BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

OBJECTIVE

This seven-year, two-center retrospective cross-sectional study aimed to describe the demographic, clinical characteristics and surgical indications of patients managed with open or laparoscopic cholecystectomy in the pediatric age group, and determine these variables’ associations with patient outcomes.

Records of all patients less than 19 years old who underwent laparoscopic or open cholecystectomy at Jose R. Reyes Memorial Medical Center (JRRMMC) and National Children’s Hospital (NCH) from January 2015 to December 2021 were reviewed. The gathered data were organized, described and analyzed using univariate and multivariate statistics.

A total of 32 patients underwent open or laparoscopic cholecystectomy at the two institutions. Majority were female (78.1%). The diagnoses included chronic calculous cholecystitis (62.5%), acute calculous cholecystitis (21.9%), choledocholithiasis (12.5%). One (3.1%) patient had empyema of the gallbladder. The 15 – 18 year age group made up 78.1%, with the rest (21.9%) from the 10 – 14 year age group. By BMI percentile, 62.5% were normal, 15.6% were overweight, and 12.5% were obese. Most patients across all conditions (96.9%) had no known hemolytic disorder. Underweight patients (9.4% of the cohort) had statistically higher lengths of stay [F(3,28) = 3.444, p = .030]. No significant associations were found between the categorical outcomes (discharged well, morbidity, mortality) and patient variables (age group, sex, BMI percentile, presence of co-morbidities, symptoms, indication for surgery, operation done).

In pediatric patients undergoing laparoscopic or open cholecystectomy, BMI percentile is inversely related to the length of hospital stay.

BACKGROUND

Growing old is a remarkable journey filled with diverse experiences and wisdom. It’s a time when individuals often reflect on their lives, cherish memories, and share invaluable lessons with younger generations. Understanding aging is crucial as it encompasses more than just physiological and psychological processes, to comprehend the subjective sensations of the phenomenon of “being an elderly person”.

The purpose of this study was to describe the daily lives of frail older adults living alone in Quezon City.

The study utilized a qualitative research design. The approach employed was a descriptive phenomenological study describing the fundamental nature of being an elderly. The population consisted of frail older adult people (>60 years old) assessed using the Clinical Frailty Scale and living alone in Quezon city using a purposive sampling of those who were present in their homes during the designated interview period. The study was conducted in a private, safe and secured place both agreed by the participants and the researcher through face to face interview.

Being an frail older adult in this study essentially involves balancing one’s life in a flow of motion. The older adult is balancing a number of life-altering events and a shift in their circumstances influenced by recollections from various stages of life. In the life of an older adult, all ages are harmonious and wisely expressed and developed from pleasant and lovely or less pleasant and beautiful or more stressful early life experiences that went throughout adolescence and young adulthood, middle age, and later years. Their family, children and grandchildren were their source of strength and inspiration.

This study gave light on the realities faced daily by a frail older adult. Insights gained from this study serve as an opportunity to develop or innovate appropriate support. This information is crucial for clinicians, community-based aged care providers, legislators, elderly associations, and other concerned citizens. On a local level, the government unit’s key officials or proponents for the welfare of older adults are encouraged to delve deeper and focus on the unique needs and life experiences of the elderly population.

BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

INTRODUCTION: Obstructive sleep apnoea (OSA) is a serious but underdiagnosed condition. Demand for the gold standard diagnostic polysomnogram (PSG) far exceeds its availability. More efficient diagnostic methods are needed, even in tertiary settings. Machine learning (ML) models have strengths in disease prediction and early diagnosis. We explored the use of ML with oximetry, demographic and anthropometric data to diagnose OSA. METHODS: A total of 2,996 patients were included for modelling and divided into test and training sets. Seven commonly used supervised learning algorithms were trained with the data. Sensitivity (recall), specificity, positive predictive value (PPV) (precision), negative predictive value, area under the receiver operating characteristic curve (AUC) and F1 measure were reported for each model. RESULTS: In the best performing four-class model (neural network model predicting no, mild, moderate or severe OSA), a prediction of moderate and/or severe disease had a combined PPV of 94%; one out of 335 patients had no OSA and 19 had mild OSA. In the best performing two-class model (logistic regression model predicting no-mild vs. moderate-severe OSA), the PPV for moderate-severe OSA was 92%; two out of 350 patients had no OSA and 26 had mild OSA. CONCLUSION Our study showed that the prediction of moderate-severe OSA in a tertiary setting with an ML approach is a viable option to facilitate early identification of OSA. Prospective studies with home-based oximeters and analysis of other oximetry variables are the next steps towards formal implementation.
Humans ; Oximetry/methods* ; Sleep Apnea, Obstructive/diagnosis* ; Male ; Female ; Middle Aged ; Machine Learning ; Polysomnography ; Adult ; Anthropometry ; ROC Curve ; Aged ; Algorithms ; Predictive Value of Tests ; Sensitivity and Specificity ; Neural Networks, Computer ; Demography

BACKGROUND: Prospective evidence on how offspring number influences morbidity and mortality remains limited. This study investigated the associations between number of offspring and morbidity and mortality risks among 0.5 million Chinese adults. METHODS: By using data from the China Kadoorie Biobank (CKB; n = 512,723, an approximately 12-year follow-up), sex-stratified phenome-wide association study (PheWAS) analyses were conducted to investigate associations between offspring number (without vs . with offspring; more than one vs . one offspring) and risks of ICD10-coded morbidity and mortality. Sex-specific adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated by Cox proportional-hazards models. RESULTS: Among 210,129 men and 302,284 women aged 30-79 years, 1,338,837 incident events were recorded. PheWAS results revealed that offspring number was associated with disease risks across multiple systems. Cox models showed that childless men ( vs . one offspring) had higher risks for nine of 36 diseases, while childless women for five of 37. Each additional offspring was associated with reduced risks of mental and behavioral disorders in men (aHR [95% CI] = 0.93 [0.87-0.98]) and both mental and behavioral disorders (aHR [95% CI] = 0.93 [0.89-0.97]) and breast cancer (aHR [95% CI] = 0.82 [0.78-0.86]) in women. However, each additional offspring was associated with a 4% increase in the risk of cholelithiasis and cholecystitis in women (aHR [95% CI] = 1.04 [1.02-1.07]). Among 282,630 patients, 44,533 deaths were documented. Childless patients had higher mortality risk in both men (aHR [95% CI] = 1.37 [1.28-1.47]) and women (aHR [95% CI] = 1.27 [1.15-1.41]). For men, each additional offspring reduced mortality by 4% (aHR [95% CI] = 0.96 [0.95-0.98]), while for women, the lowest risk was observed among those with three to four offspring ( Pnonlinear <0.0001). CONCLUSIONS Offspring number is closely linked to morbidity and mortality risks. Further research is warranted to verify our findings and clarify the underlying mechanisms involved.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Morbidity ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Family Characteristics ; Mortality ; East Asian People

OBJECTIVES: To analyze sex and age distribution of global disease burden of calcific aortic valve disease (CAVD) from 1990 to 2021. METHODS: CAVD data during 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC). RESULTS: In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/10⁵) than that in females (128.9/10⁵). Patients in 65-<85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990 to 2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000 to 2010, slowed thereafter, and declined from 2015 to 2021. In <65 years old, the mortality of males was 2.4 times higher than that of females, while in ≥85 years old, mortality of females (117.3/10⁵) exceeded that of males (99.1/10⁵). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in ≥85 years old, with a greater increase in females. CONCLUSIONS There are significant gender and age disparities in global disease burden of CAVD, with the elderly, especially super-elderly females deserving particular attention. It is recommended to develop personalized intervention strategies for these populations.
Humans ; Male ; Female ; Aged ; Calcinosis/mortality* ; Prevalence ; Global Burden of Disease ; Aged, 80 and over ; Middle Aged ; Aortic Valve/pathology* ; Aortic Valve Stenosis/epidemiology* ; Age Distribution ; Adult ; Disability-Adjusted Life Years ; Sex Distribution ; Global Health ; Aortic Valve Disease/epidemiology* ; Sex Factors

