Community Management Program Research Articles

Keberlanjutan Program Pengelolaan Hutan Rakyat di Wilayah UPT KPHP Dolago Tanggunung

The Indonesian government continously strives to increase the forest resources which continue be the problem is managing community around forests. It is due to weaknesses in management the forests area, to facilitate it is needed an institution that can manage the forest areas sustainability. Through KPH, forest management is getting better and sustainable. The aim of this research is to analyze the sustainability of the forest village community management program. This research was conducted for three months from june to August 2020 in Petimbe village and Sigimpu village, Palolo district, Sigi regency. The samples in this research were 58 respondens obtained by purposive sampling method. The data analysis method was descriptive analysis. The result shows that the sustainability of the forest village community management program obtains in to 3 dimensions (a) management planning dimension with the value of 180.89 in medium category, (b) The social community dimensions with the value of 197 in moderate category, (c) implementing management activities with the value of 127.6 in the low category

Genetic diversity assessment of the indigenous goat population of Benin using microsatellite markers.

Improved knowledge of the diversity within and among local animal populations is increasingly necessary for their sustainable management. Accordingly, this study assessed the genetic diversity and structure of the indigenous goat population of Benin. Nine hundred and fifty-four goats were sampled across the three vegetation zones of Benin [i.e., Guineo-Congolese zone (GCZ), Guineo-Sudanian zone (GSZ), and Sudanian zone (SZ)] and genotyped with 12 multiplexed microsatellite markers. The genetic diversity and structure of the indigenous goat population of Benin were examined using the usual genetic indices (number of alleles Na, expected and observed heterozygosities He and Ho, Fixation index FST, coefficient of genetic differentiation GST), and three different methods of structure assessment [Bayesian admixture model in STRUCTURE, self-organizing map (SOM), and discriminant analysis of principal components (DAPC)]. The mean values of Na (11.25), He (0.69), Ho (0.66), FST (0.012), and GST (0.012) estimated in the indigenous Beninese goat population highlighted great genetic diversity. STRUCTURE and SOM results showed the existence of two distinct goat groups (Djallonké and Sahelian) with high crossbreeding effects. Furthermore, DAPC distinguished four clusters within the goat population descending from the two ancestry groups. Clusters 1 and 3 (most individuals from GCZ) respectively showed a mean Djallonké ancestry proportion of 73.79% and 71.18%, whereas cluster 4 (mainly of goats from SZ and some goats of GSZ) showed a mean Sahelian ancestry proportion of 78.65%. Cluster 2, which grouped almost all animals from the three zones, was also of Sahelian ancestry but with a high level of interbreeding, as shown by the mean membership proportion of only 62.73%. It is therefore urgent to develop community management programs and selection schemes for the main goat types to ensure the sustainability of goat production in Benin.

Prevalence and risk factors of diabetic peripheral neuropathy in Chinese communities

Objective: To investigate the prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients under community management programs. Methods: A cross-sectional study was conducted on T2DM patients in eight communities in Wuhan and Changshu cities. Data would included questionnaire, body measurement, blood testing and clinical examination. The criterion of diabetic peripheral neuropathy was under the combination of symptoms with five physical examinations. Binary logistic regression model was used to analyze the influential factors. Results: The overall prevalence of peripheral neuropathy was 71.2% among the diabetic patients who were managed in primary care health services in the two cities. The binary logistic regression method identified older age (≥60 years, OR=2.39, 95%CI:1.95-2.94), longer diabetic duration (≥10 years, OR=1.25, 95%CI: 1.02-1.54), and worse postprandial glucose control (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.65, 95%CI:1.33-2.04) (all P<0.05) as risk factors for the presence of diabetic peripheral neuropathy, while higher education level was protective factor (compared to patients with education levels of primary school or below, OR=0.52, 95%CI: 0.41-0.66; OR=0.59, 95%CI: 0.44-0.79; OR=0.64, 95%CI: 0.44-0.94 for those with education levels of junior high school, senior high school, and college, respectively). Conclusions: High rates of diabetic peripheral neuropathy among T2DM patients suggested the urgent need for early screening and standardized management at the community levels. It is necessary to promote appropriate screening techniques and methods to identify the peripheral neuropathy, in the primary health service institutions.

