Objective. The present study aims to correlate the LGU list of PhilHealth Sponsored Members in a municipality of Batangas with the list of poor residents as identified by the Participatory Action Research (PAR) methodology. Method. Interview of key informants documented the processes utilized by the LGU in determining PhilHealth beneficiaries for the Sponsored Program and the Participatory Action Research (PAR) survey in the classification of households into poor, middle and rich in four barangays of the municipality. The list of LGU Sponsored members was then cross matched with the PAR household classification. Results. The comparison of the LGU list of Sponsored members and the household classification by the PAR survey showed a wide discrepancy: (1) 464 "Not Found" Sponsored households or 70% of the LGU's Sponsored list; (2) inclusion of the non-poor: 140 middle class families as classified by the PAR survey or 21.1% of the LGU's Sponsored list; and (3) exclusion of 413 or 87.5% of true poor families identified by the PAR Survey. Only 59 families or 8.9% of the LGU Sponsored list were classified as poor families by PAR. Conclusion. PAR offers communities, LGUs and the National Health Insurance Program a tool to validate the coverage of the Sponsored program. LGUs and the PhilHealth should consider such tool or similar tools to validate their identification, selection and enrollment of the poor, which is extremely vital in achieving universal coverage. Given the right tool, communities are in the best position to identify the poor for the Sponsored program. By way of collaboration with the underprivileged themselves, the academe has a role in assisting communities in acquiring collective awareness of their own situation and developing capacity for improving their lives. The academe also has a role in assisting LGUs in improving their health systems and national health programs in validating and improving their implementation. Further studies should be done to investigate the following: the identity of the "not found" SP members; the utilization of PhilHealth benefits by the poor; and the prospect of utilizing the PAR method by other non-academic institutions in monitoring the progress of community programs.
Human ; Male ; Female ; PUBLIC-PRIVATE SECTOR PARTNERSHIPS ; HEALTH SERVICES ; INSURANCE, HEALTH ; HEALTH CARE ECONOMICS AND ORGANIZATIONS ; ECONOMICS ; FINANCING, ORGANIZED ; INSURANCE

Introduction. Several studies have been conducted on the use of Immunoglobulin Y (IgY) technology in the fields of diagnostics and therapeutics. IgY is the avian counterpart of the mammalian immunoglobulin G (IgG) which is exclusively transferred from the hen to the yolk thus conferring passive immunization to the growing embryo. However, despite the advantages it offers over the use of mammalian immunoglobulin, IgY technology has remained underutilized. Objective. The objective of this study is to produce an IgY with activity against synthetic peptide analogs of known immunogenic epitopes of the Hepatitis B Surface Antigen (HBsAg) - a molecular marker of Hepatitis B infection. Methods. Chickens were immunized with synthetic peptide analogs of previously reported immunogenic epitopes of the S and the pre-S1 regions of the Hepatitis B surface antigen (HBsAg). IgY specific for the synthetic peptides was isolated by delipidation and salt precipitation and was further purified by affinity chromatography. Purity and molecular weights of the whole IgY molecule and its subunits were assessed and determined by SDS-PAGE. Anti-peptide activity and specificity were determined by indirect ELISA. The study was approved by the Ethical Review Board (ERB) and Technical Review Board of the Research Implementation and Development Office (RIDO), University of the Philippines Manila. Results and Conclusion. The IgY that was purified in this study had an approximate molecular weight of 165 kilodaltons. The heavy and light chains are 60 and 28 kilodaltons, respectively. The affinity purified IgY demonstrated anti-peptide antibody activity against synthetic peptide analogs of known immunogenic epitopes of the HBsAg. Specific binding against a battery of synthetic peptides also revealed that the affinity purified IgY specifically binds to the known immunogenic epitope of the HBsAg.
HEPATITIS B SURFACE ANTIGENS ; HEPATITIS B ANTIGENS ; HEPATITIS B VIRUS ; IGY

