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FAR EASTERN UNIVERSITY - DR. NICANOR REYES MEDICAL FOUNDATION

Medical JournalEditor-in-Chief

POLICARPIO B. JOVES JR., MD, MPH, MOH, FPAFP

Associate EditorMACARIO F. REANDELAR JR., MD, MSPH, FPAFP

FAR EASTERN UNIVERSITY - DR. NICANOR REYES MEDICAL FOUNDATION

BIOCHEMISTRY & NUTRITIONMari-Ann B. Bringas, MD, DPAAB

HUMAN STRUCTURAL BIOLOGYLeona Melodia T. Matheus, MD, FPCS,FPSGS

MICROBIOLOGY & PARASITOLOGYCerelyn E. Dacula, MD, MSc, DPPS

CLINICAL LAB./PATHOLOGYCheryl May C. Tan, MD, MPM, FPSP

CHILD HEALTHEva I. Bautista, MD, MSc, FPPS

COMMUNITY & FAMILY MEDICINEJenell O. Naldo, MD, MPH, FPAFP

OBSTETRICS & GYNECOLOGYLylah D. Reyes, MD, MSc, FPOGS

OPHTHALMOLOGYAngelico L. Alejo, MD, DPBO

RADIOLOGYMa. Theresa M. Bisquera, MD, FUSP, FPCR

SURGERYOmar O. Ocampo, MD, FPCS, FPSCRS, FPSGS, FPALES

ANESTHESIOLOGYKhristine I. Ramos, MD, FPSA

PHARMACOLOGYAbraham Daniel C. Cruz, MD, MSPH

PHYSIOLOGYRonald Allan G. Cruz, MD

OTORHINOLARYNGOLOGY-HEAD & NECKSURGERYCecile C. Cobangbang, MD, FPSOHNS

INTERNAL MEDICINEEleazar P. Daet, MD, FPCP, FPCC

SCHOOL OF RESPIRATORY THERAPYCesar Ayes M. Ong, MD, FPPS, FPAPP, MHPEd

SCHOOL OF NUTRITION & DIETETICSFelina P. Calimbo, RND, MPH

SCHOOL OF NURSINGBenilda V. Medallo, RN, MAN

GENERAL EDUCATIONRose Marie Mendoza, ChE, PhD

EDITORIAL CONSULTANTS

LINDA D. TAMESIS, MD, MS, MHADean, School of Medicine

REY H. DELOS REYES, MD, MHSA, FPOGSChief of Clinics

MAGDALENA F. NATIVIDAD, RMT, MSPH, PhDDean, School of Medical Technology

TITA Y. CRUZ, RN, MAN, EdDDean, School of Nursing

EDITHA C. DIZON, MD, FPARMDean, School of Physical Therapy

REY MELCHOR F. SANTOS, MD, MHA, FPCS, FACSChair, Research Development Office

PIO T. ESGUERRA, MD, FPCP, FPCCP, DIHDean, School of Respiratory Therapy

MARITES V. SINGH, RND, PhDDean, School of Nutrition & Dietetics

ROSALINDA C. SOLEVILLA, RPh, PhDDean, School of Pharmacy

MARCELINO E. MENDOZA, MD, FPCR, FUSPDean, School of Radiologic Technology

SCHOOL OF MEDICINE

SCHOOL OF RADIOLOGIC TECHNOLOGYNestor Q. Galvez, RRT, MPH

SCHOOL OF PHYSICAL THERAPYLeonilo F. Pallasigui, MRS, PT, PTRP, ACE-CPT

SCHOOL OF PHARMACYRobert Paul S. Lim, RPh

SCHOOL OF MEDICAL LABORATORY SCIENCESherwin N. Reyes, RMT, MSc, ISID

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FEU-NRMF Medical JournalVolume 23 Number 1 June, 2017

Contents

Assessment of FEU-NRMF Second Year and Third Year UndergraduateStudents Knowledge on HIV and Their Perception of Risks 1

Hans Kaiser Y. Herrera, ChessaDandoy, FatmaJamela D. Abdul, Al Rica G. Santos,Maelyn C.Villanueva, Jan Arwin D. Enriquez, Roena Joyce J.Barretto,Angelo Jesus P.Magno, Allein D. Taguibao and Magdalena F. Natividad, PhD

Antibiogram and Resistogram of Isolated Microbial Consortia 10Sharmaine G. Fajardo, Claudine D. Vallejos, Sharmaine Leigh J. Antiporda,Frinzes G. Castillo, Jasmin N. Cortez, Lanrick James S. Fabregas, Nicolas J.Ibay,Alfredo Miguel P. Perez IV, Renzo B.Salinas, Ricardo Jose P. Valdezand Sherwin N. Reyes

Zinc Deficiency and its Relationship with Control of Type 2 Diabetes Mellitus 15Mari-Ann B. Bringas, MD and Dolores V. Viliran, MD

Ethanolic Extract of Red Cabbage as pH Indicator in Minimum InhibitoryConcentration of Escherichia coli and Staphylococcus aureus 23

Mary Denneth R. Fuentes, Maria Benilda B. De Guzman, Sherwin N. Reyes,Stephanie Ann Bago, Joyce Anne Canicosa, Chrislen Freal, Gina Claire Galido;Raven Galvez, Monica Stephanie Moreno, Jerie Anne Aira Ruizand Nicole Ayana Singzon

Needs Assessment for Faculty Development Programs in FEU-NicanorReyes Medical Foundation Institute of Medicine 27

Magdalena F. Natividad, PhD

Far Eastern University - Dr. Nicanor Reyes Medical Foundation Medical Journal, Vol. 23, No. 1 - January - June 2017 1

Assessment of FEU-NRMF Second Year and Third YearUndergraduate Students Knowledge on HIV and Their

Perception of Risks

Hans Kaiser Y. Herrera, ChessaDandoy, FatmaJamela D. Abdul, Al Rica G. Santos,Maelyn C.Villanueva, Jan Arwin D. Enriquez, Roena Joyce J.Barretto, Angelo Jesus P.Magno,

Allein D. Taguibao and Magdalena F. Natividad, PhD

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) do not seem toconcern a lot of people especially the adolescents. The cases of HIV infection and AIDS continue to rapidlyrise in the Philippines. It is certain that this increase can be attributed to the population's lack of awarenesson HIV and AIDS. Thus, spreading awareness on HIV and AIDS is a critical part in solving this problem. Inline with this.Objective: the study aimed to assess the knowledge of 2nd year and 3rd year undergraduate students of FEU-NRMF about HIV and AIDS, and their perception on the risks of acquiring HIV infection and progression toAIDS.Methodology: The research is an analytical comparative research with a cross-sectional research design. Aquestionnaire with graded questions was used to gather data regarding the assessment of knowledge andperception of risks. The presence of a significant difference among the groups was determined using theKruskal-Wallis Test.Conclusion: It was concluded in the study that: 1) the groups of Medical Laboratory Science, PhysicalTherapy, Nursing, Radiologic Technology, Respiratory Therapy, Male, and Female have an intermediate levelof knowledge; 2) the groups of Pharmacy and Nutrition and Dietetics have a basic level of knowledge; 3) allgroups have an average degree of perception; 4) there is a significant difference among the mean knowledgeof each program group; 5) there is a significant difference among the mean perception of each program group;6) there is no significant difference between the mean knowledge of each sex group; and 7) there is nosignificant difference between the mean perception of each sex group.

Key words: human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), perception,awareness

Cases of Human Immunodeficiency Virus-infection and Aquired Immunodeficiency Syndromeincreased rapidly in the Philippines. According to the1Department of Health (DOH), there are already41,315 cases of HIV infection and 3,849 cases ofAIDS reported from January 1987 to February 2017.It was also reported that the number of new reportsof HIV cases per day rose up to 22 in the year 2015from just 1 case/day in 2008, 4 cases/dayin 2010, 9cases/day in 2012, and 17 cases/day in 2014.2 In theyear 2016, there were approximately 27 new casesof HIV infection reported per day.

ABSTRACT

To lessen the cases of HIV infection and ofAIDS,3 the medical field has produced drugs forantiretroviral therapy (ART) which are classifiedbased on their mechanism of action. However, themedical field has not been successful in completelyeradicating HIV.4 The factors that make the controland eradication of HIV are the nature of HIV itself,social factors, sexual practices, and limitedaccessibility of antiretroviral therapy and testingcenters for HIV.

In line with the goal of suppressing the growth ofHIV and AIDS cases, and in execution of one of its

Far Eastern University - Dr. Nicanor Reyes Medical Foundation Medical Journal, Vol. 23, No. 1 - January - June 20172

primary responsibilities which is to produce competentmedical professionals, the Far Eastern University-Dr.Nicanor Reyes Medical Foundation aimed to assessthe knowledge and perception of its students when itcomes to HIV and AIDS. The objectives of this studywere: 1) to determine the level of knowledge anddegree of perception of the population based on theirprogram and sex; and 2) to determine whether thereis a significant difference among the different groupsbased on their knowledge and perception.

METHODOLOGY

Research Design

The research is an analytical comparative studywith a cross-sectional research design. The generalprocess was to select samples from the studypopulation in order to establish the sample populationwhose members were grouped based on theirrespective program and sex. After which, a surveyquestionnaire was administered to collect data thatwere processed and analyzed.

23 Respiratory Therapy students, 50 Pharmacystudents, 50 Radiological Technology students, and 16Nutrition and Dietetics students). In addition, thesample population is composed of 123 and 218females.

Data Collection

The HIV-K-Q 45-item version served as basisof the survey questionnaire used to collect data. Thequestions of the constructed survey questionnaireasked either about facts on HIV/ AIDS or properpractices done to prevent or manage HIV infection.To further assess and establish the validity of theconstructed survey questionnaire, the researchersconsulted their research adviser, an expert in the fieldof HIV and AIDS, and conducted a pilot study inwhich random members of the study populationanswered the questionnaire while the researcherstook note of the issues of confusion and clarificationencountered.

Data Analysis

The grade of the respondents for each test wascomputed and classified based on the cut-off valuesset. The levels of knowledge were classified as Basic(<50%), Intermediate (50%-75%), or Advanced(>75%) and the degrees of perception of risks wereclassified as Risky (<50%), Average (50%-75%),or Precautious (>75%). For each group, the absoluteand relative numbers of those belonging to each levelof knowledge and each degree of perception wererecorded. The level of knowledge and degree ofperception on risks of each group as a whole werealso recorded.

The Kruskall-Wallis Test was used to comparethe different groups based on their respective meanknowledge grade and mean perception grade. It wasthe chosen statistical test because the different datagroups had unequal number of data, the dependentvariables were in the ratio scale, the groups wereindependent from each other, and the different datagroups had similar distributions as proven by theLevene's test.

Item analyses were done on each item bydetermining the percentage of a population that gotthe correct answer for each corresponding item. Thistest measures the prevalence of a fact or a practicein a given sample which bears implications regardingthe prevalence of the same throughout the population

Study Population

The study population consisted of 500 second yearand third year undergraduate students of A.Y. 2016-2017. The sample size was computed uponconsultation with a statistician regarding Dr. Careyand company's study on the HIV-K-Q, the surveyquestionnaire to be adopted

The sample population was composed of 341respondents (84 Medical Laboratory Science students,84 Physical Therapy students, 34 Nursing students,

Figure 1. Flow chart


being represented. In addition to this, related itemswere grouped into clusters which were subjected tocluster analyses. The cluster grades of each groupfor each cluster were computed by getting the averageof the group's item grades for the items included inthe cluster. The items in the Knowledge test wereclustered as follows: Cluster A - "Pathology andPathogenesis"; Cluster B - "Management, Prognosis,and Treatment"; Cluster C - "Signs and Symptoms,Diagnosis"; Cluster D - "Transmission, Safety,Disinfection, and Sterilization"; and Cluster E - "Socialand Legal Aspects". On the other hand, the items inthe Perception test are clustered as follows: ClusterA - "Sexual Transmission"; Cluster B - "PhysicalContact"; Cluster C - "Respiratory, Oral, Urine,Sweat"; Cluster D - "Surgery, Punctures,Transfusions"; Cluster E - "Medications, Diet"; ClusterF: "Vertical Transmission"; Cluster G - "VectorTransmission"; Cluster H - "Assessment"; and ClusterI - "Social and Legal Aspects".

RESULTS AND DISCUSSION

Grades of the Respondents in the KnowledgeTest and Perception Test

The grades of the respondents in the Knowledgetest and in the Perception test reflected theirknowledge about HIV and AIDS and their cautiousnessin preventing and managing HIV infection respectively.However, these grades alone could only evaluate therespondent and not the group to which the respondentbelonged. Respondents who had basic level ofknowledge or risky degree of perception or both did

not have enough knowledge or were misinformedregarding HIV/ AIDS and were at greater risk of beinginfected with HIV. Thus, they needed to undergoactivities that would expand their knowledge regardingHIV and AIDS and that would introduce thempractices that they can adopt in order to effectivelylessen the risk of having HIV infection and progressionto AIDS.

Distribution of Respondents Throughout theLevels of Knowledge and Degrees of Perception

The distribution of the members of each groupthroughout the scales of knowledge and perceptionprovides an overview of the population's knowledgeand perception.

Based on the distribution of the respondents ingeneral, most of the population still needed to improvetheir knowledge on HIV and AIDS and be more carefulin their practices to prevent HIV infection. Althoughmost of them had intermediate level of knowledge(55.72%) and average degree of perception (56.30%),a significant portion still had a basic level of knowledge(40.76%) and risky degree of perception (24.63%).In addition to this, only 3.52% of the population hadan advanced level of knowledge and only 19.35% hada precautious degree of perception.

