Position statements on oral micronutrient supplementation in nutrition and appetite support across the continuum of care

@#A Technical Working Group composed of health professionals and multispecialty healthcare experts, have come together to emphasize the crucial role of nutrition in promoting overall health and wellbeing. Nutrition serves as the cornerstone of optimal physical and mental functioning, and they firmly believe that a well-balanced diet should be the primary source of essential nutrients for individuals of all ages. However, they acknowledge the existence of prevalent gaps in nutrition and the potential benefits of oral micronutrient supplementation particularly those that contain iron and appetite stimulants in addressing these gaps across the entire disease spectrum. Despite the importance of nutrition, various factors like appetite loss due to medications and illnesses contribute to gaps in dietary intake. Modern dietary patterns, often characterized by highly processed foods, excessive added sugars, unhealthy fats, and insufficient intake of fruits, vegetables, whole grains, and lean proteins, can result in nutrient deficiencies. Additionally, socio-economic factors, cultural practices, limited access to nutritious food options, and individual dietary restrictions may further contribute to these gaps. Moreover, individuals who have poor appetite and nutrient intakes with certain conditions, or those who avoid certain foods (such as strict vegetarians and vegans) might benefit from taking supplementation. Multivitamin supplementation can play a supportive role in addressing nutritional gaps. These supplements, when used appropriately and as part of a balanced diet, can provide a convenient and reliable source of essential vitamins and minerals. Multivitamins are particularly useful in situations where dietary intake alone may not meet individual nutrient requirements due to limitations or specific health conditions. They offer an accessible option to help bridge the nutritional gaps and ensure adequate nutrient intake.

Attitudes and perceptions of Filipino family physicians toward the Universal Health Care Act

Background@#Family physicians are at the forefront of the Universal Health Care (UHC) Act as primary care providers, and their attitudes and perceptions of the law can affect its implementation. These must be explored so that adequate organizational support can be provided to its members.@*Objective@#This study describes the family physicians’ attitudes and perceptions towards UHC. It also determined if the attitudes and perceptions of family physicians are associated with the types of membership and their year of graduation from family medicine residency training.@*Methods@#A cross-sectional study was conducted among active members of the Philippine Academy of Family Physicians (PAFP) during workshops held between January to February 2020. The PAFP UHC survey was employed to members who were purposively sampled during the workshops. The attitudes and perceptions of family physicians were summarized through frequencies and percentages, while the relationship of selected variables to physicians’ attitudes and perceptions were determined through a chi-square test.@*Results@#A total of 195 family physicians from the three provinces and one city responded to the survey questionnaire. All (100%) participants reported a positive attitude toward their current practice, but this optimistic attitude slightly decreased to 85.4% regarding UHC. The perceptions of family physicians towards UHC practice are generally positive. Most have a realistic view on the comprehensiveness of service coverage (55.33%) and are agreeable to certification (84.62%) and accreditation by network (64.81%). Majority (82.17%) also have positive perception toward the future practice of family physicians. The year of graduation from training was found to be associated with their perception of the future practice of family physicians (p-value 0.048), and those with the older age group are more likely to report a negative perception.@*Conclusion@#PAFP members’ attitudes and perceptions towards UHC are mostly positive. Majority of respondents are positive about the inclusive PHIC membership, comprehensive service coverage, certification and accreditation, and the future of medical practice upon the implementation of UHC. The negative attitudes and perceptions of some members may be due to various factors related to the individual or to the processes of implementation and operationalization of the UHC law.

Community-oriented health care during a COVID-19 epidemic: A consensus statement by the PAFP task force on COVID-19

Initial Planning@#Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions.@*Adjustment in the Community Organization and Environment@#Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings@*Performance of Routine Tasks and Activities@#Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19@*What to Do When a Member or Household is Exposed or Diagnosed COVID-19@#Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days@*Epidemiology and Surveillance@#Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices

Family-focused home care plan during a COVID 19 epidemic: A consensus statement by the PAFP task force on COVID 19

Initial Planning@#Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic@*Adjustment in the Family Structure and Home Environment@#Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home@*Performance of Routine Tasks and Activities @#Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol@*What to Do When a Member is Exposed@#Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice