Author: Emily Holton

For his work to improve the health of people experiencing homelessness and to make social justice and health equity central to medical practice, Dr. Stephen Hwang has received the University of Toronto President’s Impact Award.

A professor in the department of medicine and scientist in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Hwang is a world-renowned expert. His research and advocacy has elucidated the causes and risk factors for death among homeless people, the relationship between traumatic brain injury and homelessness, and the effects of homelessness on health status.

Hwang has played a pivotal role in advancing Canadian and international scholarship and advocacy related to homelessness. His work helped inspire the creation of the 100,000 Homes Campaign, which has mobilized officials in hundreds of cities across the U.S. to house thousands of long-term and medically vulnerable homeless individuals who were at increased risk of death.

“Homelessness affects hundreds of thousands of Canadians and takes a tremendous toll on health,” Hwang said. “Our work has shown that the Housing First approach ends chronic homelessness and should be widely implemented. This award will support our ongoing research on new interventions to meet complex health needs and improve well-being and social integration among people experiencing homelessness.”

…Stephen Hwang, MD, an internist, homelessness researcher, and director of [MAP Centre for Urban Health Solutions] at St. Michael’s Hospital in Toronto, said “living on the streets or in a shelter is a hazardous environment.”

He said neurologists treating homeless patients should be aware of the possibility that a history of TBI could be the cause of behavioral issues, seizures or unexplained cognitive deficits. He helped craft recommendations issued in October 2018 by the National Health Care for the Homeless Council that focus on the care of patients who are homeless and living with the effects of TBI. It includes recommendations for assessment of possible deficits, including which screening tools to use.

Over one billion people globally experience some form of disability, yet despite having greater health needs, people with disabilities often encounter barriers to accessing care and have worse outcomes.

In a study published in Disability and Health Journal, MAP scientists Dr. Andrew Pinto and Dr. Tara Kiran examined how patients responded to being asked about disabilities as part of a routine survey and compared survey responses to data available in medical charts.

Featuring MAP scientist Dr. Ann Burchell, and her project: Effectiveness of human papillomavirus vaccine in gay, bisexual and other men who have sex with men

Five cases of the mysterious Wuhan coronavirus have been confirmed in the United States, giving rise to concerns about a potential global pandemic. We’ve seen this story before, as health authorities working with threadbare data try to walk the line between epidemic readiness and needless panic. Is this new outbreak poised to become the next AIDS pandemic or a new SARS, which was stopped in its tracks after 774 deaths? To cut through the headlines, we can use a simple concept called the “epidemic triangle.” Employed by epidemiologists since the discipline’s earliest days, it is indispensable in predicting whether localized outbreaks will transform into full-blown epidemics.

…One stumbling block for approval from Health Canada has been the lack of a clinical trial in Canada showing how accurate and easy to use the kits are, and whether users will seek medical care if they test positive. So, Dr. Sean Rourke, a psychiatrist and scientist at MAP Centre for Urban Health Solutions, raised the money for a 1,000-person clinical trial across give Canadian cities on INSTI finger-prick self-testing kits. Pant Pai is running the Quebec side of the trial. They expect it to be finished in February.

Once bio-Lytical submits the results to Health Canada, Rourke predicts the government will have everything it needs to approve the kits. “Hopefully by early spring or summer, the first self-test kits will be available in Canada,” he says.

…If self-test kits are finally approved for drug-store shelves and if more Canadians living with HIV gain access to medication, it’s a whole new world.

“We can end the HIV epidemic,” says Rourke. “Other countries have targets for 2030. We can do this in three to five years.”

The three biggest problems for patients surveyed about their discharge from Ontario hospitals all concern publicly funded home care, according to new research published in an international medical journal.

The researchers hope the findings will encourage improvements in the hospital-to-home transition navigated by some one million patients every year in this province.

Children who drink whole milk are less likely to be obese, according to a study which questions international dietary guidelines.

Researchers analysed data from 28 existing studies across seven countries involving a total of 20,897 healthy children aged between one and 18 years old. They concluded those who drank whole milk had a 40 percent lower chance of being overweight or obese compared with those who drank low-fat milk. The findings were published in The American Journal of Clinical Nutrition.

Published Dec. 20, 2019

Summary

In Toronto, the Medical Officer of Health issues an extreme cold weather alert when temperatures fall below -15C. Recently, researchers led by St. Michael’s Hospital reviewed coroner’s records and emergency department charts from five downtown hospitals to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness between 2004-2015. They found that while extreme cold temperatures put people at higher risk of hypothermia, most cases of injury and death due to cold occur in moderate winter weather.

This data suggests that the current state of the housing, shelter, respite, and warming centre systems in Toronto leaves many people at risk of injury and death due to cold. For example, there is currently only one warming centre open during extreme cold weather alerts (Metro Hall, with a capacity for 50 people). It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

Background

In Toronto, extreme cold weather alerts trigger additional services for people experiencing homelessness. One dedicated warming centre opens at Metro Hall, and there are additional overnight street outreach staff. Community agencies are also asked to relax service restrictions and let more people inside.

According to the City’s Shelter Census, most emergency shelters, respite centres and volunteer Out of the Cold programs are at or exceeding capacity. Even when the Metro Hall warming centre is open during extreme cold weather alerts, many people are still left outside. For example, in a recent interview, an outreach worker described how his client was turned away from Metro Hall, leaving her with no option but to sleep on the street. This suggests that more warming centres are needed, and not just during extreme cold weather alerts, but all winter long.

About the Research

Researchers reviewed coroner’s records, and charts from emergency departments at St. Michael’s Hospital, Mount Sinai Hospital, Toronto General Hospital, Toronto Western Hospital, and St. Joseph’s Health Centre to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness in Toronto between 2004 – 2015.

Findings

• Seventy-two percent of hypothermia cases in people experiencing homelessness occur when temperatures are warmer than -15C, the threshold for an extreme cold weather alert.
• Rain, snow and damp amplify the effects of cold temperatures, leading to more cases of hypothermia.
• People who are homeless in Toronto are much more likely to experience hypothermia than the general population. People who are homeless account for 25% of all hypothermic injuries and 20% of hypothermic deaths.
• While moderate winter weather puts people experiencing homelessness at increased risk of injury and death, extreme cold weather further heightens this risk.

Implications

The current state of the housing, shelter, respite and warming centre systems in Toronto leaves many people at risk of injury and death.

It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

For more information about this evidence brief, please contact MAP Director Dr. Stephen Hwang: Stephen.Hwang@unityhealth.to

References

• Zhang P, Wiens K, Wang R, Luong L, Ansara D, Gower S, Bassil K & Hwang SW. (2019). Cold Weather Conditions and Risk of Hypothermia Among People Experiencing Homelessness: Implications for Prevention Strategies. International Journal of Environmental Research and Public Health.
• CP24 clip

New research led by St. Michael’s Hospital of Unity Health Toronto analyzed the essential medicines lists of 137 countries and found all but one list included one or more medicines that have either been withdrawn by a regulator or not approved for marketing due to adverse effects in other countries. Somalia listed 83 medicines, and did not include a withdrawn medicine on its essential medicines list.

The study, published in PLOS ONE, identified 97 medicines that were withdrawn from markets between 1953 and 2014 but still included on a national essential medicines list. Eleven of these medicines were withdrawn worldwide because of their associations with harm, but were still included on up to 39 lists.