Background: Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as schoolage children (SAC). This paper complements the published results of the parasitological survey (prevalence and intensity of STH) conducted in selected Aeta and Ata-Manobo communities. Objectives: This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies. Methods: Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation. Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conducted separately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation. Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016). Results: The characteristics of the STH control strategies and the target populations are interrelated factors that influence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drug shortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceived harm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and schoolbased MDA programs also affected engagement of SAC. IP communities are special settings where geographic isolation, peace and order situation as well as water supply need to be considered to help ensure access to STH control strategies, high MDA coverage, and improvements in WASH leading to desired outcomes. Conclusions Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated.
Indigenous Peoples ; Mass Drug Administration

Objectives: Since the effectiveness of the Zero Open Defecation (ZOD) program as a scaling-up approach in lowering the rates of soil-transmitted helminth (STH) infections has not yet been locally explored, this study aimed to (1) describe the association between environmental determinants and STH cumulative prevalence, and (2) to predict the 2020 STH cumulative prevalence. Methods: A generalized linear regression (GLR) model was used to determine the association of 2014–2015 environmental determinants and observed 2015 STH cumulative prevalence, while a geographically weighted regression (GWR) model was used to produce predicted 2020 STH cumulative prevalence. Results: ArcGIS’ GLR tool with R2 of 63% found that statistically significant environmental determinants include distance near to water bodies, forest land use, access to sanitary toilet, level one water source, and ZOD status, while the ArcGIS’ GWR tool found that barangays, Cabangcalan, Matalangtalang, Talabaan, and Talib in Aroroy hypothetically met the national target below 30% for 2020 STH cumulative prevalence. Conclusion This study showed that barangays with a moderately low percentage of area with freshwater bodies, a moderately high percentage of households with sanitary toilet and level one water source, and a 100% status of ZOD have lower rates of STH cumulative prevalence in preschool-aged children in the selected municipalities in Masbate.
Mass Drug Administration ; Hygiene ; Sanitation ; Geographic Information Systems

BACKGROUNDFew studies have given suggestions on appropriate individual progesterone dosage in patients with progesterone deficiency. This study was designed to provide a reference for the clinical use of oral progesterone by exploring the relationship among Body Mass Index (BMI), dosage of progesterone, and serum progesterone concentration. Many gynecology and obstetrics doctors are unfamiliar with progesterone treatment. Our study is intended to help determine the dosage of oral progesterone.

METHODSThis was a block randomized, open-label, prospective clinical trial. Eighty women undergoing cessation of menses were recruited, given oral progesterone therapy for 10 consecutive days. They were randomly assigned to four groups (four different doses of progesterone, n = 20): group A 100 mg/d, group B 200 mg/d, group C 300 mg/d, and group D 400 mg/d.

RESULTSSeventy-four patients (92.5%, 74/80) completed the study. It was observed that administration of progesterone significantly increased serum progesterone concentration in the four groups (all P < 0.001). And there is a positive correlation between the increase and dosage (r(p) = 0.613, P < 0.001). A further linear regression analysis found the major regression equation: when 18.5 kg/m(2) ≤ BMI < 24 kg/m(2), Y = 8.4820×10(0.003X) (R(2) = 0.425, P < 0.001); Y was the increase of serum progesterone concentration in nmol/L, and X was the dosage of oral progesterone in mg/d.

CONCLUSIONSSerum progesterone levels went up linearly as the dosage increased. The higher the patient's BMI, the higher dosage would be needed to achieve the same serum progesterone concentration. The appropriate dosage of oral progesterone for different patients can be roughly calculated in light of the results of this study.

Administration, Oral ; Adult ; Body Mass Index ; Female ; Humans ; Menstruation Disturbances ; drug therapy ; Progesterone ; administration & dosage ; therapeutic use

OBJECTIVE: Elimination eforts for lymphatic flariasis are underway in the Philippines using mass drug administration (MDA) of diethylcarbamazine and albendazole as one of the main strategies. This cost analysis was done to determine the MDA implementation cost and provide useful information to the control programme on how to best utilize limited resources.

METHODS: This cost analysis study was conducted in the province of Sorsogon, Philippines in 2004. The study was done from a program perspective. Cost data for 2003 was obtained retrospectively via key informant interviews and records review using a standardized guide from a multi-country cost analysis study of flariasis elimination programs. Cost fgures were classifed as either economic or fnancial costs and expressed in real terms using 2002 as base year. Sensitivity analysis was likewise performed.

