BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

BACKGROUND AND OBJECTIVES

This study examines how grieving Filipinos use Facebook to cope and find support. It investigates the combination of traditional mourning practices and the influence of social media. By exploring this intersection, the study fills an essential gap in the existing literature on digital mourning within Filipino culture. Understanding these digital bereavement practices can inform palliative care interventions, particularly in providing psychosocial support to grieving families.

The study used a hermeneutic phenomenological approach, conducting in-depth interviews with ten bereaved Filipinos selected by specific criteria. Data were gathered through video calls and in-person interviews to explore their experiences, and the qualitative data was thematically analyzed for key insights.

The analysis revealed three key themes: (1) blending mourning traditions with Facebook for emotional support; (2) Facebook interactions that provide relief and validation in grief; and (3) digital mourning experiences that foster healing. Social media enhances grieving practices for Filipinos, allowing them to honor loved ones and strengthen community connections.

The study stresses the need for culturally sensitive digital spaces and grief support services that combine online and offline mourning practices. It calls on healthcare providers and grief counselors to incorporate digital mourning and highlights the need for further research on grief expressions on social media.

: One of the most commonly used tools by clinicians to identify cases of anxiety and depression in medically ill patients is the Hospital Anxiety and Depression Scale, or the HADS Filipino version. However, there were some “gray areas” with its use, particularly for those who are in the non-psychiatric setting. Some translated items may pertain to something else which could influence patients' responses. Furthermore, local studies showed differences in the conception, understanding, and expression of depression unique to Filipino culture and could be potentially missed during the assessment. This paper determined the validity and reliability of the Anxiety and Depression Symptom Assessment Guide or ADSAto a sample of 91 adult cardiac Filipino patients in the in-patient setting. In addition to the 29-item ADSAtool that was generated from HADS, the review of literature and other sources was also reviewed by experts from two rounds of Delphi Survey. It was written in a yes-or-no format and available in both English and Filipino versions. The tool was tested for internal consistency, intra-class and inter-item reliability. Another test used was criterion-based validity utilizing HADS to identify cases of anxiety and depression. The results showed that ADSAis highly reliable with Cronbach's alpha of 0.97, poor-to-moderate intra-class correlation (0.670 for anxiety, 0.440 for depression), and consistent/acceptable interitem correlation (0.528 for anxiety, 0.382). Both HADS and ADSAwere positively correlated with correlation coefficients of 0.667 and 0.391 (p-value<0.5) for anxiety and depression respectively. Using a cut-off score of 5, ADSA has moderate sensitivity and specificity of 72.5% and 78.4% for anxiety, and 66.7% and 64.3% for depression. Further research is needed to strengthen ADSA's validity by increasing the sample size and the multi-center sites.
Anxiety ; Depression

BACKGROUND

Leadership and leadership development are increasingly recognized as essential aspects of the medical profession today; however, these are not expressly taught and reinforced in current medical education, with many students having to learn on their own time or while already on the job.

This study aimed to determine the perceptions of graduates of the UST Faculty of Medicine and Surgery (Class of 2023) on leadership in the medical profession and leadership development within the basic medical curriculum.

A cross-sectional study using descriptive analysis was done using responses to a web-based questionnaire regarding participants’ perceptions of medical leadership, its incorporation into the basic medical curriculum, and self-assessment of specific leadership competencies.

Two hundred three (203) individuals participated in the study, 83% of whom reported having prior leadership experience. 75% of participants strongly agreed that leadership is relevant in the medical profession, and only 27% strongly agreed that leadership development is adequately incorporated into the medical curriculum. Participants rated themselves highest in emotional self-awareness and adaptability for the intrapersonal domain, and in empathy, organizational awareness, and teamwork for the interpersonal domain. There was a statistically significant positive correlation between perceptions regarding adequacy of incorporation of leadership development into medical education and participants’ mean scores in interpersonal leadership competencies. The top three gaps in leadership development identified by participants were lack of interest from the medical student, lack of time to incorporate leadership development in the medical curriculum, and lack of adequate exposure to leadership development in regular learning activities.

The study was able to determine the perceptions of recent medical graduates regarding leadership in the context of medicine and leadership development in the current basic medical curriculum. It has also ascertained how they viewed themselves regarding specific leadership competencies, particularly communication and interpersonal relations. The contexts provided by the students gave a more nuanced view of what leadership is like for them, both in the classroom and hospital setting.

Introduction: Telemedicine services have steadily been relied upon since the onset of the COVID-19 pandemic. Understanding its usability and contextual performance is of paramount importance if it were to pervade the local health delivery system. Hence, a tool to assess usability is warranted. Objective: The study aims to adapt a reliable and validated instrument in English to Filipino, the Telehealth Usability Questionnaire (TUQ), on evaluating the usability of telemedicine services in the Philippines. Methodology: The research is a translation and validation study. The methodology includes forward translation in collaboration with our UST Sentro sa Salin at Araling Salin and expert panel review with five experts using the telehealth system. It was followed by pretesting (pilot testing and cognitive debriefing) of the pre-final tool to 30 family medicine telehealth patients and field testing of the final instrument to 85 telehealth patients from USTH. Appropriate statistical methods for assessment included internal consistency, content validity and linguistic with conceptual equivalence. Results: All translated items were retained, but through the focus group discussion, several statements were modified to fit the cultural context. Each item and the overall tool showed excellent validity and internal consistency. The mean difference scores for each item and domain were less than ±0.25. Tests of equivalence showed that majority of items and each domain were not statistically different (p>0.05), suggesting that both questionnaires are similar and homogenous. Furthermore, the Bland-Altman plots for each dimension/domain are within the upper and lower boundaries indicating agreement between the two versions. Conclusion TUQ-Filipino is a valid and appropriate instrument to assess telehealth usability in the local setting.
Telemedicine

In the Philippines, organ donation is regulated under the Organ Donation Act (RA7170) and promoted by the Department of Health through the Philippine Network for Organ Sharing (PHILNOS). The number of organ donors to meet the increasing demand in the country continues to lag. The emergency department (ED) was identified in several foreign studies to be a significant source of successful organ donation. This action research project investigated the attitude and perception of 125 ED healthcare workers (HCWs) from three hospitals in Metro Manila before and after an awareness event. The study reveals that ED nurses and doctors are generally supportive and hold positive perceptions and attitudes toward organ donation. Despite the positive attitude, HCWs seem to be uncomfortable or unwilling to perform tasks important to organ donation such as approaching relatives and management of the deceased organ donor. Future training on organ donation will increase the positive attitude, confidence and likelihood to participate in organ donation and transplant activities.
Tissue and Organ Procurement ; Emergency Service, Hospital

Background: The COVID-19 pandemic has significantly disrupted students' lives and daily routines, resulting in increased stress and mental health issues that impact their perceived life satisfaction and self-efficacy. While life satisfaction and self-efficacy may influence student academic performance and success, current data on life satisfaction and self-efficacy in Filipino occupational therapy students is limited. Objectives: This study aims to describe the life satisfaction and self-efficacy level of occupational therapy students at a university in Metro Manila, Philippines, during the COVID-19 pandemic and explore the relationship between these two variables. Methods: The study adopted an analytic cross-sectional study design and records review methodology utilizing the Student Life Survey 2021 database. Data from the survey participants who fit the study's inclusion criteria were extracted to determine their life satisfaction and self-efficacy based on their responses on the Satisfaction with Life Scale and Self-Efficacy Formative Questionnaire. Descriptive statistics using measures of central tendency and dispersion were used to analyze data. Spearman-Rho correlation analysis was performed to examine the correlation between participants’ life satisfaction and self-efficacy. Results: A total of 205 occupational therapy students completed the survey. Results reveal that the participants were slightly dissatisfied with their lives (M=18.45; SD=1.52) and that they had satisfactory or adequate self-efficacy (M=64.66; SD=1.37). An analysis of their self-efficacy scores reveals that participants had a poor belief in their personal ability (M=37.71; SD=1.33) and a satisfactory or adequate belief that their ability can grow with effort (M=26.92; SD=1.32). Life satisfaction and self-efficacy were found to decrease as the participants’ year level increased. Furthermore, correlation analysis revealed a statistically significant moderate correlation between participants’ life satisfaction and self-efficacy (⍴=0.40, p<0.05). Conclusion The participants have a slightly dissatisfied level of life satisfaction and a satisfactory or adequate level of self-efficacy during the COVID-19 pandemic. Life satisfaction and self-efficacy were found to have moderate correlation. Online learning adjustments, pandemic restrictions, and societal expectations are factors that may have influenced these findings, as emphasized in existing studies. This study may inform the academe in modifying existing learning environments and providing enhancement programs to deliberately target these constructs influencing overall academic performance.
Self Efficacy

This is a case of a 22-year-old female who presented with labile mood, impulsivity and persistent suicidality. Despite numerous pharmacologic and psychotherapeutic regimens, she only had minimal improvement. Subsequently, she revealed traumatic events in younger years.She has been experiencing recurrent intrusive thoughts, low self-worth, guilt and avoidance behavior. Pharmacotherapeutic management was revised as well as her psychotherapy, which resulted in a positive outcome. However, recurrence occurred after she encountered negative life events. Electroconvulsive therapy and revision of pharmacologic treatment eventually led to significant improvement. This case highlights the importance of underlying psychological trauma that caused persistent symptoms. The intensity of impact and the chronic recurrent negative effect of the trauma on the patient influenced the treatment outcome. It is important to optimize therapeutic management with the use of pharmacologic agents, psychotherapy and somatic therapies.
Stress Disorders, Post-Traumatic ; Bipolar Disorder

Aims: This meta-analysis aims to synthesize available evidence from published studies on the effectiveness of parental non-pharmacologic smoking cessation programs which aim to reduce children's exposure to secondhand smoke.

Methodology: A database search using The Cochrane Library, PubMed®, Medline, Embase, and Google Scholar, was done by the investigators. This study included 20 randomized controlled trials published up to 2020. Pooled estimates of risk ratio (RR) for quit rates were computed using the random effects model.

Results: Overall, the quit rate among those who underwent parental smoking cessation was 13.4% while the quit rate for controls was 11.9%. The pooled RR demonstrated that the parental smoking cessation program was significantly associated with higher quit rates (RR = 1.22, 95%CI = 1.01 to 1.46, p-value = 0.04). The studies demonstrated moderate heterogeneity only (I2 = 54%). Among studies published prior to year 2000, no significant difference was observed between parental smoking cessation program and control (RR = 1.02, 95% CI = 0.62 to 1.70, p-value = 0.93). On the other hand, the pooled RR demonstrated that among studies published after 2020, parental smoking cessation program was significantly associated with higher quit rates (RR = 1.27, 95%CI = 1.03 to 1.56, p-value <0.0001). Among studies with self-help interventions, parental smoking cessation program has no additional benefit on quit rates (RR = 1.20, 95%CI = 0.94 to 1.58, p-value = 0.14). Among studies with biofeedback intervention also, no significant difference was observed (RR = 1.27, 95% CI = 0.86 to 1.89, p-value = 0.23).

Conclusions: This meta-analysis demonstrated sufficient evidence that non-pharmacologic interventions for parental smoking cessation are effective.

BACKGROUND: Depression and anxiety are the most common mental disorders seen and managed in primary care. Both mental disorders have been increasingly prevalent worldwide. Filipinos are known for being family-centered and the family has been consistently a good ally in healthcare. A family- focused intervention is believed to be a good adjunct in the reduction of symptom severity of depression and anxiety.
Objective: This study aims to systematically analyze the effectiveness of family-focused interventions among patients with depression and anxiety.

METHODS: Studies were obtained from electronic search for literature (PubMed, Cochrane, HERDIN). Additional cross-referencing was done from the reference lists of included studies. Two independent reviewers assessed the methodological quality of included trials.

RESULTS: Two studies met the selection criteria and were included for meta-analysis. There was a total of 224 participants who were all clinically diagnosed with depression and anxiety. Compared with the standard care for depression and anxiety, family-focused intervention was found to be more effective (SMD=-1.20, z=6.92, p=0.001, 95% CI=-1.54 to -0.86). There was also no substantial heterogeneity (I2=13.80%) seen among the included studies (Q=1.16, p=0.281; ?2=0.01).

CONCLUSION: Family-focused intervention was shown to be effective in reducing the symptom severity of depression and anxiety.

RECOMMENDATION: The authors recommend future researchers to use more studies, both published and unpublished, on the utilization of family-focused interventions in the management of depression and anxiety. Applicability of the results in the Asian region, especially in the Philippines, should be explored. This review also suggests the option to provide different family-focused intervention techniques as an adjunct in the management of depression and anxiety in primary care.