How does studying rurally affect peer networks and resilience? A social network analysis of rural- and urban-based students.

OBJECTIVE: To examine differences in peer networks between urban-based students and rural-stream students in an Australian medical school and to examine how characteristics of networks relate to resilience. DESIGN: Cross-sectional survey asking students to signify social, academic and support relationships with students in the same year and to complete a survey on their resilience. SETTING AND PARTICIPANTS: All second-, third- and fourth-year students at the Australian National University Medical School. MAIN OUTCOME MEASURES: Social network analysis comparing peer networks, t-test comparing mean resilience of urban and rural students. RESULTS: A visual analysis of the peer networks of year 2, 3 and 4 medical students suggests greater integration of rural-stream students within the year 2 and 4 urban cohorts. Resilience is similar between year 2 and 3 students in both urban and rural streams, but is significantly higher in year 4 rural-stream students, compared to their urban-based peers. Networks of rural-stream students suggest key differences between their period spent rurally and on their return and integration within the larger student cohort. Furthermore, rural students, once reintegrated, had larger and stronger social networks than their urban counterparts. CONCLUSION: The results of the study suggest that the rural experience can instruct support systems in urban settings. However, whether the rural placement creates a more resilient student or resilient students are selected for rural placement is unclear.

Scope of practice of family medicine graduates who completed a rural versus urban program.

INTRODUCTION: In Canada, rural-based family medicine residency programs were established largely in response to a shortage of rural physicians and the perception that urban-based training programs were not meeting the needs of rural populations. Examinations of practice patterns of physicians trained in rural and urban programs are lacking. The purpose of this study was to compare the scope of practice of family medicine graduates who completed a rural versus an urban residency program, by practice location. METHODS: This was a cross-sectional, mail-out, questionnaire survey of 651 graduates who had completed the family medicine residency program at the University of Alberta or the University of Calgary, Alberta, Canada during 2006-2011. Rural program graduates lived and trained in regional settings and spent a considerable amount of time in smaller rural and remote communities for their clinical experience. The training of urban program graduates was primarily based in large urban settings and family medicine clinical experience was based in the community. Practice location (rural, urban) was classified by population size of the town/city at which physicians practiced. Scope of practice was ascertained through four domains of care: types of care, clinical procedures, practice settings and specific populations. Items within each domain were rated on a five-point scale (1='not part of practice', 5='element of core practice'). Mean rating scores for items in the domains of care were compared between urban and rural program graduates using ANOVA. RESULTS: A total of 307 (47.2%) graduates responded to the survey, of whom 173 were categorized as urban program graduates and 59 as rural program graduates. Overall, rural program graduates exhibited a broader scope of practice in providing postnatal care, intrapartum care/deliveries, palliative care, office-based and in-hospital clinical procedures, emergency care, in-hospital care, home visits, long-term care, and caring for rural and Aboriginal populations. Irrespective of program completed, those in a rural practice location had a broader scope of practice than those in urban practice. Urban and rural program graduates in rural locations tended to have a similar scope of practice. In urban locations, rural program graduates were more likely to include intrapartum care/deliveries as part of their clinical practice. Rural program graduates were more likely to practice in rural locations than urban program graduates. CONCLUSION: A combination of site of training (rural or urban program) and location of practice appear to work together to influence scope of practice of family physicians. A conceptual framework that summarizes the factors that have been reported to be associated with the scope of family practice is proposed.

The wire and urban health education.

As urban health has emerged as a distinct field, experts have collaborated to develop models for interdisciplinary education to train health professionals. Interdisciplinary learning is an important yet challenging imperative for urban health education. This paper explores lessons learned from a 2010 speaker series at the Johns Hopkins Bloomberg School of Public Health. The television show, The Wire, was used as a teaching tool to illustrate the context of health disparities in American cities and to explore the complex factors perpetuating urban health outcomes. We suggest that individuals interested in developing interdisciplinary teaching models can learn from both the form and the content of The Wire. As a popular televised serial narrative, The Wire prompts an investigation into the forms and circulation of academic research in a fractured and specialized media landscape. The formal narrative structure of the show provides mental scaffolding from which epidemiological, historical, geographical, anthropological, and other relevant disciplinary learning can build. The Wire encourages critical reflection among public health professionals about the forces that shape public health training, research, and practice and offers creative expansions to existing urban health educational efforts.

Social mapping: a potential teaching tool in public health.

BACKGROUND: Mapping is a fundamental way of displaying spatial human cognition. It is a rapid technique of summarising and presenting large amount of information. Social map is a technique that finds use as a participatory rural appraisal tool. AIM: To evaluate the feasibility of using social mapping as a public health teaching tool. METHODS: A resident doctor posted in the Urban Health Training Centre was assigned to do social mapping of an urban resettlement colony. The area was first divided into segments. The mapping was done by people residing in each segment and compiled with the assistance of the resident doctor. RESULTS: Social mapping helped the student acquire various cognitive, affective and psychomotor skills. It also helped in understanding the geographical area, people, language, cultural practices, social networks and interactions. It trained the student in using rapid appraisal techniques, cartography, effective and succinct summarising and presentation of data of social relevance. The different language and cultural background of the community was the main challenge encountered. CONCLUSION: Social mapping is an excellent learning and a very practical teaching tool in public health, especially when the researcher/health care provider has little knowledge about his/her field practice area.

Development and delivery of evidence-based messages to reduce the risk of zoonoses in Nairobi, Kenya.

This paper describes a trans-disciplinary process of co-generating and disseminating evidence-based messages for reducing the risk from cryptosporidiosis and other zoonoses in an urban community in Nairobi. Research findings about disease prevalence, risk factors and observed risky and risk-mitigating practices were analysed by a team comprising researchers, community members and local policy- and decision-makers. Using participatory planning, multiple strategies were developed for disseminating key information. We identified five vulnerable groups at higher risk of exposure to cryptosporidiosis and other cattle zoonoses with similar transmission pathways (women, children, elderly people, immunosuppressed people and male farm workers). For each group, targeted messages were developed. Good practices already in use, as were also practices as practices to improve environmental conditions. These messages were disseminated through printed material, in a workshop, through community campaigners and also an edutainment soap opera episode broadcast on Kenyan television. In conclusion, a participatory and trans-disciplinary process can help transform the findings of research into messages that are targeted, attractive and understandable.

New competences to manage urban health: Health City Manager core curriculum.

A core curriculum is an essential step in development knowledge, competences and abilities and it defines educational content for the specialized area of practice in such a way that it can be delivered to new professional job. The Health City Manager core curriculum defines the strategic aspects of action to improve health in cities through a holistic approach, with regard to the individual, and a multi-sectoral approach, with regard to health promotion policies within the urban context. The Health City Manager core curriculum recognizes that the concept of health is an essential element for the well-being of a society, and this concept does not merely refer to physical survival or to the absence of disease, but includes psychological aspects, natural, environmental, climatic and housing conditions, working, economic, social and cultural life - as defined by the World Health Organization (WHO). The Health City Manager core curriculum considers health not as an "individual good" but as a "common good" that calls all citizens to ethics and to the observance of the rules of civil coexistence, to virtuous behaviours based on mutual respect. The common good is therefore an objective to be pursued by both citizens and mayors and local administrators who must act as guarantors of equitable health ensuring, that the health of the community is considered as an investment and not just as a cost. The role of cities in health promotion in the coming decades will be magnified by the phenomenon of urbanization with a concentration of 70% of the global population on its territory.

Community knowledge on dengue in territories under risk in the state of São Paulo

In the last decades, the global incidence of arboviruses transmitted by the vector Aedes aegypti has increased dramatically with the increased oh human mobility and urbanization. The study of the mosquito population is of great importance for public health in countries where climatic and environmental conditions are favorable for the spread of these diseases transmitted by A. aegypti. This was a cross-sectional study that assessed causal relationships between why mosquitoes are prevalent in the region studied and socioeconomic variables, practices, knowledge, attitudes, and the effect of the cause in two regions chosen according to vulnerability (São Paulo Social Vulnerability Index). Of the 435 residents interviewed, 95% (413/435) were informed about vector control and claimed to contribute to the day-to-day sanitary practices necessary to combat it, in addition to being able to identify it. Most participants in both regions believed they were at risk, but vector control practices did not match those recorded in the survey. A correlation was found between the population's level of education and the practices observed. Despite the high levels of knowledge and the perceptions of the interviewed population about A. aegypti, the erroneous behavior of the residents persisted, thus hindering disease prevention and vector control actions, promoting the conditions conducive to the proliferation of the vector, and, consequently, increasing the risk of disease. The study indicated that one of the most effective means to control the A. aegypti vector is a society informed about preventive measures in the surveillance sectors.

Colorado Immersion Training in Community Engagement: Because You Can't Study What You Don't Know.

BACKGROUND: Community engagement (CE)has become a major element in medical research. In alliance with the goals of the Clinical and Translational Sciences Award program, Colorado Immersion Training in Community Engagement (CIT) is a community-campus partnership that aims to introduce an expanded pool of researchers to community-based participatory research (CBPR) and CE. OBJECTIVES: To describe CIT components and preliminary results. METHODS: CIT attempts to support a change in the research trajectory of academic health researchers, program developers, and graduate students toward CE. The program occurs on campus and in six community settings: Urban African American, urban Asian and refugee, urban Latino, urban American Indian/Alaska Native, rural northeast Colorado, and rural San Luis Valley. Components include a 4-week Directed Reading, a seminar on CBPR, 4-day community immersion, reflection, and 6-month support. Evaluation describes recruitment, implementation, and participants' understanding of CBPR and skills post-training. RESULTS: Fifty-eight people have participated. A comprehensive curriculum was developed to address (1) principals of CBPR, (2) health disparities, (3) listening to community, (4) self-reflection, and (5) engagement tools. Community immersions expose participants to a community's culture and opportunities to discuss health issues with a range of community members. Local "community guides" enhance participants' experience. Of the first two cohorts, 90% changed the way they plan to approach their research, 94% changed how they viewed community involvement in research, and 77% learned new skills to help engage communities in research. CONCLUSIONS: CIT applies to and positively impacts researchers from a variety of disciplines. CIT creates opportunities for long lasting partnerships between researchers and communities.

Urban health and primary care at Johns Hopkins: urban primary care medical home resident training programs.

Johns Hopkins University recently implemented two novel urban health residency training programs (UHR). The programs include increased access programs, community health worker-delivered care, substance abuse screening and treatment, community psychiatry/ mental health programs, case and disease management teams, and interprofessional training. These programs are designed to create well-trained physicians who competently provide care for the underserved inner-city patient.

Urban policy engagement with social sustainability in metro Vancouver.

This article presents an analysis of social sustainability in comparative theoretical context and as a challenge to the post-political interpretation of sustainability in policy practice at the urban and regional scales. Metro Vancouver provides a case study for improving our understanding of the meaning of social sustainability as a framework for social policy in that it is among the handful of cities around the world currently working to define and enact social sustainability in governance terms. Results of this participant research provide evidence that some cities are politically engaging alternative development pathways using the concept of social sustainability. For sustainable development to retain its promise as an alternative policy framework for cities, social sustainability must be at the forefront.

"The law has no feeling for poor folks like us!" Everyday responses to legal compulsion in England's working-class communities, 1871-1904.

