Flood is a recurrent natural disaster that has caused enormous human and material damage in many places and continues to hit local committees at an alarming rate. The need to setup permanent committees to prevent and ...Flood is a recurrent natural disaster that has caused enormous human and material damage in many places and continues to hit local committees at an alarming rate. The need to setup permanent committees to prevent and manage flood disasters by local communities is therefore indispensable. In rural areas, the creation of such a structure is always a welcome relief to flood victims but it is often marred by numerous management problems. This study aimed to analyze the community-based approach in the prevention and management of flood disasters in Babessi Subdivision (North West Cameroon), to identify the causes of flood disasters and the preventive strategies used by this local community. A total number of 300 questionnaires as well as structured interviews were used to collect data in the field and the data were analyzed by simple descriptive statistics. The main results revealed that the main cause of flood disasters is heavy and consistent rainfall. Also, poor refuse disposal and drainage system management contribute to floods. The identification of areas likely to be affected by floods and preventing the riparian population from constructing houses along these areas especially beside the main rivers are the flood preventive measures adopted by the local flood management committee. The flood victims are reluctant to relocate to the settlement site earmarked by the Government, meanwhile, the local flood committee do not have the legal tools to forcefully relocate them. The population of Babessi needs to be sensitized on the impending dangers of flood hazard and be encouraged to participate in implementing the adopted strategies to prevent and manage subsequent flood disasters.展开更多
The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect...The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
AIM: To explore any gender-related differences in prevalence of and condition-associated factors related to an elevated serum alanine aminotransferase (ALT) level amongst residents of Kinmen, Taiwan. METHODS: A total ...AIM: To explore any gender-related differences in prevalence of and condition-associated factors related to an elevated serum alanine aminotransferase (ALT) level amongst residents of Kinmen, Taiwan. METHODS: A total of 11 898 of a potential 20 112 regional residents aged 30 years or more completed a related questionnaire that was carried out by the Yang-Ming Crusade between 1991 and 1994 inclusively, with blood samples being collected by public nurses. The overall questionnaire response rate was 59.3% (52.4% for males and 66.0% for females). RESULTS: The prevalence of an elevated serum ALT level for this sub-population was found to be 7.2%, the prevalence revealing a statistically significant decrease with increasing population age (P<0.0001). Males exhibited a greater prevalence of elevated serum ALT level than did females (9.4% vs 5.3%, P<0.0001). Using multiple logistic regression analysis, in addition to male gender, a younger age, greater waist circumference, presence of type-2 diabetes and hyperuricemia were the significant factors associated with an elevated serum ALT level for both males and females. Gender-related differences as regards associated factors were also revealed. For males, obesity was significantly related to an elevated serum ALT level (OR = 1.28, 95%CI: 1.00-1.66) but this was not so for females (OR = 1.09, 95%CI: 0.84-1.42). Hypertriglyceridemia (OR = 1.80, 95%CI: 1.36-2.39) and hyperuricemia (OR = 1.61, 95%CI: 1.03-2.52) were significantly related to elevated serum ALT levels only for females. CONCLUSION: Several gender-related differences were noted pertaining to the prevalence of and relationship between obesity, hypertriglyceridemia and hyperuricemia and elevated serum ALT level in the present study.展开更多
This paper introduces a new concept of community-based ecotourism (CBET) that originated in foreign countries. Then it analyzes the significance of CBET development in nature reserve (NR). The authors think that commu...This paper introduces a new concept of community-based ecotourism (CBET) that originated in foreign countries. Then it analyzes the significance of CBET development in nature reserve (NR). The authors think that community participation is the evitable choice of nature reserve′s conservation and development. CBET, as the self-improved model of ecotourism, can promote tourism community sustainable development. Based on the stakeholder analysis of CBET in NRs, this paper addresses the reality, especially the problem of CBET development in NRs of China. In order to develop CBET in NRs of China, this paper takes some suggestions to promote the community participation: 1)gradual political empowerment, 2) deep level economic incentive, 3) widespread educational support, 4) impartial distribution of community benefits, and 5) stakeholders cooperation.展开更多
Objective:This study aims to examine the effects of a community-based friendly health clinic(CFHC)program that adopts manual participatory learning(MPL)intervention on the adolescents living in the rural and urban are...Objective:This study aims to examine the effects of a community-based friendly health clinic(CFHC)program that adopts manual participatory learning(MPL)intervention on the adolescents living in the rural and urban areas of Indonesia to gain further insights into their knowledge,attitudes,and skills related to adolescent reproductive health(ARH).Methods:A quasi-experimental design was used to obtain information on the ARH knowledge,attitudes,and skills of adolescents.Two intervention studies that used similar protocols and measures were conducted.A total of 192 adolescents(96 adolescents from urban and rural areas)participated in the project,and the participants from each area were divided into eight groups.A questionairre was adopted to measure the ARH knowledge,attitudes,and skills of these participants.A content analysis of the logbook entries of these respondents was conducted to identify their ARH-related problems.The questionnairre and self-reported ARH data were collected before and after the eight-week program.Results:The CFHC program significantly increased the ARH attitudes(p=0.045)and skills(p=0.009)of adolescents in the rural area,but only improved the ARH knowledge(p<0.001)of adolescents in both rural and urban areas.Fourteen themes were identified in three dominant categories,namely,schools,families,and communities.Conclusions:The CFHC with MPL intervention can improve the ARH knowledge,attitudes,and skills of adolescents in the rural area,but can only improve the ARH knowledge of adolescents in the urban area.The ARH program must be designed based on the characterictics of these adolescents to improve their life skills during puberty.展开更多
AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 ...AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and β-cell dysfunction (HOMA β-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4th vs 1st quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4th vs 1st quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA β-cell function was significantly related to decreased risk of GSD [4th vs 1st quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA β-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and β-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.展开更多
This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative qu...This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.展开更多
BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality ...BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.展开更多
Community-based watershed management is different from the traditional natural resources management. Traditional natural resources management is a way from up to bottom, but the community-based watershed management is...Community-based watershed management is different from the traditional natural resources management. Traditional natural resources management is a way from up to bottom, but the community-based watershed management is from bottom to up. This approach focused on the joining of different stakeholders in integrated watershed management, especially the participation of the community who has been ignored in the past. The purpose of this paper is to outline some of the important basic definitions, concepts and operational framework for initiating community-based watershed management projects and programs as well as some successes and practical challenges associated with the approach.展开更多
BACKGROUND Although South Korea has developed and carried out evidence-based interventions and prevention programs to prevent depressive disorder in adolescents,the number of adolescents with depressive disorder has i...BACKGROUND Although South Korea has developed and carried out evidence-based interventions and prevention programs to prevent depressive disorder in adolescents,the number of adolescents with depressive disorder has increased every year for the past 10 years.AIM To develop a nomogram based on a naïve Bayesian algorithm by using epidemiological data on adolescents in South Korea and present baseline data for screening depressive disorder in adolescents.METHODS Epidemiological data from 2438 subjects who completed a brief symptom inventory questionnaire were used to develop a model based on a Bayesian nomogram for predicting depressive disorder in adolescents.RESULTS Physical symptoms,aggression,social withdrawal,attention,satisfaction with school life,mean sleeping hours,and conversation time with parents were influential factors on depressive disorder in adolescents.Among them,physical symptoms were the most influential.CONCLUSION Active intervention by periodically checking the emotional state of adolescents and offering individual counseling and in-depth psychological examinations when necessary are required to mitigate depressive disorder in adolescents.展开更多
This study investigates the community-based ecotourism (CBE) model using a sample of the Aksu-Zhabagly nature reserve (NR). The aim is to propose a suitable CBE model for Aksu-Zhabgly nature-based tourism destinations...This study investigates the community-based ecotourism (CBE) model using a sample of the Aksu-Zhabagly nature reserve (NR). The aim is to propose a suitable CBE model for Aksu-Zhabgly nature-based tourism destinations by employing a combination of field observation, examination, evaluation, and SWOT analysis. The study determines the strategic suggestions for CBE model designing by the results of SWOT analysis. It concludes that convenient transportation and superior location, diversified wild animals and plants, rich in ethnocultural resources, traditional and tranquil life in a typical rural setting, hospitality and positive attitude of locals to tourism and great potential of the region for sustainable development of ecotourism are the strengths. At the same time, the far residential location from the provincial cities, low-quality service, outdated facilities and shortage of skilled employees in tourism management are the main weakness. Another group of constraints to tourism development is lack of tourism marketing and promotion agencies, lack of transparency, poor institution arrangement and corruption, and lack of preferential policies for CBE development. Finally, the paper recommends that economic development, environmental protection, culture and heritage, marketing and image, favorable political environment, and local residents’ empowerment are the main essential to effectively implement the sustainable development of CBE in the Aksu-Zhabagly tourist destination.展开更多
Community-based tourism (CBT) is considered as one of the typical types of tourism towards sustainable development with three important goals such as bringing back economic benefits, protecting natural environment and...Community-based tourism (CBT) is considered as one of the typical types of tourism towards sustainable development with three important goals such as bringing back economic benefits, protecting natural environment and preserving indigenous cultural values. Therefore, this paper analyzes the factors that affect community ecotourism development associated with environmental protection in emerging economies, including Vietnam, by the method of key and community tourism potential value assessment with 721 sample surveys. In this paper, we have applied to assess the key factors of tourism in Vietnam and other key points to have more comprehensive solutions to promote the development of community-based tourism with environmental protection. The article has used vip-based approach and method of assessing the key success factors. The results of researching factors to develop community tourist (impacting tourist community needs of tourists) by running Logit function have shown the great influence of factors such as: environmental protection (influence factor +3.585780, with a statistical significance of 99%), security and safety (+3.024816—statistical significance 99%) followed by infrastructure conditions & facilities for the community based tourism, the level of information etc… for your community based tourism needs. From the research results, we propose the following policy groups: 1) Developing guidelines for CBT, the first step as a basis for the development of community based tourism laws later;2) Policies related to the implementation of planning, development of key community tourist areas and destinations;3) Policies related to the development of community-based tourism associated with the protection of natural and cultural environments;4) Policies related to tourism management;coordinating monitoring of community tourism resource points;policies related to the local community in community tourism development;5) Policies related to human resource development;promotion work;developing community based tourism products.展开更多
