BACKGROUND

Self-management is crucial for individuals with chronic illnesses. While mobile applications (mAPPs) have emerged to support diverse health needs, evidence regarding their efficacy for self-management among chronically ill Filipino patients is inconsistent and limited, particularly in provincial settings.

To investigate the effectiveness of the Health Storylines mAPP compared to a traditional pamphlet for enhancing self-management among individuals with chronic illnesses in Baguio City, Philippines.

We conducted a two-arm quasi-experimental study with 33 participants diagnosed with cancer, type 2 diabetes, or heart disease/hypertension. Participants were recruited via convenience sampling and allocated to an intervention group (n=17), which used the Health Storylines mAPP for four weeks, or a comparison group (n=16), which received a traditional pamphlet. Selfmanagement was assessed pre- and post-intervention using the Self-Management Assessment Scale (SMASc).

Participants demonstrated a high level of selfmanagement at baseline (μ=5.20, SD=0.70). After four weeks, the intervention group showed a non-significant decrease in self-management scores (from μ=5.25 to 5.00, p=0.27), while the comparison group exhibited a non-significant increase (from μ=5.19 to 5.37, p=0.61). There was no statistically significant difference in posttest self-management scores between the two groups (U=83.50, p=0.23).

In a population of chronically ill patients already proficient in managing their condition, the Health Storylines mAPP had a marginal impact on selfmanagement, while the use of a traditional pamphlet showed a slight positive effect. The findings suggest that for this population, familiar, low-barrier resources remain valuable, and mHealth interventions must account for baseline self-management capabilities and digital literacy. Chronic Illness; Health Storylines mAPP; Self-management; mHealth; Philippines.

BACKGROUND

Youth with disabilities (YWDs) in countries like the Philippines face substantial employment barriers. While school-to-work (STW) transition programs and strong family support are crucial for their success, family involvement in planning is often insufficient.

This study aims to explore the perspectives of families of YWDs on STW transition in the Philippines and the differences in perspectives among families from varying socioeconomic backgrounds.

This exploratory-descriptive qualitative study utilized semi-structured interviews with seven primary caregivers of YWDs in Metro Manila, representing diverse socioeconomic backgrounds. Thematic analysis was employed.

Three key themes emerged. First, families underscored the value of education in shaping STW transition outcomes, emphasizing its role in building literacy and practical life skills and highlighting the need for improved school support and educator training. Second, significant challenges in accessing support and transition services were reported, with financial constraints in obtaining government aid being a major hurdle regardless of socioeconomic status. Finally, caregivers stressed the family's vital role in transitioning YWDs for adulthood and work, particularly in fostering independence, nurturing strengths, and developing relevant skills for future employment.

This study explored the Filipino families' shared perspectives on STW transition, highlighting the value of education, challenges in accessing support, and the family's role in the transition process. It emphasized the need for accessible and inclusive transition services addressing socioeconomic and cultural factors affecting YWDs and their families. Enhanced stakeholder collaboration is crucial in creating comprehensive and culturally relevant STW services that promote successful workforce integration of YWDs.

