Family physicians see victims of violence, abuse and neglect regularly as they care for individuals of all ages, sexual orientations, socioeconomic, ethnic and cultural backgrounds. Early identification of abuse is essential to eliminating violence and subsequent health problems in women's lives. Universal screening procedure may be the most effective way to identify battered women. Objective: The purpose of this study was to test the validity of the Filipino HITS tool in screening patients who have experienced physical emotional/psychological intimate partner violence in a primary care setting. Method: This was cross-sectional study with purposive non-probability sampling conducted at the Family Medicine Clinic of the Outpatient Department of the Philippine General Hospital from September 1 to 16, 2005. Results: A total of ninety-two patients were included in the study. The mean age of the study participants was 45 years old. Most of the women screened were housewives (39.1%); most their partners were unemployed (33.7%). Using the Filipino HITS screening tool, 8 out of 92 (8.7%) women were screened to be positive for intimate partner violence while using the modified Conflicts Tactics Scale, 45 out of 92 (48.9%) women were identified to have experienced physical and emotional intimate partner violence within the past year. There is no significant difference between the employment status, average monthly incomes, religion and areas of residence of women who have experienced intimate partner violence and those who have not. Conclusion: The Filipino HITS scale is a poor screening tool due to its low sensitivity however its high specificity makes it a good diagnostic tool. Assessment of comfort levels of both patients and physicians in using the screening tools for domestic violence is recommended. The inclusion of other items which can assess other common forms of abuse such as economic abuse is also recommended.
VIOLENCE ; PRIMARY HEALTH CARE

Objectives: A cross-sectional study was conducted to describe the relationship of the resident physicians' knowledge, attitudes and practices on end-of-life and demographic features, medical specialty, formal training on care of the dying, personal and clinical experience on care of the dying patients. Methods: A total of 67 resident trainees participated in the study. They were asked to answer the K-A-P questionnaire on end-of-life care. The data gathered were tallied using Microsoft Excel and analyzed using SPSS 10.0 statistical software. Results: More than half of the respondents have adequate knowledge (52.2 percent), positive attitude (53.7 percent), and have appropriate practices (53.7 percent). Nearly half (49.3 percent and 44.8 percent) of the resident physicians regarded themselves as satisfactory in knowledge and attitudes, nearly half (44.8 percent) and a third (38.8 percent) of the residents respectively assessed themselves as fair and satisfactory in end-of-life care practices. Using chi-square test, the relationship between the different physicians' characteristics and their knowledge, attitudes and practices was assessed. Males had adequate knowledge (68.2 percent) than females (44.4 percent) (p=0.068). More married individuals (77.7 percent) had positive attitude and appropriate practices than single individuals (50.0 percent) (p=0.167). Nearly two-thirds (63.3 percent) of third year and higher residents had positive attitude and appropriate practices than first and second year residents (45.9 percent) (p=0.156). More than two-thirds (66.7%) of those with formal training had more appropriate practices than those without formal training (46.5 percent) (p=0.113). No significant association between end-of-life care knowledge-attitudes-practices and these aforementioned physicians' characteristics was observed. In all other characteristics, relationship was far from being statistically significant. For knowledge, ENT-HNS, Family Medicine and Surgery residents had the most residents with adequate knowledge. The difference in the proportion of residents' knowledge across medical specialties was statistically significant (p=0.055). For attitude, Family Medicine, Obstetrics and Gynecology and Surgery had the most residents with positive attitude. The difference though was not statistically significant (p=0.156). For practices, Family Medicine, Child Health and Surgery had the most residents with appropriate practices. Here, the difference was statistically significant (p=0.010). Because of inadequate sample size however, chi-square test for these associations may not be valid. Those with personal experience with death of a loved one or a close friend (61.2 percent) had appropriate practice in end-of-life care than those without (33.3 percent). The difference was statistically significant (p=0.042). More of those with clinical experience on care of dying patients had appropriate practices (59.3 percent) than those without (30.8 percent). The difference was almost statistically significant (p=0.064). Among those residents with more than three years of clinical practice, 81.8 percent had positive attitude compared to only 45.5 percent both for less than two and 2-3 years of clinical practice. The difference likewise was of borderline significance (p=0.097). Lastly, relationship between the physician's own assessment of their knowledge, attitudes and practices and their actual knowledge, attitudes and practices Was also assessed using the same statistical test. Actual and personal assessment of end-of-life care, residents who rated themselves as either having a very satisfactory and satisfactory knowledge, attitudes and practices in end-of-life care had higher proportion of actual adequate knowledge, positive attitude and appropriate practices.
ATTITUDE ; PATIENT CARE ; TERMINAL CARE

Objective: To compare Nimesulide alone with Nimesulide and Green Tea (Camellia sinensis) as adjunct therapy in the management of osteoarthritis. Design: Single-blind controlled therapeutic trial. Setting: Out Patient Department of Quezon City General Hospital. Study Subjects: Patients aged 40 years old and above who satisfied the clinical criteria for osteoarthritis. Interventions: A total of 30 out of 39 patients aged 42-82 from the QCGH Out Patient Department were included in the study. Patients were randomly assigned to receive either the Control Group - Nimesulide only taken on as needed basis for four weeks or the Treatment Group - Nimesulide and Green Tea (Camellia sinensis), the former taken on an as needed basis, while the latter taken three times a day for four weeks upon enrollment in the study. Both groups contained 15 patients each. Using the Epi-Info, Epistal and SPSS softwares, the sociodemographic characteristics and the efficacy of Green Tea as an adjunct therapy were analyzed and compared, as well as the occurrence of adverse events observed between the two treatment groups. Cost-effectiveness of Green Tea as adjunct treatment was measured using the mean treatment cost as compared to Nimesulide only treatment. Results: Thirty patients completed the study. The mean age of the Control Group is 62 and 58 for Treatment Group. There were more females than males in both groups at 67 percent and 80 percent, respectively. A big part of the study subjects for the Control Group were laborers 7 (46.7 percent) and housewives 5 (33.3 percent) for the Treatment Group. As to body mass index, most of the patients belonged to Obese Class I, 53.3 percent and 40 percent, respectively. The most commonly involved joint for both groups was the knee (33.3 percent, 46.7 percent, respectively). Pain control improved in both groups as shown by a decreasing trend in Visual Analog Scale scores but difference between the two was not statistically significant. Improvement in functionality was observed in both groups as evidenced by decreasing scores in Functional Capacity Scoring System but the difference between the two groups became statistically significant after the 3rd and 4th weeks of treatment. There was also an improvement in the degree of pain control in both groups as seen by a decreasing amount of Nimesulide used and the difference between the two was statistically significant. Three patients from the Control Group had untoward symptoms during the course of treatment compared to only one from the Treatment Group. Three from the Control Group presented with gastrointestinal symptoms most probably due to the Nimesulide being taken, while the patient from the Treatment Group experienced insomnia on the 4"1 week of treatment. However, difference between the two groups was not significant. As to the total cost of the entire treatment (4 weeks), the Treatment Group had Php2.37 more than the Control Group. Conclusion: This study showed that Green Tea (Camellia sinensis) is an effective, safe and cost-effective adjunct therapy in the treatment of osteoarthritis.
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; OSTEOARTHRITIS ; PLANTS, MEDICINAL ; NIMESULIDE

Background: von Willebrand Diseases (vWD) is the most commonly inherited bleeding disorder. It is defined as a deficiency or abnormality of von Willebrand Factor (vWF) causing impaired hemostasis. Studies in a predominantly pediatric population reveal that the prevalence of vWD is 0.8-1.3 percent. Objective: To determine the prevalence of von Willebrand Diseases and to establish its clinico-hematologic profile. Methods: Ninety-nine patients with bleeding manifestations referred to the National Hemophilia Center from all over the Philippines were studied. Patients who fulfilled the inclusion criteria of at least 2 symptoms consistent with vWD, underwent initial screening tests: a complete blood count with actual platelet, blood typing, bleeding time, prothrombin time and activated partial thromboplastin time. Laboratory tests to diagnose vWD were done. Results: Thirty four patients (34.34 percent) with bleeding manifestations had vWD. Patients with vWD and those without were comparable as to age, sex distribution, family history of bleeding, blood type and bleeding manifestations. Among the patients with vWD, 11 (32.35 percent) had Type I vWD and 23 (67.65 percent) had Type 2 vWD. The mean FVIII, vWF: Ag and vWF: RCo were decreased. Conclusion: The study suggests that there is a high proportion of vWD among patients with bleeding tendency in the Philippines.
Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; VON WILLEBRAND DISEASES ; HEMORRHAGE

Objective: To modify a validated questionnaire to prospectively identify individuals at increased risk for undiagnosed diabetes. Research Design and Methods: Each subject was asked to answer the ADA Diabetes Risk Test (ADADRT). The total score was tabulated to know if the patient was at increased risk or not for developing diabetes. All subjects submitted venous blood samples for a fasting blood sugar (FBS) determination. The ADADRT total scores were compared with the FBS values using chi square (chi2) tests and likelihood ratios (LR). The ADADRT of the study population was modified using the new Asian BMI. Scores were recomputed and compared with FBS using the same statistical measure. The ADADRT and the Modified Diabetes Risk Test (MDRT) were compared to determine if they were statistically different using Fisher's exact test and which one would have a better sensitivity, specificity and positive predictive value. The study population in the First Phase of the study included patients in a primary care clinic in a tertiary hospital, the Second Phase was the validation in a rural community and the Third Phase was the actual implementation of the validated screening tool among patients seen in a primary care clinic in a community set-up. Results: In a representative sample of USTH patients (Phase 1), the sensitivity of the ADADRT was 41 percent, the specificity was 89 percent, x2 was at 10.59 which was significant at P> 0.05; likelihood ratio for a positive test LR (+) computed was 3.72; Likelihood ratio for negative test LR (-) computed was 0.66. In the same representative sample, the sensitivity of the MDRT was 81 percent, the specificity was 92 percent, x2 was 32.2 which was significant at P>0.05; LR (+) was 10.125 and the LR (-) was 0.21. Computed Fisher's exact test was 0.387, which was significant at P>0.05. In Phase II, ADADRT sensitivity was 64 percent, specificity was 83 percent LR (+) 3.11 and LR (-) 0.19 whereas the MDRT sensitivity was 86 percent, specificity was 72 percent, LR (+) 3.73 and LR (-) 0.43 and f-test 0.0063. In Phase III, the MDRT identified 18 as high risk where only 15 had elevated FBS. Conclusion: The modified ADA Risk Test using the new Asian BMI performed significantly better than the existing ADADRT and should serve as a simple, noninvasive and potentially cost-effective add-on screening tool for detecting those at increased risk for diabetes mellitus type 2 in the local setting.
Human ; Male ; Female ; DIABETES MELLITUS, TYPE 2

BACKGROUND: Physician empathy is an effective therapeutic component of patient-physician communication. It is thus essential to develop and sustain it throughout medical school to equip the would be physicians with this attribute throughout their clinical careers. However, several studies have shown that empathy levels of medical students decline overtime.

OBJECTIVE: To determine the empathy score across medical school years of students in the University of the Philippines College of Medicine.

METHODOLOGY: First through fifth year medical students enrolled in the College of Medicine for the school year 2014 to 2015 and who consented to participate were included.

DESIGN: Analytical cross sectional study of medical students at the University of the Philippines College of Medicine in 2014.

DATA COLLECTION: The primary measure of empathy used was the Jefferson Scales of Empathy--Student Version (JSE-S), a 20-item psychometrically validated instrument measuring components of empathy among medical students in patient care situations.

RESULTS: Mean empathy scores significantly varied across year level, sex and age group (P<0.05). The significant difference in the adjusted mean empathy scores was seen between the first and third year levels (117.0 vs. 108.1 P<0.05) and first and fifth year levels (117.0 vs. 107.1 P=0.04). The mean empathy score of female medical students as compared to male medical students was higher (114.4 vs. 109.8 P=0.002). Difference in empathy scores were noted between the less than 22 and 25-27 age groups (115.2 vs. 104.5 P=0.006). While there was a note of decrease in the empathy scores among students who chose"technology- oriented"specialties from"people-oriented"specialties, the difference was not statistically significant. (112.2 vs 113.2 P=0.942).

CONCLUSION: Empathy scores of the medical students in the University of the Philippines College of Medicine declines across year levels.

Human ; Male ; Female ; Empathy ; Personality ; Behavior and Behavior Mechanisms ; Students, Medical

BACKGROUND: Caregivers play an important role in the care of chronically ill patients. In order to be effective carers, it is essential that factors affecting their quality of life be measured.

OBJECTIVE: To determine the different factors (socio-demographic, patient, and caregiver) affecting family function and quality of life of primary caregivers of chronically-ill patients, De La Salle University Medical Center July-October 2014.

METHOD: This cross-sectional study included 104 primary caregivers of chronically-ill adult patients from the out-patient department, service and pay wards of De La Salle University Medical Center. Included in the study are primary caregivers aged 18 years and above. The days of interview with primary caregivers of chronically-ill patients at the OPD, service and pay wards were randomly selected. Three days per week were allotted for the interview. Medical charts of admitted adult patients at service and pay wards were reviewed to identify those suffering from chronic illness. All primary caregivers present during the day of interview who passed the inclusion criteria were included as participants after obtaining their consent for the study. An interview using an interview guide followed right after consent was given.

