The Sixth Environmental and Occupational Health Forum, conducted virtually on November 23 to 24, 2023, focused on "Accelerating the Development of Healthy and climate-smart Hospitals in the Southeast Asian Region." This forum, a collaborative effort of the University of the Philippines Manila and Health Care Without Harm Southeast Asia, aimed to explore and exchange strategies, challenges, and innovative practices for integrating environmental sustainability in healthcare settings across Southeast Asia. The event gathered healthcare professionals, policymakers, and environmental experts to discuss the transformation of hospitals into health and climate-smart institutions. Keynote speakers from various countries presented case studies and research findings, emphasizing the need for holistic approaches that include policy development, stakeholder engagement, and continuous education. Significant outcomes highlighted were the identification of effective policies for sustainable hospitals, understanding the impact of healthcare facilities on climate change, and the necessity for political acumen in promoting environmental stewardship in healthcare. The forum concluded with a consensus on the critical need for ongoing collaboration and innovation in environmental and occupational health, underscoring the importance of transforming healthcare facilities into entities that prioritize both patient care and planetary health.
Delivery of Health Care ; Occupational Health

Background: The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency. Methods: This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups. Results: Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups. Conclusions Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure.Level of evidence: IV.

Background: The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency. Methods: This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups. Results: Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups. Conclusions Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure.Level of evidence: IV.

Background: The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency. Methods: This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups. Results: Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups. Conclusions Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure.Level of evidence: IV.

Background: The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency. Methods: This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups. Results: Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups. Conclusions Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure.Level of evidence: IV.

This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). Methods: LP’s performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. Results: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15–58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). Conclusions: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss. Level of evidence: III.

COVID-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China in late 2019. Rapidly spreading worldwide, it was declared a pandemic by the World Health Organization (WHO) in early 2020 [1]. Various mitigation strategies, such as physical distancing, travel restrictions, and other public health protocols, were enforced globally to curb virus transmission [2,3]. However, these measures also disrupted daily life, work environments, and public health systems, posing significant challenges in balancing virus prevention and continuation of economic activity [4]. This paper aimed to highlight key lessons from the Third Environmental and Occupational Health (EOH) Forum on public health emergency response as demonstrated by selected Asian countries. Proceedings from the forum were reviewed and analyzed, arriving at the following lessons and themes: proactive and strategic public health interventions, leadership and governance, community participation, policy adjustments, technological integration and innovation, and balancing health and economic activities. The forum, themed “Environmental and Occupational Health Initiatives During the COVID-19 Pandemic,” was held virtually in November 2020 [5]. Understanding environmental and occupational health interventions as well as the themes of strategies by Asian countries, provides valuable insights into early pandemic management and contributes to a repository of knowledge that can be adapted and applied globally, enhancing the overall effectiveness of pandemic responses.
Occupational Health ; Environmental Health ; Publich Health ; COVID-19 ; Pandemics ; Asia

Even after two years, the COVID-19 pandemic still disrupts public activities and services as it exposes vulnerabilities among the population and negatively impacts environmental conditions. The crisis also impeded global progress toward achieving Sustainable Development Goals (SDG). The Fourth Environmental and Occupational Health (EOH) Forum held virtually on November 25 to 26, 2021 provided a venue for learning about local and international COVID-19 responses to help prepare for the next global crisis. Through the systems thinking approach, the discussions prioritized analyses of leadership and governance, financing, human resource, technologies, information management, and service delivery. These analyses focused on community and/or workplace programs and services linked to air quality, waste management, psychosocial wellness, and COVID-19 vaccination. The forum amplified calls for climate actions and public health improvement and emphasized the significance of a collaborative, evidence-based, integrated public health response to a crisis underscoring the apparent interdependence of the SDGs.
Environmental Health ; Occupational Health ; Sustainable Development Goals ; Covid-19 ; air quality

Background and Introduction. The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.

Materials and Methods. The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.

Results and Discussion. RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.

Conclusions. These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.

The prevalence of non-communicable diseases (NCDs) across the globe has reached epidemic proportions, with more than three quarters of NCD deaths now occurring in low- and middle-income countries (LMIC).1 NCDs encompass a broad range of chronic conditions, which include cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental disorders.2 To mitigate the growing global NCD burden and its associated challenges, upscaling high-impact essential interventions for the prevention and control of NCDs has remained a priority, especially in low-resource settings. One such intervention is strengthening self-care strategies or self-management of individuals living with NCDs.3 In the past few decades, the self-management approach to NCD has proven to be a cost-effective strategy to improve a patient’s quality of life by reducing symptom severity and decreasing pain. This approach has also encouraged patients to become key decision makers in the treatment process.4 Self-management includes both technological (e.g. smartphone applications, telemonitoring systems, or wearable devices) and non-technological interventions (social support, educational materials, or in-person training seminars).5 Telemedicine has played several important roles in the whole spectrum of care for patients with NCD. These include promotion of healthy behaviors, prevention of risk factors, prompt recognition and initiation of treatment, disease monitoring and follow-up, rehabilitation, and palliation. Telemedicine not only increases access to health care but also improves the quality of health care especially in rural areas.6 7 The unique challenges resulting from the COVID-19 pandemic has limited patient access to health care, especially in geographically isolated and disadvantaged areas. This literature review aims to determine the effectiveness of telemedicine on clinical and psychosocial outcomes of adult patients diagnosed with NCDs. We conducted a literature search on PubMed, EBSCOhost, ProQuest, Google Scholar, and Gale using the search words “telemedicine,” “adult,” “non-communicable disease,” “self-management,” and “teleconsultation.” We filtered the results to only include randomized controlled trials (RCT). To narrow down the scope of this literature review, only previous studies that compared telemedicine and usual care (non-telemedicine) among adults with non-communicable diseases, and those that report clinical and psychosocial outcomes—i.e., symptom outcomes, laboratory outcomes, knowledge on disease, or behavior outcomes that pertain to self-management of disease—were assessed. We excluded studies if they were done among patients <18 years old, if they included telemedicine that supplemented rather than replaced the usual (face-to-face) care, if they were not able to report outcomes between groups, or if they did not meet the criteria of a RCT. Two reviewers independently reviewed the abstracts yielded from the search strategy and assessed them based on the set criteria. If neither reviewer was able to rule out an article based on the abstract, the full text was retrieved and assessed to determine inclusion into the study. After the final assessment, a total of 9 RCT reports were included in this review. The general characteristics and key findings of the 9 studies included in this literature review are summarized in Table 1. The included studies, published in various journals between 2014 and 2021, were carried out in eight countries—two studies were done in Australia, and one each in Bangladesh, India, Italy, USA, Germany, China, and the Netherlands. The studies enrolled patients who were diagnosed with type 2 diabetes mellitus (DM) (n=3), chronic obstructive pulmonary disease (n=1), type 1 DM (n=1), congestive heart failure (n=1), stroke (n=1), osteoarthritis (n=1), and various non-specific chronic conditions, including type 2 DM, hypertension, coronary artery diseases, heart failure, chronic depression, and schizophrenia (n=1). The sample sizes of the studies included ranged from 29 to 10,815 participants. Follow-up periods ranged from 3 to 36 months. The telemedicine techniques that were used in the studies included mobile phone-based health interventions, telemedicine-based visits, and telephone-based health coaching. In general, most of the studies included in this review reported that telemedicine is as good as, if not better than, usual care approaches in achieving clinical and psychosocial outcomes.
Noncommunicable Diseases ; Chronic Disease