Devolution as a Means for Self-governance: Its Potential for Poverty Reduction in Kenya

A Study on Healthy Food Service Designing for Semi-disabled Elderly Based on SAPAD

Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial

The aim of this research was to discover whether day case surgery for cataract is associated with an increased use of community resources in comparison with inpatient surgery. Retrospective postal questionnaires were sent to determine the use of resources in the community. More detailed information was gathered by interviews with a sub-sample. The response rate was high (86 per cent). Generally, the reported use of community resources was low. The most important formal care services appeared to be those provided by nurses, general practitioners and home helps/domestic assistance. Inpatients rather than day case patients made greater use of these services. Day case patients made greater use of some forms of informal care. It appears that, day case cataract surgery does not result in high levels of community health care. This might in part be as a result of more rigorous discharge protocols for inpatients.

BackgroundThe prevalence of dependency personality disorder (DPD) is high among elderly people living in rural areas. This study aims to explore the association between dependency on community resources and social support among elderly individuals living in rural areas.MethodsA cross-sectional study was conducted in 26 locations in China. A total of 1160 participants aged ≥ 60 years were selected using a complex multistage sampling design. All data were obtained using questionnaires via face-to-face interviews. DPD was measured using the Minnesota Multiphasic Personality Inventory-II in the standardized Chinese version. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Social support was measured using the Chinese version of the questionnaires of the Older American Resources and Services scale. Community services and resources comprised 44 items. The association between DPD and levels of social support and self-efficacy was evaluated using a logistic regression model. The association between social support and self-efficacy was assessed using analysis of covariance.ResultsUnivariate analysis results showed that elderly people living in rural areas had higher DPD scores and lower levels of self-efficacy compared with those living in urban areas (P < 0.001). Logistic regression analysis showed that DPD was positively associated with the received frequencies of community health service, contracted family doctor services, and regular lectures on health knowledge among the elderly people with odd ratios of 1.58 (P < 0.001), 2.03 (P = 0.013), and 2.67 (P = 0.005), respectively. Logistic regression analysis showed significant interaction between social support and self-efficacy effect on DPD was found in the additive model (P < 0.001).ConclusionDPD was associated mainly with the community resources among elderly people living in rural areas. Social support and self-efficacy were commonly associated with DPD through a synergistic effect. These results suggest that DPD among elderly people may be reduced through effective social support to directly and indirectly promote the elderly’s use of community resources and improve their self-efficacy.

This paper describes the application of a large-scale active learning method to characterize the parameter space of a computational agent-based model developed to investigate the impact of CommunityRx, a clinical information-based health intervention that provides patients with personalized information about local community resources to meet basic and self-care needs. The diffusion of information about community resources and their use is modeled via networked interactions and their subsequent effect on agents' use of community resources across an urban population. A random forest model is iteratively fitted to model evaluations to characterize the model parameter space with respect to observed empirical data. We demonstrate the feasibility of using high-performance computing and active learning model exploration techniques to characterize large parameter spaces; by partitioning the parameter space into potentially viable and non-viable regions, we rule out regions of space where simulation output is implausible to observed empirical data. We argue that such methods are necessary to enable model exploration in complex computational models that incorporate increasingly available micro-level behavior data. We provide public access to the model and high-performance computing experimentation code.

