Vitamin D and COVID New Studies - Evidence for a Protective Role of Vitamin D in COVID

I can always hear radio advertisements regarding Vitamin D3 supplementation in preventing diseases especially COVID patients. In fact, I have one patient before who had been prescribed by another doctor of Vitamin D3. I have come upon a good video in you tube wherein it discusses the merit of using vitamin D3 supplementation as a treatment for COVID and cites good, credible clinical trials and medical studies about it. (I will link the said youtube video below:)

VITAMIN D AND COVID NEW STUDIES - EVIDENCE FOR A PROTECTIVE ROLE OF VITAMIN D IN COVID BY DR. MIKE HANSEN

So regarding Vitamin D supplementation: according to studies, vitamin D insufficiency MAY INCREASE THE RISK of COVID and Covid complications BUT vitamin D supplementation IS ONLY VALUABLE TO THOSE WHO ARE VITAMIN D DEFICIENT. Meaning Vitamin D supplementation for those who are Not Vitamin D Deficient may not be of great value.

No Approved Therapeutic Claim/Use!

I had always wanted to talk about this with my patients but I have not had the time to sufficiently discuss this.

As a medical doctor I cannot and will not endorse any product which has a 'No Therapeutic Use' on its label. I am for any thing herbal and natural but it does not mean that I will disregard the safety of my patients.

I have a professor in Medschool that is an advocate of herbal medicine but she is also a medical doctor. And so, while advocating for herbal medicine, she tediously explained the process and the science of preparing an herbal medicine, and so let's take some important points about it:

• Herbal medicine preparations should be an exact ....science. This simply means that exact measurements should be used. Meaning if you prepare (let's take for an example Sambong leaves) leaves, and you are instructed to take 5 leaves. You should take leaves with proportionally same size with each other. There are some preparations that prescribes the exact size of the leaves like for example (I am only hypothesizing here) Sambong leaves should have 1-inches leaves while recommendations for Malunggay leaves is only 1-cm leaves. AND there are different preparations for barks, roots, fruits, etc.
• Even the procedures in preparations should be exact. As my mentor explained, preparing a decoction is also exact meaning a certain decoction is prescribed with a 1 cup water while others are prescribed with a 1 glass water (yes a cup is different from a glass!). If you boil a decoction for 30 minutes and you start the time from the moment you pour the water into the pot, it may be a whole lot different if you start the 30-minute time on the moment that the water boils. Plus there's a difference if the instruction is like 'You boil the leaves with 2 cups water until the point that the water remaining is only 1 cup.'
• The time of the day when you pick up a leaf/root/bark matters. We had been advised that the perfect time to pick leaves is in the morning just before the sun rises as the leaves has the perfect consistency to it.

Environmental Sanitation

ENVIRONMENTAL SANITATION: 

• defined as the study of all factors in man's physical environment, which may exercise a deleterious effect on his health, well-being and survival
• Included are:
• Water sanitation
• Food sanitation
• Refuse and garbage disposal
• Excreta disposal
• Insect vector and rodent control
• Housing
• Air pollution
• Noise
• Radiological protection
• Institutional sanitation
• Stream pollution

MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAM

Field Health Services and Information System

PhotoCredit: YourPersonalHealthRecord.Blogspot.Com

Field Health Services Information System Objectives

• To provide summary of data on health services delivery and selected program accomplished indicators at the barangay, municipality/city, district, provincial, regional and national levels
• To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes
• To provide a standardized, facility level database which can be accessed for a more in-depth studies
• To ensure that the data to the FHSIS are useful and accurate and are disseminated in a timely and easy to use fashion
• To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promotive activities

Demography

PhotoCredit: ToonPool.Com

 Demography

• science which deals with the study of the human population size, composition and distribution in space
• Population size - refers to the number of people in a given place or area at a given time
• When the population is characterized in relation to certain variables such as age, sex, occupation or educational level, then the population composition is being described
• The nurse also describes how people are distributed in a specific geographic location

Epidemiology

PhotoCredit: Epidemiology.UCSD.Edu

Epidemiology

• the study of occurences and distribution of diseases as well as the distribution and determinants of health states or events in a specified population, and the application of this study to the control of health problems
• this emphasizes that epidemiologists are concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health
• backbone of the prevention of disease

Vital Statistics

PhotoCredit: Dreamstime.Com

Statistics

• refers to a systematic approach of obtaining, organizing and analyzing numerical facts so that conclusions may be drawn from them

