Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social ...determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights.
This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included.
The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed.
Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account.
Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged ...as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30-80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30 to more than 300 mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an "off-label" prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD.
Protective factors such as safe, stable, nurturing relationships and environments can prevent the long-term effects of adverse childhood experiences (ACEs). Recently, policymakers and ...practitioners have sought to better understand environmental level influences on exposure to ACEs, given the crucial role of social determinants of health in alleviating racial health inequities. Thus, this study seeks to understand how ACEs can be mitigated through neighborhood-level factors; it examines the relationships among ACEs, safe and supportive neighborhoods, and overall health status by race/ethnicity using a national data sample. Data were obtained from 30,530 households with children who participated in the 2018 National Survey for Children’s Health, a nationally representative survey. Using multivariable logistic regression, safe and supportive neighborhoods were assessed as potential moderators of the association between ACEs and overall health status by race/ethnicity. Two separate models were run for each moderator, controlling for sex, age, and gender of the child. The presence of a safe neighborhood weakened the association between ACEs and overall health status. This was demonstrated by lower odds of experiencing poor health. The presence of a supportive neighborhood showed a similar pattern. However, these patterns varied when disaggregating the data by race/ethnicity. This study underscores the importance of community-level prevention and intervention efforts to mitigate the health effects of ACEs. Public health efforts seeking to prevent poor health outcomes should consider the socio-environmental influences on health behaviors across the lifespan and continue to address the varying needs of historically disadvantaged populations.
Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) may impact brain development in children and adolescents into adulthood. While prior research demonstrated racial-ethnic ...disparities in ACEs, less is known about racial and ethnic differences in PCEs, particularly among adults. To better understand racial and ethnic differences in positive childhood experiences, this study (1) examined the prevalence of PCEs in an adult population in South Carolina (SC), a representative southern US state and (2) examined whether PCE exposure differed across racial and ethnic groups. Data were drawn from the 2019 SC Behavioral Risk Factor Surveillance System survey (BRFSS). Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions and unadjusted associations for each variable. Multivariable regression models were used to examine the association between race/ethnicity and PCEs. Our analyses revealed that people of color were less likely to be supported by friends, have an adult who took interest in them, and have a family who stood by them during difficult times. Education and poverty were significantly associated with feeling safe and protected, supported by friends, and having a family that stood by them during difficult times.
Conclusions
: Findings from this study may be used to promote health equity in early childhood through programs, policies, and practices that seek to address historic, systemic, and intergenerational trauma.
Increasing the number of racially and ethnically underrepresented students who pursue scientific graduate studies in programs focusing on science and aging offers an opportunity to increase the ...number of aging specialists while simultaneously promoting diversity in the research labor market and supporting new ideas. This case study aims to better understand how students participating in an academic preparatory program experience a writing class contextualized within (1) students' writing background and (2) students' future ambitions related to science and aging. The individually-tailored writing class was taught as a critical component of a comprehensive educational program that targets underrepresented racial and ethnic minority undergraduate students who are interested in pursuing scientific graduate studies in fields related to aging. The researchers conducted semi-structured qualitative interviews with students (
= 4) enrolled in the 24-month fellowship training program, which included participation in the writing course during the summer prior to their senior year of undergraduate education. All participants were young adult college students who identified as Black or African American and female. Using thematic coding, statements about professional writing skills were divided into four primary themes: (1) prior experiences, (2) class experiences, (3) future goals and ambitions, and (4) structural considerations. These themes suggest potential implications for effective interventions aimed to advance the writing skills and academic and career readiness of racially and ethnically diverse students entering fields of science and aging.
Experiencing parental deportation during childhood is associated with higher rates of mental health and behavioral health challenges. This adversity may be exacerbated by the uncertainty of what is ...happening to their deported parent and to their family system following a deportation experience. Effective clinical intervention can reduce the likelihood and/or severity of physical health, mental health and behavioral health difficulty caused by the trauma of parental deportation; however, clinicians have insufficient resources and guidance on effectively engaging with children and their families following parental deportation. Semi-structured qualitative interviews were conducted with English-speaking Latino individuals from the United States who experienced parental deportation between the ages of 6 and 17 (n = 10). Using interpretive phenomenology analytic procedures, three major themes emerged related to participants’ experiences of their family after their parent’s deportation: (a) I wish I knew what was happening, (b) I wish people had checked in on my emotions, and (c) I wish people had been supportive and included us in the conversation. These findings are examined from an ambiguous loss framework to provide clinical implications of children’s needs after parental deportation. Suggestions are offered from the adults who lost their parent to deportation as a child about what they needed following their loss. By understanding what children need in these moments of crisis, practitioners, providers, and others are better prepared to address this form of complex childhood adversity.
Introduction: The COVID-19 pandemic has exacerbated, and complicated stressors related to immigrant families' experience with U.S. immigration policies. Method: This article uses a critically engaged ...practice (CEP) framework to examine three policies and their implications for the health and well-being of immigrant families during the COVID-19 pandemic (a) Detention and Removal of Alien Parents or Legal Guardians policy, (b) Order Suspending the Right to Introduce Certain Persons from Countries where a Quarantinable Communicable Disease Exists, and (c) Field Guidance on Deportability and Inadmissibility on Public Charge Grounds. Results: Our article presents a CEP framework to empower clinicians in integrated healthcare settings to better understand and communicate policies with their patients. Discussion: Policy-informed CEP asks clinicians to (a) remain current with policy change; (b) have the ability to interpret policy and or policy change to clients; and (c) be aware of not only the primary effects of policy on the family but also the secondary impacts to their system. Clinical implications are provided.
Public Significance StatementMitigation strategies related to the COVID-19 pandemic have generated many new policies at the local, state, and federal levels. A Critically Engaged Practice perspective, asks clinicians to understand and communicate their understanding of relevant policies to their patients to increase their patients' access to resources and promote accurate information.
Children in foster care face disproportionate rates of biopsychosocial challenges but social and extracurricular activities (SEAs) may support their healthy development. The Reasonable and Prudent ...Parenting Standard (RPPS), a 2014 federal policy, aims to increase access to these opportunities for children in foster care. Analyses of statutes from 50 US states and the District of Columbia (n = 51) revealed similarities and differences in state-level RPPS policy implementation. Building on these findings, researchers conducted semi-structured retrospective telephone interviews with foster parents across one southeastern state (n = 20) to identify local retrospective perspectives on RPPS implementation. Using thematic inductive coding two unique themes emerged about SEAs prior to RPPS: 1) negative social impacts and 2) complicated activity approval processes. Three unique themes emerged after RPPS: 1) empowerment, 2) implementation disparities and 3) resource recommendations. Policy implications include the need to support foster parents by increasing resources (funding, transportation, access), clarifying liability and clarifying motivation expectations.
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