Predictors of contact with public service sectors among homeless adults with and without alcohol and other drug disorders

OBJECTIVE: Homeless persons with alcohol and other drug (AOD) disorders face multiple problems that go beyond their AOD use. As a consequence, they commonly access services in multiple sectors in addition to the AOD treatment system. This study examined the predictors of contact with agencies in the health, mental health, social welfare and criminal justice sectors by AOD status among a probability sample of homeless adults in Houston, Texas. METHOD: Cross-sectional data were collected from a multistage random sample of 797 homeless adults (579 men), age 18 or older, who were living in shelters and on the streets of Houston in 1996. Structured face-to-face interviews provided screening diagnoses for AOD disorders, self-report data on AOD treatment use and candidate predictors of treatment use. Service use was tracked retrospectively through administrative data obtained from 10 federal, state, county and municipal agencies that provide finding for physical and mental health services and AOD treatment, as well as emergency income; we also tracked criminal justice contacts. Logistic regression analyses were stratified by AOD status. RESULTS: Adjusting for eligibility factors, key aspects of need were significant predictors of any utilization among those without an AOD problem, but not for those with an AOD problem. For those with AOD disorders, contact with one sector was not predictive of contact with other sectors. CONCLUSIONS: Our findings indicate that AOD disorders hinder utilization of public sector services by homeless persons. These disorders may be masking need or otherwise acting as a barrier to accessing treatment and support.     

Multispectral analysis of magnetic resonance images

Magnetic resonance (MR) imaging systems produce spatial distribution estimates of proton density, relaxation time, and flow, in a two dimensional matrix form that is analogous to that of the image data obtained from multispectral imaging satellites. Advanced NASA satellite image processing offers sophisticated multispectral analysis of MR images. Spin echo and inversion recovery pulse sequence images were entered in a digital format compatible with satellite images and accurately registered pixel by pixel. Signatures of each tissue class were automatically determined using both supervised and unsupervised classification. Overall tissue classification was obtained in the form of a theme map. In MR images of the brain, for example, the classes included CSF, gray matter, white matter, subcutaneous fat, muscle, and bone. These methods provide an efficient means of identifying subtle relationships in a multi-image MR study.     

Validation of the brief instrumental functioning scale in a homeless population

This report describes the psychometric properties of the six-item Brief Instrumental Functioning Scale (BIFS), a self-report questionnaire for measuring instrumental functioning in community populations, and the results of a study to validate the scale among homeless persons. The participants in the study were 1,509 homeless persons, of whom 1,077, or 71 percent, were seriously mentally ill, substance dependent, or both. Confirmatory factor analysis provided evidence for the unidimensionality of the items in the scale. The BIFS had high internal consistency, respectable stability, and reasonable convergent validity. The BIFS is useful for community populations when self-report data on functioning are required. Additional research is needed to develop and validate comparable scales for assessing other domains of functioning.     

Excretory urography with iohexol: evaluation in children

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.