Vital Statistics

• refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths
• statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success or failure of health work

National Health Situation

PhotoCredit: Taopo.Org

HEALTH INDICES

Basic Health Indicators

• Nutrition
• Disease Patterns
• Leading Causes of Morbidity
• Leading Causes of Mortality
• Other Indicators
• Infant Mortality Rate
• Maternal Mortality Rate
• Life Expectancy at Birth
• Median Age
• Crude Birth Rates and Crude Death Rates

Public Health Programs

PhotoCredit: Ghf12.Org

FAMILY HEALTH

• Maternal Health Program
1. Antenatal registration
2. Tetanus Toxoid immunization
3. Micronutrient supplementation
4. Treatment of Diseases and Other conditions
5. Clean and Safe delivery
• The Family Planning Program: Family Planning Methods
1. Female sterilization
2. Male sterilization
3. Pills
4. Male condom
5. Injectables
6. Lactating amenorrhea methods or LAM
7. Mucus/Billings/Ovulation
8. Basal Body Temperature
9. Symptothermal Method
10. Two Day method
11. Standard Days method

Non-Communicable and Communicable Disease Prevention and Control

PhotoCredit: Sanilachealth.com

Non-Communicable Disease Prevention and Control

• Integrated Community Based Non-Communicable Disease Prevention and Control Program
• Causes and Risk Factors of Major Non-Communicable Diseases
• Diseases of the Heart and Blood Vessels
1. Hypertension
2. Coronary Artery Disease
3. Cerebrovascular Disease or Stroke
• Cancer
• Diabetes Mellitus
• Chronic Obstructive Pulmonary Disease
• Bronchial Asthma

Community Organizing

PhotoCredit: OaklandCommunity.Org

• Studies have underscored some key elements of the community which may be reactivated to bring social and behavioral change
• These include social organizations (relationships. structure and resources), ideology (knowledge, beliefs and attitudes) and change agents
• This process of change is often termed as "empowerment" or building the capability of people for future community action

Community-Based Nursing Services

PhotoCredit: Zytech.Com.Cn

• Assessment of Community Health Needs
• Community Diagnosis aims to obtain a general information about the community.
• The following are elements of a comprehensive community diagnosis:
1. Demographic variables
2. Socio-economic and cultural variables
3. Health and Illness patterns
4. Health resources
5. Political/Leadership patterns

Family Based Nursing Services (Family Health Nursing Process)

PhotoCredit: PinoyExpat.Net

• Nursing Assessment of Family:
• First Level Assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance and disease prevention
• Second Level Assessment:
• data include those that specify or describe the family's realities, perceptions about and attitudes related to the assumption or performance of family health tasks on each health condition or problem identified during the first level assessment

Primary Health Care

PhotoCredit: GameOps.Net

• WHO defines as essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development
• Primary Health Care was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on September 6-12, 1978 by WHO. The goal was "Health for All by year 2000". This was adopted in the Philippines through Letter of Instruction 949 signed by President Marcos on October 19, 1979 and has an underlying theme of "Health in the Hand of the People by 2020".

Health Care Delivery System

• The PHILIPPINE HEALTH CARE DELIVERY SYSTEM is composed of two sectors:
1. PUBLIC SECTOR - largely financed through a tax-based budgeting system at both national and local levels and where health care is given free at the point of service
2. PRIVATE SECTOR (for profit and non-profit providers) - largely market-oriented and where health care is paid through user fees at the point of service
• The PUBLIC SECTOR consists of the national and local government agencies, providing health services. At the national level, the Department of Health (DOH), is mandated as the lead agency in health. It has a regional field office in every region and maintains specialty hospitals, regional hospitals and medical centers. It also maintains provincial health team made up of DOH representatives to the local health boards and personnel involved in communicable disease control, specifically for malaria and schistosomiasis. other national government agencies providing health care services such as the Philippine General Hospital are also part of this sector

Types of Clientele

PhotoCredit: TrippleAccounting.Wordpress.Com

Individual

• Basic approaches in looking at the individual:
1. Atomistic
2. Holistic
• Perspectives in Understanding the Individual:
• Biological
1. Unified whole
2. Holon
3. Dimorphism
• Anthropological
1. Essentialism
2. Social constructionism
3. Culture

Principles and Standards of CHN with Levels of Care

PhotoCredit: OrangeCup.Multiply.Com

Basic Principles of Community Health Nursing (CHN)

1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems - e.g. children, elderly) and the community
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is part of health care system and the larger human service system

Measles

Definition:

Also known as Rubeola, an acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract; the eruption is preceded by about 2 days or coryza, during which stage grayish pecks (Koplik spots) may be found on the inner surface of the cheeks. A morbilliform rash appears on the 3rd or 4th day affecting face, body and extremities ending in branny desquamation.

