Building back better: resilient environmental and occupational health systems for the next global crisis

@#Even after two years, the COVID-19 pandemic still disrupts public activities and services as it exposes vulnerabilities among the population and negatively impacts environmental conditions. The crisis also impeded global progress toward achieving Sustainable Development Goals (SDG). The Fourth Environmental and Occupational Health (EOH) Forum held virtually on November 25 to 26, 2021 provided a venue for learning about local and international COVID-19 responses to help prepare for the next global crisis. Through the systems thinking approach, the discussions prioritized analyses of leadership and governance, financing, human resource, technologies, information management, and service delivery. These analyses focused on community and/or workplace programs and services linked to air quality, waste management, psychosocial wellness, and COVID-19 vaccination. The forum amplified calls for climate actions and public health improvement and emphasized the significance of a collaborative, evidence-based, integrated public health response to a crisis underscoring the apparent interdependence of the SDGs.

Assessment of core and functional competencies of technical personnel of the Center for Health Development Calabarzon, Philippines

Objective@#To assess the competency levels of the technical staff of the Center for Health Development Calabarzon (CHD 4A) to inform the development of a human resource management plan. @*Methods@#A cross-sectional assessment design to determine the CHD 4A technical staff's competency level was utilized. The team from the College of Public Health, University of the Philippines Manila invited all the CHD 4A technical staff to complete a self-assessment using the Learning and Development Needs Assessment Tool (LDNA) (version 3-45), rating their perceived competency and the level of importance to their functions on core and functional competencies stipulated in the Department of Health Compendium of Competency Standards. Gaps were identified by comparing perceived competency levels with a predetermined standard for each agency's salary grade or position. @*Results@#All 67 technical staff took part in the assessment. Entry- and senior-level professionals had minimal deviations from predetermined standards, with gaps in quality service focus and teamwork for the former and planning and political savvy for the latter. In contrast, mid-career professionals had larger gaps in magnitude and number than entry and senior-level staff – the largest being on results orientation – reflective of newly-promoted staff's adjustment period. Of note, these gaps were based on the prevailing competency standards in force at the time of assessment in 2015. Findings may need to be revisited when the agency updates the core and functional competency standards. @*Conclusion@#The participants perceived core and functional competencies as important, with the level of perceived importance increasing as the salary bracket increases. Core competency gaps were widest in integrity and quality service focus. Simultaneously, results orientation, and planning and organizing were the functional competencies that registered the widest gap and prioritized. Training needs assessments should be conducted in times of change to ensure an organization's training programs' relevance and to develop peak-level employee performance.

A look at an urban tertiary hospital's indoor air pollutants using source apportionment of PM₂.₅

Background@#Ironically, the hospital which is believed to be a healthy and safe place can be dangerous to health. Pollutants such as particulate matter 2.5 microns (PM₂.₅) can be present in hospital indoor air and may adversely affect the health of the hospital occupants. @*Objective@#Possible sources of indoor PM₂.₅ in an urban tertiary care hospital in the Philippines are identified and apportioned in this study. @*Methods@#PM₂.₅ measurements were conducted in two naturally ventilated wards (NVWs), two mechanically ventilated wards (MVWs), and a roof deck near the hospital. Mass concentrations with analytical uncertainties of thirteen elements (Al, Na, S, Si, Cl, K, Ca, V, Fe, Zn, Br, Hg, Pb) from PM₂.₅ measurements were utilized with Positive Matrix Factorization (PMF) receptor model to identify and apportion possible sources of indoor PM₂.₅. @*Results@#In NVWs and MVWs, four types of sources were identified including sodium and chlorine sources, crustal emissions, anthropogenic sulfur sources, and road dust. Cleaning agents used in the hospital were identified as an anthropogenic indoor source of sodium while the other factors mainly came from outdoor sources. @*Conclusion@#The contribution of anthropogenic outdoor pollutants such as road dust and sulfur sources to indoor PM₂.₅ are highlighted in the study. The types of both indoor and outdoor sources of indoor PM₂.₅ can be influenced by the type of ventilation.

