BACKGROUND AND OBJECTIVE

Community pharmacies are among the most accessible healthcare facilities and play a critical role during medical emergencies. While many countries have implemented structured emergency preparedness systems in pharmacies, such practices remain limited and under-researched in the Philippines. The lack of empirical data on pharmacy-based emergency readiness hampers efforts to strengthen their role in crisis response and inform context-specific policies and training programs. This study aimed to assess the level of medical emergency preparedness and its associated factors among community pharmacies in Metro Manila, Philippines.

A community-based, cross-sectional study was conducted among 533 Filipino community pharmacy staff, consisting of 38.8% pharmacy assistants/technicians, 36.8% branch/staff pharmacists, and 24.4% managers/ supervisors. Data was collected using a modified survey questionnaire administered online and face-to-face across various cities in Metro Manila. Self-efficacy and collective efficacy scales were utilized to assess medical emergency preparedness and linear regression models were employed to identify factors associated with preparedness in acute medical emergencies.

Community pharmacies in Metro Manila are moderately prepared (overall mean scores: self-efficacy 3.65, collective efficacy 3.69 on a 1-5 scale) to respond to acute medical emergencies. Regression analysis shows that age, position, and training in first aid, cardiopulmonary resuscitation (CPR), and basic life support (BLS) are positively associated with self-efficacy. Conversely, the number of emergency equipment, pharmacy staff, and training experience are positively associated with collective efficacy.

The study’s findings highlight key factors influencing the preparedness of community pharmacies in Metro Manila. Pharmacies with staff trained in first aid and CPR/BLS, as well as those equipped with adequate emergency supplies, demonstrated significantly higher levels of preparedness for medical emergencies. These results emphasize the critical role of ongoing, comprehensive training for pharmacy personnel. Ensuring that all staff are properly trained to manage acute medical situations can greatly enhance emergency response and improve patient outcomes.

BACKGROUND AND OBJECTIVE

Due to disasters and calamities, the number of internally displaced persons (IDPs) in the country is steadily increasing. With their disadvantaged situation, this population is prone to experiencing powerlessness and poor health outcomes. However, there is limited information on how these communities can gain control over their health and well-being. While community empowerment is a crucial process in the health sciences, this concept remains understudied. Hence, this study aimed to explore the process of community empowerment in health and develop a theory grounded on the experiences of displaced communities.

This study utilized the classic grounded theory (CGT), primarily aimed at discovering a conceptual theory anchored on the experiences of internally displaced persons. Particularly, this GT variant sought to explicate a social process of community empowerment in health through the participants’ lenses. A total of 45 individuals from six towns of Bulacan province, Philippines were purposively recruited to participate in focus group discussions and key informant interviews. Data analysis employed the constant comparison method, which involved concept development, reduction, and refinement to derive the emerging theory from the gathered information.

he 5 C's Grounded Theory of Community Empowerment in Health depicts marginalization as the main context of internal displacement, where participants’ experiences of resource deprivation and social neglect made them vulnerable to poor health outcomes. The theory further explicates five processes involved in the empowerment of IDPs, namely: consciousness-raising, collaborating, capacity building, carrying out responsibilities, and continuing work. Particularly, the key steps involve (1) raising the community’s awareness on the importance of gaining control over their health and well-being; (2) establishing collaborative relationships within and outside communities; (3) developing competencies on various health-related domains; (4) assuming multiple roles and implementing programs; and (5) continuing efforts to train more people, sustain partnerships, and expand community involvement. These steps lead to the study’s core variable of self-sufficiency, where communities are anchored on the philosophy of communal unity (bayanihan) in managing their own health needs, promoting healthcare access, and addressing other social determinants of health. Moreover, study findings highlight the unique contribution of women, spirituality, and multisectoral engagement in facilitating the process of community empowerment.

This is one of the first few studies to explore the process of community empowerment in health, which guided the development of a theory based on the experiences of internally displaced communities. The theory emphasizes that community empowerment is an iterative and continuous process that involves interactions among community members and other stakeholders. Holistic social preparation and capacity building, together with the integration of local culture and philosophy, could support the successful transition of IDPs into their new lives. Hence, multisectoral collaboration involving government agencies, private offices, higher education institutions, healthcare facilities, and faith-based organizations is crucial in promoting the movement of IDPs from marginalization towards gaining control over their health.

BACKGROUND AND OBJECTIVE

Midwives are critical for quality maternal and child healthcare, particularly in underserved rural areas. Despite their crucial role in challenging environments, understanding factors motivating them to work in such settings is limited. This study explores these underlying motivations among midwives in Aurora Province, Philippines, providing insights essential for developing effective strategies to support and retain this vital workforce.

A descriptive, qualitative design using a semi-structured approach with a purposive sample of midwives was employed. Data collection was conducted from October to December 2024. Analysis of data utilized Braun and Clarke’s thematic analysis alongside NVivo software for coding. Iterative process allowed for the refinement of themes ensuring a comprehensive understanding of midwives’ motivations.

Four main themes were identified: (a) motivations to midwifery practice, (b) career path decisions, (c) challenges in midwifery, (d) impact of work, and (e) professional growth and stability. Study revealed that midwives in underserved areas were deeply committed to their communities, facing significant challenges. Their dedication went beyond duty, stemming from personal experiences and a desire to reduce healthcare inequalities.

Midwives are driven by their steadfast dedication with compassion and resilience in providing maternal and child health services while confronting local challenges. Their experiences reflect a deep commitment to creating positive change in the lives of the families and communities they serve. Gaining insight into these motivations can help enhance support systems for midwives, enabling them to thrive in their roles and improve the well-being of underserved populations.

BACKGROUND

Worldwide, the WHO showed that stroke is the second leading cause of death for people above 60, and 5th among the aged 15 to 59 population. In the Philippines, statistics revealed that 500,000 Filipinos suffer from stroke annually. Although preventive efforts have brought about a steady decline in incidence over the last several years, stroke is still the third leading cause of death. Baguio-Benguet Chapter notes a rise in the number of stroke patients affecting both adult and younger age groups. The increasing cases of lifestyle diseases predispose people to stroke. Stroke prevention, management, and rehabilitation are essential in bringing back the normal functioning of stroke patients. Care for stroke clients is a challenging task because of the varied knowledge, practices, and attitudes (KAP) fostering the needs of a stroke client. In the Philippines, family members of the stroke client are more likely to be the preferred caregivers.

The study determined the knowledge, attitudes, and practices of the community members and the community resources on stroke prevention, management, and rehabilitation as a basis for program development.

This study utilized a mixed research design. Data were gathered from 275 residents of Camp 4, Tuba, Benguet using a structured questionnaire, and 10 FGD Groups. Frequency, percentage, and mean computations were done to analyze quantitative data, whereas descriptive analysis was done for qualitative data.

The majority of the respondents (76%) knew that stroke happens due to insufficient blood supply to the brain. Generally, the community agreed about their attitude on the prevention (2.89), management (2.68), and rehabilitation (2.75) of stroke. The community sometimes practices stroke prevention (3.17), management (2.83), and rehabilitation (2.92). Qualitative data revealed that experiences on stroke resulted in scientific knowledge, evidence-based practices, and utilization of existing resources that include personnel, infrastructure, and programs for stroke prevention, management, and rehabilitation.

The experience, social support, and maximized utilization of existing community resources have assisted the knowledge acquisition, favorable attitudes, and safe practices of the community on stroke.

BACKGROUND

This study explores the professional functions and experiences of male midwives in the Province of Aurora, highlighting their roles, challenges, and contributions to maternal and child healthcare in a traditionally female-dominated profession.

This study aims to investigate the professional functions and lived experiences of male midwives in the Province of Aurora.

This research employed a qualitative ethnographic design using semi-structured interviews to collect data. Participants were six male midwives practicing in Aurora. Data collection was conducted via mobile phone interviews from August to September 2024. A purposive sampling technique was utilized to select participants. The study adhered to ethical guidelines, receiving approval from the University of Northern Philippines Ethics Review Committee Code: 2024-251, and informed consent was obtained from all participants. Data were analyzed using qualitative content analysis. Qualitative inductive content analysis as described by Padgett was utilized to allow for data-driven analysis without pre-defined themes, making it suitable for exploring the diverse experiences of male midwives.

