A PRECEDE-PROCEED approach in the advocacy for computer-based education on correct medical certification of cause of death among physician-learners

Objective@#Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. @*Methods@#An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification.@*Results@#Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines.@*Conclusion@#The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

Psychosocial experiences of selected pediatric occupational therapists in the Philippines on the shift to Telehealth Practice during the COVID-19 pandemic

BACKGROUND@#At the beginning of the COVID-19 pandemic, healthcare professionals including pediatric occupational therapists (OTs) mandatorily had to shift to the practice of telehealth in the absence of a safe in- person setup caused by the outbreak.@*OBJECTIVE@#This study aims to determine the psychosocial experiences encountered by selected pediatric OTs in the Philippines brought by the shift to telehealth practice during the COVID-19 pandemic@*METHODOLOGY@#Purposive sampling was used in the study to gather six (6) licensed pediatric OTs who provide occupational therapy (OT) services via telehealth in the Philippines, and the respondents were not personally connected to any of the researchers. A semi-structured one-on-one interview with the participants through a Zoom call was conducted to obtain their psychosocial experiences. A thematic analysis was used and four (4) themes emerged by the end of the study: consequences of the shift to telehealth practice, changes during telehealth provision, increased resilience, and increased psychological strain.@*CONCLUSION@#In conclusion, the transition to provision of telehealth services to pediatric clients has challenged the practices of the selected pediatric OTs in terms of preparing for the session, where one of the main prevalent concerns was toward collaboration and communication with the caregivers; conducting of telehealth sessions, where communication interruption was one of the main concerns; and in ethical considerations, where OTs made it a point that they rectified ethical dilemmas amidst telehealth provision. These experienced challenges also included increased workload and psychological distress, while improved occupational balance and adaptability were most commonly experienced by OTs

Assessment of readiness for a community-based teleaudiology program of selected primary care health facilities in the Philippines

Introduction@#Access to appropriate and timely care underpins the Republic Act 9707 or the Universal Newborn Hearing Screening and Intervention Act of 2009. However, less than 10% of babies born every year have been screened for hearing loss. The Hearing for Life (HeLe) research program aims to increase the rate of newborn hearing screening (NHS) nationwide through the development and deployment of novel digital health or eHealth technologies in government rural primary care health centers (PCHC). The HeLe is also built on the global call for increased and systematic use of eHealth to strengthen health systems. Effectiveness of eHealth innovations requires acknowledgment of the product’s life cycle; one consideration is organizational readiness at this development stage of the HeLe. @*Objective@#This study assessed readiness of the eight PCHC selected to use the HeLe technologies. @*Methods@#This research utilized the Khoja-Durrani-Scott (KDS) eHealth evaluation tool to assess the PCHC’s readiness level prior to the implementation of HeLe. The KDS tool was distributed through a self-administered survey; data was analyzed using descriptive statistics. Readiness is measured in terms of seven dimensions or outcomes resulting from the use of the HeLe technologies. @*Results@#The study revealed that the eight PCHC were most to least ready, in decreasing order, in the following areas: Ethical, Health, Technology, Social & Cultural, Readiness & Change Management, as well as Economic, and Policy outcomes. The study affirms the PCHCs’ value for equity in health care, i.e., providing accessible NHS services in the community setting closest to where the families and their newborns are. Likewise, results confirm the PCHC staff’s preparedness for another set of innovations, through agreement with statements on Technology, Social & Cultural as well as Readiness & Change Management parameters. @*Conclusions@#The results informed the training and technical support strategies to be implemented by the HeLe program proponents. However, even in this early development phase of the HeLe technologies, the PCHC are already concerned with how to sustain NHS services after the research. Fully aware that the HeLe ICT tools need to be maintained and upgraded, the PCHC views that economic and policy support should also be in place to ensure continuous delivery of the ICT-enabled NHS services. While results are illustrative, usefulness is limited by the small sample size and character of the study sites. Nevertheless, social dimensions still have to be carefully considered as innovative NHS tools are introduced to primary care health workers nationwide. Researchers have to be deliberate in working with broader health systems and policy advocacy efforts to allow novel NHS technologies to be smoothly introduced at the community level and frontlines of care.

