The impact of the housing status on clinical outcomes and health care utilization among individuals living with HIV

ABSTRACT

The lack of stable housing can impair access and continuity of care for patients living with human immunodeficiency virus (HIV). This study investigated the relationship between housing status assessed at multiple time points and several core HIV-related outcomes within the same group of HIV patients experiencing homelessness. Patients with consistently stable housing (CSH) during the year were compared to patients who lacked CSH (non-CSH group). The study outcomes included HIV viral load (VL), CD4 counts, and health care utilization. Multivariable and propensity weighted analyses were used to assess outcomes adjusting for potential group differences. Of 208 patients, 88 (42%) had CSH and 120 (58%) were non-CSH. Patients with CSH had significantly higher proportion of VL suppression and higher mean CD4 counts. The frequency of nurse visits in the CSH group was less than a half of that in the non-CSH group. Patients with CSH were less likely to be admitted to the medical respite facility, and if admitted, their length of stay was about a half of that for the non-CSH group. Our study findings show that patients with CSH had significantly better HIV virologic control and immune status as well as improved health care utilization.     

The case for a medication first approach to the treatment of opioid use disorder

Background: The opioid addiction and overdose crisis continues to ravage communities across the U.S. Maintenance pharmacotherapy using buprenorphine or methadone is the most effective intervention for Opioid Use Disorder (OUD), yet few have immediate and sustained access to these medications. Objectives: To address lack of medication access for people with OUD, the Missouri Department of Mental Health began implementing a Medication First (Med First) treatment approach in its publicly-funded system of comprehensive substance use disorder treatment programs. Methods: This Perspective describes the four principles of Med First, which are based on evidence-based guidelines. It draws conceptual comparisons between the Housing First approach to chronic homelessness and the Med First approach to pharmacotherapy for OUD, and compares state certification standards for substance use disorder (SUD) treatment (the traditional approach) to Med First guidelines for OUD treatment. Finally, the Perspective details how Med First principles have been practically implemented. Results: Med First principles emphasize timely access to maintenance pharmacotherapy without requiring psychosocial services or discontinuation for any reason other than harm to the client. Early results regarding medication utilization and treatment retention are promising. Feedback from providers has been largely favorable, though clinical- and system-level obstacles to effective OUD treatment remain. Conclusion: Like the Housing First model, Medication First is designed to decrease human suffering and activate the strengths and capacities of people in need. It draws on decades of research and facilitates partnerships between psychosocial and medical treatment providers to offer effective and life-saving care to persons with OUD.     

Women's Danger Management Strategies in an Inner‐City Housing Project*

The danger management strategies of low‐income African American women who live in a public housing community characterized by chronic violence are examined. Based on qualitative interviews with 18 single mothers, we explored the violent community dangers with which women contend, the nature of this violence, the strategies used to deal with community violence, and their benefits and costs to family and community life. Findings show that multiple types of violence characterized life in the community and that this violence has specific physical locations, a particular set of actors, and a temporal rhythm. Women's responses to violence were nonconfrontational and family focused in nature. These efforts were effective in keeping women and their children safe, but did not reduce the prevalence of violence.     

激素敏感型肾病单个核细胞培养上清液对大鼠肾小球多阴离子及超微结构的影响

用刀豆蛋白Ａ刺激激素敏感型肾病单个核细胞，并将其培养上清液灌注于大鼠肾内。结合电镜观察，用图像分析仪及体视学方法分别对其肾组织胶体铁染色切片和电镜照片上的足突和滤过裂隙的平均宽度进行测定。结果表明：该病极期上清液灌注的鼠肾小球多阴离子明显减少，足突肿胀、融合，滤过裂隙变窄；而该病缓解组和正常对照组则为阴性。说明该病单个核细胞培养上清液可引起鼠肾小球微小病变型肾病综合征的病变，并揭示该变化可能是由其上清液中一种异常的Ｔ淋巴细胞因子所致。     

