Does urban agriculture help prevent malnutrition?

Previous research has suggested that urban agriculture has a positive impact on the household food security and nutritional status of low-socioeconomic status groups in cities in Sub-Saharan Africa, but a formal test of the link between semisubsistence urban food production and nutritional status has not accompanied these claims. This paper seeks to redress this gap in the growing literature on urban agriculture through an analysis of the determinants of the nutritional status of children under five in Kampala, Uganda, where roughly one-third of all households in the sample engage in some form of urban agriculture. When controlling for other individual child, maternal, and household characteristics, these data indicate that urban agriculture has a positive, significant association with higher nutritional status of children, particularly height-for-age. Several pathways by which this relationship is manifested are suggested, and the implications of these results for urban food and nutrition policy and urban management are briefly discussed.Food policies. ,Urban agriculture. ,Food security Household. ,Children Nutrition. ,Nutritional status ,

Putting State Broadband Funds to Work: Best Practices In State Rural Broadband Grant Programs

After a year of pandemic and crisis, the scale of our national digital divide is at last recognized by policymakers at all levels, with federal, state, and local governments making unprecedented commitments to narrow the divide.While most of the funds to address these challenges flow from the federal government, it is at the state, county, and local levels where remarkable innovation has developed.Particularly critical in this moment are state-level efforts to distribute federal funds and incubate local initiatives.Those states that have long-established programs for addressing rural broadband gaps offer a valuable history of lessons learned, both of what works and what doesn't. Through more than a decade of significant efforts and experimentation in broadband funding strategies, new innovations and trends have emerged that offer insights for other states that are developing new rural broadband funding programs or retooling existing programs.Given this rich set of data and experience, this paper describes the commonalities among many of the leading state rural broadband funding programs and recommends best practices

Health Related Web Site Usage by Persons with Serious Mental Illness: Design and Use of a Heath Literacy Survey Tool

Objectives: A health literacy focused web site review survey was designed as an initial step in a multi-institutional project to build a website for persons with serious mental illness to help them better understand issues relating to their physical health. This presentation will describe the design, testing, implementation and results of this survey tool. Methods: The literature shows that persons with serious mental illness (SMI) approach the use of online health information differently than the general population. In 2015, the University of Massachusetts, in collaboration with other academic medical institutions, received a grant to build a new website for persons with SMI that will teach them how to find high quality online health information and will specifically guide them to information about their physical health. As a first step, the project team created a health literacy based survey tool to evaluate current health websites for their utility with an SMI audience. The survey was designed using and building upon an existing validated instrument. It was administered to experts on mental and physical disease. Results will be used to determine quality indicators of the new site and to selected sites to which it will link. Results: 13 reviewers were identified to complete the survey. Four of the identified participants did not complete the task and others were identified to take their places. Ten participants ultimately completed the surveys. Participants were asked to review between four and five websites focusing on four different topics – cardiovascular health, diabetes, obesity and smoking – all comorbidities with prevalence in the SMI community. The websites were chosen based on Google searches that were performed using examples of layperson searches observed in preliminary focus group activities. The top five non-advertiser-supported sites were included. The survey consisted of 61 questions. The questions were developed using existing open access survey tools (e.g., the DISCERN instrument) and findings on website usage by people with SMI that were discovered in the existing literature. Questions focused on format, navigation, usability and credibility of the sites. Questions were also asked about any etiologic, diagnostic, therapeutic or prognostic information contained in the sites. 65 responses were received. Conclusion: Results of the survey demonstrated a sampling of health websites that met the criteria for effective use with an SMI population. The authors believe that this survey could also be adapted and used as a general comprehensive health website evaluation tool. It will be made available as an open access document

The Development of a Standardized Tool to Evaluate Physical Health Websites through the Lens of Persons with Serious Mental Illness

In 2015, the Lamar Soutter Library and the Department of Psychiatry at the University of Massachusetts Medical School received a grant from the National Library of Medicine to design an online tool that will provide persons with serious mental illness a means to acquire resources that will assist them in learning about co-morbidities often faced by this population. One of the first steps in creating this tool is to identify health-related websites that will meet strict quality measures applicable for use by our target audience. To facilitate this process, subject experts with skills in both mental health and physical health have been identified and will be asked to complete a comprehensive survey that will evaluate the identified websites. The survey will address aspects of each website reviewed such as content and credibility, format, usability and interactivity plus the evaluation of etiologic, diagnostic, therapeutic and/or prognostic information contained on the site. This poster will describe the evidence-based methodology used in developing and testing this survey instrument. Preliminary results, discussion of evaluative data and next steps will also be discussed

eMental Health Bridges Project: A Web Site Development Project to Provide Needed Mental and Physical Health Information to People with Serious Mental Illness [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. The eMental Health Bridges project will promote health literacy by developing, testing, and implementing: 1) eMH4me training modules to provide guidance for individuals with SMI on web-based information searching, judging source and site credibility, and interpreting data; and 2) web site prototypes that will serve as a connection to essential physical health information for individuals living with SMI. eMental Health Bridges will embrace user experience and design accommodations required for individuals with SMI to benefit fully from eHealth resources

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments

Background: Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. Methods: This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration’s review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. Results: The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Conclusions: Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness

Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care

Background Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study. Methods Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported. Results Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHRlinkage) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared p = 0.004). Of those who deferred blood draw, 48.3% cited clinic-related and 51.7% cited personal reasons. AHRlinkage was 0.60 (95%CI: 0.44, 0.82) for clinic-related and 0.53 (95%CI: 0.38, 0.75) for personal reasons relative to having day-of-diagnosis blood draw. Conclusions Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed—regardless of the reason for deferring—had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care

Paternal obesity is associated with IGF2 hypomethylation in newborns: results from a Newborn Epigenetics Study (NEST) cohort

Data from epidemiological and animal model studies suggest that nutrition during pregnancy may affect the health status of subsequent generations. These transgenerational effects are now being explained by disruptions at the level of the epigenetic machinery. Besides in vitro environmental exposures, the possible impact on the reprogramming of methylation profiles at imprinted genes at a much earlier time point, such as during spermatogenesis or oogenesis, has not previously been considered. In this study, our aim was to determine associations between preconceptional obesity and DNA methylation profiles in the offspring, particularly at the differentially methylated regions (DMRs) of the imprinted Insulin-like Growth Factor 2 (IGF2) gene