Acta Medica Philippina最新文献

Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem.

Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4^th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices.

Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines' availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation.

Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker's day wage.

Conclusion: Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.

Background and objective: COVID-19 has been associated with cardiac injury, often detectable through electro-cardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

Methods: This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

Results: The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common co-morbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

Conclusion: The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

Background: The National Cochlear Implant Program (NCIP) is a national program that addresses the increasing prevalence of hearing loss, especially in the pediatric population here in the Philippines. In its pilot implementation, it included three tertiary hospitals to represent Luzon, Visayas, and Mindanao, and was able to enroll 20 patients who successfully underwent cochlear implantation (CI).

Objectives: The aim of this study is to evaluate the auditory outcomes of the patients who underwent cochlear implantation under the NCIP using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Questionnaire and Categories of Auditory Performance (CAP) score questionnaire.

Methods: This is a retrospective cohort study including all recipients of the cochlear implants, under NCIP from December 2019 to December 2021, except one with incomplete data during the course of his follow up. The outcomes measured included the PEACH Questionnaire score and CAP Questionnaire score and were compared on various factors which included patient's sex and age, parents' socioeconomic status, duration of hearing aid use prior to CI, pre-CI imaging findings, and CI electrode placement using nonparametric statistical tests.

Results: The mean PEACH score of the 19 patients was 53.59% ± 12.76% (range: 30% - 75%) while the mean CAP score was 3.16 ± 1.04 (range: 1 - 4.3). Parents of the included patients who have a higher educational background and those in which the electrode was located on the ideal location, scala tympani, have a statistically significant higher PEACH score (p-value of 0.017 and 0.012, respectively). In comparing the CAP scores, those who have unremarkable or normal preoperative imaging have a statistically significant higher score (p-value 0.013).

Conclusion: Patients who had normal preoperative imaging, proper placement of electrodes, and those patients with parents belonging to a higher educational background had statistically significant better auditory outcomes after cochlear implantation. Patients who had the cochlear implantation before 36 months of age and hearing aid use of 7 to 18 months prior to cochlear implantation had higher PEACH and CAP scores, however these were not statistically significant. Further studies with a larger sample size is recommended.

Tuberculosis is a global disease with a high prevalence rate in the Philippines. Frank hemoptysis often occurs later in the disease and is usually not massive since the availability of anti-Koch's treatment. However, Rasmussen's aneurysm, a pulmonary vascular complication secondary to tuberculosis from the weakening of the pulmonary arterial wall adjacent or within a tuberculous cavity, can be an uncommon cause of massive and potentially fatal hemoptysis. A 35-year-old male patient presented with episodes of hemoptysis while being treated for pulmonary tuberculosis for two weeks. An episode of massive hemoptysis of ~400ml prompted his admission. Chest tomography with contrast showed bronchiectatic changes, cavitary formation, and an aneurysmal dilatation of the anterior segmental artery of the left upper lobe. He was diagnosed with Rasmussen's aneurysm. A multidisciplinary team consisting of pulmonologists, interventional radiologists and thoracic surgeons planned for a surgical intervention as coil embolization was deemed to be difficult due to the wide neck character of the aneurysm. On re-admission after patient optimization, repeat chest tomography showed interval regression of pulmonary cavity with thrombosis of the previously identified Rasmussen's aneurysm. Patient completed his 6-month antitubercular treatment with no further episodes of hemoptysis. In patients with tuberculosis, hemoptysis results from involvement of the parenchyma, bronchiectasis, or erosion of residual cavities. Hemoptysis from the rupture of a dilated vessel such as Rasmussen's aneurysm is a rare cause. Chest tomography with contrast is the imaging modality of choice as it demonstrates the focal pulmonary artery dilatation. Embolization or surgical lobectomy are typically utilized to control the bleeding. However, treatment with anti-tuberculous regimen may result already in regression and eventual thrombosis of the aneurysm. Watchful monitoring is imperative as massive hemoptysis may recur; radiologists and surgeons must be available at any time in case intervention is required.

Objective: To describe the trend and landscape of Coronavirus Disease (COVID-19)-related publications in nursing authored by at least one Philippine-based author.

Methods: This study is a bibliometric analysis of documents retrieved from Scopus using the search terms "COVID-19" and "nurs*" in the article title, abstract, and keywords. The documents were limited to those published in English, affiliated with Philippine-based authors, and those published from 2020 to 2023. We used the 'analyze report' function in Scopus to analyze the data including the number of publications, types, sources, authors, and affiliations. We used VOSViewer for the co-authorship analysis of countries and co-occurrence analysis of author keywords.

Results: A total of 136 documents were found. Majority of these documents were classified as original articles (83%). There was a rapid increase in COVID-19 publications in nursing authored by at least one Philippine-based researcher published from 2020 to 2021 and plateaued from 2022-2023. Co-authorship analysis showed that Philippine-based authors have written documents with authors from 111 countries most notably from Saudi Arabia, the United States, Indonesia, and Australia. Most documents were published in the Belitung Nursing Journal. Authors from the University of Santo Tomas had the most publications. The most cited articles focused on psychosocial impacts, resilience, workplace stress, and online education. Author keywords commonly used in the documents were COVID-19, nursing, and nursing students, covering topics such as pandemic impacts, workplace impacts, nurse well-being, psychosocial impacts, and nursing education. Keywords have evolved through the pandemic period with a recent focus on stress and professional values.

