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The Urban High-Risk Patient

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Urban Family Medicine

Abstract

Most family practitioners would intuitively say that urban dwellers are subject to specific, urban health risks, but whether this is actually the case is a question that bears close scrutiny. Most appraisals of how healthy or unhealthy urban life is reflect the antiurban bias of American culture. Medical practitioners who have chosen to live and work in urban areas are not immune to this bias even while they may perceive many advantages to urban living. Physicians committed to the care of an urban population, therefore, must carefully consider whether their risk assessments reflect mere prejudice or actual health conditions. When physicians examine the medical literature concerning these conditions, they find contradictions, studies of very limited scope or applicability, and even obvious underlying biases. Undoubtedly, an urban/nonurban dichotomy colors medical research, and many studies are interesting mainly as urban or rural apologetics.

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References

  1. Clark D: A vocabulary for preventive and community medicine. In: Clark DW, MacMahon B (eds). Preventive and Community Medicine, 2nd edit. Little Brown, Boston, 1981, pp 3–16.

    Google Scholar 

  2. Battista RN, Spitzer WO: The periodic health examination. In: Rakel RE (ed). Textbook of Family Practice, 3rd edit. WB Saunders, Philadelphia, 1984, pp 135–160.

    Google Scholar 

  3. Brueschke EE, Schoenberger JA: The patient at risk. In: Rakel RE (ed). Textbook of Family Practice, 3rd edit. WB Saunders, Philadelphia, 1984, pp 161–174.

    Google Scholar 

  4. Frame PS, Hennen BK: Periodic health screening. In: Rakel RE, Conn HF (eds). Family Practice, 2nd edit. WB Saunders, Philadelphia, 1978, pp 123–137.

    Google Scholar 

  5. Green LA, Reed FM, Martini C, et al.: Differences in morbidity patterns among rural, urban, and teaching family practices: a one year study of twelve Colorado family practices. J Fam Pract 9:1075–1080, 1979.

    PubMed  CAS  Google Scholar 

  6. Alexander ER: Acute infections of the alimentary tract. In: Clark DW, MacMahon B (eds). Preventive and Community Medicine, 2nd edit. Little Brown, Boston, 1981, pp 367–390.

    Google Scholar 

  7. Henderson R: Sexually transmitted diseases. In: Clark DW, MacMahon B (eds). Preventive and Community Medicine, 2nd edit. Little Brown, Boston, 1981, pp 411–424.

    Google Scholar 

  8. Update-Acquired immunodeficiency symdrome (AIDS). Morbid Mortal Wkl 32:688–691, 1984.

    Google Scholar 

  9. Rudov M, Santangelo N: Health Status of Minorities and Low Income Groups. DHEW publication HRA 79–627.US Government Printing Office, Washington, DC, 1979.

    Google Scholar 

  10. Tuberculosis-United States 1982. Morbid Mortal Wkl 32:478–480, 1983.

    Google Scholar 

  11. Inselman S, El-Maraghy NB, Evans HE: Apparent resurgence of tuberculosis in urban children. Pediatrics 68:647–649, 1981.

    PubMed  CAS  Google Scholar 

  12. Flores E, Plumb SC, McNeese MC: Intestinal parasitosis in an urban pediatric clinic population. Am J Dis Child 137:754–756, 1983.

    PubMed  CAS  Google Scholar 

  13. Pickering LK, Woodward WE, DuPont HL, Sullivan P: Occurrence of Giardia lamblia in children in day care centers. J Pediatrics 104:522–526, 1984.

    Article  CAS  Google Scholar 

  14. Garcia-Palmieri MR, Costas R, Cruz-Vidal M: Urban-rural differences in coronary heart disease in a low incidence area. Am J Epidemiol 107:206–215, 1978.

    PubMed  CAS  Google Scholar 

  15. Kleinman JC, DeGruttola VG, Cohen B, Madans J: Regional and urban-suburban differentials in coronary heart disease mortality and risk factor prevalence. J Chronic Dis 34:11–19, 1981.

