Health and lifestyle issues as risk factors for homelessness.

BACKGROUND: The objective of this study was to test the hypothesis that there are health and lifestyle issues among homeless persons that differentiate them from other segments of the population and that can be described as risk factors for homelessness. METHODS: This case-control study investigated health and lifestyle issues in a panel of patients visiting a health care clinic for homeless persons. The same information was collected from a panel of county indigent patients and an equal number of privately insured patients enrolled in a nearby academic family practice center. RESULTS: We found significant differences among these three groups. Differences in health problems were evident, as significantly more homeless persons reported mental health, drug and alcohol abuse, and smoking problems. There were no differences in the prevalence of other general medical conditions as listed by the patients. Homeless persons were younger than the control group respondents and more likely to be male, a member of a minority group, and unmarried. The childhood experiences of homeless persons were distinctive; they were more likely to have lived in a group home or some other nonfamily situation, considered themselves to have been delinquent, run away from home, been expelled from school, or been placed in reform school. The same held true for having been in jail as an adult. They had significantly less education, their job experiences were in manual and unskilled arenas, and they were more likely to have a gambling problem. A continuum of risk also appeared in that for the most part the characteristics and experiences of the indigent group members ranked in frequency between those of the homeless and insurance groups. CONCLUSIONS: Causes of homelessness appear to be multifactorial. Issues related to mental health, alcohol, nicotine, and other drug and substance abuse could be responsible for their medical problems, whereas other lifestyle issues might be regarded as risk factors for homelessness.

Risk factors for homelessness: a study of families of origin.

OBJECTIVE: This study's objective was to test the hypothesis that there are health issues and other factors in families of origin that have an association with, and may be risk factors for, homelessness. METHODS: This case control study identified risk factors in a group of homeless patients at a health clinic for the homeless. Two comparison groups from an academic family practice center were included. One comparison group was county indigent patients, and the other was patients who had health insurance. RESULTS: Significant differences in families of origin among these three groups were identified. On univariate analysis, homeless persons were found to have an increased prevalence of alcoholism in the family of origin, earlier departure from the home, minority status, a self-described negative childhood, experiences of abuse as a child, high birth order in large families, less parental education, less-skilled parental occupations, less feeling of love in the childhood family, less likelihood of the father being in the home, more risk of the father having been in jail, and less identification with a religious group. Multivariate analysis revealed that compared to the study groups, the following family of origin factors were associated with homelessness: ethnic group, alcoholism, feeling loved as a child, and having one's father in jail. CONCLUSIONS: Homelessness is a multifactorial issue, but risk factors can be identified that may distinguish individuals at increased risk. Root causes may begin in childhood and be related to the family of origin.

Christian mission hospitals as family practice educational resources.

With the worldwide family practice movement, a need has arisen to develop new residency training programs in economically developing countries. Christian mission hospitals exist in many areas where there is a need for more family physicians. These hospitals have been providing service and education, and some are now becoming training sites for family physicians. Currently, seven such institutions have operational family practice residency programs, all of which welcome personnel exchanges with faculty or residents in North American training programs. Christian mission hospitals with family practice residency programs exist in South America, Asia, and Africa.

Persistent scabies in nursing home patients.

Persistent scabies outbreaks in extended care facilities result from multiple factors: atypical presentations in the elderly, leading to delayed or inaccurate diagnosis; incomplete or ineffective treatment of the patient and exposed population; and failure to coordinate notification, education, treatment, and disinfection. A case report of scabies in an elderly resident of an extended care facility illustrates various types of scabies manifestations, the advisability of obtaining diagnostic scrape preparations, and the efficacy and safety of permethrin. Guidelines for an aggressive and comprehensive effort for eradication are offered.

Success strategies for departments of family medicine.

Strong departments of family medicine in academic medical centers help assure the future scope and quality of family practice patient care, the ongoing evolution of family medicine as a scholarly discipline, and a continued flow of qualified medical school graduates into family practice residency programs and eventually into practice. This report presents key strategies of six successful departments of family medicine and describes the methods and skills considered important by the leaders of these departments. Common themes that emerge are (1) recruit and mentor the best faculty, (2) build a reputation for clinical excellence of faculty and residents, (3) become part of schoolwide curriculum activities, (4) establish a scholarly presence, and (5) develop networks of support.

Imipramine treatment of ADHD in a fragile X child.

Fragile X syndrome, an X-linked genetic disorder, is the third most common cause of mental retardation. The following is a case of a 6-year-old boy with fragile X syndrome and its characteristic cognitive and behavioral symptomatology, including attention deficit hyperactivity disorder. In addition, this child experienced initial insomnia and nocturnal enuresis, problems not previously reported with fragile X. Previous pharmacological treatment of the syndrome's behavioral difficulties and attention deficit has included stimulants, folic acid, and neuroleptics. This is the first report of the successful use of imipramine. Imipramine also improved the boy's insomnia and enuresis, whereas methylphenidate caused an overall worsening of his condition.

Children from disrupted and adoptive homes on an inpatient unit.

Among 375 children and adolescents admitted to a psychiatric hospital inpatient unit, the proportion of adopted children was considerably higher than that of a general pediatric population or of census figures, and the majority of nonadoptees were from disrupted homes. Based on a review of case records, adoption and family disruptions appear to increase significantly the length of hospitalization and to shift diagnoses toward behavioral disturbances. Implications for prevention and treatment are considered.

The educational opportunities in a departmental program of health care for the homeless.

Persons who live on the streets and are homeless present many challenges to providers of health care. This paper describes a 14-year ongoing project in the Department of Family, Community, and Emergency Medicine at the University of New Mexico School of Medicine. This small clinic started in an inner-city rescue mission and subsequently has progressed to a much larger health care project for the homeless. Experience in this setting demonstrates that such a site can provide service to the homeless, while at the same time providing educational experiences for medical students and residents and an opportunity for academic research. This project can be duplicated in any academic medical center to provide both service and education.

Methylphenidate plasma concentrations in chronically and acutely treated latency-age children.

In 5 latency-age boys, methylphenidate plasma concentrations following multiple doses of methylphenidate were consistently higher than those obtained after a single dose. Pharmacological and clinical implications are discussed.

Hyperactivity and child abuse.

The role of a child in his/her physical abuse was reviewed with particular attention to hyperactive children. A retrospective analysis of the records of children referred to a university-based hyperactive children's clinic revealed that children both with and without Attention Deficit Disorder (ADD) were more often physically abused than children in the general population. The period prevalence of physical abuse in children with ADD did not differ significantly from that in children without ADD. This suggests that hyperactivity may either contribute to, or result from, physical abuse.

Clinical pharmacy in the family practice residency programs.

A descriptive study of all family practice residencies in the United States was conducted to determine the level of teaching by clinical pharmacists. Ninety percent of the programs were covered, and 29 percent of them had teaching involvement by pharmacists. Two thirds of all pharmacists held an academic appointment. One half of the pharmacists had a Doctor of Pharmacy degree. Three fourths were under 36 years of age and the salary ranged from +15,000 to over +27,000. Duties of the pharmacists were extremely varied. In general, residency directors reported that adding clinical pharmacy to the teaching program was a positive asset.

The dental technician in Australia.

The training, employment and distribution of dental technicians in Australia is described. Since 1945 illegal practice by dental technicians has been widespread particularly among a group of technicians who operate one-man surgeries and operate illegally full time. Legislation has now been introduced in Tasmania, Victoria and New South Wales to permit registered technicians to make dentures direct to the patient and similar legislation is imminent in South Australia. The hope is expressed that the trend away from a technician being employed on the premises by the dental practitioner may be reversed, and that with the increasing sophistication of dental treatment and the technician being treated much more as a full member of the dental team, his interest and job satisfaction can be significantly improved.

Double-blind evaluation of the safety and hypnotic efficacy of temazepam in insomniac outpatients.

1 Efficacy of temazepam 30 mg at night as an hypnotic was compared with placebo in 55 out-patients with insomnia. The study was double blind, with two comparable groups of patients established by random allocation. Placebo and medication were taken for 4 consecutive nights and sleep questionnaires were completed the next day. 2 Patients reported that temazepam was more effective than placebo in reducing the difficulty of falling asleep and improving sleep maintenance. They also indicated that they awoke less and were less disturbed by early morning awakenings reported as a group that the average duration of sleep was increased by 1 hour. 3 The patients receiving temazepam reported being more alert in the morning and for the entire day than with placebo.