Cardiometabolic disorders contribute to morbidity and mortality in people with severe mental illnesses (SMI), yet lifestyle-intervention efficacy in patients with SMI is unclear. Israel's unique ...mental-health rehabilitation hostels (MHRHs) provide housing to subjects with SMI. We tested how multi-component lifestyle intervention affects cardiometabolic risk-factors in at-risk SMI populations residing in MHRHs.
In a prospective, cluster-randomized, controlled study, six MHRHs, paired by residents' functioning level, were randomized to lifestyle intervention (nutrition education, physical education), or usual care. Subjects recruited included those with ≥1 of: BMI > 25 kg/m
; plasma triglycerides ≥150 mg/dL; HbA1c ≥ 5.7%; fasting plasma glucose ≥ 100 mg/dL and plasma HDL < 40
/ 50
mg/dL. Primary outcome was BMI change after 15 months; other outcomes were plasma lipids levels and glycemic control. Low cooperation in one MHRH pair led to their exclusion, the others were assigned to intervention or control.
Eighty residents were enrolled to intervention groups and 74 to control. Compared to baseline, intervention-arm participants experienced improvements in BMI (-0.83 kg/m
-1.36, -0.29
), triglycerides (-30.60 mg/dL -49.39, -11.82
) and LDL (-15.51 mg/dL -24.53, -6.50
) (all P ≤ 0.003). BMI improvement correlated with number of dietitian consultations (r = -0.30; P = 0.001). No significant differences were found between treatment arms in BMI (-0.46 kg/m
-1.11, 0.18
;P = 0.189), triglycerides (-24.70 mg/dL -57.66, 8.25
), LDL (-9.24 mg/dL -20.50, 2.03
), HDL and glycemic control.
Lifestyle intervention significantly improved BMI, LDL and triglycerides compared to baseline in at-risk MHRHs residents with SMI, yet compared to usual care the differences did not reach statistical significance. The association between the number of dietitian's consultations and BMI improvement suggests that programs should highlight participants' adherence.
This paper draws on ethnographic research in Chennai to unpack the pre‐emptive logic that shapes anti‐suicide interventions at hostels—dormitories—for college‐going women in this city. Its central ...contention is that a concern for the production of a presumed future becomes, in hostels, a governmental technology that is used to limit young women’s lifeworlds in the present. These regimes of intervention reinforce the unliveability of attachments, intimacies and affects that popular discourse and scaled‐up demographic narrative associate with the potential for suicide. Building from this, the paper also shows that such regimes engender feelings of suffocation and attrition among the young women who live in hostels. “Being slowly killed”, as they call it, draws attention to suicide not as a spectacular event but as a site where the terms of everyday life are remade.
This article focuses on the 'frictions' felt by international backpackers who have been stuck and locked-down while they were living and working in regional Australian hostels. Backpackers play a ...central role as both tourists and migrant workers in Australia, where they undertake significant periods of required farm work in order to extend their visas. They are a highly visible and long-standing mobile population in Australia and are relatively under-studied given their significance to tourism cultures and economies. Based on forty semi-structured interviews with backpackers living and working in Bundaberg, Australia, we explore how experiences of immobilities prior to and during the pandemic restrictions manifest as experiences of escalating and alleviating frictions. Friction is understood as an embodied and relational feeling of tension produced by a shortage of space. Friction has always been a feature of hostel living but prolonged lockdowns and inconsistent health messaging escalated frictions into open conflict. We propose that the concept of friction sits between mobilities and immobilities, and that particular mobility contexts exacerbate such frictions. The article contributes to ongoing discussions on pandemic immobilities and the interwoven concerns of tourism, migration, and labour mobilities.
Given the hepatitis C virus (HCV) burden and despite curative treatments, more efforts focused on scaling-up testing and treatment in homeless populations are needed. This project aimed to implement ...education and flexible on-site HCV testing, treatment, and follow-up for a homeless population in south London and to evaluate engagement, therapy initiation, and cure rates.
A mobile unit (van) for on-site HCV education, screening, treatment, and follow-up was placed on the street in a well-known homeless population areas from January 2018 to September 2021. Homeless was defined as living in temporary housing (hostel/hotel-based) or living on the street (street-based). Sociodemographic status, risk factors, comorbidities, concomitant medication, and data related with HCV treatment were recorded. Univariable and multivariable modeling were performed for treatment initiation and sustained virological response (SVR).
Nine hundred forty homeless people were identified and 99.3% participated. 56.2% were street-based, 243 (26%) tested positive for HCV antibody, and 162 (17.4%) were viremic. Those with detectable HCV RNA had significantly more frequent psychiatric disorders, active substance use disorders, were on opioid agonist treatment, had advanced fibrosis, and had lower rates of previous treatment in comparison with undetectable HCV RNA. Overall treatment initiation was 70.4% and SVR was 72.8%. In the multivariable analysis, being screened in temporary housing (odds ratio OR 3.166; P = 0.002) and having opioid agonist treatment (OR 3.137; P = 0.004) were positively associated with treatment initiation. HCV treatment adherence (OR 26.552; P < 0.001) was the only factor associated with achieving SVR.