Estimación de la proporción de sexos de neonatos de tortuga charapa (Podocnemis unifilis) mediante morfometría del caparazón, en la Amazonía ecuatoriana

Una de las causas de la declinación de poblaciones de Podocnemis unifilis es la captura y consumo de hembras adultas y sus huevos; por esta presión, existen varios programas de manejo comunitario, los cuales mediante incubación, crianza y liberación de juveniles intentan mitigar esta disminución, sin embargo, en estos programas no conocen la proporción de sexos que van a ser devueltos al río. Este estudio busca determinar la proporción de sexos en neonatos de P. unifilis, mediante métodos morfométricos como una técnica alternativa a procedimientos invasivos de determinación sexual.Se registró un promedio de 31.1 huevos por nido, con un 70 % de éxito de eclosión y períodos de incubación de 72-83 días. El análisis histológico gonadal de 35 individuos permitió la clasificación de 14 neonatos machos y 21 neonatos hembras. El resultado del PCA, realizado con las medidas morfométricas de neonatos, mostró una tendencia en la separación de machos y hembras, con el largo, ancho, plastrón del caparazón como las medidas que más aportaron con esta tendencia, y un porcentaje de clasificación del 77.8 %. Sin embargo no se encontró una diferencia estadísticamente significativa (p &lt;0.05) de las medidas morfométricas con respecto a la separación de sexos.

Effect of community management of diabetic patients with hypertension

Objective To evaluate the effect of community management of diabetic patients with hypertension in Beijing Cuigezhuang community in last three years. Methods A community diabetic management program was started from 2007 in Beijing Cuigezhuang community. Three hundred and seventy six patients who participated in the program for more than 3 years were enrolled in the study, including 196 with type 2 diabetes mellitus (T2DM) only (DM group) and 180 with T2DM and hypertension (DMH). The control rate of blood glucose, blood pressure, lipids and the comprehensive control rate were compared between two groups after 3-year intervention. Results There were no significant differences in age, gender ratio, course of diabetes, education background, monthly income and the history of stoke between two groups; while prevalence of dyslipidemia in DMH group was significantly higher than that in DM group [41.7%(75/180) vs. 24.5%(48 196), χ2=11.938, P=0.001]. Compared with the baseline data, the types of antidiabetic drugs used were not significantly changed in two groups after 3-year intervention (DM group: 1.32±0.81 vs.1.31±0.93, t=-0.155, P=0.877, DMH group: 1.43±0.72 vs. 1.48±0.82, t=0, 831, P=0.407). The types of antihypertensive drug in DMH group were significantly decrease. (1.12±0.77 vs. 1.25±0.45, t=2.484, P=0.014), while the rate of statins usage in DM group was significantly increased [13.3%(26/196) vs. 5.1%(10/196), χ2=7.830, P=0.005]. The hemoglobin A1c (HbA1c) levels in DM group was decreased [(7.4±1.5)% vs. (7.8± 2.1)%, t=2.586, P=0.011]. The systolic pressure [(129±12) mmHg (1 mmHg=0.133 kPa) vs. (133±16) mmHg, t=3.503, P=0.001] and the diastolic pressure [(80±8) mmHg ratio (82±10) mmHg, t=2.436, P=0.016] in DMH group were significantly declined. The average LDL-C level [DM group: (3.0±0.9) mmol/L vs. (3.2±1.0) mmol/L, t=2.165, P=0.032; DMH group (2.9±1.0) mmol/L vs. (3.2±1.1) mmol/L, t=3.210, P=0.002] were also significantly decrease. Compared with the baseline, the comprehensive control rates of blood glucose, blood pressure and lipid level were increased in both groups [DM group: 9.7% (19/196) vs. 6.1%(12/196), χ2=1.716, P=0.190, DMH group 13.9% (25/180) vs. 5.0%(9/180), χ2=8.315, P=0.004]. Conclusions The community management program is effective for improvement of comprehensive control rates of blood glucose, blood pressure and blood lipids in diabetic patients with hypertension in Beijing Cuigezhuang community. Key words: Community health services; Diabetes mellitus, type 2; Hypertension; Disease management

