Heatstroke-related ambulance dispatch risk before and during COVID-19 pandemic: Subgroup analysis by age, severity, and incident place

Background: In summer 2020 under the COVID-19 pandemic, the Ministry of Health, Labour and Welfare has made public warnings that specific preventive measures such as maskwearing and stay-at-home orders, may increase heatstroke risk. In our previous work, we found a lower risk of heatstroke-related ambulance dispatches (HSAD) during the COVID-19 period, however, it is uncertain whether similar risk reductions can be observed in different vulnerable subgroups. This study aimed to determine the HSAD risk during the COVID-19 pandemic by age, severity, and incident place subgroups.Method: A summer-specific (June–September), time-series analysis was performed, using daily HSAD and meteorological data from 47 Japanese prefectures from 2017 to 2020. A two-stage analysis was applied to determine the association between HSAD and COVID-19 pandemic, adjusting for maximum temperature, humidity, seasonality, and relevant temporal adjustments. A generalized linear model was utilized in the first stage to estimate the prefecture-specific effect estimates. Thereafter, a fixed effect meta-analysis in the second stage was implemented to pool the first stage estimates. Subsequently, subgroup analysis via an interaction by age, severity, and incident place was used to analyze the HSAD risk among subgroups.Results: A total of 274,031 HSAD cases was recorded across 47 Japanese prefectures. The average total number of HSAD in the pre-COVID-19 period was 69,721, meanwhile, the COVID-19 period was 64,869. Highest reductions in the risks was particularly observed in the young category (ratio of relative risk (RRR) = 0.54, 95% Confidential Interval (CI): 0.51, 0.57) compared to the elderly category. Whereas highest increment in the risks were observed in severe/death (RRR = 1.25, 95% CI: 1.13, 1.37) compared to the mild category.Conclusion: COVID-19 situation exhibited a non-uniform change in the HSAD risk for all subgroups, with the magnitude of the risks varying by age, severity, and incident place

Arsenic in Groundwater Sources from Selected Communities Surrounding Taal Volcano, Philippines: An Exploratory Study

Arsenic (As) is a highly toxic, carcinogenic trace metal that can potentially contaminate groundwater sources in volcanic regions. This study provides the first comparative documentation of As concentrations in groundwater in a volcano-sedimentary region in the Philippines. Matched, repeated As measurements and physico-chemical analyses were performed in 26 individual wells from 11 municipalities and city in Batangas province from July 2020 to November 2021. Using the electrothermal atomic absorption spectrometric method, analysis of the wells revealed that in 2020, 23 out of 26 (88.46%) had As levels above the WHO limit of \u3e10 ppb while 20 out of 26 wells (76.92%) had persistently high As levels a year later. Using a Wilcoxon signed-rank test, levels of As were found to be statistically elevated compared to the national safe limit of 10 pbb in the 26 matched sampling sites in both 2020 (p-value \u3c 0.001) and 2021 (p-value = 0.013). Additionally, a two-paired Wilcoxon signed-rank test revealed that As levels were statistically higher in 2020 than in 2021 (p-value = 0.003), suggesting that As levels may be higher in years when there is more volcanic activity; however, this remains to be further elucidated with suitable longitudinal data, as this study is still in its preliminary stages. The data was also analyzed using a bivariable regression, which showed no evidence of a significant relationship between As levels and distance from the danger zone (Taal volcano crater); however, results showed an inverse but statistically insignificant relationship between As levels and elevation. Due to the toxic profile and persistence of As in groundwater in Batangas Province, continuous groundwater As monitoring, timely public health risk communication, and the provision of alternative water sources to affected populations are recommended

Arsenic in Groundwater Sources from Selected Communities Surrounding Taal Volcano, Philippines: An Exploratory Study

Arsenic (As) is a highly toxic, carcinogenic trace metal that can potentially contaminate groundwater sources in volcanic regions. This study provides the first comparative documentation of As concentrations in groundwater in a volcano-sedimentary region in the Philippines. Matched, repeated As measurements and physico-chemical analyses were performed in 26 individual wells from 11 municipalities and city in Batangas province from July 2020 to November 2021. Using the electrothermal atomic absorption spectrometric method, analysis of the wells revealed that in 2020, 23 out of 26 (88.46%) had As levels above the WHO limit of \u3e10 ppb while 20 out of 26 wells (76.92%) had persistently high As levels a year later. Using a Wilcoxon signed-rank test, levels of As were found to be statistically elevated compared to the national safe limit of 10 pbb in the 26 matched sampling sites in both 2020 (p-value \u3c 0.001) and 2021 (p-value = 0.013). Additionally, a two-paired Wilcoxon signed-rank test revealed that As levels were statistically higher in 2020 than in 2021 (p-value = 0.003), suggesting that As levels may be higher in years when there is more volcanic activity; however, this remains to be further elucidated with suitable longitudinal data, as this study is still in its preliminary stages. The data was also analyzed using a bivariable regression, which showed no evidence of a significant relationship between As levels and distance from the danger zone (Taal volcano crater); however, results showed an inverse but statistically insignificant relationship between As levels and elevation. Due to the toxic profile and persistence of As in groundwater in Batangas Province, continuous groundwater As monitoring, timely public health risk communication, and the provision of alternative water sources to affected populations are recommended