Community-based approaches for malaria case management in remote communities in the Brazilian Amazon

Abstract INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Challenges and opportunities in environmental and occupational health: Highlights of the First National Environmental and Occupational Health Forum

@#<p>Environmental and occupational health are interconnected disciplines of public health that are concerned in maintaining a symbiotic relationship between the ecosystem and humans. This relationship is under threat by the continuous and alarming increase of the Earth's temperature causing climate change that impacts not just health but also the economy and the safety of the population. The First National Environmental and Occupational Health Forum was organized by the Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila to address and discuss the complex issues that the Philippines is currently experiencing when it comes to environmental and occupational health by providing a space where stakeholders from different sectors can actively participate in mapping out challenges and opportunities. The organizer's long-term vision is to catalyze and build a network of collaboration that is geared towards the improvement of health and safety in the workplace that involves mitigating the effects of climate change. The discussions in the forum gave a comprehensive insight into the different challenges we face for being one of the most vulnerable countries to natural disasters: how this affects health, workplace, and environment. These challenges created new opportunities for the country to build resilience and formulate adaptive strategies to decrease the vulnerability of the population especially the workforce who are constantly exposed to different hazards that are exacerbated by changes in the environment.</p>

Physico-chemical and microbiological quality assessment of ice blocks sold in selected wet markets in Manila, Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to determine the physico-chemical and microbiological quality of ice blocks sold in selected wet markets located in the city of Manila.</p><p style="text-align: justify;"><strong>METHODS:</strong> Twenty-eight samples were collected from three markets. Microbiological quality was analyzed in terms of the presence or absence of coliforms with E. coli as indicator organism. Physico-chemical quality was determined by measuring turbidity, apparent color, pH, iron, and residual chlorine. Measurements obtained were compared with the 2007 Philippine National Standards for Drinking Water (PNSDW).</p><p style="text-align: justify;"><strong>RESULTS:</strong> Results showed that all samples tested positive for coliforms while 25 out of the 28 samples were positive for E. coli. Mean turbidity was 2.74 ± 3.68 NTU; for both apparent color and iron tests, all samples complied with the PNSDW standard limit set; mean pH was 6.15 ± 0.64; and mean residual chlorine was 0.06 ± 0.02 mg/L. Average values of apparent color and iron comply with the PNSDW standards. Six out of 28 samples had turbidity values exceeding the standards. All samples were found to have residual chlorine levels below the standards.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Ice in markets do not comply with key 2007 PNSDW standards and findings warrant strict compliance of ice quality from manufacturers to the point of distribution to protect consumer health.</p>

Stakeholder perceptions on the challenges of financing debilitating illnesses: The case of colorectal cancer and schizophrenia in the Philippines

BACKGROUND: There is a perceived need among policymakers and other actors in the local health system to better address the challenges in financing healthcare, in general, and chronic or debilitating conditions, in particular, in order to develop appropriate policy and program responses.OBJECTIVE: This paper aimed to present perceived issues and challenges in financing schizophrenia and colorectal cancer in the Philippine context, as identified by stakeholders.METHODS: Verbatim transcription of the proceedings of a moderated discussion of stakeholders in schizophrenia and colorectal cancer care was analyzed for themes on challenges and recommendations in the financing of the two conditions in the local setting.RESULTS: A total of 28 stakeholders representing healthcare providers, professional organizations, health maintenance organizations, patient support groups, and government participated in the meeting. Three main issues on financing debilitating conditions were identified by participants: a) government support for the two conditions is currently limited; b) coverage by third-party payors for schizophrenia or colorectal cancer is either absent or restricted; and c) the process of accessing medicines or alternative modes of financing for healthcare was perceived to be disparate and inconvenient for patients and their caregivers. Participants also provided recommendations in improving the mechanism of healthcare financing.CONCLUSION: The general picture that emerged from this moderated discussion pointed to limitations in the prevailing mechanisms for financing schizophrenia and colorectal cancer in the Philippines. Improvements in the current financing mechanisms, and identification of alternative modes, is necessary to ensure universal health coverage.

