Storylines of family medicine IX: people and places-diverse populations and locations of care.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.

Attitudes Towards Family Planning among Bhutanese, Burmese, and Iraqi Refugee Women: A Qualitative Study.

The number of foreign-born people living in the United States continues to increase yearly. Foreign-born women in the United States, a group that includes both refugees and immigrants, continue to have higher birth rates when compared to their US-born counterparts. This study examines the cultural and socioeconomic factors influencing family planning choices of resettled refugee women living in the United States. Thirty-two Bhutanese, Burmese, and Iraqi women living in Philadelphia participated in interviews and focus groups. A grounded theory approach was used for analysis. Three overarching themes were identified: knowledge acquisition and experiential learning with trans-border migration and resettlement, changes in gender roles and family relations, and provider relationships and provision of care. Findings from the study show that a stable environment results in increased opportunities and personal freedoms, a sense of empowerment, and the desire for family planning. Women want to discuss options, but healthcare providers must begin the conversation. As health care providers in Hawai'i, a state with about 18% of residents being foreign-born, what can be learned from the Philadelphia refugee experience and family planning?

Urban underserved program: an analysis of factors affecting practice outcomes.

BACKGROUND AND OBJECTIVES: Fewer medical students are choosing to work in primary care, and it is difficult to recruit and retain physicians to work in underserved communities. Positive exposures with underserved communities are known to increase a physician's likelihood of practicing in an underserved area. While a number of medical school programs are designed to address the rural physician workforce shortage, there are fewer medical school programs designed to specifically recruit and retain physicians to work in urban underserved areas. This article describes a multifaceted, longitudinal medical school curriculum at Jefferson Medical College known as the Urban Underserved Program (UUP) and a survey administered to UUP graduates exploring the association between program participation and practice outcomes. METHODS: A mixed methods analysis of an online survey was administered to UUP graduates. RESULTS: Results indicated that 75% of UUP graduates work in urban areas, 75% in an underserved or physician shortage area, and 61% in a primary care capacity. Additionally, results indicate that the UUP supports and encourages medical students to work with urban underserved populations by increasing knowledge of health disparities and empathy for underserved populations. CONCLUSIONS: Urban underserved communities have greater health disparities and less access to health care, and programs that promote and prepare students to enter practice in these communities can potentially impact the health of these populations.

Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis.

We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980-2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval=23.8%, 29.9%; n=43 studies) and of diabetes was 8.0% (95% confidence interval=6.8%, 9.2%; n=39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.

The use of international service learning initiatives for global health education: case studies from Rwanda and Mexico.

Global health education and health promotion have the potential to engage students, scholars, and practitioners in ways that go beyond the classroom teaching routine. This engagement in global communities, can range from reflection on continuing deep-seated questions about human rights and civic responsibility to the use of health education and promotion-related theoretical, intellectual, and practical skills. In the arena of global health education and promotion, these skills also range from leadership and advocacy to decision making, critical and creative thinking, teamwork, and problem solving. In recent times, there has been a growing interest in cross-cultural collaborations and educational initiatives to improve stakeholder's understanding of global health principles and practices, to enrich the experiences of health professionals, and to improve the lives of those who are disenfranchised and live across borders. In this article of Health Promotion Practice, we highlight two unique cases of cross-national collaborations and provide a glimpse of the various shapes and forms taken by cross-cultural educational initiatives for global health education and promotion. We summarize the history, philosophy, and current working practices relevant to these collaborations, keeping in view the global health domains, competencies, and activities. In addition, we also compare the key components and activities of these two case studies from Rwanda and Mexico, wherein communities in these two countries collaborated with academic institutions and health professionals in the United States.

A partnered approach for structured observation to assess the environment of a neighborhood with high diabetes rates.

BACKGROUND: The Communities IMPACT Diabetes Center uses partnered methods to address diabetes-related conditions among African Americans and Latinos in East Harlem, New York. OBJECTIVES: To describe a novel, partnered approach that integrates simultaneous structured observation by community and academic partners with "on-the-spot" resolution of differences to collect baseline data regarding the built and food environments in a two census tract area of East Harlem and present select findings. METHODS: We designed an environmental assessment to explore characteristics of the environment related to walking and eating. We paired community and academic partners to assess each block, resolve any differences, and report results. Nearly one year later, we surveyed the data collectors and analyzed responses using standard qualitative methods. RESULTS: Key themes included connection to and characteristics of the community; interactions with partners; surprises and learning, and aspects of data collection. All but the first were common to academic and community partners. Relationships between partners were generally amiable. Both community-"I think it was very helpful, we made sure neither of us made mistakes, and helped each other when we could"-and academic-"I really enjoyed it . . . I learned a lot about the areas I surveyed"-partners were complimentary. Community partners' strengths included local knowledge of the community, whereas academic partners' focus on adherence to the specifications was critical. Structured observation identified many sidewalks in disrepair or obstructed, few benches, and highly variable times allocated for pedestrians to cross at cross walks. CONCLUSIONS: The partnered data collection was both successful and formative, building additional relationships and further capacity for ongoing partnership. Community partners saw their community in a new way, seeing, "little things that are important but people don't pay attention to." Structured observations added to our understanding of how an environment may contribute to diabetes.

Rapid assessment of existing HIV prevention programming in a community mental health center.

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention.