Residents Visit Research Articles

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Segregated by whom? Examining triple neighbourhood disadvantages and activity spaces in Seoul, South Korea

This study explores the potential mechanisms by which neighbourhood isolation is created and reinforced in non-home activity locations. The existing discussion on neighbourhood isolation, its consequences, and the subsequent reproduction of interactions between individuals and their environment has focused on their residential locations. However, the vitality of a neighbourhood depends not only on its own socioeconomic conditions but also on the conditions of the other neighbourhoods its residents visit and are visited by. Residential locations are only one of the many spaces in which individuals engage in their activities; therefore, to fully comprehend people’s everyday experiences of integration and isolation, it is imperative to look at interactions within both home and non-home activity spaces. Building on this extended perspective, we examine: (1) whether residential neighbourhood isolation is intensified by socioeconomic conditions individuals’ encounter in consumption and commuting activity spaces; and (2) which socioeconomic group drives the association between residential neighbourhood isolation and activity spaces—whether both disadvantaged and privileged groups contribute to isolation through the differential use of urban space or either group predominantly leads this association. We use Seoul as a case study, characterised as a city that is highly populated, contains multiple economic centres, functions with a highly affordable and efficient public transportation system, and suffers from increasing socioeconomic segregation. The results suggest that mobility patterns in activity spaces tend to reinforce neighbourhood isolation through potential forces driven by neighbourhood homophily. Isolation in the use of urban spaces appears to be driven mainly by the self-seclusion of the most advantaged neighbourhood group, while neighbourhoods in the lower socioeconomic status groups indicate broader cross-interactions across status groups, probably because of Seoul’s transit-friendly environment. Our study contributes to enhancing the understanding of spatial-societal inequalities in Korea and beyond and could assist in formulating policies for a more balanced provision of diverse urban social services and infrastructure.

Engagement of forest-dependent communities in the sustainable management of Akure forest reserve

Sustainable forest management is linked to stakeholder involvement, openness, accountability of decision-makers, adherence to the rule of law, predictability, efficient and effective management of natural resources. It is essential in accomplishing the goal of good governance. This study was conducted to evaluate the involvement of the forest-dependent people in the management of the Akure forest Reserve in Ondo state, Nigeria. Two-hundred structured questionnaires were distributed to respondents in four specifically chosen communities out of the twelve communities bordering the Reserve. A total of fifty structured questionnaires were distributed to respondents in each of the four chosen localities. Data were examined using descriptive statistics and chi-square analysis. The results revealed that the majority of the community's population consists of males (72.5%) and individuals aged 43 and above (38.5%), followed by individuals aged 31-36, accounting for 28.0% of the population. The majority of the residents (40.5%) visit the reserve on a daily basis, while thirty percent (30%) visit weekly to collect firewood and for agricultural production. The level of participation of community dwellers in Forest Management and Conservation is significantly influenced by their age (χ²= 9.456, df = 6, p = 0.024), marital status (χ² = 11.873, df = 2, p = 0.003), and occupation (χ²= 44.237, df = 4, p = 0.000). The primary endeavours undertaken by the inhabitants of the reserve are agricultural in nature. Age, household size, marital status and monthly income were the primary factors influencing their decision not to participate in forest governance in the Reserve

Green space access and visitation disparities in the phoenix metropolitan area

Previous green space equity studies have relied on access measures, such as the distance to, number of, or size of green spaces and have produced mixed results on green space disparities in the U.S. While the benefits of green spaces can be fulfilled when people visit them, attention to the differential use of green spaces has been less common. We examined green space inequalities using traditional access measures in order to understand which group has lower access to local parks and then investigated which urban residents visit local parks more using SafeGraph’s mobility data. We found that the Phoenix metro area experiences green space access disparities by age group and (partially) income rather than by race and ethnicity. Access to local parks consistently decreased as the percentage of the elderly population increased in a neighborhood. However, the visit to local parks consistently increased as the percentage of children and the elderly increased. We discuss the implications of our findings for urban planning.

Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study.

Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents' perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

Evaluation of urban wetland landscapes based on a comprehensive model — a comparative study of three urban wetlands in Hangzhou, China

Urban wetlands constitute an integral part of urban ecosystems. Unsurprisingly, wetland landscapes affect the frequency with which urban residents visit wetland areas. Objectively evaluating the beauty of landscapes and exploring the factors that influence their perceived beauty can inform urban wetland landscape design. This study selects three wetlands located in the core, fringe, and suburban areas of Hangzhou, respectively: Xixi wetland, Tongjian Lake wetland, and Qingshan Lake wetland. To explore the impact of ecological design techniques on the scenic beauty of wetlands, the selected wetlands were used to conduct field investigations. In addition, the wetland landscapes were submitted to public evaluations using scenic beauty estimation (SBE). At the same time, the factors affecting the beauty of the wetland landscape were quantified using the semantic differential (SD) method, and the impact paths of ecological design and plant diversity on scenic beauty were analyzed through the structural equation model (SEM). The results indicated that plant richness, cultural expression, color harmony, and coordination of landscape elements have both a significant and positive impact on the scenic beauty of urban wetlands. By way of contrast, habitat diversity had a significant yet negative impact. Across the three urban wetlands, ecological design techniques were found to significantly improve plant diversity and scenic beauty. This study demonstrated that the application of well-thought-out ecological design methods was conducive to the integration of environmental protection, landscape aesthetics, and the sustainable utilization of urban wetlands in the rapid urbanization process, providing a reference for urban wetland landscape conservation, planning, and design.

Healthcare Access and Health Seeking Behaviors among Households in Katsina State, North-Western, Nigeria

Achieving Universal Health Coverage (UHC) is one of the targets set by nations of the world when adopting the Sustainable Development Goals in 2015. The law establishing Katsina State Contributory Healthcare Management Agency (KTSCHMA) was signed on 27th December 2018 as Law No. 10 of 2018. The agency carried out the Household Baseline Assessment Survey to implement the Scheme across the state. This aimed at determining the households, access to healthcare services, and health-seeking behaviors among households' in Katsina State. It is a descriptive cross-sectional design study carried out across the state. In January 2020, 416 households were surveyed using multi-stage sampling techniques. The result shows that the majority (88.5%) of households have male heads, with (56.1%) having no formal education. Most (46.6%) household heads are self-employed, and only 9.6% of household heads are working in the public sector. The average household is made up of 6 members. The majority (95.2%) of residents visit healthcare facilities when ill, and only about 63.9% visit government health facilities as their first point of call for treatment, with fewer (15.2%) visiting chemists and pharmacists, usually without a prescription from a doctor. Access to healthcare facilities is also very high, with about 83.6% of residents living within 30 minutes of a healthcare facility. Full implementation of the scheme will improve healthcare coverage and utilization among residents of Katsina State.

Exurban and suburban forests have superior healthcare benefits beyond downtown forests

Forests in urban areas provide great healthcare benefits to citizens, but it is less well known whether this benefit is related to different geographical spaces. We selected exurban forest, suburban forest, downtown forest, and urban control in Guangzhou, China to analyze the change characteristics of negative air ion concentration (NAIC), air oxygen content (AOC), and human comfort index (HCI). Based on Criteria Importance Through Intercriteria Correlation (CRITIC) method, the urban forest comprehensive healthcare index (UFCHI) was established. Finally, the evaluation criteria for UFCHI were identified by cluster analysis. The results demonstrated that (1) The NAIC in exurban forest (2,713 ± 1,573 ions/cm3) and suburban forest (2,147 ± 923 ions/cm3) was evidently better than downtown forest (1,130 ± 255 ions/cm3) and urban control (531 ± 162 ions/cm3). (2) The AOC was in the order of exurban forest (21.17 ± 0.38%) > suburban forest (21.13 ± 0.30%) > downtown forest (21.10 ± 0.16%) > urban control (20.98 ± 0.12%). (3) The HCI in urban control (5.56 ± 2.32) and downtown forest (5.15 ± 1.80) is higher than suburban forest (4.02 ± 1.53) and exurban forest (3.71 ± 1.48). (4) The UFCHI in exurban forest (1.000), suburban forest (0.790), and downtown forest (0.378) were beneficial to human health to some extent, while urban control (0.000) was at Level IV, having no healthcare benefit. Except in winter, the UFCHI in exurban forest and suburban forest were all at Level II and above; while downtown forest and urban control were all at Level III and below at all seasons. Overall, urban forests in the exurbs and suburbs have better healthcare benefits than those in the downtowns. Furthermore, it is recommended that urban residents visit exurban and suburban forests for forest therapy in spring, summer, and autumn.

Telehealth for Comprehensive Care to Quarantine Residents: A Novel Approach and Lessons Learned.

