Community capacity for sustainable community–based dengue prevention and control: domain,assessment tool and capacity building model

In order to understand the community capacity for sustainable community-based dengue prevention and control, this paper proposes the approach of a previous study about meaning and domains of dengue prevention and control, an assessment tool and a community capacity building model for sustainable community-based dengue prevention and control in the Southern Thailand. A study of dengue community capacity domains was conducted by utilizing a qualitative method, whereby ten initial community domains were identified by means of a literature review, in-depth interviews of sixty community leaders, and eight focus group discussions with sixty non-leaders in four sub-districts of southern Thailand. In the final study, there were 14 identifiable domains in leaders group and 11 domains in non-leaders. The resulting dengue community capacity-assessment tool (DCCAT) consisted of two parts: one for leaders (DCCAT-L) and the other for non-leaders (DCCAT-NL). DCCAT-L was composed of 115 items within 14 domains and 83 items within 11 domains for the DCCAT-NL. The key domains of leaders and non-leaders had a partial overlap of domains such as critical situation management, personal leadership, health care provider capacity, needs assessment, senses of community, leader group networking, communication of dengue information, community leadership, religious capacity, leader group and community networking, resource mobilization, dengue working group, community participation, and continuing activities. The application of the new tool consisted of five steps: 1) community preparation, 2) assessment, 3) a community hearing meeting, 4) interventions, and 5) conclusion and improvement step. All stakeholders in the community should use the new tool based on a clear understanding of the measurement objectives, the desired outcomes, resources available and characteristics of their community. If communities need to develop and build dengue community capacity, then the designed pre-post intervention assessments or serial assessments are essential.     

南宁市秀山社区居民高血压认知与行为习惯调查

目的分析社区居民对高血压的认知与行为因素现状,为加强社区对高血压防治提供参考依据。方法采用参考相关文献并自行修改的调查问卷,对130例年龄>35岁的社区居民的一般情况、高血压认知情况以及行为因素展开调查并进行分析。结果51.5%的社区居民不知道高血压的诊断标准;31.5%的社区居民大量饮酒,28.5%的社区居民吸烟。结论社区居民缺乏高血压相关知识的教育,对高血压的危害性认识不足,部分社区居民长期处于高危行为因素下,有必要建立有效的社区高血压防治。     

Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men.

Culturally relevant prevention programs are required to reduce HIV risk exposure of Latino young men who have sex with men (YMSM). As part of Hermanos Jóvenes, 465 Latino YMSM were surveyed at community venues of New York City outside the gay-identified area of lower Manhattan. We examined factors that influence ethnic and gay community attachments; the association between community attachments and social support in sexual matters; and the relationship between levels of attachment, social support in sexual matters, and sexual risk behaviors. Sixty-eight percent felt closely connected to their ethnic community; about 34% were highly attached to both neighborhood and New York City gay communities. Greater social support in sexual matters was associated with ethnic and gay community attachments. Latino YMSM connected to their ethnic community were about 40% less likely to report recent unprotected anal intercourse (UAI) with a male partner, and 60% less likely to have engaged in UAI during the last sexual contact with a nonmain male partner. Gay community attachment was not significantly related to risk behaviors. Findings point to the importance of ethnic ties and involving ethnic community organizations in HIV prevention efforts.     

空心莲子草人工群落灭螺效果及机理研究

目的构建空心莲子草人工群落,对其灭螺效果及机理进行研究。方法人工构建空心莲子草灭螺群落,向该人工群落及钉螺孳生地红穗苔草和闵草群落分别进行投螺实验,比较3种群落的灭螺效果及小气候环境因子,并分析莲子草化感作用对钉螺孳生地其他杂草种子萌发率和生物量的影响。结果空心莲子草群落中钉螺死亡率显著高于红穗苔草群落和闵草群落(P均0.05)。3种群落的土壤pH值、NaCl和有机碳含量差异有统计学意义(P0.01);空心莲子草根系水浸液能抑制钉螺孳生地杂草种子萌发,降低杂草生物量。结论空心莲子草人工群落灭螺效果显著,其可能通过改变钉螺孳生环境的小气候因子及化感作用起作用。     

老年人群脑卒中现患率及危险因素调查

目的　探讨脑卒中的现患率及相关危险因素。方法　北京万寿路地区脑卒中患者现况调查 ,对老年人群进行整群抽样 ,总调查人数 2 12 4人 ,调查结果进行统计学分析。结果　被调查老年人群脑卒中现患率为 16 .31% ,logistic回归分析显示与脑卒中有显著相关的因素包括 :高血压病、冠心病、短暂性脑缺血发作病史、饮酒。结论　被调查人群脑卒中现患率较高 ,相关危险因素包括高血压病、冠心病、短暂性脑缺血发作病史等。     

