***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Although youth homelessness presents a significant public health problem , the needs of homeless youths with mental illness , as distinct from adults , are not well understood . This study examined the unique demographic , clinical , and service use characteristics of homeless youths . METHODS At Home/Chez Soi was a large r and omized controlled trial of the  Housing First model in five cities in Canada . Of 2,255 participants , 7 % ( N=164 ) were youths ages 18 to 24 . Youths were compared with older participants on baseline demographic , clinical , and service use characteristics . RESULTS More youths than adults had not finished high school ( 76 % versus 54 % ) , had a drug use disorder ( 66 % versus 52 % ) , and had been assaulted in the past six months ( 44 % versus 36 % ) ( all p<.05 ) . Fewer than half the youths ( 49 % ) had a regular medical doctor , 50 % reported unmet need for health care , and 61 % visited an emergency department in the past six months . CONCLUSIONS This sample of homeless youths with mental illness had low education , high rates of substance use disorders and victimization , and problems accessing services . These findings suggest that youths have trajectories to homelessness and service needs that are distinct from adults and may guide future planning for this vulnerable population Objective : To characterize the associations between a history of traumatic brain injury ( TBI ) and subsequent healthcare utilization , legal involvement , and victimization . Setting : Three major Canadian cities . Participants : A total of 1181 homeless and vulnerably housed adults who were single and 18 years or older . Data for 968 participants ( 82 % ) were available at 1-year follow-up . Design : Prospect i ve cohort study . Data were collected using structured , in-person interviews at baseline in 2009 and approximately 1 year after baseline . Main Measures : Self-reported TBI , 12-item Short Form Health Survey , healthcare , and criminal justice use question naires . Results : The lifetime prevalence of TBI was 61 % . A history of TBI was independently associated with emergency department ( ED ) use [ adjusted odds ratio ( AOR ) = 1.5 , 95 % confidence interval ( CI ) : 1.11–1.96 ] , being arrested or incarcerated ( AOR = 1.79 , 95 % CI : 1.3–2.48 ) and being a victim of physical assault ( AOR = 2.81 , 95 % CI : 1.96–4.03 ) during the 1-year follow-up period . Conclusions : Homeless and vulnerably housed individuals with a lifetime history of TBI are more likely to be ED users , arrested or incarcerated , and victims of physical assault over a 1-year follow-up period even after adjustment for health status and other confounders . These findings have public health and criminal justice implication s and highlight the need for effective screening , treatment , and rehabilitation for TBI in this population Collaboration among investigators , centers , countries , and disciplines is essential to advancing the care for traumatic brain injury ( TBI ) . It is thus important that we " speak the same language . " Great variability , however , exists in data collection and coding of variables in TBI studies , confounding comparisons between and analysis across different studies . R and omized controlled trials can never address the many uncertainties concerning treatment approaches in TBI . Pooling data from different clinical studies and high- quality observational studies combined with comparative effectiveness research may provide excellent alternatives in a cost-efficient way . St and ardization of data collection and coding is essential to this end . Common data elements ( CDEs ) are presented for demographics and clinical variables applicable across the broad spectrum of TBI . Most recommendations represent a consensus derived from clinical practice . Some recommendations concern novel approaches , for example assessment of the intensity of therapy in  severely injured patients .  Up to three levels of detail for coding data elements were developed : basic , intermediate , and advanced , with the greatest level of detail attained in the advanced version . More detailed codings can be collapsed into the basic version . Templates were produced to summarize coding formats , explanation of choices , and recommendations for procedures . Endorsement of the recommendations has been obtained from many authoritative organizations . The development of CDEs for TBI should be viewed as a continuing process ; as more experience is gained , refinement and amendments will be required . This proposed process of st and ardization will facilitate comparative effectiveness research and encourage high- quality meta- analysis of individual patient data IMPORTANCE Scattered-site housing with Intensive Case Management ( ICM ) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment . OBJECTIVE To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health services . DESIGN , SETTING , AND PARTICIPANTS The At Home/Chez Soi project was an unblinded , r and omized trial . From October 2009 to July 2011 , participants ( N = 1198 ) were recruited in 4 Canadian cities ( Vancouver , Winnipeg , Toronto , and Montreal ) , r and omized to the intervention group ( n = 689 ) or usual care group ( n = 509 ) , and followed up for 24 months . INTERVENTIONS The intervention consisted of scattered-site housing ( using rent supplements ) and off-site ICM services . The usual care group had access to existing housing and support services in their communities . MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of days stably housed during the 24-month period following r and omization . The secondary outcome was generic quality of life , assessed by a EuroQoL 5 Dimensions ( EQ-5D ) health question naire . RESULTS During the 24 months after r and omization , the adjusted percentage of days stably housed was higher among the intervention group than the usual care group , although adjusted mean differences varied across sites . [ table : see text ] The mean change in EQ-5D score from baseline to 24 months among the intervention group was not statistically different from the usual care group ( 60.5 [ 95%CI , 58.6 to 62.5 ] at baseline and 67.2 [ 95%CI , 65.2 to 69.1 ] at 24 months for the intervention group vs 62.1 [ 95 % CI , 59.9 to 64.4 ] at baseline and 68.6 [ 95%CI , 66.3 to 71.0 ] at 24 months for the usual care group , difference in mean changes , 0.10 [ 95%CI , −2.92 to 3.13 ] , P=.95 ) . CONCLUSIONS AND RELEVANCE Among homeless adults with mental illness in 4 Canadian cities , scattered site housing with ICM services compared with usual access to existing housing and community services result ed in increased housing stability over 24 months , but did not improve generic quality of life . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N42520374 OBJECTIVE The health of people living in marginal housing is not well characterized , particularly from the perspective of multimorbid illness . The authors investigated this population in a community sample . METHOD A prospect i ve community sample ( N=293 ) of adults living in single-room occupancy hotels was followed for a median of 23.7 months . Assessment included  psychiatric and neurological evaluation , multimodal MRI , and viral testing .  RESULTS Previous homelessness was described in 66.6 % of participants . Fifteen deaths occurred during 552 person-years of follow-up . The st and ardized mortality ratio was 4.83 ( 95 % CI=2.91 - 8.01 ) . Substance dependence was ubiquitous ( 95.2 % ) , with 61.7 % injection drug use . Psychosis was the most common mental illness ( 47.4 % ) . A neurological disorder was present in 45.8 % of participants , with definite MRI findings in 28.0 % . HIV serology was positive in 18.4 % of participants , and hepatitis C virus serology in 70.3 % . The median number of multimorbid illnesses ( from a list of 12 ) was three . Burden of multimorbidity was significantly correlated with lower role functioning score . Comorbid addiction or physical illness significantly decreased the likelihood of treatment for psychosis but not the likelihood of treatment for opioid dependence or HIV disease . Participants who died during follow-up appeared to have profiles of multimorbidity similar to those of the overall sample . CONCLUSIONS This marginally housed cohort had greater than expected mortality and high levels of multimorbidity with adverse associations with role function and likelihood of treatment for psychosis . These findings may guide the development of effective health care delivery in the setting of marginal housing Purpose Previous cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation , which are strongly associated with completed suicide . We conducted the first known longitudinal study of suicidal ideation in the homeless . Methods We used data collected over 24 months in the Vancouver At Home project ( N = 497 ) , comprised two r and omized-controlled trials of housing interventions for homeless individuals with mental disorders . Presence of suicidal ideation was determined using the Colorado symptom index . Results Suicidal ideation significantly decreased over time [ odds ratio ( OR ) = 0.31 at 24 months , 95 % confidence interval ( CI ) 0.21–0.46 ] . Baseline diagnoses of mood ( OR = 2.18 , 95 % CI 1.48–3.21 ) and anxiety disorders ( OR = 2.05 , 95 % CI 1.42–2.97 ) , as well as depressive mood ( OR = 2.52 , 95 % CI 1.90–3.33 ) , use of any substance ( OR = 1.59 , 95 % CI 1.09–2.32 ) , and polysubstance use ( OR = 1.90 , 95 % CI 1.40–2.60 ) were significantly associated with suicidal ideation in the multivariate model . Baseline diagnosis of a psychotic disorder ( protective effect ) , daily substance use , intravenous drug use , recent arrest , multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only . Conclusions Interventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals . Mental health services need to be tailored to address the complex needs of socially marginalized individuals . Trial registration Current controlled trials : IS RCT N57595077 ( Vancouver At Home study : Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual ) and IS RCT N66721740 ( Vancouver At Home study : Housing first plus intensive case management versus treatment as usual ) . Assigned 9 Oct. 2012 
    Output:
    
TBI was consistently associated with poorer self-reported physical and mental health , higher suicidality and suicide risk , memory concerns , and increased health service use and criminal justice system involvement .
INTERPRETATION The lifetime prevalence of TBI is high among homeless and marginally housed individuals , and a history of TBI is associated with poorer health and general functioning .