Proactive engagement and care with regular and timely information are required to manage the health and well-being of people in quarantine. At Australia's Howard Springs International Quarantine Facility, a telehealth model was rapidly established using trained non-clinical Customer Service Officers (CSO's) with the aim to provide comprehensive care to residents, maximize staff safety, and reduce clinical workforce capacity pressures. We describe this model, whereby CSO's provided residents with daily COVID-19 symptom and well-being screening, weekly psychological screening, and ongoing linkage to additional clinical and administrative services. In addition, CSO's went beyond these duties to deliver personalized care through delivery of care packages and attendance of the departure point to farewell residents. From October 2020 to May 2021, across 7105 residents, we estimated that CSO's prevented over 75 000 face-to-face resident visits, which reduced workforce requirements and preserved staff safety through minimizing potential COVID-19 transmission and time spent in personal protective equipment in the challenging ambient environment. We share key lessons learned which may inform future telehealth models and guide a positive experience for quarantine residents.

Most dentists approve of oral health check-ups for local residents at community pharmacies and desire collaboration with community pharmacists.

Community pharmacies are required to play a role in maintaining the health of local residents. Since September 2015, a national policy in Japan has allowed saliva tests to be used for oral health check-ups at community pharmacies. In the present study, we aimed to reveal dentists' perceptions and expectations for oral health check-ups provided at community pharmacies. A questionnaire survey was administered to dentists at 1,000 randomly selected dental clinics in Tokyo, Japan; 257 responses (25.7%) were included in the analysis and 85.2% of respondents approved of oral health check-ups at community pharmacies. Most respondents who approved of oral health check-ups expected that community pharmacists would recommend that local residents visit a dental clinic (85.8%) and provide a report to dentists (60.3%) after the check-up. Furthermore, 79.0% of respondents desired collaboration with community pharmacies. These findings suggested the potential for oral health check-ups to facilitate collaboration between community pharmacies and dental clinics aimed at maintaining and improving oral health of local residents.

Implementing a community garden in a socially vulnerable urban area of Brazil

Community urban gardens are a type of urban agriculture. They provide spaces for social interaction and increase in life quality of maintainers and consumers. This study implements a community garden in Vila Buritis II, Planaltina, Brasília, Federal District, Brazil. The population of Planaltina has low purchasing power and high indices of social vulnerability. The implementation of the vegetable garden resulted from a partnership between agroecology students from the Federal Institute of Brasília, the local community, and the government. The work relied on donations, reuse of materials, and volunteer labor. Educational actions in the neighborhood approached the relationship between production in the garden and food choices, with a focus on healthy eating, consumption of fresh food, and reduction of industrialized items. The building of the vegetable garden converted an idle area, with a history of accumulating garbage and rubble, into a productive space for social coexistence and leisure. Twenty-seven edible species and an undefined number of ornamental plants were planted. Between 30 and 40 residents visit the space regularly and collect food for their daily meals. However, the maintenance and increase of garden productivity still need technical assistance and resources.

Sustainable Renewal Strategies for Older Communities from the Perspective of Living Experience

This paper takes the old district of the east Huan Shi Road area in the Yuexiu District, Guangzhou City, as an example. Through field research, resident visits, and expert interviews, the secondary and tertiary indicators in the measurement framework were obtained by combining six years of living experience. The questionnaire was designed through the relationship between the indicators, and a small sample test was conducted to test the results before generating the final questionnaire. The questionnaires were distributed both online and offline, and the data were analysed in conjunction with the Kano model; then, the results were compared with the field research. Based on the perspective of living experience, a sustainable renewal strategy is proposed for the renovation of old neighbourhoods in practice.

Impact of a resident and student-led video visitation navigation program

BackgroundMany institutions implemented telehealth initiatives to provide social support for patients during the SARS-CoV-2 (COVID-19) pandemic. Little is known about the impact of these programs on patient support persons and the trainees who facilitated them.ObjectiveTo assess perceptions of a resident physician and medical student-driven video visit program.MethodsWe designed and implemented a trainee-led video visit navigation program across three affiliated urban hospitals to facilitate video visits between patients and their support persons. We used descriptive statistics to understand the patient population served by the program and employed surveys for support persons and trainees to assess attitudes on the program.ResultsFrom April to June 2020, a total of 443 video visits were completed. Surveys were conducted for 101 out of 184 (54.9%) support persons and 39 out of 65 (60.0%) of medical trainees. Surveys demonstrated that video visits helped alleviate the stress and anxiety of support persons having a hospitalized loved one they could not visit. For trainees, facilitating these connections helped mitigate stress and provided a mechanism to contribute to the pandemic response.ConclusionTelehealth navigation programs provide high levels of connection for patients and their support persons during the COVID-19 pandemic and potentially beyond. Residents and medical students involved in these initiatives mobilized telehealth modalities to improve experiences with care delivery.

Neighborhood socioeconomic inequality based on everyday mobility predicts COVID-19 infection in San Francisco, Seattle, and Wisconsin.

Race and class disparities in COVID-19 cases are well documented, but pathways of possible transmission by neighborhood inequality are not. This study uses administrative data on COVID-19 cases for roughly 2000 census tracts in Wisconsin, Seattle/King County, and San Francisco to analyze how neighborhood socioeconomic (dis)advantage predicts cumulative caseloads through February 2021. Unlike past research, we measure a neighborhood’s disadvantage level using both its residents’ demographics and the demographics of neighborhoods its residents visit and are visited by, leveraging daily mobility data from 45 million mobile devices. In all three jurisdictions, we find sizable disparities in COVID-19 caseloads. Disadvantage in a neighborhood’s mobility network has greater impact than its residents’ socioeconomic characteristics. We also find disparities by neighborhood racial/ethnic composition, which can be explained, in part, by residential and mobility-based disadvantage. Neighborhood conditions measured before a pandemic offer substantial predictive power for subsequent incidence, with mobility-based disadvantage playing an important role.

Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019

BackgroundInequality in maternal healthcare use is a major concern for low-and middle-income countries (LMICs). Maternal health indicators at the national level have markedly improved in the last couple of decades in Nepal. However, the progress is not uniform across different population sub-groups. This study aims to identify the determinants of institutional delivery, measure wealth-related inequality, and examine the key components that explain the inequality.MethodsMost recent nationally representative Multiple Indicator Cluster Survey (MICS) 2019 was used to extract data about married women (15-49 years) with a live birth within two years preceding the survey. Logistic regression models were employed to assess the association of independent variables with the institutional delivery. The concentration curve (CC) and concentration index (CIX) were used to analyze the inequality in institutional delivery. Wealth index scores were used as a socio-economic variable to rank households. Decomposition was performed to identify the determinants that explain socio-economic inequality.ResultsThe socio-economic status of households to which women belong was a significant predictor of institutional delivery, along with age, parity, four or more ANC visits, education status of women, area of residence, sex of household head, religious belief, and province. The concentration curve was below the line of equality and the relative concentration index (CIX) was 0.097 (p < 0.001), meaning the institutional delivery was disproportionately higher among women from wealthy groups. The decomposition analysis showed the following variables as the most significant contributor to the inequality: wealth status of women (53.20%), education of women (17.02%), residence (8.64%) and ANC visit (6.84%).ConclusionsTo reduce the existing socio-economic inequality in institutional delivery, health policies and strategies should focus more on poorest and poor quintiles of the population. The strategies should also focus on raising the education level of women especially from the rural and relatively backward province (Province 2). Increasing antenatal care (ANC) coverage through outreach campaigns is likely to increase facility-based delivery and decrease inequality. Monitoring of healthcare indicators at different sub-population levels (for example wealth, residence, province) is key to ensure equitable improvement in health status and achieve universal health coverage (UHC).

Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017.

The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009-2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009-2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014-2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014-2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86-196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30-3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33-4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18-3.74). Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women's attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey

BackgroundAlthough malaria in pregnancy is preventable with the use of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP), it still causes maternal morbidity and mortality, in sub-Saharan Africa and Nigeria in particular. Socioeconomic inequality leads to limited uptake of IPTp-SP by pregnant women and is, therefore, a public health challenge in Nigeria. This study aimed to measure and identify factors explaining socioeconomic inequality in the uptake of IPTp-SP in Nigeria.MethodsThe study re-analysed dataset of 12,294 women aged 15–49 years from 2018 Nigeria Demographic Health Survey (DHS). The normalized concentration index (Cn) and concentration curve were used to quantify and graphically present socioeconomic inequalities in the uptake of IPTp-SP among pregnant women in Nigeria. The Cn was decomposed to identify key factors contributing to the observed socioeconomic inequality in the uptake of adequate (≥ 3) IPTp-SP.ResultsThe study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women (Cn = 0.062; 95% confidence interval [CI] 0.048 to 0.076) in Nigeria. There is a pro-rich inequality in the uptake of IPTp-SP in urban areas (Cn = 0.283; 95%CI 0.279 to 0.288). In contrast, a pro-poor inequality in the uptake of IPTp-SP was observed in rural areas (Cn = − 0.238; 95%CI − 0.242 to − 0.235). The result of the decomposition analysis indicated that geographic zone of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria.ConclusionThe pro-rich inequalities in the uptake of IPTp-SP among pregnant women in Nigeria, particularly in urban areas, warrant further attention. Strategies to improve the uptake of IPTp-SP among women residing in socioeconomically disadvantaged geographic zones (North-East and North-West) and improving antenatal visits among the poor women may reduce pro-rich inequality in the uptake of IPTp-SP among pregnant women in Nigeria.

