Full Text Available Abstract Background With a growing trend for those with advanced cancer to die at home, there is a corresponding increase in need for primary medical care in that setting. Yet those with lower incomes and in rural regions are often challenged to have their health care needs met. This study examined the association between patient income and residence and the receipt of Family Physician (FP home visits during the end-of-life among patients with cancer. Methods Data Sources/Study Setting. Secondary analysis of linked population-based data. Information pertaining to all patients who died due to lung, colorectal, breast or prostate cancer between 1992 and 1997 (N = 7,212 in the Canadian province of Nova Scotia (NS was extracted from three administrative health databases and from Statistics Canada census records. Study Design. An ecological measure of income ('neighbourhood' median household income was developed using census information. Multivariate logistic regression was then used to assess the association of income with the receipt of at least one home visit from a FP among all subjects and by region of residency during the end-of-life. Covariates in the initial multivariate model included patient demographics and alternative health services information such as total days spent as a hospital inpatient. Data Extraction Methods. Encrypted patient health card numbers were used to link all administrative health databases whereas the postal code was the link to Statistics Canada census information. Results Over 45% of all subjects received at least one home visit (n = 3265. Compared to those from low income areas, the log odds of receiving at least one home visit was significantly greater among subjects who reside in middle to high income neighbourhoods (for the highest income quintile, adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.15, 1.64; for upper-middle income, adjusted OR = 1.19, 95%CI = 1.02, 1.39; for middle income
Students from low-income families consistently trail behind their peers in retention and degree attainment. Research on college student experiences suggests that low-income students experience "cultural mismatch" at college--they feel that their backgrounds are at odds with the middle-class values dominant on campus (Armstrong &…
Using a longitudinal dataset from the years 1995 and 2000, respectively, this study examines whether migration within the host country of Sweden generates higher total annual income for (two-earner) immigrant families. The empirical findings indicate that internal migration generates a positive outcome in terms of higher family income for newly arrived refugee-immigrant families. Further, with the length of residence in the host country, the monetary gain accruing from internal migration decr...
Brandman, David M; Haji, Faizal A; Matte, Marie C; Clarke, David B
Residents must develop a diverse range of skills in order to practice neurosurgery safely and effectively. The purpose of this study was to identify the foundational skills required for neurosurgical trainees as they transition from medical school to residency. Based on the CanMEDS competency framework, a web-based survey was distributed to all Canadian academic neurosurgical centers, targeting incoming and current PGY-1 neurosurgical residents as well as program directors. Using Likert scale and free-text responses, respondents rated the importance of various cognitive (e.g. management of raised intracranial pressure), technical (e.g. performing a lumbar puncture) and behavioral skills (e.g. obtaining informed consent) required for a PGY-1 neurosurgical resident. Of 52 individuals contacted, 38 responses were received. Of these, 10 were from program directors (71%), 11 from current PGY-1 residents (58%) and 17 from incoming PGY-1 residents (89%). Respondents emphasized operative skills such as proper sterile technique and patient positioning; clinical skills such as lesion localization and interpreting neuro-imaging; management skills for common scenarios such as raised intracranial pressure and status epilepticus; and technical skills such as lumbar puncture and external ventricular drain placement. Free text answers were concordant with the Likert scale results. We surveyed Canadian neurosurgical program directors and PGY-1 residents to identify areas perceived as foundational to neurosurgical residency education and training. This information is valuable for evaluating the appropriateness of a training program's goals and objectives, as well as for generating a national educational curriculum for incoming PGY-1 residents.
Bonke, Jens; Uldall-Poulsen, Hans
This paper analyses the phenomenon of income-pooling by applying the Danish household expenditure survey, merged with authoritative register information. Responses to additional questions on income sharing among 1696 couples also allows us to analyses whether the intra-household distribution...
Beekman, Gonne; Gatto, Marcel; Nillesen, Eleonora
This study investigates the relationship between family network density and income hiding in rural Liberia. We link people's behaviour in a modified lottery experiment and a time preference game to detailed information about their family networks. We find that individuals with a dense family
FAN Hong-zhong; ZHANG Ting; LI Ming-liang
Taking the urban population size and urban housing price as the proxy variable of city size,this paper conducts an empirical analysis with the data of CHIPS 2002 and 2008.It is found that the rising of city size and housing prices has important promotion effects on income inequality of city residents.The main reason is that the wage of migrant workers is separated from the housing price of the cities in which they reside;while their wage level can balance the wage level of the ordinary workers of city residents,making it separate from the urban housing price.But the wage of high quality worker of city residents is closely connected with the housing price.The combined action of the multy sizes in China's urban labor market leads to such a result that the greater the size of cities,the higher the urban housing prices,and the larger the income gap between urban residents.This means that in the construction of the new urbanization,to limit the over-expansion of such mega-cities as Beijing,Shanghai and so on and to develop the middle and small cities is an effective way to narrow the income gap between urban residents in China.
Women's Bureau (DOL), Washington, DC.
DATA FROM THE U.S. DEPARTMENT OF COMMERCE AND THE U.S. DEPARTMENT OF LABOR, 1964-66, DESCRIBE THE CONTRIBUTION OF WORKING WIVES TO FAMILY INCOME. NEARLY HALF OF ALL WOMEN 18-64 YEARS OF AGE WORK. ABOUT THREE OF FIVE OF THESE WOMEN ARE MARRIED AND LIVING WITH THEIR HUSBANDS. OF THE 42.1 MILLION HUSBAND-WIFE FAMILIES IN THE UNITED STATES IN MARCH…
Full Text Available Data insufficiency has become the primary factor affecting research on income disparity in China. To resolve this issue, this paper explores Chinese income distribution and income inequality using distribution functions. First, it examines 20 sets of grouped data on family income between 2005 and 2012 by the China Yearbook of Household Surveys, 2013, and compares the fitting effects of eight distribution functions. The results show that the generalized beta distribution of the second kind has a high fitting to the income distribution of urban and rural residents in China. Next, these results are used to calculate the Chinese Gini ratio, which is then compared with the findings of relevant studies. Finally, this paper discusses the influence of urbanization on income inequality in China and suggests that accelerating urbanization can play an important role in narrowing the income gap of Chinese residents.
Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.
An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.
And Others; Rood, Stewart R.
The faculty of the Department of Otolaryngology, University of Pittsburgh School of Medicine, has designed a rotation in the otolaryngology service, that is a basic clinical orientation to ear, nose and throat medicine, to fit the one-month block committed by the local family practice residency training program. The program is described and its…
Armour, Brian S.; Pitts, M. Melinda; Lee, Chung-won
The goal of this research is to quantify the association between food insecurity and smoking among low-income families. This analysis is a retrospective study using data from the 2001 Panel Study of Income Dynamics, a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Family income is linked with U.S. poverty thresholds to identify 2,099 families living near or below 200 percent of the federal poverty level. Food insecurit...
Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert
Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.
Cook, Jeffrey J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)
Historically the low and moderate income (LMI) market has been underserved by solar photovoltaics (PV), in part due to the unique barriers LMI residents face to participation in the PV market. The intent of this report is to identify the most promising strategies state policymakers might consider to finance PV for LMI customers across three housing types: single family, multi-family, and manufactured housing. The result is a financing matrix that documents the first and second tier financing options states may consider for each housing type. The first tier options were selected based upon their potential impact on LMI PV deployment. Second tier financing approaches could also be used to achieve state policy goals, but may not have as much effect on the relevant LMI market segment. Nevertheless, each financing option comes with tradeoffs that state policymakers may wish to consider when they make decisions about which financing approaches are best suited to achieve their LMI PV deployment goals.
Armour, Brian S; Pitts, M Melinda; Lee, Chung-Won
To quantify the association between food insecurity and smoking among low-income families. A retrospective study using data from the 2001 Panel Study of Income Dynamics (PSID), a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Low-income families. Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Food insecurity (i.e., having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) was calculated from the 18-core-item food security module of the U.S. Department of Agriculture. Current smoking status was determined. Smoking prevalence was higher among low-income families who were food insecure compared with low-income families who were food secure (43.6% vs. 31.9%; p < .01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p < .01). Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food-assistance and tobacco-control programs to work together to help low-income people quit smoking.
Income growth and stagnation is discussed, several trends in income inequality among American families are examined, and the notion of a vanishing middle class that may be losing the college cost race is addressed. (MSE)
Binczyk, Natalia M; Babenko, Oksana; Schipper, Shirley; Ross, Shelley
Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.
Full Text Available The resident natural persons and those who qualify for residency conditions are subject to taxation in Romania for the incomes from any source, both from Romania and from abroad. External fiscal credit can be granted in order to avoid double taxation, so that the person can be entitled to deduct from the tax on income due in Romania the tax of income paid abroad, without exceeding the share of the income tax payable in Romania related to the income from abroad. The procedure of granting external fiscal credit vary depending on different categories of income.
Humlum, Maria Knoth
to many earlier studies, the results suggest that the timing of income does not matter for long-term child outcomes. This is a reasonable result given the setting in a Scandinavian welfare state with generous child and education subsidies. Actually, later family income (age 12–15) is a more important......I investigate the effects of the timing of family income on child achievement production. Detailed administrative data augmented with Programme for International Student Assessment test scores at age 15 are used to analyze the effects of the timing of family income on child achievement. Contrary...... determinant of child achievement than earlier income....
This chapter explores: • What we mean by low income and poverty and how poverty is defined • The families living on low income in the UK today and the impact of low income and poverty on children’s well-being, development and learning • Supporting children from low income families • The attainment gap between children from low income backgrounds and their peers • The pupil premium and how schools have used the extra funding to raise attainment • Key aspects of good practice and what schools c...
Zhang, Haiyan; Washington, Rodney; Yin, Jianjun
This article discussed the significance of improving low-income family children's information literacy, which could improve educational quality, enhance children's self-esteem, adapt children to the future competitive world market, as well as the problems in improving low-income family children's information literacy, such as no home computer and…
Using the March Current Population Survey data from 1984 to 2013, I provide a comprehensive evaluation of how minimum wage policies influence the distribution of family incomes. I find robust evidence that higher minimum wages shift down the cumulative distribution of family incomes at the bottom, reducing the share of non-elderly individuals with incomes below 50, 75, 100, and 125 percent of the federal poverty threshold. The long run (3 or more years) minimum wage elasticity of the non-elde...
Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.
... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Single-family residence exemption... Requirements § 1710.10 Single-family residence exemption. (a) General. The sale of a lot which meets the...) Lot dimensions. (ii) Plat approval and recordation. (iii) Roads and access. (iv) Drainage. (v...
Berg, Jolene K.; Garrard, Judith
Research on residency education in family practice is discussed. Programmatic variables are examined: geographic region, size, and type of program. Definitions of these variables are provided, the current distribution of family practice residency programs across each of these variables is described, and data for use by other researchers is…
Mccreary, Linda L.; Dancy, Barbara L.
Family functioning is influenced by socio-economic status, culture, family structure, and developmental stage, and is assessed primarily using instruments developed for middle-income European American two-parent families. These instruments may not validly assess low-income African American single-parent families. This qualitative study was…
Glied, Sherry; Chakraborty, Ougni; Russo, Therese
ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.
Gjerdingen, D K; Chaloner, K M; Vanderscoff, J A
A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.
Sur, D K; Kaye, L; Mikus, M; Goad, J; Morena, A
This study evaluated the electrocardiogram (EKG) reading skills of family practice residents. A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18. Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents. We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.
Berkowitz, Carol D; Frintner, Mary Pat; Cull, William L
The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection. A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed. Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection. Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Fletcher, Sarah; Mullett, Jennifer; Beerman, Steve
Abstract Objective To examine the perceptions of residents, nurses, and physicians about the effect of a regional family practice residency site on the delivery of health services in the community, as well as on the community health care providers. Design Interviews and focus groups were conducted. Setting Nanaimo, BC. Participants A total of 16 residents, 15 nurses, and 20 physicians involved with the family practice residency training program at the Nanaimo site. Methods A series of semistructured interviews and focus groups was conducted. Transcripts of interviews and focus groups were analyzed thematically by the research team. Main findings Overall, participants agreed that having a family practice residency training site in the community contributed to community life and to the delivery of health services in the following ways: increased community capacity and social capital; motivated positive relationships and attitudes in the hospital and community settings; improved communication and teamwork, as well as accessibility and understanding of the health care system; increased the standard of care; and facilitated the recruitment and retention of family physicians. Conclusion This family practice residency training site was beneficial for the community it served. Future planning for distributed medical education sites should take into account the effects of these sites on the health care community and ensure that they continue to be positive influences. Further research in this area could focus on patients’ perceptions of how residency programs affect their care, as well as on the effect of residency programs on wait times and workload for physicians and nurses. PMID:25217693
Rutherford, Kimberly; Oda, Joanna
Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218
Rutherford, Kimberly; Oda, Joanna
Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.
Humlum, Maria Knoth
In this paper, I investigate the effects of the timing of family income on child achievement production. Detailed administrative data augmented with PISA test scores at age 15 are used to analyze the effects of the timing of family income on child achievement. Contrary to many earlier studies, te...... with generous child and education subsidies. Actually, later family income (age 12-15) is a more important determinant of child achievement than earlier income.......In this paper, I investigate the effects of the timing of family income on child achievement production. Detailed administrative data augmented with PISA test scores at age 15 are used to analyze the effects of the timing of family income on child achievement. Contrary to many earlier studies......, tests for early borrowing constraints suggest that parents are not constrained in early investments in their children's achievement, and thus that the timing of income does not matter for long-term child outcomes. This is a reasonable result given the setting in a Scandinavian welfare state...
Dorjana Nano; Teuta Llukani
This study investigates the differences on Financial Behaviour among Albanian university students based on their family income. The main objectives of this study are: i) firstly, to assess the level of financial behaviour of Albanian university students; ii) to examine whether the financial behaviour differs based on the level of students family income; and ii) finally, , to provide some conclusions and policy implications with regard to financial behaviour. An instrument comprised of specifi...
Linver, Miriam R; Brooks-Gunn, Jeanne; Kohen, Dafna E
A variety of family processes have been hypothesized to mediate associations between income and young children's development. Maternal emotional distress, parental authoritative and authoritarian behavior (videotaped mother-child interactions), and provision of cognitively stimulating activities (Home Observation for Measurement of the Environment [HOME] scales) were examined as possible mediators in a sample of 493 White and African American low-birth-weight premature infants who were followed from birth through age 5. Cognitive ability was assessed by standardized test, and child behavior problems by maternal report, when the children were 3 and 5 years of age. As expected, family income was associated with child outcomes. The provision of stimulating experiences in the home mediated the relation between family income and both children's outcomes; maternal emotional distress and parenting practices mediated the relation between income and children's behavior problems.
Berger, Lawrence M; Font, Sarah A; Slack, Kristen S; Waldfogel, Jane
This study estimates the associations of income with both (self-reported) child protective services (CPS) involvement and parenting behaviors that proxy for child abuse and neglect risk among unmarried families. Our primary strategy follows the instrumental variables (IV) approach employed by Dahl and Lochner (2012), which leverages variation between states and over time in the generosity of the total state and federal Earned Income Tax Credit for which a family is eligible to identify exogenous variation in family income. As a robustness check, we also estimate standard OLS regressions (linear probability models), reduced form OLS regressions, and OLS regressions with the inclusion of a control function (each with and without family-specific fixed effects). Our micro-level data are drawn from the Fragile Families and Child Wellbeing Study, a longitudinal birth-cohort of relatively disadvantaged urban children who have been followed from birth to age nine. Results suggest that an exogenous increase in income is associated with reductions in behaviorally-approximated child neglect and CPS involvement, particularly among low-income single-mother families.
Gottlieb, Aaron; Pilkauskas, Natasha; Garfinkel, Irwin
Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,701; 1998–2010), the authors studied whether the unemployment rate was associated with private financial transfers (PFTs) among urban families with young children and whether family income moderated these associations. They found that an increase in the unemployment rate was associated with greater PFT receipt and that family income moderated the association. Poor and near-poor mothers experienced increases in PFT receipt when unemployment rates were high, whereas mothers with incomes between 2 and 3 times the poverty threshold experienced decreases. Simulations estimating the impact of the Great Recession suggest that moving from 5% to 10% unemployment is associated with a 9-percentage-point increase in the predicted probability of receiving a PFT for the sample as a whole, with greater increases in predicted probabilities among poor and near poor mothers. PMID:25505802
Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce
Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.
Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina
This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.
Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W
To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.
Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e
Kates, Nick; Toews, John; Leichner, Pierre
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice...
Pauwels, Judith; Weidner, Amanda
Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.
Palmer, Adrian; Koenig-Lewis, Nicole; Medi Jones, Lisa Elinor
A long stream of literature has identified cognitive, emotional and evaluative dimensions of social identity. Previous studies have examined identity self-congruence of incoming tourists. However, the application of identity theory to the study of host communities' support of incoming tourism has been under-researched. This paper seeks to make a contribution by closing this gap by investigating residents' identity and its association with their propensity to become advocates for inward touris...
Greg J. Duncan
Full Text Available Increases in family income inequality in the United States have translated into widening gaps in educational achievement and attainments between children from low- and high-income families. We describe the mechanisms that have produced this disturbing trend. We argue that the three dominant policy approaches states and the federal government have used to improve the education of the disadvantaged have had at best modest success in improving education for disadvantaged children. To conclude, we describe the building blocks for an American solution to the problem of growing inequality of educational outcomes.
Aziz, Nusrate; Hossain, Belayet; Emran, Masum
The study investigates the macroeconomic determinants of co-residing arrangement between generations in selected developing countries with a focus on examining the effect of changing income level of the working generation. A reduced form model is specified for co-residence between the older generation and altruistic working generation. The fixed- and random-effects models are applied in two waves of data for 22 countries. Estimated results indicate that the income of the altruistic working generation has a negative effect on co-residence, suggesting that if the income of the working generation increases, co-residence decreases. This decrease is greater for older men compared with their female counterparts. Life expectancy, literacy and culture also have significant influences on co-residence. Co-residence is expected to fall in developing countries with economic growth over time. Consequently, a higher proportion of older citizens will be vulnerable in the future. Hence, governments of developing countries will face increasing pressure from their older people to provide appropriate planning and strategy to face this challenge. © 2018 AJA Inc.
Brennan, Julie; McGrady, Angele
Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident's quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents' abilities to balance personal and professional demands. © The Author(s) 2015.
Luzianne Feijó Alexandre Paiva
Full Text Available In this study, we report the experiences of occupational therapist during the Multidisciplinary Residency Program in Family and Community Health in Fortaleza, Ceará state, Brazil. With the creation of the Support Center for Family Health – NASF, occupational therapists began to participate more effectively in the Family Health Strategy of the Brazilian National Health System. Given this rocess, the category, which historically has trained its professionals following the biomedical model, is faced with the challenge to build a new field of knowledge. Objective: To analyze the inclusion of occupational therapy in the Family Health Strategy within the scope of Multidisciplinary Residency. Methodology: This is a descriptive study of qualitative approach, which was based on the experience of four occupational therapy resident students, performed through the documental analysis of field diaries, scientific papers, and case studies produced between 2009 and 2011. Results: The occupational therapists as well as the other NASF professionals operated the logic of Matrix Support to the Family Health teams, sharing their knowledge and assisting in resolving complex cases of the families, groups, and communities served. In this context, we found people with different relationships with their doings and a reduced repertoire of activities. The occupational therapists invested in the creation or consolidation of groups in the Family Health Centers and in the territory, which also stood as living and socializing spaces, focusing on prevention and health promotion.
Gonzalo Olcina Vauteren; Luisa Escriche
The aim of this paper is to explain how financial constraints and family background characteristics affect the signalling educational investments of individuals born in low-income families. We show that talented students who are poor are unable to signal their talent, as the maximum level of education they can attain may also be achieved by less talented students who are rich. Under this approach, a de-crease in inequalities across generations cannot be expected. The paper also shows that an ...
McWayne, Christine M.; Mattis, Jacqueline S.; Green Wright, Linnie E.; Limlingan, Maria Cristina; Harris, Elise
Research Findings: This within-group exploratory sequential mixed-methods investigation sought to identify how ethnically diverse, urban-residing, low-income Black families conceptualize positive parenting. During the item development phase 119 primary caregivers from Head Start programs participated in focus groups and interviews. These…
... definitions-family size and income known (owner-occupied units, actual tenants, and prospective tenants). 81...—Income level definitions—family size and income known (owner-occupied units, actual tenants, and...-income families, where the unit is owner-occupied or, for rental housing, family size and income...
Shumow, Lee; Vandell, Deborah Lowe; Posner, Jill K.
Parents' reports of their child-rearing expectations and intentions were measured for 184 low-income urban families when children were in the third and fifth grades. Parenting strategies were stable over time. Parenting strategies were related to measures of adjustment at school, behavior problems in the home, academic achievement, and…
Hoffman, Saul D.; Seidman, Laurence S.
The impact of the Earned Income Tax Credit (EITC) on working families was analyzed. The analysis established that the EITC is, on balance, a highly effective program that meets its primary objectives well. The following benefits of the EITC were identified: (1) it reduced the poverty rate in 1999 by an estimated 1.5 percentage points; (2) it is…
This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty. PMID:29401482
Full Text Available This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898, we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents and by race/ethnicity (White, Black, and Hispanic mothers. Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty.
Duque, Valentina; Pilkauskas, Natasha V; Garfinkel, Irwin
This paper examines the association between the Great Recession and real assets among families with young children. Real assets such as homes and cars are key indicators of economic well-being that may be especially valuable to low-income families. Using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4,898), we investigate the association between the city unemployment rate and home and car ownership and how the relationship varies by family structure (married, cohabiting, and single parents) and by race/ethnicity (White, Black, and Hispanic mothers). Using mother fixed-effects models, we find that a one percentage point increase in the unemployment rate is associated with a -0.5 percentage point decline in the probability of home ownership and a -0.7 percentage point decline in the probability of car ownership. We also find that the recession was associated with lower levels of home ownership for cohabiting families and for Hispanic families, as well as lower car ownership among single mothers and among Black mothers, whereas no change was observed among married families or White households. Considering that homes and cars are the most important assets among middle and low-income households in the U.S., these results suggest that the rise in the unemployment rate during the Great Recession may have increased household asset inequality across family structures and race/ethnicities, limiting economic mobility, and exacerbating the cycle of poverty.
Schnittgrund, K.P. (Univ. of California, Riverside); Baker, G.
The major focus of this research was the difference in financial-management practices used by low-income urban white, black, and Mexican-American families. A random sample of 199 interviews was completed during the spring of 1980 in Phoenix, Arizona, USA. The sample consisted of 69 white, 70 black, and 60 Mexican-American families. Differences in financial behavior did occur for each race. In addition, they were optimistic regarding their own ability to handle money and resolve financial problems but generally negative toward the ability of other families to manage money, use credit, and plan purchases. 20 references, 3 tables.
Jansen, Kate L; Rosenbaum, Marcy E
Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and
Ross, David; Schipper, Shirley; Westbury, Chris; Linh Banh, Hoan; Loeffler, Kim; Allan, G Michael; Ross, Shelley
Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.
Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A
New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.
Kates, N; Toews, J; Leichner, P
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement-particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings.
Apouey, Bénédicte; Geoffard, Pierre-Yves
Recent studies examining the relationship between family income and child health in the UK have produced mixed findings. We re-examine the income gradient in child general health and its evolution with child age in this country, using a very large sample of British children. We find that there is no correlation between income and child general health at ages 0-1, that the gradient emerges around age 2 and is constant from age 2 to age 17. In addition, we show that the gradient remains large and significant when we reduce the endogeneity of income. Furthermore, our results indicate that the gradient in general health reflects a greater prevalence of chronic conditions among low-income children and a greater severity of these conditions. Taken together, these findings suggest that income does matter for child health in the UK and may play a role in the intergenerational transmission of socioeconomic status. Copyright © 2013 Elsevier B.V. All rights reserved.
Full Text Available This study aimed to examine how family income and social distance influence young rural Chinese children's altruistic behavior in the dictator game (DG. A total of 469 four-year-old children from eight rural areas in China, including many children left behind by parents who had migrated to urban areas for work, played the DG. Stickers comprised the resource, while recipients in the game were assumed to be either their friends or strangers, with the social distance (i.e., strangers compared to friends as a between-subjects variable. Children donated significantly more stickers to their friends than to strangers. Moreover, children from lower income families donated more stickers than children from higher income families. However, no gender and parental migrant status differences in children's prosocial behaviors were evident in this sample. Findings of this study suggest that children's altruistic behaviours to peers are influenced by family characteristics since preschool age. The probable influence of local socialization practices on development and the possible adaptive significance were discussed.
Locke, Amy B; Gordon, Andrea; Guerrera, Mary P; Gardiner, Paula; Lebensohn, Patricia
The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care. © 2013 Elsevier Inc. All rights reserved.
well-being declines and wives raises the more she earns relatively to him. However, the relationships are often of an inversed u-shaped form for both sexes with men getting the highest well-being at an earlier stage than women. Within the Scandinavian welfare state regime this preferred distribution......-shaped relationship between the distribution of income and men and women’s economic well-being.......The article analyses the distribution of income within European families and the consequences for the spouses’ economic well-being. Thus, many studies have shown that women nowadays participate on the labour market in an increasing number resulting in a more equal distribution of income within...
Schoeni, Robert F; Wiemers, Emily E
Numerous studies have estimated a high intergenerational correlation in economic status. Such studies do not typically attend to potential biases that may arise due to survey attrition. Using the Panel Study of Income Dynamics - the data source most commonly used in prior studies - we demonstrate that attrition is particularly high for low-income adult children with low-income parents and particularly low for high-income adult children with high-income parents. Because of this pattern of attrition, intergenerational upward mobility has been overstated for low-income families and downward mobility has been understated for high-income families. The bias among low-income families is greater than the bias among high-income families implying that intergenerational elasticity in family income is higher than previous estimates with the Panel Study of Income Dynamics would suggest.
Kalyanpur, M; Rao, S S
A qualitative study of four black, low-income, single mothers used in-depth interviews and participant observation to evaluate their interactions with outreach agency professionals. Three perceived aspects (disrespect, focus on deficits, and discounting parenting style differences) were associated with exclusionary (unempowering) relationships. A reciprocal and supportive approach was associated with collaborative (empowering) relationships. Implications of these findings for professionals serving minority families are discussed.
Anthony, Jodi; Goldman, Roberta; Rees, Vaughan W; Frounfelker, Rochelle L; Davine, Jessica; Keske, Robyn R; Brooks, Daniel R; Geller, Alan C
As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance. Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations. Four low-income housing properties in Massachusetts, 12 months postpolicy adoption. Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47). Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed. Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged. Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers. Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.
Dual Income Family, Gender and Adolescents´ Self-Esteem. ... Abstract. This study examined the influence of dual income family and gender on adolescents' self-esteem in Enugu, Nigeria. ... AJOL African Journals Online. HOW TO USE AJOL.
Portela Romero, Manuel; Bugarín González, Rosendo; Rodríguez Calvo, María Sol
To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement. A cross-sectional study. Seven FP of Galicia teaching units. 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire. The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care. The results were grouped into 12 composites assessed by the mentioned questionnaire. The study variables were the socio-demographic dimensions of the questionnaire, as well as occupational/professional variables: age, gender, year of residence, and teaching unit of FP of Galicia. The "Organisational learning" and "Teamwork" items were considered strong areas. However, the "Patient safety and quality issues", "Information exchange with other settings", and "Work pressure and pace" items were considered areas with significant potential for improvement. First-year residents obtained the best results and the fourth-year ones the worst. The results may indicate the need to include basic knowledge on patient safety in the teaching process of FP residents in order to increase and consolidate the fragile patient safety culture described in this study. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Handheld computers are valuable practice tools. It is important for residency programs to introduce their trainees and faculty to this technology. This article describes a formal strategy to introduce handheld computing to a family practice residency program. Objectives were selected for the handheld computer training program that reflected skills physicians would find useful in practice. TRGpro handheld computers preloaded with a suite of medical reference programs, a medical calculator, and a database program were supplied to participants. Training consisted of four 1-hour modules each with a written evaluation quiz. Participants completed a self-assessment questionnaire after the program to determine their ability to meet each objective. Sixty of the 62 participants successfully completed the training program. The mean composite score on quizzes was 36 of 40 (90%), with no significant differences by level of residency training. The mean self-ratings of participants across all objectives was 3.31 of 4.00. Third-year residents had higher mean self-ratings than others (mean of group, 3.62). Participants were very comfortable with practical skills, such as using drug reference software, and less comfortable with theory, such as knowing the different types of handheld computers available. Structured training is a successful strategy for introducing handheld computing to a residency program.
Gardiner, Paula; Filippelli, Amanda C; Lebensohn, Patricia; Bonakdar, Robert
Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies. © 2013 Elsevier Inc. All rights reserved.
Peterson, Lars E; Johnson, Hillary; Pugno, Perry A; Bazemore, Andrew; Phillips, Robert L
The Accreditation Council for Graduate Medical Education's 2003 restrictions on resident duty hours (RDH) raised concerns among educators about potential negative impacts on residents' training. In the early wake of these restrictions, little is known about how RDH reform impacts training in primary care. The authors surveyed family medicine (FM) residency program directors (PDs) for their perceptions of the impact of RDH regulations on training in primary care. All PDs of 472 FM residency programs were asked via list-serve to complete an anonymous Internet-based survey in the fall of 2004. The survey solicited PDs' opinions about changes in staff and in residents' training experiences with respect to implementation of RDH regulations. Descriptive and qualitative analyses were conducted. There were 369 partial and 328 complete responses, for a response rate of 69% (328/472). Effects of the RDH regulations are varied. Fifty percent of FMPDs report increased patient-care duties for attendings, whereas 42% report no increase. Nearly 80% of programs hired no additional staff. Sixty percent of programs eliminated postcall clinics, and nearly 40% implemented a night-float system. Administrative hassles and losses of professionalism, educational opportunity, and continuity of care were common concerns, but a sizeable minority feel that residents will be better off under the new regulations. Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered.
Urse, Geraldine N
Although physicians regularly use numeric coding systems such as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to describe patient encounters, coding errors are common. One of the most complicated diagnoses to code is diabetes mellitus. The ICD-9-CM currently has 39 separate codes for diabetes mellitus; this number will be expanded to more than 50 with the introduction of ICD-10-CM in October 2015. To assess the effect of a 1-hour focused presentation on ICD-9-CM codes on diabetes mellitus coding. A 1-hour focused lecture on the correct use of diabetes mellitus codes for patient visits was presented to family practice residents at Doctors Hospital Family Practice in Columbus, Ohio. To assess resident knowledge of the topic, a pretest and posttest were given to residents before and after the lecture, respectively. Medical records of all patients with diabetes mellitus who were cared for at the hospital 6 weeks before and 6 weeks after the lecture were reviewed and compared for the use of diabetes mellitus ICD-9 codes. Eighteen residents attended the lecture and completed the pretest and posttest. The mean (SD) percentage of correct answers was 72.8% (17.1%) for the pretest and 84.4% (14.6%) for the posttest, for an improvement of 11.6 percentage points (P≤.035). The percentage of total available codes used did not substantially change from before to after the lecture, but the use of the generic ICD-9-CM code for diabetes mellitus type II controlled (250.00) declined (58 of 176 [33%] to 102 of 393 [26%]) and the use of other codes increased, indicating a greater variety in codes used after the focused lecture. After a focused lecture on diabetes mellitus coding, resident coding knowledge improved. Review of medical record data did not reveal an overall change in the number of diabetic codes used after the lecture but did reveal a greater variety in the codes used.
Feminin, T. A.; Wiranegara, H. W.; Supriatna, Y.
The majority of relocated, low-income families in North Jakarta city who residing the flats, complained at decreasing their accessibility to the workplaces and to the social facilities. The aim of this research was to identify the changing of their accessibility before and after relocated, viewed from three dimensions: distance, travel time, and travel cost to the workplaces, educational facilities, and shopping areas. The research design was questionnaire survey containing the degree of accessibility before and after resided the flats. Five flats were chosen as cases. Their inhabitants were chosen as respondents which used simple random sampling. The result showed that their flats accessibility to the workplaces in all three dimensions was lower than when they resided in the slum area. Also, in distance and travel time accessibility to shopping areas was lower. Only accessibility to educational facilities measured in those three dimensions was higher after they moved. Supply for affordable public transport from their flats to reach their workplaces is needed to raise their accessibility. Also, they need subsidizeto rent of their flats so the burden to their income lesser.Using the ground space of their flats for retail activities was to make more accessible for their shopping activities.
Full Text Available The Canadian personal income tax system does not pay much attention to whether the amount of money an individual brings home is supplemented by the income of a spouse or not. That means that families where one spouse earns more than the other get taxed at a higher rate than families where two working partners earn the same total income split evenly between two paycheques. In fact, a family with just a single earner making $70,000 a year pays 30 per cent more in taxes every year than a family with two partners making $35,000 a year. A single-earner family taking in $120,000 a year pays the same income tax as a dualearning couple making $141,000 between them. The federal Conservative government has at least suggested it wants to finally level that playing field — nearly six decades after a royal commission recommended that the income tax system be changed to recognize total family household income, rather than focusing on each individual’s income. Given that Canada’s income tax system aims to treat people in similar circumstances as equally as possible, it is certainly time to let couples split their income so they do not face a penalty in higher tax rates than those faced by couples bringing home the same amount of total pay. While couples with just a single earner enjoy some advantages, a dual-earning couple does not — namely the extra time the stay-at-home spouse is able to use to raise children and produce other unpaid, home-based benefits — that can be accounted for using other means. Specifically, cutting out the transferability of the unused portion of the basic personal tax exemption for couples splitting income — requiring couples splitting their income to each earn money in order to use this credit — is one way to account for the difference in unpaid benefits that single-income families do typically enjoy more than dual-income couples. That is one mechanism; there may still be others the government might consider. But the
Bennett, Kevin J; Dismuke, Clara E
High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.
... GOALS AND MISSION Housing Goals § 1282.17 Affordability—Income level definitions—family size and income..., for rental housing, family size and income information for the dwelling unit is known to the... sizes: Number of persons in family Percentageof area median income 1 70 2 80 3 90 4 100 5 or more...
Mims, Lisa D; Bressler, Lindsey C; Wannamaker, Louise R; Carek, Peter J
In 1985, the American Osteopathic Association (AOA) Board of Trustees agreed to allow residency programs to become dually accredited by the AOA and Accreditation Council for Graduate Medical Education (ACGME). Despite the increase in such programs, there has been minimal research comparing these programs to exclusively ACGME-accredited residencies. This study examines the association between dual accreditation and suggested markers of quality. Standard characteristics such as regional location, program structure (community or university based), postgraduate year one (PGY-1) positions offered, and salary (PGY-1) were obtained for each residency program. In addition, the faculty to resident ratio in the family medicine clinic and the number of half days residents spent in the clinic each week were recorded. Initial Match rates and pass rates of new graduates on the ABFM examination from 2009 to 2013 were also obtained. Variables were analyzed using chi-square and Student's t test. Logistic regression models were then created to predict a program's 5-year aggregate initial Match rate and Board pass rate in the top tertile as compared to the lowest tertile. Dual accreditation was obtained by 117 (27.0%) of programs. Initial analyses revealed associations between dually accredited programs and mean year of initial ACGME program accreditation, regional location, program structure, tracks, and alternative medicine curriculum. When evaluated in logistic regression, dual accreditation status was not associated with Match rates or ABFM pass rates. By examining suggested markers of program quality for dually accredited programs in comparison to ACGME-only accredited programs, this study successfully established both differences and similarities among the two types.
Brand, Michael W; Ekambaram, Vijayabharathi; Tucker, Phebe; Aggarwal, Ruchi
Residents are one of the prime sources of information and education for medical students. As an initial step in supporting residents as teachers, a baseline self-assessment of residents' knowledge, skills, attitudes, and values related to teaching was conducted among psychiatry and family medicine residents to compare and improve their confidence and skills as teachers. Psychiatry residents (N=12) and family medicine residents (N=23) completed self-assessments of their knowledge, skills, attitudes, and values related to teaching. Residents also were asked to list steps used in the One-Minute Preceptor process and estimate the time each spent in teaching. Descriptive summary statistics were used for four main areas related to teaching; t-test and chi-square analyses were conducted to ascertain whether there was a significant difference in resident groups. In the current study, the perceived amount of time spent for teaching patients was significantly higher among family practice residents, whereas no group differences were found for time teaching medical students, peers, community members, non-physicians, or others. However, family medicine residents rated themselves higher than psychiatry residents in their understanding of their roles in teaching medical students and teaching patients. Also, family medicine residents' self-reported teaching skills were more advanced (82.4%) than psychiatry residents' (54.2%). They most likely applied at least two different teaching methods in inpatient and outpatient settings, as compared with psychiatry residents. No significant group differences were found in the other 15 items assessing teaching knowledge, skills, attitudes, and values. Results indicate that residents' knowledge, skills, attitudes, and values regarding teaching varies across institutions and training programs. The psychiatry residents in this study do not clearly understand their role as educators with patients and medical students; they have a less clear
Tucker-Seeley, Reginald D; Harley, Amy E; Stoddard, Anne M; Sorensen, Glorian G
Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. We analyzed cross-sectional data from the Health in Common Study (N = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population.
Rideout, Victoria; Katz, Vikki S.
The data in this survey offer a unique perspective from low- and moderate-income families with school-age children in the United States. They reveal many of the nuances and complexities of digital life among lower income families today. Because lower-income parents are not usually the focus of studies on technology and learning, this report offers…
Iams, Howard M; Purcell, Patrick J
In recent decades, employers have increasingly replaced defined benefit (DB) pensions with defined contribution (DC) retirement accounts for their employees. DB plans provide annuities, or lifetime benefits paid at regular intervals. The timing and amounts of DC distributions, however, may vary widely. Most surveys that provide data on the family income of the aged either collect no data on nonannuity retirement account distributions, or exclude such distributions from their summary measures of family income. We use Survey of Income and Program Participation (SIPP) data for 2009 to estimate the impact of including retirement account distributions on total family income calculations. We find that about one-fifth of aged families received distributions from retirement accounts in 2009. Measured mean income for those families would be about 15 percent higher and median income would be 18 percent higher if those distributions were included in the SIPP summary measure of family income.
Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W
The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.
Klee, David; Covey, Carlton; Zhong, Laura
Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.
Lim, Younghee; DeJohn, Tara V; Murray, Drew
As the United States' economy continues to experience challenges, more families at or near the poverty level fall prey to predatory financial practices. Their vulnerability to these operations is increased by a lack of knowledge of asset-building resources and alternative financial services. This article focuses on Volunteer Income Tax Assistance (VITA)--a free income tax preparation program, which is a vital resource available to low-income families. Unfortunately, VITA is largely underused and often unknown to economically strained families and to the social workers and other professionals to whom these families turn for assistance. This article concludes with policy and practice implications for social workers and other professionals engaged in providing services to financially vulnerable families.
DiGiuseppe, Stephen; Luszczek, Wioleta; Keiffer, Timothy R; Bienkowska-Haba, Malgorzata; Guion, Lucile G M; Sapp, Martin J
During the entry process, the human papillomavirus (HPV) capsid is trafficked to the trans-Golgi network (TGN), whereupon it enters the nucleus during mitosis. We previously demonstrated that the minor capsid protein L2 assumes a transmembranous conformation in the TGN. Here we provide evidence that the incoming viral genome dissociates from the TGN and associates with microtubules after the onset of mitosis. Deposition onto mitotic chromosomes is L2-mediated. Using differential staining of an incoming viral genome by small molecular dyes in selectively permeabilized cells, nuclease protection, and flotation assays, we found that HPV resides in a membrane-bound vesicle until mitosis is completed and the nuclear envelope has reformed. As a result, expression of the incoming viral genome is delayed. Taken together, these data provide evidence that HPV has evolved a unique strategy for delivering the viral genome to the nucleus of dividing cells. Furthermore, it is unlikely that nuclear vesicles are unique to HPV, and thus we may have uncovered a hitherto unrecognized cellular pathway that may be of interest for future cell biological studies.
Burns, Cate; Cook, Kay; Mavoa, Helen
The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation. Copyright © 2013 Elsevier Ltd. All rights reserved.
Recent studies examining the effect of family income on child health have been unable to account for the endogeneity of income. Using data from a British cohort study, we address this gap by exploiting exogenous variation in local labour market characteristics to instrument for family income. We estimate the causal effect of family income on different measures of child health and explore the role of potential transmission mechanisms. We find that income has a very small but significant causal effect on subjective child health and no significant effect on chronic health conditions, apart from respiratory illnesses. Using the panel structure, we show that the timing of income does not matter for young children. Moreover, our results provide further evidence that parental health does not drive a spurious relationship between family income and child health. Our study implies that financial transfers are unlikely to deliver substantial improvements in child health. Copyright © 2014 Elsevier B.V. All rights reserved.
Griggs, Tracy Lambert; Casper, Wendy J.; Eby, Lillian T.
This study examines relationships between support from work, family and community domains with time- and strain-based work-family conflict in a sample of low-income workers. Results reveal significant within-domain and cross-domain relationships between support from all three life domains with work--family conflict. With respect to family support,…
Danis, Marion; Kotwani, Namrata; Garrett, Joanne; Rivera, Ivonne; Davies-Cole, John; Carter-Nolan, Pamela
To determine the priorities of low-income urban residents for interventions that address the socio-economic determinants of health. We selected and estimated the cost of 16 interventions related to education, housing, nutrition, employment, health care, healthy behavior, neighborhood improvement, and transportation. Low-income residents of Washington, D.C. (N=431) participated in decision exercises to prioritize these interventions. Given a budget valued at approximately twice an estimated cost of medical and dental care ($885), the interventions ultimately prioritized by the greatest percentage of individuals were: health insurance (95%), housing vouchers (82%) dental care (82%), job training (72%), adult education (63%), counseling (68%), healthy behavior incentives (68%), and job placement (67%). The percentages of respondents who received support for housing, adult education, and job training and placement were far less than the percentage who prioritized these interventions. Poor and low-income residents' priorities may usefully inform allocation of social services that affect health.
The declining prevalence of two-parent families helped increase income inequality over recent decades. Does family structure also condition how economic (dis)advantages pass from parents to children? If so, shifts in the organization of family life may contribute to enduring inequality between groups defined by childhood family structure. Using National Longitudinal Survey of Youth data, I combine parametric and nonparametric methods to reveal how family structure moderates intergenerational income mobility in the United States. I find that individuals raised outside stable two-parent homes are much more mobile than individuals from stable two-parent families. Mobility increases with the number of family transitions but does not vary with children's time spent coresiding with both parents or stepparents conditional on a transition. However, this mobility indicates insecurity, not opportunity. Difficulties maintaining middle-class incomes create downward mobility among people raised outside stable two-parent homes. Regardless of parental income, these people are relatively likely to become low-income adults, reflecting a new form of perverse equality. People raised outside stable two-parent families are also less likely to become high-income adults than people from stable two-parent homes. Mobility differences account for about one-quarter of family-structure inequalities in income at the bottom of the income distribution and more than one-third of these inequalities at the top.
Darko, Janice; Eggett, Dennis L.; Richards, Rickelle
Objective: To explore food shopping behaviors among low-income families over the course of the month. Design: Two researchers conducted 13 90-minute focus groups. Setting: Two community organizations serving low-income populations and a university campus. Participants: Low-income adults (n = 72) who were the primary household food shoppers and who…
Kevin R. Schwartz
Full Text Available Introduction: Increasingly, pediatric and emergency medicine (EM residents are pursuing clinical rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been established. High-fidelity simulation represents a potentially effective modality for such preparation. This study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is effective in helping to prepare residents for clinical rotations in a low-income country. Methods: 43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad. Results: Prior to simulation, 1/43 (2% participants reported they were comfortable with the diagnosis and management of severe malnutrition; this increased to 30/42 (71% after simulation and 24/31 (77% after working abroad. Prior to simulation, 1/43 (2% of residents reported comfort with the diagnosis and management of severe malaria; this increased to 26/42 (62% after simulation and 28/31 (90% after working abroad; 36/42 (86% of residents agreed that a simulation-based global health curriculum is more useful than a didactic curriculum alone, and 41/42 (98% felt a simulator-based curriculum should be offered to all residents planning a clinical trip to a low-income country. Conclusion: High-fidelity simulation is effective in increasing residents’ self-rated comfort in management of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as a component of pre-departure training for all residents rotating clinically to low-income countries.
Lusk, Anne C; Anastasio, Albert; Shaffer, Nicholas; Wu, Juan; Li, Yanping
This paper examines if, in a lower-income minority neighborhood, bicycling practices and bicycle-environment preferences of Blacks and Hispanics were different from Whites. During the summer of 2014, surveys were mailed to 1537 households near a proposed cycle track on Malcolm X Boulevard in Roxbury, MA. On the Boulevard, intercept surveys were distributed to cyclists and observations noted about passing cyclist's characteristics. Data were analyzed from 252 returned-mailed surveys, 120 intercept surveys, and 709 bicyclists. White (100%), Hispanic (79%), and Black (76%) bicyclists shown pictures of 6 bicycle facility types in intercept surveys perceived the cycle track as safest. More White mailed-survey respondents thought bikes would not be stolen which may explain why more Hispanics (52%) and Blacks (47%) preferred to park their bikes inside their home compared with Whites (28%), with H/W B/W differences statistically significant ( p bike compared with Whites (75%). Minority populations are biking on roads but prefer cycle tracks. They also prefer to park bikes inside their homes and bicycle with family and friends. Wide cycle tracks (bicycling with family/friends) and home bike parking should be targeted as capital investments in lower-income minority neighborhoods.
Margarita (Gres Wilkins
Full Text Available HOUSING AFFORDABILITY FOR FAMILIES WITH LOW INCOMES ACROSS CANADA Percentage of income devoted to paying lowest-priced rent in a city, by low-income family type, select years, 1990-2015 Much public attention has been directed towards the issue of a Canada-wide housing crisis. The focus has typically been on the cost of housing for an average income Canadian family. Less attention has been paid to families with incomes much lower than those of the average Canadian household, for which the housing crisis is far more severe. Households and individuals with particularly low incomes are at the highest risk of experiencing the worst effects of a lack of housing affordability, including homelessness.
Bowman, Shanthy A.
Examined data from Continuing Survey of Food Intakes by Individuals (USDA) concerning breakfast consumption in families and the kinds of food chosen. Found that 85% of families reported having breakfast; most of those reporting no breakfast came from lowest income group. Consumption of cereals, fruits and juices increased with income; consumption…
Longo, Francesca; McPherran Lombardi, Caitlin; Dearing, Eric
Family processes and parenting practices help explain developmental differences between children in low- versus higher-income households. There are, however, few studies addressing the question of: what are the key family processes and parenting practices for promoting low-income children's growth? We address this question in the present study,…
McCurdy, Karen; Gorman, Kathleen S.; Kisler, Tiffani; Metallinos-Katsaras, Metallinos-Katsaras
Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and ...
Fugh-Berman, Adriane; Brown, Steven R; Trippett, Rachel; Bell, Alicia M; Clark, Paige; Fleg, Anthony; Siwek, Jay
To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships. Copyright © by the Association of American medical Colleges.
A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)
Santiago, Catherine DeCarlo; Wadsworth, Martha E.
Family conflict is exacerbated by poverty-related stress and is detrimental to adolescent mental health. Adolescent coping with family conflict has the potential to buffer or exacerbate the negative effects of family conflict on internalizing symptoms. We examined coping with family conflict among 82 low-income adolescents (53.7% female, mean age…
Eubank, Daniel; Geffken, Dominic; Orzano, John; Ricci, Rocco
Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.
Anne C. Lusk
Full Text Available This paper examines if, in a lower-income minority neighborhood, bicycling practices and bicycle-environment preferences of Blacks and Hispanics were different from Whites. During the summer of 2014, surveys were mailed to 1537 households near a proposed cycle track on Malcolm X Boulevard in Roxbury, MA. On the Boulevard, intercept surveys were distributed to cyclists and observations noted about passing cyclist's characteristics. Data were analyzed from 252 returned-mailed surveys, 120 intercept surveys, and 709 bicyclists. White (100%, Hispanic (79%, and Black (76% bicyclists shown pictures of 6 bicycle facility types in intercept surveys perceived the cycle track as safest. More White mailed-survey respondents thought bikes would not be stolen which may explain why more Hispanics (52% and Blacks (47% preferred to park their bikes inside their home compared with Whites (28%, with H/W B/W differences statistically significant (p < 0.05. More Hispanic (81% and Black (54% mailed-survey respondents thought they would bicycle more if they could bicycle with family and friends compared with Whites (40%. Bicyclists observed commuting morning and evening included Blacks (55%, Whites (36% and Hispanics (9%. More Whites (68% wore helmets compared with Hispanics (21% and Blacks (17% (p < 0.001. More Blacks (94% and Hispanics (94% rode a mountain bike compared with Whites (75%. Minority populations are biking on roads but prefer cycle tracks. They also prefer to park bikes inside their homes and bicycle with family and friends. Wide cycle tracks (bicycling with family/friends and home bike parking should be targeted as capital investments in lower-income minority neighborhoods.
Parish, Susan L; Rose, Roderick A; Dababnah, Sarah; Yoo, Joan; Cassiman, Shawn A
Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden. Copyright © 2011 Elsevier Ltd. All rights reserved.
... definitions-family size not known (actual or prospective tenants). 81.18 Section 81.18 Housing and Urban... CORPORATION (FREDDIE MAC) Housing Goals § 81.18 Affordability—Income level definitions—family size not known... moderate-income families where family size is not known to the GSE, income will be adjusted using unit size...
Berman, Ellen M.; Heru, Alison M.; Grunebaum, Henry; Rolland, John; Wood, Beatrice; Bruty, Heidi
Objective: The authors discuss the knowledge, attitudes, and skills needed for a resident to be competent in supporting and working with families, as mandated by the residency review committee (RRC) core competencies. Methods: The RRC core competencies, as they relate to patients and their families, are reviewed. The Group for Advancement of…
Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul
To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.
Aalgaard Kelly, Gina
Objective: The overall purpose of this study was to propose and test a conceptual model and apply family analyses methods to understand quality of life family congruence in the nursing home setting. Method: Secondary data for this study were from a larger study, titled Measurement, Indicators and Improvement of the Quality of Life (QOL) in Nursing Homes . Research literature, family systems theory and human ecological assumptions, fostered the conceptual model empirically testing quality of life family congruence. Results: The study results supported a model examining nursing home residents and two family members on quality of life family congruence. Specifically, family intergenerational dynamic factors, resident personal and social-psychological factors, and nursing home family input factors were examined to identify differences in quality of life family congruence among triad families. Discussion: Formal family involvement and resident cognitive functioning were found as the two most influential factors to quality of life family congruence (QOLFC).
Zachrisson, Henrik Daae; Dearing, Eric
The sociopolitical context of Norway includes low poverty rates and universal access to subsidized and regulated Early Childhood Education and Care (ECEC). In this context, the association between family income dynamics and changes in early child behavior problems was investigated, as well as whether high quality ECEC buffers children from the effects of income dynamics. In a population-based sample (N = 75,296), within-family changes in income-to-needs predicted changes in externalizing and internalizing problems (from age 18 to 36 months), particularly for lower-income children. For internalizing problems, ECEC buffered the effect of income-to-needs changes. These findings lend further support to the potential benefits of ECEC for children from lower-income families. PMID:25345342
Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen
Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
Lim, Younghee; DeJohn, Tara V.; Murray, Drew
As the United States' economy continues to experience challenges, more families at or near the poverty level fall prey to predatory financial practices. Their vulnerability to these operations is increased by a lack of knowledge of asset-building resources and alternative financial services. This article focuses on Volunteer Income Tax Assistance…
Li, Mengying; Riis, Jenna L; Ghazarian, Sharon R; Johnson, Sara B
Self-regulation (SR) is a core aspect of child development with enduring effects on health and wellbeing across the lifespan. Early childhood poverty may shape SR development. This study examined the cross-sectional relationship among family income, family context, and SR in 5-year-old children. A total of 140 five-year-old children and their mothers participated in the study. Children completed a battery of SR tasks; mothers completed questionnaires. Cognitive and emotional SR composite scores were generated based on a principal component analysis of the SR tasks. The SR scores were first regressed on family income (in 10 levels ranging from family context variables were subsequently added to the models. Controlling for age, sex, and race, each level increase in family income was associated with 0.04 SD increase in emotional SR (p = .32) and 0.08 SD increase in cognitive SR (p = .01). In fully adjusted models, exposure to household instability and experiencing 10 or more negative life events was associated with worse emotional SR; exposure to mother's depressive symptoms was associated with worse cognitive SR. Higher income buffered children's SR from some contextual risk factors. Family contextual variables explained 62% of the correlation between higher income and better cognitive SR scores. Income-based cognitive SR disparities were associated with family contextual factors. Screening for family adversity in pediatric care and linking families to needed resources may protect children's developing SR capacities, with benefits to health and well-being.
Galster, G.; Andersson, R.; Musterd, S.
This paper analyses the degree to which the mixture of low-, middle- and high-income males in the neighbourhood affects the subsequent earnings of individuals, and aims to test explicitly the degree to which these impacts vary across gender, age, presence of children, employment status or income at
Reitz, Randall; Sudano, Laura; Siler, Anne; Trimble, Kristopher
Great variety exists in the roles that family medicine residency faculty fill in the lives of their residents. A family medicine-specific model has never been created to describe and promote effective training relationships. This research aims to create a consensus model for faculty development, ethics education, and policy creation. Using a modified grounded theory methods, researchers conducted phone interviews with 22 key informants from US family medicine residencies. Data were analyzed to delineate faculty roles, common role conflicts, and ethical principles for avoiding and managing role conflicts. Key informants were asked to apply their experience and preferences to adapt an existing model to fit with family medicine residency settings. The primary result of this research is the creation of a family medicine-specific model that describes faculty roles and provides insight into how to manage role conflicts with residents. Primary faculty roles include Role Model, Advisor, Teacher, Supervisor, and Evaluator. Secondary faculty roles include Friendly Colleague, Wellness Supporter, and Helping Hand. The secondary roles exist on a continuum from disengaged to enmeshed. When not balanced, the secondary roles can detract from the primary roles. Differences were found between role expectations of physician versus behavioral science faculty and larger/university/urban residencies versus smaller/community/rural residencies. Diversity of opinion exists related to the types of roles that are appropriate for family medicine faculty to maintain with residents. This new model is a first attempt to build consensus in the field and has application to faculty development, ethics education, and policy creation.
Massa, K H C; Pabayo, R; Chiavegatto Filho, A D P
The association between income inequality and health has been analyzed predominantly in developed countries with modest levels of inequality. The study aimed to analyze the association between income inequality and self-reported health (SRH) in the adult population of the 27 Brazilian capitals. Individuals aged 18 years or older from the National Health survey residing in Brazilian capitals in 2013 were analyzed (n = 27 017). Bayesian multilevel models were applied after controlling for individual factors and area-level socioeconomic characteristics. We found a significant association between income inequality and SRH, even after controlling for individual and contextual factors. The results indicate greater odds of poor SRH among those living in areas with medium (OR = 1.31, 95% CI: 1.17-1.47) and high income inequality level (OR = 1.39, 95% CI: 1.24-1.56). Income inequality remained significantly associated with SRH, even after controlling for other contextual socioeconomic characteristics, such as local illiteracy rate, violence and per capita income. The study highlights the importance of the individual and contextual characteristics associated with SRH. Our findings suggest that city-level income inequality can have a detrimental effect on individual health, over and above other contextual socioeconomic characteristics and individual factors. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Frahm, Kathryn; Gammonley, Denise; Zhang, Ning Jackie; Paek, Seung Chun
Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were…
Peterson, Janice; Song, Xue; Jones-DeWeever, Avis
This study used data from the first and last waves of the 1996 U.S. Census Bureau's Survey of Income and Program Participation to compare the characteristics and wellbeing of low-income, single parent families before and after passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), noting the characteristics and…
Silbereisen, Rainer K.; And Others
Results suggest that income loss leads to low family integration, which in turn increases adolescents' sensitivity to evaluation by peers. This can result in decreased self-esteem and an inclination to act against common rules and norms. (PCB)
Full Text Available Background: There is limited understanding of the impact of Triple C competency-based curriculums on the preparation of residents for family practice. This paper describes a competency-based curriculum within an integrated longitudinal block design and presents preliminary evaluation data on the impact of this curriculum on preparedness for family practice. Methods: First and second year family medicine residents were surveyed as a component of a year-end program evaluation to assess the extent to which the residency program is preparing them to engage in a variety of practice domains, the likelihood that they would engage in these domains, and the extent to which this residency program is comprehensive, relevant to their development as a family physician, and promotes interprofessional practice. Results: Residents perceived themselves as prepared to engage in most practice areas and their intentions to engage in various practice domains were positively correlated to their ratings of preparedness. Ratings reflected that residents perceived this program as comprehensive and relevant to their development as a family physician and they perceived a high degree of encouragement for interprofessional practice. Conclusions: This study provides some preliminary evidence that an integrated competency-based curriculum, with an emphasis on interprofessional practice has the potential to effectively prepare residents for practice in family medicine.
Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E
Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.
Mainous, Arch G; Fang, Bo; Peterson, Lars E
The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r = .195 ( P ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.
Agostinelli, Francesco; Sorrenti, Giuseppe
We study the effect of family income and maternal hours worked on child development. Our instrumental variable analysis suggests different results for cognitive and behavioral development. An additional 1,000 USD in family income improves cognitive development by 4.4 percent of a standard deviation but has no effect on behavioral development. A yearly increase of 100 work hours negatively affects both outcomes by approximately 6 percent of a standard deviation. The quality of parental investm...
Clemans-Cope, Lisa; Perry, Cynthia D; Kenney, Genevieve M; Pelletier, Jennifer E; Pantell, Matthew S
The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents' leave taking to care for themselves or others. We used a sample of low-income families (paid leave and characteristics of children, families, and parents' employer. Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without >or=1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents' leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.
Studies real household income after the birth of a baby reporting median child care expenses were zero in first and $6 in fourth quarter; mean expenses in fourth quarter were $210. Fertility rate of women aged 18-44 without high school education who had baby in 1988 was 87, compared to 63 for women with college degree. (LB)
Cawse-Lucas, Jeanne; Evans, David V; Ruiz, David R; Allcut, Elizabeth A; Andrilla, C Holly A; Thompson, Matthew; Norris, Thomas E
The Medicare Primary Care Exception (PCE) allows residents to see and bill for less-complex patients independently in the primary care setting, requiring attending physicians only to see patients for higher-level visits and complete physical exams in order to bill for them as such. Primary care residencies apply the PCE in various ways. We investigated the impact of the PCE on resident coding practices. Family medicine residency directors in a five-state region completed a survey regarding interpretation and application of the PCE, including the number of established patient evaluation and management codes entered by residents and attending faculty at their institution. The percentage of high-level codes was compared between residencies using chi-square tests. We analyzed coding data for 125,016 visits from 337 residents and 172 faculty physicians in 15 of 18 eligible family medicine residencies. Among programs applying the PCE criteria to all patients, residents billed 86.7% low-mid complexity and 13.3% high-complexity visits. In programs that only applied the PCE to Medicare patients, residents billed 74.9% low-mid complexity visits and 25.2% high-complexity visits. Attending physicians coded more high-complexity visits at both types of programs. The estimated revenue loss over the 1,650 RRC-required outpatient visits was $2,558.66 per resident and $57,569.85 per year for the average residency in our sample. Residents at family medicine programs that apply the PCE to all patients bill significantly fewer high-complexity visits. This finding leads to compliance and regulatory concerns and suggests significant revenue loss. Further study is required to determine whether this discrepancy also reflects inaccuracy in coding.
Rait, Douglas; Glick, Ira
Objective: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. Methods: After reviewing recent trends in the field that…
Silk, Hugh; Shields, Sara
Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…
Non-communicable diseases (NCDs) are a major cause of death in Peru, accounting for 60% of deaths in 2010. Unhealthy diet is one of the four major risk factors for NCDs. Researchers will explore ways to promote healthy dietary habits among residents of Lima's poor urban communities who use the city's Comedores ...
The purpose of this study is to investigate the factors in the workplace and in the home which may have effects on cumulative fatigue, and to examine the moderating effect of the quality of family life on the relationship between job related stress and cumulative fatigue. The subject is the sample of working mothers with young children in double income family. Two hypotheses were examined in this study. First, higher level of job related stress and family related stress are both associated ...
Racial disparity in family incomes remained remarkably stable over the past 40 years in the United States despite major legal and social reforms. Previous scholarship presents two primary explanations for persistent inequality through a period of progressive change. One highlights continuity: because socioeconomic status is transmitted from parents to children, disparities created through histories of discrimination and opportunity denial may dissipate slowly. The second highlights change: because family income results from joining individual earnings in family units, changing family compositions can offset individuals’ changing economic chances. I examine whether black-white family income inequality trends are better characterized by the persistence of existing disadvantage (continuity) or shifting forms of disadvantage (change). I combine cross-sectional and panel analysis using Current Population Survey, Panel Study of Income Dynamics, Census, and National Vital Statistics data. Results suggest that African Americans experience relatively extreme intergenerational continuity (low upward mobility) and discontinuity (high downward mobility); both helped maintain racial inequality. Yet, intergenerational discontinuities allow new forms of disadvantage to emerge. On net, racial inequality trends are better characterized by changing forms of disadvantage than by continuity. Economic trends were equalizing but demographic trends were disequalizing; as family structures shifted, family incomes did not fully reflect labor-market gains. PMID:26456973
Young, Richard A; Devoe, Jennifer E
Adjusted for inflation, household income has been relatively flat since the mid-1990s, but the inflation rate of employer-sponsored health insurance has been greater than both household income growth and general inflation for 50 years. We estimated the effect on average family income if health insurance inflation matched the general inflation rate since 1996, and those savings were given to employees as income. We used data from the Medical Expenditure Panel Survey, the Milliman Medical Index, and other federal sources to model the relationship between private health insurance costs and household income over the last 15 years. If the cost of family health care costs had kept pace with the Consumer Price Index (CPI) rate since 1996, the average family income could have been $8,410 higher in 2010 ($68,805 versus $60,395), 13.9% more than actual earnings. If health care costs had not exceeded the CPI rate since 1996 and if all the excess costs were converted into employee wages, median family income could be substantially higher today.
Ashkin, Evan A; Newton, Warren P; Toomey, Brian; Lingley, Ronald; Page, Cristen P
Expanding residency training programs to address shortages in the primary care workforce is challenged by the present graduate medical education (GME) environment. The Medicare funding cap on new GME positions and reductions in the Health Resources and Services Administration (HRSA) Teaching Health Center (THC) GME program require innovative solutions to support primary care residency expansion. Sparse literature exists to assist in predicting the actual cost of incremental expansion of a family medicine residency program without federal or state GME support. In 2011 a collaboration to develop a community health center (CHC) academic medical partnership (CHAMP), was formed and created a THC as a training site for expansion of an existing family medicine residency program. The cost of expansion was a critical factor as no Federal GME funding or HRSA THC GME program support was available. Initial start-up costs were supported by a federal grant and local foundations. Careful financial analysis of the expansion has provided actual costs per resident of the incremental expansion of the residencyRESULTS: The CHAMP created a new THC and expanded the residency from eight to ten residents per year. The cost of expansion was approximately $72,000 per resident per year. The cost of incremental expansion of our residency program in the CHAMP model was more than 50% less than that of the recently reported cost of training in the HRSA THC GME program.
Hughes, Sheryl O; Power, Thomas G; Liu, Yan; Sharp, Carla; Nicklas, Theresa A
Depression and other stressors have been associated with general parenting and child outcomes in low-income families. Given that parents shape child eating behaviors through their feeding interactions with their child, it is important to investigate factors that may influence parental feeding of young children. The aim of this study was to examine how depressive symptoms and parenting stress might influence the nature of parent feeding styles in low-income families. Questionnaires were completed by 290 African-American and Hispanic parents residing in a large urban city in the southwestern United States. Twenty-six percent of the parents reported depressive symptoms above the clinical cutoff. Multivariate logistic regression was used to examine how depressive symptoms and parenting stress might influence the nature of parent feeding styles. After adjusting for potential confounding variables (e.g., ethnicity, education, age), parents with an uninvolved feeding style reported less positive affect and more parenting stress than parents showing the other three feeding styles - authoritative, authoritarian, and indulgent. Because feeding styles tend to be associated with child obesity in low income samples, the results of this study provide important information regarding the parent-child eating dynamic that may promote less optimal child eating behaviors and the development of childhood obesity. This information could be useful for prevention studies aimed at changing parent behaviors that negatively impact the socialization of child eating behaviors. Copyright © 2015 Elsevier Ltd. All rights reserved.
Kozakowski, Stanley M; Travis, Alexandra; Bentley, Ashley; Fetter, Gerald
This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.
Alexander J. Dufford
Full Text Available Family income is associated with gray matter morphometry in children, but little is known about the relationship between family income and white matter structure. In this paper, using Tract-Based Spatial Statistics, a whole brain, voxel-wise approach, we examined the relationship between family income (assessed by income-to-needs ratio and white matter organization in middle childhood (N = 27, M = 8.66 years. Results from a non-parametric, voxel-wise, multiple regression (threshold-free cluster enhancement, p < 0.05 FWE corrected indicated that lower family income was associated with lower white matter organization [assessed by fractional anisotropy (FA] for several clusters in white matter tracts involved in cognitive and emotional functions including fronto-limbic circuitry (uncinate fasciculus and cingulum bundle, association fibers (inferior longitudinal fasciculus, superior longitudinal fasciculus, and corticospinal tracts. Further, we examined the possibility that cumulative risk (CR exposure might function as one of the potential pathways by which family income influences neural outcomes. Using multiple regressions, we found lower FA in portions of these tracts, including those found in the left cingulum bundle and left superior longitudinal fasciculus, was significantly related to greater exposure to CR (β = -0.47, p < 0.05 and β = -0.45, p < 0.05.
Kozakowski, Stanley M; Fetter, Gerald; Bentley, Ashley
This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.
Zakiyah, Neily; van Asselt, Antoinette D. I.; Roijmans, Frank; Postma, Maarten J.
Background A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions
Santiago, Catherine DeCarlo; Wadsworth, Martha E.
This study examined family and cultural influences on adjustment among 90 low-income Latino middle school children (46% girls; average age = 11.38, SD = 0.66) and their primary caregivers (93% female; average age = 36.12, SD = 6.13). All participants identified as Hispanic/Latino, with 75% of families identifying as Mexican-origin Latino, and 77%…
Abrahamson, Kathleen; Jill Suitor, J; Pillemer, Karl
In this study, the authors examine the influence of conflict between nursing home staff and family members of residents on staff burnout. Data were collected from interviews with a representative sample of 655 nursing home nurses and nursing assistants. Hypotheses were tested using structural equation modeling. Results indicate that conflict with family members increases staff burnout and decreases staff satisfaction. Staff and family conflict increases when staff members feel they do not have enough time to complete required tasks. Level of conflict decreases when staff perceive that family members have care expectations that are similar to their own. Interestingly, staff who have personal experience as family caregivers are more likely to report conflict with family members of residents, a result that necessitates further study. Staff burnout and dissatisfaction affects both individuals and organizations. Policy that addresses staff and family interaction can have an important place in the design and delivery of long-term care.
Ledford, Christy J W; Cafferty, Lauren A; Seehusen, Dean A
Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.
Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley
Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home. © 2016 John Wiley & Sons Australia, Ltd.
Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina
To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.
King, Richard V; Murphy-Cullen, Cassie L; Mayo, Helen G; Marcee, Alice K; Schneider, Gregory W
Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.
Full Text Available This research analysed livelihood diversifi cation and income in resident communities along the Kiri Dam, Adamawa state, Nigeria. The specifi c objectives of the study were: to describe the socio-economic characteristics of the respondents, assess the level of livelihood diversifi cation of the respondents, analyse income of the respondents, identify factors associated with varying levels of income, and identify constraints to livelihood diversifi cation in the area. A multistage sampling technique was used to collect primary data from 120 respondents from the study area. The data collected were subjected to descriptive and inferential statistical analysis. The results showed that the majority of the respondents were male (78%, married (76%, educated (70%, below 60 years of age (93% and employed in agricultural activities (83%. The Simpson index of diversifi cation shows that 43% of the respondents diversify at an average level. The majority (60% of the respondents’ annual income is over ₦ 200,000. The ordinary least square estimation shows that age, marital status, education, irrigation activities, fi shing, farm size and level of diversifi cation aff ect income level in the area. The main constraints to diversifi ed livelihood in the area were a lack of basic social infrastructure, a hippopotamus menace and fl ooding. The study recommended the provision of social infrastructure and the control of hippopotamuses.
Kraft, Amy J; Luecken, Linda J
Childhood parental divorce has been linked with negative physical and psychological health in adulthood, potentially due to alterations in adrenocortical activity resulting from chronic stress. The current study evaluated cortisol in 94 young adults (mean age 19.9) from families characterized by parental divorce (n=43) or intact parental marriages (n=51). Salivary cortisol was assessed prior to and at 3 time points after a challenging speech task. Participants from divorced families had significantly lower cortisol across the experimental period than those from intact families, even after controlling for family conflict and current depression and anxiety. Lower family income was also associated with lower cortisol, and partially mediated the relationship between parental divorce and cortisol. Findings suggest that childhood parental divorce is associated with attenuated cortisol in young adulthood, which may be explained by lower income in divorced families.
Bernabé, E; Delgado-Angulo, E K; Murasko, J E; Marcenes, W
This study explored whether the association of family income with tooth decay changes with age among children in the United States. A second objective was to explore the role of access to dental health care services in explaining the interrelationships between family income, child age and tooth decay. Data from 7,491 2- to 15-year-old children who participated in the 1999-2004 National and Health and Nutrition Examination Survey were analyzed. The association of family income with the prevalence of tooth decay in primary, permanent and primary or permanent teeth was first estimated in logistic regression models with all children, and then, separately in four age groups that reflect the development of the dentition (2-5, 6-8, 9-11 and 12-15 years, respectively). Findings showed that the income gradient in tooth decay attenuated significantly in 9- to 11-year-olds only to re-emerge in 12- to 15-year-olds. The age profile of the income gradient in tooth decay was not accounted for by a diverse set of family and child characteristics. This is the first study providing some evidence for age variations in the income gradient in tooth decay among children in the United States. Copyright © 2012 S. Karger AG, Basel.
Bramsved, Rebecka; Regber, Susann; Novak, Daniel; Mehlig, Kirsten; Lissner, Lauren; Mårild, Staffan
This study investigated the effects of two parental socio-economic characteristics, education and income, on growth and risk of obesity in children from birth to 8 years of age. Longitudinal growth data and national register-based information on socio-economic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height was compared in groups dichotomised by parental education and income. Low parental education was associated with a higher BMI from 4 years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birthweight, but did not independently predict BMI development. At 8 years of age, children from less educated families had a three times higher risk of obesity, independent of parental income. Children whose parents had fewer years of education but high income had significantly higher height than all other children. Parental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Jacobs, Mary M.
In this article, I draw on data from my qualitative dissertation study of the literacy practices of five families who resided in a homeless shelter to complicate the relationship between literacy, education, and inequality. Homelessness is examined through the lens of sponsorship to understand the differential access the families have to powerful…
Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.
Shelton, Rachel C; Puleo, Elaine; Bennett, Gary G; McNeill, Lorna H; Sorensen, Glorian; Emmons, Karen M
Research on the association between self-reported racial or gender discrimination and body mass index (BMI) has been limited and inconclusive to date, particularly among lower-income populations. The aim of the current study was to examine the association between self-reported racial and gender discrimination and BMI among a sample of adult residents living in 12 urban lower-income housing sites in Boston, Masschusetts (USA). Baseline survey data were collected among 1,307 (weighted N = 1907) study participants. For analyses, linear regression models with a cluster design were conducted using SUDAAN and SAS statistical software. Our sample was predominately Black (weighted n = 956) and Hispanic (weighted n = 857), and female (weighted n = 1420), with a mean age of 49.3 (SE: .40) and mean BMI of 30.2 kg m(-2) (SE: .19). Nearly 47% of participants reported ever experiencing racial discrimination, and 24.8% reported ever experiencing gender discrimination. In bivariate and multivariable linear regression models, no main effect association was found between either racial or gender discrimination and BMI. While our findings suggest that self-reported discrimination is not a key determinant of BMI among lower-income housing residents, these results should be considered in light of study limitations. Future researchers may want to investigate this association among other relevant samples, and other social contextual and cultural factors should be explored to understand how they contribute to disparities.
Connolly Amy B
Full Text Available Abstract Background Mindfulness-based stress reduction (MBSR programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. Methods We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes. Results and discussion Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. Conclusion A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health.
Pellerin, M.A.; Elwyn, G.; Rousseau, M.; Stacey, D.; Robitaille, H.; Legare, F.
PURPOSE: Do residents in family medicine practice share decision making with patients during consultations? This study used a validated scale to score family medicine residents' shared decision-making (SDM) skills in primary care consultations and to determine whether residents' demographic
Khanam, Rasheda; Nghiem, Son
This article investigates whether family income affects children's cognitive and noncognitive development by exploiting comprehensive information from the Longitudinal Study of Australian Children. We include variables that represent parental investment, parental stress, and neighborhood characteristics to examine if these factors mediate the effects of income. Using dynamic panel data, we find that family income is significantly associated with children's cognitive skills but not with noncognitive skills. Mother's education, parent's physical and mental health, parenting styles, child's own health, and presence of both biological parents are the most important factors for children's noncognitive development. For cognitive development, income as well as parents' education, child's birth weight, and number of books that children have at home are highly significant factors. We also find strong evidence to support the skill formation theory that children's previous cognitive and noncognitive outcomes are significantly related to their current outcomes.
Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development
Sy, Alice; Wong, Eric; Boisvert, Leslie
To determine family medicine residents' learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. London, Ont. All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians' teaching sessions (20%),and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents' homes (32%),and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents' various learning preferences and habits while providing guidance and training in the use of more effective learning methods and
Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S
Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.
Claro, Rafael Moreira; Levy, Renata Bertazzi; Bandoni, Daniel Henrique
This study describes and evaluates the influence of income on the percentage of food expenditures away from home for Brazilian families. Food acquisition data from the National Household Budget Survey conducted from 2002 to 2003 (POF 2002/2003) by the Brazilian Institute of Geography and Statistics (IBGE) or National Census Bureau was used in the analysis. Information on food-and-drink expenditures away from home was analyzed. The influence of income on the share of food purchased away from home in the household budget, adjusted for socio-demographic variables, was analyzed through elasticity coefficients estimated in multiple linear regression. Food purchased away from home accounted for 21% of total food expenditures by Brazilian households. A 10% increase in income increased the share of food purchased away from home by 3%. Income elasticity was high, especially for the lowest income families. The results demonstrate an important influence of income on food expenditures away from home, and higher income is associated with a greater share of food purchased away from home.
Caicedo, Beatriz; Berbesi Fernández, Dedsy
To evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents. The study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals=level1, locations=level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex. The prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality. In Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.