社区及中西医结合治疗甲型H1N1流行性感冒的经验

目的总结甲型H1N1流行性感冒防治经验。方法分析378例确诊甲型H1N1流感病例的临床特征以及住院治疗与社区隔离治疗效果。社区治疗组240例,住院治疗组138例,住院治疗组分为抗病毒组67例及中药治疗组71例。结果住院治疗与社区隔离治疗临床效果无差异(P>0.05)。抗病毒组与中药治疗组临床疗效无差异(P>0.05)。结论对于传播速度快、流行广泛的呼吸道传染病可以采取社区隔离治疗,可以发挥中药治疗在防治呼吸道传染病中的重要作用。     

Opposing plant community responses to warming with and without herbivores

If controls over primary productivity and plant community composition are mainly environmental, as opposed to biological, then global change may result in large-scale alterations in ecosystem structure and function. This view appears to be favored among investigations of plant biomass and community responses to experimental and observed warming. In far northern and arctic ecosystems, such studies predict increasing dominance of woody shrubs with future warming and emphasize the carbon (C)-sequestration potential and consequent atmospheric feedback potential of such responses. In contrast to previous studies, we incorporated natural herbivory by muskoxen and caribou into a 5-year experimental investigation of arctic plant community response to warming. In accordance with other studies, warming increased total community biomass by promoting growth of deciduous shrubs (dwarf birch and gray willow). However, muskoxen and caribou reduced total community biomass response, and responses of birch and willow, to warming by 19%, 46%, and 11%, respectively. Furthermore, under warming alone, the plant community shifted after 5 years away from graminoid-dominated toward dwarf birch-dominated. In contrast, where herbivores grazed, plant community composition on warmed plots did not differ from that on ambient plots after 5 years. These results highlight the potentially important and overlooked influences of vertebrate herbivores on plant community response to warming and emphasize that conservation and management of large herbivores may be an important component of mitigating ecosystem response to climate change.     

Community structure in social and biological networks

A number of recent studies have focused on the statistical properties of networked systems such as social networks and the Worldwide Web. Researchers have concentrated particularly on a few properties that seem to be common to many networks: the small-world property, power-law degree distributions, and network transitivity. In this article, we highlight another property that is found in many networks, the property of community structure, in which network nodes are joined together in tightly knit groups, between which there are only looser connections. We propose a method for detecting such communities, built around the idea of using centrality indices to find community boundaries. We test our method on computer-generated and real-world graphs whose community structure is already known and find that the method detects this known structure with high sensitivity and reliability. We also apply the method to two networks whose community structure is not well known--a collaboration network and a food web--and find that it detects significant and informative community divisions in both cases.     

Community perception and readiness for anti-helminth programmes in rural Nepal

We report on the community perception of helminth infection and readiness to participate in and pay for a community-based anti-helminth programme in rural Nepal. For data collection, 28 focus group discussions (FGDs) were conducted in 28 communities. The FGD results revealed that community members were lacking in scientific knowledge about helminth infection. They also had an unusual perception about it--they believed that a 'mul juka' (vital worm) should reside in every person's stomach from birth, and must never be killed. Nonetheless, the results showed that the community members were willing to participate in and were ready to contribute their resources to the anti-helminth programmes as long as modern medicine would not kill the 'mul juka'. Such community readiness provides us with hope for developing a sustainable anti-helminth programme at the community level through effective health education.     

Individual's perspective of local community environment and health indicators in older adults

Aim: This study evaluated the relationship between individual's perspective of local community environment and health in older people. Methods: A survey about quality of life in older adults in Spain was applied to a representative sample of 1106 community‐dwelling people (mean age ± SD = 72.07 ± 7.83 years, 43.67% males). Local community (Community Wellbeing Index, neighborhood problems, time in the neighborhood), psychosocial and sociodemographic measures were considered. Four health outcomes (self‐perceived health status, functional independence, depression and number of chronic medical conditions) were studied. Multivariate logistic analyses were carried out. Results: At least two local community measures were independently associated with each health outcome. Satisfaction with community services significantly contributed to all models; it was positively related with self‐rated health and functional independence, and negatively associated with depression and chronic medical conditions. Conclusion: The individual's perspective of the local community environment was associated with health outcomes in older adults. This can be useful in the development of policies committed to promoting social integration and active aging in the community. Geriatr Gerontol Int 2013; 13: 130–138 .     

Community environment and HIV/AIDS-related stigma in China.

This article examines the contextual effects of community environment on individual stigmatizing attitudes toward people with HIV/AIDS in China. Multilevel logistic regression models are used to analyze data on 5,658 respondents aged 15-49 from 66 communities in the Baseline Information, Education, and Communication Survey for HIV/AIDS Prevention in China, conducted by the State Family Planning Commission in 2000. The results show that a high level of HIV/AIDS-related risk behavior in the community and a low level of community development are associated with increased HIV/AIDS-related stigma, after controlling for respondents' sociodemographic characteristics, including extent of knowledge about HIV/AIDS. The findings suggest that interventions for reducing HIV/AIDS-related stigma in China should take into account community characteristics, such as level of HIV/AIDS-related risk behavior and level of development in the community.     

