BACKGROUND: Health-related quality of life is an important aspect of cancer research. Studies in the Philippines documenting this among survivors are limited in scope and number.
OBJECTIVE: To document quality of life indicators of Filipino cancer survivors starting at 12 months from diagnosis and identify predictors of these changes.
METHODS: The ACTION study is a prospective longitudinal study examining the economic and health impact of cancer in the Southeast Asian Region. A country-specific analysis for Filipino patients was conducted.
RESULTS: Of the 909 Filipinos included in the study, 462 survived month 12 and had health-related quality of life (HRQoL) data. HRQoL data showed significant improvement from baseline (0.73, SD: 0.15) to month 12 (0.79, SD: 0.24) as measured by the EQ-5D weight score. Similar trends were seen in the EQ5D VAS Scores and the QLQ30 Global function scores. There was, however, an increase in the proportion of respondents experiencing significant problems related to EQ5D domains by month 12. Data disaggregated according to cancer type showed a decrease in QLQ30 GF scores from baseline to month 12 for all types except breast cancer. Individuals at risk of anxiety and depression increased from 15.37% to 25.54% and 18.83% to 32.25%, respectively. Predictors of worsening HRQOL include experiencing economic hardship, progression of disease, and higher stage at baseline.
CONCLUSION: HRQOL scores were found to increase despite experiencing more difficulties in function among Filipino cancer survivors one year after diagnosis.

Human ; Male ; Female ; Adult ; Depression ; Quality Of Life ; Survivors ; Anxiety ; Surveys And Questionnaires ; Depressive Disorder ; Breast Neoplasms

BACKGROUND AND OBJECTIVE: Road traffic injuries were the second leading cause of death due to injury in 2003 in the Philippines. In 2011, the Philippine Road Safety Action Plan (PRSAP) was instituted. Five years into the program, latest data showed that the death rate due to road injuries continue to increase despite the presence of key legislation supporting road safety. This study was aimed at identifying the gaps in addressing road safety in the Philippines.

METHODOLOGY: Literature review and key informant interviews of representatives of the different agencies including the Department of Transportation and Communications (DOTC), Department of Public Works and Highways (DPWH), Road Board, Philippine National Police (PNP), Metro Manila Development Authority (MMDA), and Land Transportation Office (LTO) were conducted to identify gaps in the program.

RESULTS AND CONCLUSION: Key gaps include: weak leadership at the national and local level, limited material and human resources for enforcement of laws, and fragmented information system. These gaps should be addressed to improve the road safety situation in the country.

Developing Countries

Background: Cervical cancer is the second most common malignancy among Filipino women. The recent 2018 FIGO guidelines recommend imaging in cases of grossly invasive disease to determine the presence of hydronephrosis, which would immediately classify the disease as at least stage IIIB. CT and MRI are state-of-the-art modalities that can provide such information; however, these are costly and may not be accessible in areas with limited resources. Sonography is a safe and inexpensive alternative in this regard.

Objective: This study aimed to evaluate the diagnostic performance of renal sonography in identifying the presence of ureteral obstruction or hydronephrosis among patients with grossly invasive cervical cancer, with non-enhanced CT as the reference standard.

Methods: A blinded, prospective study was conducted among patients diagnosed with grossly invasive cervical cancer from the Philippine General Hospital. Participants underwent same-day evaluation with both renal sonography and non-enhanced CT. The presence of either ureteral obstruction or hydronephrosis secondary to cervical cancer was independently determined. The sensitivity, specificity, positive predictive value, and negative predictive value of renal sonography were calculated, with non-enhanced CT as the reference standard.

Results: A total of 127 participants were enrolled. The mean age was 46 years, with a range of 24 to 65 years. The majority had stage IIB (41.7%) and stage IIIB (52.0%) disease. On non-enhanced CT, 46 (36.2%) showed evidence of ureteral obstruction or hydronephrosis, while 81 (63.8%) had negative results. On renal sonography, 46 (36.2%) had positive results, and 81 (63.8%) had negative findings. The sensitivity, specificity, and positive and negative predictive values of sonography were 91.3%, 95.1%, 91.3%, and 95.1%, respectively. Among patients with stage IIIB disease, sonography was shown to have higher sensitivity and specificity of 92.1% and 96.4%, respectively. Meanwhile, among patients with stage IB to IIB disease, its sensitivity and specificity were 87.5% and 94.3%, respectively.