RESULTS: Among 104 primary caregivers of chronically-ill adult patients, 52.9% perceived their families as being highly functional, 28.8% moderately functional, 10.6% as being functionally at risk, 4.8% moderately dysfunctional and 2.9% severely dysfunctional. Majority (71.2%) reported to have a good quality of life. None of the caregivers screened positive for depression. Family function was found to be significantly associated with the number of household members (p-value: 0.01), relationship to patient (p-value: 0.03) and patient's age (p-value: 0.04). Quality of life was significantly associated with caregiver's age and relationship to patient. Family function and quality of life was significantly associated with each other (p-value: 0.04).

CONCLUSIONS: Majority of primary caregivers of chronically-ill adult patients perceived their families as highly functional. Among the socio-demographic, caregiver and patient factors included in the study, the only ones with significant association with family function are the number of household members, the caregiver's relationship to patient and the patient's age. Most of the primary caregivers reported to have a good quality of life. The only factors significantly associated with caregiver's quality of life are caregiver's age and relationship to patient. A significant association was found between quality of life and family function of primary caregivers. Adequacy of cohesion, as a subscale of family function, significanty improves.family: Arial; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">

RECOMMENDATIONS: Knowing the factors affecting family function and quality of life, and the development of family programs that will improve family function and promote good quality of life of primary caregivers are recommended.

Human ; Quality of Life ; Caregivers ; Chronic Disease

OBJECTIVE: To determine the effectiveness and safety of Aloe vera as an adjunct treatment to Metformin in lowering Fasting Blood Glucose levels in Diabetic patients.

DESIGN: Therapeutic Clinical Trial

STUDY SUBJECTS: Patients aged 40-65 years old taking Metformin 500mg twice a day with FBS of 126mg/dL to 250mg/dL with no other co-morbidities seen at Family Medicine - Quezon City General Hospital, Out Patient Department.

METHOD: Sixty (60) out of 93 study subjects were included after baseline determination of FBS and was assigned to either of the two groups after systematic random sampling method. Both groups had 30 subjects each and were given Aloe vera and placebo on the assigned group. Repeat FBS was determined after 2 weeks. Data gathered were analyzed using Epi info 6 SPSS ver 20 and STATA 11.0 Software.

RESULTS: Sixty (60) patients completed the study. The mean height in Group A (OHA+Aloe vera) was 161.53(+/- 7.651) and Group B 159.83 (+/- 8.465). The mean height in Group A was 60.70 (+/-11.996) and Group B 59.95 (+/-10.528). The mean BMI in Group was 23.21 (+/- 4.027) and in Group B 23.557 (+/-4.481). The mean age in Group A was 52.97 (+/-­5.720) and in Group B 57.63 (+/-4.287). The Gender had a p value of 0.796; occupation p value 0.067; and education p value 0.796. The comparison of mean change in FBS within groups had a p value of 0.001. The comparison of mean change in FBS between groups in pre-treatment, p value of 0.933; post treatment p value of 0.0104. The FBS % change in both groups had a p value of 0.001. The comparison of age-adjusted percent change in the FBS between the 2 groups had a p value of 0.001. There was one patient who experienced bloatedness on the third day of treatment in Group A.

CONCLUSION: This study has shown that the use of Aloe vera as an adjunct treatment to Metforms is effective and safe.

Human ; Aged ; Middle Aged ; Adult ; Diabetes Mellitus ; Metformin ; Aloe ; Plants, Medicinal

BACKGROUND: The study is a post-marketing surveillance study conducted for a one month period, with two visits at two-week intervals.

METHODOLOGY: The design was prospective, open-label and observational, which included adult patients 18 years old and above, diagnosed with mild to moderate hypertension, requiring treatment with anti-hypertensive. Data collected were analyzed descriptively. Heart rate and systolic and diastolic BP were described by the total number of observations, mean and standard deviation. Efficacy and safety were determined and student's t-test was used to calculate statistical significance.

RESULTS/CONCLUSION: At the end of the study period, S(-) amlodipine was found to a have positive effect on heart rate and both systolic and diastolic blood pressure and this effect is sustained over four weeks. A very low of transient adverse events were recorded, with headache still the most common.

Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Adolescent ; Amlodipine ; Safety ; Treatment Outcome ; Hypertension

Human ; Male ; Female ; Aged 80 and over ; Aged ; Ambulatory Care ; Caregivers ; Family ; Patient care ; quality of life