Climate change continues to intensify existing disaster risks and vulnerabilities in the Philippines. Thus, implementation of climate change adaptation strategies is vital to counter the effects of climate change. It ...Climate change continues to intensify existing disaster risks and vulnerabilities in the Philippines. Thus, implementation of climate change adaptation strategies is vital to counter the effects of climate change. It is in this context that this study was undertaken to analyze the need or urgency to adopt community and ecosystem-based adaptation strategies among selected coastal barangays (villages) of Masinloc, Zambales, Philippines. Various methods of data collection were utilized such as secondary data collection, primary data collection through household survey, key informant interviews, and focus group. Results of the study indicate that in terms of community-based adaptation strategies, all of the seven barangays in Masinloc have moderate necessity. However, only Barangays Bani and Collat have high adaptation capacity in terms of infrastructure and disaster preparedness. The execution of several community-based adaptation strategies helps these barangays to respond immediately and appropriately to the moderate risk posed by floods and storm surges. On the other hand, in terms of ecosystem-based adaptation strategies, all of the seven barangays have moderate necessity which implies that they have moderate vulnerability and risk to flood and storm surge but have high adaptation capacity in terms of the conservation and protection of coastal resources (mangroves and sea grasses). The barangays implemented the necessary ecosystem-based adaptation mechanisms that they might need in the future. This only means that when they are faced with disaster, the local communities are prepared to respond appropriately and to cope up with the effects of extreme weather events which lead to floods and storm surge. Even though most of the ecosystem-based adaptation strategies are conducted by the seven barangays, there are several community-based adaptation strategies that are still lacking which will protect them from the effect of floods and storm surges. Hence, carrying out the missing adaptation strategies, both community-based and ecosystem-based, will help in improving the adaptive capacity of the affected barangays and will help them become more resilient to the amplified effects of climate change.展开更多
Introduction:Congestive heart failure(CHF)accounts for over$32 billion in health care costs per year and is at the epicenter of health care reform.CHF remains a major cause of hospitalizations.It is known and has been...Introduction:Congestive heart failure(CHF)accounts for over$32 billion in health care costs per year and is at the epicenter of health care reform.CHF remains a major cause of hospitalizations.It is known and has been reported that missed diagnosis of and missed opportunities to treat heart failure are associated with higher mortality and morbidity.CHF disease management programs have emerged as a potential solution to the CHF epidemic.The paradox remains that CHF disease management programs still cluster in tertiary hospital systems.The impact of heart failure specialists and specialty teams in community health systems is less well understood.Currently there are not enough CHF-trained teams in the community setting to address this unmet health need.Methods:We explored the impact of CHF clinics in a community-based hospital system on readmission rates,mortality,and symptomatic relief.A total of 384 patients were enrolled in the clinic between 2012 and 2015.Data collected included age,sex,type of heart failure,New York Heart Association class,ejection fraction,serum creatinine and brain natriuretic peptide values,and readmission and mortality rates within 30 days,3 months,6 months,and 1 year.We also compared readmission rates between patients who were followed up in the CHF clinic versus those who were not seen in the CHF clinic.Results:A statistically signifi cant difference was demonstrated in readmission rates between patients who were followed up in the CHF clinic versus those who did not visit the CHF clinic for up to 1 year of follow-up.Conclusion:CHF community hospital clinics that use a rapid and frequent follow-up format with CHF-trained teams effectively reduce rehospitalization rates up to 1 year.展开更多
BACKGROUND Evidence for exercise as an efficacious strategy to improve aerobic capacity of breast cancer survivors(BCS)has come largely from intervention studies conducted in laboratory settings.There is an increasing...BACKGROUND Evidence for exercise as an efficacious strategy to improve aerobic capacity of breast cancer survivors(BCS)has come largely from intervention studies conducted in laboratory settings.There is an increasing need to translate to community-type settings,but the efficacy of those interventions using gold standard evaluation is not well-established.AIM To investigate whether similar improvement in aerobic capacity(maximal oxygen consumption[VO2])measured with gold standard testing can be achieved through a community-based setting in BCS.METHODS A peak cardiopulmonary exercise test(VO2peak),6-min walk test(6MWT),and timed up and go test(TUG)were assessed pre-and post-16 wk of progressive intensity aerobic and strength training exercise at a community center.RESULTS The sample consisted of 31 early BCS(<1 year since treatment completion)and 15 controls(CTLs).Both groups significantly improved VO2peak(+1.2 mL/kg/min;P=0.030),6MWT(+35 meters;P<0.001),and TUG(-0.44 s;P<0.01)following training.Both groups improved peak cycling power during the cardiopulmonary exercise test with BCS improving by+10 watts more than the CTLs(P=0.020).Average exercise attendance was 71%(34 of 48 possible days),but compliant days averaged only 60%of total days for aerobic,and<40%for strength in both groups.CONCLUSION Community-based exercise programs can be an effective strategy to improve aerobic capacity and physical function for early-stage BCS but potentially not to the same extent observed in laboratory-based randomized controlled trials.Further research is needed to explore barriers and facilitators of exercise engagement in community-based centers to maximize training benefits for adults with cancer.展开更多
Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI...Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI) can help to address obesity, however the approach of such programs to reach diverse groups, including Aboriginal people, must be considered. This paper considers one mainstream1 CBOPI, the eat well be active (ewba) Community Programs in South Australia, which was delivered in two communities and sought to reach Aboriginal people as part of the overall program. This paper considers how well this approach was received by the Aboriginal people living and working in those communities. Semi-structured interviews were conducted with nine Aboriginal workers who had some connection to the ewba program, and seven ewba project staff. Qualitative data analysis was performed and factors found to affect how well the program was received by Aboriginal people include relationships, approach and project target group, including geographical area. A different response was observed in the two communities, with a more positive response being observed in the community where more relationships were developed between ewba and Aboriginal staff. For any CBOPI seeking to work with Aboriginal (or other Indigenous) communities, it is vital to consider and plan how the program will meet the needs and preferences of Aboriginal people in all stages of the project, in order to reach this group.展开更多
Chronic diseases, such as diabetes and obesity, are more prevalent in low-income and minority communities. One promising method to understand and address these chronic conditions is through Community Based Participato...Chronic diseases, such as diabetes and obesity, are more prevalent in low-income and minority communities. One promising method to understand and address these chronic conditions is through Community Based Participatory Research (CBPR). CBPR engages and empowers community members to identify risk factors and work toward solutions as equal partners with researchers. One positive and lasting outcome may be an increase in the community capacity which includes individual and community leadership development, policy making, creating connections and utilizing existing community resources. Evaluating community capacity created as a result of a CBPR project is one way to measure its effectiveness. This paper is a retrospective analysis of the capacity built during a CBPR study of diabetes and obesity in East and South Los Angeles which are two low-income and minority neighborhoods. Four people, who were heavily involved in the project, completed a retrospective analysis of the capacity built utilizing a validated instrument. There was consensus about the capacity built, which included: excellent participation by community members, inclusion of members’ ideas to leverage additional funding, and pride of community members in their participation in the project. One area that could have been strengthened was increased access for leadership and research experience among community members, especially since the project ended prematurely. There were differences among the two community groups with East Los Angeles members focusing more on tangible interventions and grant writing, while South Los Angeles members had a greater policy focus. Communities and researchers who are embarking on a CBPR project can learn from those who have implemented the strategy. Measuring capacity built during and after the project, can be one way to understanding the contributions of a project in a community. CBPR is an empowering research methodology which, done correctly, can build community capacity and have long-term impacts on individuals and communities.展开更多
Increased availability of antiretroviral treatment for HIV makes the goal of universal access attainable. However, in most resource constrained settings where existing health systems are?largely dysfunctional, major b...Increased availability of antiretroviral treatment for HIV makes the goal of universal access attainable. However, in most resource constrained settings where existing health systems are?largely dysfunctional, major barriers to achieving this goal remain. While treatments with antiretroviral drugs (ART) are the focal point of HIV management, it is increasingly recognized that ART alone will not be sufficient to adequately deal with the lifelong consequences of the disease. In addition, the current global economic downturn will continue to impact on funding for HIV care and support, making the search for sustainable solutions more urgent. This article reviews the current evidence base on the impact of community-based programs on HIV/AIDS treatment and general health outcomes, as well as their contribution to ensuring sustained care for HIV-positive people. Our findings suggest that these programs overall have a positive impact on various dimensions of HIV treatment and care, and make a significant contribution to health and HIV outcomes. The authors argue that better use of community platforms for HIV treatment and care programs could be critical for attaining desired goals and should be prioritized at all levels of program design, implementation, and monitoring and evaluation.展开更多
Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresh...Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.展开更多
文摘Flood is a recurrent natural disaster that has caused enormous human and material damage in many places and continues to hit local committees at an alarming rate. The need to setup permanent committees to prevent and manage flood disasters by local communities is therefore indispensable. In rural areas, the creation of such a structure is always a welcome relief to flood victims but it is often marred by numerous management problems. This study aimed to analyze the community-based approach in the prevention and management of flood disasters in Babessi Subdivision (North West Cameroon), to identify the causes of flood disasters and the preventive strategies used by this local community. A total number of 300 questionnaires as well as structured interviews were used to collect data in the field and the data were analyzed by simple descriptive statistics. The main results revealed that the main cause of flood disasters is heavy and consistent rainfall. Also, poor refuse disposal and drainage system management contribute to floods. The identification of areas likely to be affected by floods and preventing the riparian population from constructing houses along these areas especially beside the main rivers are the flood preventive measures adopted by the local flood management committee. The flood victims are reluctant to relocate to the settlement site earmarked by the Government, meanwhile, the local flood committee do not have the legal tools to forcefully relocate them. The population of Babessi needs to be sensitized on the impending dangers of flood hazard and be encouraged to participate in implementing the adopted strategies to prevent and manage subsequent flood disasters.