Conclusion: Renal sonography has high sensitivity and specificity in the diagnosis of ureteral obstruction or hydronephrosis in patients with grossly invasive cervical cancer. Its sensitivity is higher when used in patients with stage IIIB disease, compared with those having lower-stage tumors.

Uterine Cervical Neoplasms ; Hydronephrosis ; Ureteral Obstruction ; Ultrasonography

BACKGROUND: Entamoeba histolytica is an important etiologic agent of diarrhea. Globally, it is estimated to infect 40 to 50 million people and cause 40,000 to 100,000 deaths per year. Metronidazole is effective but can cause adverse reactions in certain individuals. In search of alternatives, traditional medicinal plants are being studied. Several plants in Family Simaroubaceae have shown anti-amoebic activity. Quassia amara, a member of this family has not been tested.
OBJECTIVE: To determine the effect of Q. amara crude extract on Entamoeba histolytica in vitro.
METHODS: Initial testing of 104 µg/ml ethanolic bark extract was performed. Counts were made after 72 hours. Three trials in triplicates were performed.
Nine (9) dilutions of extract were then tested (18.8 to 5,00 µg/ml). Test tubes were checked for viable amoeba after 24-hour and 72-hour incubation. Minimum inhibitory concentrations (MIC) were determined for the two incubation periods. At least two trials in triplicates for each dilution were performed. metronidazole served as positive control.
RESULTS: At 104 µg/ml incubated for 72 hours, no viable amoeba was obtained and counted. The MIC after 24 hours was 5,000 µg/ml, while the MIC at 72 hours was 37.5 µg/ml.
CONCLUSION: Q. amara crude extract has inhibitory effects on E. histolycain vitro.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Quassia ; Metronidazole ; Entamoeba Histolytica ; Plants, Medicinal ; Amoeba ; Simaroubaceae ; Microbial Sensitivity Tests ; Diarrhea

BACKGROUND: Dysphagia is common among post-stroke patients,causing disability due to malnutrition and pneumonia. Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment modality to address this complication.

OBJECTIVE: The study aimed to compare real versus sham rTMS in treating post-stroke dysphagia.

METHODS: PubMed, Ovid, ClinicalKey, Herdin, and Google Scholar databases were searched from their earliest record to 31 July 2015 for randomized controlled trials that used rTMS to treat post-stroke dysphagia. The Jadad scale was used to assess the quality of the studies. The weighted mean difference (WMD) between baseline and post-treatment mean for Penetration Aspiration Scores (PAS) measured in the experimental and control groups were extracted for subsequent meta-analyses.

RESULTS: Three studies were analyzed. The WMD in PAS score between rTMS and control using liquid bolus two weeks after treatment in two good quality studies was -1.14 (95% confidence interval (CI) = -1.80 - -0.48, P = 0.001, I2 = 0.0%), and after four weeks was -1.83 (CI = -3.22 - -0.44, P = 0.010, I2 = 0.0%).

CONCLUSION: Treatment of post-stroke dysphagia with rTMS improved PAS on subgroup analyses of studies using liquid bolus after two weeks, and between real and sham treatment after four weeks.?

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Deglutition Disorders ; Transcranial Magnetic Stimulation ; Stroke ; Pubmed ; Qualitative Research ; Pneumonia ; Malnutrition

BACKGROUND: Injuries are common causes of hospital visits and deaths in the Philippines. The national healthcare-associated expenses due to these injuries have not been established.

OBJECTIVE: To estimate the healthcare-associated expenses due to injuries in the Philippines. Methods. Review of patient charts and patient interviews were conducted in 21 hospitals in the Philippines. A convenience sample of patients was interviewed to ascertain other direct medical and non-medical expenses.

RESULTS: Median admission costs based on hospital bills were: road injuries: PhP10,192.25, poisoning: PhP4,402.00, burns: PhP6,521.53, animal-related: PhP5,105.92, other accidents: PhP7,545.71 and intentional injuries: PhP8,023.00. Based on survey, other expenses not stated in hospital bills include medical supplies (PhP4,000.00), diagnostic tests (PhP 2,000.00), and post-discharge expenses (PhP 1,000.00).

CONCLUSION: Expenses due to injuries varied according to cause. Admission expenses recorded in the bill were not the only healthcare-related expenses shouldered by the patient and accounted for 68.6-159.0% of the bill value.

Human ; Philippines ; Wounds And Injuries

Background: Injury surveillance is viewed as an important component of injury prevention. Several data systems in the Philippines exist but have not been analyzed together. Analyzing these readily available data can guide policy making. Objective: This report aimed to describe the epidemiology of injuries in the Philippines using secondary datasets. Method: Death data of 2013 from the Philippines Statistics Authority and injury surveillance data of 2014 from the Department of Health were obtained and recoded. Summary statistics were generated. Results: Injured persons mainly come from the young age group. There were a higher number of males compared to females. Provincial variations in death rates for specific injury types existed. There did not seem to be an obvious pattern in injury occurrence according to month and time of day. High numbers of injuries were reported during daytime but admission and death rates peak at night. Injuries were shown to be an anatomically heterogeneous group with dominance in superficial injuries, head trauma, and hand fractures. Conclusion Analysis of secondary datasets revealed the epidemiology of injuries in the Philippines. Results have implications in health policy and injury prevention.
Epidemiology ; Secondary Data Analysis ; Wounds and Injuries

BACKGROUND: Road traffic injuries (RTI) are a leading cause of morbidity and mortality globally. Despite underreporting, the scarce Philippine data suggest that RTI pose a significant health problem in the country. It is imperative, therefore, to accurately quantify the burden of RTI in the Philippines.

OBJECTIVE: This study aimed to provide the first comprehensive baseline estimation of the socioeconomic burden of RTI in the Philippines for year 2014.

METHODS: The study was a mixed method study design that utilized both primary and secondary data. These data were used to construct parameters needed for the modeling estimates. Measure of socioeconomic burden estimated were (1) economic costs, (2) disability-adjusted life years (DALYs), and (3) healthy life years (HeaLY).

RESULT: Estimated deaths due to RTI in 2014 were 12,336 translating to 454,650 years life lost due to premature death. Injury episodes from RTI were estimated to be 2,798,088 in 2014 with 186,174 leading to admissions, translating to 56,224 years life lost to disability. The total DALY loss due to RTI in 2014 was estimated at 510, 874, while healthy life years lost were estimated to be 76,215,477.4. The estimated deaths and injuries for that year equaled to direct medical cost of PhP 1.213 B, productivity loss due to premature death of PhP 24.620 B, and productivity loss due to illness of PhP 685 M resulting to a total economic cost of PhP 26.519 B to the society.

CONCLUSION: The findings indicate that RTI is an important public health concern in the Philippines with substantial economic and health burden. Investing in preventive measures will likely yield significant economic and health gains for the Philippines.

Human ; Wounds And Injuries

The use of child restraints such as car seats or booster seats inevitability increases with the implementation of laws mandating its use in the general public. This is of great importance to child health and injury prevention as child restraint use has been shown to reduce the risk of serious injury by 71% to 82% for children less than 1-year-old, and 45% for children aged 4 to 8 years old.2,3 In terms of averting death, child restraints were associated with 28% reduction in risk for death.4 It has been found that using ageand size-appropriate child restraints is the best way to save lives and reduce injuries in a crash.5 It is reasonable, therefore, that one study that investigated the association between child restraint law implementation and traffic injury rate among 4 to 6 years old children in New York State found that these children experienced an 18% reduction in traffic injury rate. (See full-text for continuation).
Human ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Pediatrics

BACKGROUND: Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.

OBJECTIVE: This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.

METHOD: The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.

RESULTS: Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.

CONCLUSION: Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.

Human ; Neoplasms ; Cohort Studies ; Healthcare Financing ; Philippines