Majority of the members of the MLS, PT, N, RT,and RdT groups were adequately informed regardingHIV and AIDS. However, their knowledge could stillbe improved. On the other hand, majority of the Phgroup and the ND group were insufficiently informedregarding HIV and AIDS. Thus, interventions werewarranted. (Figure 2)

Figure 2. Distribution of members of each program group throughout the levels of knowledge. In general, most ofthe sample population had an intermediate level of knowledge while a significant portion accounting for 41% hada basic level of knowledge and only 4% had an advanced level of knowledge. In addition, most of the members ofthe groups of MLS, PT, N, RT,and RdT had an Intermediate level of knnowledge while most members of the groupsPh and ND had a basic level of knowledge.


Majority of the Male and Female groups wereadequately informed regarding HIV and AIDS.However, a significant portion of each group was stillinsufficiently informed regarding the subject and thusrequired interventions as well. (Figure 3)

Most of the members of each program grouprecognized the risks of acquiring HIV infection andprogression to AIDS. The groups of MLS, N, and RdTwere notable for having a significant portion with aprecautious degree of perception. However, there werealso significant portions that do not sufficientlyrecognize the risks. Interventions would be critical inimproving their awareness on risks. (Figure 4)

Most of the members of the male and femalegroup recognized the risks. Although a significantportion had a precautious degree of perception, therewas also a significant portion with a risky degree of

perception. Still, interventions were indicated. (Figure5)

Notable limitations of using the distribution ofrespondents across the scales of knowledge andperception in approximating the level of knowledgeand degree of perception of a group's member werethat the distribution may change upon sampling whilemaintaining the mean and that the mean did not alwayslie within the level or degree with the highestdistribution.

Mean Knowledge and Mean Perception

In order to support the distribution of therespondents across the scales of knowledge andperception, the mean knowledge and mean perceptionof the groups were determined.

Figure 3. Distribution of the members of each sex group throughout the levels of knowledge. Most of themembers of the groups Male and Female had an intermediate level of knowledge although a significant portionaccounting for 38% and 42% in the Male group and Female group respectively still had a basic level of knowledge.

Figure 4. Distribution of the members of each program groups throughout the degrees of perception. In general,most of the members of the sample population had an average degree of perception while significant portionsaccounting for 24% and 19% had a risky and a precautious degree of perception respectively. In addition, most ofthe members of all program groups had an average degree of perception.


The mean knowledge and mean perception ofeach program group lay in the level of knowledgeand degree of perception where the group had thelargest portion. The program groups of MLS, PT, N,RT, and RdT had an intermediate mean level ofknowledge. The program groups of Ph and ND hada basic mean level of knowledge. All program groupshad an average mean degree of perception. (Figures2, 4 & 6)

The same could be said for the cases of the sexgroups Male and Female. Their respective meanknowledge and mean perception lay in the level ofknowledge and degree of perception where they hadthe most portion of their population. Both sex groupshad an intermediate mean level of knowledge and anaverage degree of perception. (Figures 3, 5 & 7)

The limitation of using the mean to approximatethe knowledge and perception was that they could notbe used to assess the knowledge and perception of astudent who was not a member of a group because themean knowledge and mean perception represented thegroups and not the program or the sex in general. Thislimitation was exhibited in the situation wherein onecould approximate the knowledge and perception of astudent who was a member of any group but not thoseof a student who was not a member of any group.

Kruskal Wallis (H) Test Results

It was determined that the knowledge of thepopulation regarding HIV and AIDS significantlydiffered across programs and so did the perception of

Figure 5. Distribution of the members of each sex group throughout the degrees of perception. Most of themembers of the Male and Female groups had an average degree of perception while significant portions had arisky and a precautious degree of perception.

Figure 6. Mean knowledge grade and mean perception grade of each program group. All program group had anaverage degree of perception and the groups of MLS, T, N, RT, and RdT had an intermediate level of knowledgewhile the groups of Ph and ND had a basic level of knowledge. The sample population had an intermediate level ofknowledge and an average degree of perception.


the population on the risks of acquiring HIV infectionand progression to AIDS. Such difference ofknowledge and perception across programs could havebeen caused by the differences among the programof the respondents, its inherent nature, and its uniquemethodologies.

The limitations of the Kruskal-Wallis test were thatit could not determine which groups significantly differedfrom which groups, that it could not determine thedirection and degree of the difference, and that it couldnot confirm or deny the relationships of knowledge andperception to the programs of the population.

Item Analysis

All items were subjected to item analysis to gaugethe prevalence of an idea or a practice in a group bydetermining the percentage of the group that answeredthe item correctly.

Each item in the knowledge test revolved on aspecific information regarding HIV and AIDS and eachitem in the perception test revolved on a safe or properpractice in preventing and managing HIV infectionand progression to AIDS. The item grade of a groupfor an item represented the extent to which theinformation or practice central to the item wasdisseminated throughout or observed by the group.Information or practices represented by items withlow item grades were not widely known to or werenot widely observed by a group. At the same time,these items indicated points of improvement to whichintervention should have focused on. Examples ofsuch case are the knowledge test items along withthe corresponding item grade of the whole sample

population 5 (10%), 39 (6%), 40 (4%), and 41 (8%).These items referred to the different agents used tokill HIV. By allotting focus in the topics of these items,the knowledge of the group was increased. Thelimitation of the item analysis was that it could not beused to evaluate an aspect HIV and AIDS. Anexample that demonstrates this limitation is the inabilityto determine whether or not a group is knowledgeableabout the ways on how to kill HIV by merely basingon the item grade of knowledge item 5 (10%) alone.Another limitation of the item analysis was that not allinformation and precautious practices could becondensed in a 90-item survey. Therefore, not all focuspoints could be presented by the item analysis.

Cluster Analysis

The grade of a group in one item does not reflectthe mastery of the group in one aspect of HIV andAIDS. To evaluate an aspect of HIV and AIDS, andto encompass all focus points, cluster analysis wasrun on each aspect.

The items of the knowledge test were clusteredinto five aspects. Cluster A pertained to the aspect ofpathology which included the etiology, pathogenesis,molecular changes, and functional defects that underliethe disease. Cluster B pertained to the management,treatment, and prognosis of the disease. It is concernedwith the course of the disease and on the ways onhow to control it. Cluster C pertained to the clinicalmanifestations of the disease as well as themethodologies of its diagnosis. Cluster D pertained tothe ways on how HIV is being transmitted, on thesafe practices to prevent HIV transmission, and

Figure 7. Mean knowledge grade and mean perception grade of each sex group. Both groups had an intermediatelevel of knowledge and an average degree of perception.


methods of disinfection and sterilization. Cluster Epertained to the social and legal aspects of HIV andAIDS. This cluster included topics regardingdiscrimination, voluntary testing, social stigma,addiction, and prostitution.

The items in the perception test were clusteredinto nine aspects. Cluster A focused on the sexualtransmission of HIV. Cluster B focused on physicalcontact as a mode of HIV transmission. Cluster Cfocused on the transmission of HIV by respiratorydroplets, aerosols, saliva, urine, and sweat. Cluster Dfocused on the technicalities of transmitting HIV byinvasive procedures such as surgery, transplants,transfusions, and punctures. Cluster E focused onthe effects of diet and medications to the acquisitionof HIV infection and progression to AIDS. Cluster Ffocused on the vertical transmission of HIV from themother to her child. Cluster G focused on the abilityof vectors to transmit HIV. Cluster H focused on theways on how to evaluate if one has HIV or not. Thiscluster was similar to Cluster C of the knowledge testonly that it revolved on the practicality of the test whilethe former pertained to the facts of the test. Cluster I,pertained to the social and legal aspects of HIVinfection and AIDS in a practical sense. The gradeof a group for a cluster measured the group'sknowledge or perception on the aspect of HIV andAIDS the cluster represented.

Interventions aimed at improving the knowledgeand perception of all groups should emphasize onclusters D and E of the knowledge test and on cluster

G of the perception test. Those designed for the PTgroup should also focus on clusters C, D, E, and H ofthe perception test. Those designed for RT groupshould also focus on clusters E and H of the perceptiontest. Those designed for the Ph group should also focuson cluster C of the perception test. Those designedfor the ND group should also focus on the cluster Bof the knowledge test and on clusters C, E, and H ofthe perception test. (Figures 8 & 9)

Interventions designed for the male and femalegroups should focus on clusters D and E of theknowledge test and on the cluster G of the perceptiontest. (Figures 10 & 11)

The knowledge or perception of the groups forthe other clusters not mentioned were Intermediateor average. These, along with those with advancedlevel or precautious degree, were areas whereawareness and safety were present.

The limitations of the cluster analysis were thatthe number of items in each cluster was not balancedand some clusters could be further separated whilesome could be combined. Nevertheless, it still managedto point out areas of strength and areas of weaknesswhen it comes to the knowledge and perception ofthe study population.

CONCLUSION

Based on the distribution of the respondents acrossthe scales of knowledge and perception, and on themean knowledge and mean perception of each group,

Figure 8. Cluster grades of each program group for the clusters of the knowledge test. The clusters are A(Pathology), B (Management, Prognosis, and Treatment), C (Diagnosis, Signs and Symptoms), D (Transmission,Safety, Disinfection, Sterilization), and E (Social and Legal Aspects). All program groups have an intermediate levelof knowledge on clusters A, B, and C with the exception of the ND group that has a basic level of knowledge oncluster B. All groups also have a basic level of knowledge on clusters D and E.


Figure 9. Cluster grades of each program group in the clusters of the perception test. The clusters are A (SexualTransmission), B (Physical Contact), C (Transmission via Respiratory and Oral droplets, Urine, and Sweat), D(Surgery, Punctures, and Transfusions), E (Medications and Diet), F (Vertical Transmission), G (Vectors), H(Assessment), and I (Social and Legal Aspect). All groups have a risky degree of perception on cluster G. The MLSgroup and N group have a precautious degree on clusters A, B, and F. The FPT group has a risky degree onclusters C, D, E, and H. The RT group has a precautious degree on clusters B and F but also a risky degree oncluster E. The Ph group has a precautious degree on cluster F but also a risky degree on cluster C. RdT has aprecautious degree on cluster B. The ND group has a risky degree on clusters C, E, and H.

Figure 10. Cluster grades of each sex group for the clusters of the knowledge test. The clusters are A(Pathology), B (Management, Prognosis, and Treatment), C (Diagnosis, Signs and Symptoms), D (Transmission,Safety, Disinfection, Sterilization), and E (Social and Legal Aspects). Both groups have an intermediate level ofknowledge on clusters A, B, and C and a basic level of knowledge on clusters D and E.

Figure 11. Cluster grades of each sex group in the clusters of the perception test. The clusters are A (SexualTransmission), B (Physical Contact), C (Transmission via Respiratory and Oral droplets, Urine, and Sweat), D(Surgery, Punctures, and Transfusions), E (Medications and Diet), F (Vertical Transmission), G (Vectors), H(Assessment), and I (Social and Legal Aspect). The Female group has a precautious degree while the Male grouphas an average degree of perception on cluster B. Both groups have an average degree of perception on clustersA, C, D, E, F, H, and I but have a risky degree on cluster G.


it was concluded that: 1) the Medical LaboratoryScience group, Physical Therapy group, Nursing group,Radiologic Technology Group, Respiratory Therapygroup, Male group, and Female group have anintermediate level of knowledge; 2) the Pharmacygroup and the Nutrition and Dietetics group have abasic level of knowledge; 3) all groups have anaverage degree of perception.

Based on the comparison of the groups in termsof their mean knowledge and mean perception, it wasconcluded that: 1) there is a significant differenceamong the mean knowledge of each program group;2) there is a significant difference among the meanperception of each program group; 3) there is nosignificant difference between the mean knowledgeof each sex group; and 4) there is no significantdifference between the mean perception of each sexgroup.

RECOMMENDATIONS

Based on the findings regarding: a) the knowledgegrades and perception grades of the respondents;b) the distribution of the respondents throughout thescales of knowledge and perception; and c) the meanknowledge and mean perception of the groups, it isrecommended to conduct interventions that: spreadawareness on HIV and AIDS throughout the studypopulation; and present proper and safe practices inpreventing HIV infection and AIDS progression. Theseinterventions may be in the form of a seminar, smallgroup discussion, a video presentation, a hands-onworkshop, etc.

Based on the findings regarding the comparisonof groups based on their knowledge on HIV and AIDSand their perception on the risks of acquiring HIVinfection and progression to AIDS, it is recommendedto: a) conduct a post-hoc analysis to determine whichamong the program groups are significantly differentfrom the others; b) conduct a comparative studyamong the program groups of the succeeding batchesin terms of knowledge and perception to determine ifthey will also exhibit similar results; and c) conduct astudy to determine whether or not a relationship

between the program of the members of the studypopulation on their knowledge on HIV and AIDS ortheir perception on the risks of acquiring HIV infectionand progression to AIDS exists.

Based on the results of the item analyses andcluster analyses, it is recommended to designinterventions that: are adjusted for each programgroups based on their respective item analyses andcluster analyses results; or are able to encompass allshortcomings of every program groups.

To improve the study, it is recommended to includeall aspects of HIV and AIDS in the surveyquestionnaire, and to balance the number of items forevery cluster in the knowledge and perception tests.

