BACKGROUND AND OBJECTIVE

In 2018, the Philippine Congress passed the Universal Healthcare (UHC) Law and its implementing rules which mandated the enrollment of all Filipinos to PhilHealth, the national social health insurance corporation. The Department of Health (DOH) and PhilHealth will leverage their strategic purchasing power by affiliating Health Care Provider Networks (HCPNs), established within the geopolitical boundaries of a province or a highly urbanized city, through service level agreements. This study aims to shed light on what is expected from providers, payers, and regulators to implement UHC successfully.

The researchers conducted an inductive, content analytic qualitative study guided by the World Health Organization’s (WHO) Building Blocks Framework to determine the understanding and acceptance of the implementing rules of the UHC Law and the perceived barriers and enablers from the provider, payer, and regulator stakeholders in three provinces in the Philippines. Purposive sampling was utilized to provide the best representation across different economic and physical settings. A content analysis was done through an inductive process of coding concepts, which was the basis for categories grouped and matched deductively with the WHO framework. This formed the broader sub-themes and were used for the final data interpretation.

A total of 16 focus group discussions (FGDs) and nine in-depth interviews (IDIs) were performed with 84 participants. Inductive thematic analysis of categories and subcategories showed that the participants support the goals and objectives of the UHC Law. Still, perceived barriers refer to the lack of and improper use of funds, the need to clarify the implementing guidelines, and the role of politics. The participants indicated that solidarity and social connectedness with health system adaptability and resilience are enablers for the success of UHC reforms.

Proposals to mitigate the barriers include expanding the funding source, clarifying rules on the f inancial management system, and providing guidelines on health delivery integration to ensure access to patient care. Decentralization with autonomy will allow the stakeholders to align health programs with local needs. Proper representation in decision-making bodies is desirable to establish strong community involvement and solidarity. Resilience and adaptability based on a feedback loop are imperative.

BACKGROUND

Mental health literacy (MHL) is an important mental health strategy since it contributes to early detection, enhances help-seeking behavior, and reduces stigma and discrimination against people with mental disorders.

The objectives of the present study were to assess the level of mental health literacy and its correlation, and to examine the predictive effect of demographic profiles on mental health literacy among young and adult populations in the five cities of Caraga, using a standardized mental health literacy scale in 2023.

This study applied a cross-sectional survey. It surveyed 729 individuals from five cities in Caraga using the Mental Health Literacy Scale from Dias et al. Descriptive analysis, such as frequency, percentage, mean, and standard deviation, and inferential statistics, such as Pearson correlation, independent t-test, and multi-linear regression, were used for data analysis.

The mental health literacy of the young and adult populations can be classified as adequate or good. Zooming in on details, the respondents have a very good understanding of help-seeking behavior and self-strategies but only a good understanding of knowledge and beliefs/attitudes. Pearson’s correlation analysis revealed a significant positive relationship between knowledge, erroneous beliefs, self-strategies, and help-seeking behavior (p < 0.001). In addition, Independent t-test and ANOVA revealed significant differences in sex, family income, employment, civil status, educational level, and age group (p < 0.01). A multiple linear regression indicated that demographic profile predictors were found to be statistically significant, and positively with mental health literacy, with education and family income as the strongest predictors.

The present study concluded that the young and adult populations in the five cities in Caraga have adequate literacy on mental health, encompassing knowledge, beliefs, self-strategies, and help-seeking behaviors. The increases in knowledge, belief, and self-strategies are associated with their higher level of help-seeking; in addition, the demographic profiles (e.g., sex, age, education, monthly income, and employment) have implications on young and adults’ mental health literacy in the five cities in Caraga. The result may not be generalizable beyond the studied region or demographic. In addition, it recommended that mental health literacy programs prioritize individuals with lower levels of education and family income as these factors Xwere found to have the most significant influence.

Congenital cytomegalovirus (cCMV) infection is a major cause of neurodevelopmental impairment and sensorineural hearing loss worldwide, particularly in low- and middle-income countries where standardized molecular screening programs are not routinely implemented. Early laboratory confirmation within the first 21 days of life is essential to differentiate congenital from postnatal infection. This study evaluated the diagnostic agreement between the Simplexa cCMV Direct real-time PCR assay and conventional nested PCR for detecting CMV DNA in neonatal urine specimens in Indonesia. A cross-sectional diagnostic agreement study was conducted between September and December 2023 at a tertiary referral hospital. Urine samples from 87 neonates aged < 21 days with clinical suspicion of congenital infection were tested using both assays. The Simplexa assay detected 29 positive and 58 negative samples, while conventional nested PCR identified 28 positive and 59 negative samples. Agreement was assessed using Cohen’s kappa coefficient, McNemar’s test, and positive and negative agreement rates. The assays demonstrated near-perfect agreement (k = 0.87; 95% CI: 0.75–0.98; p < 0.001). Positive and negative agreement were 91.2% and 95.7%, respectively, with no statistically significant difference between methods (McNemar p = 1.00). Simplexa Direct real-time PCR showed high agreement with conventional nested PCR while offering operational advantages including simplified workflow and reduced contamination risk. These findings support the implementation of automated direct molecular platforms for neonatal cCMV diagnosis in tropical and resource-limited healthcare settings.

Mosquito-borne arboviral diseases such as dengue and chikungunya have continuously been a major global public health concern. Introducing the intracellular bacterial endosymbiont Wolbachia into mosquito populations has been proven to reduce dengue virus transmission, and its broader efficacy against other arboviruses has also been investigated. Several Wolbachia strains have been successfully propagated in insect cell lines, highlighting the utility of in vitro systems for studying microbial-host interactions under controlled conditions. This study investigated the initial establishment and replication kinetics of a flea-derived Wolbachia strain (wCfe), which was originally isolated from Malaysian Ctenocephalides felis and maintained in the Ixodes scapularis tick-derived cell line (IDE8), and then transferred into an Aedes albopictus-derived cell line (C6/36). The wCfe strain was semi-purified from IDE8 cultures and inoculated into C6/36 cells in 24-well plates. Replication dynamics were monitored by quantitative real-time PCR targeting the Wolbachia pipientis 16S rRNA gene. Following infection, a lag phase was observed at day 0 to 5 days post-infection (d.p.i.), followed by exponential growth from 6 d.p.i. after which Wolbachia levels remained relatively stable until the end of the observation period at 12 d.p.i. Overall, a 25.30-fold increase in Wolbachia density was detected relative to 0 d.p.i. Across replicates, the estimated generation time of wCfe in C6/36 cells ranged from 1.7 to 2.5 days. These results demonstrate successful initial establishment and replication of the flea-derived Wolbachia strain in the Aedes mosquito cell line. However, longer-term in vivo studies will be necessary to determine the persistence of wCfe infection in C6/36 cells and within the mosquito host.

Bartonella henselae is an uncommon but important cause of prolonged pyrexia of unknown origin (PUO) and hepatosplenomegaly. Conventional diagnostic tools often fail in disseminated disease, leading to delayed or missed diagnoses. We report a 60-year-old man with PUO, progressive weight loss, and hepatosplenomegaly. Clinical suspicion, guided by significant cat exposure, led to molecular confirmation of B. henselae infection after conventional workup proved inconclusive. Liver biopsy revealed pleomorphic rod-shaped organisms on Warthin-Starry staining, while real-time PCR targeting the rpoB gene and conventional PCR targeting the gltA gene performed on bone marrow aspirate confirmed disseminated bartonellosis. The patient responded well to prolonged doxycycline and rifampicin therapy, achieving near-complete recovery. This case underscores the importance of clinical vigilance, histological clues, and molecular diagnostics in identifying rare but treatable infections.