RESULTS: The total economic cost and cost per person treated with MDA were estimated at US$223,549.55 (Php12,116,385.48) and US$0.40, respectively. The fnancial costs were less than half of the economic costs. The main cost driver was drug distribution. The highest economic and fnancial costs were incurred at the national (54.5%) and municipal (74.4%) levels, respectively. High variation in costs of MDA activities was observed.

CONCLUSION: This cost analysis provides reasonable estimates which may be used to assist government and other stakeholders in program planning and resource generation for flariasis elimination programs in endemic areas.

Diethylcarbamazine ; Albendazole ; Philippines ; Mass Drug Administration ; Costs And Cost Analysis ; Health Resources ; Lymphatic Vessel ; Elephantiasis, Filarial

Breast ultrasonography (US) is currently considered the first-line examination in the detection Epub ahead of print and characterization of breast lesions. However, conventional handheld US (HHUS) has several limitations such as operator dependence and the requirement of a considerable amount of radiologist time for whole-breast US. Automated breast US (ABUS), recently approved by the United States Food and Drug Administration for screening purposes, has several advantages over HHUS, such as higher reproducibility, less operator dependence, and less required physician time for image acquisition. In addition, ABUS provides both a coronal view and a relatively large field of view. Recent studies have reported that ABUS is promising in US screening for women with dense breasts and can potentially replace handheld second-look US in a preoperative setting.
Breast ; Early Detection of Cancer ; Female ; Humans ; Mass Screening ; Ultrasonography ; Ultrasonography, Mammary* ; United States Food and Drug Administration

BACKGROUNDS: Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts. METHODS: PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment. RESULTS: A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts. CONCLUSIONS Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.
Anti-Bacterial Agents/therapeutic use* ; Azithromycin/therapeutic use* ; Humans ; Infant ; Mass Drug Administration ; Prevalence ; Trachoma/epidemiology*

This study used UPLC-TQ-MS technology to replicate a Henoch-Schonlein purpura(HSP) model in rats by administering warm drugs by gavage and injecting ovalbumin with Freund's complete adjuvant emulsion. The distribution differences and characteristics of eight major components(ferulic acid, caffeic acid, neochlorogenic acid, cryptochlorogenic acid, benzoyl oxypaeoniflorin, tracheloside, loganin, and paeoniflorin) in rat liver, lung, heart, spleen, and kidney tissues were determined after oral administration of the Liangxue Tuizi Mixture at a dose of 42 g·kg~(-1) in both normal physiological and HSP states at 0.5, 1, 2, 6, and 12 hours. The results showed that the distribution patterns of the eight components of Liangxue Tuizi Mixture in the tissues of normal and HSP model rats were different. The main component, paeoniflorin, in Moutan Cortex and Paeoniae Radix Alba had higher content in all tissues. The eight components were predominantly distributed in the liver, lung, and kidney tissues, followed by spleen and heart tissues.
Rats ; Animals ; IgA Vasculitis/drug therapy* ; Monoterpenes ; Administration, Oral ; Liquid Chromatography-Mass Spectrometry

AIMTo develop and validate a liquid chromatography-tandem mass spectrometric (LC/MS/MS) method for the simultaneous quantification of ephedrine and chlorpheniramine in human plasma after oral administration of a compound preparation.

METHODSThe analytes and the internal standard, diphenhydramine, were isolated from plasma by protein precipitation with methanol, then chromatographied on a Zorbax SB-C18 column (150 mm x 4.6 mm ID) using a mobile phase consisted of methanol-water-formic acid (80: 20: 0.5, v/v), at a flow rate of 0.5 mL x min(-1). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and was operated in the positive ion mode. Selected reaction monitoring (SRM) using the precursor to produce ion combinations of m/z 166-->115, m/z 275-->230 and m/z 256-->167 were used to quantify ephedrine, chlorpheniramine and the internal standard, respectively. Results The linear concentration ranges of the calibration curves for ephedrine and chlorpheniramine were 0.50 - 200 microg x L(-1) and 0.050 - 20.0 microg x L(-1), respectively. The lower limits of quantification were 0. 50 microg x L(-1) for ephedrine and 0.050 microg x L(-1) for chlorpheniramine, individually. The intra- and inter-day relative standard deviation (RSD) across three validation runs over the entire concentration range was less than 9.3% for both ephedrine and chlorpheniramine. The inter-day accuracy (RE) was within +/- 3.4% for the analytes. Each sample was chromatographied within 3.3 min. The method was successfully used in pharmacokinetics study of ephedrine and chlorpheniramine in human plasma after oral administration of a compound preparation containing 5 mg ephedrine hydrochloride, 1 mg chlorpheniramine maleate, 50 mg phenytoin, 12.5 mg theophylline, 12.5 mg theobromine and 7.5 mg caffeine. No interaction among the six components was observed on their pharmacokinetic parameters.

