Community health workers’ concept and understanding of diabetes: A qualitative study

Objectives@#Community health workers (CHWs) fill in the insufficiency of health professionals in low-income countries. The CHWs’ roles include health education of their constituents whose health they likewise take care. This study aimed to describe the concept and understanding of diabetes among CHWs in the Philippines.@*Methods@#Fifty female CHWs currently working in rural and urban areas participated in six focus group discussions with guidance from Kleinman’s eight questions. With the written informed consent of the participants, discussions were recorded and transcribed by the Research Assistant. A multi-disciplinary team manually analyzed the data. Disagreements were discussed among them and the physicians provided clinical analyses and explanations on the results. Quotations of an important point of view were also presented. Pseudonyms were utilized to uphold anonymity.@*Results@#CHWs were aged 32 to 72 years; older participants reside in rural areas. Majority were married, housekeepers, and high school graduates. Some CHWs and their family were suffering from diabetes or dyabetis, the disease of the rich according to them. Its causes were food and lifestyle, and believed to be hereditary. Complications lead to death. Amputation was feared the most. Diabetes is incurable. Persons with diabetes should take maintenance medicines, and seek physicians’ and family’s help. Together with the patient, the family must decide on its management. Balanced diet, healthy lifestyle, maintenance medicines, food supplements, and herbal plants were perceived treatments. The internist should lower blood sugar level as well as prolong life span. Proper diet and regular check-up prevent diabetes.@*Conclusions@#CHWs’ concept and understanding of diabetes reflect some of the biomedical causes, effects, treatment, and prevention of diabetes as well as its social determinants. The efficacy and safety of herbal plants in the treatment of diabetes, however, should be further studied. Training on diabetes care should be provided to address their fears of amputation, insulin injection, and complications.

Variants near CETP, MTTP and BUD13-ZPR1-APOA5 may be nominally associated with poor statin response among Filipinos

@#<p style="text-align: justify;"><strong>Objective.</strong> Several studies showed that genetic factors affect responsiveness to statins among different populations. This study investigated the associations of candidate genetic variants with poor response to statins among Filipinos.</p><p style="text-align: justify;"><strong>Methods.</strong> In this unmatched case-control study, dyslipidemic participants were grouped into statin responders and poor responders based on the degree of reduction in LDL-c from baseline. DNA from blood samples were genotyped and analyzed. The association of candidate variants with statin response was determined using chi-square and logistic regression analysis.</p><p style="text-align: justify;"><strong>Results.</strong> We included 162 adults on statins (30 poor responders as cases, 132 good responders as controls). The following variants are nominally associated with poor response to statin among Filipinos at a per-comparison error rate of 0.05: rs173539 near CETP (OR=3.05, p=0.015), rs1800591 in MTTP (OR=3.07, p=0.021), and rs1558861 near the BUD13-ZPR1-APOA5 region (OR=5.08, p=0.004).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Genetic variants near CETP, MTTP and the BUD13-ZPR1-APOA5 region are associated with poor response to statins among Filipinos. Further study is recommended to test the external validity of the study in the general Filipino population.</p>

A genetic polymorphism in GCKR may be associated with low high-density lipoprotein cholesterol phenotype among Filipinos: A case-control study

@#<p style="text-align: justify;"><strong>Background.</strong> Low levels of high-density lipoprotein cholesterol (HDL-c) is a well-recognized risk factor in the development of cardiovascular diseases. Associated gene variants for low HDL-c have already been demonstrated in various populations. Such associations have yet to be established among Filipinos who reportedly have a much higher prevalence of low HDL-c levels compared to other races.</p><p style="text-align: justify;"><strong>Objective.</strong> To determine the association of selected genetic variants and clinical factors with low HDL-c phenotype in Filipinos.</p><p style="text-align: justify;"><strong>Methods.</strong> An age- and sex-matched case-control study was conducted among adult Filipino participants with serum HDL-c concentration less than 35 mg/dL (n=61) and those with HDL-c levels of more than 40 mg/dL (n=116). Genotyping was done using DNA obtained from blood samples. Candidate variants were correlated with the low HDL-c phenotype using chi-squared test and conditional logistic regression analysis.</p><p style="text-align: justify;"><strong>Results.</strong> Twelve single nucleotide polymorphisms (SNPs) were associated with low HDL-c phenotype among Filipinos with univariate regression analysis. The variant rs1260326 of glucokinase regulator (GCKR) (CT genotype: adjusted OR=5.17; p-value=0.007; TT genotype: adjusted OR=6.28; p-value=0.027) remained associated with low HDL-c phenotype, together with hypertension and elevated body mass index, after multiple regression analysis.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The variant rs1260326 near GCKR is associated with low HDL-c phenotype among Filipinos. Its role in the expression of low HDL-c phenotype should be further investigated prior to the development of possible clinical applications.</p>

Establishing validity of EQ-5D-3L (Tagalog) to measure health-related quality of life states among adult Filipinos (20-50 years old)

