title: Contribution of a shelter-based survey for screening respiratory diseases in the homeless.
abstract: BACKGROUND
  The homeless are at very high risk for both respiratory diseases and poor access to health care delivery systems. The aim of this study was to assess the contribution of a shelter-based survey to identify respiratory diseases in the homeless population in Marseilles, in order to further develop preventive interventions.
  
  
  METHODS
  A prevalence survey of respiratory diseases was conducted in two homeless shelters in Marseilles, in February 2005. A multidisciplinary team including infectious diseases specialists, lung specialists, residents, nurses, physiotherapists and X-ray technicians visited the two shelters. Interview, physical examination, sputum sampling for Mycobacterium tuberculosis detection, nasal swabs for virus detection and chest X-rays were performed in shelters. Chest X-rays were subsequently analysed by a pneumonologist and subjects found to have radiological abnormalities were hospitalized for further investigations.
  
  
  RESULTS
  Of the 221 homeless persons enrolled, 110/221 (50%) had at least one respiratory manifestations. Chest X-rays were abnormal in 14 persons. Active tuberculosis was diagnosed in two, influenza in two, respiratory syncytial virus infection in two, acute pneumonia in one, asthma in two, lung cancer in one, acute bronchitis in 23, chronic bronchitis in 42, and exacerbation of chronic obstructive pulmonary disease in 22 persons, respectively.
  
  
  CONCLUSIONS
  Our shelter-based survey, including clinical evaluation and chest radiographic screening, shows that this approach can be useful to control and prevent respiratory diseases among the homeless. However, further studies are necessary to determine the magnitude of influenza in the homeless, the impact of influenza immunization and optimal frequency of interventions in shelters.
authors.affiliation: URMITE CNRS-IRD UMR 6236, Faculté de médecine, Marseille, France.
authors.forename: Sékéné
authors.initials: S
authors.lastname: Badiaga
authors.forename: Hervé
authors.initials: H
authors.lastname: Richet
authors.forename: Patricia
authors.initials: P
authors.lastname: Azas
authors.forename: Christine
authors.initials: C
authors.lastname: Zandotti
authors.forename: Françoise
authors.initials: F
authors.lastname: Rey
authors.forename: Rémi
authors.initials: R
authors.lastname: Charrel
authors.forename: El-hadi
authors.initials: el-H
authors.lastname: Benabdelkader
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Philippe
authors.initials: P
authors.lastname: Brouqui
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006703:Ill-Housed Persons; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult