Nutritional deficiencies in homeless persons with problematic drinking:A systematic review

BACKGROUND: A significant proportion of homeless people drink alcohol excessively and this can lead to malnutrition and consequent medical problems. The aim of this review was to assess the evidence on the range of nutritional deficiencies in the homeless problem-drinking populations. METHODS: We conducted a comprehensive search of nine scientific literature databases and 13 grey literature sources. We included studies of any design that included homeless population with problem-drinking and reported measures of nutritional deficiencies in urine or blood. Study selection and data extraction was done by one reviewer and checked by another. Data on malnutrition profile were summarized narratively. RESULTS: We found nine studies reporting nutritional deficiencies in homeless populations with problem-drinking. The oldest study was from the 1950s and the most recent from 2013. The following nutrients were reported across studies: vitamins B1, B2, B6, B9, B12, C, A, and E; haemoglobin; and albumin. The most common deficiencies reported were of vitamin B1 (prevalence of deficiency was 0, 2, 6, 45, and 51% in five studies) and vitamin C (29, 84, and 95% in three studies). None of the studies were assessed to be at a low risk of bias. CONCLUSIONS: The limited, low quality and relatively old evidence suggests that homeless people who drink heavily may be deficient in vitamin C, thiamine, and other nutrients. New, well conducted studies are needed in order to optimally inform public health interventions aimed at improving deficiencies in this population

Interventions for preventing or treating malnutrition in problem drinkers who are homeless or vulnerably housed:protocol for a systematic review

BACKGROUND: Problem alcohol drinking in homeless and vulnerably housed people can lead to malnutrition, which is associated with complications such as alcohol-related brain damage. Homeless alcohol drinkers are likely to have worse health outcomes and different nutritional needs compared with housed alcohol-drinking persons. It is not clear whether interventions to improve nutritional status in this population have been effective. The purpose of this review is to assess the effectiveness and cost-effectiveness of interventions for preventing or correcting micronutrient deficiencies and other forms of malnutrition and related comorbidities in this population. METHODS/DESIGN: A systematic search for studies of a nutrition-based intervention applied in the homeless or vulnerably housed population with problem drinking will be conducted. The following electronic databases will be systematically searched for relevant studies: MEDLINE, EMBASE, Web of Science, PsycINFO, CAB abstracts, CINAHL, Cochrane Public Health Group Register and Cochrane Drugs and Alcohol Group Register. Screening of identified abstracts for relevance and assessment of papers for inclusion will be done in duplicate. One reviewer will extract data from the studies and assess quality, and this will be checked by another reviewer. Discrepancies will be resolved by consensus. The primary outcomes are (mal)nutrition status or micronutrient deficiencies or change in (mal)nutrition status or micronutrient deficiencies, measures of liver damage and cognitive function. Secondary outcomes include comorbidities, quality of life and functional scales, resources used to deliver treatment, uptake/acceptability of the intervention and engagement with treatment services. Results will be analysed descriptively, and, if appropriate, meta-analyses will be performed. DISCUSSION: The results of this review should help to inform the development of effective interventions that can be implemented in the community to improve the health of homeless people who are problem drinkers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015024247 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-015-0114-3) contains supplementary material, which is available to authorized users

Cellular entry of nanoparticles via serum sensitive clathrin-mediated endocytosis, and plasma membrane permeabilization

Increasing production and application of nanomaterials raises significant questions regarding the potential for cellular entry and toxicity of nanoparticles. It was observed that the presence of serum reduces the cellular association of 20 nm carboxylate-modified fluorescent polystyrene beads up to 20-fold, relative to cells incubated in serum-free media. Analysis by confocal microscopy demonstrated that the presence of serum greatly reduces the cell surface association of nanoparticles, as well as the potential for internalization. However, both in the presence and absence of serum, nanoparticle entry depends upon clathrin-mediated endocytosis. Finally, experiments performed with cells cooled to 4°C suggest that a proportion of the accumulation of nanoparticles in cells was likely due to direct permeabilization of the plasma membrane

A consultation-level intervention to improve care of frequently attending patients: a cluster randomised controlled feasibility trial

Background: Frequent attenders (FAs) to primary care receive considerable NHS resources without necessarily gaining benefit, and may even be harmed. Aim: To assess the feasibility of a consultation-level intervention to improve care and address service use of FAs. Design & setting: A cluster randomised controlled feasibility trial was undertaken. The study used a mixed-methods process evaluation and took place in six practices in England. Method: All practices screened the top 3% of all attending patients over the previous 12 months for eligibility. Following randomisation, intervention patients were matched with named GPs, trained to use the Background, Affect, Trouble, Handling, Empathy (BATHE) technique during consultations. Telephone consultations were encouraged. Feasibility outcomes assessed were recruitment, retention, data collection and completeness, implementation fidelity, and acceptability Results: A total of 599/1328 (45.1%) FAs were eligible. Four practices were randomised to the intervention (n = 451) and two to usual care (n = 148). A total of 96 (23.7%) patients were recruited to complete questionnaires. Retention and completeness of data were good; for example, 76% of those agreeing to complete questionnaires did so at the 12-month assessment point. Thirty-four GPs were trained and delivered BATHE ≥1 times to 50.1% of patients (n = 577 consultations). There were minimal increases in continuity and telephone consultations. Patients were positive about the intervention, but noticed little change in their care. Despite valuing BATHE, low adherence to training was indicated and GPs used it less than anticipated. Conclusion: It was feasible to identify FAs and collect trial data. GPs were keen to engage and there was evidence that the BATHE technique was taken into practice. Optimising training is likely to improve fidelity. The intervention was low cost and low risk