Association between Teenage Pregnancy and Family Factors: An Analysis of the Philippine National Demographic and Health Survey 2017

Adolescence is a key developmental period in one’s life course; health-related behaviors of adolescents can be linked to lifelong consequences, which affect their future health. Previous studies highlight the role of family and its significant association with adolescents’ health. In East Asia and the Pacific, the Philippines is the only country that is showing an upward trend of teenage pregnancy while other countries in the region have declining teenage pregnancy rates. Against this backdrop, this study investigated the association between teenage pregnancy and family factors, specifically parent structure. Data for the study were extracted from the Philippine National Demographic and Health Survey 2017. All adolescent women aged 15–19 years old (n = 5120) were included in the analyses. The dependent variable was teenage pregnancy, while parent structure, defined as a presence or absence of parents in the domicile, was the exposure variable. Multivariable logistic regression was utilized in assessing the association of teenage pregnancy and family factors after adjusting for several potential confounders. Adolescent women were more likely to become pregnant as a teenager when they lived with neither parent (aOR = 4.57, 95% CI = 2.56–8.15), were closer to 19 years of age (aOR = 2.17, 95% CI = 1.91–2.46), had knowledge of contraception (aOR = 1.27, 95% CI = 1.22–1.32) and lived in a big family (aOR = 1.14, 95% CI = 1.09, 1.20). Furthermore, adolescent women who lived with neither parent and belonged to the poorest wealth quintile were more likely to become pregnant as a teenager (aOR = 3.55, 95% CI = 1.67–7.55). Conversely, educational attainment higher than secondary education (aOR = 0.08, 95% CI = 0.01–0.49) and those who belonged to the richest wealth quintile (aOR = 0.40, 95% CI = 0.18–0.92) exhibited a statistically inverse association with teenage pregnancy compared with those with no education and from the middle wealth quintile, respectively. Living with neither parent was found as a risk factor for teenage pregnancy. Furthermore, we found that several sociodemographic factors exhibited a non-uniform increment and reduction in the risk of teenage pregnancy

Effect modification by temperature on the association between O3 and emergency ambulance dispatches in Japan: A multi-city study

Numerous epidemiological studies have reported that ozone (O₃) and temperature are independently associated with health outcomes, but modification of the effects of O₃ on health outcomes by temperature, and vice versa, has not been fully described. This study aimed to investigate effect modification by temperature on the association between O₃ and emergency ambulance dispatches (EADs) in Japan. Data on daily air pollutants, ambient temperature, and EADs were obtained from eight Japanese cities from 2007 to 2015. A distributed lag non-linear model combined with Poisson regression was performed with temperature as a confounding factor and effect modifier to estimate the effects of O₃ on EADs at low (75th percentile) temperature for each city. The estimates obtained from each city were pooled by random-effects meta-analysis. When temperature was entered as a confounder, the estimated effects of O₃ on EADs for all acute, cardiovascular, and respiratory illnesses were largest at lag 0 (current-day lag). Therefore, this lag was used to further estimate the effects of O₃ on EADs in each temperature category. The estimated effects of O₃ on EADs for all acute, cardiovascular, and respiratory illnesses in all eight Japanese cities increased with increasing temperature. Specifically, a 10 ppb increase in O₃ was associated with 0.80 % (95 % CI: 0.25 to 1.35), 0.19 % (95 % CI: -0.85 to 1.25), and 1.14 % (95 % CI: -0.01 to 2.31) increases in the risk of EADs for all acute, cardiovascular, and respiratory illnesses, respectively, when city-specific daily temperature exceeded the 75th percentile. Our findings suggest that the association between O₃ and EADs for all acute, cardiovascular, and respiratory illnesses is the highest during high temperature. Finding of this study can be used to develop potential mitigation measures against O₃ exposure in high temperature environment to reduce its associated adverse health effects