Full Text Available Background: Although the protective effects of socioeconomic status (SES on obesity and cardiovascular disease are well established, these effects may differ across racial and ethnic groups. Aims: Using a national sample, this study investigated racial variation in the association between family income and childhood obesity in White and Black families. Methods: This cross-sectional study used data from the National Survey of Children’s Health (NSCH, 2003–2004, a nationally representative survey in the United States. This analysis included 76,705 children 2–17 years old who were either White (n = 67,610, 88.14% or Black (n = 9095, 11.86%. Family income to needs ratio was the independent variable. Childhood obesity was the outcome. Race was the focal moderator. Logistic regression was used for data analysis. Results: Overall, higher income to needs ratio was protective against childhood obesity. Race, however, interacted with income to needs ratio on odds of childhood obesity, indicating smaller effects for Black compared to White families. Race stratified logistic regressions showed an association between family income and childhood obesity for White but not Black families. Conclusions: The protective effect of income against childhood obesity is smaller for Blacks than Whites. Merely equalizing population access to SES and economic resources would not be sufficient for elimination of racial disparities in obesity and related cardiovascular disease in the United States. Policies should go beyond access to SES and address structural barriers in the lives of Blacks which result in a diminished health return of very same SES resources for them. As the likely causes are multi-level barriers, multi-level interventions are needed to eliminate racial disparities in childhood obesity.
Tamers, Sara L.; Allen, Jennifer; Yang, May; Stoddard, Anne; Harley, Amy; Sorensen, Glorian
Objective: To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population. Method: A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were…
Margolis, S; Reed, R
Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.
the contributions to the combined marginal rate, the marginal effective tax rate, METR, using the OECD term, from taxation, payment for childcare, tapering of housing benefits and sometimes child benefits, when the income varies from a low level to a high level for a single parent family. Six countries are included......High marginal tax rates constitute an issue in several countries because they are supposed to create barriers for increased labour supply. It is, however, often the case that relatively low income families with children face substantially higher combined marginal rates than even the highest...
The Zien Mechanical site is a single family residence located in Milwaukee, Wisconsin. The home has two separate solar energy systems: an air system for space heating and cooling; a liquid system to preheat the potable hot water. The space heating and cooling system design and operation modes are described. The space heating system is designed to apply approximately 44 percent of the space heating requirements for the 1388 square foot residence. Engineering drawings are provided and the performance evaluation instrumentation is described.
Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations. We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure. The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0-0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11-0.17, depending on the school grade and type of family residency. The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level. © 2015 the Nordic Societies of Public Health.
Galbraith, Alison A; Wong, Sabrina T; Kim, Sue E; Newacheck, Paul W
To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families. The Household Component of the 2001 Medical Expenditure Panel Survey. Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members. We aggregated annual OOP expenditures for all members of 4,531 families with a child members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods. A regressive gradient was noted for financial burden across income groups, with families with incomes Poverty Level (FPL) spending a mean of 119.66 US dollars OOP per 1,000 US dollars of family income and families with incomes 100-199 percent FPL spending 66.30 US dollars OOP per 1,000 US dollars, compared with 37.75 US dollars for families with incomes >400 percent FPL. For low-income families (families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage.
Veronnie Faye Jones
Full Text Available Background: Childhood obesity is a growing problem for children in the United States, especially for children from low-income, African American families. Objective: The purpose of this qualitative study was to understand facilitators and barriers to engaging in healthy lifestyles faced by low-income African American children and their families. Methods: This qualitative study used semi-structured focus group interviews with eight African American children clinically identified as overweight or obese (BMI > 85 and their parents. An expert panel provided insights in developing culturally appropriate intervention strategies. Results: Child and parent focus group analysis revealed eleven barriers and no definitive facilitators for healthy eating and lifestyles. Parents reported confusion regarding what constitutes nutritional eating, varying needs of family members in terms of issues with weight, and difficulty in engaging the family in appropriate and safe physical activities; to name a few themes. Community experts independently suggested that nutritional information is confusing and, often, contradictory. Additionally, they recommended simple messaging and practical interventions such as helping with shopping lists, meal planning, and identifying simple and inexpensive physical activities.Conclusions: Childhood obesity in the context of low-resource families is a complex problem with no simple solutions. Culturally sensitive and family-informed interventions are needed to support low-income African American families in dealing with childhood obesity.
Jones, Veronnie Faye; Rowland, Michael L; Young, Linda; Atwood, Katherine; Thompson, Kirsten; Sterrett, Emma; Honaker, Sarah Morsbach; Williams, Joel E; Johnson, Knowlton; Davis, Deborah Winders
Childhood obesity is a growing problem for children in the United States, especially for children from low-income, African American families. The purpose of this qualitative study was to understand facilitators and barriers to engaging in healthy lifestyles faced by low-income African American children and their families. This qualitative study used semi-structured focus group interviews with eight African American children clinically identified as overweight or obese (BMI ≥ 85) and their parents. An expert panel provided insights in developing culturally appropriate intervention strategies. Child and parent focus group analysis revealed 11 barriers and no definitive facilitators for healthy eating and lifestyles. Parents reported confusion regarding what constitutes nutritional eating, varying needs of family members in terms of issues with weight, and difficulty in engaging the family in appropriate and safe physical activities; to name a few themes. Community experts independently suggested that nutritional information is confusing and, often, contradictory. Additionally, they recommended simple messaging and practical interventions such as helping with shopping lists, meal planning, and identifying simple and inexpensive physical activities. Childhood obesity in the context of low-resource families is a complex problem with no simple solutions. Culturally sensitive and family informed interventions are needed to support low-income African American families in dealing with childhood obesity.
Falcone, John L; Middleton, Donald B
The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.
Maia, Alexandre Gori; Sakamoto, Camila Strobl
This study analysed the impact of changing family structure on income distribution. Specifically, it analysed how changes in the proportions of different categories of family in the population contributed to increases in the income of the richest and poorest social strata in Brazil, and the consequent impacts on income inequality. Rural and urban families were compared in order to understand how these dynamics had different impacts on more developed (urban) and less developed (rural) areas. The results emphasize how changes observed in family structure are more pronounced among the richest families, contributing to an increase in (i) the income of the richest families and (ii) income inequality between the richest and poorest families, as well as between urban and rural areas.
Sigmon, J Lewis; McPherson, Vanessa; Little, John M
In light of the ongoing consideration for extending the length of residency education in family medicine in the United States, this paper reports the findings from a retrospective, qualitative study of six family physicians that elected to extend their residency training from 3 to 4 years. Each participant completed a written questionnaire and a structured personal interview focusing on various aspects of career development resulting from the additional year of training. The authors independently evaluated these interviews to identify major themes. All the participants were found to have been involved in teaching medicine, valued a more flexible and expanded curriculum, and appreciated their individualized curricula-based on their respective career interests. Given the opportunity, each would opt again for a fourth year of training. There were mixed opinions as to whether the fourth year should be required of all family medicine residents. Other perceived benefits reported were: a better opportunity to find a personally satisfactory practice, additional time for gaining clarity about career plans, and a higher beginning salary as a result of the additional skills and experiences gained. This study of mid-career physicians supports that a fourth-year (PGY4) curriculum in family medicine may enhance subsequent career satisfaction. Further studies of residents in other PGY4 training programs are necessary to assess outcomes comparing our findings as well as guide the discipline's leaders in residency redesign.
Nåden, Dagfinn; Høy, Bente; Lohne, Vibeke
or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether......, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: 'A feeling of being abandoned'. The sub-themes are designated as follows: deprived of the feeling of belonging...
Levin, Kate; Torsheim, Torbjørn; Vollebergh, Wilma
Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequ...
Levin, Kate Ann; Torsheim, Torbjorn; Vollebergh, Wilma; Richter, Matthias; Davies, Carolyn A.; Schnohr, Christina W.; Due, Pernille; Currie, Candace
Adolescence is a critical period where many patterns of health and health behaviour are formed. The objective of this study was to investigate cross-national variation in the relationship between family affluence and adolescent life satisfaction, and the impact of national income and income inequality on this relationship. Data from the 2006…
Dahl, Gordon; Lochner, Lance
Past estimates of the effect of family income on child development have often been plagued by endogeneity and measurement error. In this paper, we use two simulated instrumental variables strategies to estimate the causal effect of income on children's math and reading achievement. Our identification derives from the large, non-linear changes…
Reid, Megan; Golub, Andrew; Vazan, Peter
This article examines the division of domestic labor in low-income cohabiting Black stepfamilies. We analyze survey data collected from 136 such families in order to understand how stepparent gender and relationship length impact the distribution of domestic labor. We hypothesize that women do more domestic work than men across all three family types, and that stepfathers are more involved in domestic labor in established relationships compared to new relationships. Findings indicate that coh...
Liu Yan; Nicklas Theresa A; Fisher Jennifer O; Hughes Sheryl O; Hoerr Sharon L; Shewchuk Richard M
Abstract Background Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head S...
Susman-Stillman, Amy; Englund, Michelle M.; Storm, Karen J.; Bailey, Ann E.
Preschool attendance problems negatively impact children's school readiness skills and future school attendance. Parents are critical to preschoolers' attendance. This study explored parental barriers and solutions to preschool attendance in low-income families. School-district administrative data from a racially/ethnically diverse sample of…
Lachman, Jamie M.; Kelly, Jane; Cluver, Lucie; Ward, Catherine L.; Hutchings, Judy; Gardner, Frances
Objective: This mixed-methods process evaluation examined the feasibility of a parenting program delivered by community facilitators to reduce the risk of child maltreatment in low-income families with children aged 3-8 years in Cape Town, South Africa (N = 68). Method: Quantitative measures included attendance registers, fidelity checklists,…
Bono, Katherine E.; Sy, Susan R.; Kopp, Claire B.
This study focuses on the associations between family variables and academic and social school readiness in low-income Black children. Analyses drew from the National Institute for Child Development (NICHD) Study of Early Child Care and Youth Development dataset. The participants included 122 children and their mothers. Data collection occurred…
Rising costs are putting an education at California's public universities out of reach for many Californians. Eroding state funding for higher education has meant that more costs are passed on to students and their families in the form of increased fees. Room and board and other costs have grown much faster than inflation. Incomes have not kept…
O'Sullivan, Robyn Hackford; Chen, Yung-Chi; Fish, Marian C.
This study explores the relationships between methods of parental assistance (i.e., provision of structure, direct assistance, and autonomy support) with mathematics homework for high-achieving and low-achieving students and children's achievement in mathematics in low-income families and examines the impact of parental efficacy on these…
... VOUCHER PROGRAM Rent and Housing Assistance Payment § 982.516 Family income and composition: Regular and... assistance payment. (For a voucher tenancy, the housing assistance payment shall be calculated in accordance... the housing assistance payment resulting from an interim redetermination. (2) At the effective date of...
Osman, Habab; Alahmadi, Maryam; Bakhiet, Salaheldin; Lynn, Richard
Data are reported showing statistically significant negative correlations between intelligence and family size, position, and income in a sample of 604 adolescent girls in Saudi Arabia. There were no statistically significant correlations or associations between whether the mother or father were deceased or both parents were alive, and whether the parents were living together or were divorced. © The Author(s) 2016.
Aber, Lawrence; Chaudry, Ajay
Children and youth vary in their developmental health due to differences in family economic security and exposure to toxic stress. The economic downturn has increased the challenges facing low-income children. The American Recovery and Reinvestment Act of 2009 (ARRA) and the President's first budget made significant down-payments on investments in…
Bier, Melinda; Gallo, Michael; Nucklos, Eddy; Sherblom, Stephen; Pennick, Michael
Describes a United States Department of Commerce (National Telecommunications and Information Administrations, NTIA, 1995) study of home Internet use by Low-income families. The study investigated the barriers, benefits (empowerment), and perceived worth of the Internet and concluded that home Internet access enabled powerful emotional and…
Drajea, Alice J.; O'Sullivan, Carmel
This article investigates the effect of parents' literacy levels and family income in Uganda on the quality and nature of parents' involvement in their children's primary education. A mixed-methods study with an ethnographic element was employed to explore the views and opinions of 21 participants through a qualitative approach. Methods for data…
A PROPOSAL FOR AN ENRICHMENT PROGRAM FOR ACADEMICALLY TALENTED JUNIOR HIGH SCHOOL STUDENTS FROM LOW-INCOME FAMILIES IN CERTAIN AREAS OF BOSTON IS PRESENTED. BASIC ASSUMPTIONS ARE THAT THERE IS AND OBVIOUS AND PRESSING NEED TO GIVE EXTRA HELP TO THE ABLE STUDENT FROM A DISADVANTAGED BACKGROUND, AND THAT A RELATIVELY BRIEF ENRICHMENT EXPERIENCE FOR…
L. Mourao (Luciana); A. Macedo de Jesus (Anderson)
markdownabstract__Abstract__ Income transfer programmes are common in various countries and play an important role in combating poverty. This article presents a review of the results of the Bolsa Família (Family Grant) Programme, implemented in Brazil by the government of Lula da Silva in
Pan, Barbara Alexander; Rowe, Meredith L.; Singer, Judith D.; Snow, Catherine E.
This study investigated predictors of growth in toddlers' vocabulary production between the ages of 1 and 3 years by analyzing mother-child communication in 108 low-income families. Individual growth modeling was used to describe patterns of growth in children's observed vocabulary production and predictors of initial status and between-person…
Zachrisson, Henrik D.; Dearing, Eric
The sociopolitical context of Norway includes low poverty rates and universal access to subsidized and regulated Early Childhood Education and Care (ECEC). In this context, the association between family income dynamics and changes in early child behavior problems was investigated, as well as whether high-quality ECEC buffers children from the…
Snow, Patrick; McNally, Mary E
Dental disease is concentrated among those with low socioeconomic status. Dental care is not publicly funded, and many Canadians must therefore make difficult financial choices when accessing dental care. Families who live in poverty have difficulty meeting even their most basic household needs, so dental treatment may not be affordable. The objective of this study was to understand how the cost of dental treatment affects the monthly budgets of families with low incomes. A chart review was conducted for a sample of 213 new patients examined at the Dalhousie University dental clinic over a 1-year period. Costs for proposed treatment plans were averaged. The patients" ability to pay for proposed treatment was examined in the context of various income scenarios. Two hundred and one patients were included in the final analysis. Dental treatment costs per patient averaged approximately $1600 for the year, with 42% of the planned treatment completed within the first year. The estimated monthly cost of completed treatment was $55. When the cost of a healthy diet was included in the monthly budget, it was determined that families in Nova Scotia with parents working for minimum wage and those receiving income assistance would experience a 100% shortfall for dental expenses. Low-income families in Nova Scotia were unable to afford both a nutritious diet and dental care. This is disturbing, given the links between a healthy diet and both overall health and dental health. An understanding of the significance of income shortfalls for those with low incomes, especially as they affect even basic nutritional needs, will help dental professionals to appreciate the seriousness of this issue and the difficulties that many Canadians face when trying to access basic dental care.
Full Text Available Abstract Background Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents. Methods Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis; access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10 were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior. Results Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the
Quandt, Sara A; Arcury, Thomas A; Rao, Pamela; Snively, Beverly M; Camann, David E; Doran, Alicia M; Yau, Alice Y; Hoppin, Jane A; Jackson, David S
Children of farmworkers can be exposed to pesticides through multiple pathways, including agricultural take-home and drift as well as residential applications. Because farmworker families often live in poor-quality housing, the exposure from residential pesticide use may be substantial. We measured eight locally reported agricultural pesticides and 13 pesticides commonly found in U.S. houses in residences of 41 farmworker families with at least one child < 7 years of age in western North Caro...
Runyan, Christine; Savageau, Judith A; Potts, Stacy; Weinreb, Linda
Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Full Text Available Background: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results: Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions: This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Shippee, Tetyana P.; Henning-Smith, Carrie; Gaugler, Joseph E.; Held, Robert; Kane, Robert L.
This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews (n = 16,790 family members), (2) multidimensional survey of resident QOL (n = 13,433 residents), and (3) facility characteristics (n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: “care,” “staff,” “environment,” and “food.” Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics. PMID:26534835
Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.
Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…
Silk, Hugh; Savageau, Judith A; Sullivan, Kate; Sawosik, Gail; Wang, Min
National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates' level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.
Murray, Vicki E.
In 2009, the "East Valley Tribune and the Arizona Republic" alleged that Arizona's individual income tax-credit scholarship program disproportionately serves privileged students from higher-income families over those from lower-income backgrounds. Yet neither paper collected the student-level, scholarship recipient family income data…
Schmeiser, Maximilian D
The rising rate of obesity has reached epidemic proportions and is now one of the most serious public health challenges facing the US. However, the underlying causes for this increase are unclear. This paper examines the effect of family income changes on body mass index (BMI) and obesity using data from the National Longitudinal Survey of Youth 1979 cohort. It does so by using exogenous variation in family income in a sample of low-income women and men. This exogenous variation is obtained from the correlation of their family income with the generosity of state and federal Earned Income Tax Credit (EITC) program benefits. Income is found to significantly raise the BMI and probability of being obese for women with EITC-eligible earnings, and have no appreciable effect for men with EITC-eligible earnings. The results imply that the increase in real family income from 1990 to 2002 explains between 10 and 21% of the increase in sample women's BMI and between 23 and 29% of their increased obesity prevalence. (c) 2009 John Wiley & Sons, Ltd.
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Dixon-Roman, Ezekiel J.; Everson, Howard T.; McArdle, John J.
Background: Educational policy makers and test critics often assert that standardized test scores are strongly influenced by factors beyond individual differences in academic achievement such as family income and wealth. Unfortunately, few empirical studies consider the simultaneous and related influences of family income, parental education, and…
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Claro, Rafael Moreira; Monteiro, Carlos Augusto
To analyze the influence of family income and food prices on the participation of fruits and vegetables in the food purchases of Brazilian households. Data analyzed refers to the Household Budget Survey conducted by the Instituto Brasileiro de Geografia e Estatística on a probabilistic sample of 48,470 Brazilian households between 2002 and 2003. Fruit and vegetable participation in total food purchases was expressed as a percentage of total calories purchased and as calories from fruit and vegetables adjusted for total calories purchased. A multiple regression analysis was employed to estimate elasticity coefficients, controlling for sociodemographic variables and price of other foods. Fruit and vegetable participation in total food purchases increased as the price of these foods decreased, or as income increased. A 1% decrease in the price of fruit and vegetables would increase their participation by 0.79%, whereas a 1% increase in family income would increase participation by 0.27%. The effect of income tended to be smaller among higher income strata. Reducing the price of fruit and vegetables, either by supporting their production or through fiscal measures, is a promising public policy instrument, capable of increasing the participation of these foods in the diet of the Brazilian population.
Milan, Stephanie; Wortel, Sanne
Adolescents' beliefs about family obligation often reflect cultural variations in their family context, and thus are important for understanding development among diverse youth. In this study, we test hypotheses about the role of family obligation values in risk behavior and mental health in a sample of 194 low-income adolescent girls (mean age = 15.2; 58% Latina, 28% African-American/Black). We hypothesized that family obligation values can be both a protective and vulnerability factor, depending on the type of outcome and the presence of other risk factors. Across the sample, higher family obligation values tended to occur with indicators of positive family functioning (e.g., more frequent communication, less maternal hostility) based on mother and adolescent reports. As hypothesized, family obligation values moderated the relationship between established risk factors and adjustment in distinct ways, such that high family obligation values decreased risk in some domains (i.e., a protective factor) but increased risk in other domains (i.e., a vulnerability factor). Specifically, high family obligation values diminished the relationship between peer norms for risky behavior (sex and substance use) and individual engagement in those behaviors. At the same time, high family obligation values magnified the relationship between exposure to negative life events and poor mental health (PTSD and depressive symptoms). The results suggest that family obligation is an important but complex aspect of development among diverse adolescent girls.
Milan, Stephanie; Wortel, Sanne
Adolescents’ beliefs about family obligation often reflect cultural variations in their family context, and thus are important for understanding development among diverse youth. In this study, we test hypotheses about the role of family obligation values in risk behavior and mental health in a sample of 194 low-income adolescent girls (Mean age = 15.2; 58% Latina, 28% African-American/Black). We hypothesized that family obligation values can be both a protective and vulnerability factor, depending on the type of outcome and the presence of other risk factors. Across the sample, higher family obligation values tended to occur with indicators of positive family functioning (e.g., more frequent communication, less maternal hostility) based on mother and adolescent reports. As hypothesized, family obligation values moderated the relationship between established risk factors and adjustment in distinct ways, such that high family obligation values decreased risk in some domains (i.e., a protective factor) but increased risk in other domains (i.e., a vulnerability factor). Specifically, high family obligation values diminished the relationship between peer norms for risky behavior (sex and substance use) and individual engagement in those behaviors. At the same time, high family obligation values magnified the relationship between exposure to negative life events and poor mental health (PTSD and depressive symptoms). The results suggest that family obligation is an important but complex aspect of development among diverse adolescent girls. PMID:25351163
Full Text Available This study shows that family poultry husbandry, business activities and paid employment contribute 35%, 30% and 18% respectively to the household income of women in Niger Delta, Nigeria. The average income from family poultry is N16, 784.53 ($124.33, which is about 25% and 50% of national minimum wage and per capita income in Nigeria respectively. The major constraints to the family poultry in the study area are disease and pest, pilfering and lack of capital. The econometric analysis indicates that wage, business and family poultry income are significant determinants of income of women in the study area. The estimated regression coefficients are, 0.35, 0.32 and 0.19 for wage, business and family poultry income respectively. This suggests that if wage income, business income and family poultry income increase by 100%, total income of the women will increase by 35%, 32% and 19% respectively. This indicates that family poultry husbandry has third rating in potentially influencing women income in the study area. It is recommended from the study that the contribution of family poultry to total income of the women can be improved through proper medication and vaccination of their birds with vaccines that are stable under tropical environment. It is also imperative that semi intensive, if not intensive, rearing technology should be considered as a reasonable option if the problem of pilfering is to be addressed. Improving the capital base of the women through formation of cooperating and micro-credit schemes should also be a welcome development in addressing the problem of lack of capital.
McCurdy, Karen; Gorman, Kathleen S; Kisler, Tiffani; Metallinos-Katsaras, Elizabeth
Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and depression while trained assistants collected anthropometric data from children at seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Multivariate analysis of covariance revealed that higher maternal depression scores were associated with lower scores on maternal presence when child eats (P maternal control of child's eating routines (P maternal presence whenever the child ate was significantly associated with lower child BMI z scores (β = .166, P Maternal depression did not modify the relationship between family food behaviors and child weight. Overall, caregiver presence whenever a child eats, not just at meals, and better parental food resource management skills may promote healthier weights in low-income preschoolers. Further research is needed to identify the mechanisms that connect caregiver presence and food resource management skills to healthier weights for this age group. Copyright © 2014 Elsevier Ltd. All rights reserved.
Marcella, Jennifer; Howes, Carollee; Fuligni, Allison Sidle
Research Findings: The home literacy environment and other early learning settings such as preschool play a role in children's language and literacy outcomes, yet research suggests that Latino, Spanish-speaking families are less likely than other families to participate in family literacy activities. This study explored the relations among…
The family stress model proposes that financial stress experienced by parents is associated with problem behavior in adolescents. The present study applied an actor-partner interdependence approach to the family stress model and focused on low-, middle-, and high-income families to broaden our understanding of the pathways by which the financial stress of mothers and fathers are related to adolescent outcomes. The study uses dyadic data (N = 798 heterosexual couples) from the Relationship between Mothers, Fathers and Children study in which two-parent families with an adolescent between 11 and 17 years of age participated. Path-analytic results indicated that in each of the families the association between parents' financial stress and problem behavior in adolescents is mediated through parents' depressive symptoms, interparental conflict, and positive parenting. Family stress processes also appear to operate in different ways for low-, middle-, and high-income families. In addition to a higher absolute level of financial stress in low-income families, financial stress experienced by mothers and fathers in these families had significant direct and indirect effects on problem behavior in adolescents, while in middle- and high-income families only significant indirect effects were found. The financial stress of a low-income mother also had a more detrimental impact on her level of depressive feelings than it had on mothers in middle-income families. Furthermore, the study revealed gender differences in the pathways of mothers and fathers. Implications for research, clinical practice, and policy are also discussed.
Jarrett, Robin L.; Coba-Rodriguez, Sarai
Researchers have examined the impact of family on child literacy among low-income African American families and preschoolers considered to be at risk for not being ready for kindergarten. Quantitative studies identify family-parental variables associated with poorer literacy outcomes, whereas qualitative studies detail family practices that…
Full Text Available The conzequence low income of the farmer household in agricultural sector is the increase in their activities as miner of sand and stone. It means for increasing of their household income. However, how important mining role on the increasing of household income has to be studied in deeply. The factual problem is the base for research aims, with the spesific stress on studying socio-economic characteristic of sand and stone miner, and the contribution of the mining income to household income. This research was carried out in Progo catchment area, Yogyakarta Special Region. Survey method was employed by data collecting from respondents. The respondents are head of households (HH working as sand and stone miner. Sampling technique was proportionally simple random sampling in which 120 HH was taken as respondents sample. They were representatives of upper part, middle part, and lower part of Progo catchments area. Data on socio-economic structure of the household and household income were collected by mean of structured interview. Data analysis was performed through descriptive technique in which frequencies and cross tabulation varians statistic, and multiple regression analysis were mostly used. The research shows that there are relatively similarities on socio-economic characteristic of sand and stone miners, between at lower part, middle part with upper part of Progo catchments area. This existing of sand and stone mining employs about 70% labours are local miners and 30% labours came from out of the area. Landless farmers who land own less than 500 m2 characterize them. The most of them are male, withlow formal education, and as small family (4 people evey HH. Some of them have been as sand and stone miners for more than 4 years. Generally, they work less than 8 hours for mining every day. This research is also finding that the income of the sand and stone miners are seasonal. The averages of mining income on dry season (Rp 571,880 per month
Hamann, Darla J
This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.
Tompkins, Catherine J; Ihara, Emily S; Cusick, Alison; Park, Nan Sook
Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.
Sagasser, Margaretha H; Fluit, Cornelia R M G; van Weel, Chris; van der Vleuten, Cees P M; Kramer, Anneke W M
Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.
Kohan, Shahnaz; Talebian, Ferdos; Ehsanpour, Soheila
Background: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. Materials and Methods: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. Results: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method (P = 0.01) and the length of usage of their present contraception method (P = 0.04) as well as where they received family planning services (P = 0.02). Conclusions: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples’ family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration. PMID:25400671
Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren
The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must
Caspi, Caitlin E.; Kawachi, Ichiro; Subramanian, S.V.; Adamkiewicz, Gary; Sorensen, Glorian
In the U.S., supermarkets serve as an important source of year-round produce (Chung & Myers, 1999), and yet access to supermarkets may be scarce in “food deserts,” or poor, urban areas that lack sources of healthy, affordable food (Cummins & Macintyre, 2002). This study examined objective distance to the nearest supermarket and participant-report of supermarket access in relation to fruit and vegetable intake. Street-network distance to the closest supermarket was calculated using GIS mapping. Perceived access was assessed by a survey question asking whether participants had a supermarket within walking distance of home. Cross-sectional survey data were collected from 828 low-income housing residents in three urban areas in greater-Boston. Generalized estimating equations were used to estimate the association between perceived and objective supermarket access and diet. Fruit and vegetable consumption was low (2.63 servings/day). Results suggest that most low-income housing residents in greater-Boston do not live in “food deserts,” as the average distance to a supermarket was 0.76 km (range 0.13–1.22 km). Distance to a supermarket was not associated with fruit and vegetable intake (p = 0.22). Perceived supermarket access was strongly associated with increased fruit and vegetable intake (0.5 servings/day) after controlling for socio-demographic covariates (p supermarket within walking distance from home despite the objective presence of a supermarket within 1 km consumed significantly fewer fruits and vegetables (0.56 servings/day) than those with a supermarket who reported one, even after controlling for socio-demographic variables (p = 0.0008). Perceived measures of the food environment may be more strongly related to dietary behaviors than objective ones, and may incorporate components of food access not captured in objective measures. PMID:22727742
Roley, Michelle E; Kawakami, Ryoko; Baker, Jessica; Hurtado, Gabriela; Chin, Andrew; Hovey, Joseph D
Acculturative stress is a risk factor for depression, and may be important in the risk for depression among acculturating Japanese adolescents. However, little to no research has been published on the mental health of acculturating Japanese adolescents. Further, although family cohesion has been shown to be protective against depression across ethnic groups, no prior research has examined family cohesion as a protective factor for Japanese adolescents. To examine these relationships, 26 Japanese temporary resident adolescents and 76 parents in the Midwest were recruited to participate. Moderate to strong correlations between acculturative stress, depression, likelihood for and seriousness of family conflict were found. A regression analysis found that likelihood for family conflict moderated the relationship between acculturative stress and depression. Findings broaden our understanding of the role of acculturative stress and family conflict on depression risk for Japanese adolescent immigrants.
Heisler, Jean; Huber, Thomas; Huntington, Mark K
The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development. Copyright© South Dakota State Medical Association.
Tañón, Vilmarie; Borrero, Clarimar; Pedrogo, Yasmín
Previous research has indicated that, despite being the most trusted source of health information, medical students, residents and other health related professionals lack accurate and current knowledge regarding immunization practices. To evaluate medical students and primary care resident knowledge about immunizations. Self-administered survey given to students from four medical schools, Pediatrics residents (2 training programs) and Family Medicine residents (2 programs). Data was analyzed using Statistix 8.0. One-way ANOVA test was used to compare means, and a p-value less than 0.05 was considered statistically significant. Participants (N=376) included 3rd (64%) and 4th (18%) year medical students and a homogenous distribution of 1st, 2nd and 3rd year residents. The mean percent of correct answers about immunizations was 61%. The participants showed poor knowledge about indications (62% correct answers), contraindications (46% correct answers) and myths (71% correct answers). Knowledge about immunizations correlated with higher levels of education (p immunizations followed by books (48%) and the internet (36%). They referred poor exposure to immunizations in clinical settings. Most medical students do not have the expected knowledge about immunization indications and contraindications. Residents were not proficient in immunization contraindications. Both groups had an adequate understanding about vaccination myths. Efforts towards ensuring adequate exposure to immunizations education during training years are needed in order to eliminate one of the barriers to adequate immunizations in children.
CERN has recently been informed that the Swiss Federal tax authorities have still not authorised the Canton of Vaud to modify the taxation rules for members of the personnel residing in the Canton, in particular those of Swiss nationality, following the introduction of the internal taxation system at CERN. Pending a statement from the Federal tax authorities, the members of the personnel concerned are requested to complete the 2005 income tax declaration in compliance with the following instructions: Members of the personnel of Swiss nationality residing in the Canton of Vaud must complete the 2005 income tax declaration, declaring all their sources of income and assets, including the income they received from CERN (state the taxable amount as it appears in the annual certificate of internal taxation that you received in April). They must return their declaration forthwith to the relevant tax office. N.B.: they should write the following statement in the Comments section of the form, namely 'Membre du pers...
Boogaard, Jannie A; Werner, Perla; Zisberg, Anna; van der Steen, Jenny T
In a context of increasing emphasis on shared decision-making and palliative care in dementia, research on family caregivers' trust in health professionals in advanced dementia is surprisingly scant. The aim of the present study was to assess trust in nursing home health professionals of family caregivers of nursing home residents with advanced dementia, and possible correlates, such as family caregivers' satisfaction, involvement in care, care burden and patients' symptom burden. A cross-sectional study was carried out using structured questionnaires administered through the telephone. Generalized estimating equation analyses with adjustment for nursing home clustering were applied to assess the most important associations with family caregivers' trust. A total of 214 family caregivers of persons with dementia residing in 25 nursing homes participated in the study. The majority of the participants (67%) were women and adult children (75%). The majority of the family caregivers trusted physicians, nurses and nurses' aides at a moderate-to-high level. Approximately half to one-third reported moderate-to-low levels of trust. Higher levels of trust were associated with more positive care outcomes, such as higher family satisfaction with care and more positive evaluations of physician-family communication. The present study showed the importance of family caregivers trusting nursing home health professionals for their experiences as caregivers. Although causation cannot be established, increased family caregivers' trust in nursing home health professionals by improving communication and exchange of information might provide a good basis for providing optimal palliative care in advanced dementia. Geriatr Gerontol Int 2017; 17: 2466-2471. © 2017 Japan Geriatrics Society.
Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M
Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.
Brandt-Kreutz, Richard L; Ferguson, Kyle E; Sawyer, Devin
The family medicine residency behavioral science curriculum is more effective if prioritized to match what is needed in practice after graduation. Two prior studies (Kendall, Marvel, & Cruickshank, 2003; Marvel & Major, 1999) identified physician priorities for behavioral science education. The present study extends this research to include topics from more recent curriculum guidelines and examines the extent to which size of community and perceived competence correlate with prioritization of Washington state family physicians. Practicing family physicians in Washington state (N = 2,270) were invited to complete the survey. Respondents provided demographic and practice information. Respondents then rated, on a scale from 1 to 4, 35 behavioral science topics on 2 different scales including (a) priority to be given in residency education and (b) perceived level of competence. A total of 486 responded and 430 completed both priority and competence scales for a response rate of 19%. The top half of 35 topics of the present study included the top 13 topics found in the 2 prior studies. Priority and competence scales were moderately correlated (r = .48, n = 430, p = .001). There was a small significant correlation with size of community and priority ratings (r = .13, n = 435, p = .006). Family physicians in Washington state prioritize behavioral science topics in residency education similar to Colorado and Mississippi. The results of this study support recent ACGME guidelines, in that training should focus on common psychiatric illnesses, including depression and anxiety, and interpersonal processes. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Full Text Available A significant number of women in low and middle income countries (L-MICs who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research.A systematic review was performed in several electronic databases i.e Medline (Pubmed, Embase, Popline, The National Bureau of Economic Research (NBER, EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS statement.From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors.Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary
Zakiyah, Neily; van Asselt, Antoinette D I; Roijmans, Frank; Postma, Maarten J
A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate
Poonawalla, Insiya B; Kendzor, Darla E; Owen, Margaret Tresch; Caughy, Margaret O
Although childhood socioeconomic disadvantage has been linked with adolescent tobacco and alcohol use in cross-sectional research, less is known about the influence of changes in socioeconomic status during childhood. Upward socioeconomic mobility may attenuate the negative influence of earlier socioeconomic disadvantage on health, while downward mobility may counter the health benefits of earlier socioeconomic advantage. This study evaluated the influence of common trajectories of family income during childhood on smoking and alcohol use during adolescence. Data utilized were part of the 15-year longitudinal Study of Early Child Care and Youth Development. A 5-class trajectory model (two stable, one downward, and two upward income trajectories) was developed previously with this sample (N=1356). Logistic regression analyses were conducted to determine whether children of the more disadvantaged income trajectories were more likely to engage in tobacco and alcohol use at age 15 relative to those of the most advantaged trajectory. Family income trajectory was significantly associated with ever-smoking (p=.02) and past-year alcohol use at age 15years (p=.008). Children from the less advantaged trajectories were more likely to have ever-smoked than children of the most advantaged trajectory (all p'schildhood socioeconomic disadvantage influences adolescent smoking, while downward socioeconomic mobility influences adolescent alcohol use. Copyright © 2014 Elsevier Ltd. All rights reserved.
Rothwell, David W.; Han, Chang-Keun
The "hard times" resulting from the 2008 Great Recession represent an opportunity to re-examine the theoretical framework for how families use economic resources to manage stress. M. Sherraden's (1991) theory of assets and H. I. McCubbin and J. Patterson's (1983) family adjustment and adaptation response model informed this study of how assets…
Athari, Pegah; Department of educational psychology, Faculty of Education Universiti Teknologi Malaysia; Ghaedi, Leila; Department of educational psychology, Faculty of Education Universiti Teknologi Malaysia
This study was conducted to investigate the relationship between mothers’ depression and stress compared with severity of autism in children and the effect of family income on the relationship between these two latter variables. Levels of depression and stress among mothers (n=250) were measured based on Depression Anxiety and Stress Scale of 42 items (DASS¬-42). The severity of autism among children was assessed by Autism Behavior Checklist (ABC) according to children’s teachers reports (n=2...
Bradbury, Katharine L.
Much of America's promise is predicated on economic mobility - the possibility that people can move up and down the economic ladder during their lifetimes. Mobility is of particular consequence when economic disparities are increasing. Using panel data and mobility concepts and measures adapted from the literature, this paper examines 10-year income mobility levels and trends for U.S. working-age families during the time span 1977 - 2012. According to many measures, mobility, already limited ...
Racial disparity in family incomes remained remarkably stable over the past 40 years in the United States despite major legal and social reforms. Previous scholarship presents two primary explanations for persistent inequality through a period of progressive change. One highlights continuity: because socioeconomic status is transmitted from parents to children, disparities created through histories of discrimination and opportunity denial may dissipate slowly. The second highlights change: be...
