A pathway on serving multicultural and underserved populations.
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Attitude of Health Personnel↗
Biomedical subjects
L Weinreb
Publications and source records attributed to L Weinreb.
Post-traumatic stress disorder in extremely poor women: implications for health care clinicians.
OBJECTIVES: To identify childhood antecedents for lifetime post-traumatic stress disorder (PTSD) and to determine how this diagnosis relates to health and service use among extremely poor women. METHODS: We conducted a secondary data analysis of 425 women in the Worcester Family Research Project, a case-control longitudinal study of 220 sheltered homeless and 216 extremely poor housed (never homeless) women in Worcester, Massachusetts. RESULTS: We found that extremely poor women with lifetime PTSD were more likely to have grown up in family environments of violence, threat, and anger than those without PTSD. The strongest risk factor for PTSD was childhood sexual abuse with threat. Low-income women with lifetime PTSD had more bodily pain, even when controlling for other health and demographic factors. Women with PTSD experienced more chronic health conditions and had more problematic relationships with their health care providers and perceived more barriers to care. CONCLUSION: Many low-income women have difficulty using medical care appropriately because of childhood histories of physical and sexual abuse, the subsequent development of post-trauma responses, and structural barriers to care. Given these factors, it is critical that health care clinicians routinely screen for histories of violence and PTSD and develop treatment plans that ensure safety, link current symptoms with prior experiences, and provide support as necessary. A team approach coordinated by a case manager may be the best strategy. Without routine screening for PTSD and sensitive treatment, many extremely poor women will receive compromised health care and may even be retraumatized.
Adult↗
HIV-risk practices among homeless and low-income housed mothers.
BACKGROUND: Knowledge of human immunodeficiency virus (HIV) and its risk behaviors have not been systematically studied in homeless mothers. The identification of the factors associated with HIV-risk practices will guide interventions for low-income housed and homeless women. METHODS: We interviewed 220 homeless and 216 low-income housed mothers living in Worcester, Massachusetts, to gather information on demographic, psychosocial , and HIV-risk practice characteristics. We used standardized instruments and questions drawn from national surveys. The primary study outcome was high HIV-risk behavior. RESULTS: Although homeless mothers were more likely than low-income housed mothers to report first sexual contact at an early age, multiple partners during the last 6 months, and a history of intravenous drug use, homelessness was not associated with high HIV-risk practices. Both homeless and low-income housed mothers demonstrated misconceptions about HIV transmission through casual contact. Among high-risk women, approximately 75% perceived themselves as having low or no risk for contracting HIV. A history of childhood victimization, adult partner violence, or both placed women at a significantly increased likelihood of high HIV-risk practices. African American race, knowledge about HIV, and self-perception of risk were also significantly associated with high-risk practices. CONCLUSIONS: Homeless mothers are a subgroup of poor women at high risk for HIV and should be targeted for preventive interventions. In addition, there are potentially modifiable factors associated with HIV-risk practices in both low-income housed and homeless mothers that should be directly addressed.
Adult↗
Genetic and developmental influences on infant mouse ultrasonic calling. II. Developmental patterns in the calls of mice 2-12 days of age.
Infant house mice, Mus musculus, produce ultrasonic calls that reliably lead to retrieval by adult mice. While individual differences in calls have been demonstrated both among and within species, the influences of age and sex on call characteristics have not been systematically investigated in mice. This study examined the influences of age, sex, and genotype (inbred versus hybrid) on the rate, length, and frequency characteristics of the calls of 486 male and female mice from 2 to 12 days of age. Rate of calling followed a shallow inverted U-shaped function across days. Call lengths decreased and call frequency characteristics increased, in a linear manner, with age. Females emitted fewer calls, with a smaller bandwidth, at some ages than males. Hybrid pups produced more calls of greater length and a lower frequency than inbred pups. These results indicate the presence of cues that could allow adult mice to behave differentially toward pups as a function of their age and sex.
Age Factors↗
Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers.
OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household. DESIGN: Case-control study. SETTING: Community of Worcester, Massachusetts. PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare. MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p = .10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38). CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services.
Adult↗
Determinants of health and service use patterns in homeless and low-income housed children.
OBJECTIVE: Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children. METHODS: Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes. RESULTS: Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings. CONCLUSIONS: Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.
Adolescent↗
Genetic and developmental influences on infant mouse ultrasonic calling. I. A diallel analysis of the calls of 3-day olds.
Ultrasonic calls produced by young mice reliably elicit investigation and retrieval by adults. While there are large individual differences in the characteristics of these calls, little work has been done to partition that variation. We completed a 4 x 4 diallel cross and Hayman analyses on several characteristics of these cries. The major result was the detection of directional dominance toward a higher rate of calling, longer calls, and calls of lower overall frequency with a greater bandwidth. Within the context of biometrical genetic theory, we conclude that calls with such characteristics may have important fitness value. Extending this idea, we propose that within the population sampled for this study (the animals of the four inbred strains and 12 F1 hybrid groups), the calls most effectively eliciting investigation and retrieval would be calls with the average hybrid values of the diallel cross.
Animals↗
Services for homeless pregnant women: lessons from the field.
Although a significant subset of homeless women are pregnant and at risk for adverse pregnancy outcomes, programmatic responses to their special needs are limited. Findings from the process evaluation of an innovative service demonstration program are explored, and recommendations for future service delivery efforts are offered.
Adult↗
Homeless pregnant women: two generations at risk.
The impact of pregnancy on the course of homelessness and the adverse effects of homelessness on pregnant women and their babies are explored. Recommendations for policy to address the urgent needs of this population are offered, and components of an innovative three-site demonstration program are described.
Adult↗
Homeless families: program responses and public policies.
Numerous programs have been developed nationwide to address the needs of homeless families but many of their policies and practices raise serious questions about the adequacy of the nation's response. Significant problems in the current service delivery system are examined and recommendations are offered for a comprehensive program response that emphasizes service-enriched housing, specialized approaches to meet the needs of homeless mothers, and preventive interventions.
Adult↗
Faculty supervision of residents in an internal medicine practice.
This study examines the supervision of residents by faculty members in an outpatient internal medicine practice. For the study, the investigators developed a methodology to analyze the cognitive content and the focus of residents' thoughts during conversations between faculty members and residents. The residents also identified characteristics of productive and less productive exchanges with the faculty. The study shows that both residents and faculty members use the majority of their part of conversations to present information. Residents in early training appear to be more challenged by diagnostic issues, while residents later in training are more concerned with therapy and management. The study results suggest that effective supervision may relate more to the ability of faculty members to display their reasoning as they present information to residents than to the quantity and types of questions they pose to residents.
Communication↗
Health and psychosocial needs of homeless families: a pilot education and research program.
Family homelessness is increasing and poses unique clinical challenges to physicians who provide health services to this population. Curricula designed to prepare health professionals to effectively care for homeless families is lacking. This report describes a pilot education and research program for family practice residents based at the University of Massachusetts' community health center training site. In addition to providing critical health services to Worcester area homeless families, the program prepares residents to provide continuous, comprehensive, and context-sensitive care to families. The program also familiarizes residents with methods to conduct clinical research with an underserved population.
Education, Medical, Continuing↗