BACKGROUND

Internationalization in medical education aims to align programs with global standards, foster intercultural competence, and expand academic collaboration. In private medical schools in Northern Luzon, clarifying how internationalization is conceptualized and enacted can enhance the medical curriculum.

To explore how private medical schools in Northern Luzon conceptualize and implement internationalization, identify associated challenges, and propose curriculum inputs to enhance delivery of the medical curriculum.

The qualitative study utilized a multiple case study design. The study was approved by the Saint Louis University Research Ethics Committee. Using purposive sampling, 45 participants from private institutions in Northern Luzon Philippines consented to engage in focus group discussions and in-depth interviews from February to April 2025. Data were analyzed through inductive content and thematic techniques.

Participants conceptualized internationalization as (1) alignment with international quality and practice standards; (2) global engagement and exchange encompassing knowledge, skills, culture, institutional networking, and collaboration; (3) inclusivity and multicultural responsiveness; and (4) pursuit of global recognition and accreditation. Implementation occurred via “internationalization at home” (embedding global perspectives in local learning environments), “internationalization abroad” (student/faculty mobility and external exposure), and alignment of philosophical and curricular frameworks. Reported challenges included institutional and curricular constraints, language and cultural barriers, sociocultural and financial limitations, and external/contextual pressures.

Addressing the identified barriers and scaling the documented practices can enhance the delivery of the medical curriculum. The study offers actionable curricular revisions that private institutions may adopt to strengthen internationalization in medical education.

Occupational allergies and respiratory health issues are an increasing concern across various industries, significantly impacting worker productivity, well-being and long-term health outcomes. These health problems are primarily triggered by exposure to airborne allergens such as pollen, mold and chemical irritants commonly found in workplace environments. Climate change exacerbates these issues by altering environmental conditions that influence allergen distribution and intensity. Rising temperatures, increased humidity, worsening air pollution and extreme weather events contribute to prolonged pollen seasons, greater mold proliferation, increased volatile organic compound (VOC) emissions and heightened respiratory health risks among workers. VOCs are chemical pollutants emitted from a range of indoor and outdoor sources, further aggravating air quality in workplace environments.

An emerging concern is the relationship between climate change and thunderstorm asthma, a phenomenon where allergens are dispersed during thunderstorms, leading to acute asthma events. Ongoing research continues to examine how environmental changes contribute to the frequency and intensity of asthma-related health issues, particularly in occupational settings.

Both outdoor and indoor workers face distinct challenges due to climate-driven changes in allergen exposure. Agricultural, forestry and construction workers are especially vulnerable to longer pollen seasons and higher concentrations of air pollutants. In contrast, office, healthcare and industrial workers face increased exposure to indoor allergens due to poor ventilation, rising VOC concentrations and other environmental stressors. Low-income workers, older adults and those in developing countries face disproportionate risks due to limited access to healthcare and protective measures.

This viewpoint article explores the relationship between climate change and occupational respiratory allergies, emphasizing the need for effective workplace adaptation strategies such as improving ventilation systems, using air filtration technology and creating allergen-free zones. It also examines the socioeconomic barriers to implementing these measures, mental health impacts of occupational allergies (including stress, anxiety and absenteeism) and the emergence of new allergens due to changing environmental conditions. Furthermore, technological solutions such as AI-driven air quality monitoring systems and wearable sensors hold promise in mitigating allergen exposure by providing real-time data, enabling proactive health measures and supporting policy development to protect worker health. Addressing these challenges is critical to ensuring workers’ health, well-being and productivity in the face of ongoing climate change.

BACKGROUND

In the Philippines and other developing countries, access to high-stability external fixators for traumainduced bone fracture management is limited, as modular external fixators, especially those with snap-on features, are manufactured overseas and are prohibitively expensive for most Filipino patients.

This study aimed to assess the biomechanical performance of a locally-developed modular external fixator prototype for tibial diaphyseal fractures in comparison to available external fixators, such as Roger Anderson and Hoffmann. This provides an initial evaluation for the use of the external fixator as an alternative in terms of its stability.

Using axial compression testing compliant with the ASTM F1541-24 standards, the ultimate strength, yield strength, safe strength, and stiffness were measured across various fixator types and tightening mechanisms, with or without the aid of a wrench. Statistical tools such as the t-test assuming equal variances, one-way analysis of variance, and Tukey-Kramer test with a 0.05 level of significance were used to determine any significant differences.

The mechanical performance of the external fixator prototype increased by a factor of 1.5 to 2.5 after the clamps were tightened with the wrench. However, when hand-tightened, it still performed sufficiently, showing a comparable mechanical performance with the Roger Anderson Fixator. In terms of the ultimate, safe, and yield strengths, it performed competitively in comparison with the Hoffmann system. However, there is a significant difference in stiffness between the prototype and the Hoffmann system.