Background. Emergence of multidrug-resistant tuberculosis (MDR-TB) poses a major challenge to prevailing disease management. MDR-TB arises from mutations in several genes comprising the resistance determining regions, including rpoB, katG and gyrA. Objective. To detect and characterize mutations in rpoB, katG and gyrA. Methods. Thirty selected Mycobacterium tuberculosis isolates from the IDS-PGH were subjected to PCR amplification and sequencing. Sequences were compared to the wild type strain H37Rv. Results. Mutations were detected in codons 512, 513, 516, 522, 526, 531 and 533 of rpoB, codons 280, 281, 315 and 333 of katG, and codons 90 and 94 of gyrA sequences. The most frequently mutating codons for rpoB, katG and gyrA were 531, 315 and 94, respectively. A clustering analysis of the sequences showed occurrence of seven, four and three clusters for the genes rpoB, katG and gyrA, respectively. The eight clusters obtained from the concatenated sequences of the three genes represent the eight potential genotypes of local strains. One cluster represents the wild type strain genotype, another cluster represents the XDR strain genotype, and six clusters represent the MDR strain genotypes. Conclusion. These findings indicate the utility of multiple RDR sequence analysis in both identifying specific drug resistance mutation and genotyping of various M. tuberculosis isolates.
TUBERCULOSIS ; THERAPEUTICS ; THERAPY

Objective. This study was conducted to determine the dietary diversity score and its relation to nutritional adequacy among 16-19 year-old adolescents. Methods. Secondary data analyses were undertaken with a representative sample of 16-19 year-old adolescents (n=521) in a university campus in Manila in 2008. Dietary diversity scores (DDS) were calculated. Nutrient adequacy ratio (NAR) is the ratio of subject's nutrient intake to the 2002 Recommended Energy and Nutrient Intakes (RENI) for Filipinos. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a ratio (range from 0-1). MAR was used as a measure of adequacy of overall diet. Pearson correlation coefficients between DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. Results. The adolescents had a mean DDS of 3.94 (1.21) and a mean MAR of 0.67 (0.18). There was a strong correlation between MAR and DDS (r=0.543; P < 0.0001). A DDS of 4 was shown to be the best indicators for both MAR equivalent to 0.5 and 0.7 since they provided the best sensitivity and specificity. Conclusion. DDS can be used as a simple and quick indicator of the nutritional adequacy of the diets among these group of adolescents. Further investigation of this tool is needed for other population groups i.e., adults and elderly.
Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; DIET ; ADOLESCENT NUTRITIONAL PHYSIOLOGICAL PHENOMENA ; PHYSIOLOGICAL PHENOMENA ; NUTRITIONAL PHYSIOLOGICAL PHENOMENA ; DIET THERAPY

Objectives. As part of the global initiative to eradicate poliovirus infections this study aims to: (1) estimate the prevalence of vaccine-derived poliovirus excretion among persons diagnosed with primary immune (B-cell or combined B/T-cell) deficiency disorders (PIDD) in the Philippines; (2) describe clinical features of these PIDD patients excreting poliovirus; (3) genetically characterize vaccine-derived polioviruses isolated from persons with PIDDs; and (4) determine the duration of poliovirus excretion among subjects who tested positive for vaccine-derived poliovirus excretion. Methods. Seventy-one (71) Filipino patients (ages 0-35 years of age) with PIDD were recruited retrospectively and prospectively over a period of 16 months. The study participants, after informed consent and administration of a questionnaire for baseline data, underwent further testing of quantitative immunoglobulin levels (IgG, IgA, and IgM) and stool poliovirus isolation using two stool samples. Stool specimens which tested positive for the poliovirus were sent to the Regional Reference Laboratory in Australia for further characterization by Intratypic Differentiation (ITD) and Vaccine-derived polioviruses (VDPV) real-time PCR. These participants were then monitored on a monthly basis until laboratory tests identified two sequential months of negative poliovirus stool specimens. Results. Seventy-one (71) patients underwent interview and quantitative serum immunoglobulin testing. However, one patient expired prior to stool isolate collection. This study, then, documented that none of the remaining 70 Filipino individuals (0-35 years old) with confirmed or suspected PIDDs chronically excreted immunodeficiency-associated vaccine-derived poliovirus (IVDPV). One patient who was a recent OPV-recipient excreted poliovirus Sabin-like 1 transiently (less than 1 month) and two patients excreted non polio-enteroviruses. Conclusions. Chronic and prolonged poliovirus excretion appears to be uncommon among Filipino patients with diagnosed Primary Immunodeficiency Disease Disorders. However, as part of the continuing global initiative for poliovirus eradication, vigilance is still necessary in patients with primary immunodeficiency diseases. Adequate identification of these patients followed by monitoring their capacity for viral excretion and environmental contamination may be necessary to achieve this goal.
Human ; Male ; Female ; POLIOVIRUS VACCINE, ORAL