Predictors of poor glycemic control and increased glucose variability among admitted moderate to critical COVID-19 patients with type 2 diabetes mellitus: A single center cross-sectional study / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#COVID-19 exacerbates the long-standing, low-grade chronic inflammation observed in diabetes leading to heightened insulin resistance and hyperglycemia. Mortality increases with hyperglycemia and poor glycemic variability, hence, this study aims to identify the predictors associated with poor glycemic control and increased glucose variability among patients with COVID-19 and Type 2 Diabetes Mellitus (T2DM).@*Methodology@#A retrospective chart review of 109 patients with moderate to severe COVID-19 and T2DM admitted from March 2020 to June 2021 was done. Logistic regression was done to determine predictors for hyperglycemia and poor variability.@*Results@#Of the 109 patients, 78% had hyperglycemia and poor variability and 22% had no poor outcomes. Chronic kidney disease (eOR 2.83, CI [1.07-7.46], p=0.035) was associated with increased glycemic variability. In contrast, increasing eGFR level (eOR 0.97, CI [0.96-0.99], p=0.004) was associated with less likelihood of increased variability. Hs-CRP (eOR 1.01, CI [1.00-1.01], p=0.011), HbA1c (eOR 1.86, CI [1.23-2.82], p=0.003), severe COVID-19 (eOR 8.91, CI [1.77-44.94], p=0.008) and critical COVID-19 (eOR 4.42, CI [1.65-11.75], p=0.003) were associated with hyperglycemia. Steroid use (eOR 71.17, CI [8.53-593.54], p<0.001) showed the strongest association with hyperglycemia.@*Conclusion@#Potential clinical, laboratory and inflammatory profiles were identified as predictors for poor glycemic control and variability outcomes. HbA1c, hs-CRP, and COVID-19 severity are predictors of hyperglycemia. Likewise, chronic kidney disease is a predictor of increased glycemic variability.

Systematic and Collaborative Review of E-health Ecological Networks (SCREEN) Model

@#Due to the Covid-19 pandemic, occupational therapy services in the Philippines experienced a shift in service delivery. As face-to-face services were halted, E-health became the key solution for rendering rehabilitation services. Practitioners relied on their clinical judgment in accepting clients for this type of service delivery. The Systematic and Collaborative Review of E-health Ecological Networks or SCREEN is a model that may aid occupational therapists practicing in the pediatric setting and providing services through E-health. The SCREEN model will assist practitioners in deciding what type of service delivery would be beneficial for the client and if the therapist is equipped to provide E-health as a service. SCREEN model includes the framework and a decision tree for its usability and application to OT practice, particularly in E-health.

The University of Santo Tomas Hospital (USTH) 2022 Institutional Chest Pain Pathway: Approach to diagnosis, risk stratification, and management

@#This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.

Function-based rehabilitation model: An initial step towards universal health coverage

Objective@#As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. @*Methods@#Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. @*Results@#The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation.@*Conclusion@#A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.

Burden of foodborne trematodiases and taeniasis in selected areas in southern Philippines

Background@#There are limited reports on foodborne trematodiases (FBT) and taeniasis prevalence and distribution in the Philippines. @*Objective@#This study aimed to describe their prevalence and distribution and determine the species causing these infections in selected areas in southern Philippines. @*Methodology@#The study was implemented in selected barangays in Caraga and Davao regions in southern Philippines. School-age children and adults with gastrointestinal manifestations within the last two weeks were examined using the modified Kato thick technique, while adults with cough for more than two weeks underwent sputum examination using NaOH concentration technique. The adult helminths from patients positive for FBT and/or taeniasis were processed, mounted, and stained for species identification.@*Results@#Variable FBT and taeniasis prevalence across geographic areas and population groups was seen with a highly focal distribution. Heterophyidiasis was the most common FBT with a 7.5% (168 out of 2,238) prevalence. Species not known to be endemic in the area were identified including Haplorchis taichui, Opisthorchis felineus, and Echinostoma ilocanum. Variable prevalence of soil-transmitted helminthiasis and schistosomiasis was also seen. @*Conclusion@#The study revealed the hidden burden of FBT and taeniasis and identified species not known to be endemic in selected areas in southern Philippines. Addressing this hidden burden will require enhancing service delivery. This may be done by utilizing more accurate diagnosis, updating treatment guidelines, implementing evidence-based control interventions, and improving surveillance. Integrating control programs, for instance, integrating FBT and taeniasis control with STH and schistosomiasis control, and integrating paragonimiasis control with the national TB program, may also help in optimizing resources.