OBJECTIVES: Rheumatoid arthritis (RA) imposes a heavy burden on individuals, families, and society. This study analyzed the incidence and mortality trends of RA in China from 1990 to 2023 to provide epidemiological evidence for precise prevention and control. METHODS: Data on RA incidence, age-standardized incidence rate (ASIR), deaths, and age-standardized mortality rate (ASMR) in China by sex and age group from 1900 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression was used to analyze trends in ASIR and ASMR. An age-period-cohort model was constructed using R4.3.1 to evaluate longitudinal age trends and estimate relative risk (RR) values for period and cohort effects. RESULTS: In 2021, the number of RA cases, ASIR, deaths, and ASMR in China were 247 300, 13.70 per 100 000, 10 300, and 0.54 per 100 000, respectively. From 1990 to 2021, the ASIR of RA increased annually among both females and males, with average annual percentage changes (AAPCs) of 0.44% and 0.72%, respectively. Over the same period, ASMR declined in the total population and among females, with AAPCs of -0.78% and -1.19%, while the change in males was not statistically significant. Age-period-cohort analysis showed that the peak incidence occurred in women aged 60-64 years and men aged 75-79 years, and mortality increased with age. The period effect for incidence rose in both sexes, reaching 1.10 [95% confidence interval (CI) 0.94 to 1.27] for females and 1.14 (95% CI 1.02 to 1.27) for males during 2017 to 2021, compared with 2002 to 2006. The mortality period effect RR exhibited a downward-upward-downward pattern, decreasing to 0.56 (95% CI 0.52 to 0.61) in females and 0.75 (95% CI 0.68 to 0.82) in males in 2017 to 2021. Cohort analysis indicated that the highest incidence risk occurred in individuals born during 2012 to 2016, while the cohort effect RR for female RA mortality showed a continuous decline beginning with the 1922 to 1926 birth cohort. CONCLUSIONS The incidence and mortality risks of RA in China have continued to decline. However, with the aging of the population, the incidence and mortality risks among the elderly have increased. Middle-aged women and elderly men should receive focused attention. Health authorities should strengthen education, prevention, and screening among middle-aged women and enhance disease monitoring in elderly populations to reduce the national burden of RA.
Humans ; China/epidemiology* ; Arthritis, Rheumatoid/epidemiology* ; Incidence ; Male ; Female ; Middle Aged ; Adult ; Aged ; Cohort Studies ; Mortality/trends* ; Age Distribution ; Age Factors ; Aged, 80 and over ; Adolescent

Objectives: This study described the clinical profile of patients with keratoconus at a single tertiary referral hospital. Methods: This was a single-center, retrospective, cross-sectional study that reviewed medical records of patients diagnosed with keratoconus from January 2015 to August 2022. Data on the clinical profile, intervention, and clinical outcomes were collected from the chart review. Results: Forty (40) patients (79 eyes) were included in the study. Majority (98%) had bilateral disease in which 22 (55.5%) were affected asymmetrically. The mean age was 21 years. Most patients (72.5%) were male. Blurring of vision was the chief complaint in all patients. Atopy was present in 23 patients (57.5%). History of vigorous eye rubbing was present in 31 (77.5%). The mean interval from onset of symptoms to consult was 46.4 ± 33.38 months. The mean pinhole corrected distance visual acuity was 0.47 ± 0.41 (Snellen equivalent of 20/59). The average spherical equivalent was -7.48D ± 6.99D. Corneal protrusion on slit-lamp biomicroscopy was seen in 78 eyes (98.7%). Other findings included Fleischer ring (53.2%), Vogt's striae (19.0%), and apical corneal scar (24.0%). Only one eye (1.3%) had no corneal findings. Thirty-nine eyes (49.3%) were classified as advancedsevere keratoconus. Rigid contact lens was planned for 60 eyes (75.9%). Sixty-two eyes (78.5%) were for collagen cross-linking. Deep anterior lamellar keratoplasty was planned in 10 eyes (12.7%) and penetrating keratoplasty in two eyes (2.5%). Conclusion Keratoconus at the Philippine General Hospital was most frequently seen in young males and asymmetrically affects both eyes. Patients consulted relatively late and presented with a more advanced stage of the disease. History of ocular allergy and eye rubbing were significant risk factors. Improving awareness of this condition must be emphasized to detect keratoconus earlier.
Keratoconus ; Cornea ; Demography ; Philippines

Background: The majority of women described hysterosalpingography (HSG) as a painful procedure. There is little information on the features of HSG-associated pain and factors that predispose to increased pain experience. Objectives: This study investigated preprocedure psychological state and related demographic factors as predictors of pain perception in women undergoing HSG. Methods: The sample included 99 women selected through consecutive sampling at the Radiology Department, University of Benin Teaching Hospital, Benin City, Nigeria. The study utilized a cross-sectional survey design to collect data using Spielberger's State-Trait Anxiety Inventory, Zung Self-rating Depression Scale, and Visual Analog Scale for the perception of pain and state anxiety. Results: The women with lower state anxiety reported significantly lower pain perception (X̅ = 6.69) than the women with high anxiety (X̅ = 7.93). Trait anxiety, state anxiety, and depression jointly predicted pain perception among the women undergoing HSG, with R2 = 0.117, F (3,95) = 6.797; P < 0.001. They collectively accounted for about 17.7% variance in pain perception. Conclusion Patients being prepared for the HSG procedure can be educated on concerns related to anxiety and coping strategies and be provided with anxiolytics or other medication as clinically indicated.
Demography ; Pain Perception ; Women