Food-borne trematodes (FBTs) are emerging infections and of substantial public health importance but are among the most ignored of the neglected tropical diseases (NTDs) in terms of attention, research and funding. A review of the status of FBTs in the Philippines based on the best available local and national information may provide a basis for the formulation of appropriate prevention and control measures most suitable for its setting. This review presents a summary of the key features of FBTs and the epidemiologic pattern of FBTs in the Philippines and on the current measures being done for infection control and prevention in other countries. Paragonimiasis, echinostomiasis, and heterophyidiasis are still prevalent in the Philippines with food preparation and hygiene practices and presence of infected intermediate hosts as major determinants of epidemiology and disease burden. Control and prevention of food-borne trematodes may be best achieved with political will, coordinated efforts among responsible public sectors, and involvement of relevant communities.
FOOD HANDLING

While the Philippines has one of the lowest HIV prevalence rates in the world, an unprecedented increase in recent years seems to indicate that a large epidemic is only be a matter of time. Multiple factors including poor condom use, increasing rates of casual sex, and misinformation, are ingredients for the widespread emergence of HIV. Financial consequences will be significant since the Philippine economy is increasingly driven by industries employing young people who are at risk. Recent research showing better clinical outcomes for early treatment with antiretrovirals (ARVs), coupled with data demonstrating a drastic reduction in transmission with early therapy, provide a compelling argument for a universal test and treat strategy. With just over 7,000 confirmed cases, this approach is financially feasible, and is an efficient model for proof-of-concept.
Human ; Male ; Female ; ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE ; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ; OCCUPATIONAL HEALTH

Culture possesses multiple functions in psychotherapeutic processes: (1) it creates specific sources of stress, (2) it provides specific modes of coping with distress, (3) it governs social responses to distress and disability, (4) it defines the symptoms of distress and psychopathology, (5) it determines the interpretation of symptoms and their subsequent biological, psychological, and social impacts, (6) it guides help-seeking and the response to treatment, and (7) it shapes the meaning of the illness experience. Psychotherapy, therefore, involves processes that are informed by the patient's culture. Indigenous psychotherapies could be found in many societies and they may be used alone or in conjunction with Western modalities of treatment. In the Philippines, psychotherapists largely employ Western models of psychotherapy. This paper describes some indigenous healing rituals and discusses the psychosocial framework that lends efficacy in the treatment modalities for psychological problems. Furthermore, this paper also aims to integrate this framework into the current practice of psychotherapy in the Philippines and provide recommendations vis-a-vis training, service, and research in the field of psychotherapy.
MEDICINE, TRADITIONAL

Management of infants born with cleft lip and palate entails an interdisciplinary team effort that begins from infancy to adulthood. The goal of pre-surgical infant orthopedics is to reduce the severity of the cleft deformity before surgery. However, traditional methods do not address the deformity of the nasal cartilages and alveolar ridges simultaneously. The Nasoalveolar Molding (NAM) technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. The NAM device is used to actively mold the alar dome, nasal cartilages, premaxilla, and alveolar ridges into a more normal anatomic form and position. It permits non-surgical elongation of the columella through application of tissue expansion principles. This results in better facial aesthetics and may help reduce the extent, number and cost of surgeries. The three cases presented illustrate the application of the NAM device for the pre-surgical infant orthopedics in unilateral and bilateral cleft lip and palate patients treated at the Philippine Children's Medical Center-Pediatric Dentistry Division (PCMC-PDD).
Human ; Male ; Infant Newborn ; CLEFT LIP ; CLEFT PALATE ; MUSCULOSKELETAL DISEASES ; JAW DISEASES ; JAW ABNORMALITIES

This is a case of a 52 year-old female admitted in the medicine ward of the Philippine General Hospital (PGH) for drowsiness, fever and jaundice. This paper will illustrate an unusual case of encephalopathy, chronic abdominal pain and jaundice due to disseminated strongyloidiasis. Four months prior to admission (PTA), the patient sought consult for on and off right lower quadrant abdominal pain, easy fatigability, generalized body weakness, and vomiting of previously ingested food. Physical examination revealed pallor, right costovertebral angle and right lower quadrant abdominal tenderness. Work-up done showed a urinary tract infection and hookworm. An ultrasound of the kidneys and urinary bladder did not reveal any renal abscess and showed only a hyperechoic mass confirmed to be angiomyolipoma by abdominal CT scan. Bilateral renal cysts were also noted. Treatment for the urinary tract infection and hookworm were prescribed. She was lost to follow up.
Human ; Female ; Middle Aged ; PARASITIC DISEASES ; STRONGYLOIDIASIS ; SIGNS AND SYMPTOMS ; ULTRASONOGRAPHY