Angela D. Liese
Full Text Available Low-income areas in which residents have poor access to healthy foods have been referred to as “food deserts.” It is thought that improving food access may help curb the obesity epidemic. Little is known about where residents of food deserts shop and if shopping habits are associated with body mass index (BMI. We evaluated the association of food shopping and acquisition (e.g., obtaining food from church, food pantries, etc. with BMI among 459 residents of low-income communities from two South Carolina counties, 81% of whom lived in United States Department of Agriculture-designated food deserts. Participants were interviewed about food shopping and acquisition and perceptions of their food environment, and weight and height were measured. Distances to food retail outlets were determined. Multivariable linear regression analysis was employed. Our study sample comprising largely African-American women had an average BMI of 32.5 kg/m2. The vast majority of study participants shopped at supermarkets (61% or supercenters/warehouse clubs (27%. Shopping at a supercenter or warehouse club as one’s primary store was significantly associated with a 2.6 kg/m2 higher BMI compared to shopping at a supermarket, independent of demographics, socioeconomics, physical activity, and all other food shopping/acquisition behaviors. Persons who reported shopping at a small grocery store or a convenience or dollar store as their tertiary store had a 2.6 kg/m2 lower BMI. Respondents who perceived lack of access to adequate food shopping in their neighborhoods as a problem had higher BMI. Living in a food desert census tract was not significantly associated with BMI. Other shopping attributes, including distance to utilized and nearest grocery stores, were not independently associated with BMI. These findings call into question the idea that poor spatial access to grocery stores is a key underlying factor affecting the obesity epidemic. Future research should
Liese, Angela D.; Ma, Xiaonan; Hutto, Brent; Sharpe, Patricia A.; Bell, Bethany A.; Wilcox, Sara
Low-income areas in which residents have poor access to healthy foods have been referred to as “food deserts.” It is thought that improving food access may help curb the obesity epidemic. Little is known about where residents of food deserts shop and if shopping habits are associated with body mass index (BMI). We evaluated the association of food shopping and acquisition (e.g., obtaining food from church, food pantries, etc.) with BMI among 459 residents of low-income communities from two South Carolina counties, 81% of whom lived in United States Department of Agriculture-designated food deserts. Participants were interviewed about food shopping and acquisition and perceptions of their food environment, and weight and height were measured. Distances to food retail outlets were determined. Multivariable linear regression analysis was employed. Our study sample comprising largely African-American women had an average BMI of 32.5 kg/m2. The vast majority of study participants shopped at supermarkets (61%) or supercenters/warehouse clubs (27%). Shopping at a supercenter or warehouse club as one’s primary store was significantly associated with a 2.6 kg/m2 higher BMI compared to shopping at a supermarket, independent of demographics, socioeconomics, physical activity, and all other food shopping/acquisition behaviors. Persons who reported shopping at a small grocery store or a convenience or dollar store as their tertiary store had a 2.6 kg/m2 lower BMI. Respondents who perceived lack of access to adequate food shopping in their neighborhoods as a problem had higher BMI. Living in a food desert census tract was not significantly associated with BMI. Other shopping attributes, including distance to utilized and nearest grocery stores, were not independently associated with BMI. These findings call into question the idea that poor spatial access to grocery stores is a key underlying factor affecting the obesity epidemic. Future research should consider assessing
Liese, Angela D; Ma, Xiaonan; Hutto, Brent; Sharpe, Patricia A; Bell, Bethany A; Wilcox, Sara
Low-income areas in which residents have poor access to healthy foods have been referred to as "food deserts." It is thought that improving food access may help curb the obesity epidemic. Little is known about where residents of food deserts shop and if shopping habits are associated with body mass index (BMI). We evaluated the association of food shopping and acquisition (e.g., obtaining food from church, food pantries, etc.) with BMI among 459 residents of low-income communities from two South Carolina counties, 81% of whom lived in United States Department of Agriculture-designated food deserts. Participants were interviewed about food shopping and acquisition and perceptions of their food environment, and weight and height were measured. Distances to food retail outlets were determined. Multivariable linear regression analysis was employed. Our study sample comprising largely African-American women had an average BMI of 32.5 kg/m². The vast majority of study participants shopped at supermarkets (61%) or supercenters/warehouse clubs (27%). Shopping at a supercenter or warehouse club as one's primary store was significantly associated with a 2.6 kg/m² higher BMI compared to shopping at a supermarket, independent of demographics, socioeconomics, physical activity, and all other food shopping/acquisition behaviors. Persons who reported shopping at a small grocery store or a convenience or dollar store as their tertiary store had a 2.6 kg/m² lower BMI. Respondents who perceived lack of access to adequate food shopping in their neighborhoods as a problem had higher BMI. Living in a food desert census tract was not significantly associated with BMI. Other shopping attributes, including distance to utilized and nearest grocery stores, were not independently associated with BMI. These findings call into question the idea that poor spatial access to grocery stores is a key underlying factor affecting the obesity epidemic. Future research should consider assessing
Miller, D B; Goldman, L E; Woodman, S A
The small number of respondents and the absence of specific demographic data concerning the three categories of respondents represented definite limitations. Further investigation in other long-term care facilities clearly is indicated. However, as a preliminary survey of preferences in nursing home interior design, several interesting findings have emerged: Patients, staff and families all emphasized patient safety and function over aesthetics. Yet, more residents than staff and families were concerned with appearance. Although experts advocate creating a home-like atmosphere in the nursing home, 50% or more of each group applied different criteria for specific design elements for private homes and for long-term care institutions. Design preferences for the three groups were similar, with an emphasis on modern furniture, painted walls, resilient tile rather than carpet, blinds, pastel and warm colors, and the use of paintings as accessories. Contrary to study assumptions, design features that promote patient individuality (e.g., patient artwork) received much greater emphasis from staff than from patients and families. Environmental change was considered an important aspect of interior design. Of the three constituencies, staff was most aware of periodic changes in decor and considered change as "very important" more often than did families or patients. As the nature of the nursing home patient population has changed--with residents presenting more disability and less rehabilitation potential and less likelihood of returning home--the ambiance of facilities has assumed even more importance. Clearly, the design preferences of residents who live in the facility are of paramount importance. However, it is also helpful to have an environment that is pleasing to family members who often experience difficulty in ongoing visitations, particularly to intellectually impaired relatives. Maintaining staff morale at a high level is a constant challenge in a long-term care
Arif, Ahmed A; Korgaonkar, Purva
The objective of the study was to determine the relationship of childhood asthma with mental health and developmental indicators in low-income families. Parents/guardians of approximately 400 children, aged 2-14 years, were recruited from a charity hospital serving low income neighborhoods in the outskirts of Karachi, Pakistan. Mothers of children were interviewed in their local language by a trained nurse. Eight self-reported comorbidities were grouped into two constructs based on factor analysis and conveniently labeled as mental health (anxiety, attention and behavioral problems) and developmental problems (learning, developmental delay, hearing impairment, sleep and speech problems). Data were analyzed using multiple logistic regression, adjusted for age, sex, presence of older siblings, number of people in the household, child birth weight, presence of mold, and family history of asthma or hay fever. Children with asthma had 18 times greater odds of mental health problems (adjusted OR = 18.0, 95% CI: 9.2, 35.1) as compared to children without asthma. The odds of developmental problems were more than 14 times greater for children with asthma (adjusted OR = 14.3, 95% CI: 7.8, 26.1) as compared to children without asthma. This study found mental and developmental adverse consequences of childhood asthma in low-income families. Identifying and treating asthma at an early age could reduce the burden of comorbidities in this population.
Deffenbacher, Brandy; Langner, Shannon; Khodaee, Morteza
A family medicine residency is a unique training environment where residents are exposed to care in multiple settings, across all ages. Procedures are an integral part of family medicine practice. Family medicine residency (FMR) programs are tasked with the job of teaching these skills at a level of intensity and frequency that allows a resident to achieve competency of such skills. In an environment that is limited by work hour restrictions, self-study teaching methods are one way to ensure all residents receive the fundamental knowledge of how to perform procedures. We developed and evaluated the efficacy of a self-study procedure teaching method and procedure evaluation checklist. A self-study procedure teaching intervention was created, consisting of instructional articles and videos on three procedures. To assess the efficacy of the intervention, and the competency of the residents, pre- and postintervention procedure performance sessions were completed. These sessions were reviewed and scored using a standardized procedure performance checklist. All 24 residents participated in the study. Overall, the resident procedure knowledge increased on two of the three procedures studied, and ability to perform procedure according to expert-validated checklist improved significantly on all procedures. A self-study intervention is a simple but effective way to increase and improve procedure training in a way that fits the complex scheduling needs of a residency training program. In addition, this study demonstrates that the procedure performance checklists are a simple and reliable way to increase assessment of resident procedure performance skills in a residency setting.
Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this literature review was to identify widely used public domain quality assessment tools with existing or potential application in clinic-based family planning programmes. Using PubMed, PopLine, Google Scholar and Google, key terms such as ‘quality assessment tool’, ‘quality assessment method’, ‘quality measurement’, ‘LMIC’, ‘developing country’, ‘family planning’ and ‘reproductive health’ were searched for articles, identifying 20 relevant tools. Tools were assessed to determine the type of quality components assessed, divided into structure and process components, level of application (national or facility), health service domain that can be assessed by the tool, cost and current use of the tool. Tools were also assessed for shortcomings based on application in a low- and middle-income clinic-based family planning programme, including personnel required, re-assessment frequency, assessment of structure, process and outcome quality, comparability of data over time and across facilities and ability to benchmark clinic results to a national benchmark. No tools met all criteria, indicating a critical gap in quality assessment for low- and middle-income family planning programmes. To achieve Universal Health Coverage, agreed on in the Sustainable Development Goals and to improve system-wide healthcare quality, we must develop and widely adopt a standardized quality assessment tool.
Maria Goretti Queiroz
Full Text Available The relationship between early childhood caries (ECC and obesity is controversial. This cross-sectional survey investigated this association in children from low-income families in Goiania, Goias, Brazil and considered the role of several social determinants. A questionnaire examining the characteristics of the children and their families was administered to the primary caregiver during home visits. In addition, children (approximately 6 years of age had their height, weight, and tooth condition assessed. The primary ECC outcome was categorized as one of the following: caries experience (decayed, missing, filled tooth: “dmft” index > 0, active ECC (decayed teeth > 0, or active severe ECC (decayed teeth ≥ 6. Descriptive, bivariate and logistic regression analyses were conducted. The participants in the current study consisted of 269 caregiver-child dyads, 88.5% of whom were included in the Family Health Program. Caregivers were mostly mothers (67.7%, were 35.3 ± 10.0 years old on average and had 9.8 ± 3.1 years of formal education. The mean family income was 2.3 ± 1.5 times greater than the Brazilian minimum wage. On average, the children in the current study were 68.7 ± 3.8 months old. Of these, 51.7% were boys, 23.4% were overweight or obese, 45.0% had active ECC, and 17.1% had severe ECC. The average body mass index (BMI of the children was 15.9 ± 2.2, and their dmft index was 2.5 ± 3.2. BMI was not associated with any of the three categories of dental caries (p > 0.05. In contrast, higher family incomes were significantly associated with the lack of caries experience in children (OR 1.22, 95%CI 1.01–1.50, but the mother’s level of education was not significantly associated with ECC.
Cheng, Huai Yong; Davis, Molly
Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.
Full Text Available Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents’ perspective after a year of implementation. Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% (. Eighty percent ( were women. Satisfaction level in seeking help was the highest for academics (75%. Residents scored mentorship as low in helping to tackle their personal problems (20%. Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees’ personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors.
Kendzor, Darla E; Caughy, Margaret O; Owen, Margaret Tresch
Childhood socioeconomic disadvantage has been linked with obesity in cross-sectional research, although less is known about how changes in socioeconomic status influence the development of obesity. Researchers have hypothesized that upward socioeconomic mobility may attenuate the health effects of earlier socioeconomic disadvantage; while downward socioeconomic mobility might have a negative influence on health despite relative socioeconomic advantages at earlier stages. The purpose of the current study was to characterize trajectories of family income during childhood, and to evaluate the influence of these trajectories on adiposity at age 15. Data were collected as part of the Study of Early Child Care and Youth Development (SECCYD) between 1991 and 2007 at 10 sites across the United States. A latent class growth analysis (LCGA) was conducted to identify trajectories of family income from birth to 15 years of age. Analyses of covariance (ANCOVAs) were conducted to determine whether measures of adiposity differed by trajectory, while controlling for relevant covariates. The LCGA supported a 5-class trajectory model, which included two stable, one downward, and two upward trajectories. ANCOVAs indicated that BMI percentile, waist circumference, and skinfold thicknesses at age 15 differed significantly by trajectory, such that those who experienced downward mobility or stable low income had greater adiposity relative to the more advantaged trajectories. Conversely, upwardly mobile children and those with consistently adequate incomes had similar and more positive outcomes relative to the most disadvantaged trajectories. Findings suggest that promoting upward socioeconomic mobility among disadvantaged families may have a positive impact on obesity-related outcomes in adolescence.
Kendzor Darla E
Full Text Available Abstract Background Childhood socioeconomic disadvantage has been linked with obesity in cross-sectional research, although less is known about how changes in socioeconomic status influence the development of obesity. Researchers have hypothesized that upward socioeconomic mobility may attenuate the health effects of earlier socioeconomic disadvantage; while downward socioeconomic mobility might have a negative influence on health despite relative socioeconomic advantages at earlier stages. The purpose of the current study was to characterize trajectories of family income during childhood, and to evaluate the influence of these trajectories on adiposity at age 15. Methods Data were collected as part of the Study of Early Child Care and Youth Development (SECCYD between 1991 and 2007 at 10 sites across the United States. A latent class growth analysis (LCGA was conducted to identify trajectories of family income from birth to 15 years of age. Analyses of covariance (ANCOVAs were conducted to determine whether measures of adiposity differed by trajectory, while controlling for relevant covariates. Results The LCGA supported a 5-class trajectory model, which included two stable, one downward, and two upward trajectories. ANCOVAs indicated that BMI percentile, waist circumference, and skinfold thicknesses at age 15 differed significantly by trajectory, such that those who experienced downward mobility or stable low income had greater adiposity relative to the more advantaged trajectories. Conversely, upwardly mobile children and those with consistently adequate incomes had similar and more positive outcomes relative to the most disadvantaged trajectories. Conclusions Findings suggest that promoting upward socioeconomic mobility among disadvantaged families may have a positive impact on obesity-related outcomes in adolescence.
Zalewski, Maureen; Lengua, Liliana J.; Kiff, Cara J.; Fisher, Philip A.
This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the…
Christiaens, Wendy; Bracke, Piet
Combination pressure or work-life imbalance is linked to adverse health. However, it remains unclear how work-family conflict is related to healthcare utilisation. Does work-family conflict function as a barrier or as a facilitator in relation to the use of health services and prescription medication? Lack of time may prevent people from visiting a doctor when they feel unwell. However, combination pressure can also be expected to intensify the use of health services, as the need for a quick fix is prioritised. Further, do women and men differ in their susceptibility to medicalisation and time pressure resulting from work-life imbalance? This article investigates the use of health services and prescription medication of dual-income couples with children, based on data from 23 countries in the European Social Survey round 2 (N(women) = 3755; N(men) = 3142). It was found that medical services and prescription medications are used more frequently in dual-income couples experiencing work-to-family spillover, but for women only this is irrespective of their self-reported health. Family-to-work spillover does not result in increased health service or medication use for either men or women. While women opt for a medical response to work-life imbalance, men's reluctance to seek formal health support is confirmed. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Lacasse, Miriam; Ratnapalan, Savithiri
To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are
M.F. de Wilde (Maarten)
textabstractIn this article, the author seeks to illustrate, through examples dealing with cross-border business losses, what the result would be if Member States were to subject non-resident taxpayers to unlimited income taxation whilst granting double tax relief under a Netherlands-style tax
textabstractIn this article, the author seeks to illustrate, through examples dealing with cross-border business losses, what the result would be if Member States were to subject non-resident taxpayers to unlimited income taxation whilst granting double tax relief under a Netherlands-style tax exemption method.
Wu, Justine P; Bennett, Ian; Levine, Jeffrey P; Aguirre, Abigail Calkins; Bellamy, Scarlett; Fleischman, Joan
We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents. We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs. Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01). Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.
Lampard, Amy M; Jurkowski, Janine M; Davison, Kirsten K
The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time. Parents (N=146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors. Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time. Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.
The goal of the study was to find how poverty affects parenting. For the data collection was used questionnaire Alabama Parenting Questionnaire (APQ, which measures parenthood through five dimensions (1 positive involvement with children, (2 Supervision and monitoring, (3 use of positive discipline techniques, (4 consistency in Theus of discipline chniques, (5 use of corporal punishment. The sample was divided into two groups, with the first group consisted of 188 parents living in poverty The reference group consisted of parents living in households with income standard (N−188.Analysis of the results showed differences between parents living in poverty and between parents with a standard rate of income especially in monitoring and supervision, and also in the use of positive disciplinary techniques. On the contrary, there were no significant differences in cooperation between the parents or the use of corporal punishment. Based on the results it is clear that poverty is one of the factors affecting parenting. Therefore, social worker who works with low-income families should focus attention on this area of family functioning.
Parent feeding has been associated with child overweight/obesity in low-income families. Because acculturation to the United States has been associated with increased adult obesity, our study aim was to determine whether acculturation was associated with feeding in these populations. Low-income Hisp...
Torquati, Julia C.; Raikes, Helen H.; Huddleston-Casas, Catherine A.; Bovaird, James A.; Harris, Beatrice A.
Observed child care quality and parent perceptions of child care quality received by children in poor (below Federal Poverty Line, FPL), low-income (between FPL and 200% of FPL), and non-low-income families were examined. Observations were completed in 359 center- and home-based child care programs in four Midwestern states and surveys were…
Oshman, Lauren D; Combs, Gene N
Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.
Barber, Sarah L
In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated. Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for. Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method. Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.
Jason M. Fletcher; Barbara Wolfe
There is a well known positive association between family income and children's development, including health and academic performance. This relationship is a potentially importance factor in the intergenerational transmission of socioeconomic status and has been shown to be a robust finding across countries and time periods. In contrast, much less is known about the relationship between family income and other domains of children's development, such as noncognitive (or socio-emotional) skill...
Joshi, Pamela; Quane, James M; Cherlin, Andrew J
In this paper, we advance and test an integrative model of the effects of employment status, nonstandard work schedules, male employment, and women's perceptions of economic instability on union formation among low-income single mothers. Based on longitudinal data from 1,299 low-income mothers from the 3-city Welfare Study, results indicate that employment status alone is not significantly associated with whether women marry or cohabit. We find that nonemployed mothers and mothers working nonstandard schedules were less likely to marry compared to those working standard schedules. Mothers' perceptions of economic well-being were associated with marriage at Wave 2. In contrast, cohabitation outcomes were not explained by economic factors, but were related to the perception of child care support. The policy implications of these results are discussed, in particular, as they relate to welfare reform's work and family goals.
Adra, Marina Gharibian; Hopton, John; Keady, John
Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers. Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon. The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method. Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders. The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study. Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care. © 2015 John Wiley & Sons Ltd.
Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving
Harkness, S; Machin, S; Waldfogel, J
"In this paper we evaluate the hypothesis that the over-representation of women amongst the low paid is of little importance because women's earnings account for only a small proportion of total family income. Data from the [United Kingdom] General Household Survey (GHS), together with attitudinal evidence from three cross-sectional data sources, indicate that women's earnings are in fact an important and growing component of family income. The majority of the growth in the share of women's earnings occurs as a result of changing family labour structures; women's earnings are playing an increasingly important role in keeping their families out of poverty." excerpt
Jewell, Shannon L; Letham-Hamlett, Kirsten; Hanna Ibrahim, Mariam; Luecken, Linda J; MacKinnon, David P
Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age. The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women. Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year. Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain. Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.
Using a cross-sectional design with 407 Chinese children aged 3-5 years and their parents, this study examined the effects of socioeconomic status, specifically parents' education and family income, on the children's mother-child relationships, father-child relationships, and the social environment in their families. The results indicated that income negatively predicted conflict in father-child relationships and positively predicted family active-recreational environments. Income also positively predicted family cohesion among girls but not boys. Maternal education negatively predicted conflict in mother-child relationships and positively predicted closeness in mother-child and father-child relationships, family cohesion, and the intellectual-cultural and active-recreational environments in the family. Paternal education positively predicted family cohesion and intellectual-cultural and active-recreational environments. Income was found to partially mediate the effects of both maternal and paternal education on family active-recreational environments. Findings are discussed in the frameworks of the family stress model and the family investment model. © FPI, Inc.
Nykänen, Esa-Pekka A; Dunning, Hanna E; Aryeetey, Richmond N O; Robertson, Aileen; Parlesak, Alexandr
The Ghanaian population suffers from a double burden of malnutrition. Cost of food is considered a barrier to achieving a health-promoting diet. Food prices were collected in major cities and in rural areas in southern Ghana. Linear programming (LP) was used to calculate nutritionally optimized diets (food baskets (FBs)) for a low-income Ghanaian family of four that fulfilled energy and nutrient recommendations in both rural and urban settings. Calculations included implementing cultural acceptability for families living in extreme and moderate poverty (food budget under USD 1.9 and 3.1 per day respectively). Energy-appropriate FBs minimized for cost, following Food Balance Sheets (FBS), lacked key micronutrients such as iodine, vitamin B12 and iron for the mothers. Nutritionally adequate FBs were achieved in all settings when optimizing for a diet cheaper than USD 3.1. However, when delimiting cost to USD 1.9 in rural areas, wild foods had to be included in order to meet nutritional adequacy. Optimization suggested to reduce roots, tubers and fruits and to increase cereals, vegetables and oil-bearing crops compared with FBS. LP is a useful tool to design culturally acceptable diets at minimum cost for low-income Ghanaian families to help advise national authorities how to overcome the double burden of malnutrition.
Over 100,000 low-income households living in rural, rice-farming regions of Vietnam and China rely upon family-hydro (between 100 and 200W) as the only affordable means of obtaining electricity. These systems are used for domestic lighting, radio and, in some cases, televisions. The units are small, cheap and are usually installed and owned by a single family. Funding from the CDM could be utilised in order to reduce the cost of good quality equipment to provide low-income households living in isolated off-grid locations with an affordable and sustainable electricity supply which can meet their needs for lighting, educational, productive and recreational uses. Therefore research was needed to determine the level of carbon emission reductions resulting from their use. The successful acceptance by the Prototype Carbon Fund (PCF) of the methodology of establishing the benchmark developed during this project could then be used as a precedent by other project developers in the future, thus being of long-term support to the emerging family-hydro industry. (author)
Gallagher, Erin; Moore, Ainsley; Schabort, Inge
To assess the current status of leadership training as perceived by family medicine residents to inform the development of a formal leadership curriculum. Cross-sectional quantitative survey. Department of Family Medicine at McMaster University in Hamilton, Ont, in December 2013. A total of 152 first- and second-year family medicine residents. Family medicine residents' attitudes toward leadership, perceived level of training in various leadership domains, and identified opportunities for leadership training. Overall, 80% (152 of 190) of residents completed the survey. On a Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree), residents rated the importance of physician leadership in the clinical setting as high (6.23 of 7), whereas agreement with the statement "I am a leader" received the lowest rating (5.28 of 7). At least 50% of residents desired more training in the leadership domains of personal mastery, mentorship and coaching, conflict resolution, teaching, effective teamwork, administration, ideals of a healthy workplace, coalitions, and system transformation. At least 50% of residents identified behavioural sciences seminars, a lecture and workshop series, and a retreat as opportunities to expand leadership training. The concept of family physicians as leaders resonated highly with residents. Residents desired more personal and system-level leadership training. They also identified ways that leadership training could be expanded in the current curriculum and developed in other areas. The information gained from this survey might facilitate leadership development among residents through application of its results in a formal leadership curriculum. Copyright© the College of Family Physicians of Canada.
Penders, Yolanda W H; Albers, Gwenda; Deliens, Luc; Vander Stichele, Robert; Van den Block, Lieve
High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. Post-death study using random cluster sampling. Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents. © The Author(s) 2014.
Jodi Summers Holtrop
Full Text Available The use of an electronic mailing list as a means of communication among faculty in a network of university-affiliated family practice residency programs was evaluated. Faculty were automatically subscribed to the list by the list owner. Messages were tracked for one year and a written evaluation survey was sent. Ninety two messages were sent, with 52% of the messages being posted information. While most (65% survey respondents reported reading 61% or more of the messages, with only 33% ever actually posted at least one message to the list. Given that faculty were automatically subscribed and that there were only 84 total members, the list may have failed to reach a critical mass of active participants. It is concluded that an email list for network faculty did not function as an online discussion group, although it was extremely beneficial as a way of posting information to affiliated residency faculty.
Jewell, Shannon L; Luecken, Linda J; Gress-Smith, Jenna; Crnic, Keith A; Gonzales, Nancy A
Low-income Mexican American women experience significant health disparities during the postpartum period. Contextual stressors, such as economic stress, are theorized to affect health via dysregulated cortisol output. However, cultural protective factors including strong family support may buffer the impact of stress. In a sample of 322 low-income Mexican American women (mother age 18-42; 82% Spanish-speaking; modal family income $10,000-$15,000), we examined the interactive influence of economic stress and family support at 6 weeks postpartum on maternal cortisol output (AUCg) during a mildly challenging mother-infant interaction task at 12 weeks postpartum, controlling for 6-week maternal cortisol and depressive symptoms. The interaction significantly predicted cortisol output such that higher economic stress predicted higher cortisol only among women reporting low family support. These results suggest that family support is an important protective resource for postpartum Mexican American women experiencing elevated economic stress.
Gefter, Liana; Morioka-Douglas, Nancy; Srivastava, Ashini; Rodriguez, Eunice
The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum. From 2012-2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data. A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (pknowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements. Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.
Griffith, Shayl; Arnold, David; Voegler-Lee, Mary-Ellen; Kupersmidt, Janis
There has been increasing awareness of the need for research and theory to take into account the intersection of individual characteristics and environmental contexts when examining predictors of child outcomes. The present longitudinal, multi-informant study examined the cumulative and interacting contributions of child characteristics (language skills, inattention/hyperactivity, and aggression) and preschool and family contextual factors in predicting kindergarten social skills in 389 low-income preschool children. Child characteristics and classroom factors, but not family factors, predicted teacher-rated kindergarten social skills, while child characteristics alone predicted change in teacher-rated social skills from preschool to kindergarten. Child characteristics and family factors, but not classroom factors, predicted parent-rated kindergarten social skills. Family factors alone predicted change in parent-rated social skills from preschool to kindergarten. Individual child characteristics did not interact with family or classroom factors in predicting parent- or teacher-rated social skills, and support was therefore found for an incremental, rather than an interactive, predictive model of social skills. The findings underscore the importance of assessing outcomes in more than one context, and of considering the impact of both individual and environmental contextual factors on children’s developing social skills when designing targeted intervention programs to prepare children for kindergarten. PMID:28804528
Griffith, Shayl; Arnold, David; Voegler-Lee, Mary-Ellen; Kupersmidt, Janis
There has been increasing awareness of the need for research and theory to take into account the intersection of individual characteristics and environmental contexts when examining predictors of child outcomes. The present longitudinal, multi-informant study examined the cumulative and interacting contributions of child characteristics (language skills, inattention/hyperactivity, and aggression) and preschool and family contextual factors in predicting kindergarten social skills in 389 low-income preschool children. Child characteristics and classroom factors, but not family factors, predicted teacher-rated kindergarten social skills, while child characteristics alone predicted change in teacher-rated social skills from preschool to kindergarten. Child characteristics and family factors, but not classroom factors, predicted parent-rated kindergarten social skills. Family factors alone predicted change in parent-rated social skills from preschool to kindergarten. Individual child characteristics did not interact with family or classroom factors in predicting parent- or teacher-rated social skills, and support was therefore found for an incremental, rather than an interactive, predictive model of social skills. The findings underscore the importance of assessing outcomes in more than one context, and of considering the impact of both individual and environmental contextual factors on children's developing social skills when designing targeted intervention programs to prepare children for kindergarten.
Full Text Available Withholding tax for non-resident taxpayers is a tax due to the Romanian state budget by taxpayers, the expense for the amount related to this tax playing a fiscal impact upon the fiscal result and, therefore, upon the corporate tax due within a fiscal period of time. Most of the times, in practice, a series of questions arise, such as: which is the entity having the obligation to compute and pay the tax, respectively the income payer or the one collecting it; is the transaction taxable from the point of view of the tax on non-resident taxpayers’ income, function of the nature and object of the transaction; which is the tax rate owed, in case the operation has a taxable feature; which is the fiscal treatment applicable in case of expenses incurred in the accounting records, with the amount of the tax owed on non-resident taxpayers income. Due to this reason, in practice there are several approaches which could generate fiscal risks, related to the fiscal treatment applicable in case of different types pf transactions concluded with non-resident tax payers, depending on the nature and scope of the respective transaction.
For several years, the Congressional Budget Office (CBO) has produced estimates of average pretax incomes, effective tax rates, and shares of taxes paid by income-related population groups at different income levels...
Ghosh, Sambuddha; Mukhopadhyay, Udayaditya; Maji, Dipankar; Bhaduri, Gautam
To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.
Colchero, M Arantxa; Molina, Mariana; Guerrero-López, Carlos M
Background: In January 2014, Mexico implemented a tax on sugar-sweetened beverage (SSB) purchases of 1 peso/L. Objective: We examined the heterogeneity of changes in nonalcoholic beverage (SSB and bottled water) purchases after the tax was implemented by household income, urban and rural strata, and household composition. Methods: We used 4 rounds of the National Income and Expenditure Surveys: 2008, 2010, 2012, and 2014. Changes in purchases in per capita liters per week were estimated with the use of 2-part models to adjust for nonpurchases. We compared absolute and relative differences between adjusted changes in observed purchases in 2014 with expected purchases in 2014 based on prior trends (2008-2012). The models were adjusted for sociodemographic characteristics of the households, place of residence, and lagged gross domestic product per capita. Results: We found a 6.3% reduction in the observed purchases of SSBs in 2014 compared with the expected purchases in that same year based on trends from 2008 to 2012. These reductions were higher among lower-income households, residents living in urban areas, and households with children. We also found a 16.2% increase in water purchases that was higher in low- and middle-income households, in urban areas, and among households with adults only. Conclusions: SSB purchases decreased and water purchases increased after an SSB tax was imposed in Mexico. The magnitude of these changes was greater in lower-income and urban households. © 2017 American Society for Nutrition.
Engelberg, Ruth A.; Downey, Lois; Kross, Erin K.; Reinke, Lynn F.; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W.; Back, Anthony L.; Curtis, J. Randall
Abstract Background: Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. Objective: To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. Methods: As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Results: Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Conclusions: Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families. PMID:24592958
Long, Ann C; Engelberg, Ruth A; Downey, Lois; Kross, Erin K; Reinke, Lynn F; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W; Back, Anthony L; Curtis, J Randall
Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families.
Noonan, Katharine; Burns, Richéal; Violato, Mara
The association between low family income and socio-emotional behaviour problems in early childhood has been well-documented, and maternal psychological distress is highlighted as central in mediating this relationship. However, whether this relationship holds for older children, and the precise mechanisms by which income may influence child behaviour is unclear. This study investigated the relationship between family income and child socio-emotional behaviour at 11 years of age, and examined the mediating role of maternal psychological distress over time using the UK Millennium Cohort Study. The primary outcome was parent-reported behavioural problems, as captured by the Total Difficulties Score (TDS), derived from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes were the emotional, peer-related, conduct, and hyperactivity/inattention problems subscales of the SDQ; and teacher-reported TDS. Permanent family income was the primary exposure variable; frequency of poverty up to age 11 years was the secondary exposure variable. Maternal psychological distress was operationalised to reflect the trajectory from child birth to age 11. Multivariable logistic regression models were used to estimate the effect of permanent family income on child behaviour at age 11, controlling for maternal psychological distress and other relevant covariates. Results showed a statistically significant protective effect of increased permanent family income on the likelihood of behavioural problems at age 11. This finding was consistent for all SDQ subscales apart from emotional problems, and was strongest for teacher-reported behavioural problems. Maternal distress was an important mediator in the income-child behaviour relationship for parent-reported, but not teacher-reported, behavioural problems. The results of this study strengthen empirical evidence that the child behaviour-income gradient is maintained in older childhood. Mother's psychological distress
Mills-Koonce, W. Roger; Willoughby, Michael T.; Zvara, Bharathi; Barnett, Melissa; Gustafsson, Hanna; Cox, Martha J
This study examines associations between maternal and paternal sensitive parenting and child cognitive development across the first 3 years of life using longitudinal data from 630 families with co-residing biological mothers and fathers. Sensitive parenting was measured by observational coding of parent-child interactions and child cognitive development was assessed with the Bayley Scales of Infant Development and the Wechsler Preschool and Primary Scales of Intelligence. There were multiple direct and indirect associations between parenting and cognitive development across mothers and fathers, suggesting primary effects, carry-forward effects, spillover effects across parents, and transactional effects across parents and children. Associations between parenting and cognitive development were statistically consistent across mothers and fathers, and the cumulative effects of early parenting on later cognitive development were comparable to the effects of later parenting on later cognitive development. As interpreted through a family systems framework, findings suggest additive and interdependent effects across parents and children. PMID:25954057
Hardaway, Cecily R; Sterrett-Hong, Emma; Larkby, Cynthia A; Cornelius, Marie D
Exposure to community violence is a risk factor for internalizing and externalizing problems; however, resources within the family can decrease the likelihood that adolescents will experience internalizing and externalizing problems as a result of such exposure. This study investigates the potential moderating effects of kinship support (i.e., emotional and tangible support from extended family) and parental involvement on the relation between exposure to community violence (i.e., witnessing violence and violent victimization) and socioemotional adjustment (i.e., internalizing and externalizing problems) in low-income adolescents. The sample included 312 (50 % female; 71 % African American and 29 % White) low-income youth who participated in a longitudinal investigation when adolescents were age 14 (M age = 14.49 years) and again when they were 16 (M age = 16.49 years). Exposure to community violence at age 14 was related to more internalizing and externalizing problems at age 16. High levels of kinship support and parental involvement appeared to function as protective factors, weakening the association between exposure to violence and externalizing problems. Contrary to prediction, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems. The results from this study suggest that both kinship support and parental involvement help buffer adolescents from externalizing problems that are associated with exposure to community violence.
Ghorbani, Z; Peres, M A; Liu, P; Mejia, G C; Armfield, J M; Peres, K G
The aim of this study was to investigate the association between early-life family income and dental pain experience from childhood to early adulthood. Data came from a 14-year prospective study (1991/1992-2005/2006) carried out in South Australia, which included children and adolescents aged 4-17 years (N = 9875) at baseline. The outcome was dental pain experience obtained at baseline, 14 years later in adulthood and at a middle point of time. The main explanatory variable was early-life family income collected at baseline. The prevalence of dental pain was 22.8% at baseline, 19.3% at 'middle time' and 39.3% at follow up. The proportion of people classified as 'poor' at baseline was 27.7%. Being poor early in life was significantly associated with dental pain at 14-year follow up (odds ratio = 1.45; 95% confidence interval = 1.27-1.66). Early-life relative poverty is associated with more frequent dental pain across the 14-year follow up and may be a key exposure variable for later dental conditions. © 2017 Australian Dental Association.
Butler, Dennis J; Holloway, Richard L; Fons, Dominique
This article describes the development of a Behavioral Medicine track in a family medicine residency designed to train physicians to proactively and consistently apply advanced skills in psychosocial medicine, psychiatric care, and behavioral medicine. The Behavioral Medicine track emerged from a behavioral science visioning retreat, an opportunity to restructure residency training, a comparative family medicine-psychiatry model, and qualified residents with high interest in behavioral science. Training was restructured to increase rotational opportunities in core behavioral science areas and track residents were provided an intensive longitudinal counseling seminar and received advanced training in psychopharmacology, case supervision, and mindfulness. The availability of a Behavioral Medicine track increased medical student interest in the residency program and four residents have completed the track. All track residents have presented medical Grand Rounds on behavioral science topics and have lead multiple workshops or research sessions at national meetings. Graduate responses indicate effective integration of behavioral medicine skills and abilities in practice, consistent use of brief counseling skills, and good confidence in treating common psychiatric disorders. As developed and structured, the Behavioral Medicine track has achieved the goal of producing "assertive practitioners of behavioral science in family medicine" residents with advanced behavioral science skills and abilities who globally integrate behavioral science into primary care.
Abou Malham, Sabina; Touati, Nassera; Maillet, Lara; Breton, Mylaine
The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. To identify these challenges within these clinics, as well as potential strategies to address them. The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents' patient; 2) managing and balancing residents' appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents' patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models.
Ogle, G D; Kim, H; Middlehurst, A C; Silink, M; Jenkins, A J
To assess the direct costs of necessary consumables for minimal care of a child with Type 1 diabetes in countries where the public health system does not regularly provide such care. Supply costs were collected between January 2013 and February 2015 from questionnaires submitted by centres requesting International Diabetes Federation Life for a Child Program support. All 20 centres in 15 countries agreed to the use of their responses. Annual costs for minimal care were estimated for: 18 × 10 ml 100 IU/ml insulin, 1/3 cost of a blood glucose meter, two blood glucose test strips/day, two syringes/week, and four HbA1c tests/year. Costs were expressed in US dollars, and as % of gross national income (purchasing power parity) per capita. The ranges (median) for the minimum supply costs through the private system were: insulin 10 ml 100 IU/ml equivalent vial: $5.10-$25 ($8.00); blood glucose meter: $15-$121 ($33.33); test strip: $0.15-$1.20 ($0.50); syringe: $0.10-$0.56 ($0.20); and HbA1c : $4.90-$20 ($9.75). Annual costs ranged from $255 (Pakistan) to $1,185 (Burkina Faso), with a median of $553. Annual % gross national income costs were 12-370% (median 56%). For the lowest 20% income earners the annual cost ranged 20-1535% (median 153%). St Lucia and Mongolia were the only countries whose governments consistently provided insulin. No government provided meters and strips, which were the most expensive supplies (62% of total cost). In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed. © 2015 Diabetes UK.
Czajkowski, Jeffrey; Kunreuther, Howard; Michel-Kerjan, Erwann
The development of catastrophe models in recent years allows for assessment of the flood hazard much more effectively than when the federally run National Flood Insurance Program (NFIP) was created in 1968. We propose and then demonstrate a methodological approach to determine pure premiums based on the entire distribution of possible flood events. We apply hazard, exposure, and vulnerability analyses to a sample of 300,000 single-family residences in two counties in Texas (Travis and Galveston) using state-of-the-art flood catastrophe models. Even in zones of similar flood risk classification by FEMA there is substantial variation in exposure between coastal and inland flood risk. For instance, homes in the designated moderate-risk X500/B zones in Galveston are exposed to a flood risk on average 2.5 times greater than residences in X500/B zones in Travis. The results also show very similar average annual loss (corrected for exposure) for a number of residences despite their being in different FEMA flood zones. We also find significant storm-surge exposure outside of the FEMA designated storm-surge risk zones. Taken together these findings highlight the importance of a microanalysis of flood exposure. The process of aggregating risk at a flood zone level-as currently undertaken by FEMA-provides a false sense of uniformity. As our analysis indicates, the technology to delineate the flood risks exists today. © 2013 Society for Risk Analysis.
