OBJECTIVES

The challenges faced by patients with diabetes in rural Philippine communities highlight
the need to look into how we can improve ways of communicating health education and self-management strategies. Patient education materials play a vital role in promoting regimen adherence, yet their acceptability and effectiveness in resource-limited settings remain insufficiently investigated. Therefore, this study aimed to explore participants’ experiences with and perceptions of a community-based diabetes learning module through qualitative inquiry.

METHODS

Using purposive sampling, 13 participants who successfully completed the Blood Sugar Bantayan, Diabetes Malikayan pilot health program from January to July 2022 in a rural community in southern Philippines consented to engage in in-depth interviews. A semi-structured topic guide was developed, validated by experts, and pretested.
Interviews were conducted in the local language, audio-recorded, transcribed, translated, and analyzed using Braun and Clarke's reflexive thematic approach.

RESULTS

Five major themes emerged from the analysis: initial perceptions of the module, aspects of the module found useful, perceived impact on regimen adherence, hindrances to adherence, and overall feedback with likelihood of recommendation. Participants valued the module’s visual appeal, use of local language, and comprehensive coverage of diabetes management. The module served as a guide that enabled participants to gain better control over their condition through improved self-discipline and health practices, often motivated by family support. However, challenges including time constraints, resource limitations, and competing priorities affected consistent implementation of recommended practices. Despite these barriers, participants expressed strong satisfaction with the module and willingness to share it with others, though sharing decisions were often based on perceived relevance to others’ health status.

CONCLUSION

Community-based learning modules can serve as valuable educational tools for diabetes care in rural Filipino communities. Findings underpin the importance of developing culturally appropriate and responsive campaigns for diabetes education in remote
environments, but multi-modal strategies that cut across sectors are still imperative to address persisting structural factors that pervade health program efforts.

Resource-limited Settings ; Residence Characteristics ; Play And Playthings ; Personal Satisfaction ; Family Support ; Self-management

OBJECTIVE: To summarize the clinical features and management of two brothers affected with X-linked inhibitor of apoptosis protein (XIAP) deficiency. METHODS: This study retrospectively analyzed the clinical presentations, treatment, and follow-up of two brothers with XIAP deficiency diagnosed at Shanghai Children's Hospital in 2020, and summarized similar cases recorded in databases such as PubMed, Wanfang, Chinese Medical Association Journals, and WIP from January 2006 to November 2024. This study was approved by the Medical Ethics Committee of our hospital (Ethics No.: 2025R128-E01). RESULTS: Patient 1 was the younger brother, who presented at 8 years of age with growth retardation, folliculitis, erythema nodosum, and perineal abscess. Sequencing revealed that he has carried a hemizygous c.566T>C (p.Leu189Pro) variant of the XIAP gene, which was inherited from his mother. He was allergic to infliximab treatment and underwent allogeneic stem cell transplantation (HSCT) in January 2021. During a follow-up of 3 years and 10 months post-transplantation, he showed no gastrointestinal symptoms and had a good outcome. Patient 2 was the elder brother, who presented at 10 years and 6 months of age with growth retardation, rash, and anal fistula. Genetic testing revealed the same variant. He was treated with oral azathioprine but did not have regular follow-ups. At 14-years-and-6-months of age, he had developed severe gastrointestinal infection and hemophagocytic lymphohistiocytosis, which was alleviated after treatment with antibiotics, glucocorticoids, immunoglobulin, and rituximab. He is currently being prepared for HSCT. A total of 13 publications were retrieved, which involved 64 patients from 23 families, with 23 different variants identified. The main clinical manifestations included splenomegaly (34 cases, 53.1%), hemophagocytic lymphohistiocytosis (27 cases, 42.2%), and inflammatory bowel disease or colitis (20 cases, 31.8%). There were significant phenotypic differences among patients from the same family. Thirteen patients (20.3%) underwent HSCT, with a survival rate of 61.5%. CONCLUSION For male children with early onset, poor treatment response, especially those with unexplained splenomegaly and IBD-like symptoms, early genetic testing is recommended. HSCT is a safe and effective treatment for XIAP deficiency. For patients with developmental delay, early onset, and severe IBD phenotype, early transplantation is recommended.
Humans ; Male ; X-Linked Inhibitor of Apoptosis Protein/deficiency* ; Child ; Genetic Diseases, X-Linked/therapy* ; Phenotype ; Siblings ; Retrospective Studies ; Hematopoietic Stem Cell Transplantation

Academic publishing is at a critical juncture. The challenges faced by the academics are mired in controversy. Among theseare three hotly debated concerns. First is the issue of whether technological innovations such as artificial intelligence (AI)improves research efficiency or if its use sacrifices research integrity.Another is the controversy between paywall publishingand open access. Lastly, adapting an appropriate business model for sustainability is a contentious issue and the choice betweena commercial or a university-based publishing platform is a difficult one.

