Staffing and Workload in Primary Care Facilities of Selected Geographically Isolated and Disadvantaged Communities in the Philippines.

Background and Objective: Staffing shortages and health inequities are persistent barriers in the Philippines toward achieving universal health care. To ensure an adequate and responsive health workforce, there is a need to evaluate the Human Resources for Health (HRH) status across health facilities, particularly those in underserved communities. Hence, this study aims to determine the staffing requirements and workload pressure among primary care facilities in selected geographically isolated and disadvantaged areas (GIDAs) in the Philippines. Methods: The study utilized the workload indicators of staffing need (WISN) methodology from the World Health Organization to determine the staffing and workload situation among three health worker cadres (physicians, nurses, and midwives) in the study sites. Particularly, six primary care facilities (four rural health units and two community hospitals) located in Surigao del Norte were involved in the study. WISN-related data (health service statistics, available working time, and health professionals' workload components) were collected through records review, focus group discussions, and key informant interviews. The WISN software was used to analyze the staffing levels and workload pressure in the selected facilities. Results: A total of 40 health workers, including physicians (n = 5, 13%), nurses (n = 21, 52%), and midwives (n = 14, 35%) participated in the study. The findings noted varying levels of staffing and workload pressures among the three cadres in selected primary care facilities, which were influenced by several factors. Particularly, health facilities with additional human resources obtained from deployment programs indicated adequate staffing and low to normal workload pressures. However, further analysis revealed potential HRH maldistribution and reliance on the temporary nature of the staff augmentation program in delivering primary care services, which need to be addressed to optimize health workforce planning. Service workload may also have been impacted by the temporary closure of health facilities due to disasters. Among the few cadres that reported staffing shortage and high workload pressure, these were due to higher service demands, increased task delegation, and inadequate service coordination. Hence, context-specific challenges and situational factors in GIDAs need to be considered when determining the staffing and workload requirements. Conclusion: There is a need to improve the capacities of health facilities and local government units (LGUs) to engage in evidence-based HRH planning through the WISN methodology. Doing so could improve staffing and workload distribution among health care facilities in the country. Moreover, interorganizational collaboration (DOH, LGUs, and health facilities) should be strengthened to improve delineation and prevent duplication/omission of health services, rationalize HRH distribution and augmentation, and streamline the priority health services based on the local contextual factors.

A Chrysodeixis chalcites single-nucleocapsid nucleopolyhedrovirus population from the Canary Islands is genotypically structured to maximize survival.

A Chrysodeixis chalcites single-nucleocapsid nucleopolyhedrovirus wild-type isolate from the Canary Islands, Spain, named ChchSNPV-TF1 (ChchTF1-wt), appears to have great potential as the basis for a biological insecticide for control of the pest. An improved understanding of the genotypic structure of this wild-type strain population should facilitate the selection of genotypes for inclusion in a bioinsecticidal product. Eight genetically distinct genotypes were cloned in vitro: ChchTF1-A to ChchTF1-H. Quantitative real-time PCR (qPCR) analysis confirmed that ChchTF1-A accounted for 36% of the genotypes in the wild-type population. In bioassays, ChchTF1-wt occlusion bodies (OBs) were significantly more pathogenic than any of the component single-genotype OBs, indicating that genotype interactions were likely responsible for the pathogenicity phenotype of wild-type OBs. However, the wild-type population was slower killing and produced higher OB yields than any of the single genotypes alone. These results strongly suggested that the ChchTF1-wt population is structured to maximize its transmission efficiency. Experimental OB mixtures and cooccluded genotype mixtures containing the most abundant and the rarest genotypes, at frequencies similar to those at which they were isolated, revealed a mutualistic interaction that restored the pathogenicity of OBs. In OB and cooccluded mixtures containing only the most abundant genotypes, ChchTF1-ABC, OB pathogenicity was even greater than that of wild-type OBs. The ChchTF1-ABC cooccluded mixture killed larvae 33 h faster than the wild-type population and remained genotypically and biologically stable throughout five successive passages in vivo. In conclusion, the ChchTF1-ABC mixture shows great potential as the active ingredient of a bioinsecticide to control C. chalcites in the Canary Islands.

Nursing students' and faculty members' experiences of online education during COVID-19 across Southeast Asia: A Photovoice study.

BACKGROUND: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. OBJECTIVES: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. DESIGN: A descriptive qualitative design using Photovoice was adopted. SETTING: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). PARTICIPANTS: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. METHODS: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. RESULTS: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. CONCLUSION: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum.

Remarkably efficient production of a highly insecticidal Chrysodeixis chalcites nucleopolyhedrovirus (ChchNPV) isolate in its homologous host.

BACKGROUND: A Chrysodeixis chalcites nucleopolyhedrovirus from the Canary Islands (ChchNPV-TF1) has proved to be effective for control of Chrysodeixis chalcites on banana crops. Commercialization of this virus as a bioinsecticide requires an efficient production system. RESULTS: The sixth instar (L6 ) was the most suitable for virus production, producing 1.80 × 1011 occlusion bodies (OB)/larva and showed a lower prevalence of cannibalism (5.4%) than fourth (L4 ) or fifth (L5 ) instars. Inoculation of L6 at 24 h post molting produced six times more OB (5.72 × 1011 OB/larva) than recently molted L6 larvae (1.00 × 1011 OB/larva). No significant differences were recorded in mean time to death (165-175 h) or OB production per larva (3.75 × 1011 to 5.97 × 1011 ) or per mg larval weight (1.30 × 1011 to 2.11 × 109 ), in larvae inoculated with a range of inoculum concentrations (LC50 -LC90 ). Groups of infected L6 larvae reared at a density of 150 larvae/container produced a greater total number of OBs (8.07 × 1013 OB/container) than lower densities (25, 50 and 100 OB/container), and a similar number to containers with 200 inoculated larvae (8.43 × 1013 OB/container). CONCLUSION: The processes described here allow efficient production of sufficient OBs to treat ∼ 40 ha of banana crops using the insects from a single container. © 2018 Society of Chemical Industry.

Efficacy of an alphabaculovirus-based biological insecticide for control of Chrysodeixis chalcites (Lepidoptera: Noctuidae) on tomato and banana crops.

BACKGROUND: Chrysodeixis chalcites (Esper) is a major pest of tomato in Mediterranean countries and attacks banana in the Canary Islands (Spain). The efficacy of Chrysodeixis chalcites single nucleopolyhedrovirus (ChchSNPV-TF1) was evaluated in plant growth chambers and greenhouse trials performed on tomato and banana plants respectively. Treatments were applied using a compressed air sprayer. RESULTS: Mean (± SE) lethal infection varied from 77 ± 10% to 94 ± 3% in second-instar larvae fed for 2 days on tomato plants treated with 2 × 10(6) to 5 × 10(7) virus occlusion bodies (OBs) L(-1) , increasing to ∼100% infection after 7 days. Mortality of larvae collected from banana at different intervals post-application varied from 54 ± 10% to 96 ± 4% in treatments involving 1 × 10(8) -1 × 10(9) OBs L(-1) , whereas indoxacarb (Steward 30% WG) and Bacillus thuringiensis var. kurstaki (Biobit 16% WP) treatments produced between 22 ± 6% and 32 ± 5% pest mortality. All treatments significantly reduced plant defoliation compared with untreated controls. Application of 1 × 10(9) OBs L(-1) was 3-4-fold more effective than chemical or B. thuringiensis treatments. Larvae acquired lethal infection more rapidly when feeding on tomato than banana plants, but this difference disappeared following >60 min of feeding. CONCLUSION: This information should prove useful in the registration of ChchSNPV-TF1 as a bioinsecticide in the Canary Islands and Europe.

Stage-specific insecticidal characteristics of a nucleopolyhedrovirus isolate from Chrysodeixis chalcites enhanced by optical brighteners.

BACKGROUND: Chrysodeixis chalcites is a major noctuid pest of banana crops in the Canary Islands. The stage-specific susceptibility of this pest to C. chalcites single nucleopolyhedrovirus (ChchSNPV-TF1) was determined, as well as the effect of selected optical brighteners as enhancers of primary infection. RESULTS: Susceptibility to ChchSNPV-TF1 occlusion bodies (OBs) decreased as larval stage increased; second instars (L2) were 10,000-fold more susceptible than sixth instars (L6). Virus speed of kill was 42 h faster in L2 than in L6 . OB production increased in late instars; L6 larvae produced 23-fold more OBs than L4 . Addition of 10 mg mL(-1) Tinopal enhanced OB pathogenicity by 4.43- to 397-fold depending on instar, whereas 10 µL mL(-1) Leucophor resulted in potentiation of OB pathogenicity from 1.46- to 143-fold. Mean time to death decreased by 14 to 26 h when larvae consumed OBs in mixtures with 10 mg mL(-1) Tinopal, or 10 µL mL(-1) Leucophor, although in these treatments OB yields were reduced by up to 8.5-fold (Tinopal) or up to 3.8-fold (Leucophor). CONCLUSION: These results have clear applications for the use of ChchSNPV-TF1 as a biological insecticide in control programs against C. chalcites in the Canary Islands.

