Subgroups of tenants at risk of eviction due to rent arrears in five Dutch cities: A latent class approach

This study identifies subgroups of tenants in a sample of 495 tenants at risk of eviction, due to rent arrears, by 16 housing associations in five Dutch municipalities, and examines the attuning of services to the needs of the tenants in these subgroups. Latent class analysis with eight known risk factors for eviction identified five subgroups of tenants, which can be characterised as young immigrants, native Dutch tenants with little support, highly educated native Dutch tenants with much support, depressed tenants with little support and highly educated mentally stable older single tenants. The young immigrants reported the highest number of unmet care needs; the highly educated native Dutch tenants with much support, on the other hand, mentioned the least unmet care needs. This study demonstrates the diversity of a population of tenants at risk of eviction. Together with the differences in care needs, this indicates the necessity to develop targeted and personalised interventions to prevent evictions.     

Developing homelessness prevention practice: combining research evidence and professional knowledge

This paper presents recommendations of three kinds for the development of homelessness prevention: for practice changes, for the concerted development of evidence on the effectiveness of different measures, and for a more systematic approach to the identification and dissemination of good practice. The recommendations were developed through consultation with health-care, social service and housing provider staff. They were asked to comment on the results of a study of 131 newly homeless people, which showed that there were five prevalent 'packages of reasons' that created distinctive 'pathways' into homelessness and concluded that some cases were preventable. This article outlines the principles of homelessness prevention and recent British policy initiatives in the field, summarises the research methodology and relevant findings, and describes the consultation. The final section discusses the discrepancy between the high priority that homelessness prevention currently receives and the primitiveness of both the evidence base and the arrangements for good practice dissemination.     

Housing First the conversation: discourse,policy and the limits of the possible

Researchers, policy-makers, and political leaders in Canada and the US are championing the ‘Housing First’ (HF) intervention as a solution to homelessness. HF supplies people experiencing both homelessness and challenges around mental health with housing and a range of supports that can include case-coordination, psychiatry, and primary care. While HF’s impact on the housing status of individual participants has received considerable scientific and public consideration, less attention has been paid to its effects on societal conversations related to housing, public services, and social justice. We explore some of the impacts, not of HF the intervention, but of HF the conversation – the way public documents related to HF interact with broader discourses. Specifically, we examine the potential for this conversation to undermine the ultimate goal of ending homelessness in Canada. We conclude that positioning program interventions – no matter how important in the current context – as singular solutions to issues like homelessness or preventable chronic disease risks obscuring distal causes and marginalizing systemic responses.     

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self‐assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre‐booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.     

家庭卫生筹资公平性研究

目的　测算上海市郊区家庭卫生筹资公平性状况 ,并估计全国情况。方法　通过家庭入户调查获得卫生支出、政府卫生投入等数据 ,应用WHO所介绍的卫生系统绩效评价中的家庭卫生筹资公平性指标及其测量方法。结果　测算出家庭卫生筹资公平性系数为 0 735 ;合作医疗覆盖率能提高家庭卫生筹资公平性。结论　上海市郊区家庭卫生筹资公平性水平与WHO对我国的估计相符 ,而全国的筹资公平性水平要更低 ;WHO所推荐的卫生筹资公平性测算方法中 ,政府对家庭卫生补贴的测算不适合我国实情。     

Passive versus active parental permission: implications for the ability of school-based depression screening to reach youth at risk

BACKGROUND: Depression is prevalent among children and adolescents and often goes untreated with adverse effects on academic success and healthy development. Depression screening can facilitate early identification and timely referral to prevention and treatment programs. Conducting school-based emotional health screening, however, raises the controversial issue of how to obtain informed parental permission. METHODS: During implementation of a depression screening program in an urban school district in the Pacific Northwest, the district's parental permission protocol changed from passive (information provided to parents via a school mailer with parents having the option to actively decline their child's participation) to active (information provided to parents via a school mailer requiring the written permission of the parents for their child's participation). This change provided an opportunity to examine differences in participation under these 2 conditions. RESULTS: A total of 1533 students were enrolled in this program across both years. Compared to conditions of passive permission, participation was dramatically reduced when children were required to have written parental permission, dropping from 85% to 66% of eligible children. Furthermore, under conditions of active parental permission, participation decreased differentially among student subgroups with increased risk for depression. CONCLUSIONS: Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents.     

