Discussion on the model of community management of chronic diseases in cold areas

Because of the overbearing low temperature,cold areas increase the morbidity and mortality of chronic non-communicable diseases(chronic diseases)in exposed populations.With the growth of the aging population and the superposition of lifestyle risk factors,the number of people with chronic diseases in cold areas is climbing,and the family and social burdens are rising.These health-threatening circumstances in the cold areas render the general practitioners to face serious challenges and difficulties in the community management of chronic diseases.This paper summarizes the current situation of chronic disease management in cold areas and explores the relevant management models so as to provide a useful reference for regional health construction,graded diagnosis and treatment,and prevention and control of chronic diseases in China.

Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh

Background: Until recently, the experience on implementing community based management of acute malnutrition (CMAM) among children has been largely based in African settings. While the government in Bangladesh is yet to scale up CMAM approach, there is still paucity of knowledge on the experience of CMAM within the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka, Bangladesh, this paper describes a CMAM programme performance and outcomes run by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme data of children admitted with severe acute malnutrition between May 2010 and November 2011. Kamrangirchar is an urban slum of a large migrant population in Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of whom 333 (52%) were males. The median age was 18 months (Inter-quartile range (IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of 69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5% reported to the programme that they will leave the slum and go back to their villages. These performance indicators did not meet the threshold level indicators set by MSF and Sphere standards. Conclusions: Our experience highlights the need for developing more adapted and contextualised indicators for assessing the performance of CMAM programmes in settings such as urban slums. Community engagement in the process of developing relevant standards is crucial. Nutrition humanitarian actors have a vital role to collaborate with local authorities to contextualize and refine these standards.

Community Health Management and Nursing Strategies for Elderly Hypertension

Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.

The influence of environmental factors on species composition and distribution in a community forest in Northern Thailand

Understanding the environmental factors that influence tree species composition is essential for successful management of biodiversity and sustainable use of community forest resources.This study aims to assess tree species composition and distribution in the deciduous Ban Mae Chiang Rai Lum Community Forest in Northern Thailand and to analyze the influence of environmental factors on tree biodiversity in the forest.We conducted a stratified systematic sampling of the forest’s total area of 3925 ha,and twenty-five 0.16 ha survey plots were established in three different stands of the deciduous forests to estimate and characterize the difference in biological diversity among the stands.Canonical correspondence analysis(CCA)was used to investigate the environment factors affecting such differences in biodiversity of the stands.The results showed a high diversity of trees in the forest as 197 species,144 genera,and 62 plant families were recorded.The CCA ordination identified the environmental factors—the most important of which were elevation,distance to streams,soil moisture,organic matter,and distance to communities—that signifi-cantly influenced the diversity and distribution of tree species(p<0.05)in the community forest.Our findings indicate that the implementation of drought reduction measures such as building check dams,fire protection,and monitoring community forest-product usage would be recommended to further biodiversity conservation and the sustainable use of community forest resources.

上海市实施整合式慢性病社区健康管理模式的促进和障碍因素

目的分析整合式慢性病社区健康管理模式实施的促进和障碍因素,区分模式服务量高覆盖率组和低覆盖率组在实施性研究的整合性理论框架(consolidated framework for implementation research,CFIR)上的结构差异,为政府部门提供政策建议。方法结合CFIR对22名专家进行半结构化访谈,采用定性结构评级法对13家社区卫生服务中心受访者评分,利用NVivo 12软件编码。结果高覆盖率组和低覆盖率组的相对优势、外部政策与激励、实施准备度、反思和评价、领导个人特质5个CFIR结构有差异。促进因素包括:测量数据更加精准,提高了高血压和糖尿病患者的异常检出率和控制率;模式实现了服务、技术、数据“三整合”,优化管理流程,提供管理抓手;基础性和个性化服务结合吸引患者到基层就诊;模式与我国政策背景,初级卫生保健工作和以患者为中心理念兼容;数字化工具的应用减轻医护人员工作负担;领导重视是基础,利益方间的通力合作是重要保障。障碍因素包括:宏观层面缺少卫生行政机构的支持性政策,组织架构和运行机制尚未建立,建设、投入主体以及具体工作规范和流程有待明确;缺乏监督管理机制和质量评估小组;模式推广目标模糊;缺乏规范化系统性的培训计划;为不同群体提供服务存在挑战,缺乏有效的社会面宣传;模式仍须提高需方获得感;社区布局限制了模式的服务提供。结论卫生行政部门应明确模式的建设、运行、投入主体,完善组织架构并明确各利益方的功能定位和职责分工,进一步制定工作规范和工作流程;建立信息反馈机制和质量控制小组并进行定期评估;制定清晰的目标;加大宣传教育,扩大宣传面;利用数字化工具形成良性医患互动机制。

Availability and social determinants of community health management service for patients with chronic diseases:An empirical analysis on elderly hypertensive and diabetic patients in an eastern metropolis of China

Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China.Information from the database of the above survey involving 1495 hypertensive or diabetic patients>60 years of age,as representatives of the city,were included.The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey.An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results:Eighty-one percent of hypertensive patients and 84.7%of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey.Among elderly hypertensive patients,those registered as non-agricultural household members,those with high and above-average income,as well as management personnel of government agencies,enterprises,and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings.Among elderly diabetic patients,such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement.More effort should focus on promoting the availability of community health management services for elderly hypertensive patients,especially those with lower socio-economic status.

Longitudinal study of a community hospital integrated model for diabetes management in the Beijing Jingsong community

Objective:To determine the effects of a community hospital integrated model on the longitu-dinal management of diabetic patients.Methods:Four hundred forty-one patients with type 2 diabetes residing in Jingsong Commu-nity were randomly assigned to intensive and standard groups.Metabolic parameters were meas-ured in the two groups at baseline and after 36 months of management to compare the rate of goal achievement.Results:After comprehensive management,the overall control rate in the intensive group was increased from 2.7%to 9.6%compared with 2.3%-4.5%in the standard group.Specifically,the control rates for fasting plasma glucose,glycosylated hemoglobin,and blood pressure in the intensive group were significantly increased from 54.1%,40.0%,and 68.2%to 85.5%,74.6%,and 89.1%,respectively.The control rate for glycosylated hemoglobin in the intensive group was significantly higher than the standard group after 36 months of treatment.Conclusion:The community hospital integrated model for longitudinal management effec-tively improved the control rate of glycosylated hemoglobin and the overall control rate in patients with type 2 diabetes.

Contemporary Currents in Japanese Machizukuri (Citizens Collaborative Community Improvements and Management) and Their Socio-Cultural Meanings

This paper studies the contemporary attempts of Japanese Machizukuri,Citizens Collaborative Community Improvement and Management,and their socio-cultural meanings in order to shed light on the sustainable planning approaches dealing with population ageing and decreasing.In recent years,as response measures for non-physical local issues such as environmental problems and welfare,and with the aim of further enhancing community-centred planning capabilities against a background of decentralisation in various fields and the establishment of civic society,new cooperative/collaborative-style planning theory is being deployed.Through this process,community improvement and management is becoming deeper,in terms of technology,systems,and technique.The study attempts to find out a solution to real-world problems-how to construct a comprehensive planning theory based on spatial and social challenges arising in modern civic communities,with local resources,social capital and systems that have resulted from such issues.It also seeks to show how to achieve a vision for the city as a whole by mutually compiling individual community improvement and management scenarios and programs,based on the autonomous determination and future vision of the organisations and residents that play leading roles in the community.

Community-led initiatives for the rehabilitation and management of vernacular settlements in Oman:a phenomenon in the making

Once abandoned for more than three decades,vernacular settlements in Oman are now being progressively reinvested in to foster the country’s heritage tourism sector.The present research focuses on the emerging phenomenon of community-led initiatives for vernacular heritage rehabilitation and adaptive reuse in Oman.Through an examination of three case studies,its aim is to describe this process and its modes of action and discuss its efects on vernacular settlement transformations.A mixed research methodology was designed to include(A)analyses of relevant primary and secondary data,(B)documented onsite observations,(C)interviews with local community representatives and key players in the operations of rehabilitation,and(D)extractions and analyses of quantitative data from a hotel booking website.The research sheds light on unsuspected interrelations within and between the projects being implemented in these settlements and their operating modes.It reveals the focal role of a local community in a kind of‘bottom-up’management of its built heritage,coupled with a‘horizontal cooperation’between the three initiatives studied in this research.Moreover,it shows that a heavily centralised and top-down policy for the feld of heritage conservation and management is among the main obstacles that hinder such initiatives.Furthermore,community-led operations of vernacular heritage rehabilitation are being undertaken under insufcient regulations in terms of land use,building restoration and adaptive reuse.In this context,the paper discusses some of the serious threats and concerns faced by such initiatives and proposes actionable solutions to mitigate these hindrances.

Decision Making for Managing Community Flood Risks:Perspectives of United States Floodplain Managers

To reduce flood losses,floodplain managers make decisions on how to effectively manage their community’s flood risks.While there is a growing body of research that examines how individuals and households make decisions to manage their flood risks,far less attention has been directed at understanding the decision-making processes for flood management at the community level.This study aimed to narrow this research gap by examining floodplain managers’perceptions of the quality of their community’s flood management decision-making processes.Data gathered from interviews with 200 floodplain managers in the United States indicate that most floodplain managers perceive their community’s flood management decision-making processes to be good.The results also indicate that communities participating in the Federal Emergency Management Agency’s Community Rating System,as well as communities with a higher level of concern for flooding and a lower poverty rate,are significantly more likely to report better flood management decision-making processes.

Social and cultural dimensions of rodent pest management

Rice production in Vietnam is threatened by rodent pests, with a significant increase in impact reported from 1990through to the early 21st century. Pre-harvest rice losses are typically 5–10%, with losses of >20% occurring insome years in some regions. Farmers’ rodent control practices are generally reactive and rely essentially on chemicaland physical methods. Ecologically-based rodent pest management (EBRM) was developed in the late 1990s tomanage rodents in rice-based farming systems in Vietnam and other parts of South-East Asia. EBRM combinesboth cultural and physical rodent management practices such as synchrony of cropping, short 2-week rat campaignsat key periods in key habitats, increasing general hygiene around villages, and use of a communitytrap-barrier system. Although EBRM has been reported to be economically profitable, the successful adoption ofthis set of technologies requires community participation. In this paper we address issues relating to the adoptionand sustainability of EBRM in lowland irrigated rice fields in the Mekong Delta in Vietnam. We particularly explorethe social and cultural mechanisms involved in maintaining community participation to further understandthe conditions under which EBRM works and does not work. Positive indications of sustained use of community-based EBRM include: a policy pronouncement from the prime minister directing the use of integrated rodentmanagement;the use of existing cooperatives for developing community actions;budgetary allocation fromprovincial and local governments;diffusion of EBRM to provinces in the south and north that are not involved infarmer participatory field trials;and the adoption of EBRM by a non-governmental organization, World VisionVietnam, in their area-development programs.

Characterizing the urban spatial structure using taxi trip big data and implications for urban planning

Urban spatial structure is an important feature for assessing the effects of urban planning.Quantifying an urban spatial structure cannot only help in identifying the problems with current planning but also provide a basic reference for future adjustments.Evaluation of spatial structure is a difficult task for planners and researchers and this has been usually carried out by comparing different land use structures.However,these methods cannot efficiently reflect the influence of human activities.With the wide application of big data,analyzing data on human travel behavior has increasingly been carried out to reveal the relationship between urban spatial structure and urban planning.In this study,we constructed a human-activity space network using the taxi trip big data.Clustering at different scales revealed the hierarchy and redundancy of the spatial structure for assessing the appropriateness and shortcomings of urban planning.This method was applied to a case study based on one-month taxi trip data of Dongguan City.Existing urban spatial structures at different scales were retrieved and utilized to assess the effectiveness of the master plan designed for 2000 to 2015 and 2008 to 2020,which can help identify the limitations and improvements in the spatial structure designed in these two versions of the master plan.We also evaluated the potential effect of the master plan designed for 2016 to 2035 by providing a reference for reconstructing and optimizing future urban spatial structure.The analysis demonstrated that the taxi trip data are important big data on social spatial perception,and taxi data should be used for evaluating spatial structures in future urban planning.

Experience and lessons from health impact assessment guiding prevention and control of HIV/AIDS in a copper mine project,northwestern Zambia

Background:To avoid or mitigate potential project-related adverse health effects,the Trident copper project in Kalumbila,northwestern Zambia,commissioned a health impact assessment.HIV was identified a priority health issue based on the local vulnerability to HIV transmission and experience from other mining projects in Africa.Hence,an HIV/AIDS management plan was developed,including community and workplace interventions,with HIV testing and counselling(HTC)being one of the key components.We present trends in HTC data over a 4-year period.Methods:In 13 communities affected by the Trident project,HTC was implemented from 2012 onwards,using rapid diagnostic tests,accompanied by pre-and post-test counselling through trained personnel.In addition,HTC was initiated in the project workforce in 2013,coinciding with the launch of the mine development.HTC uptake and HIV positivity rates were assessed in the study population and linked to demographic factors using regression analysis.Results:In total,11,638 community members and 5564 workers have taken up HTC with an increase over time.The HIV positivity rate in the community was 3.0%in 2012 and 3.4%in 2015,while positivity rate in the workforce was 5.2%in 2013 and 4.3%in 2015.Females showed a significantly higher odds of having a positive test result than males(odds ratio(OR)=1.96,95%confidence interval(CI):1.55-2.50 among women in the community and OR=2.90,95%CI:1.74-4.84 among women in the workforce).HTC users in the 35-49 years age group were most affected by HIV,with an average positivity rate of 6.6%in the community sample and 7.9%in the workforce sample.These study groups had 4.50 and 4.95 higher odds of being positive,respectively,compared to their younger counterparts(15-24 years).Conclusions:While HTC uptake increased five-fold in the community and almost three-fold in the workplace,the HIV positivity rates were insignificantly higher in 2015 compared to 2012.Our data can be used alongside other surveillance data to track HIV transmission in this specific context.Guided by the health impact assessment,the HIV prevention and control programme was readily adapted to the current setting through the identification of socioeconomic and environmental determinants of health.