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Street Health Definitions and Bibliography


Street health Definitions

Alcoholism: A primary chronic disease influenced by genetic predisposition, psychosocial, environmental and cultural factors. The alcoholic who chooses to drink does so because of a complex interaction between these factors.

Alcoholics Anonymous: AA is a community program designed to encourage abstinence from alcohol using group support. The group is composed of previous alcoholics. It involves following 12 Steps that are written in the “Big Book.”

Anti-social personality disorder: A psychiatric condition in which the rights of others or socially accepted behaviour are violated.

Ascites: Fluid that accumulates in the abdomen when the liver fails.

Asterixis: (liver flap) a motor disturbance marked by intermittent lapses of an assumed posture often due liver or kidney failure.


Bartonella Quintana: An organism which often causes endocarditis in the homeless who suffer from alcoholism. It is often misdiagnosed as Chlamydia.


CAGE: A questionnaire used to screen for alcohol abuse. Two positive answers for males and one positive answer for females indicate alcohol abuse with 85% sensitivity and 89% specificity.
C: Have you ever tried to Cut down on your drinking?
A: Have you ever felt Annoyed by others telling you to cut down?
G: Have you ever felt Guilty about your drinking
E: Have you ever had to have an Eye-opener in the morning?

Cellulitis: Occurs when bacteria infect the skin. Any form of skin breakdown will facilitate the development of cellulitis. Untreated cellulitis may lead to lymphatic damage and edema.

Cheeking: A medical slang term to describe patients who hide their medications in their cheek or under their tongue to prevent swallowing them.

Cirrhosis: Endstage liver disease.

Cocaine: A short acting sympathomimetic drug. It is snorted if it is in the form cocaine hydrochloride (a.k.a. Free base). It is smoked if it is in the form of an alkaloid base (crack).

Conduct disorder: A psychiatric condition seen in childhood in which the rights of others or age-appropriate socially accepted behaviour are violated.


Direct observed therapy: DOS is a program designed to ensure anti-TB medications are taken daily. The patient has a contract with a nearby pharmacy/clinic. When they arrive at the pharmacy/clinic each day they are given a liquid form of their medication. The liquid form is used to prevent “cheeking.” DOS is also used for the treatment of HIV/AIDS.


Encephalopathy: Any degenerative brain disease

Endocarditis: occurs when a microbe infects the endocardium. Right sided endocarditis involves the tricuspid valve and is frequently caused by intravenous drug use or by central venous lines.

Esophagous: musculomembranous passage extending from the pharynx to the stomach (ie. the swallowing tube)


Frostbite: is cold, hard, anesthetic, frozen tissue. The tissue has severe cellular water loss and ischemia. Frostbite may progress to neuropathy and gangrene. It may also contribute to the acquisition of peripheral vascular disease in the homeless.



Hepatitis: Inflammation of the liver, due usually to alcohol or viral infection but also sometimes secondary to toxic agents. (Stedman’s Medical Dictionary, 2000).

Detection of hepatitis B antigens and/or on the finding of the antibodies against these antigens is a sign of infection.

Detection of hepatitis C antigens and/or detection of hepatitis C antibodies are signs of infection.

Hepatomegaly: Large liver

Heroine: An opiod that is synthesized from morphine. It is an analgesic that causes euphoria. It is usually injected intravenously. However, due to the recent increase in potency, more users are smoking and snorting.

Homelessness: A consequence of globalization, urbanization, political and religious strife, financial restraint and physical disability including psychiatric disease and drug/alcohol addiction.


Immersion foot: May develop after 10-12 hours of cold liquid exposure. Factors that encourage its development and complications include vasoconstrictor drugs, cognitive dysfunction, peripheral neuropathy, peripheral vascular disease and tobacco use. Weight baring pain, cold sensitivity and hyperhidrosis may persist for years.

Impetigo: The homeless are vulnerable to bullous and non-bullous impetigo. It also occurs when breaks in the skin allow bacteria to enter. However, the skin does not have to break to develop impetigo. Complicated impetigo may result in cellulitis.


Jaundice (icterus): yellowing of the skin, sclera, mucous membranes due to hyperbilirubinemia

Junk: A slang term for heroine. Other street names include black tar, china white, dog food, dreamer, dust, H, horse, scag, and smack.


Klebsiella: An organism which usually causes pneumonia in homeless alcoholics.


Liver Disease: A complex disease that involves different hepatic physiological dysfunctions (i.e. hepatocellular dysfunction, cholestasis and/or the vascular system). It may also involve systemic disease.


Mental Disorder: Clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress or disability or with significantly increased risk of suffering death, pain, disability or an important loss of freedom.

Methadone: A heroin substitute because it has a longer half-life and less sedation. It is used to prevent withdrawal symptoms. Doctors must obtain a special license to prescribe methadone.


