Levorato S, Bocci G, Troiano G, Messina G, Nante N
Department of Molecular and Developmental Medicine, University of Siena, Italy.
Post Graduate School of Public Health, University of Siena, Italy.
Ann Ig. 2017 Jan-Feb;29(1):54-62. doi: 10.7416/ai.2017.2132.
Homeless persons can be considered a vulnerable group and several studies showed in this group an higher prevalence of chronic and infectious diseases, a lower mental health status, and a higher abuse of alcohol. The aim of our study was to investigate the health status of homeless in Padua, Italy, administering a questionnaire composed by SF-36 and EQ-5D.
We conducted a cross-sectional study from 15 December 2015 to 15 February 2016.
We enrolled in our study 73 homeless persons welcomed in the municipal dorm of Padua. 5 persons refused to participate in the study; 9 had a mental status incompatible with the participation to the study.
We administered to the participants a questionnaire composed by three parts: in the first part we asked sociodemographic information (gender, age, nationality, qualification, height and weight) to calculate BMI, time spent at the dorm, period of homelessness, alcohol intake, smoking habit, availability of a general practitioner, emergency room visits in the last year, admissions in the last year, pre-existing conditions and in act, participation in screening programs. The second part was represented by the Short Form 36 questionnaire. The third part by the EQ-5D questionnaire.
Our sample was composed by 79% men and 21% women. 54.7% were Italian. The mean age was 48 years. 72.8% were smoker and 60,3% drunk alcohol. In this latter group 28.8% drunk more than 1 liter of wine per day. Non Italian homeless smoke less than the Italian: this difference is statistically significant (OR = 3.7 p = 0.032 ). Only 9 foreigners had a general practitioner compared to 30 Italian homeless: this difference is statistically significant (OR = 60 P < 0.01). 43 of the 59 respondents (72.8 % ) said to suffer from some disease. No one reported a history of tuberculosis. The most represented diseases were pneumonia (30%), myocardial infarction (17%), hepatitis C (13.5%). Participation in screening programs was very low. From the analysis of the SF-36 results, homeless persons obtained lower scores than Italian population. In our study, 40 persons reported a level 2 or 3 in the EQ-5D dimension called "anxiety/ depression". In the EQ visual-analogue scale, the homeless population showed a lower perception of its health status.
Compared to the general population, the homeless reported a worse mental health, and this showed that they represent a particularly vulnerable group. Moreover they had a higher percentage of incorrect habits for their health (alcoholism and tobacco addiction), they suffered from chronic conditions, and tended to have a higher frequency of accesses to the emergency rooms. It would be better to improve the state of health of the homeless, through initiatives that could reduce the causes of homelessness, and that could prevent the onset of diseases in this group.
无家可归者可被视为弱势群体，多项研究表明该群体中慢性疾病和传染病的患病率更高、心理健康状况较差且酒精滥用情况更严重。我们研究的目的是通过发放一份由SF - 36和EQ - 5D组成的问卷，调查意大利帕多瓦市无家可归者的健康状况。
我们于2015年12月15日至2016年2月15日进行了一项横断面研究。
我们在帕多瓦市市政宿舍接待的73名无家可归者中开展了研究。5人拒绝参与研究；9人的精神状态不符合参与研究的条件。
我们向参与者发放了一份由三部分组成的问卷：第一部分我们询问了社会人口学信息（性别、年龄、国籍、学历、身高和体重）以计算体重指数（BMI）、在宿舍居住的时间、无家可归的时长、酒精摄入量、吸烟习惯、是否有全科医生、过去一年的急诊就诊次数、过去一年的住院次数、既往疾病情况以及目前正在患有的疾病、参与筛查项目的情况。第二部分由简短健康调查问卷（SF - 36）组成。第三部分由EQ - 5D问卷组成。
我们的样本中男性占79%，女性占21%。54.7%为意大利人。平均年龄为48岁。72.8%的人吸烟，60.3%的人饮酒。在后一组中，28.8%的人每天饮酒超过1升。非意大利籍无家可归者的吸烟率低于意大利籍：这种差异具有统计学意义（比值比[OR]=3.7，P = 0.032）。只有9名外国人有全科医生，而意大利籍无家可归者中有30人有：这种差异具有统计学意义（OR = 60，P < 0.01）。59名受访者中有43人（72.8%）表示患有某种疾病。无人报告有结核病病史。最常见的疾病是肺炎（30%）、心肌梗死（17%）、丙型肝炎（13.5%）。参与筛查项目的比例非常低。从SF - 36结果分析来看，无家可归者的得分低于意大利人群。在我们的研究中，40人在EQ - 5D量表中名为“焦虑/抑郁”的维度报告了2级或3级。在EQ视觉模拟量表中，无家可归人群对其健康状况的认知较低。
与普通人群相比，无家可归者报告的心理健康状况更差，这表明他们是一个特别脆弱的群体。此外，他们有更高比例的不利于健康的不良习惯（酗酒和吸烟成瘾），患有慢性疾病，并且往往有更高的急诊就诊频率。最好通过一些举措来改善无家可归者的健康状况，这些举措可以减少无家可归的原因，并预防该群体疾病的发生。