HIV in Mental Health Facilities Sometimes Gets too Little Attention

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessHIV in Mental Health Facilities Sometimes Gets too Little AttentionVabren WattsVabren WattsSearch for more papers by this authorPublished Online:31 Mar 2014https://doi.org/10.1176/appi.pn.2014.4a7AbstractResearchers call for better integration of HIV testing and care in public mental health facilities.Individuals receiving treatment for mental disorders are significantly more likely to be infected with HIV than is the general population. This is a key finding from to a study published February 13 in the American Journal of Public Health led by Michael Blank, Ph.D., an associate professor of psychiatry at the University of Pennsylvania Perelman School of Medicine and a co-director of the Penn Mental Health AIDS Research Center. Blank spearheaded a multisite study with researchers from the University of Maryland and the Centers for Disease Control and Prevention (CDC) to evaluate the prevalence of HIV among patients receiving care at mental health facilities. In an interview with Psychiatric News, Blank stated that it was as a graduate student, more than 20 years ago, when he observed the lack of psychiatric disorders being diagnosed in primary care settings, as well as the dearth of primary health care services available in facilities specializing in mental health care. “Since that time, we haven’t made much progress in care for people with complex co-occurring conditions such as HIV and mental illness.”According to Blank, previous studies have evaluated the prevalence of HIV infections among those with mental illness, but they reported wide variations in incidence rates, ranging from 1 percent to 23 percent.“Most studies of HIV prevalence among persons with mental illness were limited by the use of a single convenience sample, which caused the prevalence estimates from those studies to vary widely,” Blank explained. “While our study also used samples of convenience, we were systematic in including a large number of treatment sites and feel as though we were rigorous in representing a significant amount people receiving mental health care across multiple facilities.”In the current study, Blank and colleagues administered HIV tests to more than 1,000 patients who were being treated for symptoms of depression, psychosis, or substance abuse at 10 inpatient psychiatry units, community mental health centers, and community management programs throughout Baltimore and Philadelphia from January 2009 to August 2011. Psychiatric symptoms were measured by the 24-itiem Behavior and Symptom Identification Scale (BASIS-24). Mental illness diagnoses were based on DSM-IV criteria. Results revealed that 51 of the patients (4.8 percent) receiving treatment for mental illness were infected with HIV, approximately four times the rate for the general public in each city and 16 times the rate for the general U.S. population. In addition, 13 of the 51 individuals reported they were unaware of their HIV status. Rates were higher in those who reported homelessness and in those who reported co-infection with hepatitis C.“These findings paint a recent picture of HIV infection rates in the community and reinforce how important it is to identify patients. . .in a timely manner while they are being treated for mental illness,” commented Blank.Francine Cournos, M.D., believes that mental health facilities should offer voluntary HIV testing to ensure that patients with mental illness who test positive for HIV are linked to adequate care for their HIV diagnosis.Francine Cournos, M.D., a professor of clinical psychiatry at Columbia University and an expert in HIV disease, agreed. Cournos told Psychiatric News that the current findings expose the lack of HIV testing being provided to individuals by mental health professionals, despite recommendations from the CDC to offer voluntary HIV testing in all health care facilities—including those providing mental illness treatment.“Psychiatrists should ensure that patients who test positive for HIV are linked to adequate HIV care, retained in care, and begin needed treatment,” Cournos emphasized.As for Blank, he told Psychiatric News that he and his colleagues have recently developed an intervention program, Preventing AIDS Through Health (PATH), that is individually tailored for people with comorbid HIV infection and mental illness. “The observation that the current health care system is fragmented, costly, and ineffective has been voiced far too often over many decades. It is time to integrate health care such that health and mental health services are more commonly available to everyone,” Blank stated. The current study was funded by the CDC, National Institute of Mental Health, and National Institute of Allergy and Infectious Diseases. ■An abstract of “A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings” can be accessed here. ISSUES NewArchived

Caring for Depressed Elderly in the Emergency Department: Establishing Links Between Sub-Acute, Primary, and Community Care

Elderly patients presenting to St. Vincent's Health Emergency Department (ED) constitute approximately one third of presentations. A significant proportion of these involve preexisting conditions including depression that, within elderly patients, is associated with social isolation, physical and mental health problems, and barriers to accessing community services. It is also often overlooked as a clinical diagnosis among the elderly. This study aimed to assess the efficacy of a brief depression screening tool and examine the change over time in quality of life and social factors for elderly patients who present to ED. Patients aged 65 years and over were screened for depression using a short form of the Geriatric Depression Scale (GDS-15). Participants were randomized into control (usual care) and intervention (an assertive outreach community management program) groups and assessed in relation to depression, quality of life, and social support/functioning at recruitment and 6 weeks post discharge. Approximately one in four participants experienced mild to moderate depression that was related to medical factors and associated reduced mobility. This study suggests that an assertive outreach program, with the inclusion of community intervention and links to social supports and services, could improve the management of depression in the elderly and associated health outcomes.

Long‐term outcome of phenobarbital treatment for epilepsy in rural China: A prospective cohort study