CONCLUSIONThe method was proved to be highly sensitive, selective, and suitable for pharmacokinetics investigations of different compound preparations containing low dosage of both ephedrine and chlorpheniramine.

Administration, Oral ; Area Under Curve ; Chlorpheniramine ; administration & dosage ; blood ; pharmacokinetics ; Chromatography, Liquid ; methods ; Drug Combinations ; Ephedrine ; administration & dosage ; blood ; pharmacokinetics ; Humans ; Male ; Spectrometry, Mass, Electrospray Ionization ; methods

OBJECTIVETo study on the differences of metabolites in the blood of rats after injection or oral administration of volatile oil in Houttuyniae Herba and of 2-undecanone in order to validate hypothesis of network compatability and to establish the theoretical foundation of elucidating metabolic mechanism for multiple constituents in Chinese Material.

METHODA gas chromatography-mass spectrometry method was employed for qualitative determination of the metabolites in blood of rats by injection or oral administration of volatile oil in Houttuyniae Herba and of 2-undecanone, which were compared with the differences between binary two drugs as well as two administration.

RESULTThere were 45 kinds of ingredients in volatile oil for original materials for Houttuyniae Herba, and 53, 69 kinds of metabolites were detected in blood of rats for oral administration of volatile oil in Houttuyniae Herba, and 2-undecanone, respectively, whereas 52, 42 kinds of metabolites were detected for injection administration. Although there were various constitutes, i. e. single versus multiple ingredients, administrated by various ways, i. e. oral versus injection, the metabolites were so similar with each manners, in which alpha-pinene and beta-myrcene occurred in two constitute forms and two administrations, while there were 18, 13 kinds of ingredients for oral or injection administration of volatile oil in Houttuyniae Herba, i. e. 34%, 25% of total ingredients, respectively, and 17, 15 kinds of ingredients, i. e. 24.6%, 35.7% for that of, 2-undecanone, respectively, on average of 29.8% that suggested one of third as co-metabolites.

CONCLUSIONThere are network compatibility existed in metabolism of the houttuynia volatile oil in rats, and similar metabolic pathways in accordance with original plant, among their ingredients no matter alone or multiple constitute forms and oral or injection administration.

Administration, Oral ; Animals ; Gas Chromatography-Mass Spectrometry ; Herb-Drug Interactions ; Houttuynia ; chemistry ; Injections, Intravenous ; Ketones ; administration & dosage ; pharmacokinetics ; Oils, Volatile ; administration & dosage ; pharmacokinetics ; Plants, Medicinal ; chemistry ; Rats

OBJECTIVETo observe the efficacy of regular or intermittent inhalation of salmeterol/fluticasone propionate (SM/FP) in the treatment of bronchial asthma and its effects on growth and development in children.

METHODSA total of 112 children diagnosed with bronchial asthma between September 2012 and October 2013 were assigned to standardized treatment (standard group, n=56) and non-standardized treatment (intermittent group, n=56). Comparisons of clinical symptom scores and main pulmonary function indicators between the two groups were carried out before treatment and at 6 and 12 months after treatment. The growth velocity and changes in body mass index (BMI) were observed in the two groups.

RESULTSAt 6 and 12 months after the treatment, the standard group had significantly reduced clinical symptom scores and significantly increased pulmonary function indicators (percentage of predicted peak expiratory flow, PEF%; percentage of forced expiratory volume in 1 second, FEV1%) (P<0.05); the intermittent group had significantly reduced clinical symptom scores and significantly increased FEV1% (P<0.05), but PEF% was significantly increased only at 6 months after treatment (P<0.05). At 12 months after treatment, the standard group had significantly lower clinical symptom scores and significantly higher PEF% and FEV1% when compared with the intermittent group (P<0.05). The growth velocity and BMI showed no significant differences between the two groups at 6 and 12 months after treatment (P>0.05).

CONCLUSIONSCompared with intermittent inhalation, long-term regular inhalation of SM/FP performs better in controlling clinical symptoms and enhancing pulmonary function in children with asthma. Inhalation of SM/FP for one year reveals no apparent effect on the growth and development of these children.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; Asthma ; drug therapy ; Body Mass Index ; Child ; Child Development ; drug effects ; Child, Preschool ; Female ; Humans ; Male