Traditional models of scientific investigation relied on tedious intellectual calisthenics in all aspects of research —identifying research gaps, reviewing of published literature, devising valid methodology, collecting data, analysing results, and,finally, drawing conclusions. With the advent of powerful tools employing artificial intelligence, these heavy tasks are efficientlycarried out. The dilemma lies in determining which parts of the work can be attributed to the authors and which are ascribedto the output of large language models (LLMs) and other automated assistance employed.Despite requiring adequate vettingby experts of these AI-aided output, many in the scientific community still question these methods. Can research employingAI be considered honest work? Will full disclosure answer doubts as to the integrity of the scientific work?

Indeed, LLMs just gather information that is already out there, albeit more efficiently. After all, science progresses bystanding on the shoulder of giants. AI makes such work comprehensive and efficient. Standing on those proverbial shoulders,however, require access to prior work, hence our next challenge in academic publishing--open access versus paid access.Paywalls limit the benefits of valuable research to institutions and universities with the capacity to pay. Excluded from these arethose from low resourced countries, with nations from the global south being affected disproportionately. Additionally, whilenumerous authors appreciate the features of open access as it improves their impact and visibility, many feel unduly burdenedsince the cost of publishing in this format is passed on to them.

This brings us to our third issue: who bears the cost of academic publishing? Indeed, it is a lucrative industry, generatingan annual revenue of US$19 billion and an estimated 40 percent profit margin. Many, however, find fault in this businessmodel as concerns about the profit motives of the commercial publishers far overshadow their sustainability goals.

How do we navigate this landscape of controversies? We, at the ACTA, as part of the community of scholars, would needto clarify our mission. Our goals for this publication should be consistent with our values. These values, such as scientific rigor,integrity, and accountability, should be reflected in our policies. We should be cognizant of the role we play in national scientificdiscourse while we endeavor to make an impact in the global scene. We are accountable to our stakeholders — nurturingearly career scholars, supplying evidence to health policymakers, and being accountable to those who provide resources tosustain us. This stewardship is essential so that ACTA will stand shoulder to shoulder with the giants on which science buildsupon to benefit future generations.

Artificial Intelligence ; Commerce ; Costs And Cost Analysis ; Disclosure ; Drawing ; Efficiency ; Family Characteristics ; Forecasting ; Goals ; Gymnastics ; Health ; Health Resources ; Industry ; Intelligence ; Inventions ; Language ; Literature ; Methods ; Play And Playthings ; Policy ; Publications ; Publishing ; Research ; Residence Characteristics ; Role ; Science ; Shoulder ; Social Responsibility ; Universities ; Ursidae ; Volition ; Work ; World Health Organization

Human ; Observation ; Widowhood

BACKGROUND

Growing old is a remarkable journey filled with diverse experiences and wisdom. It’s a time when individuals often reflect on their lives, cherish memories, and share invaluable lessons with younger generations. Understanding aging is crucial as it encompasses more than just physiological and psychological processes, to comprehend the subjective sensations of the phenomenon of “being an elderly person”.

OBJECTIVE

The purpose of this study was to describe the daily lives of frail older adults living alone in Quezon City.

METHODS

The study utilized a qualitative research design. The approach employed was a descriptive phenomenological study describing the fundamental nature of being an elderly. The population consisted of frail older adult people (>60 years old) assessed using the Clinical Frailty Scale and living alone in Quezon city using a purposive sampling of those who were present in their homes during the designated interview period. The study was conducted in a private, safe and secured place both agreed by the participants and the researcher through face to face interview.

RESULTS

Being an frail older adult in this study essentially involves balancing one’s life in a flow of motion. The older adult is balancing a number of life-altering events and a shift in their circumstances influenced by recollections from various stages of life. In the life of an older adult, all ages are harmonious and wisely expressed and developed from pleasant and lovely or less pleasant and beautiful or more stressful early life experiences that went throughout adolescence and young adulthood, middle age, and later years. Their family, children and grandchildren were their source of strength and inspiration.

CONCLUSION

This study gave light on the realities faced daily by a frail older adult. Insights gained from this study serve as an opportunity to develop or innovate appropriate support. This information is crucial for clinicians, community-based aged care providers, legislators, elderly associations, and other concerned citizens. On a local level, the government unit’s key officials or proponents for the welfare of older adults are encouraged to delve deeper and focus on the unique needs and life experiences of the elderly population.