Death is due to complication (e.g. secondary pneumonia, usually in children under 2 years old. Measles is severe among malnourished children with fatality of 95-100%. Infection confers life-long immunity.

Etiologic Agent: Filterable virus of Measles

Source of Infection: Secretion of nose, mouth and throat of infected persons.

Modes of Transmission:

1. Directly - by being sprayed with droplets emanating from a cough or sneeze
2. Indirectly - with articles newly contaminated with respiratory secretions from a patient.
3. Probably Airborne

• Incidence peak age is about 1-5 years old in congested urban areas and at early school age in less crowded sections.
• Immunity from the disease is long lasting while passive immunity transmitted transplacentally from mothers who have had measles may last about 5-6 months. The live attenuated vaccine confers almost lifelong immunity while the inactivated antigen gives an immunity 0f 6-18 months.
• Recent data suggests that cases is on the rise again in the United States and Canada due to the unsubstantiated claim that measles vaccine is associated with autism. In fact, various studies by government and non-government agencies disputing these claims.

Incubation Period:

• 10-12 days; one attack usually confers a lasting immunity
• 8 days shortest; 20 days longest

Period of Communicability:

• During the period of coryza or catarrhal symptoms - 9 days (from 4 days before and 5 days after rash appears)

Clinical Manifestations:

1. Pre-eruptive Stage
   • patient is highly communicable
   • fever
   • catarrhal symptoms - start in the nasal cavities; then in the conjunctivae, oropharynx, progress to the bronchi resulting successively in rhinitis, conjunctivitis and then bronchitis.
   • Respiratory symptoms - which appear first as a common cold, and sneezing nasal discharges, steadily progress into a distressing and annoying cough that persists up to convalescence.
2. Eruptive Stage/Stage of Skin Rashes
   • exanthem sign - means eruption in the skin
     • Maculopapular Rashes - appears 2-7  days after onset
     • With high fever - increases steadily
     • Anorexia and irritability - are disturbing particularly at the height of the fever
     • Diarrhea, pruritis, lethargy and occipital lymphadenopathy
3. Stage of Convalescence
   • Rashes - fade in the same manner as they appeared, from the face downwards, leaving a dirty brown pigmentation and finely granular which maybe noted for several days.
   • Fever - gradually subsides as the eruptions disappear on the hands and feet

Tests:

• Usually none (most diagnosis is based clinically)
• Measles serology
• Viral culture (rarely done)

Treatment:

No therapy is indicated for uncomplicated measles, Gamma globulin although effective in prophylaxis is no value once symptoms are evidence. Patient should be monitored for the development of bacterial infections which should be treated with appropriate antibiotics on the basis of clinical and bacteriological findings.

The patient may also take over-the-counter medications such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs) to help relieve the fever that accompanies measles. Don’t give aspirin to children because of the risk of Reye’s syndrome — a rare but potentially fatal disease.

Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the patient not to rub the eyes. Administer antipyretic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.


Prognosis


Prognosis is very good specially for those who do not develop complications like bronchitis, encephalitis (1 of 1000 cases), ear infections and pneumonia.

Methods of Prevention and Control

1. Avoid exposing children to any person with fever or with acute catarrhal symptoms
2. Isolation of cases from diagnosis until about 5-7 days after onset of rash
3. Disinfection of all articles soiled with secretion of nose and throat
4. Encourage by health department and by private physician of administration of measles immune globulin to susceptible infants and children under 3 years of age in families or institutions where measles occurs.
5. Live attenuated and inactivated measles virus vaccines have been tested and are available for use in children with no history of measles, at 9 months of age or soon thereafter

Public Health Nursing Responsibilities

1. Emphasize the need for immediate isolation when early catarrhal symptoms appear .
2. If immune serum of globulin is available (gamma Globulin), explain this to the family and refer to physician or clinic giving this service.
3. Observe closely the patient for complications during and after the acute stage.
4. Teach, demonstrate, guide and supervise adequate nursing care indicated.
5. Explain proceedings in proper disposal of nose and throat discharges.
6. Teach concurrent and terminal disinfection.

Nursing Care

1. Protect eyes of patients from glare of strong light as they are apt to be inflamed.
2. Keep the patient in an adequately ventilated room but free from drafts and chilling to avoid complications of pneumonia.
3. Teach, guide and supervise correct technique of giving sponge bath for comfort of patient.
4. Check for corrections of medication and treatment prescribed by physician.

Chicken Pox vs. Small Pox

PhotoCredit: Ourmed.Org

In smallpox, lesions are commonly found on the palms and soles. In chickenpox, however, there are very few or no lesions on the palms and soles.

In smallpox, fever is present for 2 to 4 days before the rash begins, while with chickenpox, fever and rash develop at the same time.

All the pocks of the smallpox rash are in the same stage of development on any given part of the body and develop slowly. In chickenpox, the rash develops more rapidly, and vesicles, pustules, and scabs may be seen at the same time.

Small Pox

• Evolution: Centripetal distribution - eruption starts from the face and extremities towards the body
• Rashes: Pocks present on palms and soles
• Associated Symptoms: Malaise, fever, rigors, vomiting, headache and backache
• Incubation Period: 7 to 17 days after close contact with a smallpox patient
• Prodromal Period: Prolonged and severe; systematic manifestations are more pronounced
• Fever: High grade fever
• Scabs: Forms 10 to 14 days after appearance of rash and may be infectious; fall off 14 to 28 days after rashes appear
• Characteristics: Multilocular, areas of the body (areas of the pressure and tight skin), hard shotty discrete and deep lesions
• Vesicles: Do not collapse on puncture

Chicken Pox

• Evolution: Centrifugal distribution - eruption starts from the trunk and spread to exposed parts or away from the center
• Rashes: Pocks seldom present on palms and soles
• Associated Symptoms: None
• Incubation Period: 14 to 21 days after close contact with chicken pox patient
• Prodromal Period: Milder constitutional manifestations with less complications
• Fever: Low grade fever
• Scabs: Form 4 to 7 days after appearance of rash and may not be infectious; fall off within 14 days after rashes appear
• Characteristics: Unilocular, over the body (exposed parts of the body), skin superficial lesions
• Vesicles: Collapse on puncture

Article: Concept of Family

The family is the basic unit of society. Families exist in all sizes and configurations and are essential to the health and survival of the individual members and to society as a whole. As the primary group for the individual, the family serves as a buffer between the needs of the individual and the demands and expectations of society. The role of the family is to meet the needs of society (Taylor, et. Al., 1989).
The family is a unity of interacting persons related by ties of marriage, birth or adoption, whose central purpose is to create and maintain a common culture which promotes the physical, mental, emotional and social development of each of its members (Duval, 1971).
In today’s society, Friedman defines the family as composed of two or more people who are emotionally involved with each other and live in close geographical proximity.
The family provides a set of functions important to the needs of the individual members and to society as a whole. The family provides the individual with the necessary environment for development and interactions; it also provides new and socialized members for society.
4 Major Functions of a Family: (Friedman, 1981)

1. Physical Function – carried out by providing a safe, comfortable environment necessary to growth, development and rest/recuperation.
2. Economic Function – provide financial aid for members, as well as, meeting monetary needs of society.
3. Reproductive Function – it is met by the birth of children.
4. Socialization Function – this is of major importance and includes teaching; transmitting beliefs, values, attitudes and coping mechanisms; providing feedback and guiding problem – solving.

Family Structure
Family Stages and Tasks

STAGES	TASKS
Beginning Family	• establishing a mutually satisfying marriage • planning to have or not have children
Child – bearing Family	• having and adjusting to infant • supporting the needs of all three members • renegotiating marital relationship
Family with Pre – school Children	• adjusting to costs of family life • adapting to needs of pre-school children to simulate growth and development • coping with parental loss of energy and privacy
Family with Pre – school Children	• adjusting to the motivity of growing children • promoting joint decisions between children and parents • encouraging and supporting children’s educational achievements
Family with Teenagers and Young Adults	• maintaining open communication among members • supporting ethical and moral values within the family • balancing freedom with responsibility for teenagers • releasing young adults with appropriate ritual and assistance • strengthening marital relationship • maintaining supportive home base
Post – parental Family	• preparing for retirement • maintaining ties with older and younger generations
Aging Family	• adjusting to retirement • adjusting to loss of spouse • closing family house