Barriers to Optimal Health for Under 5s Experiencing Homelessness and Living In Temporary Accommodation in High-Income Countries: A Scoping Review

BACKGROUND: The first 5 years of life are crucial for optimising growth, health, and cognitive development. However, many children do not reach their full cognitive and developmental potential because of multilevel barriers, including those resulting from poverty and homelessness. This review summarises the evidence characterising the barriers to achieving optimal health and cognitive outcomes, and to accessing health services for homeless children younger than 5 years of age (U5s)-one of the most vulnerable populations in High Income Countries (HICs). METHODS: For this scoping review, we followed the PRISMA-ScR checklist and CATS framework. We searched Medline, PubMed, Embase, CINAHL, Web of Science, OVID Maternity and Infant Care, and The Cochrane Library (publications dates from Jan 1, 1980, to Jun 23, 2020) using the key words “homelessness”, “housing”, “paediatrics”, “interpersonal relations”, “social exclusion”, “toddler”, “children under 5”, “engagement”, and “communication and insecurity”. The search strategy yielded 3253 articles. Retrieved articles were organised by study design. Because of the considerable heterogeneity of methods and outcomes, we used a narrative synthesis analytic approach. Our outcome of interest was barriers to optimal health and accessing health services, focusing on U5s living in HICs. FINDINGS: Twenty-nine full texts were selected in the final synthesis, including primary research studies and systematic or narrative reviews of primary research studies from HICs. There was limited evidence describing links among housing insecurity, health, and cognitive outcomes in U5s. This age group was rarely studied as a discrete group and often combined with older ages (eg, ≤25 years). The quality of articles varied greatly because of the heterogeneity in study design. Nevertheless, important themes were identified: barriers were described at the individual and family level (eg, ethnicity, immigration status, and fear), system level (eg, policies, poor access to medication, absence of care plan, and no insurance) and community level (eg, transportation limitations and poor housing conditions). INTERPRETATION: Although evidence is sparse, further methodologically rigorous research is needed to identify what barriers exist for U5s and their parents in accessing health services, and how this affects the child’s health. The multi-level nature of these barriers implies a system’s approach may be required. However, more evidence is needed including cross-sector studies and tailored interventions to address these barriers by working directly with experts with experience of social exclusion and their children

Diabetes Ther

INTRODUCTION: Type 2 diabetes represents a significant public health issue, with increasing prevalence in developing countries while adherence to insulin treatment remains a challenge. No studies have evaluated the relationship between adherence to insulin, diabetes-related distress, and trust in physician among persons with diabetes. Our objectives were to evaluate treatment adherence to insulin, emotional distress (using the Problem Areas in Diabetes Questionnaire, PAID), trust in physician, and to examine associations between them among Lebanese patients with diabetes. METHODS: This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 135 adult patients. RESULTS: The mean percentage score of adherence to insulin was 79.7 +/- 19.94. A significantly higher mean adherence score was found in non-sedentary (81.96) compared to sedentary patients (67.41) (p = 0.017), with no difference between gender, employment, rural vs non-rural residence, or familial history of diabetes. In addition, no significant relationship was seen between adherence score and education level, smoking, or alcohol intake. A significant positive association was found between trust in physician and adherence scores, whereas a significant but negative one was found between PAID and adherence scores. The results of linear regressions showed that a secondary level of education (beta = - 13.48) significantly decreased the trust in physician score, whereas the total number of oral antidiabetics (beta = 0.93) increased it. Having a sedentary lifestyle (beta = - 12.73) and smoking < 3 waterpipes/week compared to no smoking (beta = - 16.82) significantly decreased the adherence score. Female gender (beta = 10.46), smoking < 3 waterpipes (beta = 27.42) and 3 + waterpipes/week (beta = 17.95) significantly increased the PAID score. CONCLUSION: Trust in physician is associated with an increased adherence and with decreased diabetes-related distress. This distress was also associated with poor adherence in our study

Satisfaction of well-controlled type 2 diabetes patients with three-monthly and six-monthly monitoring

<p>Background: Patient's satisfaction with monitoring frequency is of interest when implementing six-monthly monitoring for well-controlled type 2 diabetes patients. Here we want to determine the satisfaction of well-controlled type 2 diabetes patients with either three-monthly or six-monthly diabetes monitoring and their future preference.</p><p>Methods: Survey among 2215 well-controlled type 2 diabetes patients (not using insulin, HbA1c</p><p>Results: Most patients (70.8%) would like to continue their monitoring frequency. Patients from the preference groups were more often satisfied than randomised patients (92.7% and 88.1%, respectively) and patients monitored three-monthly were more often satisfied than patients monitored six-monthly (93.5% and 88.5%, respectively). Higher age, better physical health, less diabetes-related distress, higher diabetes treatment satisfaction and less perceived hyper- and hypoglycaemias were associated with a higher monitoring satisfaction.</p><p>Conclusions: Most well-controlled type 2 diabetes patients were satisfied with their monitoring frequency and would like to continue it. Although the satisfaction for three-monthly monitoring was slightly higher, the satisfaction with six-monthly monitoring was still rather high (88.5%).</p>