The design and outputs of the pilot implementation of the “Enhancing skills in screening and assessment for physicians and rehabilitation practitioners level 2 course”, Philippines, 2014

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> The Philippine Department of Health (DOH) is mandated by law to, among others, develop capacities and accredit physicians and rehabilitation practitioners across the country on the assessment and management of drug dependence. This paper describes the design and presents the outputs of an advanced course on screening and assessment of drug dependence developed by DOH in partnership with the College of Public Health of the University of the Philippines Manila, Philippine College of Addiction Medicine, and the Group for Addiction Psychiatry of the Philippines.</p><p style="text-align: justify;"><strong>Methodology:</strong> Review, abstraction and synthesis of data from training-related documents and records for the training activities implemented in 2014.</p><p style="text-align: justify;"><strong>Results:</strong> The Level 2a course is a five-day program that focuses on enhancing the skills of physicians and rehabilitation practitioners on the screening and assessment of drug dependence using team-based and practical learning approaches, and builds on learnings from the basic accreditation course. A total of 36 participants from ten Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in nine regions completed the pilot implementation of the course in 2014. In general, the overall participant feedback on the training was mainly favorable based on data from 47% of participants who agreed or strongly agreed to statements on the relevance and attainment of the course aims (mean rating of 1.10±0.31, 1 = Strongly agree, 5 = Strongly disagree), and the appropriateness of its content (1.24±0.43) and design (1.18±0.39). A paired-samples t-test comparing scores for 44% of participants showed that there was a highly statistically significant difference in the pre-test (54%±13%) and post-test scores (69%±10%); t(16)=6.4240, p <0.0001.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development and design of capability-building initiatives in the field of drug rehabilitation will necessitate alignment with practice standards, grounding in the real-world setting in which professionals work, and orientation towards practical learning.</p>

Tuberculosis case finding and case holding practices in selected Drug Abuse Treatment and Rehabilitation Centers (DATRCS) in Luzon, Philippines

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs.</p><p style="text-align: justify;"><strong>Methods:</strong> Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country.</p><p style="text-align: justify;"><strong>Results:</strong> Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.</p><p style="text-align: justify;"><strong>Key Words:</strong> tuberculosis, case finding, case holding, drug abuse treatment and rehabilitation centers, Philippines</p>

Tuberculosis in Selected Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in Luzon, Philippines

Background and Objectives@#Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerable populations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higher risks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegal drugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users and dependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population is absent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence, treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015.@*Methods@#All medical records of drug users admitted in this period were reviewed. Information on the total patient census was sought from DATRC heads and used to compute for prevalence.@*Results@#A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000 population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at least high school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. The majority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used for TB diagnosis in 92.80% (322) of the cases.@*Conclusion@#The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscore the critical need for standards and guidelines in the National Tuberculosis Control Program addressing the unique context of these facilities.

Lessons learned from government-academe-civil society partnership to improve the assessment and management of drug dependence in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>This paper presents the experiences of, and lessons learnt from, a seven-year government-academe-civil society collaboration in the development, implementation, and evaluation of a training program for Filipino physicians and rehabilitation practitioners on the management of drug dependence.</p><p style="text-align: justify;"><strong>METHODS:</strong> Review of memoranda, records, and reports relevant to the initiation and implementation of the training activity. Where relevant, we also perused internal notes and minutes of meetings written by the authors, who are also members of the training team.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A tripartite collaboration between government, academe, and professional organizations developed a training program on the management of drug dependence for physicians and rehabilitation practitioners. Learner-centered approaches to education were adopted in the delivery of training content. Participation in the training is a prerequisite for government accreditation as rehabilitation professionals. A ladderized approach to the training was adapted, with participants first obtaining a broad introduction to the program, followed by in-depth focus on the assessment and management of drug dependency. This was done as a response to the perception that a single, two-week training program is insufficient to fully capacitate physicians and rehabilitation practitioners with the requisite knowledge and skills necessary to manage persons with drug dependence. Future plans include an executive course for established practitioners, and a course on community-based management of drug dependency.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The current perspective on drug use and dependence is transitioning from a politico-legal issue to a public health concern. Attaining the sustainable development goals in 2030 will necessitate the development of a cadre of professionals who are, among others, capable of assessing and treating persons who suffer from drug dependence. The Philippine experience may serve as a model for other countries struggling with the drug menace.</p>

Evaluación psicométrica de la psicopatía: una revisión metaanalítica / Psychometric assessment of psychopathy: A meta-analytical review