    Article  PubMed  CAS  Google Scholar 

  16. Tyroler HA, Cassel J: Health consequences of culture change II. The effect of urbanization on coronary heart mortality in rural residences. J Chronic Dis 17:167–177, 1964.

    Article  PubMed  CAS  Google Scholar 

  17. Syme SL, Borhani NO, Buechly RW: Cultural mobility and coronary heart disease. Am J Epidemiol 82:344–346, 1966.

    Google Scholar 

  18. Marmot MG, Syme SL: Acculturation and coronary heart disease in Japanese Americans. Am J Epidemiol 104:225–247, 1976.

    PubMed  CAS  Google Scholar 

  19. Greenberg MR: A note on changing geography of cancer mortality within metropolitan regions of the United States. Demography 18:411–420, 1981.

    Article  PubMed  CAS  Google Scholar 

  20. Greenberg M, Barrows D, Clark P, et al.: White female respiratory cancer mortality: a geographical anomaly. Lung 161:235–243, 1983.

    Article  PubMed  CAS  Google Scholar 

  21. Ford AB, Bialik O: Air pollution and urban factors in relation to cancer mortality. Arch Environ Health 35:350–359, 1980.

    PubMed  CAS  Google Scholar 

  22. Goldsmith JR: The &#01C;urban factor” in cancer: smoking, industrial exposures, and air pollution as possible explanations. J Environ Pathol Toxicol 3:205–217, 1980.

    PubMed  CAS  Google Scholar 

  23. Mueller D: The current status of urban-rural differences in psychiatric disorder: an emerging trend for depression. J Nerv Ment Dis 169:18–27, 1981.

    Article  PubMed  CAS  Google Scholar 

  24. Wirth L: Urbanism as a way of life. Am J Sociol 44:3–24, 1938.

    Article  Google Scholar 

  25. Milgram S: The experience of living in cities. Science 167:1461–1468, 1970.

    Article  PubMed  CAS  Google Scholar 

  26. Rutter M: The city and the child. Am J Orthopsychiatry 51:610–625, 1981.

    Article  PubMed  CAS  Google Scholar 

  27. Brown GW, Prudo R: Psychiatric disorder in a rural and an urban population 1. aetiology of depression. Psychol Med 11:581–599, 1981.

    Article  PubMed  CAS  Google Scholar 

  28. Prudo R, Brown GW, Harris T, Dowland J: Psychiatric disorder in a rural and an urban population 2. Sensitivity to loss. Psychol Med 11:601–616, 1981.

    Article  PubMed  CAS  Google Scholar 

  29. Neff JA: Urbanicity and depression reconsidered: the evidence regarding depressive symptomatology. J Nerv Ment Dis 171:546–552, 1983.

    Article  PubMed  CAS  Google Scholar 

  30. Srole L, Fischer A (eds): Mental Health in the Metropolis: The Midtown Manhattan Study Revisited. NYU Press, New York, 1979.

    Google Scholar 

  31. Louria DB: Drug and alcohol abuse. In: Clark DW, MacMahon B (eds). Preventive and Community Medicine, 2nd edit. Little Brown, Boston, 1981, pp 437–450.

    Google Scholar 

  32. Brown BS, Voskuhl T, Lehman PE: Comparison of drug abuse clients in urban and rural settings. Am J Drug Alcohol Abuse 4:445–454, 1977.

    Article  PubMed  CAS  Google Scholar 

  33. Dembo R, Farrow D, Schmeidler J, Burgos W: Testing a causal model of environmental influences on the early drug involvement of inner city junior high school students. Am J Drug Alcohol Abuse 6:313–336, 1979.

    Article  PubMed  CAS  Google Scholar 

  34. Dembo R, Burgos W, DesJarlais D, Schmeidler J: Ethnicity and drug abuse among urban junior high school youths. Int J Addict 14:557–568, 1979.

    PubMed  CAS  Google Scholar 

  35. Dembo R, Schmeidler J, Burgos W: Life-style and drug involvement in an inner city junior high school. Int J Addict 15:171–188, 1980.

