Objective: To understand the growth and development levels of four physical measurements in children aged 3-6 years in China, so as to provide a reference for child nutrition improvement and health promotion. Methods: A stratified random sampling method was used to collect physical measurement data from 120 kindergartens 25 842 children aged 3-6 years across 24 provinces and cities in seven natural geographical regions of North China, Northeast China, East China, Central China, South China, Southwest China and Northwest China from 2020 to 2023. The development levels of head circumference, chest circumference, waist circumference, and hip circumference were evaluated using a grading method. The analysis of gender and age differences was conducted using Mann-Whitney U- test and Kruskal-Wallis test, and the comparison of abnormal detection rates for different genders was conducted using Chi square test. Results: The distribution range of children aged 3-6 was 51.74(50.08, 53.33) cm in terms of head circumference, 55.73(52.09, 59.04) cm in terms of chest circumference, 53.04(48.92, 56.40) cm in terms of waist circumference, and 59.36(56.30, 62.32) cm in terms of hip circumference. The detection rate of abnormal head circumference in boys and girls aged 3-6 years old was relatively high (19.71%-42.02%), and the detection rate of abnormal physical circumference development levels in boys was higher than that in girls of all ages ( χ 2=5.63-83.35, P <0.05). The detection rate of abnormal hip circumference (4.89%-6.53%) and chest circumference (4.51%-6.38%) in boys and girls aged 3-6 was relatively low, and there was no statistically significant difference in the abnormal rate between different ages and genders ( χ 2=0.00-1.61, 0.00-3.71, P >0.05). The detection rate of abnormal waist circumference in boys and girls aged 3-6 was relatively high (13.70%-42.45%), and the detection rate of abnormal waist circumference in girls was higher than that in boys aged 4-6 groups ( χ 2=10.49-58.18, P < 0.05). Conclusions The overall physical development of children aged 3-6 years in China is improving, but the abnormal detection rates for head circumference and waist circumference are relatively high. Child healthcare should focus on preventing and treating abdominal obesity, with differentiated health intervention strategies based on different age groups and genders.

BACKGROUND

The Philippines has been significantly affected by the HIV epidemic in the Asia-Pacific region, with a notable increase in new cases over the past decade. Despite efforts to promote HIV testing, access to treatment, and awareness campaigns, progress has been slow, particularly among youths. Tangere, a market research application, conducted surveys during and after the COVID-19 pandemic to assess HIV knowledge among Filipinos.

This study aimed to evaluate changes in HIV awareness among young Filipinos during and after the COVID-19 pandemic using data collected via Tangere’s surveys. Specifically, it sought to analyze demographic characteristics, sources of HIV information, and knowledge regarding HIV transmission, prevention, and stigma.

Tangere collaborated with the investigators to develop a questionnaire assessing HIV knowledge among young Filipinos. Surveys were conducted during and after the COVID-19 pandemic, targeting subscribers aged 18-35 years, primarily from the National Capital Region and Luzon area. Data analysis involved calculating frequencies and percentages to summarize demographic characteristics and HIV knowledge. An Independent-Samples Proportions procedure was used to compare HIV knowledge during and after the pandemic.

The survey revealed that while respondents generally possessed reasonable knowledge about HIV, there were notable changes in the awareness during and after the pandemic. Social media and television were identified as primary sources of HIV information. Knowledge regarding HIV transmission and prevention increased postpandemic, particularly concerning preventive measures such as pre-exposure prophylaxis (PREP) and motherto-child transmission (MTCT). However, persistent misconceptions and stigma surrounding HIV remained, indicating the need for continued education and advocacy efforts.

The study underscores the importance of utilizing social media platforms for HIV awareness campaigns, especially among youths who are disproportionately affected by the epidemic. Despite improvements in knowledge, the Philippines has yet to achieve global HIV prevention goals. Continued efforts to enhance awareness, particularly regarding recent advancements in HIV prevention and treatment, are essential for curbing the epidemic and improving public health outcomes nationwide.

BACKGROUND AND OBJECTIVES

With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.

The study utilized a descriptive design using qualitative methods of data collection namely key informant interviews (KIIs) and focus group discussions (FGDs). Participating institutions and their designated representatives were purposively sampled as key informants. OPs and carers from select barangays in NCR and Region IVA participated in the FGDs. Guided by the interpretivism approach, thematic analysis was performed. A trained research assistant coded the FGD and KII transcripts through the Nvivo PRO plus software and verified by the first author. Themes were reviewed and validated by the multidisciplinary team.

A total of 15 KIIs and two FGDs were conducted. The participating institutions and organizations were found to have varied roles and initiatives relevant to LTC; from strategic planning, development of policies and standards of care, training and capacity-building, and up to the actual implementation of LTC services. Identified challenges include implementation issues, financial issues, lack of political and stakeholder support, OPs and familial issues, and lack of knowledge on LTC.

Participants shared their description on what LTC is, an LTC facility, and the conditions of those in LTC facility. OPs expressed their willingness to utilize LTC services and identified several factors related to their preferred LTC arrangements. Carers identified various topics related to taking care of OPs that they would like to learn.

The roles, initiatives, and awareness of relevant stakeholders, older persons, and carers towards LTC were found to greatly vary. Policy makers, health workforce, families, communities, and the older persons themselves should have a better understanding of longterm care before they can provide or utilize the system. With the current landscape of LTC provision, the country still has a long way to go in achieving the integrated continuum of LTC appropriate to promote healthy aging. Promoting awareness, integrating LTC in the current programs and services for older persons in the country, capacitating the formal and non-formal caregivers, and strengthening collaborations are recommended.