Resumen La mayoría de la literatura sobre la psicopatía gira en torno a su medida. Cuatro son los instrumentos y familias de referencia en la evaluación de la psicopatía: la Psychopathy Checklist (PCL), la Levenson's Primary and Secondary Psychopathy Scales (LPSP), la Self-Report Psychopathy Scale (SRP), y el Psychopathic Personality Inventory (PPI). Ante este estado de la cuestión, nos planteamos llevar a cabo un metaanálisis psicométrico correlacional con el cual someter a prueba la validez convergente de estos instrumentos a nivel unidimensional y en los dos factores comunes a todos ellos: el factor afectivo y el factor antisocial. Los resultados mostraron una validez convergente positiva, significativa y generalizable entre los instrumentos, tanto en la dimensión psicopatía como en los factores afectivo y antisocial. Asimismo, los resultados pusieron de manifiesto que la PCL es el instrumento más idóneo para la evaluación de la psicopatía en poblaciones clínicas y el PPI en población subclínica.

Abstract Most of the literature on psychopathy is focused on its measurement. There are four reference tools used to assess psychopathy: the Psychopathy Checklist (PCL), the Levenson's Primary and Secondary Psychopathy Scales (LPSP), the Self-Report Psychopathy Scale (SRP), and the Psychopathic Personality Inventory (PPI). In order to do this, a psychometric correlational meta-analysis was designed to test the convergent validity between these tools on the psychopathy dimension and the two common factors among them: the affective and antisocial deviation factors. The results showed a positive, significant and generalisable convergent validity between tools, in the psychopathy dimension, as well as in the affective and antisocial factors. Moreover, the results also showed that the PCL was the most appropriate tool to measure psychopathy in clinical samples, and the PPI was so in sub-clinical cases.

A cross-sectional study on the relationship between stress and the level of job satisfaction among the burn unit staff of UP-PGH

OBJECTIVES: This study looked into the relationship between stress and the level of job satisfaction among the Burnt Unit staff of UP-PGH. Emphasis was placed in identifying the common stressors that the Burn Unit Staff of UP-PGH experience as a result of their day to day work in a critical care setting.The level of job satisfaction among staff was also determined.METHODOLOGY: Questionnaires assessing stress and job satisfaction were handed out to all the 31 participants of the study. The study population included 10 doctors and 21 nurses who had worked at the Burn Unit during the period of March to September 2007. Odds ratios were computed to determine if the presence of stress affects the level of job satisfaction among the Burn Unit Staff of UP-PGH. The resulting odds ratios were further tested for statistical significance using Fisher exact test and confidence limits.RESULTS: Of the 31 survey forms initially handed out to the Burn Unit staff, only 28 forms were completed and returned to the investigator at the end of the study period. Two items in the Stressful Situations Questionnaire were rated to be "stressful" by majority (>50%) of the respondents. Twenty-five percent of the respondents obtained positive scores in the Job Dissatisfaction Scale and were classified as being "dissatisfied" with their jobs. Twenty-two situations in the Stressful Situations Questionnaire were found to be significantly associated with job dissatisfaction among the Burn Unit staff of UP-PGH. These situations concerned the following areas: relationship with patients, family rejection, identification with the patient, deterioration and complications, job criticism, workspace, daily work, and therapeutic decisions.CONCLUSIONS: From the results of the study, recommendations were made to promote a system of stress-reduction for the Burn Unit staff. Regular group psychosocial processing sessions can be provided to allow the staff to ventilate their thoughts and feelings regarding personal and professional concerns. Team building activities for the staff can likewise be scheduled regularly to help solidify the group and resolve interpersonal conflicts among them. Future researchers could explore if a difference exists between the nurses and surgery residents in terms of their perceived stressors and their level of job satisfaction with their work in the Burn Unit.

The utilization pattern of psychiatric consultation services at the University of the Philippines-Philippine General Hospital (UP-PGH) from 1999-2008

OBJECTIVE: This study describes the utilization pattern of psychiatric consultation services at the UP-PGH from 1999 - 2008 by reviewing the demographic data of patients referred, describing the Axis I (Clinical Disorders and Other Disorders That May Be a Focus of Clinical Attention) and Axis III (General Medical Conditions) diagnoses of referred patients, and by identifying the sources of, and reasons for the different referrals.METHODS: Relevant data from the annual census of the Consultation - Liaison (CL) Psychiatry Section from 1999 - 2008 was reviewed according to age, sex, civil status, reasons for referral, DSM-IV TR Multi-axial diagnoses and sources of referrals.RESULTS: The percentage of referrals to consultation psychiatry has increased from 1.03% in 1999 to 1.77% in 2008. There is equal distribution between males and females. Majority of the consultation referrals were married and belonged to the 21-40 age group. The top five referring services were general medicine, surgery and trauma, obstetrics-gynecology, otorhinolaryngology and orthopaedic departments. The top three reasons for referring patients were mood problems, agitation and restlessness, and suicide attempts/behaviour. Majority of the axis I diagnoses were adjustment disorder, depressive disorders, and psychological reactions to illness. According to Axis III diagnoses, majority of the referrals were associated with poisoning and injury, neoplasms, and endocrine, nutritional, metabolic and immunity disorders.CONCLUSION: The referral rate to the CL-Psychiatry Section at the UP-PGH has increased throughout the period studied. This may be attributed to programs and activities that improve efficiency in the delivery of psychiatric knowledge and skills, and better personnel supervision. The referral rate of 1.03% to 1.82% was consistent with those in other countries.

Prevalence of depression and phantom limb pain among amputated patients of the Philippine Orthopedic Center from April-May 2001

OBJECTIVES: The aim of this study is to determine the prevalence of depression and phantom limb pain among amputated patients at the Philippine Orthopedic Center (POC) from April to May 2001, as well as describe the characteristics of such patients. This study also seeks to determine if there is an association between phantom limb pain and depression among the amputated patients at POC. METHODS: This is a cross sectional study where 48 in and out patients from 18-61 years old were interviewed using the McGill Pain Questionnaire (MPQ) to evaluate the presence of phantom limb pain and Beck Depression Inventory (BDI) to evaluate the presence of depression, for the time period between April and May 2001. RESULTS: Eighteen (37.5 percent) patients were noted to be depressed, while only eight (16.7 percent) reported experiencing phantom limb pain. Among the 18 depressed patients, majority (68.8 percent) did not experience any pain but about one third (33.3 percent) admitted to phantom limb pain. Among the 8 who experienced phantom limb pain, 6 (75 percent) were depressed as compared to only 30 percent of those without phantom limb were depressed. Depression was more severe among those who were amputated due to a medical illness (24 percent) and interviewed within a year after their amputation (27.3 percent). CONCLUSION: Depression was more prevalent than phantom limb pain among amputees of the POC. Using the Fisher test for independent variables and Mann-Whitney 2 sample test, an association between phantom limb pain and depression was observed among the amputated patients in this study. Depression may also be more evident within the first year after amputation and more prevalent among those with medical illness.

Developing a trophoblastic disease psychiatric liaison program

Psychiatric Liaison Programs are designed to provide service, training and research technology using the biopsychosocial approach for problems encountered in a general hospital ward or specialty clinic. When psychosocial problems arise in individuals or groups comprehensive liaison programs are designed based on an analysis of needs that consider the psychosocial dynamics of patients, their family, nursing staff, and medical staff of that particular ward or clinic. These programs are created and implemented by a multidisciplinary team of psychiatrists, social worker, nurse, OT/PT, and consultee physician. Liaison Programs have been set up at the Trophoblastic Disease Ward and the Cancer Institute of the Philippine General Hospital. Among the interventions set up are regular group therapy sessions for patients and their relatives, expressive therapy including visual art therapy, and music, relaxation techniques, meditation, and guided imagery activities, and activity therapy. For the nursing and medical staff seminars and workshops were held to aid in the detection and early intervention-of behavioral problems. Group therapy sessions were also done when interpersonal problems and burn-out were detected; Individual psychotherapy was done when the need arose. At the Trophoblastic Disease Ward, the physiological, psychological and social domains of the WHO-DOH Quality of Life questionnaire were administered to in-patient before instituting the Liaison Program, and six months after. A comparison of the pre-test and post-test scores showed a significant improvement in all the domains a p-0.05 level of significance. A Purpose-in-life test was also administered to the bantays of these patients which showed significant improvement in their scores after six months at p-0.05 level of significance. Subjective evaluations done on the ward staff showed an improvement in interpersonal relationships with other staff, patients and their bantays. We endorse Psychiatric Liaison Programs as effective interventions in dealing with the psychosocial problems of cancer patients, their bantays, and the ward staff.