Contemporary prevalence and predictors of anxiety among patients living with HIVAIDS in Ghana

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8 Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 ­ 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 ­ 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 ­ 2.38) and depression (aOR: 13.62, 95%CI: 7.91 ­ 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety

Predictores Perinatales De APGAR Persistentemente Bajo A Los 5 Minutos En Un Hospital Peruano / APGAR perinatal predictors persistently low at 5 minutes in a Peruvian Hospital

Objetivo: Determinar los predictores perinatales de Apgar persistentemente bajo a los 5 minutos en un hospital EsSalud. Material y métodos: Estudio observacional, analítico de caso-control. Se realizó un análisis censal de 889 neonatos con Apgar bajo (< 7) al primer minuto atendidos en el Hospital Octavio Mongrut Muñoz del periodo 2009-2018, previa verificación de los criterios de inclusión y exclusión. Se usó el Sistema de Vigilancia Perinatal (SVP) de EsSalud. Se empleó la prueba Chi cuadrado y odds ratio crudo (ORc), como medida de asociación. Asimismo, se aplicó regresión logística binaria para estimar odds ratios ajustados (ORa). Resultados: Hubo 17 780 nacimientos vivos durante el periodo de estudio, de los cuales 889 (11.9%) presentaron puntaje Apgar bajo al minuto. La incidencia de puntaje Apgar persistentemente bajo a los cinco minutos fue 5.68 por 1 000 nacidos vivos. En el análisis multivariado, los únicos predictores perinatales de puntaje Apgar persistentemente bajo a los 5 minutos fueron la aspiración de líquido amniótico meconial (ORa=7.82; p<0.01) y la presencia de anomalía congénita (ORa=3.19; p<0.01). Conclusión: la aspiración de líquido amniótico meconial y la presencia de anomalía congénita son predictores perinatales de puntaje Apgar persistentemente bajo al quinto minuto de vida extrauterina en un hospital EsSalud.

Objective: To determine the perinatal predictors of persistently low Apgar at 5 minutes in an EsSalud hospital. Material and methods: Observational, analytical case-control study. A census analysis of 889 neonates with low Apgar (<7) at the first minute treated at the Octavio Mongrut Muñoz Hospital from 2009-2018 was carried out, after verification of the inclusion and exclusion criteria. The EsSalud Perinatal Surveillance System (SVP) was used. The Chi square test and crude odds ratio (ORc) were used as a measure of association. Likewise, binary logistic regression was applied to estimate adjusted odds ratios (ORa). Results: There were 17,780 live births during the study period, of which 889 (11.9%) had low Apgar scores at one minute. The incidence of persistently low Apgar score at five minutes was 5.68 per 1,000 live births. In the multivariate analysis, the only perinatal predictors of a persistently low Apgar score at 5 minutes were aspiration of meconium amniotic fluid (ORa = 7.82; p <0.01) and the presence of a congenital anomaly (ORa = 3.19; p <0.01). Conclusion: meconium amniotic fluid aspiration and the presence of a congenital anomaly are perinatal predictors of a persistently low Apgar score at the fifth minute of extrauterine life in an EsSalud hospital.

Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy

Methods@#This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score. @*Results@#A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores. @*Conclusions@#Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

Factors affecting adoption of a telemedicine device by primary care health workers in the Philippines

@#<p style="text-align: justify;"><strong>Background and Introduction.</strong> The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.</p><p style="text-align: justify;"><strong>Materials and Methods.</strong> The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.</p><p style="text-align: justify;"><strong>Results and Discussion.</strong> RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.</p><p style="text-align: justify;"><strong>Conclusions.</strong> These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.</p>

The biological fate of the polymer nanocarrier material monomethoxy poly(ethylene glycol)-

Monomethoxy poly(ethylene glycol)-

Respuesta de Aedes aegypti L. (Diptera: Culicidae) a transflutrina y linalol impregnados en diferentes tipos de tela / Response of Aedes aegypti L. (Diptera: Culicidae) to transfluthrin and linalool impregnated in different of fabric types