The locally-developed external fixator was comparable biomechanically to the commercially available external fixators and the prototypes in different studies.

BACKGROUND

Internationalization in medical education aims to align programs with global standards, foster intercultural competence, and expand academic collaboration. In private medical schools in Northern Luzon, clarifying how internationalization is conceptualized and enacted can enhance the medical curriculum.

To explore how private medical schools in Northern Luzon conceptualize and implement internationalization, identify associated challenges, and propose curriculum inputs to enhance delivery of the medical curriculum.

The qualitative study utilized a multiple case study design. The study was approved by the Saint Louis University Research Ethics Committee. Using purposive sampling, 45 participants from private institutions in Northern Luzon Philippines consented to engage in focus group discussions and in-depth interviews from February to April 2025. Data were analyzed through inductive content and thematic techniques.

Participants conceptualized internationalization as (1) alignment with international quality and practice standards; (2) global engagement and exchange encompassing knowledge, skills, culture, institutional networking, and collaboration; (3) inclusivity and multicultural responsiveness; and (4) pursuit of global recognition and accreditation. Implementation occurred via “internationalization at home” (embedding global perspectives in local learning environments), “internationalization abroad” (student/faculty mobility and external exposure), and alignment of philosophical and curricular frameworks. Reported challenges included institutional and curricular constraints, language and cultural barriers, sociocultural and financial limitations, and external/contextual pressures.

Addressing the identified barriers and scaling the documented practices can enhance the delivery of the medical curriculum. The study offers actionable curricular revisions that private institutions may adopt to strengthen internationalization in medical education.

OBJECTIVE: To lay a foundation for formulating clinical evaluation and regulatory policies regarding radiotherapy equipment in China. METHODS: Comprehensive retrieval and comparison of the regulatory requirements for radiotherapy equipment from regulatory agencies in the United States, the European Union, and China are conducted, and their similarities and differences are analyzed. RESULTS: For mature radiotherapy systems in the European and American regions, the comparison of performance parameters serves as an important basis for determining whether a product can be marketed. Both the European Union and China regard the clinical evaluation report as a crucial part of the medical device review and submission process. CONCLUSION Identifying clear state of the art standards, performance parameters, and clinical indicator parameters, and establishing relevant technical guidelines are important directions for promoting the standardized development of radiotherapy equipment supervision.
Radiotherapy/standards* ; United States ; China ; European Union

In this study, the pre-market regulatory requirements for typical Class Ⅱ wound dressings, as well as the status of testing and post-market adverse events monitoring, were reviewed from the perspective of the whole lifecycle of medical devices. Additionally, the regulatory requirements for wound dressings in China, the United States, and the European Union were compared. Supplementary research was also conducted on Class Ⅰ and Ⅱ liquid and paste dressing products. Furthermore, this study analyzed the issues in the registration and application of typical Class Ⅱ wound dressings and provided regulatory recommendations, aiming to offer technical references for the review and approval, inspection and testing, and post-market supervision of wound dressing products.
Bandages/standards* ; United States ; China ; Humans ; European Union

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.

INTRODUCTION: Randomised controlled trials (RCTs) have informed guideline recommendations for the management of stable coronary artery disease (CAD). However, the real-world impact of contemporary guidelines and trials on practising physicians in the Asia-Pacific region remains uncertain. We aimed to evaluate the knowledge, attitudes and practices among cardiovascular physicians in the region regarding stable CAD management. METHOD: An anonymised cross-sectional electronic survey was administered to cardiovascular practitioners from the Asia Pacific, assessing 3 domains: 1) baseline knowledge on recent trials and society guideline, 2) attitudes towards stable CAD, and 3) case scenarios reflecting management preferences. Correlations among knowledge, attitudes and practice scores were assessed between physicians from developed and developing countries using Pearson correlation. RESULTS: Overall, 713 respondents from 21 countries completed the survey. The mean knowledge score was 2.90±1.18 (out of 4), with 37.3% of respondents answering all questions correctly, while 74.6% noted that guidelines have significant impact on their practice. Despite guidelines recommending optimal medical therapy, majority chose revascularisation (range 53.4- 90.6%) as the preferred strategy for the case scenarios. Practitioners from developed regions had higher knowledge scores and lower attitude scores compared to developing regions, while practice scores were similar in both groups. Weakly positive correlations were noted between knowledge, attitude and practice scores. CONCLUSION Variations exist in knowledge and attitudes towards guideline recommendations and correspondingly actual clinical practice in the Asia Pacific, with most practitioners choosing an upfront invasive strategy for the treatment of stable CAD. These differences reflect real-world disparities in guideline interpretation and clinical adoption.
Humans ; Coronary Artery Disease/therapy* ; Cross-Sectional Studies ; Practice Patterns, Physicians'/statistics & numerical data* ; Asia ; Health Knowledge, Attitudes, Practice ; Surveys and Questionnaires ; Male ; Practice Guidelines as Topic ; Female ; Attitude of Health Personnel ; Middle Aged ; Developing Countries

BACKGROUND

During the COVID-19 pandemic, social isolation and quarantine measures set to control the spread of the infection paved for the increased utilization of virtual methods of consultation and follow-up. Telerehabilitation allows access to rehabilitation services despite distance and makes possible the continuation of rehabilitation services despite the lack of face-to-face interaction. This is difficult for pediatric patients who are dependent on their caregivers for understanding and making decisions regarding their health. Loss of continuity of rehabilitation services led to poorer outcomes in children with disabilities. Although advantageous for them, pediatric patients may not benefit from telerehabilitation if caregivers have negative perceptions of the process and are unwilling to utilize the service.

This study determined caregivers’ perceptions and willingness to participate in telerehabilitation as a method of outpatient follow-up for pediatric patients admitted to a COVID-referral center in a developing country.

The study utilized a descriptive cross-sectional design. Respondents were adults (≥19 years old) caring for pediatric patients admitted at non-COVID wards of the Philippine General Hospital and who were referred for rehabilitation services. A survey tool adapted from a previous study on willingness to utilize telemedicine among caregivers of pediatric patients was translated into the Filipino language and used in the study. A dataset from Excel was imported in STATA 16 (StataCorp, Texas, USA) and was exhaustively checked for completeness, accuracy, and consistency before analysis. The association between patient characteristics and willingness to utilize telerehabilitation for any app was determined using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. The latter was used when more than 20% of the cells had an expected value of less than or equal to five. A P value of less than 0.05 was considered significant for all tests.

Of 123 respondents, 92 (75%) reported willingness to utilize telerehabilitation for outpatient consultation and therapy using video calls or a customized telerehabilitation app when available. Among 31 (25%) respondents who were not willing or unsure of participation, the main reasons identified were preference for face-to-face, lack of financial resources/load, poor connectivity, and doubt about the effectiveness of telerehabilitation.Patients with younger age (Fisher’s exact test, P=0.023), low usage of video call service (Fisher’s exact test, P=0.020), and lack of available devices (Fisher’s exact test, P=0.015) significantly reduced willingness to utilize telerehabilitation. Caregiver age, sex, educational attainment, estimated monthly income, number of devices used, speed of internet connectivity, and technological behaviors did not show statistical significance in association with willingness to participate in telerehabilitation.Most caregivers recognized the usefulness of a service allowing transmission of health data to and from the hospital, consultation with a doctor in case of an emergency, sending of reminders for medical visits and therapy, and provision of a list of home exercises and nutritional recommendations. Telerehabilitation was perceived advantageous, but concerns regarding privacy, trust, lack of human contact, and technological difficulty were also present.

With high levels of willingness among caregivers, telerehabilitation is a viable method of providing rehabilitation services for the continuation of management after inpatient admission among pediatric patients. Limitations in its utilization include technological issues including the lack of devices, low level of service use, and slow internet connectivity. Although well perceived as advantageous, there are concerns regarding loss of human contact, difficulty in using technological devices, and trust and privacy issues that may affect utilization.

INTRODUCTION: Hypertension is a major risk factor for cardiovascular diseases, with adherence to treatment often influenced by socioeconomic status. This study assessed adherence to hypertension medication among patients in Quezon City across economic classes from August to October 2023. METHODS: An analytical cross-sectional design was employed, surveying 116 hypertensive Filipinos aged 18-64 years using the Brief Medication Questionnaire-1 (BMQ-1) and socioeconomic classifications based on multiples of the poverty line. RESULTS: Findings revealed that 50.9% of respondents were adherent or probably adherent to treatment, while 49.1% exhibited low or probable low adherence. Those who are low adherent and probable low adherent are 1.399 times more likely to belong to the “Low Income and Below.”, though this association was not statistically significant. CONCLUSION Adherence to hypertension treatment among the respondents was suboptimal, particularly among the lower-income groups. While the association between socioeconomic status and adherence was not statistically significant, the findings underscore the need for interventions targeting financial barriers and improving healthcare accessibility. Addressing these challenges can enhance adherence levels and reduce the burden of hypertension and cardiovascular risks across socioeconomic strata.
Cardiovascular diseases ; hypertension ; prescription drugs ; medication adherence ; developing countries