Enhancing Visual Outcomes and Patients’ Satisfaction: A Case Series of Mix-and-Match Approach for Unhappy Presbyopic Patients Post-Cataract Surgery This case series explored the mix-and-match approach of implanting an extended depth of focus (EDOF) intraocular lens (IOL) in the fellow eye to improve visual outcomes, reduce spectacle dependence, and enhance satisfaction in presbyopic patients dissatisfied with monofocal IOL outcomes, highlighting personalised refractive solutions for suboptimal results post-cataract surgery. Seven patients dissatisfied with post-operative presbyopia following monofocal IOL in first eye received EDOF IOL in the second eye (mix-and-match approach). Visual outcomes were assessed using a logMAR chart for near (40 cm), intermediate (60 cm and 80 cm) and distance (6 m) visual acuity (VA). Contrast sensitivity was measured using the Pelli-Robson chart, and halos and glare were evaluated with the Zeiss Halo and Glare Stimulator. Patient satisfaction was measured using the CATQUEST-9SF 2011 questionnaire before and after EDOF IOL implantation in the second eyes. Results showed statistically significant improvement in uncorrected near VA at 40cm and intermediate VA at 60cm in eyes with EDOF IOL (0.26 ± 0.18 and 0.11 ± 0.15 respectively) compared to eyes with monofocal IOL (0.64 ± 0.28 and 0.39 ± 0.26 respectively), while maintaining good uncorrected distance VA. Only one patient reported halos with the EDOF IOL, not affecting night driving. Contrast sensitivity showed no significant difference between monofocal IOL (1.60 ± 0.14) and EDOF IOL (1.60 ± 0.17) eyes. All patients were satisfied, experiencing improvements in recognised faces, walking on uneven surfaces, reading newspapers and TV subtitles, engaging in hobbies and seeing price tags. This mix-and-match approach demonstrated efficacy in enhancing near and intermediate vision while maintaining good distance vision, offering a personalised solution to reduce spectacle dependence without compromising contrast sensitivity or causing significant halos and glare.

Duration after Macular Hole Surgery for Stabilisation of Visual Acuity: A Long-term Retrospective Review The purpose of the study is to determine the median duration for visual recovery to achieve visual stability and visual acuity gain after macular hole surgery in our local population. This was a retrospective study. Patients with full-thickness macular holes (FTMH) from surgical logs were included between January 2009 and December 2019. The patients' medical records were reviewed for pre-, intra-, and post-operative data collection. Patients who fulfilled the inclusion and exclusion criteria were recruited and analysed. Data collected from the medical record pre-operatively, which included baseline best corrected visual acuity (BCVA), interval of symptoms development to surgery, any ocular co-morbidities, optical coherence tomography (OCT) for size and stage of macular hole and central subfield thickness (CST). Intra-operative notes included whether vitrectomy with or without phacoemulsification and with the internal limiting membrane (ILM) peel or ILM flaps, types of dye, and tamponade agent used. Post-operative data included BCVA and CST on each visit, types of macular hole closure, or any complications. Data were analysed using SPSS.Thirty-one patients were diagnosed with FTMH. Sixteen patients who underwent pars plana vitrectomy (PPV) were included and analysed. Fifteen patients (93.75%) achieved successful macular hole closure after the primary operation. The median duration BCVA reached at stability was 19.5 months (IQR 9 – 26.25), and visual acuity gained by 0.44 LogMAR (IQR 0.165 – 0.565). Ten patients (62.5%) underwent combined PPV with phacoemulsification. CST showed improvement from baseline, 444 (IQR 347.5 – 519.75) to 273 (IQR 232 -285.5), 230 (IQR 221.5-255), and 270 (IQR 254-322) at the period interval of 0 to 3 months, 3 to 6 months, and 6 to 12 months respectively. Gas C3F8 and membrane blue were commonly used as tamponade agents and dyes, and PPV with ILM peel was the common surgery performed. Six patients (40%) achieved type 1 macular hole closure within 12 months of follow-up. Despite the small sample size, our study provided practical information regarding patient’s expectations of when their vision can become stable after macula hole surgery in our local population.

Oh No! I Can’t See Well after Taking a Hot Shower! This was to report a case of a 33-year-old Malay woman who was previously diagnosed with seronegative neuromyelitis optica spectrum disorder ten years ago based on her clinical presentation, and magnetic resonance imaging (MRI) of the spine showed a long segment of the intramedullary lesion. Her diagnosis was revised to relapsing-remitting multiple sclerosis (RRMS) when she had recurrent optic neuritis with an MRI showing juxtacortical and periventricular lesions. She was started on disease-modifying treatment and was well for six years until she noticed left eye central blurred vision, especially after taking hot showers or exposure to hot weather. Ophthalmological examination revealed left eye visual acuity 6/9 with a relative afferent pupillary defect. Humphrey's visual field also showed left centrocecal scotoma. She was treated with intravenous methylprednisolone with tapering oral prednisolone, which resulted in improvement of the left central scotoma, and her visual acuity reverted to baseline.

