Urban Family Research Articles

Radiation dose estimation for indoor radon, thoron and their progenies using a stochastic method-a small-scale survey in Wuhan, China.

Passive radon monitors with CR-39s are widely used in major epidemiological surveys. However, the conventional CR-39 track density determining strategy makes it difficult to accurately estimate the concentration because of the heterogeneity of tracks on CR-39s. This study introduced a stochastic method, Latin hypercube sampling, to improve the track density determining strategy and provide the probability distribution of 222Rn concentration and equilibrium equivalent thoron concentration. The first 222Rn and 220Rn discriminated survey was conducted in Wuhan, China, in 2018 using RADUET® and deposition-based passive 220Rn progeny monitors and applying the stochastic method to the measurement. The results indicate that the stochastic method could decrease the effects of the track heterogeneity on the CR-39s and provide reliable results. The 220Rn progeny contributed more than 40% of the total inhalation dose in the survey, which cannot be ignored in urban family dwellings.

Gendered enterprise: Women and Australian business history

AbstractThis special issue examines women and Australian business history. Contributions explore women's entrepreneurship in small urban businesses, side hustles, agriculture, and family companies. Articles highlight the importance of women's businesses, as a financial necessity for women, their families, and their communities. Authors examine the barriers for women in business, including legislation, licensing, societal expectations, and discrimination. Articles also explore women's intersections with other demographic characteristics, with access to enterprise mediated by class and the rural–urban divide. Finally, contributions examine the way traditional archives have obscured histories of businesswomen, and the opportunities offered by feminist historical methodologies for studying business history.

Urban family with minor children: resources, moral guidelines and social adaptation of working parents. Part one

The first part of the article presents the results of studying the daily activities of working parents in the field of caring for minor children and their upbringing. Data from monitoring studies of the daily activities and time budget of urban residents carried out during 1986-2020 were used. The composition of families with children is considered and the resource characteristics of parents are analyzed, which turned out to be very similar for fathers and mothers. The relationship of parents' time spent on caring for children and their upbringing with parents' belonging to fathers and mothers, with their age, level of education, religious identity and income level in parents' families, as well as with some value orientations of fathers and mothers, is investigated. The analysis showed that the objective picture of working parents using time resources for activities with children does not agree with their subjective opinion that “activities with their childre n, their upbringing is the most important thing in the life of both spouses”. At the same time, most working fathers and mothers are satisfied with the time spent both on caring for children and on their upbringing as time resources. The characteristics of the provision of fathers and mothers with other resources do not affect their satisfaction with time spent. There is a direct relationship between satisfaction with the time spent on raising children and parents' satisfaction with life in general. An analysis of the moral guidelines of parents, which are the moral basis for the process of socialization of minor children in the family, has shown that more than half of the moral qualities related to virtues are the norm for the vast majority of fathers and to a somewhat lesser extent for mothers. At the same time, there is a tendency to blur parents' ideas about qualities-virtues and anti-virtues as a norm and deviation from it. In addition, a trend is emerging in which, judging by estimates, a considerable part of parents do not see a positive life prospect for their children, in terms of their social adaptation, if children in life are guided by the same virtues as the parents themselves. The first part in the article analyzes the composition and resource potential and the use of time resources of parents for child care and upbringing. The second part will be about the moral guidelines and the results of social adaptation of working parents. The numbering of tables and figures is continuous in both parts.

Balancing faith and identity: language policies and practices in Indonesian Muslim families

ABSTRACT This study investigates the complex interplay between language policies, religious beliefs, and cultural identity within two Indonesian Muslim families, residing in urban and rural contexts. Given Indonesia’s diverse linguistic landscape, with over 700 languages spoken, this research examines how religious beliefs and cultural identity shape their language ideology and their utilisation of the Indonesian language, local languages, and Arabic within Indonesian Muslim families. This research fills a gap, as there is limited literature on this topic in Indonesia. Through a case study design, including semi-structured interviews with two families in different contexts, the study explores language use for daily communication, cultural preservation, and religious practices. Findings reveal that the urban family members prioritise the Indonesian language for broader communication, while the rural family members maintain stronger ties to local languages to preserve their cultural identity. Their religious convictions place Arabic as a language designated for religious purposes rather than for daily communication. The study underscores the significance of religious beliefs in shaping language choices and highlights the challenges and strategies to preserve cultural identity and religious devotion. This research contributes to the understanding of how faith and cultural identity influence language ideology and practices in Indonesia’s multilingual society.

Telehealth for Reproductive Health Services for Economically Disadvantaged Youth

PurposeThere is a lack of studies describing reproductive health service use and outcomes with telehealth in publicly funded clinics in community settings for economically disadvantaged adolescents and young adults (AYA). This study sought to compare use of reproductive health services before and during the COVID-19 pandemic and analyze the types and quality of reproductive health-care services for patients who did and did not complete a telehealth visit. MethodsMedical records were reviewed for AYA who sought reproductive health services at 9 urban family planning and school-based clinics. Visit-type differences and associated factors by year of service and among those who did and did not complete telehealth visits were analyzed. ResultsTwenty-seven thousand nine hundred sixty-one unique patients were served between 2019 and 2021. As compared to 2019, in 2020 and 2021, there were significantly fewer visits by minors (<18 years old) versus young adults (18–24 years old) (p < .001), and by those with male versus female natal sex (p < .001). At least one telehealth visit was completed by 17.98% of patients. Telehealth visit completion was more likely in young adults, female, Black, non-Hispanic, and higher-income patients. Telehealth users were more likely to complete annual sexually transmitted infection testing, had a higher number of visits per year, and had higher odds of requiring a return visit within 2 weeks of the index visit (odds ratio 1.5, 95% confidence intervals 1.41–1.76). DiscussionOur findings illustrate disparities in telehealth use in this population of economically disadvantaged AYA and provides pragmatic targets for future interventions.

Assessing urban family physician program challenges in Iran: the insurance organizations’ perspective(2021)

BackgroundThe Family Physician Programme is a key health reform in Iran that faces significant challenges in urban areas, particularly in Mazandaran and Fars provinces The study aims to critically evaluate the challenges encountered in the Urban Family Physician Program, with a particular focus on the perspectives of insurance organizations.MethodsA qualitative approach was adopted, involving semi-structured interviews with 22 experts and managers from basic health insurance funds. Snowball sampling facilitated participant selection, and interviews proceeded until saturation. Data analysis utilized content analysis and Atlas-T software, adhering to COREQ criteria.ResultsImplementation problems of the urban family physician program were categorized into ten Categories and 22 Subcategories, including financing, stewardship, human resources, structure, culture, information system, payment, monitoring and control, the function of insurance organizations, and implementation.ConclusionThe urban family physician program’s implementation challenges, as viewed by health insurance organizations, underscore the necessity for strategic decision-making in financing, payment models, electronic system integration, structural adjustments, comprehensive monitoring, evaluation, cultural considerations, and appropriate devolution to insurance entities.

Exploring Reasons for Loss to Follow-up in Pregnancy of Unknown Location: A Mixed-Methods Study.

Objective: To quantify proportions of loss to follow-up in patients presenting with a pregnancy of unknown location and explore patients' perspectives on follow-up for pregnancy of unknown location. A pregnancy of unknown location is a scenario in which a patient has a positive pregnancy test but the pregnancy is not visualized on transvaginal ultrasound. Study Design: We conducted a retrospective cohort study of patients with pregnancy of unknown location who presented to an urban academic emergency department or complex family planning outpatient office. We sought to calculate the proportion of patients lost to follow-up, defined as inability to contact the patient within 2 weeks. We then conducted focus groups of patients diagnosed with a pregnancy of unknown location. We used thematic analysis to identify themes related to follow-up. Results: We reviewed 464 charts of patients diagnosed with pregnancy of unknown location. The median age in this cohort was 27 with most patients identifying as Black (80%, n = 370) and using public insurance (67%, n = 315). When looking at loss to follow-up rates, Black patients experienced loss to follow-up (20%, n = 72) more often than White patients (4%, n = 2; p = 0.003). Focus group participants had a mean age of 31.8+/-4.8, and the majority were of Black race (n = 16, 72.7%). Participants identified barriers to follow-up including the long duration of management, general inconvenience, and poor communication with their health care team. Participants felt a burden of responsibility to learn about their condition and to self-advocate for their follow-up and communication of results. Conclusions: These data indicate that Black patients are more likely to experience loss to follow-up compared with White patients during monitoring for pregnancy of unknown location. Patients identified many barriers to follow-up and felt that successful follow-up required substantial self-efficacy.

Comparing Unmet Service Needs Between Rural and Urban Family Caregivers of People Living With Alzheimer's Disease and Related Dementias: A Multisite Study.

The scarcity of resources and available caregiving services in rural areas in the United States has been well documented. However, less research has compared unmet service needs between caregivers of people with Alzheimer's disease and related dementias (ADRD) in rural versus urban areas. Using semistructured interviews guided by theories of health service use and dependent care, we interviewed 20 family caregivers residing in rural areas of Western North Carolina and 18 caregivers within the urban setting of Houston, Texas, and compared their unmet service needs and contextual factors that facilitate their service use. Thematic analyses revealed similar unmet service needs among rural and urban caregivers; however, the ways they approached and solved their challenges differed. Caregivers in rural areas wished for more information and caregiver support whereas urban caregivers looked for information they needed until they found the answers. Rural caregivers expressed guilt about using services because they felt they were limited and zero-sum whereas urban caregivers shared available resources so that other caregivers could use them as well. Unmet service needs for urban caregivers included more racially and ethnically specific services for people with ADRD in their ethnic-specific languages and foods while rural caregivers' cultural needs were not racially and ethnically specific but for more place-specific services. Recommendations for rural caregivers included utilizing online and virtual opportunities and expanding their reach across the United States. For urban caregivers, increasing culturally tailored service options would likely increase access and use.

Developing an AI Tool to Derive Social Determinants of Health for Primary Care Patients: Qualitative Findings From a Codesign Workshop.

Information about social determinants of health (SDOH) is essential for primary care clinicians in the delivery of equitable, comprehensive care, as well as for program planning and resource allocation. SDOH are rarely captured consistently in clinical settings, however. Artificial intelligence (AI) could potentially fill these data gaps, but it needs to be designed collaboratively and thoughtfully. We report on a codesign process with primary care clinicians to understand how an AI tool could be developed, implemented, and used in practice. We conducted semistructured, 50-minute workshops with a large urban family health team in Toronto, Ontario, Canada asking their feedback on a proposed AI-based tool used to derive patient SDOH from electronic health record data. An inductive thematic analysis was used to describe participants' perspectives regarding the implementation and use of the proposed tool. Fifteen participants contributed across 4 workshops. Most patient SDOH information was not available or was difficult to find in their electronic health record. Discussions focused on 3 areas related to the implementation and use of an AI tool to derive social data: people, process, and technology. Participants recommended starting with 1 or 2 social determinants (income and housing were suggested as priorities) and emphasized the need for adequate resources, staff, and training materials. They noted many challenges, including how to discuss the use of AI with patients and how to confirm their social needs identified by the AI tool. Our codesign experience provides guidance from end users on the appropriate and meaningful design and implementation of an AI-based tool for social data in primary care.

Reasons for encounters, diagnoses, and admission rate among emergency referrals at an urban primary care clinic in Japan: A retrospective cohort study

AbstractBackgroundComprehensive understanding of emergency referrals (EmR), encompassing reasons for encounters (RFEs) and diagnoses, is crucial for primary care physicians (PCPs). Comparing EmR rates and subsequent admission rates can potentially enhance the quality of primary care for EmR practice. However, no study has evaluated RFEs among patients with EmRs. This study aimed to identify RFE/diagnosis in relation to subsequent admission among patients receiving EmR.MethodsWe conducted a retrospective cohort study at an urban family physician teaching clinic in Kawasaki City, Japan. Our cohort recruited consecutive EmR episodes with their medical records and admissions confirmed through response letters from receiving hospitals. Using the 2nd edition of the International Classification of Primary Care, we explored the frequency of RFEs and diagnoses, calculating EmR rates and admission rates as primary outcomes. Bivariate analyses were employed to compare admission and non‐admission cases.ResultsThe present study encompassed 162 EmR episodes out of 47,901 visits, yielding an EmR rate of 3.38/1000 visits. Among 153 completely followed episodes, 99 patients were emergently admitted, resulting in a 64.7% admission rate. The admission group exhibited significantly higher age and a greater prevalence of dementia. Descriptive analysis revealed fever and pneumonia as the most frequent RFE and diagnosis, respectively, with significant differences between admission and non‐admission groups.ConclusionsThe present study reports EmR and admission rates following EmR, highlighting differences in patient characteristics, RFEs, and diagnoses. The findings offer insights to enhance PCPs' EmR practices and serve as a benchmark for the scope of EmR practice.

Uniform agricultural tax abolition and differential household labor supply: Evidence from China's urban household survey

Uniform government public policy has steadily shaped the labor supply from households in the past few decades in China with possible differential impact on each parent. This paper investigates how uniform tax policy change plays differential roles in household's labor supply through government public education spending. Utilizing the exogenous shock from China's agricultural tax abolition in 2005, we find that the abolition results in a reduction in female employment but an increase in male employment. Specifically, a 1% increase of agricultural tax to public revenue ratio in the reference year leads to a 0.485% labor supply reduction and 1.50 fewer hours of work per month for married women, whereas the married men's labor supply increases by 0.191% and their working hours by 1.06 h in a typical urban family with school-going children. The effects are greater on married women with primary school-age children and married men from high-asset households. Our mechanism analysis indicates that public education spending works as a substitute for private education spending and affects the household labor supply through investment in children's human capital. Our findings offer a new perspective on the decreasing female labor supply and the widening employment gap between (married) women and (married) men in the Chinese labor market. The findings suggest that public tax policy could lead to unintended consequences on household's labor supply decisions, and thus exacerbate the gender employment gap in the labor market.

Second-hand should come first. Sustainable home consumption beyond the market

Studies on sustainable consumption have predominantly focused on first-hand consumers, whereas research on second-hand consumers has been centered on the act of purchase. This has involved investigations into specific venues such as second-hand markets and thrift shops or the motivations, barriers, and meanings behind such acquisition behaviors. This article strives to enhance the understanding of second-hand consumption within the framework of sustainable development in peripheral countries and in contexts with a limited access to new products. Through interviews conducted in different households across the Metropolitan Region of Chile, we delved into the diverse channels through which used items are exchanged –including waste picking, inheritance, and sharing–. The findings underscore the pivotal role these objects play in numerous households and highlight how certain spatial and social factors –such as urban density, social networks, land use, family structure, and emotional attachment to belongings– are crucial in promoting the sustainable exchange of second-hand goods outside of the market economy.

Applying the Double Diamond Model to Enhance Service Design in Urban Family Kitchens

Applying the Double Diamond Model to Enhance Service Design in Urban Family Kitchens

A Retrospective Chart Review Evaluating the Changes in Depressive Symptoms in Adult Patients With Attention-Deficit/Hyperactivity Disorder (ADHD) With the Treatment of the Underlying ADHD.

Adult attention-deficit/hyperactivity disorder (ADHD) represents a significant public health burden. ADHD is often comorbid with many other psychiatric disorders, with a high co-occurrence with depression. However, there is a paucity in our understanding of the potential impact of treating patients' ADHD on their depressive symptoms. The primary objective of this study was to assess the effect of treating adult ADHD on comorbid depressive symptoms without directly administering treatment for depression in an integrated behavioral health clinic in the primary care setting. We performed a retrospective chart review between April 2021 and May 2022 on adult patients treated in the Primary Care Adult Integrated Behavioral Health Clinic at an urban family medicine residency clinic. For patients with ADHD, we administered the Adult ADHD Self-Report Scale (ASRS-v1.1) to serve as a marker of ADHD symptom burden and the nine-item Patient Health Questionnaire(PHQ-9) to serve as a marker of depressive symptom burden. We administered the questionnaires prior to initiating ADHD treatment and again at the three-month follow-up visit. The ADHD treatment included pharmacotherapy and brief psychological interventions targeted at ADHD. We compared the ASRS scores and PHQ-9 scores at baseline and after three months to determine whether ADHD treatment had any impact on PHQ-9 scores. At baseline, the average ASRS score was 11.3 and the average PHQ-9 score was 8.25. Comparing scores after three months of intervention to the initial scores, our preliminary results demonstrated a trend of improvement in both ASRS and PHQ-9 scores. A total of 75% (n=24/32) of the patients had an improvement in ASRS scores, and 56.7% (n=17/30) of the patients had an improvement in PHQ-9 scores at three months. At three months, there was a decline in PHQ-9 scores with a decrease in ASRS scores following treatment. Our preliminary results suggest that integrated behavioral health treatment of ADHD using a combination of pharmacological and non-pharmacological interventions may play a role in improving comorbid depressive symptoms.

Gene Expression Analysis in T2DM and Its Associated Microvascular Diabetic Complications: Focus on Risk Factor and RAAS Pathway.

Prolonged hyperglycemic conditions in type 2 diabetes mellitus (T2DM) cause pathological and functional damage to many organs and tissues, including the kidneys, retina, skin, and neuronal tissues, resulting in the development of microvascular diabetic complications. The altered renin angiotensin aldosterone system (RAAS) pathway has been reported to play an important role in the development of insulin resistance in T2DM and associated complications. The current study was carried out to evaluate the association of risk factors and altered expression of RAAS genes in T2DM patients without complications and T2DM patients with complications (retinopathy, nephropathy, and neuropathy). Four hundred and twenty subjects including 140 healthy controls, 140 T2DM patients with diabetic complications, and 140 T2DM patients without diabetic complications were included in the study. Risk factors associated with the development of T2DM and diabetic complications were evaluated. Further, expression analysis of RAAS genes (AGT, ACE, ACE2, and AGT1R) was carried out using qRTPCR in healthy controls, T2DM patients with complications, and T2DM patients without complications. Various risk factors like urban background, higher BMI, alcoholism, smoking, and family history of diabetes among others were found to be associated with the development of T2DM as well as diabetic complications. The expression level of AGT, ACE, and AGT1R was found to be upregulated whereas ACE2 was found to be downregulated in T2DM patients with complications and T2DM patients without complications as compared to controls. Altered expression of the studied genes of RAAS pathway is associated with the development of microvascular diabetic complications.

Urban relatives ameliorate survival disparities for genitourinary cancer in rural patients.

Patients living in rural areas have worse cancer-specific outcomes. This study examines the effect of family-based social capital on genitourinary cancer survival. We hypothesized that rural patients with urban relatives have improved survival relative to rural patients without urban family. We examined rural and urban based Utah individuals diagnosed with genitourinary cancers between 1968 and 2018. Familial networks were determined using the Utah Population Database. Patients and relatives were classified as rural or urban based on 2010 rural-urban commuting area codes. Overall survival was analyzed using Cox proportional hazards models. We identified 24,746 patients with genitourinary cancer with a median follow-up of 8.72 years. Rural cancer patients without an urban relative had the worst outcomes with cancer-specific survival hazard ratios (HRs) at 5 and 10 years of 1.33 (95% CI 1.10-1.62) and 1.46 (95% CI 1.24-1.73), respectively relative to urban patients. Rural patients with urban first-degree relatives had improved survival with 5- and 10-year survival HRs of 1.21 (95% CI 1.06-1.40) and 1.16 (95% CI 1.03-1.31), respectively. Our findings suggest rural patients who have been diagnosed with a genitourinary cancer have improved survival when having relatives in urban centers relative to rural patients without urban relatives. Further research is needed to better understand the mechanisms through which having an urban family member contributes to improved cancer outcomes for rural patients. Better characterization of this affect may help inform policies to reduce urban-rural cancer disparities.

Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre.

With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.

Study on Urban and Rural Medical Insurance Co-ordination Improving Rural Family Education

Study on Urban and Rural Medical Insurance Co-ordination Improving Rural Family Education

Health Crowding-Out Effect of Family Migration on First Cohort Migrant Workers: An Empirical Analysis.

In the dynamic panorama of China's shifting social mobility, characterized by a transition from individual to family mobility, the migration of the first cohort of migrant workers and their families has taken center stage. However, the scholarly discourse on how family migration influences the health of migrant workers remains contentious. This study uses data from the China Migrants Dynamic Survey (CMDS) of 2017 to focus on the first cohort of migrant workers. Drawing on the theories of family stress and life course, the empirical analysis incorporated heterogeneity tests, total effects, robustness tests, mediation effects, and propensity score matching to explore the mechanisms underlying the impact of family migration on migrant workers' health. Data analysis reveals a substantial negative impact of family migration on the health status of the first cohort of migrant workers. Variations in health outcomes were identified across different family migration patterns. Further analysis indicates that the first cohort of migrant workers, when confronted with family livelihood pressures, tends to prioritize economic resources to support urban family life over their own health. This is because they are influenced by a family-centered culture. Our findings reveal a nuanced landscape. While family migration provides potentially enhances social support systems, it also imposes significant health trade-offs due to increased life stressors. These stressors include economic instability, increased responsibility for family care, and the psychological impacts of adapting to new urban environments. There are the health crowding-out effect of family migration on first cohort migrant workers.

Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents.

Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error. Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection. Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance. Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.