社区糖尿病及其高危人群饮食干预效果评价

目的评价在社区通过饮食控制预防糖尿病（DM）的效果。方法随机选取福州鼓楼区两个社区作为干预（安泰社区）与对照社区（温泉社区）,于2009年10月至2011年10月对干预社区进行综合饮食干预,对照社区未进行干预。2年后根据2个社区住户分布的实际情况分为每100户一群,每个社区随机抽取30群,共调查3702名干预人群和3666名对照人群。干预社区调查了一般人群980例、高危人群2070例、糖尿病人群652例,对照社区分别为898、2016和692例;两组人群采用食物频率法进行问卷调查及体检（身高、体重、血糖、血压等）,比较两组一般情况。率的比较采用）f2检验;均数比较应用t检验。结果干预社区与对照社区的建档率比较差异有统计学意义（76．7％比71．2％,x2=294．69;P〈0．01）;与对照社区比较,干预社区一般人群、高危人群和糖尿病人群的空腹血糖（FPG）、高危人群和糖尿病人群的体质指数（BMI）与收缩压（SBP）及高危人群的舒张压（DBP）均显著下降（t=4．289、11．847、8．517、4．946、7．838、8．176、12．931、8．315,均P〈0．01）;一般人群蛋白质和脂肪摄人量均显著增加而碳水化合物摄人量显著减少（t=12．72、11．40、4．11,均P〈0．01）,高危人群蛋白质摄人量显著增加而碳水化合物和脂肪摄入量均显著减少（t=9．45、14．32、7．44,均P〈0．01）,糖尿病人群蛋白质和脂肪摄入量均显著减少（t=5．98、15．22,均P〈0．01）。与对照社区比较,干预组一般人群的豆类、水果类、乳类、蛋类的摄入有显著增加（t=6．778、9．035、4．718、14．223,均P〈0．01）;干预组高危人群的豆类、蔬菜类、水果类、乳类及蛋类的摄入有显著增加而主食、肉类和食用油的摄人量则显著下降（t=5．358、2．827、9．627、21．346、3．351、12．970、19．342、3．241,均P〈0．01）,干预组糖尿病人群的乳类和蛋类的摄入有显著增加而肉类、水产品、食用油、零食及含糖饮料的摄入量则显著下降（t=8．376、2．702、4．155、3．121、8．494、6．702、10．854,均P〈0．01）。结论饮食干预可有效改善社区人群的膳食和营养结构,促进健康。其中糖尿病患者及高危人群的干预效果优于一般人群。但部分干预对象的饮食结构仍不合乎标准,因此社区饮食干预仍需长期开展,并强调控制豆类、油盐摄人量,提高果蔬及乳类摄入量。     

二级医院与社区健康服务中心互动式管理在社区高血压患者健康管理中的应用及效果研究

目的探讨二级医院与社区健康服务中心(社康中心)互动式管理在社区高血压患者健康管理中的应用及效果。方法选择深圳市宝安区西乡人民医院及其所属的35家社康中心和深圳市第七人民医院及其所属的5家社康中心作为现场试点,进行为期1年(2011年12月—2012年11月)的健康管理。其中将实施与医院互动式管理的17家社康中心作为观察组,其他未实施与医院互动式管理的23家社康中心作为对照组。通过文献研究、专家咨询制定互动式管理路径,通过试点对互动式管理模式进行验证及修改。比较健康管理前后两组患者健康管理意识及依从性变化,并分析两组患者健康管理质量。结果管理前两组患者中遵医嘱用药、主动要求管理及参加自我管理小组者所占比例比较,差异均无统计学意义(P0.05);管理后观察组患者中遵医嘱用药、主动要求管理及参加自我管理小组者所占比例高于对照组(P0.05)。观察组不良行为改变率、规范管理率及血压控制率均高于对照组(P0.05)。结论二级医院与社康中心互动式管理模式能有效提高社区高血压患者管理依从性及管理质量,适宜推广。     

Evidence-based medicine knowledge,attitudes, and skills of community faculty

CONTEXT: As medical schools turn to community physicians for ambulatory care teaching, assessing the preparation of these faculty in principles of evidence-based medicine (EBM) becomes important. OBJECTIVE: To determine the knowledge and attitudes of community faculty concerning EBM and their use of EBM in patient care and teaching. DESIGN: Cross-sectional survey conducted from January to March of 2000. SETTING: A clinical campus of a state medical school; a midwestern city of a half-million people with demographics close to national means. MAIN OUTCOME MEASURES: Comparisons of community faculty with full-time faculty in perceived importance and understanding of EBM (5-point scale), knowledge of EBM, and use of EBM in patient care and teaching. MAIN RESULTS: Responses were obtained from 63% (177) of eligible community faculty and 71% (22) of full-time faculty. Community faculty considered EBM skills to be less important for daily practice than did full-time faculty (3.1 vs 4.0; P < .01). Primary care community faculty were less confident of their EBM knowledge than were subspecialty community or full-time faculty (2.9 vs 3.3 vs 3.6; P < .01). Objective measures of EBM knowledge showed primary care and subspecialty community faculty about equal and significantly below full-time faculty (P < .01). Thirty-three percent of community faculty versus 5% of full-time faculty do not incorporate EBM principles into their teaching (P < .01). CONCLUSIONS: Community faculty are not as equipped or motivated to incorporate EBM into their clinical teaching as are full-time faculty. Faculty development programs for community faculty should feature how to use and teach basic EBM concepts.     

Outcomes and Transfer Patterns for First Non-ST-Elevation Myocardial Infarction (NSTEMI): Comparisons Between Community and Tertiary Care Hospitals

BackgroundTransfer patterns, procedure rates, and outcomes of patients with non–ST-segment elevation myocardial infarction (NSTEMI) presenting to Canadian community hospitals are not well understood.MethodsWe documented all patients admitted to British Columbia (BC) hospitals with a primary diagnosis of NSTEMI between 2007 and 2008. Patients were divided by admitting hospital type into tertiary care hospitals, nonremote community hospitals, and remote community hospitals. The aims were to compare transfer rates and time to transfer to a tertiary hospital as well as procedure rates and outcomes at index admission, at 30 days, and at 1 year.ResultsThe mean transfer rates to a tertiary hospital were 72.6% for nonremote and 57.1% for remote community hospitals (P < 0.001). Times to and rates of cardiac procedures differed significantly among these 3 hospital types. Admission to a nonremote or remote community hospital was associated with similar 1-year mortality compared with admission to a tertiary care hospital (nonremote hospitals, adjusted odds ratio [OR], 0.87; P = 0.26; remote hospitals, adjusted OR, 1.19; P = 0.33). At 1 year, admission to a nonremote community hospital was associated with a lower composite outcome of death or readmission for acute myocardial infarction (AMI) (adjusted OR, 0.80; P = 0.04).ConclusionsOne-year mortality rates were not different between patients with NSTEMI admitted to BC community and tertiary care hospitals; however, the rate of readmission for AMI/death was significantly less in patients admitted to nonremote community hospitals. This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings.     

Functional disability among partners and community activity in elderly Japanese: The Ohsaki Cohort 2006 Study

IntroductionThis cross-sectional study aimed to determine association between partners’ functional disability and community activity in an elderly Japanese population.MethodsA baseline survey was conducted between December 1 st and December 15th, 2006 and included 6600 participants from whom we collected data regarding their participation in community activity and functional disability among their partners. We defined functional disability as receiving certification for long-term care insurance in Japan, and frequent community activity as engaging in community activity more than once a month. Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for frequent community activity based on functional disability among partners. We also conducted additional analyses using three types of community activities (neighborhood associations; sports, exercise, or a hobby; and volunteering for nonprofit organizations) as outcomes.ResultsMultivariate adjusted analysis showed that the OR (95% CI) for frequent community activity was 0.70 (0.54–0.89, P < 0.01) among those whose partners had functional disabilities, compared with those whose partners did not have functional disabilities. This finding remained true even for different types of community activities such as neighborhood activities, sports, exercises, hobbies, and volunteering for nonprofit organizations.ConclusionIn this cross-sectional study of an elderly Japanese population, participants whose partners had functional disabilities were less likely to participate in community activity. We conclude that enhancement of support systems is important to promote participation in community activity, not only for patients with disability but their partners as well.     

社区糖尿病患者降糖药物应用情况调查分析

目的了解社区糖尿病患者用药情况和对用药知识的需求程度。方法对139例该社区糖尿病患者用药情况进行问卷调查,统计服药人数、规律服药率和对不良反应的知晓率。结果社区糖尿病患者服药率为68.3%（95/139）,规律服药率为34.5%（48/139）,不良反应知晓率为25.2%（35/139）。结论社区糖尿病患者用药存在多方面误区,开展针对糖尿病的社区药学服务很有必要。     

Aggregate community properties and the strength of species’ interactions

Although humanity depends on the continued, aggregate functioning of natural ecosystems, few studies have explored the impact of community structure on the stability of aggregate community properties. Here we derive the stability of the aggregate property of community biomass as a function of species’ competition coefficients for a two-species model. The model predicts that the stability of community biomass is relatively independent of the magnitude of the interaction strengths. Instead, the degree of asymmetry of the interactions appears to be key to community stability.