胎儿主要肢骨发育时间表──超声骨龄

用Ｂ超检测正常妊娠中的胎儿。选择受精龄为１２至３８整周（ｃｏｍｐｌｅｔｅｄｗｅｅｋ）的胎儿２９７例。测量其主要肢骨（干）长度。并将所测数据进行统计学处理。结果表明胎儿肢骨的生长发育与胎龄有显著的正相关关系。     

马桑内酯所致癫痫发作大鼠红细胞免疫粘附功能的研究

作者用红细胞Ｃ＿３ｂ受体花环试验和红细胞免疫复合物花环试验对马桑内酯所致癫痫发作大鼠红细胞免疫粘附功能的变化进行了观察，结果表明，癫痫组动物红细胞Ｃ＿３ｂ受体花环率明显低于对照组，而红细胞免疫复合物花环率相差不显著．提示癫痫发作可导致大鼠红细胞免疫粘附功能降低，因此在癫痫治疗中注意调整和增强患者的红细胞免疫功能具有重要意义。     

'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Risk factors for wheezing in Ukrainian children: Ukraine European Longitudinal Study of Pregnancy and Childhood Group

The prevalence of wheezing in children varies widely around the world. The reasons for this geographic variability remain unclear but may be related in part to exposures in the home environment during pregnancy and early childhood. We investigated the prenatal and early childhood risk factors for wheezing symptoms among 2127 children aged 6–8 years who were participants in the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). Cases included the 169 children whose parents answered yes to the International Study of Asthma and Allergy in Children (ISAAC) question: 'Has your child had wheezing or whistling in the chest in the past 12 months' during the ELSPAC assessment of the children at age 7. These were compared with the 1861 children in the cohort whose parents answered 'no' to this question.
Factors significantly associated with increased risk of wheezing illness at age 7 in adjusted analyses included mother's asthma [adjusted odds ratio (OR) 3.46, 95% confidence interval (CI) 1.22, 9.85]; mother's allergy problems (OR 1.43, [1.00, 2.05]); rarely playing with other children at age 3 (OR 1.84, [1.09, 3.11]); water intrusion (OR 1.62, [1.09, 2.39]) and inadequate heating of the home (OR 1.52, [1.06, 2.16]) during pregnancy. Factors protective of wheezing at age 7 included being first-born (adjusted OR 0.70, 95% CI 0.50, 0.98); living in the city of Dniprodzerzynsk as compared with Kyiv (OR 0.36, [0.24, 0.54]) and weekly contact with furry animals (OR 0.44, [0.20, 0.97]) before age 3. The constellation of risk factors for wheezing in Ukrainian children is similar to that of children in other parts of the world. Known risk factors do not account for the significant between-city variability of wheezing in Ukrainian children.     

对－苯二甲酸衍生物的合成及其诱导分化HL－60细胞的活性

作者合成了１３个对－苯二甲酸衍生物，其中有９个化合物尚未见文献报道。通过对ＨＬ－６０细胞诱导分化活性试验，发现有两个化合物在浓度为５×１０￣（－６）ｍｏｌ／Ｌ时，可使细胞分化率达５５％，低于维Ａ酸的分化率（７９％，１０￣（－７）ｍｏｌ／Ｌ）。     

赖型钩端螺旋体重组DNApCX7的特异性鉴定和限制性内切酶谱分析

本实验将赖型钩端螺旋体（简称钩体）ＤＮＡ基因库的克隆ｐＣＸ７制备成￣（３２）Ｐ－重组ＤＮＡ探针，对８个不同血清群的１７株问号状钩体、双曲钩体ＰａｔｏｃⅠ株以及细螺旋体３０５５株ＤＮＡ进行打点杂交；同时用１５种ＤＮＡ片断进行限制性内切酶谱分析。结果表明，该重组ＤＮＡ具有问号状钩体种（Ｓｐｅｃｉｅｓ）特异性，但与不同问号状钩体之间的同源性程度有差别；限制性内切酶谱分析发现ｐＣＸ７重组ＤＮＡ片段长约１．７ｋｂ，具有１个Ｂｇ１Ⅱ识别位点和３个ＢｓｔＢ１识别位点。