Purpose: Periodontitis, the most prevalent chronic inflammatory condition affecting teeth-supporting tissues, is diagnosed and classified through clinical and radiographic examinations. The staging of periodontitis using panoramic radiographs provides information for designing computer-assisted diagnostic systems. Performing image segmentation in periodontitis is required for image processing in diagnostic applications. This study evaluated image segmentation for periodontitis staging based on deep learning approaches. Materials and Methods: Multi-Label U-Net and Mask R-CNN models were compared for image segmentation to detect periodontitis using 100 digital panoramic radiographs. Normal conditions and 4 stages of periodontitis were annotated on these panoramic radiographs. A total of 1100 original and augmented images were then randomly divided into a training (75%) dataset to produce segmentation models and a testing (25%) dataset to determine the evaluation metrics of the segmentation models. Results: The performance of the segmentation models against the radiographic diagnosis of periodontitis conducted by a dentist was described by evaluation metrics (i.e., dice coefficient and intersection-over-union [IoU] score). Multi-Label U-Net achieved a dice coefficient of 0.96 and an IoU score of 0.97. Meanwhile, Mask R-CNN attained a dice coefficient of 0.87 and an IoU score of 0.74. U-Net showed the characteristic of semantic segmentation, and Mask R-CNN performed instance segmentation with accuracy, precision, recall, and F1-score values of 95%, 85.6%, 88.2%, and 86.6%, respectively. Conclusion Multi-Label U-Net produced superior image segmentation to that of Mask R-CNN. The authors recommend integrating it with other techniques to develop hybrid models for automatic periodontitis detection.

Objective: Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA1/2 mutations. Methods: In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with BRCA1/2 mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use. Results: The mean age at RRBSO was 42.4 years (range, 26–49) and the median follow-up for women with BRCA1/2 mutations was 6.9 years (range, 1.1–19.9). There was no increased hazard of fractures for women with BRCA1/2 mutations (adjusted hazard ratio [aHR]=0.80; 95% confidence interval [CI]=0.56–1.14 compared to women who had BO; aHR=1.02; 95% CI=0.65–1.61 compared to women with intact ovaries). Among women who had DEXA-scan, those with BRCA1/2 mutations had higher risk of osteoporosis (aHR=1.60; 95% CI=1.00–2.54 compared to women who had BO; aHR=2.49; 95% CI=1.44–4.28 compared to women with intact ovaries). Women with BRCA1/2 mutations were more likely to get DEXA-scan than either control groups, but only 46% of them were screened. Of the women with BRCA1/2 mutations diagnosed with osteoporosis, 36% received bisphosphonates. Conclusion Women with BRCA1/2 mutations had higher risk of osteoporosis after RRBSO, but were not at increased risk of fractures during our follow-up. Low rates of DEXA-scan and bisphosphonates use indicate we can improve prevention of bone loss.

Background: Pruritus can impair quality of life in patients with atopic dermatitis. There is evidence that acupuncture reduces pruritus and disease severity, and improves quality of life. Objectives: This study aimed to determine the efficacy of acupuncture in reducing pruritus intensity, disease severity, and medication use, and improving quality of life. Methods: This was a patient- and assessor-blinded, randomized, placebo-controlled trial. Patients diagnosed with atopic dermatitis underwent twice-weekly acupuncture for 12 weeks, with an 8-week follow-up period. Baseline and weekly assessment were done using standard data collection forms and validated assessment tools. Results: Thirty patients were randomized and 28 patients were eligible for the efficacy analysis. There were no significant differences in the baseline demographic and clinical characteristics between the True Acupuncture group (TA) (n=16) and Sham Acupuncture group (SA) (n=12). Both groups showed reduction in mean itch intensity (visual analogue scale, VAS) (p=0.024) but TA showed greater reduction (p=0.009) that was sustained after end of treatment. There was also a reduction in medication use in both groups. The comparable efficacy of SA to TA is attributed to similar peripheral receptive fields and stimulation of cutaneous C-fibers which depletes the neurotransmitters mediating pruritus and results in tachyphylaxis. Mild adverse events, such as petechiae and erythema, were noted in both groups and resolved spontaneously. Conclusion: Acupuncture is a promising adjunct treatment in atopic dermatitis with significant reduction in pruritus, disease severity and medication use and a trend towards improved quality of life. Studies with larger sample size and comparison to acupuncture points farther from the true acupuncture points are recommended. Trial Registration Food and Drug Administration Philippine Health Research Registry ID PHRR171012-001696
Acupuncture ; Pruritus ; Dermatitis, Atopic

Background: Herbal supplementation has been used by diabetic patients, unfortunately it has regulatory, safety, and efficacy concerns. Objective: This review was conducted to determine the best evidence in terms of the identified active substance, mechanism of action, pre-clinical and clinical studies of commonly used local herbal preparations. Methods: This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of herbal supplementation in diabetes. Results: After the initial review, the authors identified thirteen herbal preparations that have been investigated for its anti-diabetic properties. Six have extensive studies including randomized controlled trials but cinnamon and fenugreek seed are not readily available locally. Their detailed review eventually focused on four locally available herbal preparations i.e. bitter melon, turmeric, aloe vera and banaba. They decrease glucose absorption and gluconeogenesis, improve glucose utilization and insulin production. Unlike conventional anti-diabetics, herbal preparations also have favorable effect on lipid metabolism and anti-oxidant effect. Bitter melon seems to be the best herbal preparation. But human studies of bitter melon showed it is inferior to conventional anti-diabetic drugs in terms of its anti-diabetic effect but better in terms of its effect on lipid metabolism and anti-oxidant properties. Turmeric, aloe vera and banaba have also been shown to have anti-diabetic effects. Conclusion In summary, herbal preparation may have multiple beneficial effect for patients with diabetes. Use of combined preparations can produce complementation of the effects and may be a promising approach to the use of herbal supplementation as treatment standard among patients with diabetes.
Dietary Supplements ; Plant Preparations

Background: In the past musculoskeletal complaints were treated with topical preparations from medicinal plants until the advent of NSAIDs. However, because of the side effects of NSAIDs, interest has increased on going back to the use of topical traditional herbal medicines in patients with musculoskeletal pain. Objective: This review was conducted to identify the active substance, its mechanism of action, pre-clinical and clinical studies and propose a topical herbal formulation balancing its analgesic and anti-inflammatory effect with skin care effect among patients with various somatic pain conditions. Methods: This is a qualitative review of both local and international published medical literature to identify and summarize information on the use of topical herbal preparation for the treatment of musculo-skeletal pain. Results: After the initial review, the authors identified six herbal preparations that have been investigated for its analgesic and anti-inflammatory properties in clinical trials. They eventually arrived at a consensus to consider the final combination of ginger, capsaicin, peppermint and virgin coconut oil. Gingerol, a naturally occurring plant phenol, is one of the major components of ginger known to have diverse pharmacologic effects including anti-oxidant, anti-apoptotic, and anti-inflammatory activities in vitro and in vivo. Capsaicin is a highly selective agonist for the transient receptor potential vanilloid 1 receptor expressed in nociceptive sensory nerves. The mechanisms underlying capsaicin-induced analgesia likely involve reversible ablation of nociceptor terminals. Local application of peppermint oil generates a long-lasting cooling effect on the skin and result to muscle relaxation. Ginger, capsicum and peppermint have been shown in clinical trials to relieve musculoskeletal pain and inflammation. Virgin coconut oil on the other hand has no analgesic effect but has been shown in some studies to be favorable for skin conditions and facilitate skin penetration of some substances. Conclusion Using combined preparation may have the advantage of complementation of its effect i.e. analgesic and anti-inflammatory effect of ginger, warm sensation of capsicum and the cold sensation of peppermint.
Musculoskeletal Pain ; Anti-Inflammatory Agents, Non-Steroidal ; Plant Preparations