Conclusion: Philippine-based authors actively contributed in understanding the impact of COVID-19 on nurses and nursing education. Their scientific productivity was driven partly by their collaboration with foreign-based researchers. To sustain this trend in productivity and collaboration, policies, programs, and strategies are needed to promote, support, and foster research collaboration among local and international nursing researchers and institutions.

Objectives: The objective of this study was to synthesize existing literature on nursing informatics (NI) and propose updates to the Philippine Nursing Informatics curriculum that embrace current trends and integrate a globally acknowledged framework.

Methods: A literature search was conducted on PubMed and ScienceDirect. This search identified 79 articles, of which only eight met the inclusion criteria. The Technology Informatics Guiding Education Reform (TIGER) initiative provided the framework for analyzing the literature review outcomes and for developing the revised course structure for the Nursing Informatics (NI) curriculum in the Philippines.

Results: The revised course outline incorporated 31 topics across the six domains outlined by the TIGER framework. Upon comparison, it was found that numerous topics identified were absent from the existing NI curriculum in the Philippines. Key subjects identified for inclusion encompass research, examination of standards and terminologies, application in community health, cybersecurity, project management, and advocacy. These areas hold particular relevance for the Philippines, attributed to the limited recognition of NI and the ongoing advancements related to technological applications in healthcare.

Conclusion: The nursing informatics curriculum in the Philippines is not up to date, failing to align with global NI standards. It is recommended that a thorough revision and enhancement be undertaken to ensure alignment with international frameworks and current industry practices.

Background and objective: Non-communicable diseases (NCDs) are medical conditions that are associated with long durations, slow progress, and lifetime medications. This study aimed to assess the household out-of-pocket (OOP) expenditures on NCDs in a 4^th class municipality.

Methods: This cross-sectional study was conducted to determine the characteristics of the households and household heads, healthcare needs, expenditures on medicines, health, and household, and alternative coping strategies to avail healthcare needs.

Results: This study surveyed 200 households from all ten barangays of Ternate, Cavite. Top NCDs recorded include hypertension, diabetes, heart diseases, and asthma, while top NCDs medicines recorded were Losartan, Amlodipine, Metformin, and Glimepiride. Blood tests were the most needed medical laboratory service, while X-ray was the most needed diagnostic imaging service. Although more than half of the households have a member with only one NCD-the most prevalent being hypertensive disease, diabetes mellitus and other metabolic diseases-it is also common to have household members taking medicines for two to three NCDs.To cope with healthcare expenses, households often resorted to seeking alternative or cheaper treatments (61.0%), borrowing money (39.5%), or relying on existing funds/savings (29.0%). The median proportion of expenditures on medicines for NCDs over the total health expenditures is 59.41%. Meanwhile, the median proportion of all medicine expenditures over the total health expenditures is at 77.57%. 74.00% of households incurred catastrophic health expenditures (CHE) using the 10% threshold, while only 30.50% incurred CHE using the 25% threshold. Finally, the univariable analysis found that households with one NCD member had lower odds of CHE (OR=0.316, p=0.004 at 10%, OR=0.39, p=0.003 at 25%), while those with two NCD members had higher odds at 10% (OR=2.365, p=0.034) and those with three members had nearly six times higher odds at 25% (OR=5.88, p=0.012).

Conclusion: This study highlights the need to address issues with lack of access and availability of essential medicines for NCDs especially in the primary health care setting. This study provides evidence on the minimal financial risk protection provided for medicines with data suggesting that it is the primary cause of CHEs for NCDs. Households covered by the Primary Care Benefit Packages were excluded from the study, thus, the estimates derived from the sample may be an overestimate of the true prevalence of CHE in the municipality. Therefore, there is a need to have mechanisms in place to expand insurance coverage and increase government programs catering to certain population groups to reduce the financial burden of medicines for NCDs.

Background: With childhood overweight and obesity becoming widespread in the Philippines, there is an increased risk of developing non-communicable diseases at a younger age. The school environment, found to be associated with body mass index, offers an avenue to address and prevent school-aged obesity. However, the lack of data on the current school environment poses a barrier to improving these conditions.

Objective: This study aimed to describe the physical, political, and sociocultural environment characteristics of primary schools in the Municipality of Pateros (Philippines) that affect nutrition and physical activity of school-aged children.

Methods: Self-administered questionnaires for key school personnel and observational checklists were used to examine available resources, policies, and current practices for obesity prevention in five public schools in a municipality. The role perceptions of all school personnel on childhood obesity prevention were also gathered. Descriptive statistics was used to describe the number and categories of food items, functional spaces and equipment for physical activity, policies and scores of attitude toward obesity prevention. Data were collected in May to June 2019 and were analyzed descriptively.

Results: Majority of the schools serve food items that contain high amounts of saturated fat, sugar, or salt, provide excess calories, and are not recommended to be sold at school canteens based on guidelines by the Department of Education. While all schools have areas and functional equipment for physical activity, students have limited access to these. Policies and guidelines for nutrition were present but sparse for physical activity and obesity prevention. Positive attitude towards childhood obesity prevention was seen across all school personnel respondents.

Conclusion: Participant primary schools are eager to address childhood obesity, however, the physical, political, and sociocultural environments do not seem to enable this. This situation may promote, rather than prevent, overweight and obesity among school children. This points to the need of reorientation and implementation of policies on obesity prevention to the schools as well as developing the skills of both teaching and non-teaching personnel in healthy eating and physical activity to students. School-based healthcare workers like school nurses and doctors would have critical roles in supporting schools in this regard.