Meteorological factors affecting dengue incidence in Davao, Philippines

BackgroundDengue fever is a major public health concern in the Philippines, and has been a significant cause of hospitalizations and deaths among young children. Previous literature links climate change to dengue, and with increasingly unpredictable changing climate patterns, there is a need to understand how these meteorological variables affect dengue incidence in a highly endemic area.MethodsWeekly dengue incidences (2011–2015) in Davao Region, Philippines were obtained from the Department of Health. Same period of weekly local meteorological variables were obtained from the National Climatic Data Center (NCDC) and the National Oceanic and Atmospheric Administration (NOAA). Wavelet coherence analysis was used to determine the presence of non-stationary relationships, while a quasi-Poisson regression combined with distributed lag nonlinear model (DLNM) was used to analyze the association between meteorological variables and dengue incidences.ResultsSignificant periodicity was detected in the 7 to 14-week band between the year 2011–2012 and a 26-week periodicity from the year 2013–2014. Overall cumulative risks were particularly high for rainfall at 32 mm (RR: 1.67, 95% CI: 1.07–2.62), while risks were observed to increase with increasing dew point. On the other hand, lower average temperature of 26 °C has resulted to an increased RR of dengue (RR: 1.96, 95% CI: 0.47–8.15) while higher temperature from 27 °C to 31 °C has lower RR.ConclusionsThe observed possible threshold levels of these meteorological variables can be integrated into an early warning system to enhance dengue prediction for better vector control and management in the future

Effect modification in the temperature extremes by mortality subgroups among the tropical cities of the Philippines

BackgroundTemperature–mortality relationships have been extensively probed with varying temperature range but with relatively similar patterns and in some instances are being modified by specific mortality groups such as causes of mortality, sex, and age.ObjectiveThis study aimed to determine the risk attributions in the extreme temperatures and also identified the risks associated with the various mortality subgroups.DesignWe used the 2006–2010 daily average meteorological and daily mortality variables from the Philippine Atmospheric Geophysical and Astronomical Services Administration and Philippine Statistics Authority–National Statistics Office, respectively. Mortality data were divided according to cause (cardiovascular and respiratory), sex, and age (0–14 years, 15–64 years, and >64 years). We performed a two-stage analysis to estimate the extreme temperature effects stratified by the different mortality subgroups to observe the effect modification.ResultsIn the pooled analysis, greater risks were observed in the extreme high temperature (99th temperature percentile; RR (relative risk)=2.48 CI: 1.55–3.98) compared to the extreme low temperature (1st temperature percentile; RR=1.23 CI: 0.88–1.72). Furthermore, effect modification by mortality subgroups was evident, especially higher risks for extreme temperatures with respiratory-related diseases, women, and elderly.ConclusionsBoth sex and age were found to effect modify the risks in extreme temperatures of tropical cities; hence, health-related policies should take these risk variations into consideration to create strategies with respect to the risk population

How Does Ambient Air Temperature Affect Diabetes Mortality in Tropical Cities?

Diabetes is well-known as one of the many chronic diseases that affect different age groups. Currently, most studies that evaluated the effects of temperature on diabetes mortality focused on temperate and subtropical settings, but no study has been conducted to assess the relationship in a tropical setting. We conducted the first multi-city study carried out in tropical cities, which evaluated the temperature–diabetes relationship. We collected daily diabetes mortality (ICD E10–E14) of four Philippine cities from 2006 to 2011. Same period meteorological data were obtained from the National Oceanic and Atmospheric Administration. We used a generalized additive model coupled with a distributed lag non-linear model (DLNM) in determining the relative risks. Results showed that both low and high temperatures pose greater risks among diabetics. Likewise, the study was able to observe the: (1) high risk brought about by low temperature, aside from the largely observed high risks by high temperature; and (2) protective effects in low temperature percentile. These results provide significant policy implications with strategies related to diabetes risk groups in relation to health service and care strategies

Assessing frontline HIV service provider efficiency using data envelopment analysis: a case study of Philippine social hygiene clinics (SHCs)

AbstractBackground:Globally, local and frontline HIV service delivery units have been deployed to halt the HIV epidemic.However, with the limited resources, there is a need to understand how these units can deliver their optimumoutputs/outcomes efficiently given the inputs. This study aims to determine the efficiency of the social hygieneclinics (SHC) in the Philippines as well as to determine the association of the meta-predictor to the efficiencies.Methods:In determining efficiency, we used the variables from two data sources namely the 2012 Philippine HIVCosting study and 2011 Integrated HIV Behavioral and Serologic Surveillance, as inputs and outputs, respectively.Various data management protocols and initial assumptions in data matching, imputation and variable selection,were used to create the final dataset with 9 SHCs. We used data envelopment analysis (DEA) to analyse theefficiency, while variations in efficiencies were analysed using Tobit regression with area-specific meta-predictors.Results:There were potentially inefficient use of limited resources among sampled SHC in both aggregate and keypopulations. Tobit regression results indicated that income was positively associated with efficiency, while HIVprevalence was negatively associated with the efficiency variations among the SHCs.Conclusions:We were able to determine the inefficiently performing SHCs in the Philippines. Though currentlyinefficient, these SHCs may adjust their inputs and outputs to become efficient in the future. While there wereindications of income and HIV prevalence to be associated with the efficiency variations, the results of this casestudy may only be limited in generalisability, thus further studies are warranted