Human ; Family Characteristics

OBJECTIVES

This study described the demographic and clinical profile, mental health problems, prevalence of psychiatric conditions, psychosocial interventions used, and outcomes of the management of mental health problems among in-patients admitted to non-psychiatry units of tertiary hospitals referred to mental health care providers; and described gender-disaggregated data related to mental health care providers and patients receiving psychosocial interventions in tertiary hospitals.

METHODS

This study employed a mixed-method design, using both qualitative and quantitative methodologies following the convergence model of triangulation. The following were the data sources: (1) cross-sectional review of charts of patients referred for psychosocial problems using the ICD-10 classification; (2) a survey of mental health service providers; (3) key informant interviews of mental health service providers; and (4) focus group discussions of mental health providers. All data were collated, compared, and contrasted, then analyzed using the convergence model of triangulation design.

RESULTS

Among the 3,502 patients in the chart review, 1,870 (53.40%) were males. The median age was 46.08 years and 92.06% were adults. The most common diagnosis among the patients were mood disorder (744, 21.25%) and organic mental disorder (710, 20.27%). Combination treatment of psychosocial intervention and pharmacology was the most common strategy received by patients. There was a higher proportion of patients admitted to public hospitals (996, 45.27%) who received psychosocial interventions only compared to those admitted to private hospitals (235, 18.05%). There were 3,453 out of 3,502 in-patients referred for psychiatric intervention. Of these 2,420 (70%) received psychoeducation, 2,365 (68.5%), received supportive psychotherapy/counseling, 535 (15.5%) family therapy, and 286 (8.3%) behavior modification. There were more patients given psychosocial interventions 2,541 (72.56%) who were discharged with instruction to follow-up, while around one in 10 (456, 13.02%) was not instructed to do a follow-up consultation. The types of interventions across all data sources were similar.

CONCLUSION

The most common type of management for psychosocial problems of in-patients in tertiary hospitals was a combination of psychosocial intervention and pharmacotherapy. Psychoeducation, supportive psychotherapy/ counseling, and family therapy were the most often given psychosocial interventions. The patient-related reasons for the choice of interventions were patient’s medical status (diagnosis and severity of symptoms) and psychological status (psychological mindedness), while the provider-related factors influencing the choice of intervention were provider’s skills and personal preference. Moreover, resources (human and material) and service provision policies (treatment guidelines and aftercare interventions) were the most common hospital-related factors. Further prospective research to determine the associated patients, providers, and hospital factors in larger geographic and cultural settings will provide evidence for the effectiveness and outcomes of psychosocial interventions.

Human ; Counseling ; Psychotherapy ; Family Therapy ; Mental Health

BACKGROUND AND OBJECTIVE

Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4th class municipality.

METHODS

This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

RESULTS

This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD— the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases—it is also common to have household members taking medicines for two to three NCDs.

CONCLUSION

This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

Human ; Noncommunicable Diseases ; Out-of-pocket Expenditures ; Health Expenditures ; Households ; Family Characteristics

INTRODUCTION: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, children with COVID-19 in Singapore required hospital isolation. We aimed to explore the psychological experiences of children and their caregivers isolated in a tertiary university hospital due to COVID-19. METHODS: A prospective mixed-methods design was used to evaluate the psychological status of hospitalised family units with one or more children aged <18 years who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patient medical records were reviewed for demographic and clinical information. Parents and children ≥7 years of age underwent a psychologist-administered telephone-based interview. Self-reported, age-appropriate instruments, Short Mood and Feelings Questionnaire, and Screen for Adult/Child Anxiety-Related Disorders, were used to assess anxiety and depression, respectively. Participants were also interviewed qualitatively. RESULTS: Fifteen family units were hospitalised between March 2020 and May 2020. Of these, 13 (73%) family units were recruited. The median age of the children and median hospitalisation duration were 57 months and 21 days, respectively. Median number of COVID-19 polymerase chain reaction swabs performed for each child was eight. All children had asymptomatic to mild SARS-CoV-2 disease. The criteria indicative of anxiety disorder were met by 40% of adults and 80% of children, while the criteria indicative of separation anxiety were met by 60% of parents and 100% of children. One child met the criteria indicative of depression. Uncertainty, separation, prolonged hospitalisation and frequent swabs caused significant reported anxiety. CONCLUSIONS Families, especially children, had heightened anxiety while in hospital isolation. Therefore, home-based recovery from COVID-19 and psychological support for children and their families, with focus on early recognition of anxiety disorders, are recommended. We support review of paediatric isolation policy as the pandemic evolves.
Humans ; COVID-19/epidemiology* ; Male ; Child ; Female ; Singapore/epidemiology* ; Anxiety/etiology* ; Prospective Studies ; Adolescent ; Hospitalization ; SARS-CoV-2 ; Adult ; Child, Preschool ; Pandemics ; Parents/psychology* ; Caregivers/psychology* ; Family/psychology* ; Depression ; Patient Isolation/psychology* ; Surveys and Questionnaires