During the late Victorian period, the role of the state increased dramatically in England's working-class urban communities. New laws on labor, health, and education, enforced by a growing bureaucracy of elected and appointed officials, extended the reach of public authority into daily life on an unprecedented scale. Everyday negotiations between these officials and working-class men and women, I argue, were key moments for determining the practical impact of new social welfare policies. This was particularly true in the contestation over children's compulsory school attendance, as I demonstrate through a close examination of the daily encounters between parents and education officials. Despite the growing size and authority of the Victorian state, working-class parents effectively mitigated the impact of the compulsory education laws on their families. They were able to do so because the categories that governed the level of enforcement­age, household economic status, health, and labor­were themselves determined through daily dialogues between parents and education officials. Parents' familiarity with the law and with the dynamics of the public education bureaucracy were key factors in these negotiations, as were internal fractures within the Victorian state itself. Working-class parents, and mothers in particular, also countered officials' moral policy justifications with their own discourse of right and wrong, which focused on the legitimacy of parental authority, an insistence on just treatment, and the elevation of household needs over the laws' requirements.

Spatial variations in US poverty: beyond metropolitan and non-metropolitan.

Because poverty in rural and urban areas of the US often has different causes, correlates and solutions, effective anti-poverty policies depend on a thorough understanding of the ruralness or urbanness of specific places. This paper compares several widely used classification schemes and the varying magnitudes of poverty that they reveal in the US. The commonly used 'metropolitan/non-metropolitan' distinction obscures important socioeconomic differences among metropolitan areas, making our understanding of the geography of poverty imprecise. Given the number and concentration of poor people living in mixed-rural and rural counties in metropolitan regions, researchers and policy-makers need to pay more nuanced attention to the opportunities and constraints such individuals face. A cross-classification of the Office of Management and Budget's metro system with a nuanced RUDC scheme is the most effective for revealing the geographical complexities of poverty within metropolitan areas.

Land rent and housing policy: a case study of the San Francisco Bay area rental housing market.

In the San Francisco Bay Area, where residential rent is among the highest in the United States, an analysis of data from several sources demonstrates that high rent cannot be accounted for by higher quality, higher operating costs, or higher construction costs. At least one-third of the total rent paid is land rent. Despite increases in real incomes, very-low-income tenants in the Bay Area today have less income remaining after payment of rent than tenants did in 1960. High land rent is a long-term feature of the Bay Area rental market that results mostly from its geography, the density of its urban centers, and a strong economy, rather than from regulatory barriers to new multifamily construction. Deregulation is not a sufficient response to the effects of land rent on low-income tenants. Government should subsidize non-profit housing organizations, particularly land trusts that remove residential land from the market. Taxes on land rent would be a particularly appropriate funding source.

Resumen Reunión Nacional de la Red de Vivienda Saludable Proyecciones, logros y retos al culminar el 2014 / Report on the National Meeting of the Healthy Housing Network. Perspectives, achievements and challenges at the end of 2014

Se realiza una relatoría de lo acontecido en la Reunión Nacional de Vivienda Saludable 2014, para informar a los interesados en el tema de los logros y los retos del trabajo de la Red Cubana durante el año 2014 ylas proyecciones a futuro, cuyos miembros trazan para el próximo año(AU)

A report is provided on the National Meeting of the Healthy Housing Network 2014, with the purpose of informing those interested in the topic about the achievements and challenges of the Cuban Network in 2014, as well as the actions planned by its members for next year(AU)

Resumen Reunión Nacional de la Red de Vivienda Saludable Proyecciones, logros y retos al culminar el 2014 / Report on the National Meeting of the Healthy Housing Network. Perspectives, achievements and challenges at the end of 2014

Se realiza una relatoría de lo acontecido en la Reunión Nacional de Vivienda Saludable 2014, para informar a los interesados en el tema de los logros y los retos del trabajo de la Red Cubana durante el año 2014 y las proyecciones a futuro, cuyos miembros trazan para el próximo año(AU)

A report is provided on the National Meeting of the Healthy Housing Network 2014, with the purpose of informing those interested in the topic about the achievements and challenges of the Cuban Network in 2014, as well as the actions planned by its members for next year(AU)