ORCID Profile
0000-0002-1628-1228
Current Organisation
University College London
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Publisher: Oxford University Press (OUP)
Date: 09-2020
DOI: 10.1093/EURPUB/CKAA165.1350
Abstract: The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital. This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities. The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. In iduals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87). This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population. The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.
Publisher: F1000 Research Ltd
Date: 11-03-2019
DOI: 10.12688/WELLCOMEOPENRES.15151.1
Abstract: Background : Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods : We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths and deaths from amenable causes. We compared our results to a s le of people living in areas of high social deprivation (IMD5 group). Results : We collected data on 3,882 in idual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7% 130/600), cancer (19.0% 114/600) and digestive disease (19.0% 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion : Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.
Publisher: Elsevier BV
Date: 04-2018
Publisher: BMJ
Date: 16-12-2021
DOI: 10.1136/SEXTRANS-2021-055210
Abstract: Physical restrictions imposed to combat COVID-19 dramatically altered sexual lifestyles but the specific impacts on sexual behaviour are still emerging. We investigated physical and virtual sexual activities, sexual frequency and satisfaction in the 4 months following lockdown in Britain in March 2020 and compared with pre-lockdown. Weighted analyses of web panel survey data collected July/August 2020 from a quota-based s le of 6654 people aged 18–59 years in Britain. Multivariable regression took account of participants’ opportunity for partnered sex, gender and age, to examine their independent associations with perceived changes in sexual frequency and satisfaction. Most participants (86.7%) reported some form of sex following lockdown with physical activities more commonly reported than virtual activities (83.7% vs 52.6%). Altogether, 63.2% reported sex with someone (‘partnered sex’) since lockdown, three-quarters of whom were in steady cohabiting relationships. With decreasing relationship formality, partnered sex was less frequently reported, while masturbation, sex toy use and virtual activities were more frequently reported. Around half of all participants perceived no change in partnered sex frequency compared with the 3 months pre-lockdown, but this was only one-third among those not cohabiting, who were more likely to report increases in non-partnered activities than those cohabiting. Two-thirds of participants perceived no change in sexual satisfaction declines were more common among those not cohabiting. Relationship informality and younger age were independently associated with perceiving change, often declines, in sexual frequency and satisfaction. Our quasi-representative study of the British population found a substantial minority reported significant shifts in sexual repertoires, frequency and satisfaction following the introduction of COVID-19 restrictions. However, these negative changes were perceived by some more than others predominantly those not cohabiting and the young. As these groups are most likely to experience adverse sexual health, it is important to monitor behaviour as restrictions ease to understand the longer term consequences, including for health services.
Publisher: Oxford University Press (OUP)
Date: 11-2019
DOI: 10.1093/JAC/DKZ452
Abstract: HCV infection disproportionately affects underserved populations such as homeless in iduals, people who inject drugs and prison populations. Peer advocacy can enable active engagement with healthcare services and increase the likelihood of favourable treatment outcomes. This observational study aims to assess the burden of disease in these underserved populations and describe the role of peer support in linking these in iduals to specialist treatment services. Services were identified if they had a high proportion of in iduals with risk factors for HCV, such as injecting drug use or homelessness. In iduals were screened for HCV using point-of-care tests and a portable FibroScan. All positive cases received peer support for linkage to specialist care. Information was gathered on risk factors, demographics and follow-up information regarding linkage to care and treatment outcomes. A total of 461 in iduals were screened, of which 197 (42.7%) were chronically infected with HCV. Referral was made to secondary care for 176 (89.3%) and all received peer support, with 104 (52.8%) in iduals engaged with treatment centres. Of these, 89 (85.6%) started treatment and 76 (85.4%) had a favourable outcome. Factors associated with not being approved for treatment were recent homelessness, younger age and current crack cocaine injecting. Highly trained peer support workers working as part of a specialist outreach clinical team help to identify a high proportion of in iduals exposed to HCV, achieve high rates of engagement with treatment services and maintain high rates of treatment success amongst a population with complex needs.