Purpose: Splenic flexure mobilization (SFM) is occasionally utilized during sigmoidectomy to facilitate a tension-free colorectal anastomosis. Present literature regarding its use, safety, and efficacy predominantly evaluates traditional laparoscopic vs. open techniques, thus not adequately representing the current minimally invasive surgical landscape. Methods: This retrospective cohort analysis evaluated SFM during sigmoidectomy for diverticular disease via traditional laparoscopic, single-incision laparoscopic, and robotic techniques at a United States academic institution from 2019 to 2022. Primary outcomes were the rate of SFM, independent predictors, and short-term outcomes. Results: A total of 117 patients underwent sigmoidectomy for diverticulitis by six colorectal surgeons, of whom 27 underwent SFM. SFM was associated with higher rates of complicated diverticulitis (85.2% vs. 46.7%, p < 0.001), including abscess (55.6% vs. 33.3%, p = 0.037) and fistulae (59.3% vs. 17.8%, p < 0.001). Presence of a fistula was an independent predictor of SFM by logistic regression (odds ratio [OR], 5.886; p < 0.001). Mobilization was associated with more concomitant surgical procedures (66.7% vs. 28.9%, p < 0.001). There was a significant association between SFM and conversion to open approach (14.8% vs. 3.3%, p = 0.049), longer length of stay (4.2 ± 2.8 days vs. 3.6 ± 4.3 days, p = 0.041), and increased operative time (241.7 ± 76.4 minutes vs. 199.2 ± 75.7 minutes). There was no difference in 30-day morbidity/mortality. Conclusion Routine SFM can be considered in minimally invasive sigmoidectomy for complicated diverticulitis without significant impact on 30-day morbidity/mortality regardless of surgical approach and may be anticipated preoperatively, particularly when a fistula is present.

Objectives: Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023–2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia. Methods: This study used a cross-sectional design and analyzed data from the 2023–2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication. Results: A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%). Conclusions Under-reporting of childhood TB was significantly associated with both age group and type of health facility

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease of clinical importance in the Philippines. While its actual prevalence in the Philippines is unknown due to a lack of organized cohorts and community-level screening, Filipino females in the second and third decades of life are primarily affected, commonly presenting with mucocutaneous, musculoskeletal, hematologic, and renal involvements. Several risk factors have been described as influencing the development of SLE in Filipinos, including molecular/genetic, clinical, lifestyle, and environmental factors. The diagnosis of SLE in the Philippines still relies on international standards, such as the Systemic Lupus International Collaborating Clinics 2012 and the European League Against Rheumatism/American College of Rheumatology 2019 classification criteria. Similarly, the lack of published local guidelines for SLE requires Filipino practitioners to rely on international management guidelines, which now include the Asia-Pacific League of Associations for Rheumatology recommendations for the Asia-Pacific region, with management goals including the achievement of a low disease activity state, the prevention of organ damage, the prevention of flares, and the promotion of quality of life. Structural barriers still impede comprehensive lupus care in the country, manifesting as poor access to essential drugs and rheumatologists, low capacity for community-level surveillance, lacking research and guidelines in Philippine-specific nuances (i.e., common presentations and comorbidities such as tuberculosis), and education. The medical community in the country must be mobilized to ensure holistic care for SLE patients, as it is one of the most important rheumatologic conditions in the Philippines.

Agarwood (Aquilaria spp.) is a resinous wood traditionally used in various medicinal systems across Asia for treating inflammation-related ailments. Despite its longstanding ethnopharmacological use, scientific validation of its anti-inflammatory effects remains fragmented. This scoping review aims to systematically evaluate and synthesize current evidence from animal studies investigating the anti-inflammatory potential of agarwood. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Inclusion criteria focused on original animal studies assessing the anti-inflammatory effects of agarwood extracts, essential oils, or derivatives. Data on study design, animal models, agarwood species, treatment dosage, duration, biomarkers, and outcomes were extracted and summarized narratively due to methodological heterogeneity. Eight studies met inclusion criteria, involving models of inflammation-related conditions such as pain, neuroinflammation, gastrointestinal injury, cancer, and toxicity. Agarwood treatment consistently reduced pro-inflammatory cytokines (e.g., IL-1β, IL-6, TNF-α), modulated oxidative stress markers (e.g., NO, SOD, GSH), and regulated signalling pathways including NF-κB, p38 MAPK, and Nrf2–ARE. Notably, improvements were observed in behavioural and histological outcomes across models, with evidence of dose-dependent effects in several studies. In conclusion, preclinical evidence supports agarwood’s broadspectrum anti-inflammatory and antioxidant properties across multiple organ systems. These findings provide mechanistic insights and a scientific basis for its traditional use. However, variability in species, extraction methods, and study designs highlights the need for standardised protocols and clinical validation to advance agarwood as a potential therapeutic agent.

BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.