ABSTRACT
Handwashing with soap at critical times helps prevent diarrhoeal diseases. Changing handwashing practices through behaviour change communication remains a challenge. This study designed and tested a scalable intervention to promote handwashing with soap. A cluster-randomised, controlled trial compared our intervention against standard practice. Subjects were men, women and children in 14 villages in Cross-River state, Nigeria. The primary outcome was the proportion of observed key events on which hands were washed with soap. Binomial regression analysis calculated prevalence differences between study arms. The intervention had minimal effect on the primary outcome (+2.4%, p = 0.096). The intervention was associated with increased frequency of handwashes without soap before food contact (+13%, p = 0.017). The intervention failed to produce significant changes in handwashing with soap at key times. The low dose delivered (two contact points) may have increased scalability at the cost of effectiveness, particularly in the challenging context of inconvenient water access.
Subject(s)
Hand Disinfection , Soaps , Child , Diarrhea/epidemiology , Diarrhea/prevention & control , Female , Humans , Male , Nigeria , Rural PopulationABSTRACT
AIM: The aim of the study was to evaluate the contribution to outpatient care and the perspectives of employed and self-employed ophthalmologists in isolation and in comparison to other professional groups. METHOD: Based on statistical data (source: statistical information provided by the National Association of Statutory Health Insurance Physicians) from 31 December 2015, newly admitted physicians in 2015 and their contribution differentiated by employment relationships were evaluated according to head count and working time equivalents (using "planning of demand equivalents"). The results were subdivided into type of outpatient facility, e.g. single practice, group practice and medical care centers (MVZ). RESULTS: The proportion of employed ophthalmologists (head count) in outpatient care (23%) and newly admitted physicians (81%) is above the interdisciplinary average (16% and 65%, respectively). In all medical professional groups the contribution according to time equivalents of employed physicians compared to self-employed physicians is lower (utilization rate: 65% in total and 70% in ophthalmology). In ophthalmology employment is seen in all types of outpatient practices: the number of ophthalmologists working in group practices is above average, compared to other groups they are underrepresented in MVZ and are working in single practices as frequently as all other specialties. DISCUSSION AND CONCLUSION: Employment of physicians is more common in all types of outpatient ophthalmological facilities than in other specialized professional groups. Possible reasons are the working conditions in ophthalmology attracting physicians preferring employment and the competitive situation for practice takeover. Since employed physicians contribute less time to medical care than self-employed physicians, ophthalmology has a higher risk of a shortage in medical care despite an increasing number of physicians. An increasing number of employed physicians has an impact on the structures of outpatient care; however, the intensity of concentration in healthcare structures can only be partially evaluated due to insufficient data. Based on the available data there is no end in sight for the trend towards employment in outpatient ophthalmological care.
Subject(s)
Eye Diseases/therapy , Ophthalmology , Ambulatory Care , Employment , Humans , Outpatients , SpecializationABSTRACT
A new gel is presented to effect contact between contact lens and cornea during vitrectomy. Mainly it differs from comparable products in terms of higher viscosity. The advantages lie in the stabilisation of the lens and in reduction of air bubbles or blood under the contact lens.