Promoting education and having flexible and reflex mobile on-site testing and treatment for HCV in the homeless population improve engagement with the health care system, meaning higher rates of treatment initiation and SVR. However, street-based homeless population not linked with harm reduction services are less likely to initiate HCV treatment, highlighting an urgent need for a broad health inclusion system.
Access to physically, psychologically, and emotionally safe spaces is of critical importance for those experiencing the stress and stigmatisation of homelessness. Nightshelters, hostels and day ...centres provide material resources and respite from dangerous, stigmatising, public space. Yet these spaces also reinscribe a binarised, essentialist understanding of gender by selectively permitting hegemonic masculine behaviours. Structural and economic inequalities translate to significantly elevated homelessness risks among trans people, yet trans people are often under-represented among homelessness service users. Based upon interviews with 28 trans people about their experiences of homelessness spaces, I argue that a hegemonic centring of masculinities results in the physical and emotional safety of trans people of all genders becoming deprioritised. While trans people were not excluded from hostels, trans identity was seen as presenting risk. Thus, trans people are not regarded as normative occupants in mainstream homelessness spaces. Trans people were routinely subject to intense surveillance, and it was trans people, not cis perpetrators, who were relocated when violence occurred. Further. staff tacitly condoned transphobic marginalisation by cis service-users: violence from cis men was understood as inevitable, and normalised, with trans people responsibilised for conducting themselves in space to avoid provoking attack. This research extends hegemonic masculinity by considering spatiality, specifically through attending to the tension between the perceived needs of homeless cis men and the consequent exclusion of trans people from homelessness services. It identifies some specific areas where provision might improve, yet cautions that this must also avoid further disempowerment of homeless trans people.
This article investigates reproductive work in the Global South which thrives on the commodification of women’s reproductive bodies under local-global reproductive hierarchies, appropriating the ...process of reproduction for production. Through a qualitative study of commercial surrogacy in north India, it examines the lived experiences of surrogates within the capitalist social relations they are embedded in. Conceptualising surrogacy as reproductive labour which contributes to value generation, the article assesses labour relations at the workplace, for example hostels where surrogates ‘live and work’, and the mechanisms of recruitment, contracting and control which function through dense networks of social and material relations between various stakeholders. The weak bargaining power of surrogates and the immense power of fertility clinics and agents are compounded by the lack of effective regulation and the state’s prohibitionist policy. The article argues for protecting the rights of surrogates as workers rather than the recent ban on surrogacy imposed in India.
The Working Holiday Maker visa encourages young people from 44 nations to live and work for up to three years in Australia, contributing immensely to the temporary migrant workforce in regional ...areas. However, the conditions they experience while completing 88 days of mandatory ‘farm work’ to apply for visa extensions often place them in vulnerable situations and states of immobility that are counter to the perception of backpackers as mobile. Types of accommodation specifically for temporary migrant farm workers are known as working hostels and in some cases the ways in which they are administered have perpetuated the precarious and immobile situations in which backpackers find themselves. This article explores the lived experiences of backpackers who have undertaken farm work in the Bundaberg region, a new ‘hot spot’ for seasonal migrant labour. Drawing on ethnographic observations and interviews with 35 working holiday makers, the article advances the suggestion that recent shifts in hostelling accommodation practices and increased competition for agricultural jobs in the region place individuals in increasingly precarious states of immobility.
Hostels are an important part of the tourism industry but despite this, many of the metrics used to measure conventional hotels do not apply to the hostel sector. Therefore, this study developed a ...new methodology called HOSTELQUALITY for the classification of hostels. The method was applied in 10 establishments located in 3 tourist cities in Brazil. The method includes 29 questions in 10 dimensions: environment, leadership, security, cleanliness, location, social atmosphere, equipment, staff, price, and customers. It provides a five-level classification: Deficient, Weak, Average, Good, and Excellent. In addition, it provides graphical output. The results showed that half of the hostels received a good rating. The findings indicate that no establishment achieved a degree of excellence and demonstrated the new methodology’s applicability, providing a consistent and easy-to-interpret classification. This new methodology can be used on specialized websites, by institutions, and by governments to provide supporting information.
This study explored the implementation of psychological team formulation in two single-gender hostels for homeless individuals experiencing multiple complex needs. Nine hostel staff took part in two ...semi-structured interviews, before and after attending up to eight formulation meetings. Thematic analysis identified that staff perceived team formulation to increase their understanding of service users, led to some developments within the team, and encouraged staff to take a different approach to their work, perceiving themselves and service users more positively; however, the usefulness of formulation was restricted by the systemic limitations. Results suggest team formulation has notable benefits for staff in hostels supporting individuals with multiple complex needs.
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