ACKNOWLEDGEMENTS

The researchers would like to express theirgratitude to Dean Magdalena Natividad, Ph.D. forsharing her knowledge, expertise and dedicatedassistance in the study as research adviser. Theresearchers would also like to acknowledgeDr.Macario Reandelar for sharing his expertise thatwas greatly utilized in the study. Finally, the primaryinvestigator expresses his undying gratitude to Mr.Lorenzo C. Herrera for his valuable support in thisstudy.

REFERENCES

1. Department of Health.Newly Diagnosed HIV Cases in thePhi l ippines .Avai lablefrom:ht tp: / /www.doh.gov.ph/stat_of_the_month [Accessed 23rd June 2016].

2. Gonzalez IC. Phil ippines at Risk of 'Full-Blown'HIVEpidemic.NewInternationalist.Weblog.Availablefrom:https://newint.rg/blog/majority/2016/02/05/philippines-hiv-epidemic/ [Accessed 23rd June 2016].

3. Morse G, et al. Antiretroviral drug levels and interactionsaffect lipid, lipoprotein and glucose metabolism in HIV-1seronegative subjects: A pharmacokinetic-pharmacodynamicanalysis. National Center for BiotechnologyInformation.2007; 5(2): 1631-73. Available from:https://www.ncbi .nlm.nih .gov/pmc/ar t ic les /PMC2078603/[Accessed 15th October 2016].

4. Centers for Disease Control and Prevention.HIV/AIDS.Available from: http://www.cdc.gov/hiv/basics/whatishiv.html[Accessed 27th September 2016].


Antibiogram and Resistogram of Isolated Microbial Consortia

Sharmaine G. Fajardo, Claudine D. Vallejos, Sharmaine Leigh J. Antiporda, Frinzes G. Castillo,Jasmin N. Cortez, Lanrick James S. Fabregas, Nicolas J.Ibay, Alfredo Miguel P. Perez IV,

Renzo B.Salinas, Ricardo Jose P. Valdez and Sherwin N. Reyes

Background: This study determines the prevalent microorganisms found on the hands of Medical Technologyintern of Far Eastern University - Dr. Nicanor Reyes Medical Foundation Medical Center and theircharacteristics as to antibiotic resistance and susceptibility.Methodology: The sample population consisted a total of 63 participants with 60 microbial isolates. A DataCollection Form was given to the participants for the researchers to collect information. The participantswere also given an Informed Consent Form to aim the confidentiality of the participants.Results: The results of the study revealed that the prevalent microorganism isolated on the hands of theMedical Technology intern was Klebsiellapneumoniae. There were also other gram negative and grampositive reported. Lastly, the microorganisms isolated showed no significant pattern of resistance.

Key words: antibiogram, resistogram, health care workers

Nosocomial infections have not been only limitedto infections acquired by a patient during admission ina health care facility, but they also encompassoccupational infections among staff.1 As MedicalTechnology interns, the authors are aware of thepresence of bacteria around then which can be eitherin the counters they work on or on the patients theyextract blood from. These factors can pose a threatnot only to patients but also to the health of MT internsand staff. Most of the bacteria right now areundergoing genetic changes that give them resistanceto antibiotics. Most of the studies made focusedgenerally on the health care workers and few havebeen done on Medical Technologists and on MedicalTechnology interns.

On the basis of this recommendation, health careworkers may act as vectors in the spread of resistant

ABSTRACT

bacteria.2 Previous studies proved that health careworkers hands carry resistant microorganisms suchas Methicillin-resistant Staphylococcus aureus(MRSA) and Extended Spectrum Beta-Lactamase(ESBL).3 However, previous studies encompassed thewhole system of health care workers, most of theparticipants came from the population of nurses anddoctors.4,5

The authors hypothesized that resistant strainssuch as Methicillin resistant Staphylococcus aureus,Extended Spectrum Beta-Lactamase and MetalloBeta Lactamase are present on the hands of MedicalTechnology interns. They designed this study toinvestigate the prevalent microorganism isolated fromthe phlebotomist 's hand and to determine thecharacteristic of the isolated organisms as to sensitivityand resistance.


METHODOLOGY

The study was approved by the FEU-NRMFInstitutional Ethics Review Committee. Sixty threeMedical Technology interns trained in phlebotomyprocedure at FEU-NRMF Medical Center were thesubjects of this study. The 63 participants were selectedby simple random sampling. Exclusion criteria were MTinterns with infectious disease such as cough and coldand MT interns assigned in the bacteriology section.The subjects were asked to participate and were giveninformed consent before hand swabs were collected.

The dominant hand of the participant was used asthe site of collection. After an intern has done aphlebotomy procedure, hand swabs were collected.The collected swab is then placed on thioglyocollate

broth and was stored and incubated at 37°C for 16-18hours and was also used for back up culture. Theswabs were plated to BD BBL™ Blood Agar Plateand BD BBL™ MacConkey Agar Plate foridentification of growth characteristics anddetermination of phenotypic characteristics of themicroorganism. Isolated colonies were first identifiedusing Gram stain. Gram-positive organisms wereidentified using Catalase, Coagulase, Mannitol SaltAgar, Novobiocin test, Bacitracin test, Optochin testand SXT test. Gram-negative organisms wereidentified using a 5 battery test that consists of TripleSugar Iron Agar, Lysine Iron Agar, Sulfur-Indole-Motility test, Citrate Utilization test and Urease test.Biochemical reactions of gram negative isolates aredepicted in Figures 1 to 5.

Figure 1. Biochemical reaction of Klebsiella pneumoniae.

TSI LIA SIM Citrate Urease

A/A + gas K/K -,-,- Positive Positive

Figure 2. Biochemical reaction of Escherichia coli.


A/A + gas K/K +gas -,+,+ Negative Negative

Figure 3. Biochemical reaction of Serratia marscecens.


K/A K/K +,-,- Negative Positive

Figure 4. Biochemical reaction of Shigella species.


K/A K/K -,-,+ Negative Positive

Biochemical Reaction of Gram Negative Isolate


Susceptibility and Resistance patterns werescreened after identification. Bacterial suspension wasmade using 0.9% Normal Saline Solution and bacterialisolates and had been adjusted to 0.5 McFarlandStandard Solution. The bacterial suspension was thenplated on BD BBL™ Mueller Hinton Agar Plate andwas incubated for at 37°C for 18 hours. Gram-positiveorganisms were screened for Methicillin Resistanceand Inducible Clindamycin Resistance using BBL™Sensi-Disc™ Oxacillin, Penicillin, Clindamycin,Erythromycin and Cefoxitin. AntimicrobialSusceptibility test for Gram-negative organisms werealso done and were screened for resistance patternssuch as Extended Spectrum Beta Lactamase,Imipinem Susceptibility and Metallo Beta LactamaseTest. The tests were done by the use of BBL™ Sensi-Disc™ Aztreonam, Ampicillin with Clauvalinic Acid,Cefepime, Ceftriaxone, Impinem and Cefoxitin

The data were computed using Microsoft ExcelVersion 2010. Data for the antibiogram andresistogram were computed using the formula forpercentage.

RESULTS

Sixty three medical technology interns from FEU-NRMF Medical Center were selected to be part ofthis study, 57.14% were from FEU-NRMF, 19.05%were from Dr. Carlos S. Lanting College and 23.81%were from Manila Center University.

Sixty out of 63 (95.23%) isolates were identifiedpositive with growth and 4.76% were reported to beno growth (n=3). Accordingly, there were 8 (12.70%)Staphylococcus aureus, 6 (9.52%) Stahpylococcusepidermidis, 3 (4.76%) Bacillus subtilis, 2 (3.17%)Streptococcus spp. Viridans group, 31 (49.21%)Klebsiella pnuemoniae, 4 (6.35%) Escherichia coliand Serratia marscecens, and only 1 (1.59%) Shigellaspp. and Salmonella spp. were isolated. (Table 1).

Susceptibility study was performed on both grampositive and gram negative isolates (Table 2). For grampositive organisms, there were total of eight (8)Staphylococcus aureus isolated, 25% of it weresusceptible to Clindamycin, 100% Cefoxitin, 25% toErythromycin and 0% to both Oxacillin and Penicillin.Among the six (6) Staphylococcus epidermidisisolated, 50% were susceptible to Clindamycin andErythromycin while none of it was susceptible toCefoxitin, Oxacillin and Penicillin. Of the two (2)Streptococcus viridans isolated, only one wassusceptible to Cefoxitin, while 0% of the isolate wassusceptible to Clindamycin, Erythromycin, Oxacillinand Penicillin.

For gram negative organisms, there were total ofthirty one (31) Klebsiella pneumoniae; 26% of itwere susceptible to Amoxicillin/ClavulanicAcid, 42%to Aztreonam, 48% to Cefepime, 39% to Cefotaxime,32% to Cefoxitin, and 90% were susceptible toImipenem. Four (4) Escherichia coli were isolated;0% susceptibility to Amoxicillin/ClavulanicAcid, 50%to Aztreonam and Cefepime, 25% to Cefotaxime, 75%

Figure 5. Biochemical reaction of Salmonella species.


K/A + H2S K/A -,-,+ Negative Negative

Table 1. Prevalent organisms isolated on the hands of themedical technology interns

Organism Frequency Percentage

Staphylococcus aureus 8 12.70%Staphylococcus epidermidis 6 9.52%Bacillus subtilis 3 4.76%Streptococcus spp.

Viridans group 2 3.17%Klebsiella pneumonia 31 49.21%Escherichia coli 4 6.35%Shigella spp. 1 1.59%Salmonella spp. 1 1.59%Serratia marscecens 4 6.35%No Growth 3 4.76%

TOTAL 63 100%


to Cefoxitin, while 100% of the isolates weresusceptible to Imipenem. There were total of four (4)isolate of Serratia marscecens, One (1) isolate ofboth Shigella spp. and Salmonella spp. All those have100% susceptibility to Imipenem and 0% susceptibilityto the rest of the antibiotics used for gram negativeorganisms.

Resistogram was also performed in both grampositive and gram-negative isolates (Table 3).For grampositive, there were total of eight (8) Staphylococcusaureus isolated. The isolates had 100% resistance toPenicillin and Oxacillin, 75% to Clindamycin, and 0%to Cefoxitin. All the six (6) Staphylococcus epidermidisisolated showed 100% resistance to Penicillin andOxacillin, 50% to both Clindamycin and Erythromycin,and 0% to Cefoxitin. All two (2) Streptococcus viridansisolates showed 100% resistance to Clindamycin, 50%to Cefoxitin, and 0% resistance to Erythromycin,Oxacillin and Penicillin.

For gram negative, there were total of thirty one(31) Klebsiella pneumoniae isolated. They showed74% resistance to Amoxicillin/Clavulanic Acid, 58%to Aztreonam, 52% to Cefepime, 61% to Cefotaxime,68% to Cefoxitin, and 10% to Imipenem. All four (4)Escherichia coli isolates had 100%, resistance toAmoxicillin/Clavulanic Acid, both 50% resistance to

Aztreonam and Cefepime, 75% to Cefotaxime, 25%to Cefoxitin and no resistance to Imipenem. For therest of the Isolate, there were total of four (4) Serratiamarscecens, one (1) Shigella spp. and Salmonellaspp. All of which had 0% resistance to Imipenem and100% resistance to Amoxicillin/Clavulanic Acid,Aztreonam, Cefepime, Cefotaxime and Cefoxitin.

DISCUSSION

In this study, Klebsiella pneumoniae, accountedfor 49.21% of the total isolates, and Staphylococcusaureus was the most commonly isolated bacteria fromphlebotomists' hands.

Klebsiella pneumoniae (49.21%),was isolatedfrom phlebotomists. No patterns of resistance werereported from the isolates of Klebsiella pneumoniae.The principal pathogenic reservoirs of Klebsiellapneumoniae are the gastrointestinal tract and thehands of hospital personnel.6 Lin, et al. showed thatthere is a high incidence of Kleblesiella pneumoniaeon health care workers hands.7

Stahphylococcus aureus which accounted12.70% of the total isolates precedes Klebsiellapneumoniae, no patterns of resistance was also


recorded for Staphylococcus aureus. S. aureus isregarded as an important pathogen responsible forHAIs.8 Singh, et al. showed that 47.5% of theirisolates are Staphlyococcus aureus. Among theisolates of S.aureus, 52.6% showed MRSA.

In summary, the results of this randomized trialsuggest that Medical Technology interns’ hands wereinhabited by Klebsiella pneumoniae and no patternsof resistance were seen on the isolatedmicroorganisms.

REFERENCES

1. World Health Organization. (2014). The Burden of HealthCare-Associated. 1-4.

2. Duckro A, Blom D, Lyle E, Weinstein R, Hayden M. Transferof Vancomycin Resistant Enterococci via Health Care WorkerHands.Arch Intern Med 2005; 165(3): 302-7. doi:10.1001/archinte.165.3.302.

3. Jeer M, Shruthi U, Krishna S, Swati S. Role of hand hygienein reducing transient flora on the hands of health care workers(HCW) at a tertiary health care centre in Ballari, India. Int JCurr Microbiol App Sci 2016; 5(6): 66-71.doi:http://dx.doi.org/10.20546/ijcmas.2016.506.008

4. Chaka TE, Misgana GM, Feye BW, Kassa RT. Bacterial

isolates from cell phones and hands of health care workers:A cross sectional study in pediatric wards at Black LionHospital, Addis Ababa, Ethiopia. J Bacteriol Parasitol 2016;7:288. doi:10.4172/2155-9597.1000288

5. Duckro A, Blom D, Lyle E, Weinstein R, Hayden M.Transfer of vancomycin resistant enterococci via health careworker hands. Arch Intern Med 2005; 165(3): 302-7.doi:10.1001/archinte.165.3.302.

6. Podschun R, Ullmann U. Klebsiella spp. as nosocomialpathogens: Epidemiology, taxonomy, typing methods, andpathogenicity factors. Clin Microbiol Rev 1998; 11(4): 589-603.

7. Lin MY, Lyles-Banks RD, Lolans K, Hines DW, Spear JB,Petrak R, Albright R. The importance of long-term acutecare hospitals in the regional epidemiology of Klebsiellapneumoniaecarbapenemase-producing Enterobacteriaceae.Clin Infect Dis cit500. 2013

8. Jenner EA, Fletcher BC, Watson P, Jones FA, Miller L,Scott GM. Discrepancy between self-reported and observedhand hygiene behaviour in healthcare professionals. J HospInfect 2006;63:418-22.

9. Singh S, Singh AK. Prevalence of bacteria contaminating thehands of healthcare workers during routine patient care: Ahospital-based study. J Acad Clin Microbiol 2016; 18: 60-2.


Zinc Deficiency and its Relationship withControl of Type 2 Diabetes Mellitus

Mari-Ann B. Bringas, MD and Dolores V. Viliran, MD

Background: Diabetes mellitus (DM) is a chronic disease considered as a global problem. Decreased zinc(Zn) levels, which affect the ability of the islet cell of the pancreas to produce and secrete insulin, mightcompound the problem associated with Type 2 diabetes mellitus (T2DM). Zinc promotes different biochemicalreactions in the body and is being investigated to aid in the improvement of management strategies forvarious diseases such as DM.Objectives: To determine the relationship between serum zinc levels and control of Type II DiabetesMellitus.Methods: Serum Zinc and glycosylated hemoglobin (HbA1c) levels were determined on blood samplesfrom 101 patients in Veterans Memorial Medical Center (VMMC) and FEU-Dr. Nicanor Reyes MedicalFoundation (FEU-NRMF). General information was acquired via interview and anthropometric assessmentwas also conducted. Zinc deficiency (ZD) was summarized using percentages or proportion. Serum zincand HbA1c levels were summarized using mean and standard deviation. Linear regression, T-test, ReceiverOperating Characteristic (ROC) curve and Chi-square were utilized to correlate serum zinc levels withHbA1c. Level of significance was set at α = 0.05.Results: The prevalence of zinc deficiency in the sample population was 5.9%. Linear Regression(F = 0.6853 > α = 0.05) showed negative correlation between HbA1c and Zn levels. T-test revealed nosignificant difference between Zn levels of controlled and uncontrolled DM (P-value = 0.645, > α = 0.05).ROC curve obtained cut -off of serum zinc levels 70 µg/dL or higher predicted good control of DM, althoughnot statistically significant (p > α = 0.05).Conclusion: Prevalence of ZD was low among T2DM patients. However, there was occurrence of moreuncontrolled DM than controlled DM among patients with ZD. Inverse relationship was observed betweenserum Zn levels and HbA1c levels. Normal to high Zinc levels >70 µg/dL predicted good control of Zinclevels. The trend, although not statistically significant is consistent with claims of previous studies on therelationship of zinc levels and DM control.

Key words: prevalence, zinc deficiency, Type 2 diabetes mellitus

Diabetes Mellitus is one of the leading causes ofdeath in the Philippines. The WHO estimates that theprevalence of diabetes in the Philippines will increase

ABSTRACT

* Department of Biochemistry and Nutrition

to more than 25% from the year 2000 to 2030. Arecent study by King, Aubert, and Herbert (1998),shows that the global prevalence of adult DM isestimated at 5.4%, with the number of afflicted adultscontinually increasing. In 2010, there were around 3.4million cases of DM which is about 7.7% of thePhilippine population. Associated with this diseaseare quite a number of co-morbidities that intensifyhealth care utilization and increase medical care


costs.2 Numerous studies have been aimed at findingalternatives to insulin injections and other drugs thatare used in the management of DM. A number ofstudies have shown the benefits of zinc, assupplementation for various clinical disorders.3,4

However, the protocol for DM management does notinclude zinc supplementation.

Zinc is important in carbohydrate metabolism asevidenced by impaired glucose tolerance in patientswith zinc deficiency (ZD). Zinc homeostasis isaffected by diabetes mellitus5, and as a mineral has arole in the synthesis, storage and secretion of insulin.6

This may imply that decreased zinc levels could impairthe ability of pancreatic cells to produce and secreteinsulin, amplifying the inability of type II DM patientsto metabolize carbohydrates.

It is still unclear whether DM affects zincmetabolism or whether derangements in zinchomeostasis affect carbohydrate metabolism.7,8 Thisstudy aimed to determine the relationship betweenserum zinc levels and control of Type 2 DiabetesMellitus. The results may accentuate the importanceof Zn in carbohydrate metabolism, particularly in itsinvolvement in the production, secretion, and actionof insulin. This may provide evidence in raising theneed for zinc supplementation as part of the standardtreatment guidelines for DM. The information obtainedin this study may serve as baseline information forfuture studies about the beneficial effects of Znsupplementation on DM.

General Characteristics of Zinc

Zinc (Zn) is a non-toxic essential trace elementthat is required for various biochemical functions withinliving organisms. Normally acquired from the diet,zinc levels in normal adults range from 2-3 g, 90% ofwhich are found in muscles and bones.9

Zinc plays a vital role in the normal functioning ofall organisms and any deviation from the required levelsof zinc in the body results in various malfunctions.Bone, liver, and plasma may provide access to aminiscule amount of zinc for homeostatic purposes.10

It is the loss of a critical but small amount of zincfrom this pool that leads to the biochemical and clinicalsigns of zinc deficiency.

Zinc deficiency is most commonly caused bymalnutrition, aging, disease, and deregulatedhomeostasis, and is more often seen in developingcountries. Wessells and Brown (2012) estimate that17.3% of the global population is at risk of inadequate

zinc intake. Those countries at greatest risk includethe Philippines. The major symptoms of zincdeficiency include growth retardation, immunedysfunctions, and cognitive impairment.11 However,these symptoms are not permanent and cansometimes be reversed with zinc supplementation.Zinc deficiency can also be secondary to otherdiseases and lifestyle choices.11,12

Shankar and Prasad (1998) have identified theinvolvement of zinc in the signal transduction,normal development, and function of several immunecells.

Laboratory tests for assessing zinc status areclassified into 2 groups: analysis of zinc in body tissuesor fluids and those testing zinc-dependent enzymefunction. The accepted reference range for serum zinclevel is 70-120 µg/dl (10.7-18.4 mmol/L), and the levelof 70 µg/dl (10.7 mmol/L) was used as cut- off valueas an indicator of zinc deficiency.

Diabetes Mellitus Type 2

Diabetes mellitus (DM) is a metabolic disorderwith different etiologies defined by the presence ofchronic hyperglycemia with disturbances ofcarbohydrate, fat or protein metabolism resulting fromdefects in insulin secretion, insulin activities or both.The majority of cases of diabetes mellitus fall intotype 1 and type 2 DM classifications.13 Type 2 DM, ametabolic disorder of the body, is caused by geneticand environmental factors.14 Individuals with type 2DM have increased globally and in the Philippines atan alarming rate.15

Treatment for DM is centered in lowering bloodglucose levels through lifestyle modification andpharmaceutical methods.16 HbA1c is the preferreddiagnostic tool due to its ability to reflect average bloodglucose within a span of two to three months.17 Thistest is often used to monitor patients who are takingmedication to address the disease.

HbA1c as a Diagnostic Indicator for DiabetesMellitus

Glycosylated Hemoglobin, (HbA1c), is useful inmeasuring glucose plasma concentration. Serumglucose non-enzymatically binds hemoglobin to createHbA1c.22 HbA1c levels are resistant to rapidfluctuations of glucose within the blood and aretherefore, closely tied to one's glucose intake overthe course of 6-8 weeks.23


Unique size and charge properties allow HbA1cto be measured by High Performance LiquidChromatography (HPLC).24

Healthy levels of HbA1c, according to theAmerican Diabetic Association, are between 20-40mmol/mol (4-5.9 DCCT%). There is a correlated 3%increase of diabetic complications for every 1 mmol/mol of HbA1c over 53 mmol/mol.25 The recommendedsafe level of HbA1c by the ADA is <53 mmol/mol(7.0 DCCT%).26 HbA1c monitoring can give a clearhistory of glucose intake over the previous 6-8 weeksin diabetic patients.

Clinical Relationship of Zinc Serum Levels toPatients with Diabetes Mellitus Type II

Several studies on the effects of zinc deficiencyto type 2 DM have noted that the loss of zinc, possiblylinked to increased excretion by the kidneys, couldcontribute to the development of diabetic complicationsin later years.18 Prevalence studies indicated thatabout 33% of a sample population had significantlylower Zn than those of the healthy controls involvedin the study.19

Decreased plasma Zn has negative effects onproduction and secretion of insulin by the islet cells.20

Zinc plays a key role in the synthesis, secretion andaction of insulin in physiological and patho-physiological states.

Studies found decreased Zn and insulin levels withcorresponding glucose intolerance among Zn deficientrats. Zinc supplementation ameliorates Type 2 DMcomplications. It can therefore be concluded that Zinchas an important function in maintaining pancreaticislet cell function and possibly the prevention ofdiabetes.

In the light of limited clinical studies, this paperaimed to elucidate a deeper understanding of therelationship of zinc levels and control of Type 2Diabetes Mellitus.

This study generally aimed to determine therelationship between serum zinc levels and control ofType 2 Diabetes Mellitus.

METHODOLOGY

Research Design and Setting

This study is an analytic, cross-sectional researchstudy which involved the collection of serum zinc andglycosylated hemoglobin (HbA1c) levels among a

population of type II DM patients in FEU-NRMF andVMMC from November 2013 to February 2014.

Study Population

The number of subjects, (101) was calculatedbased on the assumption that the prevalence of ZD is30% with a precision of 10% and a 95% reliability.Twenty-five percent was also added to account fornon-respondents.

Only ambulatory patients from the Out-patientDepartments of FEU-NRMF and VMMC whoconsented to take part in the study were included assubjects.

The inclusion-exclusion criteria for this study wereas follows:

Inclusion criteria:• Male or female;• 30-65 years old;• Duration of type 2 diabetes mellitus of at least

3-8 years;• With or without insulin treatment or oral

medications.

Exclusion criteria:• Pregnant and lactating women;• Individuals with clinical signs of renal failure;• Individuals who have undergone recent surgery;• Individuals with acute infection;• Individuals with hypoalbuminemia;• Individuals with diarrhea; and• Individuals with malabsorption.

Outcome Measures

Serum Zinc levelsDeficient Less than 70 µg/dLNormal 70 µg/dL or higher

HbA1c levels Controlled DM Less than 7.0% Uncontrolled DM 7.0% or higher

Data Collection Procedure

This study was approved by the FEU-NRMFInstitutional Ethics Review Committee.

Subject recruitment: Notices of invitation were putup a week before the scheduled blood extraction dates


for FEU-NRMF and VMMC. During scheduled bloodextractions, two simultaneous recruitments of subjectswere implemented in both sampling locations.

Informed consent: Proper informed consent andpatient information and orientation was performedon all subjects.

General information: Information of the patientswere obtained using an interview questionnaire withinformation on age, family history of disease, diabeticduration, drug usage, diabetic complications and wasrecorded by a trained research assistant.

Anthropometric assessment: Height and weightwere measured from each subject. BMI (body massindex) was calculated with measured height andweight. Body mass index (BMI) was calculated basedon the Quetlet's Index kg/m2.

Biochemical assessment: Overnight fasting bloodsamples were collected into serum tubes and werestored at -70ºC HbA1c levels were measured as theindicators of glycemic regulation at SIM ClinicalLaboratory. Plasma level of zinc was assessed byFlame Atomic Absorption Spectrometry at DOST-FNRI.

Analysis of Data

Qualitative variables like zinc deficiency wassummarized using percentages and proportion.Quantitative variables were summarized using meanand standard deviation. Correlation between serumzinc level and HbA1c was analyzed using linearregression and coefficient of determination was alsocalculated. Comparison of serum zinc levels amongthe controlled and uncontrolled DM was made usingan independent T-test. Levine's test was also utilizedto determine equality of variances. Level ofsignificance was set at α = 0.05.

A Receiver Operating Characteristic (ROC) curvewas done to determine the cut-off value of zinc thatwill predict good control of DM. Chi-square test wasthereafter utilized to determine the association ofcontrol of DM and zinc level based on the cut-offvalue as determined by the ROC curve.

In data encoding, Microsoft Excel® was used toorganize the raw data which were subsequently usedin the data analysis utilizing the software SPSS 17.0.

RESULTS

Descriptive Data

The mean age of subjects was 57 (range: 30-65).Mean Body Mass Index of 26 is categorized asoverweight based on WHO (2006). Blood pressuremean of 135/86 mm/Hg was classified as pre-hypertensive based on AHA (2012).

Twenty percent of the sample population weresmokers and 39.6% were alcoholic drinkers althoughoccasionally, as per mean of 1 bottle per day. Mostsubjects have sedentary physical activity and only 10% of the sample population engaged in heavy physicalactivity.

Familial history of DM, heart disease andhypertension were reported to be high compared withcancer.

