Contribution of a shelter-based survey for screening respiratory diseases in the homeless.
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.
Badiaga
Sékéné
S
URMITE CNRS-IRD UMR 6236, Faculté de médecine, Marseille, France.
Richet
Hervé
H
Azas
Patricia
P
Zandotti
Christine
C
Rey
Françoise
F
Charrel
Rémi
R
Benabdelkader
El-hadi
el-H
Drancourt
Michel
M
Raoult
Didier
D
Brouqui
Philippe
P
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