To evaluate the long-term outcome of phenobarbital treatment for convulsive epilepsy in rural China, and to explore factors associated with overall seizure outcomes. We carried out follow-up assessments of people who took part in an epilepsy community management program conducted in rural counties of six provinces in China. People with convulsive epilepsy who were previously untreated (or on irregular treatment) were commenced on regular treatment with phenobarbital. Information was collected using a standardized questionnaire by face-to-face interviews of the individuals (and their families where necessary). Information collected included treatment status, medication change, seizure frequency, and mortality. Among the 2,455 people who participated in the original program, outcomes were successfully ascertained during the follow-up assessment in 1986. Among them, 206 had died. Information on treatment response was obtained in 1,780 (56% male; mean age 33.9 years, range 3-84; mean duration of follow-up 6.4 years). Among them, 939 (53%) were still taking phenobarbital. The most common reasons for stopping phenobarbital were seizure freedom or substantial seizure reduction, socioeconomic reasons, and personal preference. Four hundred fifty-three individuals (25%) became seizure-free for at least 1 year while taking phenobarbital, 88% of whom did so at daily doses of 120 mg or below. Four hundred six (23%) reported adverse events, which led to withdrawal of phenobarbital in <1%. The most common adverse effects were malaise/somnolence (7.4%), dizziness (3%), and lethargy (2.6%). At the follow-up assessment, 688 (39%) individuals had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking AED treatment irregularly at recruitment were less likely to become seizure-free. We observed long-term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China. One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy.

Retrospective analysis of treatment effectiveness among patients in Mianyang Municipality enrolled in the national community management program for schizophrenia.

BackgroundOver the last six years China has developed the largest community-based service network for persons with serious mental illness in the world (the ‘686 Project’) but the effectiveness of this program has not been assessed in detail.AimCompare the characteristics of patients with schizophrenia enrolled in the program whose clinical status has improved with the characteristics of patients whose clinical status has not improved.MethodsThe records of 3090 patients with schizophrenia in Mianyang Municipality, Sichuan (a community with 60% rural residents) who participated in the 686 Project at any time during 2011 were extracted from the national electronic registry system for the project and the demographic and treatment characteristics of individuals rated by treating clinicians as ‘recovered’ or ‘improved’ at the time of their last evaluation in 2011 (n=1866) were compared to those of patients rated as ‘unchanged’ or ‘worsened’ (n=1224). The factors considered included gender, age, ethnicity, occupation, education, family economic status, marital status, family history of mental illness, duration of illness, time of enrolled in the 686 Program, and adherence to medication.ResultsIn the univariate analysis there were significant differences between the two groups in all variables considered except for gender, ethnicity, and family history of mental illness. The recorded treatment outcome was better in patients who were younger, who had a shorter duration of illness, who were more educated, who came from better-off families, who were more adherent to treatment and who had participated in the program for a shorter period of time. Logistic regression analysis found that patients classified as unchanged or worsened were more likely to be non-adherent to drug treatment, to come from families living below the local poverty line, and to be enrolled in the 686 Program for a longer period of time.ConclusionPoor treatment adherence and poverty seriously limit the effectiveness of the 686 Program. New approaches to improving adherence and for providing basic financial support to families with a mentally ill member will be needed to enhance the efficacy of the program.

Predictors of re-hospitalization over a two-year follow-up period among patients with schizophrenia enrolled in a community management program in Chengdu, China.

BackgroundChina has recently introduced a community-based service network for managing individuals with schizophrenia but there has been relatively little formal evaluation of the effectiveness of this approach.ObjectiveAssess the retention rate and the two-year re-hospitalization rate of patients who are enrolled in the community management network in Chengdu, China.MethodsPatients with a confirmed diagnosis of schizophrenia who had at least one prior hospitalization and who were enrolled in the service network at the community health clinics in 14 communities in the Jinniu District of Chengdu and 10 communities in the Qingyang District of Chengdu participated in the two-year prospective follow-up assessment. Detailed demographic and clinical information was obtained at the time of intake into the follow-up program and their hospitalization status was recorded during monthly evaluations over the subsequent two years.ResultsOf the 1 027 participating patients, 963 (93.8%) remained in the program for the entire two-year period. Patients with a lower level of education and those who did not live with family members were more likely to drop-out of the network. Among the 963 patients who completed the follow-up 174 (18.1%) were re-hospitalized over the two-year period. Multivariate logistic regression identified factors related to re-hospitalization: not married or not living with family members, having more prominent positive and negative symptoms at the time of intake, and using medication less in the six months prior to intake.ConclusionThe 94% two-year retention of patients in this urban community management network for individuals with schizophrenia was excellent and the two-year re-hospitalization rate of 18% is better than that reported in most similar programs in other countries. Patients not living with family members were at higher risk for dropping out of the network and for re-hospitalization so this is a high-risk group that deserves special attention. Standardization of the community interventions and longer follow-up studies with control communities that consider the full range of factors relevant to the well-being of patients with schizophrenia (i.e., social integration, quality of life and re-hospitalization) are needed to definitively demonstrate the effectiveness of this community service network.

Potential for Extended Scope Case Management roles for Dietitians in Chronic Kidney Disease Community Management Programs.

Potential for Extended Scope Case Management roles for Dietitians in Chronic Kidney Disease Community Management Programs.