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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

INTRODUCTION

Hypertension is a serious public health issue that puts individuals at risk for various morbidity and mortality indicators. One of the most crucial factors in managing blood pressure and preventing complications is medication adherence which is linked to several determinants. This study explored the correlation between medication adherence among middle-aged hypertensive adults and the different domains of quality of life (QOL), which includes physical, psychological, social relationship and environment.

METHODS

This cross-sectional study involved 96 Filipino residents of Brgy. San Jose, Navotas City aged 35 to 65 years old diagnosed with hypertension and prescribed anti-hypertensive medications. Pearson’s correlation coefficient was used to calculate the correlation between different domains of QOL as well as the overall QOL score.

RESULTS

Results revealed a statistically significant but weak positive correlation between overall QOL and medication adherence (r = 0.336, p<0.001). Among the QOL domains, environmental domain had the strongest correlation with adherence (r = 0.446, p = 0.00), followed by physical health (r = 0.443, p = 0.01) and psychological well-being (r = 0.382, p = 0.01). The social relationship domain showed negligible correlation (r = 0.163, p = 0.4).

CONCLUSION

The study demonstrates that while medication adherence is modestly associated with better perceived QOL, especially in physical, psychological and environmental aspects, other factors likely influence both outcomes. These findings highlight the need for holistic, community-based interventions that address not only medication adherence but also environmental and psychosocial barriers to care in managing hypertension.

Human ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Quality Of Life ; Public Health ; Medication Adherence ; Antihypertensive Agents ; Blood Pressure ; Interpersonal Relations

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.

Background: Diet is an important modifiable factor that may influence sleep quality, with several foods, nutrients, and dietary patterns reported to affect sleep-related outcomes. However, evidence regarding the relationship between Halal dietary practices and sleep quality remains limited. This study aimed to determine the association between the frequency of consumption of Halal-certified food groups and sleep quality among adult Filipino Muslims. Methods: An analytical cross-sectional study was conducted among 323 adult Filipino Muslim members of the Greenhills Muslim Traders Association in San Juan City, Philippines. Participants were selected using purposive sampling based on predefined inclusion and exclusion criteria. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while dietary intake was measured using a structured questionnaire on the frequency of consumption of Halal-certified food groups. Descriptive statistics were used to summarize participant characteristics, dietary patterns, and sleep quality. Multivariable logistic regression analysis was performed to determine the association between Halal-certified food group consumption and sleep quality. Results: Halal-certified grain products were the most frequently consumed food group (mean = 2.39), while Halal-certified combination foods were the least frequently consumed (mean = 1.21). The mean global PSQI score was 4.62, indicating generally good sleep quality, and 67.8% of participants were classified as good sleepers (PSQI ≤5). Sleep efficiency had the highest mean component score (1.16), whereas subjective sleep quality had the lowest (0.00). Multivariable logistic regression showed no significant association between the frequency of consumption of most Halal-certified food groups and sleep quality (p > 0.05). However, more frequent consumption of Halal-certified combination foods was significantly associated with lower odds of good sleep quality (OR = 0.697, 95% CI: 0.529–0.919, p = 0.010). Conclusion The frequency of consumption of most Halal-certified food groups was not significantly associated with sleep quality among adult Filipino Muslims. However, increased consumption of Halal-certified combination foods was associated with lower odds of good sleep quality. Further studies should explore other dietary and behavioral factors that may influence sleep outcomes.
Sleep quality ;

BACKGROUND

Medication compliance contributes to preventing significant morbidities, such as stroke, among hypertensive patients.

OBJECTIVE

This study aimed to examine the factors affecting hypertensive patients' medication compliance in Sambag II, Cebu City.

METHODS

This study is an observational cross-sectional study. The study was conducted in Barangay Sambag II of Cebu City and involved 170 random, voluntary, self-reporting hypertensive patients. The Tao Yamane formula was used to determine the sample size. An interviewer-guided survey questionnaire was utilized to collect the data for the pilot study. The data were analyzed using Cronbach’s Alpha Test for internal consistency and reliability.

RESULTS

Three factors were shown to influence compliance with antihypertensive medications. These are the source of medication, access to medication, and symptoms experienced before intake of anti-hypertensive medications. A factor that significantly affects compliance is the source of medication, wherein hypertensive patients prefer medications from retail pharmacies compared to the free medications supplied by the local health center.

CONCLUSION

Residents of Sambag II, Cebu City preferred medications from retail pharmacies over the free medications provided by the local health center. Local health units may use this information to implement information drugs regarding the efficacy of medications provided by government agencies. Further studies are recommended to use subgroup analysis on factors influencing compliance and non-compliance to anti-hypertensive medicines.