Publisher: European Respiratory Society (ERS)
Date: 18-03-2021
Publisher: Oxford University Press (OUP)
Date: 11-2019
DOI: 10.1093/JAC/DKZ455
Abstract: Hepatitis C is one of the main causes of chronic liver diseases worldwide. One of the major barriers to effecting EU- and WHO-mandated HCV elimination by 2030 is underdiagnosis. Community-based screening strategies have been identified as important components of HCV models of care. HepCheck Europe is a large-scale intensified screening initiative aimed at enhancing identification of HCV infection among vulnerable populations and linkage to care. Research teams across four European countries were engaged in the study and rolled out screening to high-risk populations in community addiction, homeless and prison services. Screening was offered to 2822 in iduals and included a self-administered questionnaire, HCV antibody and RNA testing, liver fibrosis assessment and referral to specialist services. There was a 74% (n=2079) uptake of screening. The majority (85.8%, n=1783) were male. In total 44.6% (n=927) of the s le reported ever injecting drugs, 38.4% (n=799) reported ever being homeless and 27.9% (n=581) were prisoners. In total 397 (19%) active HCV infections were identified and 136 (7% of total s le and 34% of identified active infections) were new cases. Of those identified with active HCV infection, 80% were linked to care, which included liver fibrosis assessment and referral to specialist services. HepCheck’s screening and linkage to care is a clear strategy for reaching high-risk populations, including those at highest risk of transmission who are not accessing any type of care in the community. Elimination of HCV in the EU will only be achieved by such innovative, patient-centred approaches.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IJID.2019.11.027
Abstract: Hepatitis C virus (HCV) is a main cause of chronic liver disease worldwide and is consistently under-diagnosed. Community-based screening initiatives, such as HepCheck, have been identified as important components of HCV care. HepCheck focuses on screening and identifying HCV RNA-positive cases in high-risk populations and linking them to care as part of a larger European project to improve HCV care (HepCare). HCV testing with a self-administered questionnaire was offered to 2822 in iduals. There were 2079 patients screened. Overall, 397 (19%) of the total screened cohort were identified as having active HCV infections as measured by HCV RNA PCR. The patients were mostly male (84%), white (88%), and had a history of injecting drug use (IDU) (86%), homelessness (58%), and tattooing (42%). There were 136 new cases (7% of the total s le and 34% of identified active infections). Romania had the highest proportion of newly identified cases with 87%, then Ireland with 60%, and Spain with 43% the UK had the lowest proportion of new cases at 10%. For those lost to follow-up, a major strategy is re-engagement. For those newly diagnosed, the 'seek and treat' approach is a key strategy. Thus, different priorities are defined for different countries.
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2021-050717
Abstract: People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates—that is, trained volunteers with lived experience—to support people who are homeless to access healthcare. We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies) processes and contexts (qualitative study) fidelity and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation. Ethics approval for all study designs has been granted by the National Health Service London—Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine’s Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles.
Publisher: Swansea University
Date: 07-09-2018
Abstract: IntroductionIn England, details on hospital admissions and mortality are recorded nationally, but housing status and patients’ hospital discharge arrangements are only recorded locally within discharge services. These data are required to evaluate specialist homeless hospital discharge (HHD) services in England, and can be obtained through linkage within and across sectors. Objectives and ApproachWe aimed to improve linkage to enable the evaluation of HHD schemes. 16 sites with a scheme were recruited along with a specialist facility that deliver screening and treatment services to homeless hostels (Find\\& Treat). Linkage fields including National Health Service number (NHS number), name, gender and birthdate for clinical contacts between November 2013 and November 2016 were collected and linked to national hospital data, Hospital Episodes Statistics (HES). To improve linkage with HES, intermediate-linkage to a gender-names dictionary and a national demographic database (NDD) was performed. Ethics, access permissions were obtained through HRA-REC (REC16/EE/0018) and NHS CAG (16/CAG/0021). Results47,569 clinical contacts among people who were homeless were collected from Find& Treat and 12,931 from sites. The median age at mid-study period (15th May 2015) among contacts with sites compared to Find& Treat were similar at 44 (IQR 34-53, n=12,905) and 45 (IQR 35-54, n=47,569), respectively. Among Find& Treat, 82% (n=38,905) were contacts with Males and 18% (n=8,650) with Females. Gender was not collected at all HHD sites or for all admissions. 70% of contacts had missing gender and among these contacts, gender was assigned using the gender-names dictionary. After imputing gender, 52% of contacts all linkage fields and 47% had all but NHS number. These data were linked to the NDD, an approximate 60% linkage rate was achieved retrieving complete linkage fields for these contacts. Conclusion/ImplicationsIntermediate linkage steps described here provides the largest dataset of it’s kind, enabling investigations into effectiveness of hospital discharge schemes in England. The study provides generally a proof of concept that large cohorts of hard-to-reach population groups can be obtained through data linkage.
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3862706
Publisher: BMJ
Date: 05-01-2021
Abstract: Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each in idual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A& E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A& E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%) and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for ex le being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-045289
Abstract: To implement and assess the mobile X-ray unit (MXU) equipped with digital radiography, computer-aided detection (CAD) software and molecular point of care tests to improve early tuberculosis (TB) diagnosis in vulnerable populations in a TB outreach screening programme in Romania. Descriptive study. Prisons in Bucharest and other cities in the southern part of Romania, homeless shelters and services for problem drug users in Bucharest, and Roma populations in Bucharest and Craiova. 5510 in iduals attended the MXU service 5003 persons were radiologically screened, 61% prisoners, 15% prison staff, 11% Roma population, 10% homeless persons and/or problem drug users and 3% other. Radiological digital chest X-ray (CXR) screening of people at risk for TB, followed by CAD and human reading of the CXRs, and further TB diagnostics when the pulmonologist classified the CXR as suggestive for TB. Ten bacteriologically confirmed TB cases were identified translating into an overall yield of 200 per 100 000 persons screened (95% CIs of 109 to 368 per 100 000). Prevalence rates among homeless persons and/or problem drug users (826/100 000 95% CI 326 to 2105/100 000) and the Roma population (345/100 000 95% CI 95 to 1251/100 000) were particularly high. The human reader classified 6.4% (n=317) of the CXRs as suspect for TB (of which 32 were highly suggestive for TB) 16.3% of all CXRs had a CAD4TB version 6 score . All 10 diagnosed TB patients had a CAD4TB score 9 had a CAD4TB score . Given the high TB prevalence rates found among homeless persons and problem drug users and in the Roma population, targeted active case finding has the potential to deliver a major contribution to TB control in Romania.
