Factors affecting adoption of a telemedicine device by primary care health workers in the Philippines

@#<p style="text-align: justify;"><strong>Background and Introduction.</strong> The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.</p><p style="text-align: justify;"><strong>Materials and Methods.</strong> The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.</p><p style="text-align: justify;"><strong>Results and Discussion.</strong> RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.</p><p style="text-align: justify;"><strong>Conclusions.</strong> These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.</p>

Community-driven evaluation of E. coli levels in domestic-use underground water sources in Angono, Philippines

@#<p style="text-align: justify;"><strong>Objectives:</strong> The authors considered the community-based on-site water sampling-surveys case-study in Angono, Rizal, in the Republic of the Philippines. The study was designed to determine whether individual citizens within the community could successfully collaborate in order to develop a method for quantification of E. coli levels in water (especially underground water) for domestic use.</p><p style="text-align: justify;"><strong>Methods:</strong> We used techniques that had been validated in Japan for on-site evaluation of E. coli. These simple techniques enabled the on-site quantification of E. coli levels in multiple water sources, including underground water.</p><p style="text-align: justify;"><strong>Results:</strong> The techniques used in Japan were successfully adopted in the Philippines, and we cooperated with regional medical technicians, scientists, and citizens, in order to develop a system where ultimately, the people in Angono can perform all the tasks related to on-site water quality evaluation. From societal and economic perspectives, we were able to reduce the traditionally high laboratory cost (including testing cost and samples transit cost) of coliform bacteria and E. coli evaluation to a lower, fixed cost level that is affordable for regional health centers and other sites.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The transfer of a simple inspection method technology, under the supervision of an experienced Japanese research team, allowed us to validate the E. coli on-site quantification strategy at a regional level as "co-creation of science and society". In addition, beyond technology transfer, our collaborative efforts with scientists, regional medical engineers, and citizens, led to the creation of an NGO (non-governmental organization) that serves citizens in the town of Angono with regard to water quality assessment and certification activities.</p><p style="text-align: justify;"><strong>Key Words:</strong> water quality, water management, community, local people, participatory approach, underground water, Escherichia coli, coliform bacteria, Philippines</p>

Concentrations of trace elements in daily life water consumed in Angono, Rizal, Philippines

Objective@#The present study aims to determine the concentrations of seven trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in tap, well, spring, river, and lake waters in the town of Angono, Rizal in the Philippines, consumed for drinking, cooking, bathing, and washing. In the town of Angono, both of the tap and purified tap waters produced in the refilling station are consumed as the water for drinking.@*Methods@#Water samples from six unpurified tap, six purified taps, 10 wells, two springs, two rivers, and one lake water were obtained in October 2015. Samples were analyzed using solution nebulization inductively coupled plasma mass spectrometry. Results were evaluated for health risks of the trace elements in the water samples using WHO guideline values. The provisional WHO guideline values are as follows: Cr: 50 μg/L, As: 10 μg/L, Cd: 3 μg/L, Pb: 10 μg/L, and U: 30 μg/L. That of Cs has not been proposed yet. The WHO guideline value for the naturally occurring radioactive isotope 232Th in drinking water is 1 Bq/L, which is equivalent to 250 μg/L.@*Results@#The concentrations of the trace elements in the tap water samples were <0.5% of the WHO guideline values, except Cs and Cd, with those of Cd being ~9% of the WHO guideline value. Purified tap waters contained the seven trace elements in lower concentrations, with the exception of Pb, which may have been added in small amounts from equipment used for water purification. The concentrations of the trace elements in water samples from the wells and springs in Angono were more variable than those of the tap waters, and these were also below the WHO guideline values. The concentrations of Cs in all water samples were <0.3 μg/L. The trace-element concentrations of the waters from Angono River and Laguna Lake were almost the same as those of the well and spring waters.@*Conclusion@#At present, the concentrations of trace elements in daily life water consumed in Angono are at safe levels.

Concentrations of Trace Elements in Bottled Water Consumed in Angono, Philippines

Introduction@#We analyzed the concentrations of the trace elements [chromium (Cr), arsenic (As), cadmium (Cd), cesium (Cs), lead (Pb), thorium (Th), and uranium (U)] in commercial bottled water consumed in the town of Angono, Rizal province, Luzon island, Philippines to evaluate the health risks of the trace elements in drinking water. There are some arguments that water resources available in the Philippines are heavily polluted by various materials, inparticular heavy metal elements. @*Method@#The concentrations of seven trace elements in commercial bottled water produced and consumed in the Philippines were analyzed using a solution nebulization inductively coupled plasma mass spectrometry (SN−ICP−MS).@*Result@#The concentrations of the trace elements except for Cs, which does not yet have a WHO guideline value, in the locally produced bottled water were below the WHO guideline values. The Cs concentrations (<0.6 μg/L) of the bottled water of the Philippines were generally similar to those of the bottled water produced and consumed in other countries such as Japan, China, and Indonesia. @*Conclusion@#The concentrations of trace elements in bottled water consumed in Angono, Philippines can be regarded as being at safe levels, as well as those of daily life water (i.e. tap, well, and spring water) consumed in the said town.

Disability weight determination for road traffic injuries in the Philippines: Metro Manila scenario

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the Disability Adjusted Life Year (DALY) weights of road traffic injuries and use the DALY weights in determining the total DALYs lost in Metro Manila using available data.</p><p style="text-align: justify;"><strong>Methods:</strong> Consensus on DALY weights for each of the 31 International Classification of Diseases (ICD)10 codes related to road traffic injuries was done using Delphi Process. Experts from different fields were invited to participate in 2 rounds of discussion-and-scoring were done to obtain consensus were obtained for each DALY weight. Philippine Health Insurance Corporation (PHIC) data on the counts of the 31 ICD 10 coded claims for the years 2011, 2012, and 2013 were obtained and used to calculate the total DALY lost due to vehicular injuries for Metro-Manila.</p><p style="text-align: justify;"><strong>Results:</strong> Road traffic related injuries affected mostly young people (mean 34 yo + 15) and affected mostly men (81%). There were a total of 3,199 injuries seen in 2,573 patients. 98.1% of the patients had a < 1 year type of injury with an average disability weight of 0.34154 and a total DALYs lost of 300.4. 0.5% of the patients had a ? 1 year type of injury with an average disability weight of 0.2726 and a total DALYs lost of 218.08.1.4% of the patients most likely died from their injuries earning a total DALYs lost of 1,440.The sum of DALYs lost is equivalent to a total of 1,958.12.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The Metro Manila loses roughly Php 76.6 Million per year due to road traffic injuries and accidents. These events are highly preventable. Without proper interventions, road traffic injuries may lead to impoverishment of the young families who pick up the pieces, or are left behind.</p>