Kobayashi, Tomoko; Honjo, Kaori; Eshak, Ehab Salah; Iso, Hiroyasu; Sawada, Norie; Tsugane, Shoichiro
To examine associations between work–family conflict and self-rated health among Japanese workers and to determine whether the associations differed by household income. Data was derived from the Japan Public Health Center-based Prospective Study for the Next Generation in Saku area in 2011–2012 (7,663 men and 7,070 women). Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for poor self-rated health by work–family conflict consisting of two dimensions (work-to-family and family-to-work conflicts) were calculated by gender and household income. Multivariate ORs of high work-to-family and family-to-work conflicts for poor self-rated health were 2.46 (95% CI; 2.04–2.97) for men and 3.54 (95% CI; 2.92–4.30) for women, with reference to the low work-to-family and family-to-work conflicts (p-value for gender interaction = 0.02). Subgroup analysis indicated that health effects of work–family conflict were likely to be more evident in the low income group only among women. Work–family conflict was associated with poor self-rated health among middle-aged Japanese men and women; its health impact was relatively stronger among women, and particularly economically disadvantaged women. PMID:28207757
Kobayashi, Tomoko; Honjo, Kaori; Eshak, Ehab Salah; Iso, Hiroyasu; Sawada, Norie; Tsugane, Shoichiro
To examine associations between work-family conflict and self-rated health among Japanese workers and to determine whether the associations differed by household income. Data was derived from the Japan Public Health Center-based Prospective Study for the Next Generation in Saku area in 2011-2012 (7,663 men and 7,070 women). Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for poor self-rated health by work-family conflict consisting of two dimensions (work-to-family and family-to-work conflicts) were calculated by gender and household income. Multivariate ORs of high work-to-family and family-to-work conflicts for poor self-rated health were 2.46 (95% CI; 2.04-2.97) for men and 3.54 (95% CI; 2.92-4.30) for women, with reference to the low work-to-family and family-to-work conflicts (p-value for gender interaction = 0.02). Subgroup analysis indicated that health effects of work-family conflict were likely to be more evident in the low income group only among women. Work-family conflict was associated with poor self-rated health among middle-aged Japanese men and women; its health impact was relatively stronger among women, and particularly economically disadvantaged women.
Berge, Jerica M; Draxten, Michelle; Trofholz, Amanda; Hanson-Bradley, Carrie; Justesen, Kathryn; Slattengren, Andrew
Numerous quantitative studies have examined the association between family meal frequency and child/adolescent weight and weight-related behaviors. However, limited qualitative research has been conducted to identify mealtime characteristics (e.g., child behavior during meals, rules/expectations, family dynamics) that occur during family meals that may explain why some families engage in frequent family meals and others do not. This is particularly important within racially/ethnically diverse households, as these demographic groups are at higher risk for weight-related problems. The current study aimed to identify similarities and differences in mealtime characteristics between households that have frequent and infrequent family meals within a low-income and minority population. This qualitative study included 118 parents who participated in Family Meals, LIVE!, a mixed-methods, cross-sectional study. Parents (90% female; mean age = 35) were racially/ethnically diverse (62% African American, 19% White, 4% Native American, 4% Asian, 11% Mixed/Other) and from low-income (73% eating, involving family members in meal preparation) between households having frequent and infrequent family meals. Additionally, several differences in mealtime characteristics were identified between households having frequent (i.e., importance of family meals, flexibility in the definition of family meals, family meal rules, no pressure-to-eat feeding practices) versus infrequent family meals (i.e., pressure-to-eat parent feeding practices, family meals are dinner meals only, and difficult meal time behaviors). Study findings may be useful for developing intervention targets for low-income and racially/ethnically diverse households so more families can benefit from the protective nature of family meals. Copyright © 2018 Elsevier Ltd. All rights reserved.
Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S
having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.
Scaramella, Laura V.; Sohr-Preston, Sara L.; Callahan, Kristin L.; Mirabile, Scott P.
Hurricane Katrina dramatically altered the level of social and environmental stressors for the residents of the New Orleans area. The Family Stress Model describes a process whereby felt financial strain undermines parents' mental health, the quality of family relationships, and child adjustment. Our study considered the extent to which the Family…
Jarrett, Robin L; Hamilton, Megan-Brette; Coba-Rodriguez, Sarai
The development of emergent literacy skills are important for the development of later literacy competencies and affect school readiness. Quantitative researchers document race- and social class-based disparities in emergent literacy competence between low-income African American and middle-income White children. Some researchers suggest that deficits in parenting practices account for limited literacy skills among low-income African American children. A small body of qualitative research on low-income African American families finds that despite economic challenges, some African American families were actively engaged in promoting child literacy development. Using qualitative interviews that emphasize family strengths, we add to this small body of research to highlight positive family practices obscured in many quantitative analyses that concentrate on family shortcomings. Specifically, we examine in-home literacy practices and child literacy development with a sample of low-income African American mothers (families) of preschoolers. Key findings include identification of various literacy activities promoting child literacy development and inclusion of multiple family members assisting in literacy activities. These findings add to substantive discussions of emergent literacy and resilience. Insights from the qualitative interviews also provide culturally-sensitive recommendations to childhood educators and speech-language pathologists (SLP) who work with low-income African American families and children. Reader should recognize that (1) there is not a 'right' phenotype and therefore not a right form of environmental input and (2) that context matters (at both the level of the cell and the individual organism). Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Despite the increasing popularity of primary care sports medicine fellowships, as evidenced by the more than two-fold increase in family medicine sports medicine fellowships from a total of 31 accredited programs during the 1998/1999 academic year (ACGME, 1998 to 63 during the 2003/2004 academic year (ACGME, 2006, there are few empirical studies to support the efficacy of such programs. To the best of our knowledge, no studies have been conducted to assess the impact of primary care sports medicine fellowships on family medicine residents' learning of non-musculoskeletal sports medicine topics. Rigorous evaluations of the outcomes of such programs are helpful to document the value of such programs to both the lay public and interested medical residents. In order to evaluate such programs, it is helpful to apply the same objective standards to residents trained across multiple programs. Hence, we would like to know if there is a learning effect with respect to non-musculoskeletal sports medicine topics identified on yearly administered American Board of Family Medicine (ABFM in-training exams (ITE to family medicine residents in family medicine residency programs in the United States with and without primary care sports medicine fellowship programs. Review and approval for the research proposal was granted by the ABFM, who also allowed access to the required data. Permission to study and report only non-musculoskeletal sports medicine topics excluding musculoskeletal topics was granted at the time due to other ongoing projects at the ABFM involving musculoskeletal topics. ABFM allowed us access to examinations from 1998 to 2003. We were given copies of each exam and records of responses to each item (correct or incorrect by each examinee (examinees were anonymous for each year.For each year, each examinee was classified by the ABFM as either (a belonging to a program that contained a sports medicine fellowship, or (b not belonging to a program
This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas. © 2011 Springer-Verlag.
McMahon, Kelton; Berumen, Michael L.; Mateo, Ivan; Elsdon, Travis S.; Thorrold, Simon R.
This study explored the potential for otolith geochemistry in snapper (Family: Lutjanidae) to identify residency in juvenile nursery habitats with distinctive carbon isotope values. Conventional bulk otolith and muscle stable isotope analyses (SIA) and essential amino acid (AA) SIA were conducted on snapper collected from seagrass beds, mangroves, and coral reefs in the Red Sea, Caribbean Sea, and Pacific coast of Panama. While bulk stable isotope values in otoliths showed regional differences, they failed to distinguish nursery residence on local scales. Essential AA δ13C values in otoliths, on the other hand, varied as a function of habitat type and provided a better tracer of residence in different juvenile nursery habitats than conventional bulk otolith SIA alone. A strong linear relationship was found between paired otolith and muscle essential AA δ13C values regardless of species, geographic region, or habitat type, indicating that otolith AAs recorded the same dietary information as muscle AAs. Juvenile snapper in the Red Sea sheltered in mangroves but fed in seagrass beds, while snapper from the Caribbean Sea and Pacific coast of Panama showed greater reliance on mangrove-derived carbon. Furthermore, compound-specific SIA revealed that microbially recycled detrital carbon, not water-column-based new phytoplankton carbon, was the primary carbon source supporting snapper production on coastal reefs of the Red Sea. This study presented robust tracers of juvenile nursery residence that will be crucial for reconstructing ontogenetic migration patterns of fishes among coastal wetlands and coral reefs. This information is key to determining the importance of nursery habitats to coral reef fish populations and will provide valuable scientific support for the design of networked marine-protected areas. © 2011 Springer-Verlag.
Sharkey Joseph R
Full Text Available Abstract Background It has been recognized that the availability of foods in the home are important to nutritional health, and may influence the dietary behavior of children, adolescents, and adults. It is therefore important to understand food choices in the context of the household setting. Considering their importance, the measurement of household food resources becomes critical. Because most studies use a single point of data collection to determine the types of foods that are present in the home, which can miss the change in availability within a month and when resources are not available, the primary objective of this pilot study was to examine the feasibility and value of conducting weekly in-home assessments of household food resources over the course of one month among low-income Mexicano families in Texas colonias. Methods We conducted five in-home household food inventories over a thirty-day period in a small convenience sample; determined the frequency that food items were present in the participating households; and compared a one-time measurement with multiple measurements. After the development and pre-testing of the 252-item culturally and linguistically- appropriate household food inventory instrument that used direct observation to determine the presence and amount of food and beverage items in the home (refrigerator, freezer, pantry, elsewhere, two trained promotoras recruited a convenience sample of 6 households; administered a baseline questionnaire (personal info, shopping habits, and food security; conducted 5 in-home assessments (7-day interval over a 30-day period; and documented grocery shopping and other food-related activities within the previous week of each in-home assessment. All data were collected in Spanish. Descriptive statistics were calculated for mean and frequency of sample characteristics, food-related activities, food security, and the presence of individual food items. Due to the small sample size of the
Arif, Ahmed A; Racine, Elizabeth F
The objective of this study was to examine the relationship of breastfeeding duration with childhood asthma among low-income families in Karachi, Pakistan. Mothers/caregivers of 200 children with asthma and an equal number of children without asthma were interviewed about breastfeeding duration. Based on the responses, 6 different binary variables were constructed: breastfeeding 3 months or less, 6 months or less, 9 months or less, 12 months or less, 18 months or less, and 24 months or less. Asthma status of the child was determined by clinical examination by a primary care physician. Data was analyzed using multiple logistic regression method, adjusted for age and sex of the child, household income, parental ethnicity, number of older siblings, family history of asthma or hay fever, presence of mold, parental smoking, number of people in the household, and body mass index of the child. The average duration of breastfeeding was 21.4 months (SD = 7.33 months). Breastfeeding for at least 24 months was associated with increased odds of asthma (aOR = 1.77, 95%CI: 0.99, 3.16). Whereas breastfeeding for 12 months or less, and to some extent 18 months or less, was protective against childhood asthma. There was some evidence this protective effect may be delayed in children with a family history of asthma or hay fever. This study found breastfeeding for 12 months or less may have a protective effect against asthma. The protective effect weans down after 18 months, and if continued 24 months or more may place the child at-risk of asthma.
Viktor Steiner; Katharina Wrohlich
We analyze the effects of three alternative proposals to reform the taxation of families relative to the current German system of joint taxation of couples and child allowances: a French-type family splitting and two full family splitting proposals. The empirical analysis of the effects of these proposals on the income distribution and on work incentives is based on a behavioral micro-simulation model which integrates an empirical household labor supply model into a detailed tax-benefit model...
The aim of this study is to determine the separate effects of social class, income, education and area of residence on psychological distress. The study also assesses whether the association between prevalence of high score on the 12-item General Health Questionnaire (GHQ 12) and social class is independent of other variables. Psychological distress was assessed by means of the GHQ 12. The study covered 1,092 adults aged 15 years or more living in two different quarters of Antalya. Social class status was defined by occupational position, with income, education and area of residence treated as confounders. Chi-square and logistic regression analyses were used to evaluate the data. Large inequalities in psychological distress by all variables were observed. Psychological distress was significantly associated with class status, after adjusting for income, education, area of residence and other potential confounders (age, sex and marital status). Class inequalities in psychological distress were observed between blue-collar workers/unqualified employees and bourgeoisie. These findings support the view that the recent widening of inequalities among social classes in Turkey pose a substantial threat to health.
Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the
Gibb, Sheree J; Fergusson, David M; Horwood, L John
The aims of this study were to use data gathered over the course of a 30-year longitudinal study to examine the linkages between economic circumstances in childhood and subsequent developmental outcomes spanning educational achievement; economic circumstances; crime; mental health; and teenage pregnancy. All of these outcomes have been linked with childhood economic conditions and it is frequently argued that reducing income inequalities will mitigate psychosocial risks of children reared in families facing economic hardship. Alternatively it may be suggested that the associations between childhood family economic circumstances and later outcomes are mediated by individual, family and social factors that are correlated with low family income and contribute to later outcomes. To examine these issues, data were drawn from a birth cohort of New Zealand children born in 1977 and followed to age 30. Declining childhood family income was associated with a range of negative outcomes in adulthood, including: lower educational achievement; poorer economic circumstances; higher rates of criminal offending; higher rates of mental health problems; and higher rates of teenage pregnancy. After covariate adjustment, childhood family income remained significantly associated with educational achievement and economic circumstances, but was no longer significantly associated with the mental health, offending and teenage pregnancy outcomes. These findings suggest that, after due allowance has been made for social, family and individual contextual factors, low family income during childhood is associated with a range of educational and economic disadvantages in adulthood but is not directly related to increased risks of crime, mental health problems or teen pregnancy. Copyright © 2012 Elsevier Ltd. All rights reserved.
Bona, Kira; London, Wendy B; Guo, Dongjing; Frank, Deborah A; Wolfe, Joanne
Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)--including food, energy, and housing insecurity--have not been described in pediatric oncology. We describe the trajectory of family reported HMH and income poverty at a pediatric oncology referral center in New England with high psychosocial supports. Single site, prospective cohort study including 99 English-speaking families of children receiving chemotherapy for primary cancer. Families completed face-to-face surveys at two time-points: (1) Within 30 days of child's diagnosis (T1) (N = 99, response rate 88%); (2) 6-months following diagnosis (T2) (N = 93, response rate 94%). HMH was assessed in three domains: food, energy, and housing insecurity. Twenty percent of families reported low-income (≤200% Federal Poverty Level) and at least one HMH prior to their child's diagnosis. At T2, 25% of families lost >40% annual household income secondary to treatment-related work disruptions, and 29% of families reported HMH despite utilization of psychosocial supports. Low-income and HMH are prevalent in a significant proportion of newly diagnosed pediatric oncology families at a large referral center. Despite psychosocial supports, the proportion of families experiencing unmet basic needs increases during chemotherapy to nearly one in three families. HMH provides a quantifiable and remediable measure of poverty in pediatric oncology. Interventions to ameliorate this concrete component of poverty could benefit a significant proportion of pediatric oncology families. © 2015 Wiley Periodicals, Inc.
Hearst, Mary O; Fulkerson, Jayne A; Parke, Michelle; Martin, Lauren
To refine and validate an existing home food inventory (HFI) for low-income Somali- and Spanish-speaking families. Formative assessment was conducted using two focus groups, followed by revisions of the HFI, translation of written materials and instrument validation in participants’ homes. Twin Cities Metropolitan Area, Minnesota, USA. Thirty low-income families with children of pre-school age (fifteen Spanish-speaking; fifteen Somali-speaking) completed the HFI simultaneously with, but independently of, a trained staff member. Analysis consisted of calculation of both item-specific and average food group kappa coefficients, specificity, sensitivity and Spearman’s correlation between participants’ and staff scores as a means of assessing criterion validity of individual items, food categories and the obesogenic score. The formative assessment revealed the need for few changes/additions for food items typically found in Spanish-speaking households. Somali-speaking participants requested few additions, but many deletions, including frozen processed food items, non-perishable produce and many sweets as they were not typical food items kept in the home. Generally, all validity indices were within an acceptable range, with the exception of values associated with items such as ‘whole wheat bread’ (k = 0.16). The obesogenic score (presence of high-fat, high-energy foods) had high criterion validity with k = 0.57, sensitivity = 91.8%, specificity = 70.6% and Spearman correlation = 0.78. The revised HFI is a valid assessment tool for use among Spanish and Somali households. This instrument refinement and validation process can be replicated with other population groups.
.... Designing notes which 'prompt' residents to gather patient information vital to optimal care can teach residents the concepts of longitudinal care, particularly chronic disease management and preventive care...
Kassam, Aliya; Sharma, Nishan; Harvie, Margot; O’Beirne, Maeve; Topps, Maureen
Abstract Objective To conduct a thematic analysis of the College of Family Physicians of Canada’s (CFPC’s) Red Book accreditation standards and the Triple C Competency-based Curriculum objectives with respect to patient safety principles. Design Thematic content analysis of the CFPC’s Red Book accreditation standards and the Triple C curriculum. Setting Canada. Main outcome measures Coding frequency of the patient safety principles (ie, patient engagement; respectful, transparent relationships; complex systems; a just and trusting culture; responsibility and accountability for actions; and continuous learning and improvement) found in the analyzed CFPC documents. Results Within the analyzed CFPC documents, the most commonly found patient safety principle was patient engagement (n = 51 coding references); the least commonly found patient safety principles were a just and trusting culture (n = 5 coding references) and complex systems (n = 5 coding references). Other patient safety principles that were uncommon included responsibility and accountability for actions (n = 7 coding references) and continuous learning and improvement (n = 12 coding references). Conclusion Explicit inclusion of patient safety content such as the use of patient safety principles is needed for residency training programs across Canada to ensure the full spectrum of care is addressed, from community-based care to acute hospital-based care. This will ensure a patient safety culture can be cultivated from residency and sustained into primary care practice. PMID:27965349
Lee, Linda; Weston, W Wayne; Hillier, Loretta; Archibald, Douglas; Lee, Joseph
Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.
da Silva, Jaqueline Aragoni; da Silva, Kelly Samara; Del Duca, Giovani Firpo; Dos Santos, Priscila Cristina; Wolker, Sofia; de Oliveira, Elusa Santina Antunes; de Barros, Mauro Virgílio Gomes; Nahas, Markus Vinicius
To investigate the moderating effect of gross family income on the association between demographic indicators and active commuting to work in Brazilian adults. Secondary analysis of the survey "Lifestyle and leisure habits of industry workers" (n=46,981), conducted in 24 Brazilian states (2006-2008). Self-reported information was collected with a previously tested questionnaire. Crude and adjusted logistic regression models were applied to analyze the association between sociodemographic variables (sex, age, marital status, number of children, education, country area and company size) and active commuting to work in different strata of gross family income. To test the moderating effect, an interaction analysis was applied. The proportion of active commuters among low-, medium- and high-income workers was 40.7% (95%CI:40.0%;41.5%), 27.0% (95%CI:26.3;27.6%) and 11.1%, (95%CI:10.5%;11.7%), respectively. The moderating effect of gross family income was confirmed. Men were more likely (OR:1.22 95%CI:1.12;1.32) to commute actively than women among low-income individuals. Active commuting was less likely among older workers in low-(OR30-39:0.90 95%CI: 0.83;0.98; OR≥40: 0.76 95%CI: 0.68;0.85) and medium-income strata (OR30-39:0.87 95%CI:0.80;0.95; OR≥40:0.84 95%CI:0.76;0.93) and among married individuals in high-income strata (OR:0.72 95%IC:0.61;0.84). Adults with lower education (ORhigh:10.80 95%CI:8.47;13.77), working in the south (ORhigh:1.93 95%CI:1.53;2.44) and in small companies (ORlow:2.50 95%CI:2.28;2.74) were more likely to commute actively; however, the magnitude of these associations differed at each income strata. There was an inverse association between gross family income and active commuting. Gross family income acts as a moderator of the association between demographic indicators and active commuting. Copyright © 2016 Elsevier Inc. All rights reserved.
The conzequence low income of the farmer household in agricultural sector is the increase in their activities as miner of sand and stone. It means for increasing of their household income. However, how important mining role on the increasing of household income has to be studied in deeply. The factual problem is the base for research aims, with the spesific stress on studying socio-economic characteristic of sand and stone miner, and the contribution of the mining income to household income. ...
DeVoe, Jennifer E.; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A.
PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, “Is there anything else you would like to tell us?” Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere. PMID:18025488
Devoe, Jennifer E; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A
Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.
Chuang, Emmeline; Aftosmes-Tobio, Alyssa; Blaine, Rachel E.; Giannetti, Mary; Land, Thomas; Davison, Kirsten K.
Introduction The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social–ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM). Methods From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized. Results Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors. Conclusion The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity. PMID
Luecken, Linda J.; Jewell, Shannon L.; MacKinnon, David P.
Objective The postpartum period represents a crucial transition period in which weight gain or loss can affect lifetime obesity risk. This study examined the prevalence of obesity and the influence of childhood abuse and family conflict on postpartum weight among low-income Mexican-origin women. Depressive symptoms and partner support were evaluated as mediators. Methods At a prenatal assessment, low-income Mexican-origin women (N=322; mean age = 27.8; SD = 6.5) reported on childhood abuse and family conflict. Weight was measured seven times between 6 weeks and 2 years postpartum and calculated as body mass index (BMI). Regression and growth models were used to estimate the impact of childhood abuse, childhood family conflict, partner support, and depressive symptoms on weight and weight change. Results Higher family conflict predicted higher weight across the first (β = .12, p = .037) and second (β = .16, p = .012) postpartum years. Family conflict (β = .17; p = .018) and low partner support (β = −.16, p = .028) also predicted increasing weight in the first year. Partner support partially mediated the effect of childhood abuse on weight change in the first year (p = .031). Depressive symptomatology mediated the effects of childhood abuse and family conflict on weight status in the second year (abuse: p = .005; conflict: p = .023). Conclusions For low-income Mexican-origin women with a history of childhood abuse or high family conflict, depression and low partner support may be important targets for obesity prevention efforts in the postpartum period. PMID:27583713
Full Text Available The association between low family income and socio-emotional behaviour problems in early childhood has been well-documented, and maternal psychological distress is highlighted as central in mediating this relationship. However, whether this relationship holds for older children, and the precise mechanisms by which income may influence child behaviour is unclear.This study investigated the relationship between family income and child socio-emotional behaviour at 11 years of age, and examined the mediating role of maternal psychological distress over time using the UK Millennium Cohort Study.The primary outcome was parent-reported behavioural problems, as captured by the Total Difficulties Score (TDS, derived from the Strengths and Difficulties Questionnaire (SDQ. Secondary outcomes were the emotional, peer-related, conduct, and hyperactivity/inattention problems subscales of the SDQ; and teacher-reported TDS. Permanent family income was the primary exposure variable; frequency of poverty up to age 11 years was the secondary exposure variable. Maternal psychological distress was operationalised to reflect the trajectory from child birth to age 11. Multivariable logistic regression models were used to estimate the effect of permanent family income on child behaviour at age 11, controlling for maternal psychological distress and other relevant covariates.Results showed a statistically significant protective effect of increased permanent family income on the likelihood of behavioural problems at age 11. This finding was consistent for all SDQ subscales apart from emotional problems, and was strongest for teacher-reported behavioural problems. Maternal distress was an important mediator in the income-child behaviour relationship for parent-reported, but not teacher-reported, behavioural problems.The results of this study strengthen empirical evidence that the child behaviour-income gradient is maintained in older childhood. Mother’s psychological
Riet, van 't H.
Urbanisation and lack of economic growth have resulted in increasing urban poverty in developing countries. As urban residents rely on purchasing their foods, food security of the urban poor is predominantly determined by their purchasing power. Street foods provide many urban residents
Domoff, Sarah E; Lumeng, Julie C; Kaciroti, Niko; Miller, Alison L
To identify whether child and mother characteristics in early childhood predict TV exposure and engagement during mealtime in middle childhood. A total of 220 low-income mother-child dyads participated. Children were 4.26 years old (SD = 0.51) at baseline and 5.94 years (SD = 0.68) at 2-year follow-up. Mothers completed baseline measures of child negative emotionality and parenting practices. Family mealtimes were video recorded and coded for background TV exposure and child TV engagement. Multinomial logistic regression tested whether child emotionality and parenting practices during early childhood predicted risk of child TV exposure or engagement during mealtime, relative to no TV use, 2 years later. Children with greater negative emotionality in early childhood were more likely to engage with TV during mealtime than to have no TV. Similarly, early parenting disciplinary practices characterized by over-reactivity and laxness increased the risk for child TV engagement versus no TV during mealtime approximately 2 years later. We identified 2 factors that associated with an increased risk for TV viewing during meals. Helping parents manage child negative emotionality using positive parenting strategies might reduce later child TV engagement and improve the quality of family mealtimes. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Hoerr, Sharon L; Hughes, Sheryl O; Fisher, Jennifer O; Nicklas, Theresa A; Liu, Yan; Shewchuk, Richard M
Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head Start. Participants were 715 Head Start children and their parents from Texas and Alabama representing three ethnic groups: African-American (43%), Hispanic (29%), and White (28%). The Caregivers Feeding Styles Questionnaire (Hughes) was used to characterize authoritative, authoritarian (referent), indulgent or uninvolved feeding styles. Food intake in several food groups was calculated from 3 days of dietary recalls for the child for evening food intakes from 3 PM until bedtime. Compared to children of authoritarian parents, intakes of fruits, juice and vegetables were lowest among children of indulgent or uninvolved parents (1.77 +/- 0.09 vs 1.45 +/- 0.09 and 1.42 +/- 0.11 cups) as were intakes of dairy foods (0.84 +/- 0.05 vs 0.67 +/- 0.05 and 0.63+0.06 cups), respectively. Findings suggest that permissive parent feeding styles like indulgent or uninvolved relate negatively to children's intake of nutrient-rich foods fruit, 100% fruit juice, vegetables and dairy foods from 3 PM until bedtime.
Wertheimer, Richard; Moore, Kristin Anderson; Kahn, Jordan
Research studies based on statistics for the United States as a whole have documented differences in child and family well-being between children in low-income families and children in more affluent families and between children in single-parent families and children in two-parent families. However, researchers have not explored differences in…
Allen, Jennifer Dacey; Caspi, Caitlin; Yang, May; Leyva, Bryan; Stoddard, Anne M; Tamers, Sara; Tucker-Seeley, Reginald D; Sorensen, Glorian C
Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
Identify useful concepts related to the emotional context facing family members of nursing home residents. These concepts can be used in future studies to design and test interventions that benefit family caregivers. Secondary data analyses of qualitative ethnographic data. Two nursing homes in a large Midwestern city; 8 months of data collection in each. 44 family members of nursing home residents whose health was considered, "declining." Role theory was used to design and help interpret the findings. Data included transcripts of conversations between family members and researchers and were analyzed using a coding scheme developed for the secondary analysis. Comments about emotions related to the social role of family member were grouped into three categories: relief related to admission, stress, and decision making support/stress. Subcategories of stress include the role strain associated with "competing concerns" and the psychological pressures of 1) witnessing the decline of a loved one in a nursing home, and 2) guilt about placement. Decision-making was discussed as a challenge which family members did not want to face alone; support from the resident, health care professionals, and other family members was appreciated. Family members may benefit from role reinforcement activities provided by nursing home staff and community members. All nursing home staff members (in particular social workers) and physicians are called upon to provide educationa and support regarding nursing home admissions, during the decline of the resident, and especially regarding medical decision-making. Community groups are asked to support the family member by offering assistance with concrete tasks (driving, visiting, etc.) and social support.
Rane, Anil; Church, Sydney; Bhatia, Urvita; Orford, Jim; Velleman, Richard; Nadkarni, Abhijit
To review the literature on psychosocial interventions for addiction affected family members in Low and Middle Income Countries (LMIC). A systematic review with a detailed search strategy focussing on psychosocial interventions directed towards people affected by addiction without any gender, year or language specifications was conducted. Identified titles and abstracts were screened; where needed full papers retrieved, and then independently reviewed. Data was extracted based on the aims of the study, to describe the modalities, acceptability, feasibility and effectiveness of the interventions. Four papers met our selection criteria. They were published between 2003 and 2014; the total sample size was 137 participants, and two studies were from Mexico and one each from Vietnam and Malaysia. The predominantly female participants comprised of parents, spouses and siblings. The common components of all the interventions included providing information regarding addiction, teaching coping skills, and providing support. Though preliminary these small studies suggests a positive effect on affected family members (AFM). There was lowering of psychological and physical distress, along with a better understanding of addictive behaviour. The interventions led to better coping; with improvements in self-esteem and assertive behaviour. The interventions, mostly delivered in group settings, were largely acceptable. The limited evidence does suggest positive benefits to AFMs. The scope of research needs to be extended to other addictions, and family members other than spouse and female relatives. Indigenous and locally adapted interventions are needed to address this issue keeping in mind the limited resources of LMIC. This is a field indeed in its infancy and this under recognised and under-served group needs urgent attention of researchers and policy makers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory
Viola, Kate V; Bucholz, Emily; Yeo, Heather; Piper, Crystal L; Piper, Crystal; Bell, Richard H; Sosa, Julie Ann
To determine how marriage, children, and gender influence US categorical general surgery residents' perceptions of their profession and motivations for specialty training. Cross-sectional national survey administered after the January 2008 American Board of Surgery In-service Training Examination. Two hundred forty-eight US general surgery residency programs. All US categorical general surgery residents. We evaluated demographic characteristics with respect to survey responses using the chi(2) test, analysis of variance, and multivariate logistic regression. Interaction terms between variables were assessed. Perceptions of respondents regarding the future of general surgery and the role of specialty training in relation to anticipated income and lifestyle. The survey response rate was 75.0% (4586 respondents). Mean age was 30.6 years; 31.7% were women, 51.3% were married, and 25.4% had children. Of the respondents, 28.7% believed general surgery is becoming obsolete (30.1% of men and 25.9% of women; P = .004), and 55.1% believed specialty training is necessary for success (56.4% of men and 52.7% of women; P = .02). Single residents and residents without children were more likely to plan for fellowship (59.1% single vs 51.9% married, P Marital status, children, and gender appear to have a powerful effect on general surgery residents' career planning.
Slack, Kristen S; Font, Sarah; Maguire-Jack, Kathryn; Berger, Lawrence M
This exploratory study examines combinations of income-tested welfare benefits and earnings, as they relate to the likelihood of child maltreatment investigations among low-income families with young children participating in a nutritional assistance program in one U.S. state (Wisconsin). Using a sample of 1065 parents who received the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) benefits in late 2010 and early 2011, we find that relying on either work in the absence of other means-tested welfare benefits, or a combination of work and welfare benefits, reduces the likelihood of CPS involvement compared to parents who rely on welfare benefits in the absence of work. Additionally, we find that housing instability increases the risk of CPS involvement in this population. The findings from this investigation may be useful to programs serving low-income families with young children, as they attempt to identify safety net resources for their clientele.
The study aims to project future trends in living arrangements and access to children's cash contributions and market income sources among older people in Hong Kong. A cell-based model was constructed by combining available population projections, labour force projections, an extrapolation of the historical trend in living arrangements based on national survey datasets and a regression model on income sources. Under certain assumptions, the proportion of older people living with their children may decline from 59 to 48% during 2006-2030. Although access to market income sources may improve slightly, up to 20% of older people may have no access to either children's financial support or market income sources, and will not live with their children by 2030. Family support is expected to contract in the next two decades. Public pensions should be expanded to protect financially vulnerable older people. © 2015 AJA Inc.
Williams, Lauren K; Andrianopoulos, Nick; Cleland, Verity; Crawford, David; Ball, Kylie
The aims of the current study were to (1) determine the association between personal income and body mass index (BMI) and between individual education and BMI, and (2) examine the association between education and BMI across strata of personal income among women. The design of the study was a quantitative analysis of data from self-report questionnaires. The study setting was socioeconomically disadvantaged neighborhoods in Victoria, Australia. The study included 4065 nonpregnant women (ages 18-45 years) living in socioeconomically disadvantaged areas. The study used a self-report questionnaire measuring sociodemographic characteristics known to be associated with BMI. Multiple linear regressions with imputation were used to assess the association between education level, personal income, and BMI, while controlling for covariates. Mean (SD) observed BMI was 26.0 (6.1) kg/m2. Compared with women with low education, women with medium (b = -0.81; 95% confidence interval, -1.30 to -0.27; p = .004) and high (b = -1.71; 95% confidence interval, -2.34 to -1.09; p education had statistically significantly lower BMI values. No differences in BMI were observed between income categories. Stratified analyses suggested that the education-BMI association may be stronger in low-income than higher-income women. Our data show that among women living in socioeconomically disadvantaged areas, high education level rather than personal income may be protective against overweight/obesity. High personal income, however, may buffer the effects of low education on BMI. Obesity prevention efforts should target women with amplified disadvantage.
Pan, Liping; May, Ashleigh L.; Wethington, Holly; Dalenius, Karen; Grummer-Strawn, Laurence M.
OBJECTIVE To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. METHODS We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010–2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs. PMID:24276843
de Oliveira Adriana G
Full Text Available Abstract Background We evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers. Methods Cross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W, height (H and body mass index (BMI were classified according to the 2000 National Center for Health Statistics (CDC/NCHS. Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center. Results Children presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively. Conclusion Low income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.
The primary purpose of this study was to assess the efficacy of a family-based exploratory community study titled BOUNCE (Behavior Opportunities Uniting Nutrition, Counseling, and Exercise), to increase physical fitness and activity in low-income Latino mothers and daughters. The BOUNCE study consis...
Treviño, Roberto P.; Vasquez, Liset; Shaw-Ridley, Mary; Mosley, Desiree; Jechow, Katherine; Piña, Christina
Introduction: In the United States, one out of every seven low-income children between the ages of 2 and 5 years is at risk for overweight and obesity. Formative research was conducted to determine if preschool children participating in family-style meals consumed the minimum food servings according to U.S. Department of Agriculture dietary…
Bahatheg, Raja Omar
This research tries to investigate the technical contribution on improving the social interaction of hearing-impaired children from low income families in Saudi Arabia. It compares the social interaction skills of hearing-impaired children who do and do not have access to iPads. To achieve the goals of the study; seventeen children aged five years…
Jarlenski, Marian; Baller, Julia; Borrero, Sonya; Bennett, Wendy L
To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status. We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes immigration status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care. All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P Immigrant children had significantly lower health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Meaney, Karen S.; Hart, Melanie A.; Griffin, L. Kent
Fun & Fit is a program designed to create positive physical activity experiences and to promote healthy lifestyle choices among overweight children from low-income African American and Hispanic American families. The program is a collaborative project between Texas Tech University and the Lubbock Independent School District funded through a…
Coolahan, Kathleen; McWayne, Christine; Fantuzzo, John; Grim, Suzanne
Examined the construct and concurrent validity of the Parenting Behavior Questionnaire-Head Start (PBQ-HS) with low-income African-American families with preschoolers, and whether parenting styles differed by caregiver characteristics. Derived Active-Responsive, Active-Restrictive, and Passive-Permissive parenting dimensions; the last differed…
Leyva, Diana; Sparks, Alison; Reese, Elaine
The relation between preschoolers' phonological awareness and the frequency and quality of parents' book-reading and reminiscing practices were examined in 54 low-income and ethnically diverse families. Children's phonological awareness was assessed at the beginning and end of preschool. Mothers reported the frequency with which they read books…
Schiamberg, Lawrence B.; Chin, Chong-Hee
Focusing on the family as a context for the development of life plans by youth, this report summarizes findings of a 14-year longitudinal study on the educational and occupational life plans and achievement of youth in rural low-income areas in six southeastern states. Specific attention is given to (1) how parental educational and occupational…
The objective of this study was to examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable intake in low-income families with preschool-aged children. Focus group meetings with Head Start parents were conducted by using the nomina...
Depression and other stressors have been associated with general parenting and child outcomes in low-income families. Given that parents shape child eating behaviors through their feeding interactions with their child, it is important to investigate factors that may influence parental feeding of you...
Sano, Yoshie; Richards, Leslie N.; Zvonkovic, Anisa M.