Complete Genome Sequences of Five Chrysodeixis chalcites Nucleopolyhedrovirus Genotypes from a Canary Islands Isolate.

The Chrysodeixis chalcites single nucleopolyhedrovirus (ChchSNPV) infects and kills C. chalcites larvae, an important pest of banana crops in the Canary Islands. Five genotypes present in the most prevalent and widespread isolate in the Canary Islands were sequenced, providing genetic data relevant to the genotypic and phenotypic diversity of this virus.

Telemedicine via Short Messaging System (SMS) in rural Philippines.

The University of the Philippines National Telehealth Center extended its services to the Doctor-to-the-Barrios program of the Department of Health through Short Messaging System telereferral system. This system enables physicians from remote and underserved rural communities to refer cases to domain experts from the University of the Philippines Philippine General Hospital. Two hundred eighty-four cases were sent in a six-month period.

Nursing informatics: challenges to Philippine nursing curriculum.

The University of the Philippines College of Nursing curriculum has been the foundation of most of the curriculum in the country. But such is inferior with the current global health care delivery system. With Telehealth as the current program launched as an alternative medium to address health-care needs in geographically isolated areas through the use of ICT, nurses provide care for populations through electronic communication media and act as triage nurses who advise/consult with patients.

Complicaciones del catéter central subclavio guiado por doppler o reparos anatómicos Hospital de San José, Bogotá D.C. Colombia / Complications of doppler-guided or anatomic landmark central subclavian catheter insertion San José Hospital, Bogotá DC. Colombia

El paso de catéteres venosos centrales ya sea bajo la técnica de reparos anatómicos (convencional) o la guiada por doppler dúplex, es una práctica común en el medio hospitalario. La evidencia sugiere ventajas para el doppler y los accesos a la vena subclavia o la innominada son los más comunes. El grupo desconoce estudios que comparen los dos abordajes. El presente análisis evalúa la frecuencia de complicaciones tempranas y tardías derivadas del paso de catéter con las dos técnicas, mediante un diseño descriptivo longitudinal. Se seleccionaron 50 pacientes, 22 bajo guía doppler y 28 por reparos anatómicos. La frecuencia total de complicaciones fue del 20%, y de éstas 20% tempranas y el 80% tardías. Usando reparos anatómicos ocurrieron todas las complicaciones tempranas (neumotórax y hematoma del sitio de punción) y 37% de las tardías, mientras que con doppler fueron 63% de las tardías (infección). Las limitantes del diseño escogido y el número de pacientes impiden la generalización de las observaciones obtenidas pero son de utilidad para futuros estudios.

Central venous catheter insertion by anatomic landmarks (conventional) or doppler-guided is a common practice at the hospital setting. Evidence suggests advantages of the doppler-assisted technique and access to the subclavia or innominate veins is the most common. The group is not aware of other comparative studies on this topic. This paper evaluates the frequency of early and late complications derived from catheter insertion with the two techniques using a descriptive longitudinal design study. Fifty (50) patients were selected, 22 underwent doppler-assisted catheter insertion and 28 were conducted using anatomic landmarks. The total complication rate was 20%, of which 20% were early complications and 80% were late complications. All early complications (e.g. neumothorax and hematoma at the site of puncture) and 37% of late complications occured using anatomic landmarks, whereas, 63% of patients presented late complications (infection) with the doppler technique. Obtained observations could not be generalized because of selected study design and number of patient limitations but they are useful for further study.

Íleo biliar: reporte de un caso / Biliary ileus: a case report

El íleo biliar se define como una obstrucción intestinal mecánica secundaria a la impactación de un cálculo biliar en el tracto gastrointestinal. Es responsable, aproximadamente, del 1% al 4% de las obstrucciones intestinales de origen mecánico y se asocia con alta morbimortalidad (1). La tomografía computarizada es en la actualidad considerada como el patrón de oro para el diagnóstico de esta patología, la cual se manifiesta con neumobilia, neumocolecisto, visualización directa de la fístula bilio-entérica, niveles hidroaéreos, líquido libre en cavidad peritoneal y localización ectópica de un cálculo.