESULTS Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card. CONCLUSIONS There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced.
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Affiliation(s)
- Mercedes Botija
- Departamento de Trabajo Social y Servicios Sociales, Universitat de Valencia, Valencia, España; Cátedra del Sistema Público Valenciano de Servicios Sociales, Valencia, España
| | | | - Laura Esteban-Romaní
- Departamento de Trabajo Social y Servicios Sociales, Universitat de Valencia, Valencia, España; Federación Española de Fibrosis Quística, Valencia, España.
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Nilou FE, Christoffersen NB, Pedersen PV, Ekholm O, Ahlmark NG. The Danish Health Survey among Marginalized People: Study design and respondent characteristics. Scand J Public Health 2024:14034948231224239. [PMID: 38326783 DOI: 10.1177/14034948231224239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
AIM The Danish Health Survey among Marginalized People is a nationwide health survey targeting people in marginalized life situations in Denmark. The aim of this paper is to present the study design, data collection methods and respondent characteristics of the survey, which was conducted in 2007, 2012, 2017 and 2022. METHODS The survey applies an outreach data collection approach which entails reaching out to social services (public and private) asking for their help with distributing self-administered paper questionnaires among their users. Themes include self-rated health, mental health, morbidity, pain, oral health, health behaviours, gambling problems, social relations, violence, sexual harassment and assault, suicide, and source of income. RESULTS The overall number of respondents has decreased slightly from 2007 (1290) to 2022 (1134). In all survey waves, men were overrepresented among the respondents. In 2007, women represented only 28%, which increased to 37% in 2022. There have been remarkable changes in the age distribution among respondents between 2007 and 2022. For example, the oldest age group (55-80 years) accounted for 15% of the respondents in 2007 and 40% in 2022. CONCLUSIONS Conducting surveys among marginalized people entails methodological challenges and ethical considerations. However, continually attempting to reach marginalized people in surveys by tailoring data collection strategies to their specific life situation is essential to gain insight into their health and well-being.
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Affiliation(s)
- Freja E Nilou
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Pia V Pedersen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Nanna G Ahlmark
- National Institute of Public Health, University of Southern Denmark, Denmark
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Brennecke A, Heinrich F, van Rüth V, Dost K, Graf W, Kowalski V, Rauch A, Langenwalder F, Püschel K, Ondruschka B, König HH, Bertram F, Hajek A. Determinants of health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic. Qual Life Res 2023; 32:3075-3083. [PMID: 37432522 PMCID: PMC10522712 DOI: 10.1007/s11136-023-03455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Thus far, there is very limited knowledge regarding homeless individuals during the COVID-19 pandemic, particularly related to the health-related quality of life (HRQoL). Thus, our aim was to evaluate HRQoL and to clarify the determinants of HRQoL among homeless individuals during the COVID-19 pandemic in Germany. METHODS Data were taken from the national survey on psychiatric and somatic health of homeless individuals during the COVID-19 pandemic-NAPSHI (n = 616). The established EQ-5D-5L was used to quantify problems in five health dimensions, and its visual analogue scale (EQ-VAS) was used to record self-rated health status. Sociodemographic factors were included in regression analysis. RESULTS Pain/discomfort was the most frequently reported problem (45.3%), thereafter anxiety/depression (35.9%), mobility (25.4%), usual activities (18.5%) and self-care (11.4%). Average EQ-VAS score was 68.97 (SD: 23.83), and the mean EQ-5D-5L index was 0.85 (SD: 0.24). Regressions showed that higher age and having a health insurance were associated with several problem dimensions. Being married was associated with higher EQ-VAS scores. CONCLUSIONS Overall, our study findings showed a quite high HRQoL among homeless individuals during the COVID-19 pandemic in Germany. Some important determinants of HRQoL were identified (e.g., age or marital status). Longitudinal studies are required to confirm our findings.
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Affiliation(s)
- Anna Brennecke
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Dost
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Graf
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Veronika Kowalski
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Rauch
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felicia Langenwalder
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Szende A, Janssen MF, Cabases J, Ramos-Goni JM, Burström K. Socio-demographic indicators of self-reported health based on EQ-5D-3L: A cross-country analysis of population surveys from 18 countries. Front Public Health 2023; 10:959252. [PMID: 36684894 PMCID: PMC9853521 DOI: 10.3389/fpubh.2022.959252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background Generic health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic differences in self-reported health using the EuroQol Group's archive of EQ-5D-3L population surveys that accumulated over the past two decades. Methods Analyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data. Results Statistically significant socio-demographic differences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries. Conclusion The EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic differences in self-reported health using various analytic methods. It offered a unique insight of inequalities by health dimensions.