@#<p style="text-align: justify;"><b>OBJECTIVE: </b>To establish the validity of EQ-5D-3L in Tagalog language in assessing health-related quality of life states among adult Filipinos 20-50 years old.</p><p style="text-align: justify;"><b>METHODS:</b> A face-to-face cross-sectional community survey of apparently healthy adult Filipinos (20-50 years old) in Metro Manila and in 4 nearby provinces (Bulacan, Batangas, Quezon, Rizal) was conducted. Trained interviewers administered the Tagalog language versions of EuroQoL 5-Dimension 3 Levels (EQ-5D-3L), Short-Form 2 (SF-26V2®), and a socio-economic questionnaire. All questionnaires were pre-tested for cultural appropriateness. Concurrent validity (against the SF-36v2R®) and known group validity of the EQ-5D-3L were evaluated.</p><p style="text-align: justify;"><b>RESULTS:</b> Complete data from 3,056 participants were analyzed. Almost half of the participants reported perfect health on EQ-5D-3L and had higher scores on all SF-36v2® domains compared to those who reported some problems on EQ-5D-3L. Compared to participants who reported some problems on EQ-5D-3L mobility (or anxiety/depression), participants who reported no problem on EQ-5D-3L mobility (or anxiety/depression) reported lower SF-36v2® Physical Functioning (or Mental Health) scores (differences of 7.1 and 10 points, respectively) that were minimally important (i.e. exceeds 5 points). Participants with poorer self-reported health had considerably lower EQ-5D index scores (p < 0.05) irrespective of their socio-demographic characteristics.</p><p style="text-align: justify;"><b>CONCLUSION:</b> EQ-5D-3L (Tagalog) demonstrated construct and known groups validity among adult Filipinos (20-50 years old).</p>

Prevalence of and associations for complementary and alternative medicine use among apparently healthy individuals in the Philippine LIFECARE cohort

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> The study determined the prevalence of complementary and alternative medicine (CAM) use and its association with socio-demographic and clinical characteristics among adult Filipinos aged 20-50 years.</p><p style="text-align: justify;"><strong>METHODS:</strong> Data from the Philippine cohort of the Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) in Luzon were analyzed. Multiple logistic regression determined the factors associated with the use of CAM.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 3,072 participants were included: average age of 36 years, more females, mostly married, living in the rural areas, and employed. The prevalence of CAM use in this population was 43%. The commonly sought traditional medicine practitioners were manghihilot (bone setter or partera) and albularyo (herbalist), and participants used herbal medicines and supplements. Use of CAM was more likely among older participants, females, living in rural areas, had medical consultation in the last six months, experienced moderate to extreme pain, and with poor perception of general health.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The use of CAM is prevalent among apparently healthy individuals aged 20-50 years. Further studies should uncover reasons for CAM use.</p>

Apolipoprotein levels in patients with Acute Coronary Syndrome (LIPAS): A pilot study

Introduction@#Lowering levels of low-density lipoprotein cholesterol (LDL-C) are proven to reduce cardiovascular risk. However, some individuals experience acute coronary events despite normal LDL-C levels. Recent studies have focused on modifiable lipoprotein targets, such as apolipoprotein B (apo-B) and apolipoprotein A-1 (apo A-1) and lipoprotein (a), as targets for therapy. Apo-B is the primary apolipoprotein of LDL-C representing total number of atherogenic particles. Apolipoprotein A-1 is the major component of HDL complex. This study will determine the prevalence of elevated apo-B and low apo A-1 among adult Filipinos with acute coronary syndrome (ACS).@*Methods@#This is a cross-sectional study involving 95 patients with ACS admitted in a tertiary hospital from November 2015 to May 2016. Levels of apo-B, apoA-1, lipoprotein (a), total cholesterol, triglyceride, LDL-C, and high-density lipoprotein cholesterol (HDL-C) were measured within 24 hours upon admission.@*Results@#Forty-eight (48%) percent of patients was diagnosed with Non ST-Elevation-ACS, 39% with ST-Elevation myocardial infarction (STEMI) and 13% with unstable angina.Thirtytwo (32%) percent were on low- to high-intensity statin treatment. The mean LDL-C, non-HDL-C, and HDL-C levels were 109 mg/dL, 135 mg/dL, and 36.89 mg/dL, respectively. The prevalence of elevated apo-B (mean=103.79 mg/ dL; target:<80 mg/dL) was 82%, while that of low apo A-1 (mean=119 mg/dL; target: >120 mg/dL for males, >140 mg/dL for females) was 63%. Lipoprotein (a) levels are high (mean = 48.51 nmol/L; normal:<35 nmol/L) in 42% of patients. Among those on statin therapy, the mean LDL-C was 85 mg/dl, but the mean apo B and lipoprotein (a) levels were elevated at 87.57 mg/dL and 41 nmol/L, respectively.@*Conclusion@#Elevated levels of apo B and lipoprotein (a) and low level of apo A-1 are highly prevalent in patients with ACS. Apo-B and lipoprotein (a) levels are likewise elevated among patients with normal LDL levels.

Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Philippines: Results from the Dyslipidemia international study II

Objective@#To quantify the extent of hyperlipidemia and its treatment in patients with stable coronary heart disease (CHD) or an acute coronary syndrome (ACS) in the Philippines.@*Methods@#The Dyslipidemia International Study (DYSIS) II was an observational, multinational study conducted in patients aged ≥18 years with stable CHD or being hospitalized with an ACS. A full lipid profile was evaluated at baseline, and for the ACS cohort, at 4 months after discharge from hospital. Achievement of low-density lipoprotein cholesterol (LDL-C) targets and the use of lipid-lowering therapy (LLT) were assessed.@*Results@#A total of 232 patients were enrolled from 10 centers in the Philippines, 184 with stable CHD and 48 being hospitalized with an ACS. The mean LDL-C level for the CHD patients was 88.0±40.1 mg/dL, with 33.3% achieving the target of <70 mg/dL recommended for very high-risk patients. For the ACS cohort, the mean LDL-C level was 109.0±48.5 mg/dL, with target attainment of 25.0%. The majority of the CHD cohort was being treated with LLT (97.3%), while 55.3% of the ACS patients were receiving LLT prior to hospitalization, rising to 100.0% at follow-up. There was little use of non-statins.@*Conclusions@#For these very high-risk patients from the Philippines, LDL-C target attainment was poor. Opportunities for better monitoring and treatment of these subjects are being missed.