Indoor air quality monitoring of communities surrounding a coal-fired power plant in Pagbilao, Quezon

OBJECTIVES: The study evaluated the quality of indoor air in households surrounding a coal-fired power plant in Pagbilao, Quezon and its impact to the residents in these communities.  METHODS: The researchers used a quantitative approach and gathered both primary and secondary data from the Province of Quezon, Municipalities of Pagbilao and Padre Burgos and 12 other barangays from January to June 2008. A household survey was conducted to obtain the health and socio-demographic characteristics of the respondents. Likewise, indoor air quality surveys, respiratory health profiling and pulmonary function tests were done. Indoor air quality monitoring measured eight hour levels of particulate matter -10 (PM10) in "near" and "far" barangays and sulfur dioxide (SO2) and nitrogen dioxide (NO2) in two primary impact barangays as indicated in the environmental impact assessment of the power plant.RESULTS AND CONCLUSION: Results showed that there is no significant difference (p=

Development of water safety plan models for water refilling stations in the Philippines

OBJECTIVES: The aim of the project is to develop water safety plan (WSP) guidelines specific for water refilling station (WRS) operators. The guidelines will serve as model for future formulation of WSP among WRS across the country. METHODS: A criteria was developed for selecting WRS. Site visits were initially done along with the selection of eight (8) water refilling stations from pre-identified areas across the country. The operators of the selected WRS together wih their respective local sanitary inspectors underwent a workshop where they were trained and guided on the step-by-step process of devising a WSP. Coaching and mentoring was then conducted for the improvement of the draft WSPs. A guideline manual on how to develop WSPs for WRS was drafted to serve as reference for other WRS in the country. RESULTS: The study developed a WSP model specifically made for WRS setting. Eight (8) final drafts of WSP were also accomplished. WRS operators and local sanitary inspectors were trained on how to develop WSP which will support and facilitate appropriate implementation of these functional WSPs.CONCLUSION: The formulation of WSPs among WRS ensures delivery of safe drinking-water among its consumers. It serves as an initial step in realizing the vision of DOH of institutionalizing WSPs among all water utilities in the country. The guidelines developed will be a useful tool for other WRS in the country for preparing their own WSPs.

Cadmium concentration in brown and polished rice from selected farms in Barangay Real, Calamba City and its potential non-cancer health risk in adult population

OBJECTIVES: This study was conducted to determine the cadmium (Cd) concentration in brown and polished rice collected from the 9 farms in Barangay Real, Calamba City. This study also assessed the non-cancer health risk to adults (?20 years old) of long-term consumption of rice with Cd using the non-cancer hazard quotient (NHQ). METHODS: Rice grains with hull were collected in November-December 2013. Both rice types were analyzed for Cd using a graphite furnace atomic absorption spectrophotometer (GFAAS). The NHQ was calculated by dividing the estimated daily intake of Cd via rice consumption by the oral reference dose (RfD) for Cd.RESULTS: Mean Cd concentrations in brown and polished rice collected from the 9 farms in Barangay Real ranged from 0.0062 to 0.0725 mg/kg and 0.0047 to 0.0778 mg/kg, respectively. The NHQ values of Cd in both rice types were less than 1.0 for adults (?20 years old). CONCLUSION: Cd concentrations in brown and polished rice from the 9 farms did not exceed the 0.4 mg/kg maximum allowable Cd concentration in rice set by FAO/WHO. Since the NHQ did not exceed 1.0, long-term exposure to Cd through consumption of brown and polished rice from these farms is unlikely to cause non-cancer health effects in adults (?20 years old). It is unlikely for adults to develop kidney diseases such as tubular proteinuria, decreased glomerular filtration rates, and itai-itai disease.

Policy alternatives to reduce the health and economic effects of continued asbestos use in the Philippines