The average zinc level of 107.02, SD=26.64obtained fall under the normal range according to thestandard set by DOST-FNRI; while HbA1c mean of7.64, SD=2.06 was classified under uncontrolled DMbased on the American Diabetes AssociationStandards of Medical Care in Diabetes (2010).

A little less than three-fourths (72.28%) of thetotal sample size have been taking multivitamins withzinc while less than one-third (27.72%) are takingpurely oral hypoglycemics which do not contain zinc.

Table 2. Zinc levels for controlled and uncontrolled DM

HbA1C levels Zinc level Mean ± SD

≥ 7.0% 105.73 ± 24.7947.0 and below 108.19 ± 28.395

p value = .645

Table 1. Anthropometric data

Anthropometric Data Mean ± SD

Age 57.4 ± 7.09Height in meters 1.6 ± 0.08Weight in kilograms 67.7 ± 11.60BMI 26.3 ± 4.03

Blood Pressure Systolic 135.39 ± 15.939 Diastolic 86.24 ± 9.149


The average zinc level of the subjects withcontrolled DM was 108.19 µg/dL, and 105.73 µg/dLin subjects with uncontrolled DM. The t-test (p-.645)on both zinc levels, however, is not statisticallysignificant.

A negative slope (-0.0064) was observed in Figure1, showing that as serum zinc levels increased, therewas a lowering trend in the levels of HbA1c, althoughnot statistically significant. The r2 or coefficient ofdetermination obtained was 0.0069 which indicatedthat only 0.69% of the variance in HbA1c levels canbe explained by Zn levels.

DISCUSSION

The mean age of the subjects (57) fell under therange of age considered as risk factor for DM. Inmost populations, Diabetes Mellitus (DM) incidenceis low before 30 years of age, and increases rapidlywith older age. The mean BMI (26 kg/m2) obtainedwhich was classified under overweight is a knownrisk factor for cardiovascular disease (CVD) and type-2 DM.

Table 3. Relationship of zinc deficiency (ZD) andcontrol of DM

Uncontrolled Controlled Total↑HbA1c ↓HbA1c N (%)N(%) N(%)

ZD 4 (66.7) 2 (33.3) 6 (100)Non-ZD 44 (46.3) 51(53.7) 95 (100)Total 48 (47.5) 53 (52.5) 101(100)

P-value = 0.333 ; > α = 0.05

Prevalence and Correlation Study

The prevalence proportion in the sample populationimplies that 5.9% of Type 2 DM patients had Zndeficiency. Among those with uncontrolled DM, 66.7%of patients had Zn deficiency while 46.3% of patientswere not Zn deficient.

In the cross-tabulation and chi-square tests, when70 µg/dl was used as cut-off value for Zn, 53.7% ofthe subjects with normal serum zinc levels were foundto have controlled DM. On the other hand, 66.7% ofthe subjects with zinc deficiency exemplifieduncontrolled DM. This relationship, however was notstatistically significant, X2 (1, N = 101) = 0.333,p > .05.

The Prevalence Difference (PD) was computed as: PD = 66.7 - 46.3 = 20.4%

This implies that there were 20 more uncontrolledDM cases for every 100 patients with zinc deficiencythan for every 100 non-zinc deficient patients.

Risk estimate shows that Zn deficient patientswere 1.44 (95% CI= .785-2.638) times more likely tohave uncontrolled DM than non-Zn deficient patients.

More than half of the subjects who tookmultivitamins with zinc had controlled DM. Those whotook medications that were non-zinc-containing hadmore chances of uncontrolled DM. However, thisobservation was found to be not statistically significant,X2 (1, N = 101) = .549, p > .05.

Table 4. Relationship of multivitamin mineral (MVM) intakewith zinc and HbA1c levels

MVM ↑ HbA1c ↓HbA1c+ ZINC ≥ 7.0% < 7.0%

N (%) N (%)

NO 16 (57.1) 12 (42.9)YES 32 (43.8) 41 (56.2)

P value = .549 > α = 0.05

Figure 1. Linear regression-correlation of serum zinclevel with HBA1c level

F = 0.6853 > α = 0.05


The average blood pressure reading of the samplepopulation (135/86 mmHg) met the goal BP <140/90,for diabetic patients according to JNC 8. However,based on JNC 7, this mean BP can be classified underthe pre-hypertensive stage. Hypertension is twice ascommon among diabetics. Acemoglu, et al. found thathypertension increased the risk of diabetes andrecorded a 2.05-fold risk increase. According toMullican, et al. (2009), pre-hypertension is presentlyrecognized as a risk factor for cardiovascular disease.Subsequently, a blood pressure of 130-139/85-89mmHg was found to be associated with the incidenceof diabetes, and may be a more meaningful categoryfor diabetes risk assessment.

Most of the subjects were engaged in moderateto sedentary physical activity, placing them at higherrisk for having poor control of DM. Balducci, et al.(2009) stated that cardio-respiratory fitness is inverselyrelated to the development of type 2 diabetes,cardiovascular morbidity and mortality. Combinedaerobic and resistance training was recently shownto be more effective than either one alone inameliorating HbA1c. In a study done by Sreedharan,physical activity is a protective factor for thedevelopment of DM. Gill and Cooper also supportthe fact that physical activity has a protective role inthe development of DM.

According to Umamahesh, et al. (2014), lifestylefactors such smoking and heavy alcohol consumptionhave also been significantly associated with CVD.These factors were also found to be present in thesubjects.

IDF defines metabolic syndrome as cluster of themost dangerous heart attack risk factors: diabetes andpre-diabetes, abdominal obesity, high cholesterol andhigh blood pressure. People with metabolic syndromeare twice as likely to die from, and three times aslikely to have a heart attack or stroke compared withpeople without the syndrome. People with metabolicsyndrome have a five-fold greater risk of developingType 2 DM. This is concurrent with current findingsthat almost two-thirds (combined 61.4%) of thesubjects had family history of DM, the majority ofwhich were maternal (35.6%). Familial hypertensionwas also reported in three-fourths (75.3%) of thesubjects, while family history of heart disease waspresent in one-third (33.7%) of the sample population.

Out of 101 subjects, only 6 were zinc deficient.This may be explained by various confoundingvariables that may have affected the serum zinclevels such as present intake of multivitamins and

dietary choices. Based on the medication history ofsubjects, most of the patients were already takingzinc-containing multivitamins and minerals. This mayhave already addressed Zn deficiency among thesubjects, thus decreasing the prevalence proportionobtained. Furthermore, although no quantitative orqualitative analysis was done to assess diet, sincethe subjects were diagnosed with DM for more thanthree years, as per inclusion criteria, it could beassumed that they were observing a high proteindiabetic diet instead of a high carbohydrate diet.According to International Zinc Association, themajor sources of zinc are meat, poultry, fish andseafood, whole cereals and dairy products. Zinc ismost available to the body from meat. Hence, if thesubjects were taking a significant amount of thesefoods, they could already be supplied with zinc whichcould subsequently address zinc deficiency leadingalso to a smaller prevalence proportion. Thesefactors may explain why a greater number ofsubjects with control led DM were observedcompared to those with uncontrolled DM. Resultsfrom studies such as that by Jayawardena (2012)using zinc supplementation alone show similarfindings. A study that supplemented with Zinc +MVM (Multi Vitamin Mineral) and MVM withoutZinc reported that only diabetic patients receivingZinc + MVM showed beneficial metabolic effects.These findings were also supported by the cross-tabulation shown in Table 4, where the subjects'intake of zinc-containing oral medications reflecteda t rend of control led DM. Those who tookmedications that did not contain zinc revealed higherproportion of uncontrolled DM. This is, likewise,consistent with the claim in another study byAfkhami-Ardekani, et al. (2008), wherein there wasa significant decrease in the HbA1c values ofsubjec ts af ter 12 weeks of z inc sul fa teadministration.

The prevalence difference and prevalence ratio,on the other hand, imply that uncontrolled DM casesare more attributable to Zn deficiency than to non-Zndeficiency; and that those with Zn deficiency have ahigher probability of having uncontrolled DM. Thesewere consistent with a study conducted by Taha andElabid (2013) stating that poor glycemic control isrelated to zinc deficiency. According to a studyconducted by Shekokar, the decreased serum zinclevel in diabetic patients may be attributed to poorreabsorption of zinc and also due to excessiveexcretion of zinc (zincuria) in diabetic patients.


Results from linear regression (Figure 1), t-test,and cross-tabulation were consistent with one another,as well. The results imply that subjects with higherlevels of zinc showed lower levels of HbA1c. AlthoughZn and HbA1c were said to be poorly related asdepicted by a low coefficient of determination, thenegative correlation obtained in the linear regressionwas consistent with the study conducted by Al Maroofthat zinc supplementation for type-2 diabetics hadbeneficial effects not only in elevating serum zinc level,but also in improving their glycemic control, asexemplified by the decreasing HbA1c concentration.Other studies were found to have similar claims, suchas in an investigation done by Saharia et al. whichstated that the mean HbA1C concentration in newlydiagnosed type 2 DM cases had an inverse relationshipwith serum zinc concentration; and in another studyby Rai, et al . which showed that serum zincconcentrations were lower in diabetics as comparedto controls. In this latter study, a negative correlationbetween Zn levels and glycated proteins in blood wasalso observed. The findings obtained via t-test andcross-tabulation were, however, not statisticallysignificant. These may be attributed to the relativelysmall sample size and the effects of confounders suchas diet and multivitamin supplementation that may havecaused variations in the observations.

Based on the Receiver Operating Characterization(ROC) curve, zinc levels below 70 µg/dL predicteduncontrolled DM, while a cut-off zinc value equal toor greater than 70ug/dL predicted controlled DM.Though not statistically significant, this is very muchconsistent with the findings in numerous studies thatzinc supplementation causes significant reduction inHbA1c among patients with type 2 DM.

CONCLUSION

Although the prevalence of Zn deficiency withinthe population of type II diabetic patients is low, thereare more patients with poor DM control than goodDM control among patients with Zn deficiency. Thisis supported by the inverse relationship observedbetween serum Zn levels and HbA1c. Having zinclevel of around 70 µg/dL or higher predicts good controlof DM.

Though the results of the study did not show astatistically significant relationship between zinc levelsand HbA1c, it is consistent with preceding studies andprovides sensible basis that zinc plays a valuable rolein the good control of DM .

RECOMMENDATIONS

The following are suggested for the improvementof the study:

• Sample size may be increased to acquire theappropriate number of subjects which is morerepresentative of the general population and toobtain more statistically significant findings;

• Patients taking zinc supplements should be one ofthe exclusion criteria to acquire more accurateresults on Zn levels since Zn supplementationalready addresses Zn deficiency;

• The diet of the patients should be strictly accountedfor or should be controlled if possible because dietis a significant source of zinc aside from Znsupplementation; and

• Newly diagnosed DM patients could be recruitedas subjects to minimize confounders brought aboutby interventions for the management of thisdisease.

Future studies are also highly encouraged such asexploring the effects of zinc supplementation on HbA1clevels of those determined to have Zn deficiency anduncontrolled DM. A cohort study involving followthrough on patients with Zn deficiency can alsoprovide better evidences in the development of DMin relation to Zn.

ACKNOWLEDGEMENT

This research project was monitored and supportedby Metro Manila Health Research and DevelopmentConsortium (MMHRDC) and was funded by DOST-Philippine Health Research and Development(PCHRD).

Sincerest gratitude and appreciation is extendedto Dr. Bernardo G. Bringas Jr, Dr. Balthazar Villaraza,Dr. Gerald Dale Giron of VMMC for helping facilitatethe subject recruitment and data gathering process.

Special recognition to FEU-NRMF First YearMedicine Section B AY 2013-2014 for their unselfishassistance in the implementation of this researchproject.

Sincere appreciation is extended to Ms. MaggieFlores, department secretary and statistics consultant-Dr. Macario F. Reandelar Jr. for sharing their expertisein the completion of this paper.


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1. King H, Aubert RE, Herman WH. Global burden of diabetes,1995-2025: prevalence, numerical estimates, and projections.Diabetes Care 1998; 21, 1414-31.

2. Struijs JN, Baan, Caroline A, Schellevis FG, Westert GP andvan den Bos GA. Comorbidity in patients with diabetesmellitus: impact on medical health care utilization. BMCHealth Services Research 2006; 6: 84

3. Brown KH, Peerson JM, Allen LH. Effect of zincsupplementation on children's growth: a meta-analysis ofintervention trials. In: Role of trace elements for healthpromotion and disease prevention. Sandstrom B, Walter P,eds. Bibliotheca Nutritio et Dieta 1998; 54: 76-83.

4. Zinc Investigators' Collaborative Group. Therapeutic effectsof zinc in acute and persistent diarrhea in children indeveloping countries: pooled meta-analysis of randomizedcontrolled trials. Am J Clin Nutr 2000; 72: 1516-22.

5. Prasad AS. Discovery of human zinc deficiency and studiesin an experimental human model. Am J Clin Nutr 1991; 53:403-12.

6. Prasad AS. Zinc deficiency has been known of for 40 yearsbut ignored by global health organizations. BMJ 2003; 326:409-10.

7. Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr1998; 17: 109-15.

8. Prasad AS. Zinc in human health: an update. J Trace ElemExp Med 1998; 11: 63-87.

9. Plum LM, Rink L, Haase H. The essential toxin: Impact ofzinc on human health. Int J Environ Res Public Health2010; 7: 1342-65. doi:10.3390/ijerph7041342

10. Geidroc DP, Chen X, Apuy JL. Metal response element(MRE)-binding transcription factor-1 (MTF-1): Structure,function, and regulation. US Nat Lib Med 2001; 3(4): 577-96.