Human ; Medication Compliance ; Medication Adherence ; Hypertension ; Stroke

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched a web-based data acquisition and reporting system (QISAR), which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

Background: According to the World Health Organization (WHO), 99 percent of the world’s population is exposed to air that exceeds WHO recommendations, with low- and middle-income countries being the most affected. The main causes of indoor air pollution include human activities such as fuel burning, cooking, cleaning, and smoking; housing characteristics such as walls, floors, ceilings, and furniture; ventilation; and outdoor air pollution. Aim : To assess PM1 and PM10 concentrations in 120 selected households in Ulaanbaatar. Materials and Methods : Indoor PM1 and PM10 concentrations were measured using Purple Air real-time sensors in randomly selected Ulaanbaatar households between October 2023 and January 2024. Supplementary data on factors affecting the PM2.5 concentration were collected via questionnaires. Each measurement was taken in 10-minute intervals, yielding 51,309 data for analysis. Results : PM1 concentrations were measured at 55.5±53.2 μg/m³ in gers, 54.9 ± 46.7 μg/m³ in houses, and 31.6±40.1 μg//m³ in apartments (p<0.001) and measuring PM10 concentrations were 110.6±108.6 μg/m³ in gers, 110.6±96.7 μg/m³ in houses, and 62.2±83.0 μg/m³ in apartments (p<0.001) When considering the concentration of PM1, PM10 by heating type, PM1 was 55.3±50.1 μg/m³ and PM10 was 110.6±103.0 μg/m³ in households with stoves and furnaces, and PM1 was 31.6±40.1 μg/m³ and PM10 was 62.2±83.0 μg/m³ in households connected to the central heating system (p<0.001). Regarding the months of measurement, the highest concentration was observed in December 2023, at 77.1±94.1 μg/m³. The highest concentrations for both PM₁ and PM₁₀ were recorded in January 2024, at PM₁: 64.8±55.1 μg/m³, PM₁₀: 131.4±116.0 μg/m³. Conclusion 1. Indoor PM10 concentrations in residential environments in Ulaanbaatar city were within the MNS4585:2016 Air Quality Standard, however, it was exceeded the WHO air quality guidelines, indicating an excessive risk of increasing morbidity and mortality among the population. 2. Indoor PM1 and PM10 concentrations in residential environments in Ulaanbaatar varies depending on location, type of housing, type of heating, and month of measurement.

Background: The most common clinical manifestation of HCV infection, which includes both hepatic and extrahepatic manifestations, is mixed cryoglobulinemia, which is characterized by the precipitation of certain proteins in the blood at temperatures below 37°C (in vitro), aggregation, and deposition in the walls of small and medium-sized vessels, causing vasculitis, which is clinically manifested by a triad of joint pain, fatigue, and rash on the soles of the feet. Cryoglobulinemia is commonly diagnosed in people with HCV infection, with a prevalence ranging from 10% to 70%. Vasculitis that occurs when cryoglobulinemia is detected mainly affects the small vessels of the skin, kidneys, and peripheral nerves, causing complications in other organ systems. Aim : To determine the prevalence of cryoglobulinemia in people with HCV infection, study it in relation to the stage of liver fibrosis, and determine its clinical relevance. Materials and Methods : 200 chronic HCV infected individuals were included in the study according to the inclusion and exclusion criteria. After obtaining informed consent from each participant, a questionnaire was used to collect information, perform physical measurements, and collect peripheral blood samples. Complete blood count and biochemical tests (liver and kidney function) were performed. The degree of liver fibrosis was assessed non-invasively (APRI, FIB4). The glomerular filtration rate was calculated electronically using the MDRD GFR Equation. Skin examination was performed to assess the presence of rash, ulcers, and scarring on the shins and ankles of cryoglobulinemia. To determine cryoglobulinemia, 8 ml of blood was collected in a tube without anticoagulant, and the sample was kept motionless for 1 hour at room temperature until clotting was complete. After centrifugation, the samples were separated and stored in a refrigerator at +4°C for 7 days, and then at room temperature for 30 minutes, the precipitate was detected. Results : A total of 200 people participated in the study, of which 71 were men (35.5%), the average age was 53.39±13.0. Cryoglobulinemia protein precipitates were determined in a total of 148 people, of which 50 were men (33.8%), the average age was 52.95±13.0. Cryoglobulinemia protein precipitates were detected in 89 people, or 60.1% of the study participants. Of the total study participants, 176 (88.0%) had chronic hepatitis C (CHC). Of these, 57 people had CHC with cryoglobulinemia. Comparing laboratory parameters, the mean GGT level in the cryoglobulinemia group was statistically significantly higher than in the non-cryoglobulinemia group (p=0.039). However, when laboratory parameters were grouped by increasing or decreasing, AST and ALT levels were significantly higher in the cryoglobulinemia group, indicating more hepatocellular damage (p<0.000). Increased creatinine levels may be associated with the risk of renal dysfunction. The FIB-4 index and APRI index showed a more severe degree of fibrosis in the cryoglobulinemia group (p<0.005; p<0.000). Univariate logistic regression analysis showed that age was associated with the occurrence of cryoglobulinemia (OR=2.48; 95% CI:1.31–4.70; p=0.005). Platelet count had a statistically significant positive effect in multivariate analysis (OR=14.38; 95% CI:1.26–163.89; p=0.032). Conclusion The prevalence of cryoglobulinemia among HCV-infected patients was 60.1%, and older age and decreased platelet count among infected individuals were associated with the occurrence of cryoglobulinemia.