    PubMed  CAS  Google Scholar 

  36. Myers GC, Manton KG: The structure of urban mortality: a methodological survey of Hannover, Germany, part 1. Int J Epidemiol 6:203–211, 1977.

    Article  PubMed  CAS  Google Scholar 

  37. Manton KG, Myers GC: The structure of urban mortality: a methodological study of Hannover, Germany, part II. Int J Epidemiol 6:213–223, 1977.

    Article  PubMed  CAS  Google Scholar 

  38. Brennan ME, Lancashire R: Association of childhood mortality with housing status and unemployment. J Epidemiol Commun Health 32:28–33, 1978.

    Article  CAS  Google Scholar 

  39. Aubry F, Gibbs GW, Becklake MR: Air pollution and health in three urban communities. Arch Environ Health 34:360–368, 1979.

    PubMed  CAS  Google Scholar 

  40. Robertson CS: Environmental correlates of intercity variation in age-adjusted cancer mortality rates. Environ Health Perspect 36:197–203, 1980.

    Article  PubMed  CAS  Google Scholar 

  41. Baetjer AM: Atmospheric pollution. In: Sartwell P (ed). Maxcy-Rosenau. Preventive Medicine and Public Health, 10th edit. Appleton-Century-Crofts, New York, 1973, pp 875–889.

    Google Scholar 

  42. Rosenfeld W, Jhaveri R, Evans H, et al.: Decreasing perinatal mortality in a large urban center. NY State J Med 82:1208–1212, 1982.

    CAS  Google Scholar 

  43. Merideth HV: Research between 1950 and 1980 on urban-rural differences in body size and growth rate of children and youths. Adv Child Dev Behav 17:83–138, 1982.

    Article  Google Scholar 

  44. Barclay A, Yater A, Lamp R: Heterogeneity of intellectual performance by disadvantaged children within a metropolitan area. Percept Motor Skills 55:781–782, 1982.

    Article  PubMed  CAS  Google Scholar 

  45. Needleman HC, Gunnoe C, Leviton A, et al.: Deficits in psychologic and classroom performance of children with elevated dentine lead levels. N Engl J Med 300:689–695, 1979.

    Article  PubMed  CAS  Google Scholar 

  46. Oski FA, Honig AS, Helu B, Howanitz P: Effect of iron therapy on behavior performance in nonanemic iron-deficient infants. Pediatrics 71:887–880, 1983.

    Google Scholar 

  47. Wallace HM, Weeks J, Medina A: Services for pregnant teenagers in large cities in the United States. JAMA 248:2270–2273, 1982.

    Article  PubMed  CAS  Google Scholar 

  48. Felton BJ, Hinrichser GA, Tsemberis S: Urban-suburban differences in the predictors of morale among the aged. J Gerontol 36:214–222, 1981.

    PubMed  CAS  Google Scholar 

  49. Kallenberg GA, Beck JC: Care of the geriatric patient. In: Rakel RE (ed). Textbook of Family Practice, 3rd edit. WB Saunders, Philadelphia, 1984, pp 244–284.

    Google Scholar 

  50. Perry BC: Falls among the elderly living in high rise apartments. J Fam Pract 14:1069–1073, 1982.

    PubMed  CAS  Google Scholar 

  51. Allard R: Excess mortality from traffic accidents among elderly pedestrians living in the inner city. Am J Public Health 72:853–854, 1982.

    Article  PubMed  CAS  Google Scholar 

  52. O’Brien RM, Shichor D, Decker DL: Urban structure and household victimization of the elderly. Int J Aging Hum Dev 15:41–49, 1982–1983.

    Article  PubMed  Google Scholar 

  53. Carp FM: Life-style and location within the city. Gerontologist 15:27–34, 1975.

    Article  PubMed  CAS  Google Scholar 

  54. Sofranko AJ, Fliegel FC, Glasgow N: Older urban migrants in rural settings: problems and prospects. Int J Aging Human Dev 16:297–309, 1982–1983.

    Article  Google Scholar 

  55. Liang J, Warfel B: Urbanism and life satisfaction among the aged. J Gerontol 38:97–106, 1983.

    PubMed  CAS  Google Scholar 

  56. Ford G, Taylor R: Risk groups and selective case finding in an elderly population. Soc Sci Med 17:647–655, 1983.

    Article  PubMed  CAS  Google Scholar 

  57. Satcher D, Creary L: Family practice in the inner city. In: Rakel RE (ed). Textbook of Family Practice, 3rd edit. WB Saunders, Philadelphia, 1984.

    Google Scholar 

  58. Kleinman A, Eisenberg L, Good B: Culture, illness, and care: clinical lessons from anthropological and cross cultural research. Ann Intern Med 88:251–258, 1978.

    PubMed  CAS  Google Scholar 

  59. Antonovsky A: Social class, life expectancy and overall mortality. Milbank Mem Fund Q 45:31–73, 1967.

    Article  PubMed  CAS  Google Scholar 

  60. Kitagawa EM, Hauser PM: Differential Mortality in the United States. Harvard University Press, Cambridge, 1977.

    Google Scholar 

  61. Syme SL, Berkman LF: Social class, susceptibility, and sickness. Am J Epidemiol 104:1–8, 1976.

    PubMed  CAS  Google Scholar 

  62. Okada L, Sparer G: Access to usual source of care by race and income in ten urban areas. J Commun Health 1:163–174, 1976.

    Article  CAS  Google Scholar 

  63. Kleinman JC, Gold M, Makuc D: Use of ambulatory medical care by the poor: another look at equity. Med Care 19:1011–1029, 1981.

    Article  PubMed  CAS  Google Scholar 

  64. Knox PL, Bohland J, Shumsky NL: The urban transition and the evolution of the medical care delivery system in America. Soc Sci Med 17:37–43, 1983.

    Article  PubMed  CAS  Google Scholar 

  65. Waitzkin H: A Marxist view of medical care. Ann Intern Med 89:264–278, 1978.

    PubMed  CAS  Google Scholar 

  66. Waitzkin H, Wallace J, Sharra HJ: Homes or hospitals? Contradictions of the urban crisis. Int J Health Serv 9:397–416, 1979.

    Article  PubMed  CAS  Google Scholar 

  67. Navarro V: Medicine Under Capitalism. Prodist, New York, 1976.

    Google Scholar 

  68. Blotcky AD, Tittler BI: Psychosocial predictors of physical illness: toward a holistic model ofhealth. Prev Med 11:602–611, 1982.

    Article  PubMed  CAS  Google Scholar 

  69. Berkman LF, Syme SL: Social networks, host resistance, and mortality. A nine year follow-up of Alameda County residents. Am J Epidemiol 109:186–204, 1979.

    PubMed  CAS  Google Scholar 

  70. Cassel J: The contribution of social environment to host resistance: the fourth annual Wade Hamptom Frost lecture. Am J Epidemiol 104:107–123, 1976.

    PubMed  CAS  Google Scholar 

  71. Eisenberg L: What makes persons patients and patients well. Am J Med 69:277–286, 1980.

    Article  PubMed  CAS  Google Scholar 

  72. Smith CK, Cullison SW, Polis E, Holmes TH: Life change and illness onset: importance of concepts for family physicians. J Fam Pract 7:975–981, 1978.

    PubMed  CAS  Google Scholar 

  73. Smilkstein G: The family apgar: a proposal for a family function test and its use by physicians. J Fam Pract 6:1231–1239, 1978.

    PubMed  CAS  Google Scholar 

Download references

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© 1987 Springer-Verlag New York Inc.

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Simons, S.M. (1987). The Urban High-Risk Patient. In: Birrer, R.B. (eds) Urban Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4624-4_9

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  • DOI: https://doi.org/10.1007/978-1-4612-4624-4_9

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-9088-9

  • Online ISBN: 978-1-4612-4624-4

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