文摘The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
文摘AIM: To explore any gender-related differences in prevalence of and condition-associated factors related to an elevated serum alanine aminotransferase (ALT) level amongst residents of Kinmen, Taiwan. METHODS: A total of 11 898 of a potential 20 112 regional residents aged 30 years or more completed a related questionnaire that was carried out by the Yang-Ming Crusade between 1991 and 1994 inclusively, with blood samples being collected by public nurses. The overall questionnaire response rate was 59.3% (52.4% for males and 66.0% for females). RESULTS: The prevalence of an elevated serum ALT level for this sub-population was found to be 7.2%, the prevalence revealing a statistically significant decrease with increasing population age (P<0.0001). Males exhibited a greater prevalence of elevated serum ALT level than did females (9.4% vs 5.3%, P<0.0001). Using multiple logistic regression analysis, in addition to male gender, a younger age, greater waist circumference, presence of type-2 diabetes and hyperuricemia were the significant factors associated with an elevated serum ALT level for both males and females. Gender-related differences as regards associated factors were also revealed. For males, obesity was significantly related to an elevated serum ALT level (OR = 1.28, 95%CI: 1.00-1.66) but this was not so for females (OR = 1.09, 95%CI: 0.84-1.42). Hypertriglyceridemia (OR = 1.80, 95%CI: 1.36-2.39) and hyperuricemia (OR = 1.61, 95%CI: 1.03-2.52) were significantly related to elevated serum ALT levels only for females. CONCLUSION: Several gender-related differences were noted pertaining to the prevalence of and relationship between obesity, hypertriglyceridemia and hyperuricemia and elevated serum ALT level in the present study.
基金Under the auspices of the National Natural Science Foundation of China (No. 40371039)
文摘This paper introduces a new concept of community-based ecotourism (CBET) that originated in foreign countries. Then it analyzes the significance of CBET development in nature reserve (NR). The authors think that community participation is the evitable choice of nature reserve′s conservation and development. CBET, as the self-improved model of ecotourism, can promote tourism community sustainable development. Based on the stakeholder analysis of CBET in NRs, this paper addresses the reality, especially the problem of CBET development in NRs of China. In order to develop CBET in NRs of China, this paper takes some suggestions to promote the community participation: 1)gradual political empowerment, 2) deep level economic incentive, 3) widespread educational support, 4) impartial distribution of community benefits, and 5) stakeholders cooperation.
基金The author(s)would like to thank the grant is provided by the Ministry of Research,Technology,and Higher Education,Directorate General of Resources for Research,Technology and Higher Education of Indonesia for providing this research,School of Nursing,University of Jember,and Research Center Department(Lembaga Penelitian)of University of Jember.
文摘Objective:This study aims to examine the effects of a community-based friendly health clinic(CFHC)program that adopts manual participatory learning(MPL)intervention on the adolescents living in the rural and urban areas of Indonesia to gain further insights into their knowledge,attitudes,and skills related to adolescent reproductive health(ARH).Methods:A quasi-experimental design was used to obtain information on the ARH knowledge,attitudes,and skills of adolescents.Two intervention studies that used similar protocols and measures were conducted.A total of 192 adolescents(96 adolescents from urban and rural areas)participated in the project,and the participants from each area were divided into eight groups.A questionairre was adopted to measure the ARH knowledge,attitudes,and skills of these participants.A content analysis of the logbook entries of these respondents was conducted to identify their ARH-related problems.The questionnairre and self-reported ARH data were collected before and after the eight-week program.Results:The CFHC program significantly increased the ARH attitudes(p=0.045)and skills(p=0.009)of adolescents in the rural area,but only improved the ARH knowledge(p<0.001)of adolescents in both rural and urban areas.Fourteen themes were identified in three dominant categories,namely,schools,families,and communities.Conclusions:The CFHC with MPL intervention can improve the ARH knowledge,attitudes,and skills of adolescents in the rural area,but can only improve the ARH knowledge of adolescents in the urban area.The ARH program must be designed based on the characterictics of these adolescents to improve their life skills during puberty.
基金Supported by the grants from the National Science Council, Nos.NSC-91-2320-B-010-102 and NSC-92-2320-B-010-102
文摘AIM: To explore the association of serum insulin, insulin resistance, and β-cell dysfunction with gallstone disease (GSD) in type 2 diabetics. METHODS: We used a community-based study conducted between 1991 and 1993 in Kinmen, Taiwan to identify type 2 diabetics. A screening program for GSD was performed in 2001 by a panel of specialists who employed real-time ultrasound sonography to examine the abdominal region after the patient had fasted for at least 8 h. Screening was conducted in 2001 on 848 patients diagnosed with type 2 diabetes. The HOMA method was used to compare the profile differences for insulin resistance (HOMA IR) and β-cell dysfunction (HOMA β-cell). RESULTS: We studied 440 type 2 diabetics who attended sonography check-ups. After excluding eight insulin-treated diabetics, the prevalence of GSD among the remaining 432 was 13.9% (26/187) among males and 14.7% (36/245) among females. After adjustment for other GSD-associated risk factors in addition to age and obesity, GSD risk increased among females with levels of serum insulin [4th vs 1st quartile odds ratios (OR) = 4.46 (95%CI: 1.71-11.66)] and HOMA IR [4th vs 1st quartile OR = 4.46 (95%CI: 1.71-11.66)]. Better HOMA β-cell function was significantly related to decreased risk of GSD [4th vs 1st quartile OR = 0.16 (95%CI: 0.03-1.70)]. Among males, age and central obesity were the most significant risk factors for GSD. No association of GSD with serum insulin, HOMA IR, and HOMA β-cell was observed among males. CONCLUSION: Serum insulin, insulin resistance, and β-cell dysfunction are risk factors for GSD in females, but not males with type 2 diabetes.
基金supported by a grant from the Global Fund(No. 2008-NGS-26)
文摘This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.
基金The Preventive Medicine Research Projects of Jiangsu Province Health Department,No.Y2015010 and No.Y2018016The Science and Technology projects of Xuzhou city,No.KC15SM046the Youth Medical Talent Project of“Ke Jiao Qiang Wei Projects”in Jiangsu Province,No.QNRC2016375.
文摘BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.
文摘Community-based watershed management is different from the traditional natural resources management. Traditional natural resources management is a way from up to bottom, but the community-based watershed management is from bottom to up. This approach focused on the joining of different stakeholders in integrated watershed management, especially the participation of the community who has been ignored in the past. The purpose of this paper is to outline some of the important basic definitions, concepts and operational framework for initiating community-based watershed management projects and programs as well as some successes and practical challenges associated with the approach.
基金Basic Science Research Program through the National Research Foundation of Korea(NRF)Funded by the Ministry of Education,No.NRF-2018R1D1A1B07041091 and No.NRF-2021S1A5A8062526。
文摘BACKGROUND Although South Korea has developed and carried out evidence-based interventions and prevention programs to prevent depressive disorder in adolescents,the number of adolescents with depressive disorder has increased every year for the past 10 years.AIM To develop a nomogram based on a naïve Bayesian algorithm by using epidemiological data on adolescents in South Korea and present baseline data for screening depressive disorder in adolescents.METHODS Epidemiological data from 2438 subjects who completed a brief symptom inventory questionnaire were used to develop a model based on a Bayesian nomogram for predicting depressive disorder in adolescents.RESULTS Physical symptoms,aggression,social withdrawal,attention,satisfaction with school life,mean sleeping hours,and conversation time with parents were influential factors on depressive disorder in adolescents.Among them,physical symptoms were the most influential.CONCLUSION Active intervention by periodically checking the emotional state of adolescents and offering individual counseling and in-depth psychological examinations when necessary are required to mitigate depressive disorder in adolescents.
文摘This study investigates the community-based ecotourism (CBE) model using a sample of the Aksu-Zhabagly nature reserve (NR). The aim is to propose a suitable CBE model for Aksu-Zhabgly nature-based tourism destinations by employing a combination of field observation, examination, evaluation, and SWOT analysis. The study determines the strategic suggestions for CBE model designing by the results of SWOT analysis. It concludes that convenient transportation and superior location, diversified wild animals and plants, rich in ethnocultural resources, traditional and tranquil life in a typical rural setting, hospitality and positive attitude of locals to tourism and great potential of the region for sustainable development of ecotourism are the strengths. At the same time, the far residential location from the provincial cities, low-quality service, outdated facilities and shortage of skilled employees in tourism management are the main weakness. Another group of constraints to tourism development is lack of tourism marketing and promotion agencies, lack of transparency, poor institution arrangement and corruption, and lack of preferential policies for CBE development. Finally, the paper recommends that economic development, environmental protection, culture and heritage, marketing and image, favorable political environment, and local residents’ empowerment are the main essential to effectively implement the sustainable development of CBE in the Aksu-Zhabagly tourist destination.