INTRODUCTION: The survival rate for childhood cancer has increased with advances in medical care. Along with this comes the growing burden of long-term side effects of cancer treatment and cancer survivorship. Childhood cancer survivors are more likely to be sedentary and have a lower quality of life. Physical activity (PA) can promote health and well-being in childhood cancer survivors, but few studies have explored the role of parents of childhood cancer survivors (PCCS) in promoting PA. This qualitative study aims to explore the perceptions of PCCS in Singapore and the role they may have with regard to PA. METHODS: Participants were recruited through a local charity via email, social media and posters. One-hour semi-structured interviews were conducted online with seven parents. With consent, the interviews were recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Our study discussed thematically parents' accounts on (1) the barriers and enablers of PA and (2) the complications of cancer that potentially affect the levels of PA in childhood cancer survivors. Parents reported that childhood cancer negatively affects the quality of life and participation in PA. The determinants of participation in PA were multifaceted, and socioecological and health belief models were used to demonstrate how these factors were interlinked. CONCLUSION Participation in PA is influenced at an individual, family, community and societal level. The improved understanding facilitated by this research can be used to shape paediatric cancer care practices in Singapore and guide institutional or national policy interventions.
Humans ; Singapore ; Parents/psychology* ; Cancer Survivors/psychology* ; Qualitative Research ; Female ; Male ; Quality of Life ; Exercise ; Child ; Adult ; Neoplasms ; Adolescent ; Perception ; Middle Aged ; Interviews as Topic

OBJECTIVE: To observe the effects of electroacupuncture at the pterygopalatine region on nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)-mediated pyroptosis and inflammatory factors in rats with allergic rhinitis (AR). METHODS: Twenty-four SD rats were randomly divided into a blank group, a model group, an acupuncture group and an electroacupuncture group, 6 rats in each group. Except for the blank group, OVA-induced AR model was established in the remaining groups. In the electroacupuncture group, the rats were treated with electroacupuncture at the bilateral pterygopalatine region, with disperse-dense wave, in frequency of 2 Hz/100 Hz and current of 0.5-1 mA, 15 min each time, once every other day, for 3 times. In the acupuncture group, the rats were treated with acupuncture at bilateral pterygopalatine region simply, without electrical stimulation. The rhinitis symptom score was observed, the pathomorphology of the nasal mucosa was observed by HE staining; the serum levels of OVA-specific immunoglobulin E (OVA-sIgE), interleukin (IL)-4, IL-6 and IL-1β were detected by ELISA; the mRNA expression of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), cysteinyl aspartate specific proteinase-1 (caspase-1) and IL-18 in the nasal mucosa was detected by real-time PCR; the protein expression of NLRP3, ASC, caspase-1 and IL-18 in the nasal mucosa was detected by Western blot. RESULTS: Compared with the blank group, in the model group, the rhinitis symptom score was increased (P<0.01), the serum levels of OVA-sIgE, IL-4, IL-6 and IL-1β were increased (P<0.05), the nasal mucosa showed pathomorphology of inflammatory infiltration; the mRNA and protein expression of NLRP3, ASC, caspase-1 and IL-18 in the nasal mucosa was increased (P<0.05). Compared with the model group, in the electroacupuncture group, the rhinitis symptom score was reduced (P<0.01), the pathology of the nasal mucosa was improved; the serum levels of OVA-sIgE, IL-4, IL-6 and IL-1β were decreased (P<0.05); the mRNA and protein expression of NLRP3, ASC, caspase-1 and IL-18 in the nasal mucosa was decreased (P<0.05). CONCLUSION Electroacupuncture at the pterygopalatine region can exerting the anti-inflammatory effect by inhibiting NLRP3-mediated pyroptosis and inflammatory factor imbalance, thus alleviate rhinitis symptoms in AR rats.
Animals ; Electroacupuncture ; NLR Family, Pyrin Domain-Containing 3 Protein/immunology* ; Rats ; Rats, Sprague-Dawley ; Rhinitis, Allergic/physiopathology* ; Pyroptosis ; Male ; Acupuncture Points ; Humans ; Female ; Interleukin-1beta/genetics* ; Interleukin-18/immunology* ; Interleukin-6/genetics* ; Caspase 1/immunology*