Further research on quantitative measures of readiness for long-term care with focus on the health system and in-depth studies on the varieties or models of long-term care are recommended.

BACKGROUND

Acne vulgaris is one of the common skin diseases prompting dermatologic consult. Although prevalent worldwide, knowledge of the public about acne is still lacking. Due to this, content related to acne vulgaris has been a topic of choice on social media platforms.

A cross-sectional study was conducted among 120 patients diagnosed with acne vulgaris aged 18-50 years-old consulting via teledermatology and face-to-face consultation at the Rizal Medical Center. Patients completed a self-administered questionnaire and global acne severity was assessed.

A total of 120 newly d iagnosed patients with acne vulgaris were included in the study, with a mean age of 23.25 years, with a female predominance, household average monthly income less than PhP 10,957 and with mild to moderate acne severity. Majority of the participants used social media to look for treatment options and to gain more knowledge about the disease. The most used platforms were Youtube, Facebook and Tiktok. Short videos were viewed more often and content from dermatologists were preferred. Most commonly tried products are over-the-counted non-pharmaceutical topical products. There was a significant association between the use of social media with age and educational attainment. Furthermore, a significant association between self-medication practices and average household monthly income was seen. No association was seen between acne severity, social media use and self-medication practices.

In summary, the use of social media to access acne-related content was prevalent among young female patients, of lower socioeconomic status diagnosed with mild-moderate acne severity at a tertiary hospital in the Philippines.

Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.

BACKGROUND

Intraoperative transfusion for gynecologic surgery, when appropriately used, can improve patient outcomes. However, when utilized incorrectly, blood transfusion can worsen patient outcomes and increase patient cost. This study aimed to evaluate the blood transfusion practices of tertiary hospitals in the Philippines.

The study utilized a cross-sectional design wherein prospective data were gathered through multiple sources across seven tertiary-level hospitals. Women admitted to undergo gynecologic surgery were recruited based on a set of criteria. A chart review was conducted, and blood utilization indices were calculated. Outcomes were compared between public versus private facilities and transfused versus nontransfused patients.

Among 514 patients, 79.7% underwent cross-matching and 75.1% received transfusions. Adverse events were rare, with no transfusion-related deaths. The overall crossmatch-to-transfusion ratio (C/T ratio) was 2.8, exceeding the 2.5 optimal benchmark; all public hospitals recorded a C/T ratio >2.5, whereas private centers had more efficient usage. Six hospitals met acceptable benchmarks for transfusion probability and transfusion index. Open abdominal procedures, particularly hysterectomy, accounted for the most blood used. Transfused patients had longer operative times, greater blood loss, lower preoperative hemoglobin, and more frequently involved resident physicians in training. Public hospitals recorded higher cross-match and transfusion rates, greater resident physician participation, and broader use of general anesthesia.

Results of the study highlight the importance of monitoring blood transfusion parameters to optimize blood utilization. The observed differences between public and private institutions in the country highlight the urgent need for standardized and evidence-based practice to ensure efficient transfusion protocols nationwide.

Background and Objectives With the global population aging, there is an emerging need for access to quality longterm care (LTC) services. Many countries have developed LTC systems while others are at the infancy stage. This paper aimed to provide an overview of the country’s readiness for LTC based on the perspectives of relevant stakeholders. Specifically, it described the roles, initiatives, and challenges of relevant organizations and community leaders for LTC provision. It also described the older persons (OPs) and carers’ perspectives towards LTC including their awareness, capacity, and preferences.
Home Care Services ; Long-Term Care ; Nursing Homes ; Philippines

Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.
Sinus of Valsalva ; Aortic Rupture ; Cesarean Section ; Anesthesia, Spinal

: Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. : This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.
Pleural effusion ; Thoracentesis ; COVID-19

BACKGROUND

Appropriate use of medication is an important indicator of quality healthcare delivery among children. Previously published studies on drug utilization involved Filipino households in general and were conducted in the 1990s. No recent Philippine studies have been conducted that focus on drug utilization in children.

To describe the current prescribing patterns in one primary care service in a rural site in the Philippines using the World Health Organization (WHO) prescribing indicators.

A cross-sectional study was conducted by review of electronic medical records of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2020. Out of 9,930 total encounters, 623 patient encounters with prescriptions for pediatric patients were included in the study through systematic sampling. The average number of drugs per encounter, percentage of drugs prescribed by their generic names, percentage of encounters with prescribed antibiotics, percentage of encounters with prescribed injections, and percentage of drugs prescribed from the Philippine Drug Formulary were calculated. Values were compared to the cut-offs considered “good practice” for outpatient care in the WHO manual: (1) an average number of less than two drugs per encounter; (2) less than 30% of encounters are prescribed with antibiotics; (3) less than 20% of encounters are prescribed with injections; (4) 100% of drugs are prescribed by generic name; and (5) 100% of drugs are from the formulary.

On the average, three drugs were prescribed per encounter. Most patient encounters (80.9%) involved antibiotics prescription — higher than the WHO standard value of 30%. All drugs were prescribed by generic name and were prescribed from the formulary. Only 0.5% of encounters were prescribed injections, all of which were administered through the intramuscular route. Of the 1,962 prescriptions generated, antibiotics was the most prescribed medication (25.7%). The most common diagnosis was infectious in nature (88.8%).

The primary care service achieved the WHO standard values in terms of prescribing by injections and by generic names. There was a high rate of antibiotic prescriptions at 83%, and a high average number of drugs prescribed per encounter, exceeding the WHO standard value.