文摘Community-based tourism (CBT) is considered as one of the typical types of tourism towards sustainable development with three important goals such as bringing back economic benefits, protecting natural environment and preserving indigenous cultural values. Therefore, this paper analyzes the factors that affect community ecotourism development associated with environmental protection in emerging economies, including Vietnam, by the method of key and community tourism potential value assessment with 721 sample surveys. In this paper, we have applied to assess the key factors of tourism in Vietnam and other key points to have more comprehensive solutions to promote the development of community-based tourism with environmental protection. The article has used vip-based approach and method of assessing the key success factors. The results of researching factors to develop community tourist (impacting tourist community needs of tourists) by running Logit function have shown the great influence of factors such as: environmental protection (influence factor +3.585780, with a statistical significance of 99%), security and safety (+3.024816—statistical significance 99%) followed by infrastructure conditions & facilities for the community based tourism, the level of information etc… for your community based tourism needs. From the research results, we propose the following policy groups: 1) Developing guidelines for CBT, the first step as a basis for the development of community based tourism laws later;2) Policies related to the implementation of planning, development of key community tourist areas and destinations;3) Policies related to the development of community-based tourism associated with the protection of natural and cultural environments;4) Policies related to tourism management;coordinating monitoring of community tourism resource points;policies related to the local community in community tourism development;5) Policies related to human resource development;promotion work;developing community based tourism products.
文摘Climate change continues to intensify existing disaster risks and vulnerabilities in the Philippines. Thus, implementation of climate change adaptation strategies is vital to counter the effects of climate change. It is in this context that this study was undertaken to analyze the need or urgency to adopt community and ecosystem-based adaptation strategies among selected coastal barangays (villages) of Masinloc, Zambales, Philippines. Various methods of data collection were utilized such as secondary data collection, primary data collection through household survey, key informant interviews, and focus group. Results of the study indicate that in terms of community-based adaptation strategies, all of the seven barangays in Masinloc have moderate necessity. However, only Barangays Bani and Collat have high adaptation capacity in terms of infrastructure and disaster preparedness. The execution of several community-based adaptation strategies helps these barangays to respond immediately and appropriately to the moderate risk posed by floods and storm surges. On the other hand, in terms of ecosystem-based adaptation strategies, all of the seven barangays have moderate necessity which implies that they have moderate vulnerability and risk to flood and storm surge but have high adaptation capacity in terms of the conservation and protection of coastal resources (mangroves and sea grasses). The barangays implemented the necessary ecosystem-based adaptation mechanisms that they might need in the future. This only means that when they are faced with disaster, the local communities are prepared to respond appropriately and to cope up with the effects of extreme weather events which lead to floods and storm surge. Even though most of the ecosystem-based adaptation strategies are conducted by the seven barangays, there are several community-based adaptation strategies that are still lacking which will protect them from the effect of floods and storm surges. Hence, carrying out the missing adaptation strategies, both community-based and ecosystem-based, will help in improving the adaptive capacity of the affected barangays and will help them become more resilient to the amplified effects of climate change.
文摘Introduction:Congestive heart failure(CHF)accounts for over$32 billion in health care costs per year and is at the epicenter of health care reform.CHF remains a major cause of hospitalizations.It is known and has been reported that missed diagnosis of and missed opportunities to treat heart failure are associated with higher mortality and morbidity.CHF disease management programs have emerged as a potential solution to the CHF epidemic.The paradox remains that CHF disease management programs still cluster in tertiary hospital systems.The impact of heart failure specialists and specialty teams in community health systems is less well understood.Currently there are not enough CHF-trained teams in the community setting to address this unmet health need.Methods:We explored the impact of CHF clinics in a community-based hospital system on readmission rates,mortality,and symptomatic relief.A total of 384 patients were enrolled in the clinic between 2012 and 2015.Data collected included age,sex,type of heart failure,New York Heart Association class,ejection fraction,serum creatinine and brain natriuretic peptide values,and readmission and mortality rates within 30 days,3 months,6 months,and 1 year.We also compared readmission rates between patients who were followed up in the CHF clinic versus those who were not seen in the CHF clinic.Results:A statistically signifi cant difference was demonstrated in readmission rates between patients who were followed up in the CHF clinic versus those who did not visit the CHF clinic for up to 1 year of follow-up.Conclusion:CHF community hospital clinics that use a rapid and frequent follow-up format with CHF-trained teams effectively reduce rehospitalization rates up to 1 year.
