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BackgroundFederal meaningful use standards are promoting adoption of online portals to personal health records (PHRs). However, relatively little is known regarding barriers and facilitators for vulnerable groups such as persons living with human immunodeficiency virus (PLWH). ObjectiveThe objective of this study was to assess barriers and facilitators to use of online PHRs among PLWH. MethodsWe conducted formative research using a written waiting room survey among 120 PLWH regarding barriers and facilitators of portal PHR use. We supplemented findings with data collected from a PLWH focus group, where some members had personal experience with use of a portal. ResultsThe survey had 90 respondents. Eight PLWH participated in the focus group. Most patients (77/90, 86%) reported having at least some experience using the Internet and most expressed interest in features offered by the portal. Notably, 70% (63/90) expressed some interest in being taught how to use it to communicate with their provider. Focus group themes reinforced these findings, but also voiced concern regarding access to private computers. ConclusionsMany PLWH in our sample have experience using computers and most are interested in PHR features. However, computer or broadband access and privacy are important barriers.

Previous literature shows minor impacts of in-person business training in developing countries, but few papers study the effectiveness of digital training. A research partnership with a multinational company operating in the food sector of Guatemala enables the randomized evaluation of a digital training program involving the franchise store owners of one of its retail chains. The training program combined a mobile app offering access to reproducible video capsules and virtual one-on-one consulting meetings. The results of the randomized evaluation reveal significant impacts on knowledge, business practices, sales, and profits. An examination of the mechanisms underlying these results reveals that consulting meetings are crucial in inducing engagement with the app's content. Program flexibility, internet access, and initial sales are also crucial determinants of training effectiveness. [ABSTRACT FROM AUTHOR]

Uganda is home to 1.5 million refugees from DRC, Burundi, South Sudan and other countries. The Uganda political framework is one of the most progressive and inclusive toward refugees. Only a fraction of the refugees is likely to revert to their home countries. The papers collected in this special issue assess Uganda's progressive refugee policy with reference to how it functioned in the era of COVID-19 using a unique panel data collected between 2017 and 2021. The findings of the special issue stress that the support to refugees and hosts is helping to manage daily challenges but not to ultimately get them out of poverty. Further, this support was insufficient to provide a comprehensive response to COVID-19. For the long-term sustainable integration and development, new policy approaches are needed. [ABSTRACT FROM AUTHOR]

Developing countries have recognised the need to strengthen their agricultural extension services as an engine for improving productivity, reaching marginalised, poor and female farmers and addressing new challenges, such as environmental degradation and climate change. However, structuring effective and viable extension systems remains a major challenge in most places. This paper studies the Plantwise extension programme in Kenya, an initiative that supports and increases collaboration among actors in the national plant health system, establishes and maintains a network of plant clinics – a physical interface between farmers and crop protection experts – to address the needs of smallholders, and collects key information in the process that can be used for informing policy and for monitoring and evaluation purposes. To assess the programme in Kenya, we conducted a longitudinal mixed-methods evaluation of the programme from 2014 to 2018. Our results show that Plantwise has altered the way the Government of Kenya addresses crop protection. The programme is innovative and improves knowledge at multiple levels. At the farm level, Plantwise has contributed to improvements in the use of agricultural practices, inputs and maize productivity, a major staple crop. The results show that the Plantwise approach is a reasonable alternative to other agricultural extension systems that support smallholder farmers. [ABSTRACT FROM AUTHOR]

Uganda is home to some 1.5 million refugees. Its self-reliance policy welcomes refugees with freedom of movement and work; a piece of land for building a house and home-gardening; and social protection (food and cash transfers). While a progressive refugee policy, the onset of COVID-19 may complicate its effectiveness. This paper investigates the role of food and cash transfers in meeting negative consequences of the pandemic for both host and refugee communities. We do so by using a unique panel dataset covering the period from 2019 to 2021. Our evidence suggests that although transfers were widely used in refugee settlements prior to COVID-19, their use did not expand within the refugee nor host communities at the onset of the pandemic and, in fact, the transfer amounts declined. The evidence does not suggest that either form of transfer has a strong effect on food security or resilience although there is some evidence that cash transfers facilitate resilience. However, food transfers are associated with maintaining or increasing food security while cash transfers are more closely associated with resilience. Furthermore, food transfer seem to outperform cash transfers in responding to COVID-19 particularly when income loss due to COVID-19 is reported. [ABSTRACT FROM AUTHOR]

With 1.5 million refugees and a refugee policy that promotes long-term settlement and self-sufficiency, understanding the impact of refugees on host communities in Uganda is a critical issue. Of particular concern – not only in Uganda, but all refugee-hosting countries – is the economic impact of refugees; while refugees attract aid money into the local economy, the mass distribution of in-kind goods can drive local prices and wages down. Moreover, little is known about the role of economic integration between refugees and hosts, especially in situations of protracted displacement. Using a mixed methods approach with panel survey data and semi-structured interviews, we show significant integration between refugees and hosts that is widely perceived as positive. Results indicate that refugees provide goods and services at lower costs to hosts and often of higher quality than found elsewhere. Yet, these interactions, especially through markets, create competition and may lower prices and wages since proximity to refugees is associated with lower host labor participation and earnings from crop production. The net welfare effect for hosts of being close to refugees are found to be ambiguous. [ABSTRACT FROM AUTHOR]

Abstract Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627

Abstract Background Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether changes in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making. Methods The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables. Results Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74). Conclusion Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.

BackgroundWhether patient socio-demographic characteristics (age, sex, race/ethnicity, income, and education) are independently associated with failure to receive indicated statin therapy and/or to achieve low density lipoprotein cholesterol (LDL-C) therapy goals are not known. We examined socio-demographic factors associated with a) eligibility for statin therapy among those not on statins, and b) achievement of statin therapy goals.MethodsAdults (21-79 years) participating in the United States (US) National Health and Nutrition Examination Surveys, 1999-2006 were studied. Statin eligibility and achievement of target LDL-C was assessed using the US Third Adult Treatment Panel (ATP III) on Treatment of High Cholesterol guidelines.ResultsAmong 6,043 participants not taking statins, 10.4% were eligible. Adjusted predictors of statin eligibility among statin non-users were being older, male, poorer, and less educated. Hispanics were less likely to be eligible but not using statins, an effect that became non-significant with adjustment for language usually spoken at home. Among 537 persons taking statins, 81% were at LDL-C goal. Adjusted predictors of goal failure among statin users were being male and poorer. These risks were not attenuated by adjustment for healthcare access or utilization.ConclusionAmong person's not taking statins, the socio-economically disadvantaged are more likely to be eligible and among those on statins, the socio-economically disadvantaged are less likely to achieve statin treatment goals. Further study is needed to identify specific amenable patient and/or physician factors that contribute to these disparities.