Examining the Relationship between Health-Related Need and the Receipt of Care by Participants Experiencing Homelessness and Mental Illness

Background People experiencing homelessness and mental illness face multiple barriers to care. The goal of this study was to examine the association between health service use and indicators of need among individuals experiencing homelessness and mental illness in Vancouver, Canada. We hypothesized that those with more severe mental illness would access greater levels of primary and specialist health services than those with less severe mental illness. Methods Participants met criteria for homelessness and current mental disorder using standardized criteria (n = 497). Interviews assessed current health status and involvement with a variety of health services including specialist, general practice, and emergency services. The 80th percentile was used to differentiate ‘low health service use’ and ‘high health service use’. Using multivariate logistic regression analysis, we analyzed associations between predisposing, enabling and need-related factors with levels of primary and specialist health service use. Results Twenty-one percent of participants had high primary care use, and 12% had high use of specialist services. Factors significantly (p ≤ 0.05) associated with high primary care use were: multiple physical illnesses [AOR 2.74 (1.12, 6.70]; poor general health [AOR 1.68 (1.01, 2.81)]; having a regular family physician [AOR 2.27 (1.27, 4.07)]; and negative social relationships [AOR 1.74 (1.01, 2.99)]. Conversely, having a more severe mental disorder (e.g. psychotic disorder) was significantly associated with lower odds of high service use [AOR 0.59 (0.35, 0.97)]. For specialist care, recent history of psychiatric hospitalization [AOR 2.53 (1.35, 4.75)] and major depressive episode [AOR 1.98 (1.11, 3.56)] were associated with high use, while having a blood borne infectious disease (i.e., HIV, HCV, HBV) was associated with lower odds of high service use. Conclusions Contrary to our hypotheses, we found that individuals with greater assessed need, including more severe mental disorders, and blood-borne infectious diseases had significantly lower odds of being high health service users than those with lower assessed needs. Our findings reveal an important gap between levels of need and service involvement for individuals who are both homeless and mentally ill and have implications for health service reform in relation to the unmet and complex needs of a marginalized sub-population. (Trial registration: ISRCTN57595077 and ISRCTN66721740)

Hit and run versus long-term activation of PARP-1 by its different domains fine-tunes nuclear processes.

Poly(ADP-ribose) polymerase 1 (PARP-1) is a multidomain multifunctional nuclear enzyme involved in the regulation of the chromatin structure and transcription. PARP-1 consists of three functional domains: the N-terminal DNA-binding domain (DBD) containing three zinc fingers, the automodification domain (A), and the C-terminal domain, which includes the protein interacting WGR domain (W) and the catalytic (Cat) subdomain responsible for the poly(ADP ribosyl)ating reaction. The mechanisms coordinating the functions of these domains and determining the positioning of PARP-1 in chromatin remain unknown. Using multiple deletional isoforms of PARP-1, lacking one or another of its three domains, as well as consisting of only one of those domains, we demonstrate that different functions of PARP-1 are coordinated by interactions among these domains and their targets. Interaction between the DBD and damaged DNA leads to a short-term binding and activation of PARP-1. This hit and run activation of PARP-1 initiates the DNA repair pathway at a specific point. The long-term chromatin loosening required to sustain transcription takes place when the C-terminal domain of PARP-1 binds to chromatin by interacting with histone H4 in the nucleosome. This long-term activation of PARP-1 results in a continuous accumulation of pADPr, which maintains chromatin in the loosened state around a certain locus so that the transcription machinery has continuous access to DNA. Cooperation between the DBD and C-terminal domain occurs in response to heat shock (HS), allowing PARP-1 to scan chromatin for specific binding sites

Health behaviour in school-aged children : World Health Organization collaborative cross-national study (HBSC): findings from the 2010 HBSC survey in Scotland

The HBSC study in Scotland is funded by NHS Health ScotlandThe report, produced by CAHRU with funding support from NHS Health Scotland, provides a unique picture of the health of young people aged 11, 13 and 15 years in Scotland over the last two decades. Set against the social backdrop of family life, school experience, neighbourhood environment and peer relationships the report gives a comprehensive description of young people's health status. Please contact CAHRU (contact details) for further information about this research.Publisher PD

Gaelic and identity:A response to Iain MacKinnon

This article responds to the recent special issue of Scottish Affairs on ‘Gàidhealtachd Futures’ and in particular the article by Iain MacKinnon proposing that ancestry, ethnicity and indigeneity should become the principal elements in contemporary Gaelic identity. The editors of the special issue do not give an analytically meaningful presentation of the term Gàidhealtachd and MacKinnon fails to give a complete or balanced account of previous research on the question of Gaelic identity. There is considerable uncertainty about how the term Gael is understood today; many Gaelic speakers are reluctant to accept this label for themselves. MacKinnon's arguments concerning the role of ancestry in defining Gaelic identity are highly problematic in both analytical and political terms. His proposals concerning ethnicity and indigeneity are unsustainable, particularly in light of relevant legal standards, and amount to a strategic, ethical and legal dead end for the Gaelic revitalisation movement

Against exclusionary Gaelic language policy:A response to Ó Giollagáin and Caimbeul

This article considers a range of weaknesses and deficiencies in the article ‘Moving Beyond Asocial Minority-Language Policy’ by Conchúr Ó Giollagáin and Iain Caimbeul and the underlying research study on which it was based. The authors’ presentation of previous research was inadequate and the framing of their survey results was sensationalistic, risking the demoralisation of Gaelic speakers and the weakening of social or political support for the language. The authors fail to justify and properly define the key terms used in their analysis, including ‘vernacular community’ and ‘Gaelic group’, so that there is a pervasive lack of clarity to their discussion, with serious implications for their key policy proposal. We also identify shortcomings in the geographic framing of their study; which areas were included and which were not. We then challenge the social classification they use in their analysis, and their rigid distinction between Gaelic speakers in their study area and all those living elsewhere. We then demonstrate how the authors’ presentation of current Gaelic policy is incomplete, misleading and biased, and we critique their proposals for fundamental changes to the current policy structure, including the creation of a new Gaelic community trust. We argue that strengthening existing policy structures and exploiting such structures much more energetically and effectively offers a better approach to strengthening the language, both in the areas studied and elsewhere in the country

Bayesian Estimation of the Size of a Street-Dwelling Homeless Population

A novel Bayesian technique is proposed to calculate 95% interval estimates for the size of the homeless population in the city of Edmonton using plant-capture data from Toronto, Canada. The probabilities of capture in Edmonton and Toronto are modeled as exchangeable in a hierarchical Bayesian model, and Markov chain Monte Carlo is used to sample from the posterior distribution. Guidelines are recommended for applying the method to assess the accuracy of homeless counts in other cities

Singing for Health in Morecambe: 2019

The International Centre for Community Music (ICCM) was invited to respond to an existing brief that sought to understand how two new singing groups were developing. This was part of a pilot project established to connect with older people experiencing isolation, and, young people who were connected with the Children and Adolescent Mental Health Service (CAMHS). These singing groups were set up in partnership with a local GP practice and a local CAHMS team to explore possible arts partnerships as a way to challenge health inequalities relating to mental health experiences in Morecambe

Transforming embodied experiences of academic conferences through creative practice : Participating in an instant choir at the nordic geographers’ meeting in 2019

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Sage in Cultural Geographies on 18/08/2021.Available online: https://journals.sagepub.com/doi/pdf/10.1177/14744740211039831acceptedVersio