OBJECTIVES: Asbestos is a carcinogenic mineral substance formerly used widely in the construction industry, all forms of which, except for chrysotile asbestos, have been banned in the Philippines. This article aims to propose policy alternatives to reduce the health and economic effects of continued asbestos use in the country.METHODS: Records of asbestos-related diseases, and asbestos industry-related data in the country were consolidated. The impact of continued asbestos use on the national economy were estimated incorporating natural mortality, regulations of the Department of Labor and Employment (DOLE), and concepts of multiplier effect and net present value. Round table discussions validated data and generated policy recommendations.RESULTS: Filipinos directly and indirectly exposed to asbestos-containing materials (ACMs) are 5,289 and 30,000, respectively. The contributions of these groups to the national economy were estimated at PhP 1.08 Billion annually for workers directly exposed to ACMs and PhP 6.83 Billion annually for workers indirectly exposed. Two policy options--adjustment of threshold limit values, and a total ban--are presented.CONCLUSION: A total ban on all forms of asbestos is shown to be the more cost-effective policy option for the country. It is recommended that government agencies, stakeholders in the asbestos industry, and the general public be involved in strategies for improving surveillance on asbestos exposure, increasing public awareness, and promoting the use of asbestos alternatives.

Occupational health systems across selected public healthcare facilities in the Philippines

OBJECTIVE: The study aimed to collect data on the occupational health systems implemented across selected healthcare facilities in the Philippines, including: (1) governance system for occupational health and safety (OHS), (2) OHS information systems, (3) OHS financing systems, (4) technology and related systems for OHS, (5) the OHS workforce, and (6) the delivery of OHS services.METHODS: The data were collected through a walkthrough survey of the selected facilities as well as through the review of records and relevant documents found in the facilities.RESULTS: Governance and financing systems for OHS are not present in any of the facilities. 3 out of the 13 hospitals studied have employee medical records, accident/incident reports while none of the 19 facilities have Workplace Environment Monitoring Reports (WEM), implying the lack of OHS information systems. Due to the lack of a financing mechanism for occupational health services, there is a lack of OHS technology in the facilities which include but are not limited to the presence of an Immunization and Post-Exposure Program (present in 7 out of 13 hospitals and none of the 6 RHUs studied). 1 out of 19 facilities reported to having personnel delegated for OHS activities in their facility. Lastly, 1 out of 19 facilities have emergency treatment and medical facilities for their employees, indicating inadequate OHS service delivery in the facilities studied.CONCLUSIONS: Standards and laws such as the Philippine OHS Standards and Department of Health (DOH) Administrative Order (AO) 2012-0020 have provisions with regard to OHS in these facilities, and stricter implementation of these provisions could help in filling in the gaps in the OHS systems in these facilities. This will provide a healthy workforce capable of giving better healthcare services to the general population.

Knowledge and practices of water refilling station owners and operators in providing safe and wholesome drinking water supply in one municipality of Cavite

OBJECTIVES: This study aimed to a) evaluate the knowledge of water refilling station (WRS) owners and operators regarding the proper techniques and procedures applicable to WRS based on the Certification Course for Water Refilling Station and Plant Operators (CCWRSPO); b) assess compliance to regular physical-chemical and microbiological testing of product water and sanitary permit acquisition and c) determine the quality of product water of selected water refilling stations (WRS) in a municipality in Cavite. METHODS: The study includes WRS owners and operators who participated in the CCWRSPO from 2005 to 2009. A 50-item objective examination administered by the researchers was used to evaluate the knowledge of the respondents. This was formulated based on the objectives of the CCWRSPO. The compliance to legal requirements for WRS was assessed according to the results of the physical-chemical and microbiological tests (Multiple Tube Fermentation Technique and Pour Plate Method) and the presence of an updated sanitary permit. Results of product water analyses were compared to the 2007 Philippine National Standards for Drinking Water. Water refilling stations that failed to meet at least one of the three legal requirements were considered as "non-compliant". RESULTS AND CONCLUSION: Results showed that 71.8% of the respondents passed the written examination whereas 28.2% obtained scores less than 50.0%. Chi-square analysis indicated that there was no significant difference between the knowledge of the trainees in 2005 to 2008 and the trainees in 2009. Similarly, majority (78.9%) of the WRS included in the study were found to be non-complaint with the provisions of P.D. 856 and the prescribed standards for water quality. The quality of product water served as an important determinant of the compliance of WRS. Although majority of the water samples tested had acceptable microbiological examination results, 16.9% of the samples exceeded the standards for microbiological water quality. Aside from this, the non-compliance of WRS was attributed to the absence of an updated sanitary permit, which was one of the important indicators of product water quality. Chi-square analysis showed that the trainees who have been operating WRS for only a year after the certification course were less compliant as compared to those operating for two to five years.

Use of locally innovated radiopaque markers (MAKKO pills) for colonic transit study

Locally made radiopaque markers for colonic transit study are presented, specifically on how they were made, and how they compared radiographically with markers available abroad. These markers were produced using locally available materials like barium powder, a feeding tube, cyanoacrylate, and emptied drug capsules. They were then ingested and monitored by X-ray. They were found to be radiographically comparable with imported ones. No adverse events were noted when used in 5 patients: 2 patients with constipation secondary to chronic laxative abuse, 2 patients with reducible complete rectal prolapse, and 1 patient with constipation secondary to short segment Hirschsprungs' Disease. (Author)

Evidence-based clinical practice guidelines on seeking referral for preoperative cardiac evaluation for elective noncardiac surgery

The Philippine Council for Health Research and Development-Department of Science and Technology (PCHRD-DOST), and the Philippine College of Surgeons (PCS) signed a Memorandum of Agreement on 1 June 1999, whereby both agreed to support the formation of Evidence-Based Clinical Practice Guidelines (EBCPGs) on specific areas of surgical care in the Philippines. The areas were to be specified by the PCS, and those areas should have a reasonably large potential of improving the quality of patient care throughout the country, and can be implemented nationwide in both government and private health facilities The first clinical area selected was on when to refer for preoperative cardiac evaluation for elective noncardiac surgery, and when would the intraoperative presence of a cardiologist be beneficial. A Technical Working Group (TWG) was appointed, which: 1) searched and appraised the evidence; 2) prepared a first draft EBCPG; 3) presented the evidence to a Panel of Experts; 4) supervised the panel using the nominal group technique (6 November 1999 - PCS Building); and 5) prepared the second draft EBCPG based on the consensus recommendations of the panel. All processes strictly conformed to the methods of evidence-based guidelines formation specified by evidence-baesd medicine texts The second draft EBCPG was presented on 11 December 1999 during the 55th Clinical Congress of the PCS, and the final draft approved by the PCS Board of Regents on 29 January 2000 Literature search was conducted through the MEDLINE, COCHRANE Library an the HERDIN Database. A total of 2,156 titles, 427 abstracts and 77 full text articles were appraised. Data from 23 prospective cohort studies were encoded into the software COCHRANE Review Manager (RevMan), Version 3.0 for Windows (updated October 7, 1996). Tables were generated which contained authors, outcome rates, relative risks and the 95% confidence intervals of the relative risks. Three perioperative outcomes were identified-cardiac morbidity, cardiac death, and overall cardiac events

Injuries to the rectum and anus following radiation therapy in patients with cervical cancer: 5-year experience at the Philippine General Hospital

A five-year review of anorectal complications seen following radiotherapy for cervical carcinoma was done with the following objectives: 1) to present the profile of patients presenting with anorectal complications following radiation treatment for cervical cancer; 2) to describe the manifestations of these complications and findings on proctosigmoidoscopy with biopsy; and 3) to present the approaches in their management. A total of 116 patients, all with confirmed diagnosis of cervical cancer, were seen over this period. Mean age was 49.5 years. All received external beam cobalt and intracavitary radium. Complications were observed from 10 days to 20 months after treatment. Anal bleeding was the most common complaint (62%), followed by rectovaginal fistula (14%). Residual/recurrent malignancy was noted in seven patients (6%). Treatment modalities varied considerably, ranging from conservative and symptomatic treatment for bleeding, pain, constipation, and diarrhea, to major abdominal procedures for rectovaginal fistula

Cirugía percutánea: análisis de complicaciones y resultados / Percutaneous surgery: complications and results analysis

Se trataron 55 pacientes portadores de una litiasis renal o ureteral alta con cirugía percutánea. El porcentaje global de éxito fue de 100% con 3,6% de cálculos residuales. Se utilizó anestesia peridural en todos los enfermos. No hubo mortalidad y la morbilidad fue baja. El promedio día de estadía fue de 4,5. Se analiza la relación entre la dilatación pielocalicial, la dificultad de punción y las complicaciones operatorias. También la relación entre el tipo de cálculo y las complicaciones operatorias