Background: Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting. Objective: This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines. Methods: This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis. Results: A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role. Conclusion Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.
midwives ; professional practice

Humans ; Singapore ; Self-Management ; Diabetes Mellitus, Type 2/therapy* ; Health Knowledge, Attitudes, Practice ; Hospitals

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

The coronavirus disease 2019 (COVID-19) epidemic is evolving in Latin America despite implementation of government measures. We report a familial cluster in Lima, Peru, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two young and two middle-aged adults with a wide range of COVID-19 manifestations experienced successful management under telehealth outpatient monitoring. Telehealth monitoring was scheduled as suggested by Peruvian Ministry of Health Guidelines and was performed by a designated physician who assessed the patients and prescribed treatment. On May 14, 2020, a 25-year-old male, who worked treating COVID-19 patients, reported constitutional symptoms and tested positive for SARS-CoV-2. Clinical improvement was achieved with azithromycin and ivermectin therapy. He had been in contact with his parents (Cases 2 and 3) and his sister (Case 4). Cases 2 and 3 developed moderate pulmonary compromise requiring oxygen supplementation and pharmacological therapy, including corticosteroids and anticoagulation, under home medical assessment and telehealth monitoring. Case 4 developed mild symptoms and periorbital rash, an atypical dermatological finding. To our knowledge this represents the first report of a familial cluster with COVID-19 that was successfully managed under scheduled telehealth outpatient monitoring in Latin America.
SARS-CoV-2 ; COVID-19 ; Telemedicine ; Remote Consultation

Objectives: This study aimed to explore the reasons behind the “resistance” of higher education institutions (HEIs) located in the south Manila area in creating research ethics committees (RECs). It also examined the proportion of researches in these HEIs with human participation. Methods: Research directors underwent key informant interviews while faculty researchers participated in focus group discussions. Universal sampling was employed on all researches in the schools to determine the proportion with human participants and to know if they are ethically “high risk“ or “low risk” in terms of the participants’ involvement. Results: We included ten higher education institutions in this study. Research directors and faculty researchers agreed that their school should have a REC and that studies should undergo ethical evaluation before commencement of data collection. Half of all researches were found to have human participant involvement and, after developing a tool to determine the risk level to participants, this study found that ethically high risk researches are found to represent 10% as a proportion of the total researches done in the schools. Conclusion Almost all respondents in this study agreed that RECs should be created; however, there are financial challenges that schools face in establishing RECs.
Ethics Committees

COVID-19/transmission* ; Communicable Disease Control/organization & administration* ; Humans ; Remote Consultation/organization & administration* ; Singapore/epidemiology* ; Videoconferencing/organization & administration*

In 2003, the secretaries of the Department of Health (DOH) and the Department of Science and Technology (DOST) signed a memorandum of understanding to institutionalize the Philippine National Health Research System (PNHRS) for the management of research in the country.1 One of the groups constituted under the PNHRS was the Technical Working Group (TWG) on Ethics, which created strategies that highlight the role of ethics in a responsible health research system. Among the recommendations of the Ethics TWG was the establishment of the Philippine Health Research Ethics Board (PHREB).2 In 2006, the PHREB was formally created through DOST Special Order 2006-91 “to ensure that all phases of health research shall adhere to universal ethical principles that value the protection and promotion of the dignity of health research participants.” Since then, PHREB has become the country’s policy making body on health research ethics.2 3 In 2013, the Republic Act 10532一or the PNHRS Law一was enacted.4 The Act strengthened the mandate of PHREB to ensure protection of the welfare, rights, and safety of human research participants, and the implementing rules and regulations (IRR) of the Act specified the policies that facilitate the achievement of the PHREB mandate.5 In 2017, through DOST Special Order 2017-248, DOST established research ethics monitoring boards (REMBs) in Region I, Region VI, and Region XI to assist in the comprehensive and consistent implementation of PHREB policies at the regional level.6 The creation of PHREB in 2006 initiated several other mandates from PHREB and other agencies that implement the PNHRS. These mandates一shown in the infographic一support human research participant protection through ethical reviews of research protocols, establishment of research ethics committees, and maintenance of quality standards of these committees through accreditation. Many of these mandates are national in scope, but a few are specific to Davao Region (Region XI).
Ethics Committees, Research

When communities were forced into lockdown due to the COVID-19 pandemic, governments across different countries globally also started to impose new social restrictions. In order to comply with these new rules and to meet the demands of an emerging disease, health facilities modified the structures and processes of health care services. 1 Teleconsultations—or medical consultations wherein patients and health care practitioners are away from each other, connected only by telecommunication devices —took the place of the traditional face-toface (FTF) consultations, especially in the outpatient clinics. The provision of remote clinical services or telemedicine—which frequently involves teleconsultations—has been practiced since the early 1960’s, 2 but its utilization has grown exponentially ever since this pandemic started. 3-5 A few studies have demonstrated a significant reduction, from to 60 to 80%, in in-person outpatient visits and a four-fold increase in telehealth outpatient visits in the United States during the early days of the pandemic. 6 7 Similarly, across Asia-Pacific countries, there has been a surge of activity in telemedicine platforms since the identification of the COVID-19 virus in January 2020. 8 In the Philippines, for example, a subscription-based teleconsultation service called KonsultaMD registered a 450% increase in the number of teleconsultations in April 2020. 9 Medgate, one of the country’s leading international telemedicine providers, reported a 170% increase in teleconsultations in 2020. 10 11 The aim of this article is to recommend policies for the delivery and reporting of outpatient care using telemedicine in a tertiary hospital.
Remote Consultation ; COVID-19

OBJECTIVES: This study investigates the current state of consuming breakfast among elementary school students residing in Malang, East Java, Indonesia, and to identify factors that influence breakfast behavior.METHODS: The research model was set up as per the health belief model, and slightly modified by adding the subjective normative factors of the theory of planned behavior. The survey was conducted from July 17 to August 15, 2017 using a questionnaire, after receiving the permission PNU IRB (2017_60_HR).RESULTS: The subjects were 77 boys (49.4%) and 79 girls (50.6%) suffering from malnutrition with anemia (21.2%) and stunting ratio of Height for Age Z Score (HAZ) (11.5%). Furthermore, moderate weakness (14.8%) and overweight and obesity (12.3%) by Body Mass Index for Age Z Score (BMIZ) were coexistent. According to the results obtained for breakfast, 21.8% did not eat breakfast before school, with 18.8% of the reasons for skipping breakfast being attributed to lack of food. Even for subjects partaking breakfast, only about 10% had a good balanced diet. The average score of behavioral intention on eating breakfast was 2.60 ± 0.58. The perceived sensitivity, perceived severity, perceived benefits, and self-efficacy of the health belief model correlated with breakfast behavior. Of these, self-efficacy (β=0.447, R²=0.200) and perceived sensitivity (β=0.373, R²=0.139) had the greatest effect on breakfast behavior. Mother was the largest impact person among children.CONCLUSIONS: In order to increase the level of breakfast behavior intention among children surveyed in Indonesia, we determined the effectiveness by focus on education which helps the children recognize to be more likely to get sick when they don't have breakfast, and increase their confidence in ability to have breakfast on their own. We believe there is a necessity to seek ways to provide indirect intervention through mothers, as well as impart direct nutrition education to children.
Anemia ; Body Mass Index ; Breakfast ; Child ; Diet ; Eating ; Education ; Ethics Committees, Research ; Female ; Growth Disorders ; Humans ; Indonesia ; Intention ; Malnutrition ; Mothers ; Obesity ; Overweight

Anesthesia, General ; Coronavirus Infections ; prevention & control ; transmission ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Occupational Exposure ; prevention & control ; Operating Rooms ; Otorhinolaryngologic Surgical Procedures ; Pandemics ; prevention & control ; Personal Protective Equipment ; classification ; Pneumonia, Viral ; prevention & control ; transmission ; Practice Guidelines as Topic