Housing as Health Care During and After the COVID-19 Crisis

The COVID-19 crisis has illustrated clearly that “housing is health care.” The 567,000 people experiencing homelessness in the U.S. face heightened risk for contracting COVID-19 due to the circumstances surrounding their lack of housing. Simultaneously, an outbreak of COVID-19 among people who are homeless could threaten already burdened health systems, showing the critical interconnections between housing and health care. We describe strategies to mitigate the impact of COVID-19 for homeless populations and for the health care system. Looking forward, we suggest that guaranteeing housing for all is an essential step toward reducing the societal burden of the next pandemic.https://deepblue.lib.umich.edu/bitstream/2027.42/154767/1/Doran main article.pdfDescription of Doran main article.pdf : Main articl

Discovery of 95 PTSD loci provides insight into genetic architecture and neurobiology of trauma and stress-related disorders

Posttraumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 novel). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (e.g., GRIA1, GRM8, CACNA1E ), developmental, axon guidance, and transcription factors (e.g., FOXP2, EFNA5, DCC ), synaptic structure and function genes (e.g., PCLO, NCAM1, PDE4B ), and endocrine or immune regulators (e.g., ESR1, TRAF3, TANK ). Additional top genes influence stress, immune, fear, and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation

The effectiveness of managerial training in a fast food restaurant chain

The purpose of this comparison study was to determine the effects of three alternative managerial training methods on business outcomes in a fast food hamburger restaurant chain. The managers were trained on “customer over-satisfaction”, using three different training methods, to determine if there were differences in business outcomes due to the training method received. The different methods of training were: traditional classroom training, computer-based interactive media training, and on-the-job training. The sample for the study was 24 restaurants from one franchise group in the Midwest. Four randomly assigned groups of six restaurants were chosen for each of the three training methods and one control group, which received no additional training. A quasi-experimental control group design was used. The independent variable for the study was the training method used. The dependent variables for the study were the three following business outcomes: mystery shopper scores, customer satisfaction survey scores, and customer complaints as a percentage of total customers. These outcomes were chosen as they each measure different facets of customer satisfaction. Pre- and post-training measures were taken of each of the business outcomes. Pre-measures of the business outcomes were taken in May and June 2002. The training interventions were done in July and August 2002. Post-measures of the business outcomes were taken in September and October 2002. An analysis of variance (ANOVA) was run on the differences between the pre- and post-training measures. The analysis determined that there were no statistically significant differences at the .05 alpha level between the pre- and post-training measures based on the type of training method used. Despite the fact that there were not statistically significant differences in the business outcomes, there were some positive changes in the business outcomes that occurred after training. Mystery shopper scores improved for the interactive media training group, and customer satisfaction scores improved for the on-the-job training group. Further research on effects of training on business outcomes is recommended and ideas for this are suggested

Living in the ED: The Impact of Homelessness on the Frequent Use of Emergency Departments in Baltimore City

There is a subset of patients who visit the emergency department (ED) frequently, and this group is responsible for a disproportionate number of total visits, thereby potentially contributing to overuse of the ED. Anecdotal belief among clinicians holds that those who are ""frequent users"" of the ED are likely to be homeless. While many studies have been conducted examining the problem of frequent ED use and other studies have documented the health and service utilization of individuals experiencing homelessness, there is little information about the direct connection between these two populations.Using a retrospective administrative record review of three EDs in Baltimore City in combination with administrative data from homeless service providers, this research study examines the proportion of homelessness among frequent users, and documents how patient and visit characteristics differ between homeless and non homeless frequent users. This study found that homeless patients were not the majority of frequent users, but did have significant differences in ED utilization compared to their non-homeless counterparts. As frequency of visits increases, however, so too does the proportion of homelessness. Understanding the specific characteristics and utilization patterns of frequent users will help policy makers and hospital administrators determine how to more effectively treat this population

Living in the ED: The Impact of Homelessness on the Frequent Use of Emergency Departments in Baltimore City

There is a subset of patients who visit the emergency department (ED) frequently, and this group is responsible for a disproportionate number of total visits, thereby potentially contributing to overuse of the ED. Anecdotal belief among clinicians holds that those who are ""frequent users"" of the ED are likely to be homeless. While many studies have been conducted examining the problem of frequent ED use and other studies have documented the health and service utilization of individuals experiencing homelessness, there is little information about the direct connection between these two populations.Using a retrospective administrative record review of three EDs in Baltimore City in combination with administrative data from homeless service providers, this research study examines the proportion of homelessness among frequent users, and documents how patient and visit characteristics differ between homeless and non homeless frequent users. This study found that homeless patients were not the majority of frequent users, but did have significant differences in ED utilization compared to their non-homeless counterparts. As frequency of visits increases, however, so too does the proportion of homelessness. Understanding the specific characteristics and utilization patterns of frequent users will help policy makers and hospital administrators determine how to more effectively treat this population

Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs) in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86%) were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9), lack of housing (n=6), alteration of consciousness (n=6), infection with human immunodeficiency virus (HIV) (n=5), and nausea/vomiting (n=5). Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use