PURPOSE: This study shows the change in emergency room use behavior by homeless patients after implementation of the ‘Seoul Type Citizen Sympathy Emergency Room Project’ in July 2015. METHODS: A retrospective study was conducted in a public hospital between January 2014 and December 2014 and January 2016 and December 2016. Homeless patients who visited the emergency room in 2014 and 2016 were compared based on age, gender, mode of insurance, admission, revisit within 48 hours, length of stay (LOS) in the emergency department (ED), total cost, and major diagnostic category. RESULTS: A total of 3,642 homeless patients were enrolled during the study period, of which 1,876 visited in 2014 and 1,766 in 2016. Fewer homeless patients in 2016 revisited within 48 hours (p=0.046). Homeless in 2016 had a shorter ED LOS (p < 0.001) and lower total cost (p=0.040). More homeless patients who visited due to alcohol revisited within 48 hours in 2016 (p=0.036). Moreover, these patients did not have a different ED LOS (p=0.060) or total cost (p=0.475). Medicaid homeless patients were less connected compared health insurance by screening, brief intervention, referral to treatment program. CONCLUSION: Comparison of homeless patients who visited the emergency room in 2014 and 2016 revealed fewer total homeless patients in 2016, as well as less revisits within 48 hours, shorter ED LOS and lower total cost. These findings indicate that the ‘Seoul Type Citizen Sympathy Emergency Room Project’ was effective in the emergency room, but improvements for alcohol and medicaid homeless patients are needed.
Alcoholics ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Health Policy ; Homeless Persons ; Hospitals, Public ; Humans ; Insurance ; Insurance, Health ; Length of Stay ; Mass Screening ; Medicaid ; Referral and Consultation ; Retrospective Studies

PURPOSE: The purpose of this study was to explore the lived experiences of homeless persons. METHODS: A phenomenological methodology was used for the study. Participants were people enrolled in the Center for homeless persons in Kyunggi Province and eligible for the study. Data were collected through in-depth interviews with nine participants between October 13 and November 16, 2016. Data analysis was conducted using Colaizzi's method. RESULTS: Five themes and twenty meanings were formulated for experiences of homeless persons. The five themes were ‘Abandoning their life’, ‘Being familiar with a free homeless life’, ‘Being isolated from the world’, ‘Being impoverished’, ‘Desire to break away from the life of homelessness’. CONCLUSION: The study results suggest the need for a holistic understanding of the essential structure of the lived experiences of homeless persons. Mental health professionals need to understand the homelessness experiences from the client view and to develop programs that can help homeless persons reintegrate into the community.
Gyeonggi-do ; Homeless Persons* ; Humans ; Mental Health ; Methods ; Qualitative Research ; Statistics as Topic

PURPOSE: The purpose of this study was to investigate character strengths, physical and mental health status of the homeless. METHODS: Data were collected from November 2014 to March 2016 through the VIA-IS questionnaires and the DESC vulnerability assessment tool. The participants were 120 adultmen living in two self-reliance support facilities for homeless people, located in S city, Korea. Data were analyzed using descriptive statistics, t-test, and ANOVA with SPSS/WIN 23.0 program. RESULTS: Physical health status of the participants was as following: ‘chronicmedical conditions that were not well-managed or significant physical impairment’ 11.7%, and ‘stable significant medical or physical issues, or chronic medical conditions that were being managed’ 46.7%. The mental health status included mild 23.3%,moderate 11.7%, and seriousmental health issues 4.2%. There were no significant differences in physical health status by signature character groups, while mental health status (F=2.46, p=.038) of the courage group was worse than that of the temperance group. CONCLUSION: Findings indicate thatmental health status of homeless people should bemanagedmore appropriately and effective nursing interventions need to be developed using their signature character. However, further research about physical health status by signature character of the homeless is needed.
Courage ; Homeless Persons ; Humans ; Korea ; Mental Health ; Nursing ; Temperance

PURPOSE: Foot and ankle disease (FAD) is a frequent cause of morbidity among the homeless population. Various conditions, exacerbated by malnutrition, poor lifestyle habits, psychiatric disorders, physical injuries, poor hygiene, and limited access to healthcare, have been described in this population. The purpose of this study was to investigate the cognition and management status of FAD in shelter-based homeless people. MATERIALS AND METHODS: Fifty-two male and twenty-five female volunteer homeless individuals were recruited from two homeless shelters. Each person completed a questionnaire assessing any presence of pain, pain management, as well as foot and ankle care status. A foot and ankle surgeon examined the physical status of the individual's foot and ankle, including tenderness and instability. A radiologic evaluation was done for 18 male and 11 female homeless people who agreed to participate in this test for the existence osteophyte or joint space narrowing representing osteoarthritis and some reference angles for hallux valgus, flatfoot and cavus foot. RESULTS: Homeless people had higher prevalence of body mass index, diabetes, and smoking than the general population. The most prevalent infectious disease was fungal infection (male 78%, female 68%), with a low compliance of management for FAD. CONCLUSION: Although most of shelter-based homeless people showed an acceptable foot and ankle management status, the potential risk for FAD development and exacerbation of mild FAD was high.
Ankle* ; Body Mass Index ; Cognition ; Communicable Diseases ; Compliance ; Delivery of Health Care ; Female ; Flatfoot ; Flavin-Adenine Dinucleotide ; Foot Diseases ; Foot* ; Hallux Valgus ; Homeless Persons ; Humans ; Hygiene ; Joints ; Life Style ; Male ; Malnutrition ; Osteoarthritis ; Osteophyte ; Pain Management ; Prevalence ; Smoke ; Smoking ; Volunteers

OBJECTIVES: This exploratory study was designed to estimate the socio-demographic characteristics, course of homelessness, adverse childhood experiences, and prevalence of mental disorders among the street homeless people in Seoul, Korea. In addition, we examined the associations between chronic homelessness and study variables. METHODS: The study subjects were 75 homeless people dwelling in the street around Seoul Station. Questionnaires related to socio-demographic data and the course of homelessness were provided to each subject. The subjects' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) mental disorder diagnoses were made by using Mini International Neuropsychiatric Interview-Plus interviews. RESULTS: Most subjects exhibited chronic homelessness and the prevalence of DSM-IV mental disorders among the homeless subjects was higher than that among the Korean general population. There was a statistically significant association between chronic homelessness and adverse childhood experiences. Compared to those with no history of childhood adversity, homeless people with a history of childhood adversity had a younger age of first homeless episode and a higher prevalence of DSM-IV major mental disorders. The association between DSM-IV diagnosis and chronic homelessness was not significant, but the group with mental disorders had more prevalent re-housing and homeless recurrent histories. CONCLUSION: Street homeless people were often involved in chronic homelessness. Results of this study suggest that homeless people who were never married and had adverse childhood experiences were more vulnerable to chronic homelessness. In addition, we detected a possible relationship between the recurrence of homelessness and the presence of mental disorders.
Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Homeless Persons* ; Humans ; Korea ; Mental Disorders ; Prevalence ; Recurrence ; Seoul ; Single Person

OBJECTIVES: The purpose of this study is to investigate the differences between homeless with schizophrenia and non-homeless with schizophrenia, and to identify the correlators of homelessness in schizophrenic patients. METHODS: Forty two schizophrenic inpatients were divided into the homeless group (n=19) and non-homeless group (n=23). Psychopathologic measures, neurocognitive tests, hinting task, and the Social and Occupational Function Assessment Scale (SOFAS) were administered in both groups. RESULTS: SOFAS showed high correlation with homelessness in schizophrenic inpatients. Duration of Untreated Psychosis, negative component of Positive and Negative Syndrome Scale, Continuous Performance Test (CPT) correct number, and hinting task were all mediated by SOFAS to explain homelessness in schizophrenic inpatients. In particular, CPT correct number showed direct correlation with homelessness without mediation by SOFAS. CONCLUSION: The results of this study suggest that cognitive rehabilitation and social skill training may be helpful in prevention of homelessness of schizophrenic patients. Social cognition and neurocognitive test including CPT may be useful for evaluating the risk of homelessness in schizophrenic patients.
Cognition ; Homeless Persons* ; Humans ; Inpatients ; Negotiating ; Psychotic Disorders ; Rehabilitation ; Schizophrenia*

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.
Adult ; Alcoholic Intoxication/*complications ; Ascorbic Acid/blood/therapeutic use ; Ascorbic Acid Deficiency/*complications/drug therapy/epidemiology ; Emergency Service, Hospital ; Female ; *Homeless Persons ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Vitamin B Complex/blood

OBJECTIVETo determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran.

METHODSIn 2007-2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends.

RESULTSOverall HIV prevalence was 1.7% (95% confidence interval 1.4-1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86-13.67)], older age [AOR 1.80 (1.08-2.99) for 40-55 yr], occupation [AOR 1.64 (1.19-2.24) for unemployed], and no relation with family [AOR 1.82 (1.30-2.54)].

CONCLUSIONSThis study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.

Adult ; Aged ; Cross-Sectional Studies ; Female ; HIV Infections ; epidemiology ; Homeless Persons ; statistics & numerical data ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Prevalence ; Young Adult

PURPOSE: The purpose of this study was to examine the mediation of self-efficacy in the relationship between anger and the functional health of homeless men in order to provide a basis for planning nursing interventions to improve the functional health of homeless persons. METHODS: The participants were 137 homeless men who lived in homeless shelters or visited one center serving free meals for homeless persons in Seoul. Data were collected using self-report questionnaires and analyzed with the SPSS-WIN 20.0 program. The instruments were the Functional Health Pattern Screening Assessment Tool (FHPAST), Self-efficacy Scale (SES), and State-trait Anger Expression Inventory-Korean version (STAXI-K). RESULTS: The mean score for functional health was 2.41. Overall self-efficacy was 70.82. state anger was 16.53, trait anger was 19.54, and anger expression was 25.31. There were signigicant correlations among the 3 variables, functional health, self-efficacy, and anger. Also, self-efficacy had a complete mediating effect in the relationship between anger and functional health. CONCLUSION: Based on the findings of this study, health management programs focusing on anger management and self-efficacy improvement are highly recommended to promote functional health in homeless persons.
Adaptation, Psychological ; Adult ; Aged ; *Anger ; Cognition ; Expressed Emotion ; Health Status ; Homeless Persons/*psychology ; Humans ; Male ; Middle Aged ; Questionnaires ; *Self Efficacy ; Stress, Psychological

BACKGROUND/AIMS: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. METHODS: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. RESULTS: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. CONCLUSIONS: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.
Chronic Disease ; Communicable Diseases ; Comorbidity* ; Diabetes Mellitus ; Hemoglobin A, Glycosylated ; Homeless Persons ; Hospitals, General* ; Humans ; Incidence ; Intracranial Hemorrhages ; Medical Records ; Mortality ; Multivariate Analysis ; Peripheral Arterial Disease ; Prevalence* ; Retrospective Studies ; Seoul ; Tuberculosis, Pulmonary