Health status and utilisation of the healthcare system by homeless and non‐homeless people in Vienna

This case–control study describes the health situation, internal and external resources, and utilisation of healthcare facilities by a marginalised population consisting of homeless people in Vienna, Austria, compared with a non‐homeless control population. Among the homeless group, participants lived in halfway houses (70%) or permanent housing (30%) in Vienna. Personal interviews were conducted in July 2010 with 66 homeless individuals, and their data were compared with data from non‐homeless subjects from the Austrian Health Interview Survey using conditional logistic regression. Compared with the control group, homeless persons suffered more often from chronic diseases (P < 0.001) and rated their health considerably lower than the comparison group (P < 0.001). Homeless people suffered significantly more often from psychiatric disorders, respiratory diseases, hypertension (P < 0.001), digestive system diseases (P = 0.002) and heart diseases (P = 0.015) in comparison with the control group. Additionally, among homeless and non‐homeless individuals, the former more often consulted a general practitioner in a period of 28 days (P = 0.002). A significantly greater proportion of homeless people did not have any teeth (P = 0.024) and smoked significantly more (P = 0.002). The results demonstrate deficits in the areas of health, health behaviour, and individual and social resources of homeless people, even though homeless people seek medical care at a higher rate than controls. Continuing health promotion projects for this high‐risk group and the strengthening of social resources are recommended.     

Public health strategies in Sheffield and England: a comparison of conceptual foundations

This paper compares the conceptual foundations of two recentUK public health strategy documents: Our City Our Health, adiscussion document associated with the Healthy Sheffield initiative,and the British Government's The Health of the Nation as appliedto England. The aspects of the conceptual foundations consideredare, firstly, the definitions of health employed, and secondly,the conceptualization of the determinants of health. The questionposed is: how do these compare with current knowledge aboutthe nature of health and the social processes and factors whichshape health for better or worse? Key findings in recent Britishresearch on concepts of health and the determination of healthare reviewed as the basis for comparison.     

239厂职工健康状况现状分析与疾病防治对策研究

目的 了解239厂健康教育组织机构的网络建设、职工的卫生服务需求、主要健康问题、行为危险因素流行水平以及职工对健康教育的需求，为制定预防和控制健康危险因素的规划和计划提供依据。方法 使用定性和定量的方法，收集与健康教育机构工作有关的文字资料，进行3个专题小组访谈；对2787人进行体检，对470人进行行为危险因素问卷调查。结果 慢病患病率为43．0％，男性为40．8％、女性为46．4％；职工吸烟率为40.0％，饮酒率为30．0％；不参加体育锻炼率为61．0％。职工的主要健康问题是高血压、高胆固醇血症。结论 职工健康知识正确知晓率较低；吸烟、饮酒、不参加体育锻炼的行为发生率较高，工厂应增加对健康教育的投入；并制定相应的健康促进对策，改善工厂的物理环境。     

Drug use and other problems of residents in projects for the young, single homeless

One hundred people who make use of an organization housing the young, single homeless were interviewed using a semi-structured interview. There was a high prevalence of problems, including substance abuse and dependence, other mental health problems, extensive use of health services and extensive experience of crime both as victim and perpetrator. Most people said they had become homeless because they did not get on with their parents. Since becoming homeless, most had not spent more than a month sleeping rough, but most had spent time staying with friends or staying in other hostels for the homeless. It is concluded that most young, single homeless people who seek help have problems beyond a lack of permanent shelter. The extent to which the sample is representative of all homeless people is considered and implications for service provision are discussed.     

Responding to pandemics and other disease outbreaks in homeless populations: A review of the literature and content analysis

Considering the recent COVID-19 pandemic, we recognised a lack of synthesis amongst the available literature pertaining to the intersections of homelessness and pandemic response and planning. Therefore, the purpose of this review was to identify relevant peer-reviewed literature in this area to thematically produce evidence-based recommendations that would inform community planning and response amongst homeless populations. Although this review is inspired by the COVID-19 pandemic, our intention was to produce relevant recommendations to for all current and future outbreaks and pandemics more generally. Our search criteria focused on pandemics and rapid-spread illnesses such as contagious respiratory diseases with contact spread and with an emphasis on individuals experiencing homelessness. Content analysis methods were followed to extract and thematically synthesise key information amongst the 223 articles that matched our search criteria between the years of 1984 and 2020. Two reviewers were assigned to the screening process and used Covidence and undertook two rounds of discussion to identify and finalise themes for extraction. This review illustrates that the current breadth of academic literature on homeless populations has thus far focused on tuberculosis (TB) rather than diseases that are more recent and closely related to COVID-19—such as Severe Acute Respiratory Syndrome (SARS) or H1N1. Our thematic content analysis revealed six themes that offer tangible and scalable recommendations which include (1) education and outreach, (2) adapting structure of services, (3) screening and contract tracing, (4) transmission and prevention strategies, (5) shelter protocols and (6) treatment, adherence and vaccination. The breadth and depth of reviews such as these are dependent on the quantity and quality of the available literature. Therefore, the limited existing literature outside of tuberculosis specific to homelessness in this review illustrates a need for more academic research into the intersections of pandemics and homelessness—particularly for evaluations of response and planning. Nonetheless, this review offers timely considerations for pandemic response and planning amongst homeless populations during the current COVID-19 pandemic and can facilitate future research in this area.     

A codevelopment process to advance methods for the use of patient‐reported outcome measures and patient‐reported experience measures with people who are homeless and experience chronic illness

IntroductionPeople who experience social disadvantage including homelessness suffer from numerous ill health effects when compared to the general public. Use of patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs) enables collection of information from the point of view of the person receiving care. Involvement in research and health care decision‐making, a process that can be facilitated by the use of PROMs and PREMs, is one way to promote equity in care.MethodsThis article reports on a codevelopment and consultation study investigating the use of PROMs and PREMs with people who experience homelessness and chronic illness. Data were analysed according to interpretative phenomenological analysis.ResultsCommittee members with lived experience identified three themes for the role of PROMs and PREMs in health care measurement: trust and relationship‐building; health and quality of life; and equity, alongside specific recommendations for the design and administration of PROMs and PREMs. The codevelopment process is reported to demonstrate the meaningful investment in time, infrastructure and relationship‐building required for successful partnership between researchers and people with lived experience of homelessness.ConclusionPROMs and PREMs can be meaningful measurement tools for people who experience social disadvantage, but can be alienating or reproduce inequity if they fail to capture complexity or rely on hidden assumptions of key concepts.Patient or Public ContributionThis study was conducted in active partnership between researchers and people with experience of homelessness and chronic illness, including priority setting for study design, data construction, analysis and coauthorship on this article.     

国内外基本医疗卫生制度建设发展现状

对比分析国内外公共卫生服务体系建设、基本医疗服务体系建设、医疗保障体系建设、药品供应保障体系建设的现状及发展情况,并进行小结,以期为推进我国城乡基本医疗卫生制度建设提供建议.     

How health managers think about risk and the implications for portfolio theory in health systems

Attention is now being paid in the health economics literature to the insights offered by portfolio theory. Portfolio theory points to the advantages that arise from consideration of both risk and return when setting priorities. Realising these benefits assumes that managers in the health sector have the same understanding of risk as that suggested by the theory. We set out to explore this issue in interviews with health care managers in Alberta, Canada. To provide a point of reference and possible contrast, we also elicit the views of managers in Alberta's main industry, the oil and gas sector. Interviews were held with 25 managers across the two sectors and thematic analysis applied to draw out the main lessons from the interviews. To the oil and gas managers, risk meant opportunity that was worth taking if the return was high enough. To the health managers, risk was seen mainly in epidemiological terms as hazard and something to be avoided at all costs. Rather than reflecting a different understanding of risk, however, health managers had a more nuanced attitude, which is understandable given the consequences of adverse outcomes and the political furore that then follows. The politicisation of risk in health and its association with adverse outcomes suggests that it might be better to avoid this term when thinking about resource allocation across a portfolio of health promoting interventions and to use uncertainty instead.     

论证我国疾病预防控制体系公共职能偏废的治本策略

目的　论证解决中国疾病预防控制体系公共职能偏废的治本策略。方法　查阅 1990～ 2 0 0 1年国内八种主要卫生管理杂志 ,运用边界分析方法归纳中国疾病预防控制体系各类改革策略 ,运用逻辑分析的方法 ,结合疾病预防控制体系公共职能偏废的原因和作用机制 ,提出治本策略 ,并进一步运用意向问卷调查了15 4所省、市、县疾病预防控制中心对治本策略的认识。结果　治本策略是 ,明确政府承担疾病预防控制的筹资职能 ,保障疾病防制机构适宜投入。同时 ,通过加强管理和改革投入方式增加服务效率。样本疾病预防控制中心对该治本策略的认同率在 95 %以上。     

推进我国基本公共卫生服务均等化的策略思路

在剖析我国推进基本公共卫生服务落实中存在的认识误区、职责不明、协调不力和保障不足等问题基础上,形成了推进各项基本公共卫生服务项目落实的策略思路:一是扭转"基本公共卫生服务"替代"公共卫生服务"、"基本公共卫生服务"等同于"基层公共卫生服务"的错误观念。二是创新机制:(1)加强项目推进的统一领导,建立以疾控为主导,卫监、妇幼、基层、医政等共同参与的协调机制;(2)完善协调沟通的工作机制;(3)落实经费保障机制,明确合理的经费投入标准和分配流向。三是科学合理的流程再造,明确项目的总体目标和各方的职责分工,加强质量控制和绩效考核。四是加强人才培养,健全对基层公共卫生工作队伍的培训机制。