This study investigates the effects of a brief training programme on the communication skills of doctors in ambulatory care settings in Trinidad and Tobago. Evaluation of doctor performance is based on analysis of audiotapes of doctors with their patients during routine clinic visits and on patient satisfaction ratings. A pre-test/post-test quasi-experimental study design was used to evaluate the effects of exposure to the training programme. Doctors were assigned to groups based on voluntary participation in the programme. Audiotapes of the 15 participating doctors (nine trained and six control) with 75 patients at baseline and 71 patients at the post-training assessment were used in this analysis. The audiotapes were content-coded using the Roter Interaction Analysis System (RIAS). Doctors trained in communication skills used significantly more target skills post-training than their untrained colleagues. Trained doctors used more facilitations in their visits and more open-ended questions than other doctors. There was also a trend towards more emotional talk, and more close-ended questions. Patients of trained doctors talked more overall, gave more information to their doctors and tended to use more positive talk compared to other patients. Trained doctors were judged as sounding more interested and friendly, while patients of trained doctors were judged as sounding more dominant, responsive and friendly than patients of untrained doctors. Consistent with these communication differences, patient satisfaction tended to be higher in visits of trained doctors.

Urban agriculture is growing worldwide with the growth of cities. Urban agriculture represents about 20 % of Cuban agriculture. In Cuba, urban agriculture is institutionalized and organized with ecological principles. For instance, local agriculture enhances food security and decreases the use of nonrenewable fertilizers. However, organic crop production in urban environments is challenging because of intensive plant nutrient requirements and disease incidence. Here, we tested an innovative technology based on plant growth promoters isolated from vermicompost and applied directly to lettuce leaves. We monitored plant metabolism by measuring the activities of nitrate reductase, an enzyme linked to N assimilation, and of phenylalanine ammonia lyase, an enzyme linked to plant defense. The experiment was conducted in the organic urban system in Guines, Cuba. We applied liquid humates at 10, 15, or 20 mg C L −1 once at the seedling stage and again 15 days after transplantation. Our results show that humates at 15 mg C L −1 shortened by 21 days the lettuce production cycle, allowing early harvesting without changing quality while increasing yields expressed as the number of leaves per plant. Humate application also decreased total carbohydrate, increased protein, increased nitrate uptake, and stimulated nitrate reductase and phenylalanine ammonia lyase in lettuce leaves.

Abstract.In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide. The objective of this analysis is to describe global handwashing patterns using two proxy indicators for handwashing behavior from 51 DHS and MICS surveys conducted in 2010–2013: availability of soap anywhere in the dwelling and access to a handwashing place with soap and water. Data were also examined across geographic regions, wealth quintiles, and rural versus urban settings. We found large disparities for both indicators across regions, and even among countries within the same World Health Organization region. Within countries, households in lower wealth quintiles and in rural areas were less likely to have soap anywhere in the dwelling and at designated handwashing locations than households in higher wealth quintiles and urban areas. In addition, disparities existed among various geographic regions within countries. This analysis demonstrates the need to promote access to handwashing materials and placement at handwashing locations in the dwelling, particularly in poorer, rural areas where children are more vulnerable to handwashing-preventable syndromes such as pneumonia and diarrhea.

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Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered, characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies, only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted.