Filipino translation and validation of the University of Washington – Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Alberta Stroke Program Early CT Score (ASPECTS) in real time: A prospective study of its interobserver variation among radiologists in a training hospital from a low-resource setting

Background and Objectives: The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized system used to quantify the extent of ischemic involvement in cases of acute middle cerebral artery (MCA) infarct. It aids in clinical decision-making to identify patients who are more likely to benefit from thrombolytic therapy. This study aimed to determine the interobserver variation of ASPECTS among training and expert radiologists in a real-time, low-resource setting.Patients and Methods: A prospective study was conducted on non-enhanced CT (NECT) images of 79 patients with acute stroke. Patients with hemorrhagic stroke, or ischemic stroke from territories other than the MCA, were excluded. The ASPECTS of each case was assessed by three groups of radiologists--residents, fellows, and an expert. The level of agreement among them was then analyzed.Results: ASPECT scores were dichotomized into >7 and ?7. With the expert's reading as gold standard, residents had sensitivity of 0.94 [95% CI: 0.85, 0.99] and specificity of 0.68 [95% CI: 0.46, 0.85], while fellows had sensitivity of 0.96 [95% CI: 0.87, 1.00] and specificity of 0.76 [95% CI: 0.55, 0.91]. There was substantial agreement between residents and expert in overall ASPECTS rating (? = 0.66 [95% CI: 0.48, 0.85]; AC1 = 0.77 [95% CI: 0.62, 0.91]), and substantial to almost perfect agreement between fellows and expert (? = 0.76 [95% CI: 0.59, 0.92]; AC1 = 0.83 [95% CI: 0.71, 0.95]). Differences between the ASPECTS of the expert and trainees were within 2 points in most cases.Conclusion: ASPECTS is a reliable tool for both training and expert radiologists to quantify the extent of MCA infarcts. Assessment by trainees is comparable with that of the expert reader and is useful for immediate clinical decision making in low-resource settings.

Diagnosis of hydronephrosis or ureteral obstruction using renal sonography among patients with cervical cancer

@#<p style="text-align: justify;"><strong>Background:</strong> Cervical cancer is the second most common malignancy among Filipino women. The recent 2018 FIGO guidelines recommend imaging in cases of grossly invasive disease to determine the presence of hydronephrosis, which would immediately classify the disease as at least stage IIIB. CT and MRI are state-of-the-art modalities that can provide such information; however, these are costly and may not be accessible in areas with limited resources. Sonography is a safe and inexpensive alternative in this regard.</p><p style="text-align: justify;"><strong>Objective:</strong> This study aimed to evaluate the diagnostic performance of renal sonography in identifying the presence of ureteral obstruction or hydronephrosis among patients with grossly invasive cervical cancer, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Methods:</strong> A blinded, prospective study was conducted among patients diagnosed with grossly invasive cervical cancer from the Philippine General Hospital. Participants underwent same-day evaluation with both renal sonography and non-enhanced CT. The presence of either ureteral obstruction or hydronephrosis secondary to cervical cancer was independently determined. The sensitivity, specificity, positive predictive value, and negative predictive value of renal sonography were calculated, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Results:</strong> A total of 127 participants were enrolled. The mean age was 46 years, with a range of 24 to 65 years. The majority had stage IIB (41.7%) and stage IIIB (52.0%) disease. On non-enhanced CT, 46 (36.2%) showed evidence of ureteral obstruction or hydronephrosis, while 81 (63.8%) had negative results. On renal sonography, 46 (36.2%) had positive results, and 81 (63.8%) had negative findings. The sensitivity, specificity, and positive and negative predictive values of sonography were 91.3%, 95.1%, 91.3%, and 95.1%, respectively. Among patients with stage IIIB disease, sonography was shown to have higher sensitivity and specificity of 92.1% and 96.4%, respectively. Meanwhile, among patients with stage IB to IIB disease, its sensitivity and specificity were 87.5% and 94.3%, respectively.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Renal sonography has high sensitivity and specificity in the diagnosis of ureteral obstruction or hydronephrosis in patients with grossly invasive cervical cancer. Its sensitivity is higher when used in patients with stage IIIB disease, compared with those having lower-stage tumors.</p>

Filipino translation and validation of the University of Washington - Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Epidemiology of injuries in the Philippines: An analysis of secondary data

Background@#Injury surveillance is viewed as an important component of injury prevention. Several data systems in the Philippines exist but have not been analyzed together. Analyzing these readily available data can guide policy making.@*Objective@#This report aimed to describe the epidemiology of injuries in the Philippines using secondary datasets.@*Method@#Death data of 2013 from the Philippines Statistics Authority and injury surveillance data of 2014 from the Department of Health were obtained and recoded. Summary statistics were generated.@*Results@#Injured persons mainly come from the young age group. There were a higher number of males compared to females. Provincial variations in death rates for specific injury types existed. There did not seem to be an obvious pattern in injury occurrence according to month and time of day. High numbers of injuries were reported during daytime but admission and death rates peak at night. Injuries were shown to be an anatomically heterogeneous group with dominance in superficial injuries, head trauma, and hand fractures.@*Conclusion@#Analysis of secondary datasets revealed the epidemiology of injuries in the Philippines. Results have implications in health policy and injury prevention.

Gaps in addressing road safety in the Philippines

@#<p><strong>BACKGROUND AND OBJECTIVE:</strong> Road traffic injuries were the second leading cause of death due to injury in 2003 in the Philippines. In 2011, the Philippine Road Safety Action Plan (PRSAP) was instituted. Five years into the program, latest data showed that the death rate due to road injuries continue to increase despite the presence of key legislation supporting road safety. This study was aimed at identifying the gaps in addressing road safety in the Philippines.</p><p><strong>METHODOLOGY:</strong> Literature review and key informant interviews of representatives of the different agencies including the Department of Transportation and Communications (DOTC), Department of Public Works and Highways (DPWH), Road Board, Philippine National Police (PNP), Metro Manila Development Authority (MMDA), and Land Transportation Office (LTO) were conducted to identify gaps in the program.</p><p><strong>RESULTS AND CONCLUSION:</strong> Key gaps include: weak leadership at the national and local level, limited material and human resources for enforcement of laws, and fragmented information system. These gaps should be addressed to improve the road safety situation in the country.</p>

Estimating the burden of dengue in the Philippines using a dynamic transmission model

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> This study aimed to describe dengue burden in the Philippines. Specifically, health and economic costs of the disease were estimated.</p><p style="text-align: justify;"><b>METHODS:</b> A published serotype-specific and age-stratified dengue dynamic transmission model was populated with Philippine-specific dengue epidemiology and cost data. Data were gathered from literature and record reviews. Dengue experts were consulted to validate the model parameters. Sensitivity analyses were performed to test the uncertainty of input parameters on model outcomes.</p><p style="text-align: justify;"><strong>RESULTS:</strong> By 2016 to 2020, it is estimated that annually, average hospitalized cases will amount to 401,191 and ambulatory cases will amount to 239,497; resulting to USD 139 million (PhP 5.9 billion) and USD 19 million (PhP 827 million) worth of aggregate costs shouldered by the public payer for hospitalized and ambulatory cases, respectively. Average annual productivity losses may amount to USD 19 million (PhP 821 million) and DALY lost is expected to be 50,622.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The cost of dengue is high especially since the Philippines is an endemic country. Thus, there is a need to optimize government interventions such as vector control and vaccination that aim to prevent dengue infections.</p>

Healthcare-associated expenses due to injuries in the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Injuries are common causes of hospital visits and deaths in the Philippines. The national healthcare-associated expenses due to these injuries have not been established.</p><p style="text-align: justify;"><b>OBJECTIVE: </b>To estimate the healthcare-associated expenses due to injuries in the Philippines. Methods. Review of patient charts and patient interviews were conducted in 21 hospitals in the Philippines. A convenience sample of patients was interviewed to ascertain other direct medical and non-medical expenses.</p><p style="text-align: justify;"><b>RESULTS:</b> Median admission costs based on hospital bills were: road injuries: PhP10,192.25, poisoning: PhP4,402.00, burns: PhP6,521.53, animal-related: PhP5,105.92, other accidents: PhP7,545.71 and intentional injuries: PhP8,023.00. Based on survey, other expenses not stated in hospital bills include medical supplies (PhP4,000.00), diagnostic tests (PhP 2,000.00), and post-discharge expenses (PhP 1,000.00).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Expenses due to injuries varied according to cause. Admission expenses recorded in the bill were not the only healthcare-related expenses shouldered by the patient and accounted for 68.6-159.0% of the bill value.</p>

Cost of hospitalization of different types of schistosomiasis cases in endemic areas in the Philippines: Indicating the need to increase the coverage of government health insurance

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Schistosomiasis is endemic in the Philippines. Currently, the financial and economic costs of hospitalization due to schistosomiasis have not been studied or analyzed. This will be essential to the review of health benefit package of PhilHealth for schistosomiasis.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study estimated the cost of hospitalization due to schistosomiasis and its complications in the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional mixed-methods study. Nine (9) hospitals from schistosomiasis-endemic provinces were included in the study. Medical records and billing statements from year 2013 were retrieved and analyzed. Non-medical costs were calculated based on data from key informants and existing economic data in 2013.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 1,415 hospitalized cases were collected; 94% came from government hospitals. Fifty nine percent (59%) were classified under uncomplicated schistosomiasis. Overall hospitalization costs were PhP 8,489,524.39 (USD 200,006.70), with cases of hepatic complications having the highest costs among all types of cases. Combined nonmedical costs and productivity losses for 5,005 days of hospitalization were PhP 13,019,363.75 (USD 306,726.25).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The estimated clinical cost burden and economic losses due to schistosomiasis in selected sites in the Philippines amount to PhP 21,508,888.14 (USD 506,732.95). Significant drivers of cost were the presence of schistosomiasis sequelae or complications, co-morbidities, and increasing length of stay. Estimated productivity losses and non-medical expenses of patients due to hospitalization were found to be more burdensome than the actual hospital bills. These costs stress the need for government to provide health coverage for patients diagnosed with schistosomiasis.</p>

Estimating the adequacy of the Philippine Health Insurance Corporation case rate for pneumonia cases admitted at the general medicine wards of the Philippine General Hospital from January to May 2013

BACKGROUND: In 2011, PhilHealth introduced the case rate payment scheme and no balance billing policy for selected diseases which will supposedly provide financial protection to patients while promoting efficiency in hospitals. There are concerns that tertiary government hospitals might end losing money as they managed mostly complicated cases.OBJECTIVE: To estimate the adequacy of the pneumonia case rates for cases admitted in the charity Medicine wards of the Philippine General Hospital.METHODS: Costing of a random sample of ward admissions for pneumonia moderate- and high-risk from January 1 to June 30, 2013 was done. Charts were retrieved to collect data on diagnostic tests, medications and mechanical ventilator use and converted to costs using price lists. Additional costs were estimated using WHO-CHOICE values. Estimated admission cost was compared to case rates to assess adequacy.RESULTS: A sample of 113 moderate-risk and 42 high-risk pneumonia cases were reviewed. For moderate-risk pneumonia, the estimated mean admission cost was PhP26,033.82 (SD: 42,987.58) with only 26.5% having costs ofPhP15,000 or lower. For high-risk pneumonia, the average was PhP33,260.65 (SD: 21,865.07) with 64.4% having expenses at PhP32,000.00 or lower.CONCLUSION: The case rate of PhilHealth seems to be adequate for the cost of high-risk pneumonia but not for moderate-risk. Studies utilizing costs and for other diseases should be performed.

Philippine Costs in Oncology (PESO): Describing the economic impact of cancer on Filipino cancer patients using the ASEAN costs in oncology study dataset

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.</p><p style="text-align: justify;"><strong>METHOD:</strong> The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.</p>

A financial forecasting exercise on the child restraints market in the Philippines

@#The use of child restraints such as car seats or booster seats inevitability increases with the implementation of laws mandating its use in the general public. This is of great importance to child health and injury prevention as child restraint use has been shown to reduce the risk of serious injury by 71% to 82% for children less than 1-year-old, and 45% for children aged 4 to 8 years old.2,3 In terms of averting death, child restraints were associated with 28% reduction in risk for death.4 It has been found that using ageand size-appropriate child restraints is the best way to save lives and reduce injuries in a crash.5 It is reasonable, therefore, that one study that investigated the association between child restraint law implementation and traffic injury rate among 4 to 6 years old children in New York State found that these children experienced an 18% reduction in traffic injury rate. (See full-text for continuation).

Describing the health service delivery network of an urban poor area and a rural poor area

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to assess the health workforce's service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.</p><p style="text-align: justify;"><b>METHODS:</b> This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.</p><p style="text-align: justify;"><b>RESULTS:</b> SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.</p>

Estimating the social and economic burden of road traffic injuries in the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Road traffic injuries (RTI) are a leading cause of morbidity and mortality globally. Despite underreporting, the scarce Philippine data suggest that RTI pose a significant health problem in the country. It is imperative, therefore, to accurately quantify the burden of RTI in the Philippines.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to provide the first comprehensive baseline estimation of the socioeconomic burden of RTI in the Philippines for year 2014.</p><p style="text-align: justify;"><strong>METHODS:</strong> The study was a mixed method study design that utilized both primary and secondary data. These data were used to construct parameters needed for the modeling estimates. Measure of socioeconomic burden estimated were (1) economic costs, (2) disability-adjusted life years (DALYs), and (3) healthy life years (HeaLY).</p><p style="text-align: justify;"><strong>RESULT:</strong> Estimated deaths due to RTI in 2014 were 12,336 translating to 454,650 years life lost due to premature death. Injury episodes from RTI were estimated to be 2,798,088 in 2014 with 186,174 leading to admissions, translating to 56,224 years life lost to disability. The total DALY loss due to RTI in 2014 was estimated at 510, 874, while healthy life years lost were estimated to be 76,215,477.4. The estimated deaths and injuries for that year equaled to direct medical cost of PhP 1.213 B, productivity loss due to premature death of PhP 24.620 B, and productivity loss due to illness of PhP 685 M resulting to a total economic cost of PhP 26.519 B to the society.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The findings indicate that RTI is an important public health concern in the Philippines with substantial economic and health burden. Investing in preventive measures will likely yield significant economic and health gains for the Philippines.</p>

Quality of life changes in Filipino cancer patients from baseline to one year after diagnosis: A country-specific analysis of the ACTION Study

BACKGROUND: Health-related quality of life is an important aspect of cancer research. Studies in the Philippines documenting this among survivors are limited in scope and number.OBJECTIVE: To document quality of life indicators of Filipino cancer survivors starting at 12 months from diagnosis and identify predictors of these changes.METHODS: The ACTION study is a prospective longitudinal study examining the economic and health impact of cancer in the Southeast Asian Region. A country-specific analysis for Filipino patients was conducted.RESULTS: Of the 909 Filipinos included in the study, 462 survived month 12 and had health-related quality of life (HRQoL) data. HRQoL data showed significant improvement from baseline (0.73, SD: 0.15) to month 12 (0.79, SD: 0.24) as measured by the EQ-5D weight score. Similar trends were seen in the EQ5D VAS Scores and the QLQ30 Global function scores. There was, however, an increase in the proportion of respondents experiencing significant problems related to EQ5D domains by month 12. Data disaggregated according to cancer type showed a decrease in QLQ30 GF scores from baseline to month 12 for all types except breast cancer. Individuals at risk of anxiety and depression increased from 15.37% to 25.54% and 18.83% to 32.25%, respectively. Predictors of worsening HRQOL include experiencing economic hardship, progression of disease, and higher stage at baseline.CONCLUSION: HRQOL scores were found to increase despite experiencing more difficulties in function among Filipino cancer survivors one year after diagnosis.

The cost-effectiveness and budget impact of a community-based universal newborn hearing screening program in the Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> In 2000, the World Health Organization recommended implementation of universal hearing screening. The Philippines enacted this policy into law in 2009 as it was found to be cost-effective for the Philippines. The model at the time used a hospital-based approached to screening. This paper examines the cost-effectiveness and budget impact of implementing a community-based universal hearing screening program.<br /><strong>METHODS:</strong> A model was developed following a community-based hearing screening program. Parameters were obtained through literature review, secondary data analysis, and consultation with experts. Cost-effectiveness was assessed for a single birth cohort from a public payer and societal perspective.<br /><strong>RESULTS:</strong> A community-based universal hearing screening program was found to be cost-saving. One-way sensitivity analysis showed that results were sensitive only to treatment rate and follow-up rate. The program is also a high budget impact program.<br /><strong>CONCLUSION:</strong> A community-based hearing screening program is cost-saving for the Philippines. Ensuring treatment and good follow-up in testing will ensure cost-effectiveness.</p>

Repetitive transcranial magnetic stimulation for post-stroke dysphagia: A meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Dysphagia is common among post-stroke patients,causing disability due to malnutrition and pneumonia. Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment modality to address this complication.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to compare real versus sham rTMS in treating post-stroke dysphagia.</p><p style="text-align: justify;"><strong>METHODS:</strong> PubMed, Ovid, ClinicalKey, Herdin, and Google Scholar databases were searched from their earliest record to 31 July 2015 for randomized controlled trials that used rTMS to treat post-stroke dysphagia. The Jadad scale was used to assess the quality of the studies. The weighted mean difference (WMD) between baseline and post-treatment mean for Penetration Aspiration Scores (PAS) measured in the experimental and control groups were extracted for subsequent meta-analyses.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Three studies were analyzed. The WMD in PAS score between rTMS and control using liquid bolus two weeks after treatment in two good quality studies was -1.14 (95% confidence interval (CI) = -1.80 - -0.48, P = 0.001, I2 = 0.0%), and after four weeks was -1.83 (CI = -3.22 - -0.44, P = 0.010, I2 = 0.0%).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Treatment of post-stroke dysphagia with rTMS improved PAS on subgroup analyses of studies using liquid bolus after two weeks, and between real and sham treatment after four weeks.?</p>