Interventions for preventing or treating malnutrition in homeless problem-drinkers:a systematic review

Abstract Background Excessive drinking leads to poor absorption of nutrients and homeless problem-drinkers often have nutritionally inadequate diets. Depletion of nutrients such as vitamin B1 can lead to cognitive impairment, which can hinder efforts to reduce drinking or engage with services. This review aimed to assess effectiveness of interventions designed to prevent or treat malnutrition in homeless problem-drinkers. Methods We systematically searched nine electronic databases and 13 grey literature sources for studies evaluating interventions to improve nutrition in homeless populations, without regional or language restrictions. Screening for inclusion was done in duplicate. One reviewer extracted data and assessed risk of bias, and another checked the extractions. Primary outcomes were nutrition status/deficiency, liver damage, and cognitive function. Secondary outcomes included abstinence, comorbidities, resource use, acceptability and engagement with intervention. Results were synthesised narratively. Results We included 25 studies (2 Randomised Controlled Trials; 15 uncontrolled before and after; 7 surveys; 1 case-control). Nine studies evaluated educational and support interventions, five food provision, and three supplement provision. Eight studies evaluated a combination of these interventions. No two interventions were the same, and all studies were at high risk of bias. Nutritional status (intake/ deficiency) were reported in 11 studies and liver function in one. Fruit and vegetable intake improved with some education and support interventions (n = 4 studies) but not others (n = 2). Vitamin supplements appeared to improve vitamin deficiency levels in the blood (n = 2). Free or subsidised meals (n = 4) and food packs (n = 1) did not always fulfil dietary needs, but were usually considered acceptable by users. Some multicomponent interventions improved nutrition (n = 3) but acceptability varied (n = 3). No study reported cost effectiveness. Conclusions The evidence for any one intervention for improving malnutrition in homeless problem-drinkers was based on single studies at high risk of bias. Various food and supplement provision interventions appear effective in changing nutritional status in single studies. Educational and multicomponent interventions show improved nutritional behaviour in some studies but not others. Further better quality evidence is required before these interventions can be recommended for implementation. Any future studies should seek the end user input in their design and conduct. Trial registration Registered with PROSPERO: CRD42015024247

Deferred benefits of dominance for natal males in a cooperative breeder, the Kalahari meerkat

In many cooperatively breeding mammals, an unrelated dominant pair monopolizes reproduction in the social group while subordinates help to raise their offspring. In Kalahari meerkats (Suricata suricatta), dominant males are usually immigrants while dominant females are natal animals that have not left the group where they were born. However, in around 20% of cases, a natal male acquires and holds the dominant position – despite being closely related to the dominant female. Natal dominant males seldom mate within their group (either with the dominant female or with subordinate females) and the benefits they accrue from acquiring and main- taining the dominant position are not obvious. Here, we describe the circumstances in which natal males acquire dominance and explore the possible benefits they gain by comparing the life history, growth and behavioural differences between natal dominants, natal subordinates and immigrant dominants in wild groups. We show that natal dominant males do not appear to obtain any survival, nutritional or reproductive benefits from their status while they remain in the natal group. How- ever, after dispersing from their natal group, they have a higher chance of acquir- ing dominant status in another breeding group, suggesting that acquiring dominance in their natal group has deferred direct fitness benefits for male meerkats.European Research Council Horizon 202

Student Perspectives on Digital Phenotyping: The Acceptability of Using Smartphone Data to Assess Mental Health

There is a mental health crisis facing universities internationally. A growing body of interdisciplinary research has successfully demonstrated that using sensor and interaction data from students’ smartphones can give insight into stress, depression, mood, suicide risk and more. The approach, which is sometimes termed Digital Phenotyping, has potential to transform how mental health and wellbeing can be monitored and understood. The approach could also transform how interventions are designed, delivered and evaluated. To date, little work has addressed the human and ethical side of digital phenotyping, including how students feel about being monitored. In this paper we report findings from in-depth focus groups, prototyping and interviews with students. We find they are positive about mental health technology, but also that there are multi-layered issues to address if digital phenotyping is to become acceptable. Using an acceptability framework, we set out the key design challenges that need to be addressed

Additional file 2: of Nutritional deficiencies in homeless persons with problematic drinking: a systematic review

Graphic presentation of vitamin deficiencies in included studies. (JPG 579 kb

Additional file 1: of Nutritional deficiencies in homeless persons with problematic drinking: a systematic review

List of excluded studies. (PDF 338 kb