Six Years' Experience Using Specialty National Residency Index: An Early Dashboard to Document Change Over Time.

A decade ago, the Association of Family Medicine Residency Directors developed the Residency Performance Index (RPI) as a novel dashboard of metrics to support residency programs' quality improvement efforts. Although the RPI has since been discontinued, we sought to identify lessons learned from an analysis of 6 years of data collected while the RPI was in use to inform future quality and accreditation efforts implemented at the national level. The RPI collected data from 2012-2017 for nearly 250 distinct family medicine residency programs, identifying strengths and areas for improvement. Eighty-two programs provided data for 3 or more years of measures allowing analysis of improvement trends. For participating programs, aggregate data over 6 years indicated the majority had stable leadership and accreditation. Total family medicine center (FMC) visits by graduates and resident visit demographics were robust. Graduate scope of practice was consistent with nationally publicized trends. Programs hit most aspirational targets more than 40% of the time. However, analysis for those programs with 3 or more years of data revealed that the tool did not result in significant changes for most metrics. Linear regression analysis showed improvements in total patient visits, visits under 10 years of age, and certain procedural competencies for those programs with 3 or more years of data. The RPI was the first and only nationally utilized family medicine graduate medical education quality improvement tool. Individual programs did not show substantial change in quantifiable metrics over time despite limited evidence of select programmatic improvements. Nationally, aggregated data provided insight into scope of practice and other areas of interest in residency training. Further efforts in provision of residency improvement tools are important to support programs given the increasing complexity and high stakes of family medicine residency education.

Sacrificial Worship (Qurban) Motivation Determinant Factors of Tuatunu Population in Pangkalpinang City

This article intends to find an answer to the high level of community participation in Tuatunu Urban Village in the City of Pangkalpinang, Bangka Belitung Islands Province in the sacrificial worship (qurban) motivation during the Eid al-Adha feast day. Tuatunu Urban Village only has a population of approximately 9,000 inhabitants and the average livelihood of its inhabitants is as pepper, rubber, and pineapple farmer. But in Eid al-Adha 2019, the level of participation of the people who follow the sacrificial worship from the five mosques in this area is highest when compared to the seven sub-districts in the Municipality of Pangkalpinang. Tuatunu Urban Village sacrifices approximately 32 cows at Eid al-Adha 2019, where seven people bear one cow. This urban village celebrates Eid al-Adha like Eid al-Fitr where residents visit each other's neighbors. This article is the result of quantitative research with the dependent variable is a sacrificial worship motivation and the independent variables are religiosity, generosity, avoid harm, and social status. This study found that the variables that influence the motivation to sacrificial worship the people of Tuatunu Urban Village are the factors of religiosity, social status, and avoid harm while the elements of generosity do not significantly influence the motivation to sacrifice.

Triple Disadvantage: Neighborhood Networks of Everyday Urban Mobility and Violence in U.S. Cities

This article develops and assesses the concept of triple neighborhood disadvantage. We argue that a neighborhood’s well-being depends not only on its own socioeconomic conditions but also on the conditions of neighborhoods its residents visit and are visited by, connections that form through networks of everyday urban mobility. We construct measures of mobility-based disadvantage using geocoded patterns of movement estimated from hundreds of millions of tweets sent by nearly 400,000 Twitter users over 18 months. Analyzing nearly 32,000 neighborhoods and 9,700 homicides in 37 of the largest U.S. cities, we show that neighborhood triple disadvantage independently predicts homicides, adjusting for traditional neighborhood correlates of violence, spatial proximity to disadvantage, prior homicides, and city fixed effects. Not only is triple disadvantage a stronger predictor than traditional measures, it accounts for a sizable portion of the association between residential neighborhood disadvantage and homicides. In turn, potential mechanisms such as neighborhood drug activity, interpersonal friction, and gun crime prevalence account for much of the association between triple disadvantage and homicides. These findings implicate structural mobility patterns as an important source of triple (dis)advantage for neighborhoods and have implications for a broad range of phenomena beyond crime, including community capacity, gentrification, transmission in a pandemic, and racial inequality.