Analysis revealed six key themes: Diverse professional functions, gender bias and stereotyping, patient reluctance and shyness, cultural influences, experiences of discrimination and prejudice, and daily challenges and rewards in practice. The findings underscore the commitment of male midwives to providing quality care despite societal and professional barriers. Under the Functions theme, male midwives described their roles as not only caregivers but also as advocates for gender inclusivity in midwifery. In terms of experiences, some reported feelings of isolation and the need to prove their competence in a field dominated by women. However, they also shared empowering stories of camaraderie with female colleagues and the satisfaction derived from breaking down gender barriers.

Male midwives play a vital role in maternal and newborn healthcare, navigating challenges such as gender bias and patient hesitancy. Strengthening administrative support, promoting inclusivity, and updating policies can enhance their professional integration. Advocacy efforts from professional organizations are necessary to address workplace challenges and recognize their contributions to healthcare.

OBJECTIVE: To investigate the predictive value of early lactate/albumin ratio (LAR) combined with quick sequential organ failure assessment (qSOFA) for the 28-day prognosis of patients with sepsis caused by emergency community-acquired pneumonia (CAP). METHODS: The clinical data of patients with sepsis caused by CAP admitted to the department of emergency of Beijing Haidian Hospital from June 2021 to August 2022 were retrospectively analyzed, including gender, age, comorbidities, lactic acid (Lac), serum albumin (Alb), LAR, procalcitonin (PCT) within 1 hour, and 28-day prognosis. Patients were divided into two groups based on 28-day prognosis, and risk factors affecting patients' prognosis were analyzed using univariate and multivariate Cox regression methods. Patients were divided into two groups according to the best cut-off value of LAR, and Kaplan-Meier survival curves were used to analyze the 28-day cumulative survival of patients in each group. Time-dependent receiver operator characteristic curve (ROC curve) were plotted to analyze the predictive value of sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), and qSOFA+LAR score on the prognosis of patients with sepsis caused by CAP at 28 days. The area under the curve (AUC) was calculated and compared. RESULTS: A total of 116 patients with sepsis caused by CAP were included, of whom 80 survived at 28 days and 36 died, 28-day mortality of 31.0%. There were no statistically significant differences in age, gender, comorbidities, pH, platelet count, and fibrinogen between the survival and death groups, and there were significantly differences in blood urea nitrogen (BUN), white blood cell count (WBC), hemoglobin, Lac, Alb, PCT, D-dimer, LAR, as well as qSOFA score, SOFA score, and APACHE II score. Univariate Cox regression analyses showed that BUN, WBC, pH, Lac, Alb, PCT, LAR, qSOFA score, SOFA score, and APACHE II score were associated with mortality outcome. Multifactorial Cox regression analysis of the above variables showed that BUN, WBC, PCT, and APACHE II score were independent risk factors for 28-day death in the emergency department in patients with sepsis caused by CAP [hazard ratio (HR) were 1.081, 0.892, 1.034, and 1.135, respectively, all P < 0.05]. The best cut-off value of early LAR for predicting the 28-day prognosis of sepsis patients was 0.088, the Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of sepsis patients in the LAR ≤ 0.088 group was significantly higher than that in the LAR > 0.088 group [82.9% (63/76) vs. 42.5% (17/40), Log-Rank test: χ² = 22.51, P < 0.001]. The qSOFA+LAR score was calculated based on the LAR cut-off value and qSOFA score, and ROC curve analysis showed that the AUCs of SOFA score, APACHE II score, and qSOFA+LAR score for predicting 28-day death of patients with sepsis caued by CAP were 0.741, 0.774, and 0.709, respectively, with the AUC of qSOFA+LAR score slightly lower than those of SOFA score and APACHE II score, but there were no significantly differences. When the best cut-off value of qSOFA+LAR score was 1, the sensitivity was 63.9% and the specificity was 80.0%. CONCLUSION The qSOFA+LAR score has predictive value for the 28-day prognosis of patients with sepsis caused by CAP in the emergency department, its predictive value is comparable to the SOFA score and the APACHE II score, and it is more convenient for early use in the emergency department.
Emergency Service, Hospital/statistics & numerical data* ; Sepsis/etiology* ; Prognosis ; Community-Acquired Pneumonia/mortality* ; Organ Dysfunction Scores ; Predictive Value of Tests ; Lactic Acid/blood* ; Serum Albumin, Human/analysis* ; Biomarkers/blood* ; Retrospective Studies ; Hospital Mortality ; Kaplan-Meier Estimate ; APACHE ; Procalcitonin/blood* ; ROC Curve ; Area Under Curve ; Humans

OBJECTIVE: To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis. METHODS: Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted. RESULTS: A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I² = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I² = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I² = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I² = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I² = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I² = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I² = 53%). CONCLUSION Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans ; Hydrocortisone/therapeutic use* ; Community-Acquired Infections/drug therapy* ; Pneumonia/drug therapy* ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Community-Acquired Pneumonia

Objective To understand the willingness of general practitioner(GP) to enhance working competence in community healthcare centers in Shanghai and provide a basis for the competence training of GPs in community healthcare centers. Methods In August 2023,GPs were selected from some community healthcare centers in Shanghai and their willingness to enhance working competence were studied by a questionnaire survey.The survey included 39 secondary indicators in three dimensions:general practice theory,skills,and humanity. Results A total of 1 192 GPs completed the questionnaire,with an effective rate of 100%.The total score of GPs' willingness to enhance their working competence was 258.45±80.93,and the mean score of the three dimensions was 6.63±2.08.The score for the general practice theory was the highest (6.92±1.95),while that for general practice humanity was the lowest (6.44±2.34) among the three dimensions.The score of willingness to enhance working efficiency differed across different age ranges (P<0.001),professional titles (P<0.001),years of work (P<0.001),and educational backgrounds of GPs (P=0.039).Those with the age younger than 30 years old,junior professional titles,less than 5 years of work experience,and a college degree or below had the highest willingness score to enhance their working competence.Among the top three secondary indicators of willingness score in each dimension,the top three methods of working competence enhancement were community general practice and specialized healthcare services combined with outpatient learning,flexible further training,and continuing education courses.Conclusions There is an urgent need for young GPs in community healthcare centers in Shanghai to enhance their working competence.Targeted enhancement plans can be provided to different groups of GPs with different characteristics through community general practice and specialized healthcare services combined with outpatient learning,flexible further training,and continuing education courses,which can further enhance the ability and quality of the GP team.
Humans ; China ; General Practitioners/psychology* ; Surveys and Questionnaires ; Community Health Centers ; Clinical Competence ; Female ; Adult ; Male ; Attitude of Health Personnel ; Middle Aged

Human ; Residence Characteristics ; Community

BACKGROUND AND OBJECTIVE

Within a decentralized health system, barangay health workers (BHWs) are often the first point of contact for Filipinos seeking care. Despite their importance, BHWs are neglected in the health value chain. The study seeks to examine the lived experiences of BHWs, particularly their journey in navigating their roles within the community and the health system that encompasses their day-to-day realities, challenges, motivations, and the meanings they derive from their work.

The study draws on seven focus group discussions (FGDs) with BHWs (n=50), residents (n=7), and local government officials and health workers (n=7) of San Miguel, Bulacan. The qualitative data collected were analyzed using thematic analysis.

Findings show that BHWs perform many roles, which are not limited to health and are dependent on orders from their superiors. Guidelines are vague in appointing BHWs, with personal connections valued more than technical qualifications. Their accreditation is hardly conferred any significance. There is also a lack of formal and structured training. The informality of these processes leads to an absence of quality assurance on rendered health services. The non-provision of incentives and benefits stipulated in RA 7883 also places their health and lives at risk. Furthermore, BHW’s commitment to serve is used to excuse the inadequacy of their compensation and excessive workload.

BHWs take on diverse roles, from community organizers to healthcare providers, and are confronted with significant challenges encompassing politicization, inadequate training, and insufficient compensation. The study concludes with policy recommendations to improve the conditions of the neglected BHWs, with particular attention to coordinating, capacitating, compensating, career pathing, and connecting them to the health system.