ABSTRACT: This study aims to comprehensively examine the determinants of household poverty in Brazil, placing a specific emphasis on the heads of households as the primary unit of analysis. Household poverty is a critical and multifaceted issue in developing countries, a reality that holds true for Brazil as well. Understanding the intricate web of factors that contribute to household poverty is of paramount importance to policymakers, researchers, and advocates dedicated to poverty alleviation and socioeconomic development. Household poverty remains a persistent challenge in Brazil, with far-reaching social and economic consequences. To address this issue effectively, it is essential to identify the factors that contribute to poverty among households, particularly those led by individuals who are the primary income earners. These households often face unique economic and social challenges that demand targeted interventions. To analyze household poverty determinants, this study utilizes data from the "Pesquisa Nacional por Amostras de Domicílios Contínua" (Continuous National Household Sample Survey) (PNADC). The dataset provides comprehensive information on the individual characteristics of the household head and household-level attributes, offering a nuanced view of the factors at play. A probit model is employed to estimate the probability of a household head experiencing poverty, allowing for a examination of various factors. The research findings reveal several significant determinants of household poverty in Brazil. Firstly, households led by men are found to be less likely to be in a situation of poverty, shedding light on gender-related disparities in income and opportunities. Secondly, households with heads who have attained higher levels of education exhibit a lower probability of being in poverty, underscoring the importance of education as a pathway out of poverty. Moreover, urban households are found to be less prone to poverty compared to their rural counterparts, since households led by individuals who work in agricultural-related activities are more likely to experience poverty. This emphasizes the need for targeted rural development strategies. Additionally, households located in the North and Northeast regions of Brazil face a higher likelihood of poverty, possibly due to regional economic disparities that require specific policy attention. These findings have important policy implications for poverty alleviation efforts in Brazil. Policymakers should consider targeted interventions that focus on improving access to education, particularly in regions with higher poverty rates, as education is a powerful tool for poverty reduction. Efforts to promote gender equality and enhance economic opportunities in rural areas are also essential to address the diverse causes of poverty. Additionally, regional disparities in poverty should be addressed through comprehensive regional development initiatives that take into account the unique challenges faced by different areas of the country. Our results also highlight the importance of community-specific social programs, including conditional-cash transfers and incentives for childhood education, which can play a pivotal role in breaking the cycle of poverty in Brazil's diverse communities.

Using a stress-coping framework, we designed a six-session educational support group offering family caretakers information about schizophrenia, training in problem-solving skills for managing patient behavior, and greater access to social support and community resources. Subjects were recruited though local community mental health centers; 24 subjects participated in one of five identically structured caretakers' groups and another 24 subjects served as matched controls. Results of the multivariate analysis of covariance indicated a significant difference between the experimental and control caretakers following the intervention. Caretakers of the educational support group reported significantly reduced anxiety and personal distress and significantly more active coping behaviors (increased use of community resources and better management of home life with their schizophrenic family member). However, no changes were reported in the frequency of their negative feelings toward their mentally ill family member or in their generalized sense of self-efficacy.

This article focuses on the use of community resources to enhance student learning. The article highlights rural educational settings and provides examples of one program and how resources are identified and utilized. Educational strategies for using community resources as teaching and learning tools are included as suggestions.

Primary care physicians play an important role in care coordination, including initiating referrals to community resources. Yet, it is unclear how awareness and use of community resources vary between physicians practising with and without an extended healthcare team. We conducted a cross-sectional survey of primary care physicians practising in Toronto, Canada, to compare awareness and use of community services between physicians practising in team- and non-team-based practice models. Team-based models included Community Health Centres and Family Health Teams - settings in which the government provides funding for the practice to hire non-physician health professionals, such as social workers, pharmacists, nurse practitioners, registered nurses and others. The survey was mailed to physicians, and reminders were done by phone, fax and e-mail. We used logistic regression to compare awareness between physicians in team-based (N = 89) and non-team-based (N = 138) models after controlling for confounders. We found that fewer than half of the physicians were aware of five of eight centralized intake services (e.g., ConnexOntario, Telehomecare). For most services, team-based physicians had at least twice the odds of being aware of the service compared to non-team-based physicians. Our findings suggest that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources.

ObjectivesCoronavirus disease 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the concept of flexible surge capacity to reduce the burden on hospitals by focussing on community resources to develop home isolation centres in Bangkok, Thailand. Study designA qualitative study consisted of observational and semi-structured interview data. MethodsThe development and activities of home isolation centres were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analysed and categorised based on the practical elements necessary in disaster and emergency management. ResultsData were categorised into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: (1) coordination and collaboration; (2) staff engagement; (3) responsibility clarification; and (4) sustainability. Safety presented two subcategories: (1) patients' information privacy and treatment; and (2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organisation (WHO) guidelines and hospital operations. Several supply- and patient-related challenges were identified and managed during centre development. ConclusionsThe use of community resources, based on the flexible surge capacity concept, is feasible under restricted circumstances and reduced the burden on hospitals during the COVID-19 pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of emergencies' aetiology.