NSAID: Non-steroidal anti-inflammatory. Example: ibuprofen


Onychomycosis: A nail infection that is usually due to trichophyton rubrum. It may also develop secondary to tinea pedis.


Pancreatitis: Inflammation of the pancreas. (Stedman’s Medical Dictionary, 2000).

Pediculosis corporis: More commonly known as “body lice.” Lice live in the seams of clothing next to the host’s skin, particularly in the collar and waistband. There, they can then penetrate the host’s skin to feed on their blood.

Peptic Ulcer: An ulcer of the alimentary mucosa, usually in the stomach or duodenum, exposed to acid gastric secretion.’ (Stedman’s Medical Dictionary, 2000).

Pitted keratolysis: A non-inflammatory gram positive bacterial infection of the plantar surfaces. The lesions are discrete, shallow erosions located on the soles and beneath toes. Symptoms include hyperhidrosis, maceration and foul odour.

Pneumococcus: The most prevalent organism in homeless alcoholics, accounting for almost 50% of cases of pneumonia where organisms were isolated.


Quadruple therapy: Consists of Isoniazid (INH), Rifampin, Ethambutol, and Pyrazynamide for the treatment of tuberculosis. Vitamin B6 is added to this regimen to prevent INH toxicity.



Scabies: The organism sarcoptes scabiei is transmitted via skin to skin contact. Crowded homeless shelters are conducive to their transmission. Like lice, scabies is treated with permethrin cream 5% coupled with an anti-pruritic agent. Secondary bacterial infections are common.

Spider nevi: red skin lesion in the shape of a spider that may appear in liver disease

SSRI: Selective serotonin reuptake inhibitor. The long- term medication used for anxiety disorder.

Staph saprophyticus: An organism which usually causes UTI’s in young females.


Tinea pedis: Also known as “athlete’s foot or ringworm foot.” It is not an invasive disease. It is a superficial fungal infection affecting the feet. Bacterial infection may develop secondary to tinea pedis. This may result in cellulitis, lymphangitis, pyoderma, gangrene or systemic infections.



Varices: Dilated veins in the esophagous that appear because of portal hypertension (sever form of liver failure).

Verrucae (or warts): Common, contagious, epithelial tumors caused by at least 60 types of human papillomavirus. Any site of trauma is vulnerable for infection. In an immune compromised host (ex. HIV) multiple warts often appear and treatment in these cases is futile.




Youth: The definition is variable and is dependant on location. In Canada, after age 24, youth are no longer eligible for adolescent social services.



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48. Davis J, Kutter CJ. Independent living skills and posttraumatic stress disorder in women who are homeless: implications for future practice. American Journal of Occupational Therapy. 1998;52(1):39-44.

49. De Leon G, Sacks S, Staines G, McKendrick K. Modified therapeutic community for homeless mentally ill chemical abusers: emerging subtypes. American Journal of Drug & Alcohol Abuse. 1999;25(3):495-515.

50. Drake RE, Wallach MA. Homelessness and mental illness: a story of failure [editorial]. Psychiatric Services. 1999;50(5):589.

51. Ducq H, Guesdon I, Roelandt JL. Sante mentale des sans-abri. Revue critique de la litterature anglo-saxonne. Encephale. 1997;23(6):420-30.

52. Ensign J, Santelli J. Shelter-based homeless youth. Health and access to care. Archives of Pediatrics & Adolescent Medicine. 1997;151(8):817-23.

53. Ensign J, Santelli J. Health status and service use. Comparison of adolescents at a school-based health clinic with homeless adolescents. Archives of Pediatrics & Adolescent Medicine. 1998;152(1):20-4.

54. Evans MF. Strategy to prevent recurrent homelessness among the mentally ill. Canadian Family Physician. 1998;44:512-3.

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56. Fichter M, Quadflieg N. Alcoholism in homeless men in the mid-nineties: results from the Bavarian Public Health Study on homelessness. European Archives of Psychiatry & Clinical Neuroscience. 1999;249(1):34-44.

57. Fiore DC. A homeless shelter medical clinic organized and staffed by family practice residents. Western Journal of Medicine. 1995;163(6):537-40.

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69. Gelberg L, Andersen RM, Leake BD. The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people [see comments]. Health Services Research. 2000;34(6):1273-302.

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74. Gelberg L, Linn LS, Rosenberg DJ. Dental health of homeless adults. Special Care in Dentistry. 1988;8(4):167-72.

75. Gelberg L, Linn LS, Usatine RP, Smith MH. Health, homelessness, and poverty. A study of clinic users [see comments]. Archives of Internal Medicine. 1990;150(11):2325-30.

76. Gelberg L, Panarites CJ, Morgenstern H, Leake B, Andersen RM, Koegel P. Tuberculosis skin testing among homeless adults. Journal of General Internal Medicine. 1997;12(1):25-33.

77. Gelberg L, Siecke N. Accuracy of homeless adults’ self-reports. Medical Care. 1997;35(3):287-90.

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