BACKGROUND AND OBJECTIVES

With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.

The study utilized a descriptive design using qualitative methods of data collection namely key informant interviews (KIIs) and focus group discussions (FGDs). Participating institutions and their designated representatives were purposively sampled as key informants. OPs and carers from select barangays in NCR and Region IVA participated in the FGDs. Guided by the interpretivism approach, thematic analysis was performed. A trained research assistant coded the FGD and KII transcripts through the Nvivo PRO plus software and verified by the first author. Themes were reviewed and validated by the multidisciplinary team.

A total of 15 KIIs and two FGDs were conducted. The participating institutions and organizations were found to have varied roles and initiatives relevant to LTC; from strategic planning, development of policies and standards of care, training and capacity-building, and up to the actual implementation of LTC services. Identified challenges include implementation issues, financial issues, lack of political and stakeholder support, OPs and familial issues, and lack of knowledge on LTC.

Participants shared their description on what LTC is, an LTC facility, and the conditions of those in LTC facility. OPs expressed their willingness to utilize LTC services and identified several factors related to their preferred LTC arrangements. Carers identified various topics related to taking care of OPs that they would like to learn.

The roles, initiatives, and awareness of relevant stakeholders, older persons, and carers towards LTC were found to greatly vary. Policy makers, health workforce, families, communities, and the older persons themselves should have a better understanding of longterm care before they can provide or utilize the system. With the current landscape of LTC provision, the country still has a long way to go in achieving the integrated continuum of LTC appropriate to promote healthy aging. Promoting awareness, integrating LTC in the current programs and services for older persons in the country, capacitating the formal and non-formal caregivers, and strengthening collaborations are recommended.

Further research on quantitative measures of readiness for long-term care with focus on the health system and in-depth studies on the varieties or models of long-term care are recommended.

BACKGROUND AND OBJECTIVE

Community-based rehabilitation (CBR) represents a multifaceted social intervention designed to tackle issues related to access, equity, and service quality. Within the framework of CBR, participation stands as a pivotal principle, albeit one that frequently goes unnoticed, particularly concerning children with disabilities. Consequently, this realist synthesis embarks on an exploration of the present landscape, participation mechanisms, and resulting outcomes within CBR initiatives tailored for children with disabilities in low and low-middle-income countries.

The realist approach is utilized to explain the causal mechanisms and explore the context, mechanism, and outcome of participation in CBR programs. A systematic search was conducted across ten databases up to April 2021. Studies were included if they involved children with disabilities aged 17 years and below, were implemented in World Bank-classified low-income or low-middle-income countries, discussed implementation mechanisms and community participation, and described outcomes. No language restrictions or publication type limitations were applied. The search process employed double screening of title, abstract, and full-text levels, followed by a snowballing technique. Quality assessment followed the RAMESES standards for realist reviews. Data extraction and analysis yielded context-mechanism-outcome configurations.

Thirteen articles were included in the synthesis, from which three context-mechanism-outcome configurations were identified: (1) family-facilitated intervention through training in the immediate environment of children with disabilities leads to knowledge translation of caregivers, (2) inaccessible healthcare services require establishing a referral system and augmenting human resource to ensure the system’s capacity to accommodate the magnified need, and (3) established collaboration of researcher, professionals, and community with stakeholder involvement in the CBR management leads to program adoption and documented effectiveness. Both training and establishing referral systems as implementation mechanisms pose sustainability challenges due to dependency on funding. Overall, participation as a form of agency is more often an implied concept. Training is a common mechanism of implementation, where women play a critical role as proxies of children with disabilities, being their caregivers and advocates. Positive and negative outcomes focus on the condition of children with disabilities and the trainees’ knowledge and awareness.

A critical analysis of children's and community's participation in the context, mechanism, and outcome unravels the non-participation of children with disabilities and tokenism of the community stakeholders in the CBR programs. Maximizing the contribution of children with disabilities and community stakeholders is called for, aligned with the ladder of participation, toward their democratic participation. Study limitations include the paucity of published CBR programs reporting participation mechanisms in low and low-middle-income countries and the exclusion of studies from economically disadvantaged communities in high-income countries.

Humans ; Nebulizers and Vaporizers ; Child ; Administration, Inhalation ; Respiratory Tract Diseases/therapy* ; Asthma/therapy* ; Home Care Services ; Practice Guidelines as Topic ; Respiratory Therapy/methods*

Humans ; Genetic Counseling ; Genetic Testing ; Disorders of Sex Development/therapy* ; Consensus ; Child ; Male ; Practice Guidelines as Topic ; Female ; Quality of Life

Cardiovascular disease (CVD) is the leading cause of death worldwide. As the key pathological basis of CVD, arteriosclerosis holds great significance for early screening. However, existing clinical and homecare detection devices have many shortcomings; for instance, the commonly used non-invasive indicator PWV (pulse wave velocity) is easily interfered by blood pressure.This study developed a homecare arteriosclerosis monitoring system, which integrates the measurement functions of cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI). The hardware design of the system includes an integrated structure of flexible silver ion electrodes and clip-type cuffs, a contact heart sound sensor, and a stepped deflation blood pressure measurement module. Meanwhile, a high-precision analog-to-digital conversion module and the STM32F405 main control chip are used to realize the synchronous acquisition of multiple signals.In terms of software, the underlying driver program was designed through MDK (Keil5), and a user interface was built on the Visual Studio platform to achieve functions such as data acquisition, display, and storage. At the algorithm level, the system adopted algorithms like the Pan-Tompkins algorithm to identify key feature points of physiological signals, and then calculate CAVI and ABI.System test results show that the ECG input noise of the system is less than 20 μV, the common-mode rejection ratio is 95 dB, and the blood pressure measurement error does not exceed 2 mmHg, which meets the design goals. Clinical data analysis indicates that CAVI is highly positively correlated with pulse wave velocity (PWV) ( r=0.85, P<0.001), but CAVI is less affected by blood pressure fluctuations. In addition, with the increase of risk factors (such as hypertension, hyperlipidemia, coronary heart disease, etc.) and age, arteriosclerosis indicators (CAVI, PWV, ABI) all show an upward trend.In conclusion, the homecare arteriosclerosis monitoring system proposed in this study not only overcomes the problems of traditional devices that rely on professional operation and are susceptible to blood pressure interference, but also provides a reliable tool for arteriosclerosis screening in home scenarios, and has important reference value for clinical diagnosis.
Humans ; Cardio Ankle Vascular Index ; Home Care Services ; Atherosclerosis/diagnosis* ; Ankle Brachial Index ; Algorithms ; Pulse Wave Analysis ; Arteriosclerosis/diagnosis* ; Monitoring, Physiologic/instrumentation*

Background: People from rural communities are not spared from COVID-19. But implementing preventive measures and strategies can be made to control the spread. Objective: This study was conducted to describe the epidemiologic situation and the healthcare capacity of the locality, determine the responses and strategies implemented in the control of COVID-19, and explain the activities performed in relation to the epidemiologic situation in Tarangnan, Samar – a low-income class municipality in the Philippines. Methods: A mixed qualitative–quantitative design was employed in this study. Descriptive documentary research design through review of records from March to October 2020 was utilized. For the qualitative context, a case study design was employed whereby focus group discussions and key informant interviews using open-ended questions were performed. Results: A total of 66 individuals were recorded as having COVID-19 in the municipality from March to October 2020. The first recorded confirmed cases of COVID-19 in Eastern Visayas were two adults in Tarangnan, Samar, in March 2020. Since then, additional confirmed cases have been recorded every month, but confirmed COVID-19 dramatically reduced from August to October 2020. Qualitative analysis revealed stringent COVID-19 preventive measures reflected in the confirmed case numbers. The tailwinds of the COVID-19 response include: the SARS pandemic precedent, coordination and communication, outpouring of support from other government and nongovernment partners, and innovative community-based approaches. The headwinds of COVID-19 response were challenges in imposing minimum health and safety precautions, stigmatization, and discrimination. Conclusion Even if challenges have arisen in implementing measures against the spread of the disease, good outcomes have been achieved through persistent good practice, positive modifications, and community-based innovations.
Community Participation ; Community Health Services ; COVID-19 ; Rural Health ; Philippines

INTRODUCTION

No-scalpel vasectomy is an emerging family planning method that enables the male partner to get more involved. The procedure was first introduced in our institution in 2008 with an average of 7 clients per year (i.e., 86 patients from 2008 to 2019). There were no data when the pandemic started, but starting in March 2022, acceptance for the procedure started to increase. This coincides with the timeline of the study. At present, there are limited studies regarding no-scalpel vasectomy, especially local studies. A better understanding of the characteristics and outcomes of those who underwent no-scalpel vasectomy would aid our institution in formulating and implementing policies and family planning programs.

The study determined the characteristics and outcomes of no-scalpel vasectomy acceptors at Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023. Characteristics included the sociodemographic, medical, reproductive, and duration from inquiry until semen analysis. The outcomes included the absence or presence of complications after the procedure and result of semen analysis.

The study utilized a retrospective, descriptive, single, cohort design. Total enumeration was done to get the 36 charts of clients who underwent no-scalpel vasectomy at the Comprehensive Family Planning Center of Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023. Patient charts were retrieved, and data abstraction was done. Tables and figures were used to display the frequency distribution of data collected.

The study had a cohort of 36 individuals who underwent no-scalpel vasectomy, which accounted for 116% of the intended sample size. The characteristics of our clients were mostly urban residents, 30–39 years old, with partner, educated, middle class, employed, Roman Catholic, and having 1–2 children with the age of youngest below 3 years old. Different forms of family planning were used prior to the procedure. Teleconsultation effectively increases our clients for vasectomy. Clients were able to follow up after the procedure, but there was only a decrease in the number of clients who had their semen analysis done and were lost to follow-up.

There is an increasing awareness in no-scalpel vasectomy procedure as seen in the increase in acceptors. It is an effective, safe, cost effective, and permanent male contraceptive procedure, with very minimal manageable complications. However, there is a need for better protocol regarding follow-up with semen analysis result.

By determining the characteristics and outcomes of no-scalpel vasectomy acceptors at Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023, the findings of the study hope to aid the health-care providers gain a better insight about the characteristics and outcomes of our male clients who decided to undergo no-scalpel vasectomy as their family planning method of choice. There is a need study in further improving of the formulation and implementation of policies and family planning programs to further reach the male population.

Background and Objectives With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.
Home Care Services ; Long-Term Care ; Nursing Homes ; Philippines

Pregnancy is a critical period in every woman's life. The health of both the mother and her unborn child is at stake, with poor access to needed prenatal care services. Obtaining prenatal care is affected by the pregnancy literacy of the expectant mother. However, the assessment tool for health literacy among Filipino pregnant women is limited. This paper aimed to examine existing maternal health literacy instruments. Hopefully, an adopted tool can be found for assessing prenatal health literacy. After examining existing maternal health literacy tools, 18 questions were suggested that can be further modified before they are used for Filipino pregnant women to assess their prenatal health literacy.
Human ; Female ; Prenatal Care ; Pregnant Women

BACKGROUND

Family and Community Medicine is a medical specialty that plays a crucial role in the healthcare system and will be in the best capacity to provide primary care services, coordinate referrals to specialists when needed, and promote continuity of care across different healthcare settings in the implementation of the Universal Health Care Law. These are policy recommendations on how family and community medicine can play a significant role in the successful implementation of the UHC.

Recommendation #1. The undergraduate curriculum in Family and Community Medicine must be competency based.

Recommendation #2. The competency outcome of Family and Community Medicine undergraduate curriculum must be aligned with the need of the Philippine health system in the context of Universal Health Care reform.

Recommendation #3. The process of delivery of Family and Community Medicine undergraduate curriculum must adopt to new technology and teaching innovation.

Recommendation #4. Family and Community Medicine must develop strategies to make it as career choice.

Recommendation #5. Family and Community Medicine must develop and implement an effective and sustainable faculty development program.

Recommendation #6. Family and Community Medicine must be socially accountable to the community it serves.

Recommendation #7. Family and Community Medicine must be one of the major core competencies of a licensed physician ready to practice as primary care provider in the UHC.

Recommendation #8. Early placement for Family and Community Medicine practice must be available for newly licensed physicians.

Recommendation #9. Family and Community Medicine practitioners must be provided with continuing professional education and training to provide quality patient care.

Recommendation #10. Family and Community Medicine postgraduate education and training must adopt to new technology and training innovation.

Recommendation #11. Family and Community Medicine postgraduate training should cover urban and rural community health service.

Recommendation #12. Family and Community Medicine continuing professional education and training programs must meet the prescribed standards.

Recommendation #13. Regulation of Family and Community Medicine practice must be a public-private partnership.