Community-based tourism is often undertaken as a tool to accomplish rural development while reducing natural resource use, but research on household livelihoods suggests that tourism may substitute for or complement resource use activities depending on how households allocate a variety of assets. Drawing on intensive qualitative research and a household survey in communities with and without tourism operations in a protected area in southwest China, we examine impacts of tourism participation on non-timber forest product collection and livestock holdings. Impacts of tourism differ across resource uses and between tourism communities, due to specific ways tourism draws on labor and material inputs. Emerging commercial agriculture and off-farm labor simultaneously impact resource use, while tourism generates demand for labor and farm products from communities without tourism operations. The impacts of tourism on resource use depend on how tourism participation enters into asset allocation processes within particular social and biophysical landscapes

Biological surveys starting in the 1950s provided clear evidence that the Itombwe Massif, located in eastern Democratic Republic of Congo, is one of the most important areas for conservation in Africa. Further surveys in the mid 1990s and early 2000s showed key species were still present and could be conserved. Following a report on these surveys the Ministry of Environment established the Itombwe Reserve in 2006 without consulting local communities who have legitimate customary rights to reside within the area and use the region's natural resources. Although creating the Reserve was within the government's legal authority, its establishment violated the rights of the people there. Here we report over a decade of work by a consortium of international and national human rights and conservation NGOs, the local communities and the protected areas authority (Institut Congolais pour la Conservation de la Nature), to remediate this taking of customary rights. Starting in 2008 these partners began a participatory process with all 550 villages within and around the boundary of the Reserve. Using a community resource use mapping approach, developed from best practices, the team helped communities determine the boundary of the Reserve, and then pilot participatory zoning to identify zones for settlements, agriculture, hunting, gathering of non-timber forest products, and conservation. This process secured the customary rights of long-term residents in the Reserve and protected their lands from being taken by non-rights holders. As a result of this work the use rights of communities were largely restored and the communities agreed on 23 June 2016 to formalize the boundaries of the renamed Itombwe Nature Reserve.

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

To determine the community resources most often used, most needed, and most difficult to use for immigrants. A naturalistic study using principles of community-based participatory research. A group of 106 abused immigrant women were interviewed in person with the Community Agency Use, Frequency, Helpfulness, and Difficulty form as part of a 7-year prospective study. The most frequently noted service needed most was counseling (n = 34, 33.0%) followed by legal services (n = 23, 22.3%) and social services (n = 13, 12.6%). Law enforcement was the most commonly used service (n = 63, 59.4%) and the most difficult to receive (n = 16, 48.5%). Counseling (n = 6, 18.2%) and legal services (n = 5, 15.2%) were also reported as difficult. Law enforcement is often called on to help in partner violence, but immigrant women report difficulty in using this service. Abused immigrant women have risk factors for abuse, and they face barriers in accessing the services they need. It is important for service providers in the community to be aware of the unique challenges of abused immigrant women and to address their needs accordingly.

Protected areas for conservation and poverty alleviation: experiences from Madagascar Charlie J. Gardner*, Martin E. Nicoll, Tsibara Mbohoahy, Kirsten L. L. Oleson, Anitry N. Ratsifandrihamanana, Joelisoa Ratsirarson, Lily-Arison Ren e de Roland, Malika Virah-Sawmy, Bienvenue Zafindrasilivonona and Zoe G. Davies WWF Madagascar and Western Indian Ocean Programme Office, BP738, Antananarivo 101, Madagascar; Durrell Institute of Conservation and Ecology (DICE), School of Anthropology and Conservation, University of Kent, Canterbury, Kent CT2 7NR, UK; D epartement de Biologie, Facult e des Sciences, Universit e de Toliara, Toliara 601, BP 185, Toliara, Madagascar; Blue Ventures Conservation, Level 2 Annex, Omnibus Business Centre, 39-41 North Road, N7 9DP London, UK; ESSA-D epartement Eaux et Forets, Universit e d’Antananarivo, BP 175 Antananarivo, Madagascar; and The Peregrine Fund, BP 4113 Antananarivo, Madagascar