Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment

Rationale: The provision of surgical services in the Philippines is an essential component of our healthcare system. Despite an increasing number of accredited training programs, geographic maldistribution remains a key factor in access to surgical care in the country. This study aimed to describe the geographic distribution of surgeons and anesthesiologists in the Philippines and factors that affect their practice to provide insights into the country's surgical capabilities. Additionally, demographic factors such as workforce density, professional mobility, and economic indicators were explored. The ultimate goal was to establish an updated database for continuous monitoring of surgical manpower, facilitated through the collaboration of the Philippine College of Surgeons (PCS) and the Philippine Society of Anesthesiologists (PSA). Methods: This cross-sectional study, sponsored by the World Surgical Foundation (WSF) and the Philippine College of Surgeons Foundation (PCSF), received exemption from review by the Single Joint Research Ethics Board (SJREB) of the Department of Health. An online survey was distributed to surgeons and anesthesiologists across the Philippines from July 1 to December 31, 2020. Active practitioners in relevant specialties were eligible, excluding retirees. Procedures adhered to ICH-GCP principles, National Ethical Guidelines, and the Data Privacy Act. Additional data, sourced from various outlets, was consolidated, verified and subsequently entered into an electronic data sheet (Google Sheets, Google LLC, Palo Alto CA) to extract descriptive statistics of the surgical and anesthesia workforce at the national and regional levels. Results: Analysis of the data indicates male dominance with a noticeable trend of increasing female participation in surgical training programs, while anesthesiologist gender distribution showed a female preponderance. Maldistribution in manpower persists, influenced by factors such as training programs, medical education, and the availability of secondary and tertiary hospitals, and other socio-economic conditions in the country. The study reveals regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a notable concentration in urban centers, the highest being in Luzon, particularly in the National Capital Region (NCR). Conclusion The study highlights gender disparities and regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a significant concentration in Luzon, particularly in the National Capital Region (NCR). Disparities in subspecialty distribution are exacerbated by healthcare education discrepancies and inadequate healthcare infrastructure especially in rural areas. Addressing these challenges requires focused efforts on expanding training programs, recruiting specialists, and ensuring equitable access to surgical care nationwide. Establishing a comprehensive surgical workforce database is essential for informed policymaking, monitoring workforce distribution, and assess service quality to enhance access to surgical services.
Workforce ; Health Resources ; General Surgery ; Anesthesiology

Objective: To analyze the equity of national stomatologist resource allocation from 2016 to 2020, providing relevantly referenced basis for further stomatologist resource allocation. Methods: Collect data of domestic and international stomatologist resources in 2016, 2018 and 2020, and analyze the relevant data by using the health resources agglomeration degree and population agglomeration degree. Results: At present, at the international level, the number of dentists per 10 000 people ranks 46th in 2010-2019. The quantity of domestic dental resources is on the rise, with a balanced gender distribution and a concentrated age distribution mainly in 25-44 years old. At the specialized technical level, the proportion of junior titles can reach 79.5%-83.0%. The ratio of resource agglomeration of dental practitioners and assistants calculated based on geographical area and population density shows that the ratio of HRAD to PAD in the eastern provinces is greater than 1, while the ratios of most provinces in the central and western regions are less than 1. The eastern regions have excessive allocations, while ones in the central and western regions are insufficient. Conclusions: Unfairness still exists in the allocation of resources for dentists in China. At the national level, it is necessary to continue to cultivate high-quality stomatologists and intensify efforts to support the grass-roots and remote areas. The ability, quality and work competence of on-the-job personnel should be comprehensively improved. Multi-point practice of stomatologists should be standardized and popularized, promoting the rational flow of oral health personnel.
Humans ; Adult ; Dentists ; Professional Role ; Health Resources ; Resource Allocation ; China