11. Nguyen VQ, et al. Prevalence and correlates of zinc deficiencyin pregnant Vietnamese women in Ho Chi Minh City. AsiaPacific J Clin Nutr 2013; 22 (4): 614-9.

12. McPherson RA, Pincus MR. Henry's Clinical Diagnosis andManagement by Laboratory Methods (21sted.). Singapore:Saunders Elsevier 2009.

13. Prasad AS, et al. Antioxidant effect of Zinc in Humans. FreeRadical Biology & Medicine 2004; 37 (8): 1182-90, ElsevierInc.

14. Whitten KW, Davis RE, Peck ML, Stanley GG. Chemistry(8thed.). Belmont, CA: Thomson Brooks/Cole. 2007

15. Guerrero-Romero F, Rodriguez-Moran M. Complementarytherapies for diabetes: the case of chromium, magnesiumand antioxidants . Arch Med Res 2005; 36: 250-7.

16. Hu FB. Globalization of diabetes: Role of diet, lifestyle andgenes. Am Diab Assoc Diab Care J 2011; 34(6): 1249-57.

17. Whitten KW, Davis RE, Peck ML, Stanley GG. Chemistry(8thed.). Belmont, CA: Thomson Brooks/Cole. 2007.

18. Abbas AK, Aster JC, Fausto N, Kumar V. Robbins andCotran Pathologic Basis of Disease (8th ed.). Singapore:Saunders Elsevier 2010.

19. Jiang X, Ma H, Wang Y, Yan l. Early life factors and type 2diabetes mellitus. J Diab Res 2013; Article ID 48582, 11pages. Doi: 10.1155/22013/485082

20. Jimeno CA, Sobrepeña LM, Mirasol RC. DiabCare2008:Survey on glycaemic control and the status of diabetes careand complications among patients with type 2 diabetesmellitus in the Philippines. Phil J Int Med 2012; 50(1).

21. Jayawardena R, Ranasinghe P, Galappatthy P, MalkanthiRLDK, Constantine GR, Katulanda P. Effects of zincsupplementation on diabetes mellitus: a systematic reviewand meta-analysis. Diabetol Metabol Syndr J 2012; 4: 13.

22. Loghmani E. Diabetes mellitus: Type 1 and type 2. Guidelinesfor Adolescent Nutrition Services; Chapter 2005; 14: 167-82.

23. Afkhami-Ardekani M, Karimi M, Mohammadi SM, NouraniF. Effects of zinc sulfate supplementation on lipid andglucose in type 2 diabetic patients. Pakistan J Nutr 2008; 7(4): 550-3.

24. Haase H, Overbeck S, Rink L. Zinc supplementation for thetreatment or prevention of disease: Current status and futureperspective. Science Direct Experimental Geontology 2008;43: 394-408.

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31. Shubrook Jr JH. Risks and benefits of attaining HbA(1c)goals: Examining the evidence. J Am Osteopathic Assoc 2010;110.


Ethanolic Extract of Red Cabbage as pH Indicator inMinimum Inhibitory Concentration of

Escherichia coli and Staphylococcus aureus

Mary Denneth R. Fuentes, Maria Benilda B. De Guzman, Sherwin N. Reyes, Stephanie Ann Bago,Joyce Anne Canicosa, Chrislen Freal, Gina Claire Galido; Raven Galvez,

Monica Stephanie Moreno, Jerie Anne Aira Ruiz and Nicole Ayana Singzon

Red cabbage (Brassica oleracea) contains a class of compounds known as anthocyanin, which isresponsible for its color (violet or red-purple). The anthocyanin pigment is water-soluble and non-toxicthat displays a variety of colors depending on the pH of a substance. The anthocyanin in a very acidicenvironment, urns pink to red, and in a basic environment, turns green to blue.Methodology: Two-fold serial dilution of antibiotics (Ampicillin for Staphylococcus aureus and Gentamicinfor Escherichia coli) was performed in eight sterile tubes, then 9.5 mL of Brain Heart Infusion Broth (BHIB,Pronadisa) and 10 µL of the standard inoculum were added. The ninth tube served as the negative controlwhich contained only the Brain Heart Infusion Broth while the tenth tube was the positive control whichcontained the broth and 10uL of standard inoculum. After incubation, 1 mL of red cabbage ethanolic extractwas added to all tubes and the change in color was observed. The pH of the bacterial broth was confirmedusing litmus paper. The procedure was done in duplicate.Results: The results of the study showed that the ethanolic extract of red cabbage containing anthocyaninis an effective pH indicator. The color turned to pink in acidic medium and green in basic medium. It canalso be used as a macroscopic pH indicator for Minimum Inhibitory Concentration (MIC).Conclusion: Thus, it can be an alternative confirmatory procedure for MIC.

Key words: red cabbage, pH indicator, Minimum Inhibitory Concentration, Anthocyanin

Anthocyanin is a pigment that changes color indifferent pH concentrations,1,2,3 which can be usedas a pH indicator. It turns pink to red at a very lowpH, while at a high pH, it turns green to blue.4,5 Theanthocyanin pigment is widely used as alternative tosynthetic colorants6 that can be found from redcabbage (Brassica oleracea) and other plants likebeets, blueberries, radishes.7 Red cabbage contains25 mg of anthocyanin per 100 gram of fresh weight.Anthocyanin pigment from the extracts of these plantsis responsible in producing colors of many fruits,vegetables, cereal grains and fowers.8 Furthermore,it is a member of a class of water soluble, terrestrial

ABSTRACT

plant pigments that is classified as phenolic compoundscollectively named as flavonoids.9

Microorganisms are tested for their ability toproduce visible growth in tubes with broth-based mediathrough serial dilutions of an antimicrobial agent.Presence of turbidity in the culture media indicatesgrowth of microorganisms. Minimum InhibitoryConcentration (MIC) is the lowest antibioticconcentration that prevents visible growth of bacteriaafter overnight incubation.10

The aim of this research was to determine whetherthe ethanolic extract of red cabbage which containsanthocyanin could be used as pH indicator in MIC


using Staphylococcus aureus (S. aureus) andEscherichia coli (E.coli).

METHODOLOGY

Commercially available red cabbage was sent tothe Botany Department of National Museum forauthentication. The ethanolic extraction of red cabbageusing rotary evaporation technique was performed atthe Centro Escolar University-Manila. MinimumInhibitory Concentration was performed using brothdilution at the Far Eastern University-Nicanor ReyesMedical Foundation. The pH determination of MICwas done using the ethanolic extract of red cabbage.

Research Design

This study utilized the experimental method ofresearch to determine the ability of red cabbageethanolic extract to change its color as a pH indicatorin minimum inhibitory concentration (MIC) of S aureusand E coli.

Data Collection

Ethanolic Extraction of Red Cabbage(Brassica oleracea)

First, a whole red cabbage was submerged in aliter of ethyl alcohol for 12 hours. Then, it was placedin a blender for homogenization process. Thehomogenized red cabbage was filtered using a cheesecloth and a filter paper. Finally, the produced filtratewas subjected for rotary evaporation for 2-3 hours.

Minimum Inhibitory Concentration (MIC)

Decreasing antimicrobial solution concentrations(mcg/ml) were obtained through a series of dilutions.MIC is traditionally determined by performing two-fold serial dilutions (CLSI, 2012).11

Preparation of Inoculum

The FEU-NRMF Institute of Medicine,Microbiology Laboratory provided the bacteria (S.aureus and E. coli). These colonies were standardizedusing distilled water. It was then compared to 0.5McFarland standard for visual comparisons. Thestandardized inoculum was placed in BHIB (broth

medium) containing the antibiotic and were incubatedovernight (16-20 hours). The MIC was then recorded.

Red Cabbage Ethanolic Extract as pH Indicator

One (1) ml of the red cabbage ethanolic extractwas added onto the 10 (ten) incubated tubes containingthe antibiotic working solutions, standardized inoculum,and the broth. A change in color of the red cabbageethanolic extract (e.g turns pink when acidic)corresponding to color of the positive control (tube#10) indicates pH change that corresponds to bacterialgrowth. Meanwhile, a change in color of the redcabbage ethanolic extract corresponding to the colorof the negative control (tube #9) indicates pH changethat implies inhibition of bacterial growth. Litmus paperwas used to confirm the pH of the bacterial broth.

RESULTS AND DISCUSSION

This study determines whether the ethanolicextract of red cabbage which contains anthocyanincould be used as pH indicator in MIC using S aureusand E coli. The change in color due to the change inpH of the medium indicates presence or absence ofbacterial growth in the tubes.

Table 1 shows that the MIC of E.coli usingGentamicin is 64 mcg/ml. An acidic environmentindicating presence of bacterial growth in tubes 3 to 8and the positive control (tube 10) changed the colorof red cabbage ethanolic extract from violet to pinkwhile a basic environment in tubes 1 and 2 as well asthe negative control ( tube 9) changed its color intogreen.

Table 2 shows the MIC of S. aureus which is 4mcg/ml using Ampicillin. An acidic environmentchanges the color of the ethanolic extract (violet) intopink while a basic environment changed its color intogreen. The results confirmed the studies done byChigurupati, et al. and Khan that anthocyanin can beused as a pH indicator.4

Table 3 shows that the MIC of E. coli is 64 µg/mL using Gentamicin as the microbial agent, but thistime, litmus paper was used to confirm the pH. Theblue litmus paper changed to red in an acidicenvironment while it retained its color (blue) in a basicenvironment.

Table 4 shows the MIC of S.a. which is 4 µg/mlusing Ampicillin. An acidic environment changed thecolor of the litmus paper (blue) to red while in a basicenvironment, it retained its color.


Table 1. MIC of Escherichia coli with red cabbage ethanolicextract as pH indicator.

Table 2. MIC of Staphylococcus aureus with red cabbageethanolic extract as pH indicator.

Table 3. MIC of Escherichia coli using Litmus Paperas pH Indicator.

Table 4. MIC of Staphylococcus aureus usingLitmus paper as pH Indicator

CONCLUSION

In this study, the results showed that the ethanolicextract of red cabbage containing anthocyanin is aneffective pH indicator. The color changes from violetto pink in acidic medium and from violet to green inbasic medium. It can also be used as a macroscopicpH indicator for MIC. Pink was observed in tubeswith bacterial growth, indicating an acidic pH whilegreen was observed in tubes without bacterial growth,indicating a basic environment. Thus, it can be analternative confirmatory procedure for MIC.

ACKNOWLEDGEMENT

The researchers would like to express theirdeepest gratitude to Professor Mary Denneth Fuentes,RMT, MSMT for helping them in conceptualizing andfinishing this paper. Also to Professor Sherwin Reyes,

RMT, MSc Med Micro, ISID for his expertise inMicrobiology that made the experiment successful,Professor Maria Benilda De Guzman, Mr. FrederickM. Miranda, Mr. Isaiah Robert D. Villanueva, RMTand most specially to Professor Jerny M. Vargas, RMT,MBA for selflessly lending their time and effort forthe completion of the second part of the experiment.Profound thanks also to the National Museum andCentro Escolar University-Manila, for their facilitiesthat helped the researchers in completing the first partof the experiment.

REFERENCES

1. Tomczak DV, Czapski J. Colour changes of a preparationfrom red cabbage during storage in a model system. FoodChem 2007; 104 (2): 709-14.

2. Bondre S, Patil P, Kulkarni M, Pillai M. Study on isolationand purification of anthocyanins and its application as pHindication. Int J Adv Biotechn Res 2012; 69-70.


3. Helmenstine A. How to make red cabbage pH indicator. AboutEducation 2015; 1-2.

4. Chigurupati N, Saiki L, Gayser C Jr., Dash A. Evaluation ofred cabbage dye as a potential natural color for pharmaceuticaluse. Int J Pharm 2002; 293-9.

5. Khan P, Farooqui M. Analytical applications of plant extractas natural pH indicator. J Adv Sci Res 2011; 20-7.

6. brahim U, Muhammad I, Salleh R. The effect of pH on colorbehavior of Brassica oleracea Anthocyanin. J Applied Sci2011; 11: 2406-10.

7. Timberlake CF. The biological properties of anthocyanincompouds. NAT-COL. Quart Bull 1988; 4-15.

8. Delgado-Vargas F, Paredes-Lopez O. Natural colorants forfood and nutraceutical uses. CRC Press Boca Raton FL 2003;326.

9. Sahelian R. Anthocyanins research and health benefits. RaySahelian 2016; 1.

10. Sockett D. Antimicrobial susceptibility testing. WisconsinVeterinary Diagnostics Laboratory 2014; 1-3.

11. CLSI. Methods for Dilution Antimicrobial SusceptibilityTests for Bacteria that grow Anaerobically; ApprovedStandard, 9th edition, 2012; 32 (2).


Needs Assessment for Faculty Development Programs inFEU-Nicanor Reyes Medical Foundation Institute of Medicine

Magdalena F. Natividad, Ph.D.1

Faculty development is an essential element for quality enhancement in higher education. However, facultydevelopment programs are usually planned based on the needs perceived by the organizer of facultydevelopment activities. There is a need to actually assess the faculty competencies that have to bedeveloped or enhanced. A needs assessment study was conducted among faculty members of the FEU-Nicanor Reyes Medical Foundation.Methods: A modified partly open-ended and partly-close-ended survey instrument developed by Adkoli, etal. (2010)2 was administered to faculty members of the eight programs of FEU-NRMF. The respondentswere asked to rate the perceived importance and their perceived current performance on each of thirteenfaculty competencies. The ratings were ranked to determine priority activities for faculty development.The respondents were also asked to suggest ways to strengthen faculty development.Results: All thirteen competencies were perceived important by the respondents. Based on their rating oftheir own performance, they deemed that they are most competent in teaching in clinical setting, acquiringappropriate attitude and values, and acquiring decision-making skill. The priority needs they identified areplanning curriculum, evaluating courses and conducting research and developing learning resources suchas laboratory manuals. They suggested that the Health Profession Education Unit (HPEU) prioritize usingtechnology to enhance learning, orientation programs for the new faculty recruits, and sponsoring interestedfaculty to pursue higher degrees. They also suggested activities that should be extended by the ResearchDevelopment Office (RDO), with training in research and publication as top priority, followed by writingarticles and abstracts for journals.The respondents also suggested initiatives to be undertaken by theinstitution, HPEU and the RDO.Conclusion: Gaps between what is perceived to be important and the actual competency of the respondents,and the competencies that need to be given priority by the HPEU were identified. This study may guide theHPEU in planning faculty development activities that would cater to real needs of the faculty.

Key words: Faculty development program

Faculty development is an essential element forquality enhancement in higher education. It aims tohelp teachers develop the skills relevant to theirinstitutional and faculty positions and to sustain their

ABSTRACT

1Dean, School of Medical Technology

vitality. It aims to improve teaching effectiveness andto reinforce or alter attitudes or belies about teaching.Most health care professionals, while experts in theirfield, have little or no training in how to teach.

The FEU-Nicanor Reyes Medical Foundation hasestablished the Health Professional Education Unit(HPEU), which was previously called the Committeeon Continuing Professional Development, which ischarged to organize faculty development activities.Through the years, the Unit has come up with a series


of activities per year, each of which was based onwhat were perceived to be needed by the faculty inorder to enhance their skills and attitude in teachingand assessment. There was no formal surveyconducted to determine the priority activities relevantto the needs of the teaching population of theFoundation.

The primary objective of this study was to determinethe priority competencies, which will be the basis ofthe functional activities of the HPEU. It also aimed toestimate the willingness of the faculty to participateand the time they are willing to commit so that theHPEU will have a more realistic set of activities. Italso sought to elicit suggestions from the faculty forways to strengthen the faculty development initiatives.It also determined the difference between expectedcompetencies and actual performance of the faculty.

This study considered thirteen competencies, mostof which were based on the findings of Hesketh, etal.1 which identified twelve competencies expectedof a medical educator.

Since research activities are integral part of facultycompetencies, the study also determined the activitiesand services, which should be extended by theResearch Development Office (RDO), to enable themto conduct research.

METHODOLOGY

The author adopted and modified the partly open-ended and partly close-ended questionnaire developedby Adkoli, et al. (2010)2 for faculty needs assessment.

The questionnaire has a three-point Likert scalein which the respondents were asked to rate theperceived importance (high, moderate, low) and theirperceived current performance (good, average, poor)on each of the thirteen faculty competencies.

Other important issues addressed in thequestionnaire were perceived activities and serviceswhich should be rendered by the Health ProfessionalEducation Unit (HPEU). The respondents were askedto assess these activities in relation to their relevanceand usefulness to improve their performance.

To enable the respondents to improve theirresearch capabilities, the questionnaire included achecklist by which the respondents suggested activitiesand services to be extended by the ResearchDevelopment Office (RDO), which should be extendedby the Research Development Office (RDO).

The respondents were asked to iden t i fyproblems that may hinder them from participating

in seminars , workshops and o the r f acu l tydevelopment activities.

Finally, an open-ended question asked forsuggestions and comments for strengthening facultydevelopment.

The instrument was administered to facultymembers of the eight programs in the Institute ofMedicine (n=251), namely, Medicine, MedicalLaboratory Science, Physical Therapy, Nursing,Respiratory Therapy, Pharmacy, RadiologicTechnology, and Nutrition and Dietetics.

Analysis of data was done following the one usedby Adkoli, et al. (2010).2 Numerical data wereanalyzed using Microsoft Excel. The ratings made bythe respondents with respect to "perceived importance"against "self-rated performance" for each of thethirteen competencies were recorded as shown inTable 1.

The number of responses for perceived importanceand self-rated performance in each of the thirteencompetencies were counted. To identify the priorityscores, the four cells pertaining to Importance (High/Average) and Performance (Poor/Moderate) wereadded.

Table 1. Sample table of participant's ratings ofperceived importance and self-rated performance

for a given competency

Self-Rated PerformancePoor Ave Good Total

Perceived High 0 30 103 133Performance Moderate 0 9 11 20

Low 0 0 0 0Total 0 39 114 153

Note: Perceived importance "High" = 133Self-rated performance: 'Good' = 114Priority score: The sum of ratings in respect of four cells -perceived importance (high/moderate) and self-ratedperformance (poor/average) yield a priority score of 16 for thiscompetencies; i.e., 0 + 30 + 0 + 9 = 39

The sum represents the gap between importanceand performance, or the 'training deficit'. Thecompetency priorities were ranked according totraining deficits.

To prioritize the services and activities to berendered by the HPEU, the response counts weretallied and ranked accordingly. Likewise, the numberof responses for each of the suggested activities andservices which should be rendered by the RDO in the


future were counted and ranked according to priority.The problems encountered by the respondents resultingin their inability to attend seminars, workshops andother faculty development activities were also rankedbased on the number of responses for each activity.

Qualitative analysis of the open-ended commentsand suggestions for strengthening faculty developmentwas done by listing all the comments, identifying thethemes and then grouping all the comments withinthem.

RESULTS

Faculty Profile

A total of 154 questionnaires were returned.However three were excluded because therespondents did not completely fill up the instrument.

The profile of the participating faculty membersin each of the eight programs of the Institute ofMedicine is shown in Table 2. Sixty eight facultymembers of the undergraduate programs and 151members of the medicine program participated. Thisaccounts for about 90% of all the faculty members ofthe FEU-NRMF. Fifty two percent had more than 10

years of experience in the faculty. The response rateof the females were more than that of the males. Sixtyeight percent have a rank of Assistant Professor, andthis was particularly significant among the facultymembers of the medicine program. Only 2.7% have arank of Full Professor.

Out of 251 respondents, about 26 (11.9%) havenot attended any workshop in health science (teachingeducation). This is a substantial number that needs tobe addressed by the HPEU. Twenty eight (12.8%)are members of the committee on health professioneducation. It is not clear if this number includes thosewho were previous members of the committee. Thirtyseven percent have acted as a faculty/resourcepersons of workshops. Fifty-four (24.7%) of therespondents have formal degrees /diploma in healthscience education. Eight (3.7%) were granted byFEU-NRMF scholarship for a graduate degree andthey are required to return services after completingthe program. There are 38 (17.4%) who are currentlyenrolled in graduate programs related to the disciplinethey teach. More than half of the respondents (51.6%)have attended national/international workshops relatedto the discipline they teach. and 28.8% have attendeda 6-month to one-year postgraduate courses relatedto the discipline they teach.

Table 2. Survey participation and response rate by gender, faculty rank, and years of teachingexperience of undergraduate and medicine faculty

Characteristic Undergrad* MD** Total (N=68) (N=151) (N=219)

GenderMale 26 (38.2) 73 (48.3) 99 (45.2)Female 42 (61.8) 78 (51.7) 120 (54.8)

RankInstructor 23 (33.8) 10 (6.6) 33 (15.1)Assistant Prof 35 (51.5) 113 (74.8) 148 (67.6)Associate Prof 9 (13.2) 23 (15.2) 32 (14.6)Full Prof 1 (1.5) 5 (3.3) 6 (2.7)

Teaching Experience (years)0-2 13 (19.1) 20 (13.2) 33 (15.2)3-5 7 (10.3) 24 (1.9) 31 (14.2)6-10 23 (15.2) 19 (12.6) 42 (19.2)11-15 16 (10.6) 29 (19.2) 45 (20.5)16-20 0 (0.0) 7 (4.6) 7 (3.2)21+ 9 (6.0) 52 (34.4) 61 (27.9)

Undergrad* - Faculty of undergraduate programs: Medical Laboratory Science, Physical Therapy,Nursing, Respiratory Therapy, Pharmacy, Radiologic Technology , Nutrition & Dietetics, and GeneralEducation.MD** - Faculty of the medicine program.


Priority Competencies

The respondents were asked to rate the perceivedimportance and their self-performance of each of thethirteen faculty competencies (Table 4.) All 13competencies were perceived important by the facultyas shown by their ratings that ranged from 151 to 195.Overall , based on the ratings of their ownperformance, it is revealed that they are mostcompetent in teaching in clinical setting (167), acquiringappropriate attitude and values (166), and acquiringdecision-making skills (163). They are least confidentin evaluating and conducting research (82), planningcurriculum (99), and developing learning resourcessuch as laboratory manuals.

The faculty of the undergraduate programsidentified the top three important competencies,namely, facilitating and managing learning (59),understanding educational principles, and assessinglearners as perceived important (Table 5), and theyconsidered themselves most competent in acquiringappropriate attitude and values (54), teaching in clinicalsettings (51), team teaching (50), and facilitating andmanaging learning (50). They are least assured inevaluating courses and conducting research (23),developing learning resources (25), and planningcurriculum (26).

For the faculty of medicine, top competencies theydeemed important are facilitating and managinglearning (136), teaching in large/small groups (133),acquiring appropriate attitude and values (133), andteaching in clinical settings (132). They were leastconfident in evaluating courses and conductingresearch (59), planning curriculum (73), and assessinglearners (78).

Based on the responses on perceived importanceand self-rated importance, the priority scores and theranking of priorities for faculty development activitieswere derived for the thirteen competencies. Thepriority scores were derived (as explained in Table 1)from the sum of ratings of four cells - perceivedimportance high/average and self-rated performancepoor/average as shown in the Tables 3, 4 and 5. Forall respondents, planning curriculum received thehighest priority (115), followed by evaluating coursesand conducting research (129) and developing learningresources. Teaching in clinical settings (43), acquiringappropriate attitude and values (49), and acquiringdecision-making skills (52) were considered lowestpriorities.

The highest priorities for the undergraduate facultymembers (Table 5) are evaluating courses andconducting research (38), developing learningresources (37), and planning curriculum (36). The

Table 3. Education and experience in health science education

Education and Experience Undergrad MD ALL (N=68) (N=151) (N=251)

I have not attended any workshop in healthscience (teaching) education 11 (16.2) 15 (9.9) 26 (11.9)

I am a member of the committee on healthprofession education 7 (10.3) 21 (13.9) 28 (12.8)

I have acted as a faculty/resource personfor workshops 22 (32.4) 59 (39.1) 81 (37.0)

I have formal degree/diploma in healthscience education (e.g. MHPed, MSc) 32 (47.1) 22 (14.6) 54 (24.7)

I was granted a scholarship for a graduatedegree by FEU-NRMF 3 (4.4) 5 (3.3) 8 (3.7)

I am required to return services to FEU-NRMFafter completing the graduate / postgraduate program 6 (8.8) 2 (1.3) 8 (3.7)

I am currently enrolled in a master's degree programrelated to the discipline I teach 13 (19.1) 25 (16.6) 38 (17.4)

I have attended national / international workshopsrelated to the discipline I teach 37 (54.4) 76 (50.3) 113 (51.6)

I have attended a 6-month to 1-year postgraduatecourse related to the discipline I teach 25 (36.8) 38 (25.2) 63 (28.8)


lowest priorities are acquiring appropriate attitude andvalues (8),teaching in clinical settings (11), teamteaching (12), and facilitating and managing learning(12).

For the medicine faculty, the highest priorities areevaluating courses and conducting research (91),planning curriculum (79), and assessing learners (73),while the least priorities are teaching in clinical settings(32), acquiring decision-making skills (39), and teachingin small large groups (39).

Activities and Services to be Extended by theResearch Development Office

With research being part of the competencies offaculty members, the questionnaire asked the

respondents to suggest activities and services whichshould be extended by the RDO. Top priorities weretraining in research and publication (79.5%), Writingarticles and abstracts for journals (78.5%) andcritiquing research articles/peer review (73.1) (Table8). Although the ranking are the same betweenundergraduate faculty and medicine faculty, more than90% of the undergraduate faculty members wantedtraining in research and publication (97.1%) and writingarticles and abstracts for journals (94.1%), whereasonly about 70% of the medicine faculty suggested thesetwo activities.

The FEU-NRMF HPEU is actively conductingseminars and workshops for faculty development.However, the attendance in these activities leavesmuch to be desired. The questionnaire elicitedproblems that have been encountered by faculty

Table 4. Respondents' rating of perceived importance, self-rated performance, priority scores andranking with respect to thirteen faculty competencies (All Programs)

Competencies All Programs Perceived Self-Rated Priority (deficit) Priority Importance Performance scores Ranking

1* 2* 3* 4*

Teaching in large/small groups 187 162 53 10

Team teaching 171 160 54 9

Teaching in clinical settings 187 167 43 13

Facilitating and managing learning 195 160 55 8

Planning curriculum 179 99 115 2

Developing learning resources(Lab manual/book) 155 115 97 3

Assessing learners 184 123 89 4

Evaluating courses and conductingresearch 151 82 129 1

Understanding of educationalprinciples 175 142 72 6

Acquiring appropriate attitudesand values 188 166 49 12

Acquiring decision-making skills 182 163 52 11

Developing managerial andcommunication skills 174 140 75 5

Achieving personal development 178 152 63 7

1* represents respondents' rating of 'perceived importance' irrespective of their 'self-rated performance', with higher number indicating perceived importance2* represents respondents' rating of 'self-rated performance' irrespective of their 'perceived importance', with higher number indicating self-rated performance3* represents priority scores derived from a combination of ratings or perceived importance (high/ average), and self-rated performance (poor/average); higher scores represent higher priority4* shows ranking of the scores from 1 (highest) to 13 (lowest) derived from 3*


Table 5. Respondents' rating of perceived importance, self-rated performance, priority scores andranking with respect to thirteen faculty competencies (Undergraduate Programs)

Competencies Undergraduate Programs Perceived Self-Rated Priority (deficit) Priority Importance Performance scores Ranking

1* 2* 3* 4*Teaching in large/small groups 54 48 14 7Team teaching 51 50 12 10.5Teaching in clinical settings 55 51 11 12Facilitating and managing learning 59 50 12 10.5Planning curriculum 48 26 36 3Developing learning resources(Lab manual/book) 48 25 37 2Assessing learners 56 45 16 5Evaluating courses and conductingresearch 44 23 38 1Understanding of educational principles 57 47 14 8Acquiring appropriate attitudes and values 55 54 8 13Acquiring decision-making skills 55 49 13 9Developing managerial andcommunication skills 54 43 19 4Achieving personal development 55 47 15 61* represents respondents' rating of 'perceived importance' irrespective of their 'self-rated

performance', with higher number indicating perceived importance2* represents respondents' rating of 'self-rated performance' irrespective of their 'perceived

importance', with higher number indicating self-rated performance3* represents priority scores derived from a combination of ratings or perceived importance (high/

average), and self-rated performance (poor/average); higher scores represent higher priority4* shows ranking of the scores from 1 (highest) to 13 (lowest) derived from 3*

Table 6. Respondents' rating of perceived importance, self-rated performance, priority scores andranking with respect to thirteen faculty competencies (Medicine Program)

Competencies Medicine Programs Perceived Self-Rated Priority (deficit) Priority Importance Performance scores Ranking

1* 2* 3* 4*Teaching in large/small groups 133 114 39 11.5Team teaching 120 110 42 9Teaching in clinical settings 132 116 32 13Facilitating and managing learning 136 110 43 8Planning curriculum 130 73 79 2Developing learning resources(Lab manual/book) 106 90 60 4Assessing learners 129 78 73 3Evaluating courses andconducting research 107 59 91 1Understanding of educational principles 118 95 58 5Acquiring appropriate attitudes and values 133 112 41 10Acquiring decision-making skills 127 114 39 11.5Developing managerial andcommunication skills 120 97 56 6Achieving personal development 123 105 48 71* represents respondents' rating of 'perceived importance' irrespective of their 'self-rated

performance', with higher number indicating perceived importance2* represents respondents' rating of 'self-rated performance' irrespective of their 'perceived

importance', with higher number indicating self-rated performance3* represents priority scores derived from a combination of ratings or perceived importance (high/

average), and self-rated performance (poor/average); higher scores represent higher priority4* shows ranking of the scores from 1 (highest) to 13 (lowest) derived from 3*


Table 7. Activities and Services that should be extended by Health Profession Unit (HPEU) in the future

Rank Activities and Services Ungrad MD ALL(N=68) (N=151) (N=219)

1 Using technology to enhance learning 66 (97.1) 112 (74.2) 178 (81.3)

2 Orientation workshops for the newlyrecruited faculty 63 (92.6) 114 (75.5) 177 (80.8)

3 Sponsoring interested faculty for pursuinghigher degrees 61 (89.7) 112 (74.2) 173 (79.0)

4 Microteaching session for enhancing teaching skills 60 (88.2) 111 (73.5) 171 (78.1)

5 Developing OBE syllabus and instructional design 61 (89.7) 107 (70.9) 168 (76.7)

6 Developing leadership skills 55 (80.9) 111 (73.5) 166 (75.8)

7 Seminar on Academic Honesty and Plagiarism 52 (76.5) 109 (72.2) 161 (73.5)

8 Basic Instructional course for all teachers 49 (72.1) 110 (72.8) 159 (72.6)

9 Developing on-line teaching materials or course 50 (73.5) 108 (71.5) 158 (72.1)

10 Specialized courses (e.g. on assessment) 49 (72.1) 105 (69.5) 154 (70.3)

11 PowerPoint teaching 47 (69.1) 107 (70.9) 154 (70.3)

Table 8. Activities and Services that should be extended by the Research DevelopmentOffice in the future

Rank Activities and Services Ungrad MD All Total(N=68) (N=151) (N=219)

1 Training in research and publication 66 (97.1) 108 (71.5) 174 (79.5)

2 Writing articles and abstracts for journals 64 (94.1) 108 (71.5) 172 (78.5)

3 Critiquing research articles / peer review 58 (85.3) 102 (67.5) 160 (73.1)

4 Presenting work at conferences 58 (85.3) 100 (66.2) 158 (72.1)

5 Writing an ethics proposal 55 (80.9) 100 (66.2) 155 (70.8)

6 Grant writing 49 (72.1) 99 (65.6) 148 (67.6)

Table 9. Problems that may be encountered resulting in inability to attend seminars, workshopsand other CPD activities

Problems Ungrad MD ALL(N=68) (N=151) (N=219)

Schedule/Time of the CPD Activity 61 (89.7) 100 (66.2) 161 (64.1)

Workload 37 (54.4) 103 (68.2) 140 (55.8)

Relevance of the topics to one's discipline 39 (57.4) 77 (51.0) 116 (46.2)

Administrative support 28 (41.2) 74 (49.0) 102 (40.6)

Awareness of the Activity 33 (48.5) 60 (39.7) 93 (37.1)

Venue 26 (38.2) 59 (39.1) 85 (33.9)

members preventing them from attending the activities.The number one problem rated by the respondents isthe schedule/time of the activity (64.1%) (Table 9). Itis followed by the workload of the faculty (55.8%).The least among the list is the venue (33.9%).

Comments and Suggestions for StrengtheningFaculty Development

Most of the comments and suggestion tostrengthen faculty development came from the faculty


Table 10. Comments and suggestions given by the respondents to strengthen faculty development.

Comments/Suggestions

• More faculty members should be able to attend the two day seminar/ training.• Do not overwork faculty by assigning them to committees and giving them

responsibilities with little to no compensation.• Department heads should have a clear and frequent communication with faculty

members for uniformity of objectives and teaching. There are isolated faculty indepartments who do not follow rules and insist in their own rule. This is morepronounced in giving of tests and how students are evaluated.

• A meeting must be conducted with faculty where very few students passed intheir courses. Discuss ways how it can be resolved. Everyone in the departmentshould be involved.

• The faculty should be involved in curriculum planning.• Decrease teacher: student ratio to improve interaction and assessment.• There should be a core teacher for each subject.

• There are disciplines (subjects/courses) where more psychomotor trainingprinciples are needed to be learned. Examples: radiology tech, respiratory tech,physical therapy. New faculty members may be combined in a teacher-trainingprogram with additional emphasis and reevaluation of skills learned. Of course,cognitive learning is a must.

• Schedule faculty development during semester break or summer so as not toaffect teaching; Also, to maximize number of faculty members who attend to theseminars.

• There should be congruence with regard to what the instructor need to teachand what the learners/students need to learn.

• In house training seminars are more accessible than out of town seminars.• Higher frequency of actiities - 1 to 2 times a monthly• I suggest for a seminar concerning education of heart and how to incorporate in

our academic subjects.• Please be considerate to faculty members who are taking post graduate courses

in attending faculty development activities.• Faculty members should have a formal training on how to make examination

properly.• After an overview seminar, an in depth seminar should follow• There should be a way to monitor the implementation of what we learned.

• Criteria for promotion of faculty researchers should be applied equally withoutfavor. Criteria for inclusion in authorship of scientific works must be madespecific and clear/not just because one is head of the department or chair of theresearch committee!

• Ethics committee and related issues should be independently handled fromscientific research concerns.

• Animal ethics in research.

Category

Institutional initiatives

HPEU initiatives

RDO initiatives

of medicine. The comments and suggestions fell intothree categories: initiatives to be undertaken by theInstitute of Medicine, those to be undertaken by theHPEU, and those to be extended by the ResearchDevelopment Office (Table 10).

DISCUSSION

According to Wilkerson and Irby (1998)3,"Academic vitality is dependent upon faculty members'interest and expertise; faculty development has acritical role to play in promoting academic excellenceand innovation, and it is a tool for improving the

educational vitality of institutions through attention tothe competencies needed by individual teachers andto the institutional policies required to promoteacademic excellence."

Every educational institution is mandated todevelop or enhance the capability of its facultymembers in imparting knowledge, skills and attitudethat must be acquired by the students. Needsassessment must be conducted to determine theessential competencies that may be lacking in thefaculty. Faculty development units in educationalinstitutions are tasked to conduct activities that willimprove faculty competencies. As has been the


practice in FEU-NRMF, the Health ProfessionEducation Unit (previously called Committee onContinuing Professional Development) plans theactivities for faculty development based on what theyperceive to be needed by the faculty. Needsassessment has not been done to investigate what islacking in the competencies of the faculty.

In this study, active participation of the facultymembers of the FEU-NRMF was elicited to identifyfaculty development needs and priorities. The authormodified and used the instrument developed by Adkoli,et al. (2010)2 to determine priority areas based on thegap between the skills that the faculty perceive asmost important for their roles and how they rate theirown performance in these skills.

The needs identified and prioritized by therespondents reflect their background experience. Therespondents in this study are mostly senior facultymembers who have more than 10 years of experience.They have the notion that their skills as facultymembers are satisfactory. However, they need supportin planning the curriculum, evaluating and conductingresearch and developing learning resources such aslaboratory manuals especially in view of the challengesthey face in handling new technologies like e-learningand sustaining leadership towards the end of theircareer. Assessing learners is also of high priority,which suggests that many of the faculty have to betrained yet in using various assessment tools. This isparticularly evident among those who have beenteaching for less than 5 years. Teaching in clinicalsettings, acquiring appropriate attitude and values,team teaching, and acquiring decision-making skillswere given low priority. This can also be explainedby the training given to the faculty through a series ofworkshops regularly conducted by the HPEU.Teamteaching has been the practice and in fact theinstitution's strength.

In planning for future activities of the HPEU, thegaps or needs identified between perceivedimportance and self-rated performance should beconsidered including the suggestions for strengtheningfaculty development. With the advances in technology,the faculty would want to be informed and equippedwith recent development to enhance learning.Activities should be strategized in the way that newlyrecruited faculty members become oriented. Thefaculty would be happy if their pursuit for higherdegrees is supported by the administration, includingtime and financial support. The undergraduate facultymembers are also very much interested in enhancing

their teaching skills through microteaching sessions.In the advent of outcomes-based education (OBE)curriculum being mandated by the Commission onHigher Education, the faculty needs enhancement oftheir knowledge on how to develop OBE syllabus andinstructional design (now called learning plan). Thereare still 72% of the respondents who want to undergobasic instructional course for all teachers.

Research is one of the important competenciesrequired of a faculty member. There is dearth inresearch activities among undergraduate facultymembers. The top priority need concerning this areais training in research and publication, including writingarticles and abstracts for journals. They also need tobe trained in critiquing research articles and inpresenting work at conferences. Though grant writingis at the bottom of priorities, it is very important inview of the limited research funds available at FEU-NRMF.

The HPEU and the administration must alsoaddress the problems that have been encountered byfaculty members which prevent them from attendingfaculty development activities. On top of this is theschedule of the activities, the faculty workload andthe relevance of the topics to their respectivedisciplines.

The success of faculty development initiativesrests not only on the efforts of the HPEU but also oninstitutional initiatives such as infrastructure andfacilities, financial considerations that will allow morefaculty members to attend seminars or training heldoutside the institution. A problem was also raised wherevery few students pass certain courses. It is suggestedthat this problem must be resolved in a meeting withthe faculty concerned.

There are disciplines or courses where morepsychomotor training principles are needed to belearned. Some seminars in this regard have beenconducted but usually only a few are able to attendfor various reasons enumerated in Table 9.

CONCLUSION

The needs assessment conducted is deemed tobe more realistic with the direct participation of morethan 90% of the faculty of the FEU-NRMF Instituteof Medicine. Gaps between what is perceived to beimportant and the actual competency of therespondents, and the competencies that need to begiven priority by the HPEU were identified. This


study may guide the HPEU in planning facultydevelopment activities that would cater to real needsof the faculty.

ACKNOWLEDGEMENT

The author would like to thank Ms. Mary DennethFuentes who helped in organizing the data gatheredfrom the questionnaire.

REFERENCES

1. Hesketh EA, Bagnall G, Buckley EG, Friedman M, GodallE, Harden RM, Laidlaw JM, Leighton-Beck L, McKinlay P,Newtn R, Oughton R. A framework for developing excellenceas a clinical educator. Med Educ 2001; 35: 555-64.

2. Adkoli BV, Al-Umran KU, Al-Sheikh MH and Deepak KK.Innovative method of need assessment for facultydevelopment programs in a Gulf Medical School. Educationfor Health. 2010; 23(3): 389.

3. Wilkerson L, Irby DM. Strategies for improving teachingpractices: a comprehensive approach to faculty development.Acad Med 1998; 73(4): 387-9.

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