Guided by symbolic interactionism, this qualitative study based on interviews with 83 rural mothers investigated mothers' perceptions of nonresident fathers' involvement in low-income families. Contrary to some fathers' claims that mothers "gatekeep" their access to children, the majority of mothers in our study wanted increased father…
Bugental, Daphne Blunt; Happaney, Keith
Maternal attributions and child neonatal status at birth were assessed as predictors of infant maltreatment (harsh parenting and safety neglect). The population included low-income, low-education families who were primarily Hispanic. Child maltreatment during the 1st year of life (N = 73) was predicted by neonatal status (low Apgar scores, preterm…
Valente Da Silva
Full Text Available Background: TB treatment dropout is one causes of treatment failure, which could increase drug resistant cases. Drug resistant cases of TB were reported by the Ministry of Health of East Timor in 2008 (3 cases, 2009 (3 cases, and in 2010 (6 cases. With drug resistant emerging, TB will require longer treatment time. According to the WHO report (2013 the results of pulmonary tuberculosis BTA (+ treatment were reported: Year 2010 the number of failure of treatment was (0.53%; Died of TB (3.53%; Drop out of treatment (4.05%; Outmigration (3.98%; In 2011 cases of treatment failure (0.50% Died of TB (3.36%; Drop out of treatment (3.36%; Outmigration (1.92%; In 2012 cases of treatment failure (1.03%; Died of TB (3.49% Drop out of treatment (4.59% and migration, (2.26%. According to the National Statistics Directorate (NSD in 2011, that the East Timorese people still live mostly 70.4% in the rural areas. While access to health services remains a challenge, since the people of Timor Leste proclaimed the restoration of its independence. Objective: This study aimed to determine whether there is a relationship between the variables of education, family income, and job with cases of TB medication discontinuation. Methods: This study was conducted using descriptive correlation method. The sample was determined by Ridwan & Akdon (2010 formula. The total of samples was 100 people who met the inclusion and exclusion criteria, and selected randomly. This research was conducted in District Manatuto and Liquica Timor-Leste on March 28, 2015. Results: The correlation test showed a strong positive relationship level if r = 0.51 until +1. Analysis of significance value of r xy = 0.671 and p = 0.000 indicates that there is a significant relationship between the variables of education, job and income with variable discontinuation of treatment. Conclusion: Based on the results of research and data analysis, it can be concluded that the results of this study are as
Campbell, Oona M R; Benova, Lenka; Macleod, David; Goodman, Catherine; Footman, Katharine; Pereira, Audrey L; Lynch, Caroline A
Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect. We used 57 nationally representative Demographic and Health Surveys in low- and middle-income countries (2000-2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects. Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while short-acting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed. Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved
Cason-Wilkerson, Rochelle; Goldberg, Shauna; Albright, Karen; Allison, Mandy; Haemer, Matthew
Childhood obesity disproportionately affects low-income minority populations, yet there is a paucity of literature about effective interventions in this population. This study sought to understand the experience of low-income majority Hispanic families engaged in obesity treatment. We conducted six focus groups (2=English, 4=Spanish) with families who completed a community-based, family-oriented obesity treatment program, using standard qualitative focus group interview methods. Transcripts were recorded, transcribed, and analyzed for thematic content. Two coders using the software program ATLAS.ti (v.7.0; Scientific Software Development GmbH, Berlin, Germany) coded each transcript independently; reflexive team analysis with three study team members was used to reach a consensus. Participants (n=37) indicated high program satisfaction. Parents reported buying less junk/fast food, increased consumption of fruits and vegetables, preparing and eating more meals as a family, and increasing their families' physical activity (PA). Four barrier and facilitator themes emerged. Barrier themes were time and financial cost, parent's lack of time and energy, influence of family members, and challenges regarding physical environment. Facilitator themes were skill building around healthy eating and parenting, family involvement, and long-term health concerns. Unanticipated findings, parents reported, were that changes resulted in children sleeping better, feeling happier, and less irritability. Despite low-income families experiencing barriers to lifestyle changes to manage obesity, they made positive dietary changes and increased PA by learning specific skills and including the whole family in those changes. Additionally, some unexpected benefits were noted, including improved sleep, less irritability, and children appearing happier. Future studies should consider using these parent-identified outcomes as secondary measures of program effectiveness.
Lakin, Ashley; Sutter, Mary Beth; Magee, Susanna
The purpose of our study was to pilot a home visit program targeting neonates conducted by family medicine residents. While the literature shows that home visit programs are successful at preventing adverse outcomes for young children, such as improving parenting practices and promoting breastfeeding, no data exist about newborn home visits conducted by resident physicians. Residents conducted newborn home visits precepted by a family medicine faculty member from June 2012--May 2013. Subjects were recruited from the residency continuity practice and randomized to receive two home visits (which replaced two office visits) or routine office-based newborn care. All participants were surveyed using the validated WHOQOL-BREF quality of life scale and a patient satisfaction instrument. Metrics were also obtained from the electronic medical record. Mothers and resident physicians completed an open-ended questionnaire about their experience. All patients, whether receiving office-based or home-based care, rated their care highly. Significant differences were seen in usage of acute care in the first 6 months of life, and mothers in the home visit group trended toward initiating breastfeeding at a higher rate. The home visit group ranked their quality of life higher across all domains when compared to the control group, approaching statistical significance in two domains. Residents providing home visits reported increased connectedness to patients and improved confidence in anticipatory guidance delivery. Home visits are valuable for families with newborns, in terms of minimizing acute care service usage, breastfeeding promotion, and perhaps increasing maternal perceptions of well-being. A home visit program has the potential to enhance resident education and the doctor-patient relationship.
Full Text Available Abstract Background Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head Start. Methods Participants were 715 Head Start children and their parents from Texas and Alabama representing three ethnic groups: African-American (43%, Hispanic (29%, and White (28%. The Caregivers Feeding Styles Questionnaire (Hughes was used to characterize authoritative, authoritarian (referent, indulgent or uninvolved feeding styles. Food intake in several food groups was calculated from 3 days of dietary recalls for the child for evening food intakes from 3 PM until bedtime. Results Compared to children of authoritarian parents, intakes of fruits, juice and vegetables were lowest among children of indulgent or uninvolved parents (1.77 ± 0.09 vs 1.45 ± 0.09 and 1.42 ± 0.11 cups as were intakes of dairy foods (0.84 ± 0.05 vs 0.67 ± 0.05 and 0.63+0.06 cups, respectively. Conclusion Findings suggest that permissive parent feeding styles like indulgent or uninvolved relate negatively to children's intake of nutrient-rich foods fruit, 100% fruit juice, vegetables and dairy foods from 3 PM until bedtime.
After dramatic declines in poverty from 1950 to the early 1970s in the United States, progress stalled. This article examines the association between trends in poverty and income growth, economic inequality, and changes in family structure using three measures of poverty: an absolute measure, a relative measure, and a quasi-relative one. I found that income growth explains most of the trend in absolute poverty, while inequality generally plays the most significant role in explaining trends in relative poverty. Rising inequality in the 1970s and 1980s was especially important in explaining increases in poverty among Hispanics, whereas changes in family structure played a significant role for children and African Americans through 1990. Notably, changes in family structure no longer had a significant association with trends in poverty for any group in the 1990s.
... recipient for housing for non low-income Indian families and model activities? 1000.108 Section 1000.108... AMERICAN HOUSING ACTIVITIES Affordable Housing Activities § 1000.108 How is HUD approval obtained by a.... Assistance to non low-income Indian families must be in accordance with § 1000.110. Proposals may be...
Sano, Yoshie; Manoogian, Margaret M.; Ontai, Lenna L.
This qualitative study examined the nature of partnerships among 28 rural low-income mothers who experienced partnership transitions across three waves of annual interviews. Guided by "lens of uncertainty" and "boundary ambiguity theory," the authors specifically explored (a) how low-income mothers in rural communities experience partnership…
Full Text Available Inclusive development is mean to accommodate the marginalized people, most of whom are the poor with problem of fulfilling their need of housing. The government has tried hard to meet the need of housing by constructing rusunawa. This paper is aimed at describing about the provision and uses of rusunawa, both in cities and peri urban area by studying the cases in the City of Yogyakarta, Sleman Regency, and Bantul Regency. The study was conducted by doing observation and both structured and in-depth interviews. The research results show that rusunawa was viewed as one solutions to help low-income family in fulfilling their need of housing. In some cases in the City of Yogyakarta, rusunawa plays an important role in preventing the settlement along both sides of rivers from becoming slum areas. Rusunawa in both Regencies of Sleman and Bantul are located near the city so it is easy for the settlers to get to their workplace. The construction of rusunawa has also paid attention to the disabled by providing special facilities. The same case is providing playground for children and facilities for early education for young kids. However, there have not been special facilities for the elderly and pregnant women.
Welker, Kristen; Nabors, Laura; Lang, Myia; Bernstein, Jonathan
This review examined the impact of environmental change and educational interventions targeting young children from minority groups living in urban environments and who were from low-income families. A scoping methodology was used to find research across six databases, including CINAHL, ERIC, PsycINFO, PubMed, MEDLINE, and EMBASE. 299 studies were identified. Duplicates were removed leaving 159 studies. After reviewing for inclusion and exclusion criteria, 23 manuscripts were identified for this study: 11 featured home-environment change interventions and 12 emphasized education of children. Studies were reviewed to determine key interventions and outcomes for children. Both environmental interventions and educational programs had positive outcomes. Interventions did not always impact health outcomes, such as emergency department visits. Results indicated many of the environmental change and education interventions improved asthma management and some symptoms. A multipronged approach may be a good method for targeting both education and change in the home and school environment to promote the well-being of young children in urban areas. New research with careful documentation of information about study participants, dose of intervention (i.e., number and duration of sessions, booster sessions) and specific intervention components also will provide guidance for future research.
Full Text Available Income transfer programmes are common in various countries and play an important role in combating poverty. This article presents a review of the results of the Bolsa Família (Family Grant Programme, implemented in Brazil by the government of Lula da Silva in 2004. Over the last seven years many evaluations of the programme have been conducted, allowing an overview of its results and its strong and weak points to be mapped. Five central aspects relating to the programme are discussed in article five: (1 programme access, (2 hunger fighting results, (3 programme financial impacts, (4 conditioning factors of education and health, (5 supplementary programs and social mobility. The results of scientific research were presented for each of these aspects, and any of these believed to be convergent or divergent were discussed. As a general result it was concluded that the programme has generated significant results for the country, but there are still some issues that need to be reviewed, such as conditioning factors and the integrated management of the programme.
Schoberer, Daniela; Eglseer, Doris; Halfens, Ruud J G; Lohrmann, Christa
In this study, we describe the development of evidence- and theory-based fall prevention educational material and its evaluation from the users' perspectives. To reduce risk factors for falling in nursing homes, nursing staff must enact multifactorial fall prevention intervention programmes. A core component of these programmes is to educate residents and their family members, both verbally and in a written form. However, users can only benefit from educational material if it is based on current scientific evidence, easy to understand and process and customised. We followed a structured procedure during the development process, while considering various aspect of quality. To assess the understandability and usefulness of the resulting educational materials, we conducted a qualitative content analysis study. The educational materials development process incorporated several iterative steps including a systematic literature search and the application of frameworks for designing and writing the materials. To evaluate the material, we performed six focus group discussions separately with residents, family members and nursing staff from two nursing homes (total of 32 participants). Residents' brochures included clear information on avoiding external risks as well as coping strategies after a fall event. Family members' brochures were more comprehensive, including both concrete tips and outlining the advantages and disadvantages of interventions. Residents and family members had no difficulties understanding the material and tried to apply the content to their individual situations. Nursing staff commented on some ambiguities and incongruities relating to current nursing care practice. By involving users in the development of evidence-based educational materials, nursing staff can achieve a high acceptance rate for the materials and motivate users to address the topic. The involvement of users is essential for developing educational material that meets users' needs
Lacasse, Miriam; Théorêt, Johanne; Tessier, Sylvie; Arsenault, Louise
The CanMEDS-Family Medicine (CanMEDS-FM) framework defines the expected terminal enabling competencies (EC) for family medicine (FM) residency training in Canada. However, benchmarks throughout the 2-year program are not yet defined. This study aimed to identify expected time frames for achievement of the CanMEDS-FM competencies during FM residency training and create a developmental benchmarks scale for family medicine residency training. This 2011-2012 study followed a Delphi methodology. Selected faculty and clinical teachers identified, via questionnaire, the expected time of EC achievement from beginning of residency to one year in practice (0, 6, 12, […] 36 months). The 15-85th percentile intervals became the expected competency achievement interval. Content validity of the obtained benchmarks was assessed through a second Delphi round. The 1st and 2nd rounds were completed by 33 and 27 respondents, respectively. A developmental benchmarks scale was designed after the 1st round to illustrate expectations regarding achievement of each EC. The 2nd round (content validation) led to minor adjustments (1.9±2.7 months) of intervals for 44 of the 92 competencies, the others remaining unchanged. The Laval Developmental Benchmarks Scale for Family Medicine clarifies expectations regarding achievement of competencies throughout FM training. In a competency-based education system this now allows identification and management of outlying residents, both those excelling and needing remediation. Further research should focus on assessment of the scale reliability after pilot implementation in family medicine clinical teaching units at Laval University, and corroborate the established timeline in other sites.
The National Savings and Loan League (NSLL) has been researching techniques that may be used to finance energy-conservation measures in the residential sector. Twelve techniques developed and tested by NSLL are: future-advances clause under open-end mortgages; borrowing against existing savings accounts; home-improvement loans; variable-rate mortgages; second trusts or second mortgages; variable-payment mortgages; balloon-payment mortgages; deferred monthly payments for periods of excessive energy use; renegotiation of terms at set intervals; lower interest rates offered on mortgages in return for lender sharing in equity appreciation of the property; graduated payments; and deferred-interest loans. The testing took place in Pittsburgh, PA. The program consisted of 8 specific tasks, including several directed at different financial innovations for the financing of retrofits. Details are presented on findings; legal research; relationship of utilities to installation of retrofits; financing techniques applicable to retrofits; and national energy program for single-family residences. Some extensive attachments include information on: legal aspects, energy loan advertisements, and potential savings to be realized from various residential retrofit energy-conservation measures.
An instrumented single family residence in Greenville, South Carolina, has approximately 1086 square feet on conditioned space. Solar energy is used for space heating the home and preheating domestic and water (DHW). Solar energy enters the attic through a 416 square foot aperture which is double glazed with corrugated, translucent, fiberglass reinforced, acrylic panels. Warm air accumulates in the peak of the attic roof and circulates through the conditioned space or through storage by an air handler. Solar energy is stored in an 870 cubic foot storage bin containing 85,460 pounds of crushed rock located under the house. cold water is preheated in the attic by thermosiphoning water from the 80 gallon preheat tank through a manifold system of copper tubes. These tubes are attached to black sheet metal plates. Preheated city water is stored in the preheat tank and supplied, on demand, to a conventional 80 gallon DHW tank. When solar energy is insufficient to satisfy the space heating load, a water to air heat exchanger in the hot air supply duct provides auxiliary energy for space heating. A gas fired water heater provides auxiliary energy for the water to air heat exchanger and the DHW.
Hixon, Allen L; Buenconsejo-Lum, Lee E; Racsa, C Philip
Access to care for patients in Hawai'i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai'i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai'i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. This study found that 73 percent of graduates remain and practice in Hawai'i with over 36 percent working in Health Professional Shortage Areas. Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai'i's health workforce needs.
Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort
Hayward, R Anna; Honegger, Laura; Hammock, Amy Cristina
Over the last decade there has been an increased focus on improving father engagement to improve child and family outcomes. Recent research suggests that child and family outcomes improve with increased fatherhood engagement. This exploratory study examined risk and protective factors associated with approval of family violence among a sample of low-income fathers (N = 686) enrolled in a responsible fatherhood program. The program goals include increasing father involvement and economic stability and encouraging healthy relationships-with a focus on preventing intimate partner violence. Toward these aims, this study explored factors associated with fathers' self-reported approval of family violence. Understanding the prevalence of risk and protective factors in this population and factors associated with fathers' potential for family violence is important in developing programs to address responsible fatherhood and healthy relationships. © 2017 National Association of Social Workers.
Gewirtz, Abigail H; DeGarmo, David S; Lee, Susanne; Morrell, Nicole; August, Gerald
This article reports 2-year outcomes from a cluster randomized, controlled trial of the Early Risers (ER) program implemented as a selective preventive intervention in supportive housing settings for homeless families. Based on the goals of this comprehensive prevention program, we predicted that intervention participants receiving ER services would show improvement in parenting and child outcomes relative to families in treatment-as-usual sites. The sample included 270 children in 161 families, residing in 15 supportive housing sites; multimethod, multi-informant assessments conducted at baseline and yearly thereafter included parent and teacher report of child adjustment, parent report of parenting self-efficacy, and parent-child observations that yielded scores of effective parenting practices. Data were modeled in HLM7 (4-level model accounting for nesting of children within families and families within housing sites). Two years' postbaseline, intent-to-treat (ITT) analyses indicated that parents in the ER group showed significantly improved parenting self-efficacy, and parent report indicated significant reductions in ER group children's depression. No main effects of ITT were shown for observed parenting effectiveness. However, over time, average levels of parenting self-efficacy predicted observed effective parenting practices, and observed effective parenting practices predicted improvements in both teacher- and parent-report of child adjustment. This is the first study to our knowledge to demonstrate prevention effects of a program for homeless families residing in family supportive housing. (c) 2015 APA, all rights reserved).
Hustedt, Jason T; Vu, Jennifer A; Bargreen, Kaitlin N; Hallam, Rena A; Han, Myae
The federal Early Head Start program provides a relevant context to examine families' experiences with stress since participants qualify on the basis of poverty and risk. Building on previous research that has shown variations in demographic and economic risks even among qualifying families, we examined possible variations in families' perceptions of stress. Family, parent, and child data were collected to measure stressors and risk across a variety of domains in families' everyday lives, primarily from self-report measures, but also including assay results from child cortisol samples. A cluster analysis was employed to examine potential differences among groups of Early Head Start families. Results showed that there were three distinct subgroups of families, with some families perceiving that they experienced very high levels of stress while others perceived much lower levels of stress despite also experiencing poverty and heightened risk. These findings have important implications in that they provide an initial step toward distinguishing differences in low-income families' experiences with stress, thereby informing interventions focused on promoting responsive caregiving as a possible mechanism to buffer the effects of family and social stressors on young children. © 2017 Michigan Association for Infant Mental Health.
Suplicy, Eduardo Matarazzo
This paper presents the positive outcomes of Brazil's Family Allowance Program, in terms of combating hunger and eradicating poverty, stressing that this is the first step towards introducing a Basic Income for Citizenship (RBC - Renda Básica de Cidadania) in Brazil, as established in 2004 through Law N degrees 10,835. This Basic Income for Citizenship will be phased in by stages at the discretion of the Executive Branch, starting with the neediest segments of the population. Everyone will be endowed with the unconditional right to receive an income that will be sufficient - as far as possible - to cover vital requirements. This is not a matter of charity or welfare, but rather an across-the-board right to share in the wealth of the nation. The rationality of this tool for ensuring real freedom and dignity for all is also examined here.
Dustin T. Duncan
Full Text Available Previous research has highlighted the salience of spatial stigma on the lives of low-income residents, but has been theoretical in nature and/or has predominantly utilised qualitative methods with limited generalisability and ability to draw associations between spatial stigma and measured cardiovascular health outcomes. The primary objective of this study was to evaluate relationships between perceived spatial stigma, body mass index (BMI, and blood pressure among a sample of low-income housing residents in New York City (NYC. Data come from the community-based NYC Low-income Housing, Neighborhoods and Health Study. We completed a crosssectional analysis with survey data, which included the four items on spatial stigma, as well objectively measured BMI and blood pressure data (analytic n=116; 96.7% of the total sample. Global positioning systems (GPS tracking of the sample was conducted for a week. In multivariable models (controlling for individual-level age, gender, race/ethnicity, education level, employment status, total household income, neighborhood percent non-Hispanic Black and neighborhood median household income we found that participants who reported living in an area with a bad neighborhood reputation had higher BMI (B=4.2, 95%CI: -0.01, 8.3, P=0.051, as well as higher systolic blood pressure (B=13.2, 95%CI: 3.2, 23.1, P=0.01 and diastolic blood pressure (B=8.5, 95%CI: 2.8, 14.3, P=0.004. In addition, participants who reported living in an area with a bad neighborhood reputation had increased risk of obesity/overweight [relative risk (RR=1.32, 95%CI: 1.1, 1.4, P=0.02 and hypertension/pre-hypertension (RR=1.66, 95%CI: 1.2, 2.4, P=0.007. However, we found no differences in spatial mobility (based GPS data among participants who reported living in neighborhoods with and without spatial stigma (P>0.05. Further research is needed to investigate how placebased stigma may be associated with impaired cardiovascular health among individuals
Jimenez-Cruz, Arturo; Bacardi-Gascon, Montserrat; Pichardo-Osuna, Alexandra; Mandujano-Trujillo, Zally; Castillo-Ruiz, Octelina
The aim of this study was to determine the risk factors of childhood obesity among infants and toddlers from low-income families from three cities in Mexico. This is a cross-sectional study of mothers and their infants and toddlers attending a vaccination centre at three primary care clinics in Tijuana, Tuxtla, and Reynosa. Anthropometric measurements of the mothers and children were conducted at the clinic and a questionnaire was administered to the mother. Eight-hundred and ten mothers and their 5 to 24 months old infants participated in the study. Average age for the mothers was 24 (21-28) years, and 57% of them were either overweight or obese. The children's average age was 12.7 (5-24) months. Overall overweight prevalence in this sample was 11% and obesity 8%, these increased with age, from 3% for overweight and 6 % for obesity before 6 months, to 13 and 10% between 12 to 24 months respectively. Thirty-five percent of infants were breastfed>or=6 month and 92% were introduced to other solid foods before 6 months. Introduction of high-fat content snacks (HFS) and carbonated and non-carbonated sweetened (CSD) drinks starts before 6 months and more than sixty percent of the children between 12 to 24 months of age were eating HFS and CSD sweetened drinks at least once a week. Consumption of snacks and CSD sweetened drinks (>or=1 week) was associated with being overweight and obese (crude), OR, 1.82; 95% CI=1.24-2.65 (p=0.002). These results suggest that preventive programs should be initiated during pregnancy and continued.
Gross, Rachel S; Velazco, Nerissa K; Briggs, Rahil D; Racine, Andrew D
To characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families. We conducted a cross-sectional survey of mothers with 5-year-old children receiving pediatric care at a federally qualified community health center. We used regression analyses to examine the relationship between maternal depressive symptoms (trichotomized: none, mild, moderate to severe) and 1) child weight status; 2) obesity-promoting feeding practices, including mealtime practices and feeding styles; and 3) activity-related behaviors, including sleep time, screen time, and outdoor playtime. The sample included 401 mother-child pairs (78.3% response rate), with 23.4% of mothers reporting depressive symptoms (15.7% mild, 7.7% moderate to severe). Mothers with moderate to severe depressive symptoms were more likely to have overweight and obese children than mothers without depressive symptoms (adjusted odds ratio 2.62; 95% confidence interval 1.02-6.70). Children of mildly depressed mothers were more likely to consume sweetened drinks and to eat out at restaurants and were less likely to eat breakfast than children of nondepressed mothers. Mothers with depressive symptoms were less likely to set limits, to use food as a reward, to restrict their child's intake, and to model healthy eating than nondepressed mothers. Children with depressed mothers had less sleep and outdoor playtime per day than children of nondepressed mothers. Maternal depressive symptoms are associated with child overweight and obese status and with several obesity-promoting practices. These results support the need for maternal depression screening in pediatric obesity prevention programs. Further research should explore how to incorporate needed mental health support. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Archibald, Douglas; Macdonald, Colla J; Plante, Judith; Hogue, Rebecca J; Fiallos, Javier
As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants' responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad's contribution to teaching/learning compared to preceptors. iPad's interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing knowledge through workshops led by more skillful i
Sparks, Martha A.; Radnitz, Cynthia L.
Objective: To examine both unique and interactive effects of parent restrictive feeding and child disinhibited eating behavior on child body mass index (BMI) in low-income Latino and African American preschoolers. Methods: The sample included 229 parent-child pairs, the majority of whom were low-income and Latino (57%) or African American (25%).…
Joshi, Pamela; Quane, James M.; Cherlin, Andrew J.
In this paper, we advance and test an integrative model of the effects of employment status, nonstandard work schedules, male employment, and women's perceptions of economic instability on union formation among low-income single mothers. On the basis of the longitudinal data from 1,299 low-income mothers from the Three-City Welfare Study, results…
The work described in this paper is a continuation of the first phase of the study, which is the determination of the peak bone mass density among residents of Metro Manila using dual energy x-ray absorptiometry. However, it also aims to correlate sex, body mass index, nutritional factors, physical activity and lifestyle to peak bone mass and thus attempts to explain any discrepancies in peak bone mass density to that seen in other countries
Daniel A. Griffith
Full Text Available Computational simplifications for a space-time autoregressive response model specification are explored for the change in Spain's per capita disposable family income between 1975 and 1983. The geographic resolution for this analysis is the provincial partitioning of part of the Iberian peninsula into Spain's 47 coterminous provinces coupled with its 3 island clusters provinces. In keeping with the Paelinckian tradition of spatial econometrics, exploration focuses on both new spatial econometric estimators and model specifications that emphasize the capturing of spatial dependency effects in the mean response term. One goal of this analysis is to differentiate between spatial, temporal, and space-time interaction information contained in the per capita disposable family income data. A second objective of the application is to illustrate the utility of extending computational simplifications from the spatial to the space-time domain. And a third purpose is to gain some substantive insights into the economic development of one country in a changing Europe. A serendipitous outcome of this investigation is a detailed analysis of locational information latent in Spain's regionally disaggregated per capita disposable family income.
Petriwskyj, Andrea; Parker, Deborah; Brown Wilson, Christine; Gibson, Alexandra
A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models. The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience. Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time. Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Lindsay, Ana Cristina; Greaney, Mary L; Wallington, Sherrie F; Wright, Julie A; Hunt, Anne T
Latinos are the largest minority population group in the United States (U.S.), and low-income Latina women are at elevated risk of depression and obesity. Thus, the prevention of these two problems is a pressing public health concern in this population. Both depressive symptoms and obesity are modifiable factors that can be addressed by culturally relevant interventions. However, the association between depressive symptoms and obesity in Latina immigrant women is not well understood. Therefore, this cross-sectional study examined the association between depressive symptoms and obesity among Latina women of childbearing age (15-44). Participants ( n = 147) were low-income, predominantly immigrant Latina mothers enrolled in the Latina Mothers' Child Feeding Practices and Style Study. Women were eligible to participate if they self-identified as Latina; were enrolled in or eligible for the Special Supplemental Nutrition Program for Women, Infants and Children program; had a child between ages two and five years; and were living in the U.S. for at least one year, and residing in Rhode Island. Enrolled participants completed a survey in their language of preference (English or Spanish) administered by bilingual interviewers. About one-third (34%) of participants were classified as having obesity (BMI ≥ 30 kg/m²), 28.3% had elevated depressive symptoms (CES-D ≥ 16), and 70.1% were immigrants. Women with elevated depressive symptoms had increased odds of having obesity (odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.24-6.33). Additionally, among immigrants, length of U.S. residency was associated with increased odds of obesity (OR = 1.05, 95% CI: 1.02-1.09). Findings underscore the need for screening and culturally relevant interventions designed to address both depressive symptoms and obesity among low-income Latina women of childbearing age. Furthermore, findings highlight the importance of taking into account the length of residency in the U.S. when
Ana Cristina Lindsay
Full Text Available Latinos are the largest minority population group in the United States (U.S., and low-income Latina women are at elevated risk of depression and obesity. Thus, the prevention of these two problems is a pressing public health concern in this population. Both depressive symptoms and obesity are modifiable factors that can be addressed by culturally relevant interventions. However, the association between depressive symptoms and obesity in Latina immigrant women is not well understood. Therefore, this cross-sectional study examined the association between depressive symptoms and obesity among Latina women of childbearing age (15–44. Participants (n = 147 were low-income, predominantly immigrant Latina mothers enrolled in the Latina Mothers′ Child Feeding Practices and Style Study. Women were eligible to participate if they self-identified as Latina; were enrolled in or eligible for the Special Supplemental Nutrition Program for Women, Infants and Children program; had a child between ages two and five years; and were living in the U.S. for at least one year, and residing in Rhode Island. Enrolled participants completed a survey in their language of preference (English or Spanish administered by bilingual interviewers. About one-third (34% of participants were classified as having obesity (BMI ≥ 30 kg/m2, 28.3% had elevated depressive symptoms (CES-D ≥ 16, and 70.1% were immigrants. Women with elevated depressive symptoms had increased odds of having obesity (odds ratio (OR = 2.80, 95% confidence interval (CI: 1.24–6.33. Additionally, among immigrants, length of U.S. residency was associated with increased odds of obesity (OR = 1.05, 95% CI: 1.02–1.09. Findings underscore the need for screening and culturally relevant interventions designed to address both depressive symptoms and obesity among low-income Latina women of childbearing age. Furthermore, findings highlight the importance of taking into account the length of residency in
Chen, Jiangsheng; Yang, Hong
Employing data from the China rural-urban mobility survey conducted in 2010, this study investigates the influence of family demographic characteristics on the income, life satisfaction, and potential for rural-urban mobility at the rural household level of two provinces of China: Shaanxi and Henan. A larger labor force in a rural household was found to reduce a family's ability or inclination to move to a city. The findings reveal that family size negatively affects the average income per family member and reduces the marginal income of the labor force and that minor children can improve the life satisfaction of family members. We conclude that a larger family size does not translate to more benefits for a rural household. Family size preference is found to be a reflection of parents' concerns about elderly care and is deemed to be unfavorable for urbanization in P. R. China.
Bradley, Elizabeth H; Curry, Leslie A; Taylor, Lauren A; Pallas, Sarah Wood; Talbert-Slagle, Kristina; Yuan, Christina; Fox, Ashley; Minhas, Dilpreet; Ciccone, Dana Karen; Berg, David; Pérez-Escamilla, Rafael
Many family health innovations that have been shown to be both efficacious and cost-effective fail to scale up for widespread use particularly in low-income and middle-income countries (LMIC). Although individual cases of successful scale-up, in which widespread take up occurs, have been described, we lack an integrated and practical model of scale-up that may be applicable to a wide range of public health innovations in LMIC. To develop an integrated and practical model of scale-up that synthesises experiences of family health programmes in LMICs. We conducted a mixed methods study that included in-depth interviews with 33 key informants and a systematic review of peer-reviewed and grey literature from 11 electronic databases and 20 global health agency web sites. We included key informants and studies that reported on the scale up of several family health innovations including Depo-Provera as an example of a product innovation, exclusive breastfeeding as an example of a health behaviour innovation, community health workers (CHWs) as an example of an organisational innovation and social marketing as an example of a business model innovation. Key informants were drawn from non-governmental, government and international organisations using snowball sampling. An article was excluded if the article: did not meet the study's definition of the innovation; did not address dissemination, diffusion, scale up or sustainability of the innovation; did not address low-income or middle-income countries; was superficial in its discussion and/or did not provide empirical evidence about scale-up of the innovation; was not available online in full text; or was not available in English, French, Spanish or Portuguese, resulting in a final sample of 41 peer-reviewed articles and 30 grey literature sources. We used the constant comparative method of qualitative data analysis to extract recurrent themes from the interviews, and we integrated these themes with findings from the
Quali-quantitative study of nutritional status and eating patterns in children aged 1-3 years from low-income families in two population groups with different productive activities (Buenos Aires, Argentina, 2007-2008
Full Text Available The aim of this article is to describe the nutritional status and eating patterns of children aged 1-3 years from low-income families who reside in areas with different productive activities: primary production and production of goods and services. A descriptive cross-sectional study was performed with a qualitative and quantitative methodology, evaluating anthropometric and biochemical nutritional status, food intake, economic and demographic characteristics, dietary practices and representations. The results show that children from areas of primary production had a lower prevalence of anemia and iron deficiency. They also had a higher consumption of energy, calcium, zinc, vitamin A and protein and a greater diversity and quality in food consumption. We can conclude that the geographical context of families closer to sources of primary production favors interaction with individuals outside of the family, expanding both the informal social network and access to better quality nutritional food.
Kyu, Hmwe Hmwe; Shannon, Harry S; Georgiades, Katholiki; Boyle, Michael H
This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15-49 years) and their children (0-59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15-1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63-0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16-1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies.
Feinberg, A; Lopez, P M; Wyka, K; Islam, N; Seidl, L; Drackett, E; Mata, A; Pinzon, J; Baker, M R; Lopez, J; Trinh-Shevrin, C; Shelley, D; Bailey, Z; Maybank, K A; Thorpe, L E
To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.
Norredam, Marie; Agyemang, Charles; Hoejbjerg Hansen, Oluf K; Petersen, Jørgen H; Byberg, Stine; Krasnik, Allan; Kunst, Anton E
The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included. © 2014 John Wiley & Sons Ltd.
Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna
There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.
Full Text Available While the course and the determinants of fertility behaviour have been investigated intensively, the monetary consequences of birth have hardly been considered empirically to date. Therefore, this paper focuses on the short-term (equivalent household income changes around the time of births in a longitudinal perspective and examines them for their causes. For the analyses of the longitudinal data (GSOEP-Data 1984-2005, fixed effects panel regression models were computed. The results show that the short-term socioeconomic consequences of birth have clearly increased in the last two decades and first births in particular are associated with disproportionately severe socioeconomic consequences, while further births are rarely accompanied by negative changes in the households’ socioeconomic situations. Furthermore, household income losses attributable to births only arise in double income households and increase gradually in line with a rising level of household income before birth. Hence, the analyses suggest the need for more adequate state assistance with respect to family support. Beside the provision of adequate infrastructural conditions which allow mothers to be employed, also the payments to compensate for child-related costs (“Kindergeld” should be – in contrast to the present practice in Germany – increased and re-adjusted with respect to the child’s position in the birth sequence.
McCabe, Kristen; Yeh, May; Lau, Anna; Argote, Carolina Bertely; Liang, June
This study compared low-income Mexican American parents of young children referred for behavior problems to their nonreferred counterparts on an observational measure of parent-child interactions. Referred Mexican American parents demonstrated more negative behaviors than their nonreferred counterparts in both nondirective and highly directive situations. However, no differences were found at moderate levels of directiveness. The most and least directive situations in the Dyadic Parent-Child Interaction Coding System best differentiated referred from nonreferred Mexican American families, and families differed more in their negative behaviors than positive behaviors. Many of the parenting behaviors that have been found to differ between referred and nonreferred Caucasian families were also observed to differ between their Mexican American counterparts. PMID:20171330
Poverty is a social problem that negatively affects all dimensions of family system functioning. In order to provide effective help and intervention to the family, it is essential that the social worker is able to correctly identify problem areas and appropriately choose methods and procedures aimed at restoration of family functioning.
Powell, Catherine; Blighe, Alan; Froggatt, Katherine; McCormack, Brendan; Woodward-Carlton, Barbara; Young, John; Robinson, Louise; Downs, Murna
To explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. Qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. Fourteen semi-structured one-to-one interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015-March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
José Nilson Rodrigues de Menezes
Full Text Available Objective: To understand the psychosocial effects of stroke – cerebrovascular accident (CVA – in a low-income family context. Methods: A qualitative and descriptive research held in one of the units of Associação Beneficente Cearense de Reabilitação (ABCR in Fortaleza, Ceará, in the period from June to December, 2002. Six patients with sequel of CVA and their families joined in the study, regardless of age, with an average of six months of physiotherapy. For data collection we applied free observation and semi-structured interviews to patients and families, mediated by specific guiding questions for each group. From content analysis five categories emerged. Results: The difficulties of family life, the feelings of anguish and anxiety prevailed in the quest for rehabilitation, with the treatment being long, requiring determination and awareness of patient-family dyad. The fear of losing their jobs, the responsibility, the expenses and their family life were present in the discourse of patients and relatives, in addition to questions about the disease and concerns about recovery and / or healing. Final considerations: The stroke (CVA brings as psychological effects feelings of fear, anguish and limitation, contrasting with the determination of the quest for recovery. Socially, the unemployment, both physical and financial dependence and social isolation were highlighted.
Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W
Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.
Angelov, Nikolay; Johansson, Per; Lindahl, Erica
We compare the income and wage trajectories of women in relation to their male partners before and after parenthood. Focusing on the within-couple gap allows us to control for both observed and unobserved attributes of the spouse and to estimate both short- and long-term effects of entering parenthood. Our main finding is that 15 years after the first child was born, the male-female gender gaps in income and wages have increased with 35 and 10 percentage points, respectively. In line with a c...
Chen, Luke Y C; Hubinette, Maria M
Classroom-based learning such as academic half day has undervalued social aspects. We sought to explore its role in the professional identity development of family medicine residents. In this case study, residents and faculty from four training sites in the University of British Columbia Department of Family Practice were interviewed. The "experiences, trajectories, and reifications (ETR) framework" was used as a sensitizing tool for modified inductive (thematic) analysis of the transcripts. Classroom-based learning provided a different context for residents' interpretation of their clinical experiences, characterized as a "home base" for rotating urban residents, and a connection to a larger academic community for residents in rural training sites. Both these aspects were important in creating a positive trajectory of professional identity formation. Teaching directed at the learning needs of family physicians, and participation of family practice faculty as teachers and role models was a precipitation of a curriculum "centered in family medicine." Interactions between family medicine residents and faculty in the classroom facilitated the necessary engagements to reify a shared understanding of the discipline of family practice. Classroom-based learning has substantial impact on professional identity formation at an individual and collective level.
de Azevedo Marques, João Mazzoncini; Zuardi, Antonio W
To evaluate the validity and applicability of the Mini International Neuropsychiatric Interview (MINI) used by family medicine residents in primary health care (PHC) in Brazil. Training for administrating the MINI was given as part of a broad psychiatry education program. Interviews were held with 120 PHC patients who were at least 15 years old. MINI was administered by 25 resident physicians, while the Structured Clinical Interview for Diagnosis (SCID) was administered by a psychiatrist blind to patients' results on the MINI, and the diagnoses on both interviews were compared. The resident physicians answered questions on the applicability of the MINI. Concordance levels for any mental disorder, the broader current diagnostic categories and the most common specific diagnoses were analyzed. Kappa coefficients ranged between 0.65 and 0.85; sensitivity, between 0.75 and 0.92; specificity, between 0.90 and 0.99; positive predictive values (PPV), between 0.60 and 0.86; negative predictive values (NPV), between 0.92 and 0.99; and accuracy, between 0.88 and 0.98. The resident physicians considered MINI comprehensibility and clinical relevance satisfactory. These good psychometric results in a real-world setting may be related to a special training program, which is more frequent, intensive and diversified. In these conditions, the MINI is a useful tool for general practitioners.
