Influenza Vaccination Rates Among Homeless Adults With Mental Illness in Toronto

Objective: To determine the incidence of influenza vaccination among homeless individuals with mental illness in Toronto. Methods: A retrospective chart review was carried out using a random sample of homeless individuals with mental illness who were participants of the At Home/Chez Soi Study. Primary care charts were obtained and reviewed for the incidence influenza vaccination within a 1-year period. Results: Of the 75 participants for whom charts were reviewed, 5 (6.7%) had documentation indicating receipt of the influenza vaccination in the year prior to study recruitment. Conclusion: This study raises awareness of the low incidence of homeless adults receiving the influenza vaccination in Toronto. The data are concerning given the high risk of morbidity from communicable respiratory illnesses in this group. Further research into the causes of low influenza vaccination rates among homeless Canadians is needed to develop strategies for increased delivery of the vaccination

Influenza Vaccination Rates Among Homeless Adults With Mental Illness in Toronto

Objective: To determine the incidence of influenza vaccination among homeless individuals with mental illness in Toronto. Methods: A retrospective chart review was carried out using a random sample of homeless individuals with mental illness who were participants of the At Home/Chez Soi Study. Primary care charts were obtained and reviewed for the incidence influenza vaccination within a 1-year period. Results: Of the 75 participants for whom charts were reviewed, 5 (6.7%) had documentation indicating receipt of the influenza vaccination in the year prior to study recruitment. Conclusion: This study raises awareness of the low incidence of homeless adults receiving the influenza vaccination in Toronto. The data are concerning given the high risk of morbidity from communicable respiratory illnesses in this group. Further research into the causes of low influenza vaccination rates among homeless Canadians is needed to develop strategies for increased delivery of the vaccination

The effect of a Housing First intervention on primary care retention among homeless individuals with mental illness.

BackgroundPrimary care retention, defined as ongoing periodic contact with a consistent primary care provider, is beneficial for people with serious chronic illnesses. This study examined the effect of a Housing First intervention on primary care retention among homeless individuals with mental illness.MethodsTwo hundred individuals enrolled in the Toronto site of the At Home Project and randomized to Housing First or Treatment As Usual were studied. Medical records were reviewed to determine if participants were retained in primary care, defined as having at least one visit with the same primary care provider in each of two consecutive six-month periods during the 12 month period preceding and following randomization.ResultsMedical records were obtained for 47 individuals randomized to Housing First and 40 individuals randomized to Treatment As Usual. During the one year period following randomization, the proportion of Housing First and Treatment As Usual participants retained in primary care was not significantly different (38.3% vs. 47.5%, p = 0.39). The change in primary care retention rates from the year preceding randomization to the year following randomization was +10.6% in the Housing First group and -5.0% in the Treatment As Usual group.ConclusionAmong homeless individuals with mental illness, Housing First did not significantly affect primary care retention over the follow-up period. These findings suggest Housing First interventions may need to place greater emphasis on connecting clients with primary care providers

The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial

Abstract Background Little is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds. Methods This unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care. Results During the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72). Conclusion Housing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness. Trial registration International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009

The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial

Abstract Background Little is known about the effectiveness of Housing First (HF) among ethnic minority groups, despite its growing popularity for homeless adults experiencing mental illness. This randomized controlled trial tests the effectiveness of a HF program using rent supplements and intensive case management, enhanced by anti-racism and anti-oppression practices for homeless adults with mental illness from diverse ethnic minority backgrounds. Methods This unblinded pragmatic field trial was carried out in community settings in Toronto, Canada. Participants were 237 adults from ethnic minority groups experiencing mental illness and homelessness, who met study criteria for moderate needs for mental health services. Participants were randomized to either adapted HF (n = 135) or usual care (n = 102) and followed every 3 months for 24 months. The primary study outcome was housing stability; secondary outcomes included physical and mental health, social functioning, quality of life, arrests and health service use. Intention to treat statistical analyses examined the effectiveness of the intervention compared to usual care. Results During the 24-month study period, HF participants were stably housed a significantly greater proportion of time compared to usual care participants, 75 % (95 % CI 70 to 81) vs. 41 % (95 % CI 35 to 48), respectively, for a difference of 34 %, 95 % CI 25 to 43. HF also led to improvements in community integration over the course of the study: the change in the mean difference between treatment groups from baseline to 24-months was significantly greater among HF participants compared to those in usual care (change in mean difference = 2.2, 95 % CI 0.06 to 4.3). Baseline diagnosis of psychosis was associated with reduced likelihood of being housed ≥ 50 % of the study period (OR = 0.37, 95 % CI 0.18 to 0.72). Conclusion Housing First enhanced with anti-racism and anti-oppression practices can improve housing stability and community functioning among ethnically diverse homeless adults with mental illness. Trial registration International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009

Medically intractable temporal lobe epilepsy in patients with normal MRI: Surgical outcome in twenty-one consecutive patients

Abnormal MRI findings localizing to the mesial temporal lobe predict a favorable outcome in temporal lobe epilepsy surgery. The purpose of this study is to summarize the surgical outcome of patients who underwent a tailored antero-temporal lobectomy (ATL) with normal 1.5 T MRI. Specifically, factors that may be associated with favorable post-surgical seizure outcome are evaluated. A retrospective analysis of the Rush University Medical Center surgical epilepsy database between 1992 and 2003 was performed. Patients who underwent an ATL and had a normal MRI study documented with normal volumetric measurements of hippocampal formations and the absence of any other MRI abnormality were selected for this study. Demographic information was collected on all patients. Seizure outcomes were evaluated using Engel's classification. A two-sided Fisher exact test with Bonferroni correction was performed in statistical analyses. Twenty-one (21) patients met the inclusion criteria of normal 1.5 T MRI and underwent a tailored temporal lobectomy. Mean age at time of surgery was 28 years (SD = 8.1, range 11–44) and mean duration of the seizure disorder was 13.4 years (range 2–36). Risk factors for epilepsy included head injury ( n = 4), encephalitis ( n = 3), febrile seizures ( n = 2), and 12 patients had no risk factors. Pathological evaluation of resected tissue revealed no abnormal pathology in 12/21 patients (57%). After a mean 4.8 years follow-up post-surgical period, 15/21 (71%) patients were free of disabling seizures (Engel I outcome). At 8.3 years follow-up, 13/21 (62%) patients had similar results. Absence of prior epilepsy risk factors was the only statistically significant predictor of an Engel class I outcome ( p < 0.0022). Patients with medically intractable epilepsy and normal MRI appear to benefit from epilepsy surgery. Absence of prior epilepsy risk factors may be a positive prognostic factor

Additional file 1: Table S1. of The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial

Estimated outcome values at each study visit, by treatment group. (DOCX 13.9 kb

Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial

<div><p>Housing First (HF) is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM) among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU) in Toronto (Canada), and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS) and mental (CSI, GAIN-SS) health, social functioning (MCAS), quality of life (QoLI20), and health service use. Two-thirds of the sample (63%) was from racialized groups and half (50%) were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively). Similarly, community functioning (MCAS) improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30). There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99) relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044). Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96) and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96) from baseline to 24 months. Secondary analyses found a significant reduction in the number of days experiencing problems due to alcohol use among foreign-born (vs. Canadian-born) HF participants at 24 months (ratio of rate ratios = 0.19 95% 0.04 to 0.88), relative to baseline. Compared to usual care, HF with ICM can improve housing stability and community functioning and reduce the days of alcohol related problems in an ethnically diverse sample of homeless adults with mental illness within 2-years.</p><p>Trial Registration</p><p>Controlled-Trials.com <a href="http://www.controlled-trials.com/ISRCTN42520374" target="_blank">ISRCTN42520374</a>.</p></div

Primary study outcome, by treatment group and ethnicity.

<p>Values correspond to adjusted means and bars correspond to standard errors from linear regression model (using a mixed effect model framework) for the percentage of days stably housed over 24 month follow-up period for HF-ICM and TAU groups among participants, by ethnicity.</p