Publisher: BMJ
Date: 04-2019
DOI: 10.1136/BMJOPEN-2018-025192
Abstract: To compare health-related quality of life and prevalence of chronic diseases in housed and homeless populations. Cross-sectional survey with an age-matched and sex-matched housed comparison group. Hostels, day centres and soup runs in London and Birmingham, England. Homeless participants were either sleeping rough or living in hostels and had a history of sleeping rough. The comparison group was drawn from the Health Survey for England. The study included 1336 homeless and 13 360 housed participants. Chronic diseases were self-reported asthma, chronic obstructive pulmonary disease (COPD), epilepsy, heart problems, stroke and diabetes. Health-related quality of life was measured using EQ-5D-3L. Housed participants in more deprived neighbourhoods were more likely to report disease. Homeless participants were substantially more likely than housed participants in the most deprived quintile to report all diseases except diabetes (which had similar prevalence in homeless participants and the most deprived housed group). For ex le, the prevalence of chronic obstructive pulmonary disease was 1.1% (95% CI 0.7% to 1.6%) in the least deprived housed quintile 2.0% (95% CI 1.5% to 2.6%) in the most deprived housed quintile and 14.0% (95% CI 12.2% to 16.0%) in the homeless group. Social gradients were also seen for problems in each EQ-5D-3L domain in the housed population, but homeless participants had similar likelihood of reporting problems as the most deprived housed group. The exception was problems related to anxiety, which were substantially more common in homeless people than any of the housed groups. While differences in health between housed socioeconomic groups can be described as a ‘slope’, differences in health between housed and homeless people are better understood as a ‘cliff’.
Publisher: Unpublished
Date: 2018
Publisher: BMJ Publishing Group Ltd and British Thoracic Society
Date: 12-2018
Publisher: Informa UK Limited
Date: 08-06-2022
DOI: 10.1080/13691058.2022.2078507
Abstract: Government controls over intimate relationships, imposed to limit the spread of Sars-CoV-2, were unprecedented in modern times. This study draws on data from qualitative interviews with 18 participants in Natsal-COVID, a quasi-representative web-panel survey of the British population (
Publisher: Elsevier BV
Date: 2016
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-055284
Abstract: Physical distancing as a non-pharmaceutical intervention aims to reduce interactions between people to prevent SARS-CoV-2 transmission. Intimate physical contact outside the household (IPCOH) may expand transmission networks by connecting households. We aimed to explore whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020. The Natsal-COVID web-panel survey (July–August 2020) used quota-s ling and weighting to achieve a quasi-representative population s le. We estimate reporting of IPCOH with a romantic/sexual partner in the 4 weeks prior to interview, describe the type of contact, identify demographic and behavioural factors associated with IPCOH and present age-adjusted ORs (aORs). Qualitative interviews (n=18) were conducted to understand the context, reasons and decision making around IPCOH. Of 6654 participants aged 18–59 years, 9.9% (95% CI 9.1% to 10.6%) reported IPCOH. IPCOH was highest in those aged 18–24 (17.7%), identifying as gay or lesbian (19.5%), and in steady non-cohabiting relationships (56.3%). IPCOH was associated with reporting risk behaviours (eg, condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54 95% CI 0.32 to 0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34 95% CI 1.10 to 1.65). Two-thirds (64.4%) of IPCOH was reported as being within a support bubble. Qualitative interviews found that people reporting IPCOH deliberated over, and made efforts to mitigate, the risks. Given 90% of people did not report IPCOH, this contact may not be a large additional contributor to SARS-CoV-2 transmission, although heterogeneity exists within the population. Public health messages need to recognise how single people and partners living apart balance sexual intimacy and relationship needs with adherence to control measures.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJID.2019.02.041
Abstract: Screening for active and latent TB among migrants in low TB incidence countries may constitute an important contribution to TB elimination. E-DETECT TB, a European multi-county collaboration, aims to address the present lack of evidence on effectiveness of migrant TB screening by collating data in an international database and perform cross-country pooled and comparative analyses of screening coverage, results and linkage to care. A database was established using migrant TB screening data from participating countries' national screening programs, national screening pilots and local research projects. All partner countries contributed to a common agreed protocol with standardized variables, pooling available numerator and denominator screening data from participating countries and sites. All collaborating members drafted and agreed upon a data sharing accord as well as a protocol that clearly defined responsibilities and data governance principles. The database has been created and data transfer is ongoing. By persistence and focus the project has overcome considerable administrative, practical and legal challenges. This international collaboration provides greater power of analysis of harmonized data and thereby a unique opportunity to contribute migrant TB screening evidence. E-DETECT TB has started to invite other countries to contribute data to the database.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2019
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Dee Menezes.