Ewerling, Fernanda; Victora, Cesar G; Raj, Anita; Coll, Carolina V N; Hellwig, Franciele; Barros, Aluisio J D
Family planning is key for reducing unintended pregnancies and their health consequences and is also associated with improvements in economic outcomes. Our objective was to identify groups of sexually active women with extremely low demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries, at national and subnational levels to inform the improvement and expansion of programmatic efforts to narrow the gaps in mDFPS coverage. Analyses were based on Demographic and Health Survey and Multiple Indicator Cluster Survey data. The most recent surveys carried out since 2000 in 77 countries were included in the analysis. We estimated mDFPS among women aged 15-49 years. Subgroups with low coverage (mDFPS below 20%) were identified according to marital status, wealth, age, education, literacy, area of residence (urban or rural), geographic region and religion. Overall, only 52.9% of the women with a demand for family planning were using a modern contraceptive method, but coverage varied greatly. West & Central Africa showed the lowest coverage (32.9% mean mDFPS), whereas South Asia and Latin America & the Caribbean had the highest coverage (approximately 70% mean mDFPS). Some countries showed high reliance on traditional contraceptive methods, markedly those from Central and Eastern Europe, and the Commonwealth of Independent States (CEE & CIS). Albania, Azerbaijan, Benin, Chad and Congo Democratic Republic presented low mDFPS coverage (planning method. Subgroups requiring special attention include women who are poor, uneducated/illiterate, young, and living in rural areas. Efforts to increase mDFPS must address not only the supply side but also tackle the need to change social norms that might inhibit uptake of contraception.
Li, Kaigang; Davison, Kirsten K.; Jurkowski, Janine M.
This cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity (LTPA) and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and LTPA (3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute LTPA per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p<.01) and lower family functioning (B = 33.0, p < .05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of LTPA when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms. PMID:22860706
Li, Kaigang; Davison, Kirsten K; Jurkowski, Janine M
The authors in this cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and leisure-time physical activity (3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute leisure-time physical activity per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p < 0.01) and lower family functioning (B = 33.0, p < 0.05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of leisure-time physical activity when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.
Appelhans, Bradley M; Waring, Molly E; Schneider, Kristin L; Pagoto, Sherry L
Frequent family meals and home food preparation are considered important for children's nutritional health and weight maintenance. This cross-sectional study tested whether these parent-driven behaviors are related to the availability of food preparation supplies in low-income urban households. Caregivers of children ages 6-13 provided information on family meal frequency, child consumption of home-prepared dinners, household food insecurity, and attitudes towards cooking. Researchers used a newly developed Food Preparation Checklist (FPC) to assess the availability of 41 food preparation supplies during a physical audit of the home environment. Caregivers and children provided anthropometric measurements and jointly reported on child dietary intake. In ordinal logistic regression models, greater home availability of food preparation supplies was associated with more frequent family meals and child consumption of home-prepared dinners. Associations were independent of household financial strain, food insecurity, caregiver attitudes toward cooking, and sociodemographic characteristics. Fewer food preparation supplies were available in households characterized by greater food insecurity, lower income, and negative caregiver attitudes towards cooking, but did not differ by child or caregiver weight status. As in prior studies, more frequent family meals and consumption of home-prepared dinners were associated with healthier child dietary intake in several areas. We conclude that food preparation supplies are often limited in the most socioeconomically disadvantaged households, and their availability is related to the frequency with which children consume family meals and home-prepared dinners. The potential role of food preparation supplies as contributors to socioeconomic disparities in child nutritional health and obesity deserves further study. Copyright © 2014 Elsevier Ltd. All rights reserved.
Mancilla-Martinez, Jeannette; Pan, Barbara Alexander; Vagh, Shaher Banu
This study investigates the utility and validity of the MacArthur-Bates Communicative Development Inventory (CDI) for use with low-income parents and their 24- to 36-month-old Spanish-English bilingual children (n = 79). Issues in the interpretation of the integrated CDI/Inventarios del Desarrollo de Habilidades Comunicativas (IDHC) score to index…
Garrett-Peters, Patricia; Mills-Koonce, Roger; Zerwas, Stephanie; Cox, Martha; Vernon-Feagans, Lynne
Contextual, mother-, child-, and father-level variables were examined in association with fathers' emotion talk to infants during a shared picture book activity, in an ethnically diverse, low-income sample (N = 549). Significant main effects included the rate of emotion talk from fathers' romantic partners (i.e., the infant's mother), infant…
Wong, Rosa Sze Man; Yu, Esther Yee Tak; Guo, Vivian Yawei; Wan, Eric Yuk-Fai; Chin, Weng-Yee; Wong, Carlos King Ho; Fung, Colman Siu Cheung; Tung, Keith Tsz Suen; Wong, Wilfred Hing-Sang; Ip, Patrick; Tiwari, Agnes Fung Yee; Lam, Cindy Lo Kuen
Chronic stress has adverse effects on health. Adults and children from low-income families are subject to multiple sources of stress. Existing literature about economic hardship mostly focuses on either adults or children but not both. Moreover, there is limited knowledge on the relationship between parental generalised stress and child health problems. This study aims to explore the bidirectional relationship between parental stress and child health in Chinese low-income families and to identify other modifiable factors influencing this relationship. This prospective cohort study will sample 254 low-income parent-child pairs and follow them up for 24 months with assessments at three time points (baseline, 12 and 24 months) on parental stress, health-related quality of life (HRQOL) and child health and behaviour using both subjective measures and objective physiological parameters. This study will collect data using standardised measures on HRQOL and behaviours of children as well as on HRQOL, mental health and stress levels of parents along with physiological tests of allostatic load and telomere length. The mediating or moderating effect of family harmony, parenting style and neighbourhood conditions will also be assessed. Data will be analysed using latent growth modelling and cross-lagged path analysis modelling to examine the bidirectional effect of parental stress and child health over time. Mediation and moderation analysis will also be conducted to examine the mechanism by which the variables relate. This study was approved by the institutional review board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster, reference no: UW 16-415. The study findings will be disseminated through peer-reviewed publications and international conferences. NCT03185273; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise
Bronstein, Janet M; Felix, Holly C; Bursac, Zoran; Stewart, M Kathryn; Foushee, H Russell; Klapow, Joshua
This study examines both provider and client perceptions of the extent to which general health concerns are addressed in the context of publicly supported family planning care. A mail survey of family planning providers (n = 459) accepting Medicaid-covered clients in Arkansas and Alabama gathered data on reported actions and resource referral availability for ten categories of non-contraceptive health concerns. A telephone survey of recent family planning clients of these providers (n = 1991) gathered data on the presence of 16 health concerns and whether and how they were addressed by the family planning provider. Data were collected in 2006-2007. More than half (56%) of clients reported having one or more general health concerns. While 43% of those concerns had been discussed with the family planning providers, only 8% had been originally identified by these providers. Women with higher trust in physicians and usual sources of general health care were more likely to discuss their concerns. Of those concerns discussed, 39% were reportedly treated by the family planning provider. Similarly, over half of responding providers reported providing treatment for acute and chronic health conditions and counseling on health behaviors during family planning visits. Lack of familiarity with referral resources for uninsured clients was identified as a significant concern in the provision of care to these clients. Greater engagement by providers in identifying client health concerns and better integration of publicly supported family planning with other sources of health care for low income women could expand the existing potential for delivering preconception or general health care in these settings.
Wilson Mark C; Mustafa Reem; Gunukula Sameer; Akl Elie A; Symons Andrew; Moheet Amir; Schünemann Holger J
Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...
Nørredam, Marie Louise; Agyemang, Charles; Hoejbjerg Hansen, Oluf K
OBJECTIVES: The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disea...
Upshur Ross EG
Full Text Available Abstract Background The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG, and the implementation of these guidelines into clinical practice patterns. Methods A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI and the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III CPGs in all patient (>18 yr. charts for a period of three months. The JNC VI and NCEP III CPGs were also distributed to each Wayne State family medicine resident, and a copy of each CPG was placed in the preceptor's area of the involved clinics. Identical pre- and post- intervention questionnaires were administered to all residents concerning CPG knowledge and attitude. Results Post-intervention analysis failed to demonstrate a significant difference in CPG knowledge. A stastically significant post-intervention difference was found in only on attitude question. The barriers to CPG compliance were identified as 1 lack of CPG instruction; 2 lack of critical appraisal ability; 3 insufficient time; 4 lack of CPG accessibility; and 5 lack of faculty modeling. Conclusion This study demonstrated no significant post intervention changes in CPG knowledge, and only one question that reflected attitude change. Wider resident access to dedicated clinic time, increased faculty modeling, and the implementation of an electronic record/reminder system that uses a team-based approach are compliance factors that
Graber, Helen V.; Wolfe, Jayne L.
The Family Support Center, recognizing the need for single women with children to maintain stability, has developed a program referred to as the Family Support Center Village, which incorporates a service enriched co-housing model. The "Village" will be the catalyst for these mothers' self-sufficiency and will provide opportunities to develop…
Using a sample of 156 Chinese children aged 2-3 years and their parents, this study examined the effects of socio-economic status, specifically family income and parental education, on the children's internalizing and externalizing psychopathology and whether these effects were mediated by mother-child and father-child conflict. Results indicated that family income, maternal education and paternal education all negatively predicted externalizing symptoms. Income also negatively predicted internalizing symptoms among boys but not girls. Maternal education negatively predicted internalizing symptoms among girls but not boys. The effects of income on psychopathology were fully mediated by mother-child and father-child conflict. In contrast, the effects of education were not mediated or only partially mediated by conflict. Findings are discussed in the framework of the family stress model. © 2013 International Union of Psychological Science.
Chang, Jun-Yih; Chen, Liang-Kung; Chang, Chia-Ching
This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine. Statistical significance between the two groups was observed in sex, age, and educational level (all pexpectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month. Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples' demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.
The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.
Background Childhood depression affects the morbidity, mortality and life functions of children. Individual, family and environmental factors have been documented as psychosocial risk factors for childhood depression, especially family violence, which results in inadequate support, low family cohesion and poor communication. This study investigates the association between psychosocial depression factors in low-income schoolchildren and reveals the potential trouble spots, highlighting several forms of violence that take place within the family context. Methods The study was based on a cross-sectional analysis of 464 schoolchildren aged between 6 and 10, selected by random sampling from a city in the state of Rio de Janeiro, Brazil. Socio-economic, family and individual variables were investigated on the strength of the caregivers’ information and organized in blocks for analysis. A binary logistic regression model was applied, according to hierarchical blocks. Results The final hierarchical regression analysis showed that the following variables are potential psychosocial factors associated with depression in childhood: average/poor relationship with the father (OR 3.24, 95% CI 1.32-7.94), high frequency of victimization by psychological violence (humiliation) (OR 6.13, 95% CI 2.06-18.31), parental divorce (OR 2.89, 95% CI 1.14-7.32) and externalizing behavior problems (OR 3.53 IC 1.51-8.23). Conclusions The results point to multiple determinants of depressive behavior in children, as well as the potential contribution of psychological family violence. The study also reveals potential key targets for early intervention, especially for children from highly vulnerable families. PMID:22776354
Full Text Available Abstract Background Childhood depression affects the morbidity, mortality and life functions of children. Individual, family and environmental factors have been documented as psychosocial risk factors for childhood depression, especially family violence, which results in inadequate support, low family cohesion and poor communication. This study investigates the association between psychosocial depression factors in low-income schoolchildren and reveals the potential trouble spots, highlighting several forms of violence that take place within the family context. Methods The study was based on a cross-sectional analysis of 464 schoolchildren aged between 6 and 10, selected by random sampling from a city in the state of Rio de Janeiro, Brazil. Socio-economic, family and individual variables were investigated on the strength of the caregivers’ information and organized in blocks for analysis. A binary logistic regression model was applied, according to hierarchical blocks. Results The final hierarchical regression analysis showed that the following variables are potential psychosocial factors associated with depression in childhood: average/poor relationship with the father (OR 3.24, 95% CI 1.32-7.94, high frequency of victimization by psychological violence (humiliation (OR 6.13, 95% CI 2.06-18.31, parental divorce (OR 2.89, 95% CI 1.14-7.32 and externalizing behavior problems (OR 3.53 IC 1.51-8.23. Conclusions The results point to multiple determinants of depressive behavior in children, as well as the potential contribution of psychological family violence. The study also reveals potential key targets for early intervention, especially for children from highly vulnerable families.
Jurkowski, Janine M.; Davison, Kirsten K.
Abstract Background: Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool children's TV-viewing time and the moderating effect of social support from nonfamily members on this association. Methods: In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier. Results: Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support. Conclusions: Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool children's TV-viewing time. PMID:24168754
Li, Kaigang; Jurkowski, Janine M; Davison, Kirsten K
Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool children's TV-viewing time and the moderating effect of social support from nonfamily members on this association. In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier. Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support. Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool children's TV-viewing time.
Full Text Available Objective: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe.Methods: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents.Results: Findings from this chart review include: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative.Discussion: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients.
Martins, Mayra; Santos, Manoel Antonio Dos; Pillon, Sandra Cristina
Families who are socially excluded are vulnerable to problems related to the use of psychoactive substances. This study aimed to identify the perception regarding drugs use among families that lived in extreme poverty and participated in a social-educational group in the suburbs of a city in the interior of São Paulo State. A survey-like quantitative study was conducted involving 70 members of families who participated in the social-educational groups of the Program for Integral Assistance to the Family. Results indicated that 67 (95.7%) of the subjects were married, at an average age of 37, most of them had not completed grade school, and were unemployed. Fifty five (78.6%) had a family member who used alcohol, fifty two (74,3%) smoked, and twenty three (32.9%) used some kind of illicit drug. The results also showed that living with a relative who was a drug user was perceived as problem that elicited feelings resentment, but also conformism on the part of other family members.
I present the results of two NASA-IDEAS/STScI* sponsored and one IAU OAD grant for astronomy outreach programs for seriously ill or traumatically injured children and their families staying at the Ronald McDonald Houses of Long Island (New Hyde Park, NY) and Chicago or for children hospitalized at the Winthrop University Hospital Children’s Medical Center, (Mineola, NY). An astronomy program was also created for the five Fresh Air Fund Charity summer camps (low-income and special needs) and for a Hofstra summer camp for developmentally challenged youths.These programs are designed for children of all ages include” STSCi’s “Tonight’s Sky” (monthly guide to the sky); telescope observations of the Moon, Sun, planets, nebulae, and stars; and hands-on activities. During cloudy weather remote/robotic telescope observations are shown to the children.The staff and volunteers at the Ronald McDonald House and Children’s Medical Center are trained to use the telescope and to do astronony demonstrations. I created an Activity Book for the staff with demonstrations, participatory hands-on activities, and edible demonstrations using chocolate, marshmallows, and popcorn are to stimulate interest.These educational activities help children and their families learn about astronomy while providing a diversion to take their minds off their illness during a stressful time. The RMHs provide free or low-cost housing in a comfortable, supportive alternative atmosphere where family members sleep, eat, relax and find support from other families in similar situations. Families are kept united when mutual support is as critical as the medical treatment itself. The ill children and their families may stay for a few days or months because of chemotherapy, dialysis, or rehabilitative therapy. Children from 50 states and 50 countries stay the Chicago RMHs and there are 260 RMHs in the US and 65 worldwide.
Ho, Ka Yan; Li, William H C; Chung, Joyce Oi Kwan; Lam, Katherine Ka Wai; Chan, Sophia S C; Xia, Wei
Despite compelling evidence demonstrating the negative impact of poverty and income disparity on children's psychological well-being, there has been a lack of qualitative information which addresses its contributing factors. This study aimed to shed light on this area by comparing the experiences toward daily life between children living in low- and high-income families. A qualitative study using a phenomenological approach was conducted from May 2012 to January 2013. A random sample of 42 children aged 10-13, with 25 from low- and 17 from high-income families were asked to voluntarily response to a demographic sheet and undergo individual semi-structured interviews which lasted about 25-30 min. Content analysis was used to analyze the data. Approval for the study was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference UW 12-237). The findings of this study revealed that the living environment, physical health, social life and ability to function at school of children from low-income families are severely impaired. It fills a gap in the literature by showing how poverty and income disparity affect the daily lives of children from low-income families on different levels. Also, adopting a sedentary lifestyle and unhealthy eating habits are possible factors mediating the effects of poverty and income disparity on the psychological well-being of children from low-income families. It is vital for healthcare professionals going beyond their normal roles to give advice on healthy lifestyles and behaviors by building multidisciplinary partnerships with schools and the community. Additionally, healthcare professionals should also target on these two possible factors to develop and implement appropriate interventions for promoting the psychological well-being among children living in poverty. Trial registration NCT02877719. 19 August 2016 retrospectively registered.
Das, Birajalaxmi; Ghosh, Anu; Ahmad, Shazia; Saini, DivyaIakshmi; Chauhan, P.S.; Seshadri, M.
For this study, 200 nuclear families have been analyzed using over 40 mini- and microsatellite markers. Cord blood samples for the child and peripheral blood samples for the parent(s) were collected in EDTA vacuutainers from the hospital units located in High Level Natural Radiation Areas (HLNRA) and Normal Level Natural Radiation Areas (NLNRA). Both the parents of the newborn were exposed to the background dose. The families were grouped into four distinct dose groups - NLNRA group 5.00 mGy/year. An overall mutation rate of 2.08 X 10 -3 per cell per generation was observed for NLNRA and 2.12 X 10 -3 per cell per generation for HLNRA families. No radiation induced dose response was observed for the stratified groups. Thus, this study shows that mutation rates at mini- and microsatellites in the off springs of the parents living in the high background radiation areas of Kerala does not vary with radiation exposure. This is the first report to understand germline mutation rates at hypervariable loci in families residing in high level natural radiation areas of the world
Sandercock, Gavin R H; Lobelo, Felipe; Correa-Bautista, Jorge E; Tovar, Gustavo; Cohen, Daniel Dylan; Knies, Gundi; Ramírez-Vélez, Robinson
To determine the associations between socioeconomic status (SES) and physical fitness in a sample of Colombian youth. Prueba SER is cross-sectional survey of schoolchildren in Bogota, Colombia. Mass, stature, muscular fitness (standing long-jump, handgrip), and cardiorespiratory fitness (20-m shuttle run) were measured in 52?187 schoolchildren 14-16 years of age. Area-level SES was categorized from 1 (very low) to 4 (high) and parent-reported family income was categorized as low, middle, or high. Converting measures into z scores showed stature, muscular, and cardiorespiratory fitness were significantly (z?=?0.3-0.7) below European values. Children in the mid- and high SES groups jumped significantly further than groups with very low SES. Differences were independent of sex but became nonsignificant when adjusted for anthropometric differences. Participants in the mid-SES and high-SES groups had better handgrip scores when adjusted for body dimension. There were, however, no significant between-group differences in cardiorespiratory fitness, which was strongly clustered by school and significantly greater in students from private schools. Area-level SES is associated with measures of muscular fitness in Colombian schoolchildren. These associations were largely explained by the large differences in body dimensions observed between SES groups. When area-level SES is considered, there was no evidence that family income influenced fitness. The clustering of outcomes reaffirms the potential importance of schools and area-level factors in promoting fitness through opportunities for physical activity. Interventions implemented in schools, can improve academic attainment; a factor likely to be important in promoting the social mobility of children from poorer families. Copyright © 2016 Elsevier Inc. All rights reserved.
Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and/or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility — more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. PMID:21225585
Taylor, Ronald D
Association of demanding kin relations and family routine with adolescents' psychological distress and school achievement was assessed among 200 low-income, African American mothers and adolescents. Demanding kin relations were significantly associated with adolescents' psychological distress. Family routine was significantly related to adolescents' school achievement. Demanding kin relations were negatively associated with school achievement for adolescents from families low in routine, but unrelated to achievement for adolescents in families high in routine. Additional research is needed on poor families and their social networks. © 2015 The Author. Journal of Research on Adolescence © 2015 Society for Research on Adolescence.
Vandell, Deborah Lowe; Ramanan, Janaki
Early (during the child's first three years) and recent (during the previous three years) maternal employment were associated with less family poverty and higher scores on measures of home environment. Early maternal employment predicted second grade children's math achievement, and recent maternal employment predicted their reading achievement.…
Policymakers need to decide how to invest in strengthening the most basic foundation for early childhood development: family relationships. The challenges: (1) help parents provide the responsive and stimulating environments that will prepare young children for school; and (2) support fathers' engagement with their children regardless of whether…
Saunders, Katherine; Lower-Basch, Elizabeth
Half of all non-loan federal student aid is now offered as tax benefits for educational costs in the form of credits, deductions, and college savings accounts. These benefits help students and families offset the costs of their postsecondary education with tax savings. Yet, as explained in the 2013 report, "Reforming Student Aid: How to…
Hawley, L E; Shear, C L; Stark, A M; Goodman, P R
This cross-sectional survey of a low socioeconomic patient group was designed to determine the prevalence and severity of parentally perceived behavioral problems in adolescents as well as to investigate the correlation between such problems and single parenting, family communications, and medical care delivered. The sample population consisted of 79 parents and 121 teenagers selected from a family practice center. The medical record and telephone interview were the sources of information. Results include a parental perception of a high prevalence of problems with school grades (48 percent), school attendance (38 percent), and household problems (chores and sibling rivalry). Of low prevalence but high severity were perceived problems related to suicidal ideation, running away, sexual activity, and gang membership. Single-parent homes had a threefold higher incidence of behavioral problems, a greater degree of communication, and a lower use of community resources than two-parent families. None of the approximately 400 perceived behavioral problems listed by parents was found in the family physicians' master problem list. The results indicate the need for physician education of low socioeconomic and single-parent patients with regard to communication and coping style. In addition, it appears that training programs should provide more education in the care of adolescents.
Azami-Aghdash, Saber; Ghojazadeh, Morteza; Aghaei, Mir Hossein; Naghavi-Behzad, Mohammad; Asgarlo, Zoleikha
In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.
Mason, W A; Hanson, Koren; Fleming, Charles B; Ringle, Jay L; Haggerty, Kevin P
In November 2012, Washington State and Colorado became the first states in the United States to legalize recreational marijuana use for adults, and Uruguay became the first country to allow the cultivation, distribution, possession, and use of marijuana. One possible consequence of these changes is increased adolescent marijuana use. Parents may mitigate this adverse consequence; however, whether parents and adolescents have accurate knowledge about the laws and are discussing marijuana use in light of the law changes is unknown. We examine perceptions, knowledge, and parent-child discussions about Washington State's recreational marijuana law in a sample of low-income families. Participants were a subset of families (n = 115) in an ongoing study that originally recruited parents and adolescents from middle schools in Tacoma, Washington. In summer 2013, when students were entering the 11(th) grade, students and their parents were asked questions about the recreational marijuana law. Participants perceived that their marijuana-related attitudes and behaviors changed little as a result of the law, and displayed uncertainty about what is legal and illegal. Most parents reported discussing the new law with their children but only occasionally, and conversations emphasized household rules, particularly among parent lifetime marijuana users compared to non-users. Conclusions/Importance: Results suggest that there should be a public health campaign focused on families that provides clear information about the recreational marijuana laws.
Mohammad Reza Iravani
Full Text Available This paper presents a social work study on relationship between various family characteristics and street children in rural area as well as city of Esfahan, Iran. The proposed study selects a sample of 150 street children, 75 from city and 75 from rural area, and using some statistical tests verifies the effects of three factors including family income, place of residency and family size on street children. The results indicate that the city residence had more street children than rural residence did. In addition, there was a meaningful difference between the number of street children in low-income families and high-income families. Finally, the survey results indicate that big size families more likely suffered from street children than low size families did.
Black, Andrew P; Brimblecombe, Julie; Eyles, Helen; Morris, Peter; Vally, Hassan; O Dea, Kerin
Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10-20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23-29g) in the two higher quality WIC studies. Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy
Power, Thomas G; O'Connor, Teresia M; Orlet Fisher, Jennifer; Hughes, Sheryl O
Parent feeding has been associated with child overweight/obesity in low-income families. Because acculturation to the United States has been associated with increased adult obesity, our study aim was to determine whether acculturation was associated with feeding in these populations. Low-income Hispanic mothers of preschoolers were recruited to participate in a longitudinal study examining child eating behaviors. At baseline, mothers completed questionnaires on feeding styles, feeding practices, and acculturation. Regression analyses compared feeding styles and food parenting practices of first-generation, immigrant mothers born outside the United States (n = 138) and mothers born in the United States (n = 31). The correlates of acculturation with these same constructs were also examined. Immigrant mothers reported using highly directive food parenting practices more often than mothers born in the United States, including pressuring their child to consume more food, using food as a reward, and controlling child food intake by limiting less-healthy foods. First-generation mothers were more likely to show authoritarian, and less likely to show indulgent, feeding styles. Greater maternal acculturation was associated with less restriction of food for weight reasons. Although first-generation, immigrant mothers reported using highly controlling food parenting practices with their children, those born in the United States were more indulgent with their children in the feeding context. Mechanisms that promote greater indulgence in more-acculturated mothers need to be identified.
The design of a solar heating and hot water system for the New Castle Redevelopment Authority's single-family dwelling located at New Castle, Pennsylvania is described. Documentation submitted by the contractor for Government review of plans, specifications, cost trade studies and verification status for approval to commit the system to fabrication is presented. Also included are system integration drawings, major subsystems drawings, and architect's specifications and plans.
... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income (as...
Azzani, Meram; Roslani, April Camilla; Su, Tin Tin
In Malaysia, the healthcare system consists of a government-run universal healthcare system and a co-existing private healthcare system. However, with high and ever rising healthcare spending on cancer management, cancer patients and their families are likely to become vulnerable to a healthcare-related financial burden. Moreover, they may have to reduce their working hours and lose income. To better understand this issue, this study aims to assess the financial burden of colorectal cancer patients and their families in the first year following diagnosis. Data on patient costs were collected prospectively in the first year following diagnosis by using a self-administered questionnaire and telephone interviews at three time points for all four stages of colorectal cancer. The patient cost data consisted of direct out-of-pocket payments for medical-related expenses such as hospital stays, tests and treatment and for non-medical items such as travel and food associated with hospital visits. In addition, indirect cost data related to the loss of productivity of the patient and caregiver(s) was assessed. The patient's perceived level of financial difficulty and types of coping strategy were also explored. The total 1-year patient cost (both direct and indirect) increased with the stage of colorectal cancer: RM 6544.5 (USD 2045.1) for stage I, RM 7790.1 (USD 2434.4) for stage II, RM 8799.1 (USD 2749.7) for stage III and RM 8638.2 (USD 2699.4) for stage IV. The majority of patients perceived paying for their healthcare as somewhat difficult. The most frequently used financial coping strategy was a combination of current income and savings. Despite the high subsidisation in public hospitals, the management of colorectal cancer imposes a substantial financial burden on patients and their families. Moreover, the majority of patients and their families perceive healthcare payments as difficult. Therefore, it is recommended that policy- and decision-makers should further
Hammer, Carol Scheffner; Miccio, Adele W
Learning to read is a complex process and a number of factors affect a child's success in beginning reading. This complexity increases when a child's home language differs from that of the school and when the child comes from a home with limited economic resources. This article discusses factors that have been shown to contribute to children's success in early reading, namely-phonological awareness, letter-word identification, oral language, and the home literacy environment. Preliminary evidence suggests that bilingual children from low-income backgrounds initially perform poorly on phonological awareness and letter identification tasks, but appear to acquire these abilities quickly in kindergarten once these abilities are emphasized in early reading instruction. In addition, the findings show that bilingual preschoolers' receptive language abilities in English and Spanish positively impact their early letter-word identification abilities at the end of kindergarten. A positive relationship between bilingual preschoolers' home literacy environment and early reading outcomes has not been found to date. Educational implications for serving young, bilingual children from programs such as Head Start are discussed.
Berkenstadt, Haim; Perlson, Daria; Shalomson, Orit; Tuval, Atalia; Haviv-Yadid, Yael; Ziv, Amitai
Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.
Routine training is not enough: structured training in family planning and abortion improves residents' competency scores and intentions to provide abortion after graduation more than ad hoc training.
Macisaac, Laura; Vickery, Zevidah
Abortion provision remains threatened by the paucity of physicians trained to provide them. Lack of training during residency has been cited by obstetrician and gynecologist (ob-gyn) physicians as a reason for not including abortion in their practice. We administered surveys on interest, competency and intention to provide abortions to two groups of ob-gyn residents: one experiencing a new comprehensive and structured family planning rotation, and another group at our affiliate hospital's residency program receiving "ad hoc" training during their routine gynecology rotations. Surveys were anonymous and blinded to investigator. The structured family planning rotation group compared to the ad hoc group reported significantly increased competency score using a Likert scale in manual vacuum aspiration (MVA) (4.5 vs. 1; p=.003) and had a higher proportion reporting intent to provide office MVA postresidency (100% vs. 39%; p=.01) and being trained to 22.5 weeks' vs. 12 weeks' gestation (p=.005). In bivariate analysis, competency in MVA was associated with higher intentions to provide MVA after residency (p=.007). A structured rotation in family planning and abortion for obstetrics/gynecology residents results in increases in competency and intentions to provide abortion, and an association between the two. In-hospital structured training proved to be superior to ad hoc training in our affiliate institution in improving competency and intention to provide abortion after residency. Copyright © 2012 Elsevier Inc. All rights reserved.
Glendening, Zachary S; McCauley, Erin; Shinn, Marybeth; Brown, Scott R
Though disability and housing instability are discussed separately in public health literature, few studies address families at their intersection. As a result, little is known about families who experience both homelessness and disability, how many receive disability benefits like SSI and SSDI, or the influence of those benefits on health-promoting outcomes like housing stability and self-sufficiency. Moreover, no previous research compares the ability of different housing and service interventions to increase disability benefit access. We examine relationships between disabilities and SSI/SSDI income reported when families enter emergency shelters and later health-promoting outcomes (housing stability and self-sufficiency) and how housing interventions affect SSI/SSDI receipt. Families in the (name removed) Study (N = 1857) were interviewed in emergency shelters, randomly offered of one of three housing interventions or usual care (i.e., no immediate referral to any intervention beyond shelter), and re-interviewed 20 months later. A third of families reported a disability at shelter entry. SSI/SSDI coverage of these families increased nearly 10% points over 20 months but never exceeded 40%. Disabilities predicted greater housing instability, food insecurity, and economic stress and less work and income. Among families reporting disabilities, SSI/SSDI receipt predicted fewer returns to emergency shelter, and more income despite less work. Offers of long-term housing subsidies increased SSI/SSDI receipt. Many families experiencing homelessness have disabilities; those receiving SSI/SSDI benefits have better housing and income outcomes. Providing families experiencing homelessness with long-term housing subsidies and SSI/SSDI could improve public health. Copyright © 2017 Elsevier Inc. All rights reserved.
Kant, Ashima K; Graubard, Barry I
Children from ethnic minority and low-income families in the United States have higher rates of poor health and higher mortality rates. Diet, an acknowledged correlate of health, may mediate the known race-ethnic and socioeconomic differentials in the health of US children. The objective was to examine the independent association of race-ethnicity, family income, and education with nutritional and lipid biomarkers in US children. We used data from the NHANES 2003-2006 to examine serum concentrations of vitamins A, D, E, C, B-6, and B-12; serum concentrations of folate, carotenoids, and lipids; and dietary intakes of corresponding nutrients for 2-19-y-old children (n = ~2700-7500). Multiple covariate-adjusted regression methods were used to examine the independent and joint associations of race-ethnicity, family income, and education with biomarker status. Non-Hispanic blacks had lower mean serum concentrations of vitamins A, B-6, and E and α-carotene than did non-Hispanic whites. Both non-Hispanic blacks and Mexican Americans had higher mean serum vitamin C, β-cryptoxanthin, and lutein + zeaxanthin but lower folate and vitamin D concentrations compared with non-Hispanic whites. In comparison with non-Hispanic whites, non-Hispanic blacks were less likely to have low serum HDL cholesterol or high triglycerides. Family income and education predicted few biomarker or dietary outcomes, and the observed associations were weak. Moreover, modification of race-ethnic differentials by income or education (or vice versa) was noted for very few biomarkers. Race-ethnicity, but not family income or education, was a strong independent predictor of serum nutrient concentrations and dietary micronutrient intakes in US children and adolescents.
Wearne, Susan M.; Wearne, Susan M.; Wearne, Susan M.
but less overt components of residency education. Method Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning......, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Results Thirteen Australian family physicians from five states and one territory, and three Canadians from one...
Maulida, Rizka; Nanishi, Keiko; Green, Joseph; Shibanuma, Akira; Jimba, Masamine
The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia. Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection. Settings Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia. Public junior-high-school students (n 681) in grades 7 and 8, aged 13-14 years (377 girls and 304 boys). Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=-0·05, P=0·01) and with the health subscale (β=-0·04; P=0·02). Females were less likely than males to consider health when choosing foods (β=-0·16; P=0·03). While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food's convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.
The Solar Heating System installer guidelines are provided for each subsystem and includes testing and filling the system. This single-family residential heating system is a solar-assisted, hydronic-to-warm-air system with solar-assisted domestic water heating. It is composed of the following major components: liquid cooled flat plate collectors; water storage tank; passive solar-fired domestic water preheater; electric hot water heater; heat pump with electric backup; solar hot water coil unit; tube-and-shell heat exchanger, three pumps, and associated pipes and valving in an energy transport module; control system; and air-cooled heat purge unit. Information is also provided on the operating procedures, controls, caution requirements, and routine and schedule maintenance. Information consists of written procedures, schematics, detail drawings, pictures and manufacturer's component data.
Fashner, Julia; Drye, Stephen T
The Internet has affected the day-to-day lives of physicians, hospitals, and patients. The medical information for each is available at a moment's notice. We surveyed patients to see how many have access to the Internet and whether they are interested in using the Internet to communicate about their medical care. An anonymous one-page survey was given to patients over the age of 18 who had an office visit at the Family Medicine Center. A total of 258 of 300 surveys were returned. A majority of these patients have access to the Internet (80.6%). Patients were most interested in being able to receive appointment reminders by e-mail (44.6%), get answers to medical questions (41.9%), and schedule appointments online (41.5%). Patients would like to be active participants in their medical care electronically. We encourage other physicians to investigate what patients in their practice would consider a service to provide electronically.
Devine, Carol M; Connors, Margaret M; Sobal, Jeffery; Bisogni, Carole A
Lower status jobs, high workloads and lack of control at work have been associated with less healthful diets, but the ways through which work is connected to food choices are not well understood. This analysis was an examination of workers' experience of the relationship of their jobs to their food choices. Fifty-one multi-ethnic, urban, low- and moderate-income adults living in Upstate New York in 1995 participated in a qualitative interview study of fruit and vegetable choices and discussed employment and food choices. The workers who participated in this study described a dynamic relationship between work and food choices that they experienced in the context of their other roles and values. These workers presented a relationship that was characterized by positive and negative spillover between their jobs and their ability to fulfill family roles and promote personal health, linked by a spectrum of food choice strategies. Participants' narratives fit into three different domains: characterizations of work and their resources for food choice, strategies used to manage food choices within the constraints of work, and affect related to the negative and positive spillover of these strategies on family roles and on personal food choices. Characterizations of work as demanding and limiting or demanding and manageable differentiated participants who experienced their food choice strategies as a source of guilt and dissatisfaction (negative spillover) from those who experienced food choices as a source of pride and satisfaction (positive spillover). Ideals and values related to food choice and health were balanced against other values for family closeness and nurturing and personal achievement. Some participants found work unproblematic. These findings direct attention to a broad conceptualization of the relationship of work to food choices in which the demands and resources of the work role are viewed as they spill over into the social and temporal context of other
Kliewer, Wendy; Borre, Alicia; Wright, Anna W; Jäggi, Lena; Drazdowski, Tess; Zaharakis, Nikola
Ample research has demonstrated that alexithymia, which is characterized by difficulty processing emotions, is associated with disruptions in parenting infants and toddlers. Individuals suffering from alexithymia have among other negative outcomes difficulty building and maintaining interpersonal relationships. Research on emotional expression and recognition has documented the importance of these competencies for the quality of the parent-child relationship and for skills critical for parents of adolescents, such as effective monitoring. However, literature linking parental alexithymia to parenting behaviors and related constructs during adolescents is lacking. The present study closes this gap by examining how mothers' (M age = 39.42 years, SD = 7.62; Range = 23-67) alexithymia affects parent-reported behaviors of solicitation and control, as well as youths' (53.6% female; M age = 12.13 years, SD = 1.62; Range = 9-16) reported disclosure and felt acceptance by their mothers among a sample of 358 primarily urban, African American families. Structural equation models (SEM) revealed that mothers' alexithymia was prospectively related to less parental solicitation 2 years later for both males and females, and to lower levels of felt acceptance for males. Multiple group analyses revealed that these models fits equally well for younger and older youth. Contrary to hypotheses, alexithymia was not related to control or to disclosure. Taken together, these findings indicate that parents' difficulty in processing emotions contributes to parenting beyond early childhood. (c) 2016 APA, all rights reserved).
Garcia, Aileen S.; Ren, Lixin; Esteraich, Jan M.; Raikes, Helen H.
This study was designed to examine whether parenting stress and child behavioral problems are significant predictors of parent-child conflict in the context of low-income families and how these relations are moderated by maternal nativity. The authors conducted multiple regression analyses to examine relations between teachers' report of…
Hodges, Jaret; McIntosh, Jason; Gentry, Marcia
High-potential students from low-income families are at an academic disadvantage compared with their more affluent peers. To address this issue, researchers have suggested novel approaches to mitigate gaps in student performance, including out-of-school enrichment programs. Longitudinal mixed effects modeling was used to analyze the growth of…
WOOD, FRANK H.
THIS INVESTIGATION FOCUSED ON THE USEFULNESS OF A PROCEDURE FOR OBTAINING MEASURES OF THE MOTIVATION OF FIRST-GRADE CHILDREN FROM LOW-INCOME FAMILIES TO ACHIEVE IN READING WHICH DID NOT REQUIRE WRITTEN OR ORAL VERBAL RESPONSES FROM THE SUBJECTS. MEASURES OF ACHIEVEMENT MOTIVATION WERE CORRELATED WITH TEACHER RATINGS OF EFFORTS TO ACHIEVE IN…
Theilheimer, Ish, Ed.
Against the background of recent radical changes in the Canadian economy, this issue of the Canadian journal "Transition" examines the question of parents' concerns for their children's economic futures. "Changes in Family Incomes and Labour Market Participation in Post-War Canada" (David Ross and Clarence Lochhead) charts…
Wright, John C.; Auston, Aletha C.; Murphy, Kimberlee C.; St. Peters, Michelle; Pinon, Ronda Scantlin; Kotler, Jennifer
Collected time-use diaries of television viewing from two cohorts of children (ages 2-5 and 4-7) from low-income families and gave annual tests of reading, math, receptive vocabulary, and school readiness. Found that viewing of child-audience informative programs between ages 2 and 3 predicted higher academic performance. Frequent viewers of…
Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J
The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Wilson Mark C
Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Nijs, K.A.N.D.; Graaf, de C.; Siebelink, E.; Blauw, Y.H.; Vanneste, V.; Kok, F.J.; Staveren, van W.A.
Background. Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults. Extrapolation to the nursing home setting may lead to less malnutrition among the residents. Therefore, we investigate the effect of family-style meals on energy intake and the risk of
Malatskey, Lilach; Bar Zeev, Yael; Tzuk-Onn, Adva; Polak, Rani
The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Memorandum from the HR and FP Departments and the Legal Service concerning the annual internal taxation certificate and the declaration of income for 2008 You are reminded that each year the Organization levies an internal tax on the financial and family benefits it pays to the members of the personnel (see Chapter V, Section 2 of the Staff Rules and Regulations) and that members of the personnel are thus exempt from external taxation on salaries and emoluments paid by CERN. This memorandum is intended to provide members of the personnel residing in France with information on how salaries and emoluments paid by CERN should be indicated in the 2008 income declaration form. For any other income, they are invited to comply with the instructions attached to the form. I - Annual internal taxation certificate for 2008 The annual certificate of internal taxation for 2008, issued by the FP Department, has been available since 1st March 2009 (see Bulletin No. 11-12/2009). It is int...
Memorandum from the HR and FP Departments and the Legal Service concerning the annual internal taxation certificate and the declaration of income for 2008 You are reminded that each year the Organization levies an internal tax on the financial and family benefits it pays to the members of the personnel (see Chapter V, Section 2 of the Staff Rules and Regulations) and that members of the personnel are thus exempt from external taxation on salaries and emoluments paid by CERN. This memorandum is intended to provide members of the personnel residing in France with information on how salaries and emoluments paid by CERN should be indicated in the 2008 income declaration form. For any other income, they are invited to comply with the instructions attached to the form. I - Annual internal taxation certificate for 2008 The annual certificate of internal taxation for 2008, issued by the FP Department, has been available since 1st March 2009 (see Bulletin No. 11-12/2009). It is int...
Lam, Cindy Lo Kuen; Guo, Vivian Yawei; Wong, Carlos King Ho; Yu, Esther Yee Tak; Fung, Colman Siu Cheung
To assess health-related quality of life (HRQOL) among Chinese adults from low-income households in Hong Kong, and to explore any threshold of household income that impaired HRQOL. A cross-sectional analysis was conducted on 298 adults from low-income families when they enrolled into a cohort study between 2012 and 2014. HRQOL was measured by the 12-item Short-Form Health Survey-version 2 (SF-12v2). Their mean SF-12v2 subscale and summary scores were compared with those of 596 age-sex-matched subjects randomly selected from a database of 2763 adults from the Hong Kong general population (ratio = 1:2). Multiple linear regressions were conducted to determine any association between monthly household income and HRQOL. Subjects from low-income households had significantly lower SF-12v2 bodily pain, general health, vitality and physical component summary (PCS) scores than the age-sex matched subjects from the general population. Subgroup analysis showed that a household income income in Hong Kong (HK$10 000 ≈ US$1290, i.e. poverty line in Hong Kong) was independently associated with poorer PCS and mental component summary (MCS) scores after adjustment for socio-demographics and co-morbidities. Chinese adults from low-income households had poorer HRQOL, and income seems to be the threshold for impairment of both physical and mental HRQOL. The findings support the current definition of the poverty line. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Sagasser, M.H.; Fluit, C.R.M.G.; Weel, C. van; Vleuten, C.P.M. van der; Kramer, A.W.M.
PURPOSE: Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study
Full Text Available The impact of social economic status (SES on children's academic outcomes has been well documented. However, the mechanisms underlying this relationship remain poorly understood. Furthermore, the process by which SES relates to academic achievement needs to be studied separately for boys and girls. Using a sample of 598 Chinese children (299 boys, 299 girls in grades 4 to 6 and their parents, this study examined the process of how family SES, specifically family income and parental education, indirectly relates to children's reading achievement through parental expectation and parental involvement and whether this process differs between boys and girls. The results revealed that parental expectation and specific parental involvement behaviors played critical mediating roles between family SES and reading achievement. Moreover, the exact nature of these links differed by the gender of children. For boys, both the effect of parental education and the effect of family income were partially mediated by parental expectation and parent-child communication orderly. For girls, the effect of parental education was partially mediated by three separate pathways: (1 home monitoring; (2 parent-child communication; and (3 parental expectation followed by parent-child communication, while the effect of family income was fully mediated by parent-child communication. These findings suggest a process through which SES factors are related to children's academic development and identify a context under which these associations may differ. The practical implications of these findings are discussed, along with possible future research directions.
Guo, Xiaolin; Lv, Bo; Zhou, Huan; Liu, Chunhui; Liu, Juan; Jiang, Kexin; Luo, Liang
The impact of social economic status (SES) on children's academic outcomes has been well documented. However, the mechanisms underlying this relationship remain poorly understood. Furthermore, the process by which SES relates to academic achievement needs to be studied separately for boys and girls. Using a sample of 598 Chinese children (299 boys, 299 girls) in grades 4 to 6 and their parents, this study examined the process of how family SES, specifically family income and parental education, indirectly relates to children's reading achievement through parental expectation and parental involvement and whether this process differs between boys and girls. The results revealed that parental expectation and specific parental involvement behaviors played critical mediating roles between family SES and reading achievement. Moreover, the exact nature of these links differed by the gender of children. For boys, both the effect of parental education and the effect of family income were partially mediated by parental expectation and parent-child communication orderly. For girls, the effect of parental education was partially mediated by three separate pathways: (1) home monitoring; (2) parent-child communication; and (3) parental expectation followed by parent-child communication, while the effect of family income was fully mediated by parent-child communication. These findings suggest a process through which SES factors are related to children's academic development and identify a context under which these associations may differ. The practical implications of these findings are discussed, along with possible future research directions.
Papaioannou, Maria A; Cross, Matthew B; Power, Thomas G; Liu, Yan; Qu, Haiyan; Shewchuk, Richard M; Hughes, Sheryl O
To examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children. Focus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child. Parents completed measures in Head Start centers and/or over the telephone. 667 parents of preschool-aged children participated. Food parenting practices and F & V intake. Mean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake. The indulgent feeding style moderated the relationship between food parenting practices and child F & V intake. This study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Jones, H E; Holloway, I W; Pressman, E; Meier, J; Westhoff, C L
High prevalence of chlamydia in the USA persists despite efforts to annually screen women under the age of 26. Tailoring sexually transmitted infection (STI) services to client preferences may strengthen existing programmes. We report women's preferences for STI services from a family planning clinic in New York City serving low-income women. Seventy-eight percent (995/1275) of eligible women participated, with a mean age of 26 (SD±7). Ninety-one percent self-identified as Latina. Nineteen percent reported a past STI. Women preferred self-collection (65%) for testing to a speculum exam (20%); 15% had no preference. Women with a previous STI were more likely to prefer a pelvic exam to women with no previous STI (50% versus 32%, P preferred informing a sex partner about a positive STI test themselves, but 88% were willing to bring expedited partner therapy to a partner. Women were more likely to prefer third party partner notification if their last partner was casual rather than a main partner (14% versus 3%, respectively, P partner notification. Self-collecting specimens for screening was widely acceptable. Partner notification strategies should be based on understanding partnership status, including fears of violence.
Bannink, Rienke; Pearce, Anna; Hope, Steven
Self-esteem and life satisfaction are important aspects of positive mental health in young people, and both are socially distributed. However, the majority of evidence is based on socioeconomic characteristics of the family. As children enter adolescence and gain independence, perceptions of their own social position are likely to influence mental health. Using data on 11-year-olds from the UK Millennium Cohort Study, we investigated associations of both family income and young adolescents' perception of their social position with self-esteem and life satisfaction. We hypothesised that there would be differences in the impact of perceived social position on positive mental health when investigating the full scale scoring distribution or the bottom of the distribution. Therefore, we estimated proportional odds for having greater positive mental health (across the distribution of scores) and ORs for poor outcomes (lowest 10% scores). The likelihood of greater self-esteem and life satisfaction increased with income; similarly, the risk of having poor self-esteem and life satisfaction increased as income decreased. Young adolescents who perceived their family as poorer than their friends (instead of about the same) were less likely to have greater self-esteem and life satisfaction and were more likely to have poor outcomes. Young adolescents who perceived their family as richer were more likely to have poor self-esteem, but were not less likely to have greater self-esteem. For life satisfaction, young adolescents who perceived their families as richer were less likely to have greater and more likely to have poor life satisfaction. Policies to redistribute income in families with children are likely to benefit the mental health of young people. However, it is also important to consider the impact of social comparison on young people's mental health as they enter adolescence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted
Bannink, Rienke; Pearce, Anna
Background Self-esteem and life satisfaction are important aspects of positive mental health in young people, and both are socially distributed. However, the majority of evidence is based on socioeconomic characteristics of the family. As children enter adolescence and gain independence, perceptions of their own social position are likely to influence mental health. Design and objectives Using data on 11-year-olds from the UK Millennium Cohort Study, we investigated associations of both family income and young adolescents’ perception of their social position with self-esteem and life satisfaction. We hypothesised that there would be differences in the impact of perceived social position on positive mental health when investigating the full scale scoring distribution or the bottom of the distribution. Therefore, we estimated proportional odds for having greater positive mental health (across the distribution of scores) and ORs for poor outcomes (lowest 10% scores). Results The likelihood of greater self-esteem and life satisfaction increased with income; similarly, the risk of having poor self-esteem and life satisfaction increased as income decreased. Young adolescents who perceived their family as poorer than their friends (instead of about the same) were less likely to have greater self-esteem and life satisfaction and were more likely to have poor outcomes. Young adolescents who perceived their family as richer were more likely to have poor self-esteem, but were not less likely to have greater self-esteem. For life satisfaction, young adolescents who perceived their families as richer were less likely to have greater and more likely to have poor life satisfaction. Conclusions Policies to redistribute income in families with children are likely to benefit the mental health of young people. However, it is also important to consider the impact of social comparison on young people's mental health as they enter adolescence. PMID:26957529
Rhodes Erinn T
Full Text Available Abstract Background Information about the availability and effectiveness of childhood obesity training during residency is limited. Methods We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds, and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. Results The response rate was 42.2% (299/709 and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%, diagnosis (N = 282, 94.3%, diagnosis of complications (N = 249, 83.3%, and treatment (N = 242, 80.9%. However, only 18.1% (N = 54 of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p Conclusions While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.
Wolff, Margaret S; Rhodes, Erinn T; Ludwig, David S
Information about the availability and effectiveness of childhood obesity training during residency is limited. We surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs. The response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p obesity training was competing curricular demands (58.5%). While most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.
During the winter of 1985-86, a retrofit field test was performed in 66 occupied, low-income, single-family homes in Madison, Wisconsin. The primary objectives of the field test were to (1) determine the measured energy savings and the relative benefits of a combination of envelope and mechanical equipment retrofits that were selected following a new audit-directed retrofit procedure, (2) determine the energy savings and benefits due to performing infiltration reduction work following a recently developed infiltration reduction procedure, and (3) study general occupant behavior and house thermal characteristics and their possible change following retrofit installation. This report provides an overview of the project and summarizes the findings which will be presented in detail in separate reports. Major findings from the field test include: (1) The audit-directed retrofit procedure produced an average savings of 207 therms/year/house. The procedure also more than doubled the overall cost-effectiveness of the low-income weatherization assistance program as compared with the priority system formerly used in Wisconsin. Wall insulation and condensing furnaces were the major retrofits (predicted annual energy savings greater than 100 therms/year) most often selected under the procedure. The respective average energy savings of the houses receiving wall insulation and condensing furnace. s was 14.6 and 14.3 therms/year for each$100 spent on them under the program. (2) The blower-door-guided infiltration reduction procedure reduced expenditures for infiltration reduction to about one-fourth of previous program costs (from$570/house to$106/house). The procedure also reduced the average air leakage rate in the treated houses by 16%, whereas, in a previous study, no significant reduction was found following the installation of typical infiltration reduction measures. (3) Twenty to 60% of the deviation between predicted and measured savings can be attributed to incorrect
Verbeek, Hilde; van Rossum, Erik; Zwakhalen, Sandra M G; Ambergen, Ton; Kempen, Gertrudis I J M; Hamers, Jan P H
Small-scale and homelike facilities for older people with dementia are rising in current dementia care. In these facilities, a small number of residents live together and form a household with staff. Normal, daily life and social participation are emphasized. It is expected that these facilities improve residents' quality of life. Moreover, it may have a positive influence on staff's job satisfaction and families involvement and satisfaction with care. However, effects of these small-scale and homelike facilities have hardly been investigated. Since the number of people with dementia increases, and institutional long-term care is more and more organized in small-scale and homelike facilities, more research into effects is necessary. This paper presents the design of a study investigating effects of small-scale living facilities in the Netherlands on residents, family caregivers and nursing staff. A longitudinal, quasi-experimental study is carried out, in which 2 dementia care settings are compared: small-scale living facilities and regular psychogeriatric wards in traditional nursing homes. Data is collected from residents, their family caregivers and nursing staff at baseline and after 6 and 12 months of follow-up. Approximately 2 weeks prior to baseline measurement, residents are screened on cognition and activities of daily living (ADL). Based on this screening profile, residents in psychogeriatric wards are matched to residents living in small-scale living facilities. The primary outcome measure for residents is quality of life. In addition, neuropsychiatric symptoms, depressive symptoms and social engagement are assessed. Involvement with care, perceived burden and satisfaction with care provision are primary outcome variables for family caregivers. The primary outcomes for nursing staff are job satisfaction and motivation. Furthermore, job characteristics social support, autonomy and workload are measured. A process evaluation is performed to investigate to
Full Text Available A large literature has indicated a robust association between birth spacing and child survival, but evidence on the association of birth timing with physical growth in low and middle income countries (LMICs remains limited.Data from 153 cross-sectional Demographic and Health Surveys (DHS across 61 LMICs conducted between 1990 and 2011 were combined to assess the association of birth timing with child stunting (height-for-age z-score <-2. A total of 623,789 children of birth order 1-5 contributed to the maternal age analysis, while the birth spacing dataset consisted of 584,226 children of birth order 2 and higher. Compared to 27-34 year old mothers, maternal age under 18 years was associated with a relative stunting risk of 1.35 (95% CI: 1.29-1.40 for firstborn children, whereas the relative risk was 1.24 (95% CI: 1.19-1.29 for mothers aged 18-19 years. The association of young maternal age with stunting was significantly greater for urban residents and those in the top 50% of household wealth. Birth intervals less than 12 months and 12-23 months had relative risks for stunting of 1.09 (95% CI: 1.06-1.12 and 1.06 (95% CI: 1.05-1.06 as compared to a 24-35 month inter-pregnancy interval, respectively. The strength of both teenage pregnancy and short birth interval associations showed substantial variation across WHO region. We estimate that 8.6% (6.9-10.3% of stunted cases in the South Asian DHS sample would have been averted by jointly eliminating teen pregnancies and birth intervals less than 24 months, while only 3.6% (1.5-5.7% of stunting cases would have prevented in the Middle East and North Africa sample.Postponing the age of first birth and increasing inter-pregnancy intervals has the potential to significantly reduce the prevalence of stunting and improve child development in LMICs.
Lindsay, Ana Cristina; Wallington, Sherrie F; Lees, Faith D; Greaney, Mary L
Latinos are the largest and fastest growing minority population group in the United States, and children in low-income Latino families are at elevated risk of becoming overweight or having obesity. A child’s home is an important social environment in which he/she develops and maintains dietary and physical activity (PA) habits that ultimately impact weight status. Previous research suggests the parents are central to creating a home environment that facilitates or hinders the development of children’s early healthy eating and PA habits. Therefore, the purpose of this study was to explore low-income Latino parents’ beliefs, parenting styles, and parenting practices related to their children’s eating and PA behaviors while at home. Qualitative study using focus group discussions (FGDs) with 33 low-income Latino parents of preschool children 2 to 5 years of age. FGDs were transcribed verbatim and analyzed using thematic analysis. Data analyses revealed that most parents recognize the importance of healthy eating and PA for their children and themselves. However, daily life demands including conflicting schedules, long working hours, financial constraints, and neighborhood safety concerns, etc., impact parents’ ability to create a home environment supportive of these behaviors. This study provides information about how the home environment may influence low-income Latino preschool children’s eating and PA habits, which may be useful for health promotion and disease prevention efforts targeting low-income Latino families with young children, and for developing home-based and parenting interventions to prevent and control childhood obesity among this population group. Pediatric healthcare providers can play an important role in facilitating communication, providing education, and offering guidance to low-income Latino parents that support their children’s development of early healthy eating and PA habits, while taking into account daily life barriers faced
Us Centers For Disease Control And Prevention Epilepsy Program
People with active epilepsy are those who reported being told that they have epilepsy or a seizure disorder and either take antiseizure medication or have had a seizure during the past 12months. We used combined 2010 and 2013 National Health Interview Survey (NHIS) data on US adults with active epilepsy to examine whether taking medications and seizure frequency differed by sex, age, race/ethnicity, and reported or imputed annual family income. Of adults with active epilepsy, 45.5% reported taking medication and having at least one seizure, 41.3% reported taking medication and having no seizures, and 13.2% reported not taking any medication and having at least one seizure. About one-half of adults with active epilepsy and seizures have annual family incomes of less than $25,000. Promoting self-management supports and improved access to specialty care may reduce the burden of uncontrolled seizures in adults with epilepsy. Published by Elsevier Inc.
Dore, Anna R; Adair, Linda S; Popkin, Barry M
The social, political and economic reforms of 1992 in Russia led to a decade of rising income inequality, unemployment and economic crises, the most severe of which occurred in 1998. This study assesses dietary trends for children in low and high income households during this politically and economically unstable period from 1994 to 2000. Several possible food-related behaviors were also assessed to evaluate coping strategies adopted in the face of decreasing economic stability. Low income children maintained a steady energy intake per kilogram weight throughout the study period (251.0-259.4 kJ/kg), whereas intake for high income children increased significantly to a per capital average of 297.1 kJ/kg by 2000. At the food group level, the trend in per capita intake for all food groups was maintained for low income children except for a 22% decrease in meat and poultry consumption (P economic crisis.
Mirzawati Latifah; Bhisma Murti; Yulia Lanti Retno Dewi
Background: Age at menarche has become earlier for the last 100 years. This situation poses worrying problem as it may be lead to an increased risk of premarital sex, teenage pregnancy, mental unpreparedness, and increased risk of Malignant diseases such as ovarial cancer and breast cancer. This study aimed to determine the effect of soft drink, electronic media exposure, family income, pocket money, and nutritional status, on age at menarche among adolescents in Surakarta. Subjects and Metho...
Su, Chang; Zhang, Bing; Wang, You-Fa; Jia, Xiao-Fang; Xue, Hong; Wang, Hui-Jun
Background: Obesity has become a major health problem among children and adolescents worldwide. This study aimed to examine the trends of overweight and obesity among childhood in China and assess their associations with family income, dietary intake, and physical activity (PA) between 1997 and 2009. Methods: Two waves of cross-sectional data of Chinese children and adolescents aged 7–17 years from the China Health and Nutrition Survey were used. Weight and height were measured following standardized procedures. Dietary intake was assessed by 3 consecutive 24-h recalls. Childhood overweight and obesity were defined using the International Obesity Task Force-recommended body mass index cut-offs. Multivariate linear regression analysis was used to examine the associations of family income with diet intakes and PA. Multivariate logistic regression analysis was conducted to assess the associations of overweight and obesity with family income, dietary intake, and PA. Results: The prevalence of childhood overweight and obesity increased from 12.6% in 1997 to 22.1% in 2009, particularly in the medium- and high-family income groups, which increased by 102.7% and 90.3%, respectively. Higher fat intake (% energy), and moderate and vigorous PA were significantly associated with overweight and obesity in final model (odds ratio [OR] = 1.01, 95% confidence interval [CI]: 1.00–1.02, P = 0.004; and OR = 0.99, 95% CI: 0.98–1.00, P = 0.036, respectively). Conclusions: The prevalence of overweight and obesity among Chinese children and adolescents has increased between 1997 and 2009. Reducing fat intake and increasing PA may help obesity prevention. PMID:26168826
Flinkenflögel, Maaike; Ogunbanjo, Gboyega; Cubaka, Vincent Kalumire; De Maeseneer, Jan
International medical electives are well-accepted in medical education, with the flow of students generally being North-South. In this article we explore the learning outcomes of Rwandan family medicine residents who completed their final year elective in South Africa. We compare the learning outcomes of this South-South elective to those of North-South electives from the literature. In-depth interviews were conducted with Rwandan postgraduate family medicine residents who completed a 4-week elective in South Africa during their final year of training. The interviews were thematically analysed in an inductive way. The residents reported important learning outcomes in four overarching domains namely: medical, organisational, educational, and personal. The learning outcomes of the residents in this South-South elective had substantial similarities to findings in literature on learning outcomes of students from the North undertaking electives in the Southern hemisphere. Electives are a useful learning tool, both for Northern students, and students from universities in the South. A reciprocity-framework is needed to increase mutual benefits for Southern universities when students from the North come for electives. We suggest further research on the possibility of supporting South-South electives by Northern colleagues.
Chun, Maria BJ; Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruc...
Lyons, Heather Z.
The already limited vocational prospects of low-income African Americans in New Orleans were further devastated by Hurricane Katrina in 2005. The 2010 Deepwater Horizon oil spill added to the devastation, highlighting the continued vulnerability of New Orleanians seeking employment. As a result, opportunities persist for vocational practitioners…
Prasetyo, E.; Ekowati, T.; Roessali, W.; Gayatri, S.
The aims of study were: (i) identify of beef cattle fattening credit scheme, (ii) calculating and analyze of beef cattle farmers’ income, (iii) analyze of factors influencing beef cattle credit scheme towards farmer’s income. The research was held in five regencies in Central Java Province. Beef cattle fattening farm was standardized as an elementary unit. Survey method was used, while Two Stage Cluster Purposive Sampling was used for determining of sample. Data were analyzed using statistical method of quantitative descriptive and inferential statistics in term of income analysis and multiple linear regression models. The result showed that farmers used their own capital to run the farm. The average amount was IDR 10,769,871. Kredit Ketahanan Pangan dan Energi was credit scheme which was dominantly access by farmers. The average credit was IDR 23,312,200/farmer with rate of credit equal to 6.46%, the time of credit returning equal to 24.60 monthand the prediction of average collateral equal to IDR 35,800,00. The average of farmers’ income was IDR 4,361,611.60/2.96 head of beef cattle/fattening period. If the labour cost did not calculate as a cost production, hence the farmer’ income was IDR 7,608,630.41 or in other word the farmer’ income increase 74.44%. Factors of credit scheme which partially significant influence to the farmers’ income were number of own capital usage and value of credit collateral. Meanwhile, name of credit scheme, financing institution as a creditor, amount of credit, rate of credit scheme and time of returning credit were not significantly influence towards farmers’ income.
Integrating Photovoltaic Systems into Low-Income Housing Developments: A Case Study on the Creation of a New Residential Financing Model and Low-Income Resident Job Training Program, September 2011 (Brochure)
Dean, J.; Smith-Dreier, C.; Mekonnen, G.; Hawthorne, W.
This case study covers the process of successfully integrating photovoltaic (PV) systems into a low-income housing development in northeast Denver, Colorado, focusing specifically on a new financing model and job training. The Northeast Denver Housing Center (NDHC), working in cooperation with Del Norte Neighborhood Development Corporation, Groundwork Denver, and the National Renewable Energy Laboratory (NREL), was able to finance the PV system installations by blending private equity funding with utility rebates, federal tax credits, and public sector funding. A grant provided by the Governor's Energy Office allowed for the creation of the new financing model. In addition, the program incorporated an innovative low-income job training program and an energy conservation incentive program.
Rodríguez, Erin M; Kumar, Harsha; Alba-Suarez, Juliana; Sánchez-Johnsen, Lisa
Low-income urban children of color are at elevated risk for poor asthma control. This cross-sectional study examined associations among parents' coping (primary control, secondary control, and disengagement), parental depressive symptoms, and children's asthma outcomes (asthma control and school attendance) in a predominantly low-income, racially/ethnically diverse sample of families. Parents (N = 78; 90% female) of children (33% female; 46% Black; 38% Latino) aged 5-17 years (M = 9.5 years) reported on their own coping and depressive symptoms, their child's asthma control, and full and partial days of school missed due to asthma. Parents' secondary control coping (i.e., coping efforts to accommodate/adapt to asthma-related stressors) was negatively correlated, and disengagement coping (i.e. coping efforts to avoid/detach from stressors) was positively correlated, with their depressive symptoms. Secondary control coping was also correlated with fewer partial days of school missed. Primary control coping (i.e., coping efforts to change stressors) was not associated with depressive symptoms or asthma outcomes. Parents' depressive symptoms were also positively correlated with poorer asthma control and partial days of school missed. Regression models showed direct and indirect effects of secondary control and disengagement coping on asthma outcomes via depressive symptoms, after controlling for demographic factors. Parents' secondary control and disengagement coping are related to children's asthma outcomes. Secondary control coping may support parents' mental health and children's asthma control in low-income urban families.
Although absolute levels of mortality have decreased among Swedish men and women in recent decades, educational inequalities in mortality have increased, especially among women. The aim of this study is to disentangle the role of income and family type in educational inequalities in mortality in Sweden during 1990-2009, focusing on gender differences. Data on individuals born in Sweden between the ages of 30 and 74 years were collected from total population registries, covering a total of 529,275 deaths and 729 million person-months. Temporary life expectancies (age 30-74 years) by education were calculated using life tables, and rate ratios were estimated with Poisson regression with robust standard errors. Temporary life expectancy improved among all groups except low educated women. Relative educational inequalities in mortality (RRs) increased from 1.79 to 1.98 among men and from 1.78 to 2.10 among women. Variation in family type explained some of the inequalities among men, but not among women, and did not contribute to the trend. Variation in income explained a larger part of the educational inequalities among men compared to women and also explained the increase in educational inequalities in mortality among men and women. Increasing educational inequalities in mortality in Sweden may be attributed to the increase in income inequalities in mortality. © 2015 the Nordic Societies of Public Health.
Dumka, Larry E.; Roosa, Mark W.; Jackson, Kristina M.
Reports on a test of a risk-stress process model. Examines the influence of mothers' supportive parenting and inconsistent discipline practices on risk factors and family conflict as these affect children's conduct disorder and depression. Tests on 121 families indicate that mothers' supportive patenting partially mediated family conflict effects…
Quintiliani, Lisa M; DeBiasse, Michele A; Branco, Jamie M; Bhosrekar, Sarah Gees; Rorie, Jo-Anna L; Bowen, Deborah J
Intervention programs that change environments have the potential for greater population impact on obesity compared to individual-level programs. We began a cluster randomized, multi-component multi-level intervention to improve weight, diet, and physical activity among low-socioeconomic status public housing residents. Here we describe the rationale, intervention design, and baseline survey data. After approaching 12 developments, ten were randomized to intervention (n=5) or assessment-only control (n=5). All residents in intervention developments are welcome to attend any intervention component: health screenings, mobile food bus, walking groups, cooking demonstrations, and a social media campaign; all of which are facilitated by community health workers who are residents trained in health outreach. To evaluate weight and behavioral outcomes, a subgroup of female residents and their daughters age 8-15 were recruited into an evaluation cohort. In total, 211 households completed the survey (RR=46.44%). Respondents were Latino (63%), Black (24%), and had ≤ high school education (64%). Respondents reported ≤2 servings of fruits & vegetables/day (62%), visiting fast food restaurants 1+ times/week (32%), and drinking soft drinks daily or more (27%). The only difference between randomized groups was race/ethnicity, with more Black residents in the intervention vs. control group (28% vs. 19%, p=0.0146). Among low-socioeconomic status urban public housing residents, we successfully recruited and randomized families into a multi-level intervention targeting obesity. If successful, this intervention model could be adopted in other public housing developments or entities that also employ community health workers, such as food assistance programs or hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.
Mak, Winnie W S; Cheung, Rebecca Y M; Law, Lawrence S C
Sense of community (SOC) has been one of the most studied topics in community psychology. However, no empirical study to date has investigated SOC in Hong Kong and its relations with community characteristics and residents' psychological well-being. A representative sample of 941 Hong Kong Chinese based on a randomized household survey was conducted in all 18 districts in Hong Kong. Results of hierarchical linear modeling indicated that SOC was not associated with sociodemographic indicators on both the individual-level (i.e., gender, age, family income, education level, type of residence, and area-to-capita ratio of residence) and the community-level (i.e., proportion of individuals with tertiary education, median family income, ownership of residence, population density, and resident stability). SOC was negatively related to daily hassles and positively with social support and quality of life. Conceptualization of SOC in Hong Kong was discussed.
Gault, Barbara; Reichlin, Lindsey; Román, Stephanie
This report examines how efforts to understand and improve college affordability can be informed by the experiences and circumstances of low-income adults, students of color, and students with dependent children. The report discusses how the time and financial demands associated with financial independence, parenthood, and work affect a student's…
Teichman, J M; Tongco, W; MacNeily, A E; Smart, M
We examined how Urology residents in Canada manage their personal finances. A survey instrument was designed to elicit information on demographics, expenses, savings and incomes. The questionnaire was completed by 40 Urology residents attending the 2000 Queen's Urology Exam Skills Training (QUEST) program. Twenty-eight residents (70%) had educational debt (median debt $50 000). Seventeen residents (45%) paid credit card interest charges within the last year. Four residents (10%) maintained an unpaid credit card balance > $7500 at 17% annual interest rate. Twenty-six residents (67%) contributed to Registered Retirement Savings Program (RRSP) accounts. Seventeen residents (44%) contributed to non-RRSP retirement accounts. Nineteen residents (50%) budgeted expenses. Median resident income was $45 000. Thirteen residents (34%) had cash reserves < $250. Many residents save little, and incur substantial debt over and above educational loans. Many residents would benefit from instruction concerning prudent financial management. Residents should be informed of the consequences of low saving and high debt.
Burner, Elizabeth R E; Menchine, Michael D; Kubicek, Katrina; Robles, Marisela; Kagawa Singer, Marjorie; Arora, Sanjay
Diabetes disproportionately affects the US Latino population, due to socioeconomic pressures, genetics, reduced access to care and cultural practices. While efforts to improve self-care through interventions incorporating family are highly rated by Latinos, family can be both supportive and obstructive. To develop effective interventions, this role needs clarification. We conducted group interviews in Spanish and English with 24 participants with diabetes from a mobile health diabetes self-care intervention. We imported transcripts into Dedoose, a qualitative computer analysis program and analyzed them with a modified grounded theory technique. Utilizing an iterative process, we reexamined transcripts with new codes derived in each round of analysis until saturation was reached. We employed techniques to improve trustworthiness (co-coding, member checking). Broad categorical themes arose from the initial codes and were developed into a conceptual model of barriers to and strategies for diabetes management. Family and family responsibilities emerged as both a supportive and obstructive force for diabetes self-care. While the desire to care for family motivated patients, food at family gatherings and pressure from managing multiple family responsibilities contributed to poor diet choices. Yet, some patients believed their diabetes caused their immediate family to make healthier choices. Among these predominantly Latino patients, family and family responsibilities were key motivators as well as obstacles to self-care, particularly regarding nutrition. Finding the ideal design for social support mHealth-based interventions will require careful study and creation of culturally based programs to match the needs of specific populations, and may require educating family members to provide effective social support.
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Occupancy by police officers to... HOUSING Occupancy by Over-Income Families or Police Officers § 960.505 Occupancy by police officers to provide security for public housing residents. (a) Police officer. For purpose of this subpart E, “police...
Anderson, Riana Elyse
The Family Stress Model acknowledges forms of resilience in the face of hardship; however, few studies have emerged on the potentially positive role of familial relationships in the academic, psychological, and prosocial success of impoverished Black children. The current study evaluates how parent-child relationship conflict and financial stress are associated with children's school readiness (i.e., academic, psychosocial, and socioemotional indicators). Latent profile analyses, incorporating financial stress, general stress, and parent-child relationship variables were used to test whether varying family stress profiles differentially predicted children's school readiness in Black families with children entering kindergarten (N = 292). Findings revealed 4 latent classifications with profiles of low, moderate, moderate/high, and high/moderate stress and conflict variables, respectively. Whereas the low-profile was associated with the most desirable school readiness indicators overall, children in the high/moderate-profile were rated as significantly more psychosocially and socioemotionally prepared for school than their moderate/high-profile counterparts. Families with less conflictual parent-child relationships had more optimal school readiness relative to families with higher conflict and less financial strain. The findings of the current study have the potential to contribute to theories of poverty and parent-child relationships, as well as guide therapeutic services focused on family relationships through school- and community-related programs for impoverished urban Black youth and their families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Grey, Jillian M.; Totsika, Vasiliki; Hastings, Richard P.
Background: Providing long-term care to an adult relative with intellectual disability can impact negatively on caregivers' health and well-being. Methods: Data were collected via online and postal questionnaires on 110 family carers' physical and psychological health, family stress and perceived positive gains from caring. Psychological…
Penders, Y.W.H.; Albers, G.; Deliens, L.; van der Stichele, R.; Block, L.
Background: High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. Aim: To describe how often family
Gibbs, L; de Silva, A M; Christian, B; Gold, L; Gussy, M; Moore, L; Calache, H; Young, D; Riggs, E; Tadic, M; Watt, R; Gondal, I; Waters, E
Early Childhood Caries (ECC) is the most common, preventable disease of childhood. It can affect children's health and wellbeing and children from migrant families may be at greater risk of developing ECC. To describe ECC in children from migrant families, and explore possible influences. Cross-sectional analysis of caries data collected as baseline data for an oral health promotion study. The analysis sample included 630 1-4 year-old children clustered within 481 Iraqi, Lebanese and Pakistani families in Melbourne, Australia. Child participants received a community-based visual dental examination. Parents completed a self-administered questionnaire on demographics, ethnicity, and oral health knowledge, behaviour and attitudes. Child caries experience. Bivariate associations between oral health behaviours and ethnicity were tested for significance using chi-square. Multivariate logistic regression analyses were performed to identify associations with ECC, adjusting for demographic variables and accounting for clustering by family. Overall, 34% of children in the sample experienced caries (both non-cavitated and cavitated). For all caries lesions, parent' length of residence in Australia, consumption of sweet drinks and parental education remained as independent predictors of child caries experience. Adding sugar to drinks was an additional risk factor for cavitation. Ethnicity was associated with some individual oral health behaviours suggesting cultural influences on health, however the relationship was not independent of other predictors. Culturally competent oral health promotion interventions should aim to support migrant families with young children, and focus on reducing sweet drink consumption.
BeLue, Rhonda; Halgunseth, Linda C.; Abiero, Beatrice; Bediako, Phylicia
Objectives Minimal attention has been given to understanding parenting stress among low-income, ethnically diverse mothers of children with conduct problems. Maternal health and parenting hassles may serve as important risk factors for parenting stress. This study examined whether parenting hassles moderated the relations between maternal physical and mental health and parenting stress in a sample of low-income, ethnically diverse mothers of children with behavioral problems. Methods The sample included 177 low-income Black, Latina, and White mothers of kindergartners with behavior problems. PATH analysis was employed to assess the associations between maternal mental and physical health and parenting stress, as well as the moderating role of parenting hassles in this cross-sectional study. Results After adjusting for covariates, we found that parenting hassles mediates the relationship between social support and parenting stress as well as maternal health and parenting stress. Conclusion Findings suggest that promoting coping resources for daily parenting hassles and supporting the physical and mental health of minority mothers may have important implications for parenting children with high behavior problems. PMID:26863556
Polacsek, Michele; Moran, Alyssa; Thorndike, Anne N; Boulos, Rebecca; Franckle, Rebecca L; Greene, Julie C; Blue, Dan J; Block, Jason P; Rimm, Eric B
To carry out a pilot study to determine whether a supermarket double-dollar fruit and vegetable (F&V) incentive increases F&V purchases among low-income families. Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention. A supermarket in a low-income rural Maine community. A total of 401 low-income and Supplemental Nutrition Assistance Program (SNAP) supermarket customers. Same-day coupon at checkout for half-off eligible fresh, frozen, or canned F&V over 4 months. Weekly spending in dollars on eligible F&V. A linear model with random intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention. Secondary analyses examined changes among SNAP-eligible participants. Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared with control ($1.83; 95% confidence interval [CI], $0.29 to $3.88). The largest increase was for fresh F&V ($1.97; 95% CI, $0.49 to $3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14; 95% CI, $1.93 to $8.34) than among non-SNAP eligible participants who redeemed coupons ($3.88; 95% CI, $1.67 to $6.08). A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. Customers who were eligible for SNAP saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low-income families. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Fish, Caitlin A; Brown, Jonisha R; Quandt, Sara A
Minority families often reside in neighborhoods with few supermarkets or alternative healthy food options (e.g., farmers markets, community gardens), making fresh produce difficult to obtain. This qualitative study identified factors influencing fruit and vegetable shopping and use of alternative healthy food options. Forty-eight minority women with children completed interviews regarding food shopping habits and use of and attitudes toward alternative healthy food options. Interviews were subjected to thematic analysis. Produce shopping was motivated by costs and family preferences. For African American women, poor cooking skills restricted the variety of fruits and vegetables purchased. Latinas were receptive to alternative healthy food options, but did not use them because these sources