Introduction: The 'first generation' physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the 'first generation' physician only has himself to survive this endeavor. Through the life worlds of a select group of 'first generation' physician-in-training, this study seeks to answer the following central question: How do 'first generation' Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice?

Methodology: Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method.

Findings and Discussion: With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a 'first generation' physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be.

Recommendations: Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees' life-world, especially that of a 'first generation' physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.

Physicians

Background : Caregiver burden and its impact on the quality of life is as important as determining the quality of life of children with epilepsy as these factors inl uence each other as well as the outcome of these children. Objectives : The primary objective of the study was to determine the association between caregiver burden and quality of life as well as anxiety and depressive symptoms among caregivers of Filipino children with epilepsy. Also, the study aimed to determine the prevalence rate of caregiver burden, impaired quality of life, anxiety, and depressive symptoms in an ambulatory care setting. Methodology : In this cross-sectional survey, adult caregivers accompanying their pediatric patients with epilepsy at a single tertiary center were recruited. Sociodemographic and clinical data were collected. The participants completed questionnaires for caregiver burden, quality of life, anxiety, and depressive symptoms. Results : Fifty-three caregivers participated with a mean age of 38 years. Most of them were females, married, unemployed, and at least college level. The mean age of their patients was 9.4 years and 71.7% of patients were on a single anti-epileptic drug. Lower educational level was less likely associated with caregiver burden. Although impaired quality of life and depressive symptoms were more likely associated with caregiver burden, this association did not reach statistical signii cance. Conclusion The prevalence rate of caregiver burden, impaired quality of life, anxiety, and depressive symptoms were 24.5%, 22.6%, 28.3%, and 9.4% respectively, among caregivers of Filipino children with epilepsy at a single tertiary center. Lower educational level was the only characteristic signii cantly associated with lesser odds of having caregiver burden
Caregiver Burden ; Quality of Life ; Anxiety ; Depression

OBJECTIVES: To compare the Clock Drawing Test (CDT) performance of Filipino patients with schizophrenia and normal subjects in detecting cognitive impairment and to determine the correlation of symptom severity using Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) with the CDT performance among schizophrenic subjects.
METHODOLOGY: A descriptive cross-sectional study using convenient sampling. Stable and compliant schizophrenic subjects were recruited at the psychiatry OPD of our institution from July to November 2004. Normal subjects were recruited from the community who were age,sex, and education matched. CDT and MMSE were administered to all the subjects and the scores of the two groups were compared using the two-tailed Student t-test. Symptom severity using BPRS and PANSS were correlated with CDT and Mini Mental Status Exam (MMSE) in schizophrenic subjects using the Pearson;s correlation coefficient.
RESULTS: A total of 66 subjects, 33 schizophrenic and 33 normal subjects were included in the study. Schizophrenic subjects performed poorly on CDT and MMSE compared to the normal subjects. The difference between the mean scores was statistically significant. The examination errors on the clock drawing test was more apparent among schizophrenic subjects. There were positive correlations between CDT and MMSE, and BPRS and PANSS. Negative correlations were observed between the cognitive performance and the symptom severity of schizophrenia.
CONCLUSION: Schizophrenic subjects performed poorly on CDT compared to the normal subjects, thus it is useful in detecting cognitive impairment. Likewise, CDT performance correlates well with symptom severity. Its availability and simplicity makes it very useful in detecting cognitive impairment in our clinical practice.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Brief Psychiatric Rating Scale ; Cognition ; Cognition Disorders ; Cognitive Dysfunction ; Cross-sectional Studies ; Neuropsychological Tests ; Psychiatry ; Schizophrenia

OBJECTIVE: This paper aims to correlate the white matter changes seen in cranial Magnetic Resonance Imaging (MRI) the severity of cognitive impairment in patients diagnose Alzheimer Disease by using the conventional Cranial MRI weighted and Fluid-attenuated inversion recovery (FLAIR) images.

METHODS: All patients diagnosed with Probable Alzheimer's disease at the Memory Assessment Center in a tertiary hospital in Manila from January 2007 to September 2008 were included in the study who underwent cranial MRI (T2 weighted and FLAIR images), with ages varying from 65-87 years old using the following tests: Alzheimer's Disease Assessment Scale-Cognitive (ADASCOG), Mini-Mental Status Examination (MMSE), Boston Naming, Verbal Fluency, Word List Memory Task, Recall and Recognition, Trail making A and B and Clinical Dementia Rating (CDR). The Cranial MRI images were rated using the Age-Related White Matter Changes (ARWMC) rating scale for MRI. Analyses were done using the Statistical Package for the Social Sciences (SPSS version 14.) Correlation between continuous data was done using the Pearson correlation test while the correlation between ranked data utilized the Spearman test.

RESULT: Four patients with no white matter changes had mild AD while another two had made an AD. Among those with focal lesions, two were categorized as mild AD, another two cases as moderate and one case with severe AD. Among those with the beginning confluence of lesions, three had mild AD, two had moderate AD and one had severe AD. No case had severe age-related white matter changes. We found no significant relationship between the clinical dementia ratings (severity of AD) and the presence or absence of white matter lesions in the cranial MRI (T2 weighted and FLAIR images). 

CONCLUSION: Diffusion tensor imaging (DTI) captures neurodegenerative brain changes that traditional MRI may miss. Further studies using structural and functional imaging methodologies should be promoted to show cognitive performance and its correlation. In particular, compensatory networks in patients were shown to linearly correlate to cognitive performance. Thus, varied approaches to understanding networks could be valuable tools in developing new approaches for early diagnosis of AD and in the future, aid us in the effectivity of treatment strategies.

Human ; Diffusion Tensor Imaging ; Alzheimer Disease ; Cognitive Dysfunction ; Tertiary Care Centers ; White Matter ; Magnetic Resonance Imaging ; Brain ; Memory ; Cognition ; Early Diagnosis ; Social Sciences ; Mental Status And Dementia Tests

BACKGROUND: The Asian population is rapidly aging and a concomitant exponential rise in the number of elderly people with dementia is expected. Early diagnosis of dementia and recognition of concomitant psychiatric symptoms have profound implications for the patient. In our local setting, majority of elderly individuals live with their families due to cultural influence on family ties. However, institutionalization of elderly individuals is gradually being recognized due to the increasing demands of the society on caregivers who usually belong to the working class.

OBJECTIVE: This pilot study evaluates the cognitive status of Filipino elderly individuals residing at Hospicio De San Jose which aims to examine the prevalence of cognitive impairment and neuropsychiatric manifestations in an institutionalized environment and to determine the rate of progression of cognitive decline.

METHODOLOGY: This is a research study evaluating all Filipino elderly individuals residing at Hospicio de San Jose aged 60 years and above, with or without objective memory complaints. Only literate individuals are included. Exclusion criteria include the presence of acute confusional state or altered sensorium, severe expressive and receptive aphasia, vegetative state, blindness, deafness, and denise hemiplegia in the dominant upper limb. Cognitive status was assessed using the following tests: Mini Mental State Exam (MMSE), US Second Version of Isaac's Set Test of Verbal Fluency (IST), Zasso Cancellation Task, 4-item version of Instrumental Activities of Daily Living: Modified Lawton's Scale (I-ADL). Neuropsychiatric manifestations were evaluated with the use of the Neuropsychiatric Inventory (NPI) and Modified Geriatric Depression Scale (MGDS). Patients were assessed at baseline (BS) and after 6 months (MO). The patients were classified accordingly based on set criteria as follows: Not Cognitively Impaired (NCI), Cognitive Impairment Not Demented (CIND), and Dementia (DEM).

RESULT: There were eighty elderly individuals at Hospicio De San Jose. There were twelve male patients and sixty-eight female home dwellers in total. Twenty-five (25) were included in the study based on the set criteria. Majority were female (84%) and previously employed (70%). The mean age of the population was 70.92 years old and mean level of education (in years) was 10.52. Seventy-two percent (72%) of patients subjectively complained of progressive and insidious memory impairment with an onset ranging from 6 months to 17 years. This pilot study shows that the prevalence of CIND and dementia in an institutionalized care center in our local setting like Hospicio De San Jose is 52% and 8%, respectively.

CONCLUSION: The presentation of the patients is progressive cognitive decline so that careful clinical monitoring is essential. The rate of conversion to dementia within 6 months is negligible. Amongst the several domains evaluated, it is the verbal fluency and speed that is greatly affected which is more compatible with sub cortical white matter changes in an aging brain. The identification of  Filipino home care dwellers at potential risk of dementia is important to lessen caregiver burden, to address early intervention both pharmacologic and non-pharmacologic including improvement of facilities and in-house program to prevent neuropsychiatric complications

Human ; Male ; Female ; Cognitive Dysfunction ; Caregivers ; Activities Of Daily Living ; Persistent Vegetative State ; Prevalence ; Deaf-blind Disorders ; Early Intervention (education) ; Hemiplegia ; Pilot Projects ; Aphasia, Wernicke ; Depression ; White Matter ; Dementia ; Memory ; Memory Disorders ; Institutionalization ; Home Care Services ; Early Diagnosis ; Confusion ; Educational Status ; Cognition