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Affiliation(s)
- Agota Szende
- Global Health Economics and Outcomes Research, Labcorp, Leeds, United Kingdom
| | - Mathieu F. Janssen
- Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
- EuroQol Group, Rotterdam, Netherlands
| | - Juan Cabases
- Department of Economics, Public University of Navarra, Pamplona, Spain
| | | | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Roca Lahiguera D, Bilbeny de Fortuny B, Clusa Gironella T, Fuertes Rodriguez T, Silva Ruiz P, Franch-Nadal J. [Analysis of the homeless population health in a disadvantaged district of Barcelona: ESSELLA study]. Aten Primaria 2022; 54:102458. [PMID: 36137444 PMCID: PMC9493295 DOI: 10.1016/j.aprim.2022.102458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objetivo Conocer el estado de salud de la población sin hogar. Diseño Estudio descriptivo transversal. Emplazamiento Centro de Salud de Atención Primaria de Raval Sud (Barcelona). Participantes Personas mayores de edad en situación de sinhogarismo que han pernoctado en la calle en algún momento. Mediciones principales Datos sociodemográficos y tiempo en situación de sinhogarismo. Patologías crónicas, enfermedades infecciosas transmisibles, enfermedades mentales y trastornos por uso de sustancias adictivas. Cuestionario HAD sobre ansiedad y depresión. Cuestionario CVRS EQ-5D-3L. Estadística descriptiva. Resultados Se analizó la información de 146 pacientes con una media de edad de 51,6 años (DE = 12,8), 87% de sexo masculino y una media de 12 años (DE = 11,9) en situación de sinhogarismo. Se comparó la carga de enfermedad entre el perfil CAS Drogodependencias (Baluard) y el perfil sociosanitario (Arrels Fundació). Los usuarios del CAS presentaron mayores porcentajes de trastornos por uso de sustancias, enfermedades mentales y enfermedades infecciosas transmisibles. Las personas de perfil sociosanitario presentaron en mayor porcentaje enfermedades crónicas (respiratorias, cardiovasculares y oncológicas) y más de la mitad presentaron un trastorno por uso de alcohol y un mayor porcentaje de enfermedad asociada a su consumo. Conclusiones La población sin hogar presenta una elevada carga de enfermedad especialmente para enfermedad mental, adicciones y enfermedades infecciosas transmisibles. Creemos que son necesarios estudios para evaluar el exceso de enfermedad respecto a la población general con sus costes derivados y el diseño de nuevas estrategias para atender dicha carga de enfermedad y su especificidad.
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Affiliation(s)
- Daniel Roca Lahiguera
- Centro de Atención Primaria (CAP) Raval Sud, Institut Català de la Salut, Barcelona, España; Centro de Atención y Seguimiento de las Drogadicciones Baluard (CAS Baluard), Barcelona, Asociación Bienestar y Desarrollo (ABD). Agencia de Salud Pública de Barcelona (ASPB), Barcelona, España.
| | | | - Thaïs Clusa Gironella
- Centro de Atención Primaria (CAP) Raval Sud, Institut Català de la Salut, Barcelona, España
| | | | - Pau Silva Ruiz
- Centro de Atención Primaria (CAP) Raval Sud, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Centro de Atención Primaria (CAP) Raval Sud, Institut Català de la Salut, Barcelona, España; Unitat de Suport a la Recerca de Barcelona, Fundació IDIAP Jordi Gol, Barcelona, España
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Bisevac E, Lazovic M, Nikolic D, Mahmutovic E, Dolicanin Z, Jurisic-Skevin A. Postacute Rehabilitation Impact on Functional Recovery Outcome and Quality of Life in Stroke Survivors: Six Month Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091185. [PMID: 36143861 PMCID: PMC9505174 DOI: 10.3390/medicina58091185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study aimed to examine the impact of postacute rehabilitation duration on the outcome of the functional recovery and patients’ quality of life after the stroke. Materials and Methods: One hundred patients (52 females, 48 males, mean age: 66.5 ± 7.3; range 53 to 79 years) who experienced a stroke (50 with ischemic stroke (IS) and 50 with intracranial hemorrhage (ICH)) took part in the study. Patients (treated with postacute rehabilitation measures for six months) were examined after one, three, and six months of postacute rehabilitation. Functional independence was measured using the functional independence measure (FIM) test, while the EQ-5D-3L questionnaire was used to assess the quality of life. Results: Patients with ICH had a slightly lower FIM score (FIM motor = 29.8 ± 11.8; FIM cognitive = 14.4 ± 4.6) on admission compared to patients with IS (FIM motor = 41.8 ± 18.8; FIM cognitive = 18.7 ± 6.3), but, after six months of postacute rehabilitation, patients with ICH reached an approximate level of functional independence (FIM motor = 53.8 ± 14.4; FIM cognitive = 25.8 ± 4.7), as did patients with IS (FIM motor = 67.6 ± 16.4; FIM cognitive = 29.2 ± 4.0). The motor and cognitive FIM, as well as quality of life, was statistically significantly increased at all four measurement points (p < 0.001). Furthermore, there is a statistically significant connection between functional independence and quality of life at all tested times. Conclusion: Patients achieved the highest degree of functional independence after six months. Furthermore, our findings point out that inpatient rehabilitation as well as outpatient rehabilitation are effective in functionality and quality of life improvement after a stroke; thus, both should be emphasized and regularly implemented.
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Affiliation(s)
- Emir Bisevac
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Milica Lazovic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
- Institute for Rehabilitation, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
- Correspondence:
| | - Elvis Mahmutovic
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Zana Dolicanin
- Department of Biomedical Sciences, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Aleksandra Jurisic-Skevin
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia
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