Resumen: Objetivo: Evaluar el efecto de repelencia espacial contra Ae. aegypti de dos compuestos químicos impregnados en diferentes tipos de telas. Material y métodos: El estudio se realizó en el periodo 2015-2016 en el Centro Regional de Investigación en Salud Pública, del Instituto Nacional de Salud Pública. Se utilizó el Sistema de Procesamiento de Alto-rendimiento para evaluar la respuesta de Ae. aegypti a transflutrina y linalol, impregnados individualmente a diferentes concentraciones en popelina, algodón y poliéster. También se determinó el efecto de sus mezclas, lavado sobre la residualidad y porcentaje de protección. Resultados: La mayor respuesta de repelencia espacial fue para el tratamiento linalol-algodón al 0.1% (RE= 70 ± 5.77%). La mezcla de linalol 0.1% y transflutrina 0.001% presentó un porcentaje de repelencia espacial similar para los tres tipos de tela. El tratamiento transflutrina-popelina 0.001% mantuvo una residualidad de cinco días. El linalol al 0.1% produjo 62.50% de protección en presencia de un estímulo de atracción. Conclusión: Se sugiere la impregnación de linalol al 0.1% en ropa como medida de protección de las picaduras de Ae. aegypti.

Abstract: Objective: Evaluate the effect of spatial repellency against Ae. aegypti of two chemical compounds impregnated in different types of fabrics. Materials and methods: The study was carried out in the year 2015-2016 in the Centro Regional de Investigación en Salud Pública, del Instituto Nacional de Salud Pública. The high-throughput screening system was used to evaluate the response of Ae. aegypti to transfluthrin and linalool, impregnated individually at different concentrations in poplin, cotton and polyester. The effect of their mixtures was also determined, washing on residuality and percentage of protection. Results: The highest spatial repellency response was for 0.1% linalool-cotton treatment (RE = 70 ± 5.77%). The mixture of 0.1% linalool and 0.001% transfluthrin presented a similar spatial repellence percentage for the three types of fabric. The transfluthrin-poplin treatment 0.001% maintained a residual of five days. 0.1% linalool produced a 62.50% protection in the presence of an attraction stimulus. Conclusion: It is suggested the impregnation of 0.1% linalool in clothing as a protection measure for Ae. aegypti.

Gestational trophoblastic disease: The Philippine experience / Philippine Journal of Obstetrics and Gynecology

@#The first documented description of hydatidiform mole dates back to 400 BC when Hippocrates (470–410 BC) explained its formation through the consumption of dirty water by the pregnant woman. Interestingly, in 1276, the countess of Henneberg reportedly died after giving birth to “as many children as there were days in the year”. In 1752, William Smelie coined the terms mole and hydatidiform to describe the pathology as a bunch of grapes consisting of different sizes. Indeed, this condition that we have come to recognize as a hydatidiform mole (HM) has fascinated humans for centuries. But, it was not until 1903 when it was formally recognized as a clinical entity.

A PRECEDE-PROCEED approach in the advocacy for computer-based education on correct medical certification of cause of death among physician-learners

Objective@#Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns.@*Methods@#An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification. @*Results@#Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines. @*Conclusion@#The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

A cross-sectional study on malnutrition in elderly using mini nutrition assessment scores in an urban slum

Background: The global demographic shift presents new challenges regarding health of elderly. Nutrition in elderly affects their immunity and functional ability. Most cases of malnutrition in elderly go under-reported. Hence, this study was conducted to study malnutrition in elderly using MNA score with the aim to find out the prevalence of malnutrition in elderly and study its associated factors in an urban slum in the field practice area of parent medical college.Methods: Study was conducted in 120 elderly (>60 years) study participants. A pre-tested semi-structured questionnaire consisting of information on lifestyle, somatic, functional, social factors and Mini Nutrition Assessment (MNA)questionnaire was administered to assess the nutritional status of the elderly. Descriptive statistical measures like percentage, mean, standard deviations and inferential statistical measure like chi square were calculated.Results: Among 120 elderly study participants, 83 (69.17%) were females, 37 (30.83%) were male and their mean age was 67.21 (±6.27) years. 40 (33.33%) had malnutrition, 65 (54.17%) were at risk of malnutrition and 15 (12.5%) had satisfactory nutrition. Medication use, socio-economic status and marital status showed significant association with malnutrition in elderly.Conclusions: The high prevalence of malnutrition and risk of malnutrition in elderly necessitates appropriate preventive and corrective measures like detailed evaluation, regular follow-up and dietary interventions to be undertaken to deal with malnutrition in elderly.