文摘BACKGROUND Evidence for exercise as an efficacious strategy to improve aerobic capacity of breast cancer survivors(BCS)has come largely from intervention studies conducted in laboratory settings.There is an increasing need to translate to community-type settings,but the efficacy of those interventions using gold standard evaluation is not well-established.AIM To investigate whether similar improvement in aerobic capacity(maximal oxygen consumption[VO2])measured with gold standard testing can be achieved through a community-based setting in BCS.METHODS A peak cardiopulmonary exercise test(VO2peak),6-min walk test(6MWT),and timed up and go test(TUG)were assessed pre-and post-16 wk of progressive intensity aerobic and strength training exercise at a community center.RESULTS The sample consisted of 31 early BCS(<1 year since treatment completion)and 15 controls(CTLs).Both groups significantly improved VO2peak(+1.2 mL/kg/min;P=0.030),6MWT(+35 meters;P<0.001),and TUG(-0.44 s;P<0.01)following training.Both groups improved peak cycling power during the cardiopulmonary exercise test with BCS improving by+10 watts more than the CTLs(P=0.020).Average exercise attendance was 71%(34 of 48 possible days),but compliant days averaged only 60%of total days for aerobic,and<40%for strength in both groups.CONCLUSION Community-based exercise programs can be an effective strategy to improve aerobic capacity and physical function for early-stage BCS but potentially not to the same extent observed in laboratory-based randomized controlled trials.Further research is needed to explore barriers and facilitators of exercise engagement in community-based centers to maximize training benefits for adults with cancer.
文摘Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI) can help to address obesity, however the approach of such programs to reach diverse groups, including Aboriginal people, must be considered. This paper considers one mainstream1 CBOPI, the eat well be active (ewba) Community Programs in South Australia, which was delivered in two communities and sought to reach Aboriginal people as part of the overall program. This paper considers how well this approach was received by the Aboriginal people living and working in those communities. Semi-structured interviews were conducted with nine Aboriginal workers who had some connection to the ewba program, and seven ewba project staff. Qualitative data analysis was performed and factors found to affect how well the program was received by Aboriginal people include relationships, approach and project target group, including geographical area. A different response was observed in the two communities, with a more positive response being observed in the community where more relationships were developed between ewba and Aboriginal staff. For any CBOPI seeking to work with Aboriginal (or other Indigenous) communities, it is vital to consider and plan how the program will meet the needs and preferences of Aboriginal people in all stages of the project, in order to reach this group.
文摘Chronic diseases, such as diabetes and obesity, are more prevalent in low-income and minority communities. One promising method to understand and address these chronic conditions is through Community Based Participatory Research (CBPR). CBPR engages and empowers community members to identify risk factors and work toward solutions as equal partners with researchers. One positive and lasting outcome may be an increase in the community capacity which includes individual and community leadership development, policy making, creating connections and utilizing existing community resources. Evaluating community capacity created as a result of a CBPR project is one way to measure its effectiveness. This paper is a retrospective analysis of the capacity built during a CBPR study of diabetes and obesity in East and South Los Angeles which are two low-income and minority neighborhoods. Four people, who were heavily involved in the project, completed a retrospective analysis of the capacity built utilizing a validated instrument. There was consensus about the capacity built, which included: excellent participation by community members, inclusion of members’ ideas to leverage additional funding, and pride of community members in their participation in the project. One area that could have been strengthened was increased access for leadership and research experience among community members, especially since the project ended prematurely. There were differences among the two community groups with East Los Angeles members focusing more on tangible interventions and grant writing, while South Los Angeles members had a greater policy focus. Communities and researchers who are embarking on a CBPR project can learn from those who have implemented the strategy. Measuring capacity built during and after the project, can be one way to understanding the contributions of a project in a community. CBPR is an empowering research methodology which, done correctly, can build community capacity and have long-term impacts on individuals and communities.
文摘Increased availability of antiretroviral treatment for HIV makes the goal of universal access attainable. However, in most resource constrained settings where existing health systems are?largely dysfunctional, major barriers to achieving this goal remain. While treatments with antiretroviral drugs (ART) are the focal point of HIV management, it is increasingly recognized that ART alone will not be sufficient to adequately deal with the lifelong consequences of the disease. In addition, the current global economic downturn will continue to impact on funding for HIV care and support, making the search for sustainable solutions more urgent. This article reviews the current evidence base on the impact of community-based programs on HIV/AIDS treatment and general health outcomes, as well as their contribution to ensuring sustained care for HIV-positive people. Our findings suggest that these programs overall have a positive impact on various dimensions of HIV treatment and care, and make a significant contribution to health and HIV outcomes. The authors argue that better use of community platforms for HIV treatment and care programs could be critical for attaining desired goals and should be prioritized at all levels of program design, implementation, and monitoring and evaluation.
文摘Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.