INTRODUCTION: Maldistribution of echocardiographic expertise is a relevant issue in an archipelago such as the Philippines. We specifically looked at (1) the nationwide census of physician echocardiographers, cardiac sonographers, and cardiac laboratory managers; (2) their geographic distribution; and (3) background training and laboratory classification. METHODS: Data from paper and online surveys conducted in 2015 and 2021 were consolidated alongside the existing society database. Surveys (Google Forms; Google, Mountain View, California) were disseminated through a variety of online, social media, and communication avenues and focused on three categories of respondents: (1) physician echocardiographers, (2) cardiac sonographers, and (3) laboratory managers. The main variables of interest included estimated census per category and geographical distribution. Secondary variables included training background and laboratory classification. RESULTS: In 2021, there were 651 physician echocardiographers, 2487 cardiac sonographers, and 443 cardiac laboratory managers on record, with86 readers, 405 sonographers, and 101 managers responding to the survey. The majority of the surveyed readers (41.2%), sonographers (48.3%), and laboratory managers (28.2%) were situated in the National Capital Region. Close to half of the readers were level III echocardiographers. The majority of the sonographers (46.7%) were nurses, followed by medical technologists (21.8%) and radiologic technologists (18.9%).Most laboratory managers were in nontraining hospitals (38.2%) or stand-alone facilities (20.9%). The minority were in hospitals with cardiology (18.2%) or internal medicine (22.7%) training programs. CONCLUSION Geographical maldistribution of echocardiographic resources is still evident, with the majority of human resources being concentrated in the metropolis. The majority of the sonographers have nursing as their training background, and many laboratory managers are situated in facilities with no established training programs.
echocardiography ; laboratories ; resources ; health resources ; surveys and questionnaires

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.
COVID-19/therapy* ; Critical Care/organization & administration* ; Critical Illness ; Health Care Rationing/organization & administration* ; Health Resources/organization & administration* ; Health Services Accessibility/organization & administration* ; Humans ; Intensive Care Units/organization & administration* ; Operating Rooms/organization & administration* ; Pandemics ; Respiration, Artificial ; Singapore/epidemiology* ; Tertiary Care Centers/organization & administration*

OBJECTIVES: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.METHODS: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.RESULTS: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.CONCLUSIONS: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.
Child Health ; Child ; Conservation of Natural Resources ; Family Planning Services ; Growth Disorders ; Hepatitis B ; Human Development ; Humans ; Incidence ; Iran ; Maternal Health ; Maternal Mortality ; Mediterranean Region ; Parturition ; Vaccination

The blood supply can become disrupted in situations of increased demand during unexpected national catastrophes and when a patient needs a rare blood transfusion, which depends on the blood inventory in peacetime. Cryopreservation of blood, which can be stored up to 10 years, represents a possible solution to this problem by avoiding storage lesions. This review describes frozen red cell technologies, quality control issues related to post-thaw red blood cells, and preconditions and practical considerations for implementation of a frozen blood banking system in Korea.
Blood Banks ; Blood Transfusion ; Cryopreservation ; Erythrocytes ; Humans ; Korea ; Quality Control ; Strategic Stockpile*

OBJECTIVE: In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea.METHODS: Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps.RESULTS: Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000).CONCLUSION: Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.
Geographic Mapping ; Health Manpower ; Health Services Accessibility ; Hospital Distribution Systems ; Korea ; Neurosurgeons ; Neurosurgery ; Resource Allocation

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs).METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons.RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery.CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.
Angiography ; Cause of Death ; Cerebrovascular Disorders ; Health Resources ; Humans ; Korea ; Magnetic Resonance Angiography ; Mortality ; Operating Rooms ; Patient Transfer ; Stroke ; Surgeons ; Surgical Equipment ; Surveys and Questionnaires

PURPOSE: The Korean Triage and Acuity Scale (KTAS), which was developed in 2012 due to the need for a single triage tool for emergency patients in Korea, has since become nationalized. Although five years has passed, there has been limited evidence of its validation. Therefore, this study was conducted to analyze the validity of the new triage system. METHODS: We conducted a multicenter prospective study. Data were collected from seven hospitals and 42,187 patients were classified using the KTAS from April 1, 2013 to July 6, 2014. We analyzed whether the indirect severity variables showed meaningful differences according to KTAS levels. The variables consisted of disposition from emergency room, length of stay, numbers of consultations, examination of computed tomography, emergency room costs, and performance of emergent interventions. RESULTS: From KTAS level 1 to 5, a decreasing trend in the length of stay in emergency room, frequency of consultation with other departments, admission, computed tomography rate, emergency intervention rate, and emergency room costs was observed. Upon binominal logistic regression, disposition from emergency room and emergent intervention rate showed the highest odds ratio with statistical significance. CONCLUSION: The results of this study demonstrated that KTAS is a valid emergency triage tool that reflects the severity of the patient with indirect indicators. The results of this study will be useful as a reference for quality control of KTAS.
Emergencies ; Emergency Service, Hospital ; Health Resources ; Humans ; Korea ; Length of Stay ; Logistic Models ; Odds Ratio ; Prospective Studies ; Quality Control ; Referral and Consultation ; Triage