Anthropometric measurements as a potential non-invasive alternative for the diagnosis of metabolic syndrome in adolescents

ABSTRACT Objective: To identify which anthropometric measurement would be the best predictor of metabolic syndrome (MetS) in Brazilian adolescents. Subjects and methods: Cross-sectional study conducted on 222 adolescents (15-17 years) from a city in southern Brazil. Anthropometric, physical activity, blood pressure and biochemical parameters were investigated. MetS criteria were transformed into a continuous variable (MetS score). Linear regression analyses were performed to assess the associations of BMI, hip circumference, neck circumference (NC), triceps skinfold, subscapular skinfold and body fat percentage with MetS score. ROC curves were constructed to determine the cutoff for each anthropometric measurement. Results: The prevalence of MetS was 7.2%. Each anthropometric measurement was significantly (p < 0.001) associated with MetS score. After adjusting for potential confounding variables (age, sex, physical activity, and maternal education), the standardized coefficients of NC and body fat percentage appeared to have the strongest association (beta = 0.69 standard deviation) with MetS score. The regression of BMI provided the best model fit (adjusted R2 = 0.31). BMI predicted MetS with high sensitivity (100.0%) and specificity (86.4%). Conclusions: Our results suggest that BMI and NC are effective screening tools for MetS in adolescents. The early diagnosis of MetS combined with targeted lifestyle interventions in adolescence may help reduce the burden of cardiovascular diseases and diabetes in adulthood.

A cross-sectional study on the HIV-related knowledge, attitudes and practices of male youth having sex with men in Metro Manila / The Health Sciences Journal

INTRODUCTION: The Philippines continues to see an increasing trend in diagnosed cases of HIV. Thepredominant population of males having sex with men (MSM) is the 25-34 years age group, but trendsshow an increasing incidence in younger populations. This study aimed to determine the participants'HIV/AIDS related knowledge, attitudes and practices and its relationships with the sociodemographicfactors of youth MSM in Metro Manila.METHODS: The researchers used an analytic, cross-sectional design using a self-administered questionnaire.The survey tool consisted on 24 items on knowledge and 12 on attitudes. Respondents were classifiedinto "inadequate" and "adequate" knowledge, and "poor" and "good" attitudes for the analysis. Purposivesampling was used to recruit 251 respondents.RESULTS: The mean age of the respondents was 22 ± 1.7 years. Most of the respondents had high HIVknowledge and good attitudes towards PLHIV but still engaged in risky sexual practices. Those who hadundergone HIV testing were significantly more likely to have good knowledge regarding HIV/AIDS. Withregards to attitudes, those not in a relationship were significantly more likely to have positive attitudestowards PLHIV and HIV/AIDS.CONCLUSION: HIV testing status positively influences HIV/AIDS-related knowledge while being singlepositively influences attitudes towards PLHIV and HIV/AIDS. No significant findings were found betweenage, educational attainment and religious affiliation with knowledge and attitudes.

Annona muricata fruit extract protects against diethylnitrosamine-induced hepatocellular cancer in rats

To evaluate the anticancer potentials of Annona muricata fruit by in vitro and in vivo methods. Methods: The ethanolic extract of Annona muricata fruit was prepared by Soxhlet extraction method and further fractionated with petroleum ether, ethyl acetate and chloroform. The fractions were tested for cytotoxicity, apoptosis, scratch wound assay, and cell cycle analysis. IC50, apoptotic index and percentage cell migration were determined using HepG2 cells. For the in vivo studies, hepatocellular carcinoma was induced by administering 0.01% diethylnitrosamine (DEN) in drinking water in Wistar rats. In pre-treatment, rats were co-administered 200 mg/kg of fruit extract with DEN for 14 weeks. In post-treatment, the extract was co-administered after 8-weeks of DEN-induction for 14 weeks. Liver function test, haematological test, oxidative stress markers, relative liver weight, number of cancer nodules and histopathological parameters were determined. Results: Annona muricata fruit extract =significantly lowered cell proliferation counts. The chloroform-fraction possessed higher activity [IC50=(53.7±4.3) μg/mL]. The chloroform fraction inhibited cell migration, which was significant compared to curcumin. Further investigations regarding the mode of anticancer activity revealed that the chloroform fraction induced apoptosis. The cell cycle analysis indicated that cells were being arrested at G0/G1. In the in vivo studies, the DEN-control group showed a significant decrease in body weights with increased mortality rate, hepatic nodules, and impairment of liver function compared to normal rats. The rats pre-treated and post-treated with the extract showed positive results with significant improvement in the parameters that were adversely affected by DEN. In addition, other adverse effects of DEN, such as blood dyscrasias and hepatic endogenous antioxidant, were significantly attenuated by Annona muricata fruit extract. Conclusions: The Annona muricata fruit extract has anticancer activity when tested by in vitro and in vivo hepatocellular cancer models.