Prevalence of Potentially Pathogenic Germline Variants Among Adult Patients in the Philippines With Solid Malignancies Who Underwent Tumor Genomic Profiling.

PURPOSE: In high-income countries, 2%-10% of tumor genomic profiling (TGP) reports reveal incidental pathogenic germline variants. A third of these patients would not qualify for genetic testing on the basis of current guidelines. Our study determined the prevalence of potentially pathogenic germline variants (PPGVs) in TGP results of adult patients with solid malignancies in the Philippines. METHODS: Annotated reports of patients with solid cancers who underwent TGP using FoundationOne or FoundationOne Heme between January 2021 and July 2023 were reviewed. PPGV criteria include having a variant allele frequency of >30% and were categorized as (1) high penetrance gene (HP), founder variant (FV), or variant associated with clinical presentation (VA). Pathogenicity was crosschecked through the ClinVar database. RESULTS: Of 446 patients, 13 PPGV variants were found in 50 (11.2%) patients at a median age of 60.5 years. Of them, 28 (56%) had HP (BRCA1, BRCA2, MSH2, MSH6, MLH1, RAD51C, RAD51D), 25 (50%) patients had VA (APC, SMAD4, CDH1, CDKN2A, PTEN), and two patients with lung cancer had a FV (EGFR p.Thr790Met). Six patients had more than one PPGV. PPGVs were primarily found in patients with colorectal (42% of 50 patients with PPGVs), breast (16%), ovarian (6%), and lung (6%) cancer (P < .001). HP genes were mostly found in female patients (71.4%; P = .03). CONCLUSION: With a PPGV prevalence of 11% in this study, it is important to recognize PPGVs as it can prompt genetic counseling and confirmatory germline testing.

Navigating pregnancy in detention: lived experiences in a Philippine women's prison.

PURPOSE: Imprisonment impacts women's childbearing and mothering experiences. Using sociological concepts of total institutions, pains of imprisonment and gendered pains of imprisonment, this study aims to explore the childbearing experiences of 18 Filipino incarcerated women. DESIGN/METHODOLOGY/APPROACH: A qualitative, inductive approach was undertaken to explore imprisoned women's pregnancy experiences. This research project used reflexive thematic analysis to examine the data from semi-structured interviews with 18 Filipino pregnant prisoners. FINDINGS: The participants' experiences of childbearing in prison were reflected in three overarching themes: lack of autonomy over pregnancy; reduced capacity to manage discomforts and needs; and coping with prison deprivations. These themes embody women's experiences of how imprisonment disrupts Filipino women's childbearing and mothering experiences. Furthermore, the results illustrated how the women navigated the prison regime to address their needs and cope with the pains of imprisonment. ORIGINALITY/VALUE: Although there is a small but growing body of research specifically focusing on mothering and imprisonment, little consideration has been given to analyzing Filipino women's pregnancy experiences in custody. This paper highlights an urgent need to reform correctional policies and practices to address incarcerated women's distinct needs.

Outbreak of influenza and SARS-CoV-2 at the Armed Forces of the Philippines Health Service Education and Training Center, September 25-October 10, 2023.

In the last week of September 2023, a surge of influenza-like illness was observed among students of the Armed Forces of the Philippines (AFP) Health Service Education and Training Center, where 48 (27 males and 21 females; age in years: mean 33, range 27-41) of 247 military students at the Center presented with respiratory symptoms. Between September 25 and October 10, 2023, all 48 symptomatic students were evaluated with real-time reverse transcription polymerase chain reaction and sequencing for both influenza and SARS-CoV-2. Thirteen (27%) students were found positive for influenza A/H3 only, 6 (13%) for SARS-CoV-2 only, and 4 (8%) were co-infected with influenza A/H3 and SARS-CoV-2. Seventeen influenza A/ H3N2 viruses belonged to the same clade, 3C.2a1b.2a.2a.3a, and 4 SARSCoV-2 sequences belonged to the JE1.1 lineage, indicating a common source outbreak for both. The influenza A/H3N2 circulating virus belonged to a different clade than the vaccine strain for 2023 (3C.2a1b.2a.2a). Only 4 students had received the influenza vaccine for 2023. In response, the AFP Surgeon General issued a memorandum to all military health institutions on October 19, 2023 that mandated influenza vaccination as a prerequisite for enrollment of students at all education and training centers, along with implementation of non-pharmaceutical interventions and early notification and testing of students exhibiting influenza-like-illness.

'Whatever we have is what we eat': How marginalised urban populations in the Philippines and Thailand experienced their food environments, food security and diets through COVID-19.

This qualitative cross-country comparative study investigated the lived experience of marginalised urban populations (unemployed, daily wage earners/street vendors, and internal/external migrants) in Manila (Philippines) and Bangkok (Thailand) on food environments, food security and diets during COVID-19. Semi-structured interviews were conducted with individuals (n = 59) in April-May 2022. Thematic analysis revealed loss of income and strict mobility restrictions (Philippines) as key drivers of dietary changes and hunger. Common narratives included financial hardship, loss of personal agency, and daily survival. Coping strategies included drawing on social networks, cash and food aid, and 'scheming' around restrictions. Contextualised crisis policy planning should explicitly consider the lived experience of marginalised populations for future shocks.

Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries.

BACKGROUND: This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic. METHODS: Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data. RESULTS: Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation. CONCLUSIONS: The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.

Scuba diving-related fatalities in the Philippines from 2008 to 2022 as reported in online news media.

The present study aims to investigate the demographics and characteristics of scuba diving fatalities in the Philippines which can help in the identification of local trends and ultimately in the development of appropriate preventive measures. Data on scuba diving-related fatalities in the Philippines from 2008 to 2022 were manually retrieved from online news media sources. Information on age, sex, nationality, certification, purpose, and causative factors, whenever possible were collected and analysed. A total of 39 fatalities were identified having a median age of 43.5 (range 20-80). Majority of victims were males (n = 30), and of foreign ethnicity (n = 26). Asphyxia was identified as the possible disabling injury in almost half of the cases (n = 17). The causes of death based on autopsies were determined only for few cases which included drowning (n = 2), heart attack (n = 1), and traumatic injuries from a dynamite blast (n = 1). Potential vulnerable groups were identified to be the ageing population and foreign tourist divers. In the absence of an existing database, this preliminary report provides the best available evidence at this time concerning scuba diving fatalities in the Philippines.

Circulating cell-free RNA in blood as a host response biomarker for detection of tuberculosis.

Tuberculosis (TB) remains a leading cause of death from an infectious disease worldwide, partly due to a lack of effective strategies to screen and triage individuals with potential TB. Whole blood RNA signatures have been tested as biomarkers for TB, but have failed to meet the World Health Organization's (WHO) optimal target product profiles (TPP). Here, we use RNA sequencing and machine-learning to investigate the utility of plasma cell-free RNA (cfRNA) as a host-response biomarker for TB in cohorts from Uganda, Vietnam and Philippines. We report a 6-gene cfRNA signature, which differentiates TB-positive and TB-negative individuals with AUC = 0.95, 0.92, and 0.95 in test, training and validation, respectively. This signature meets WHO TPPs (sensitivity: 97.1% [95% CI: 80.9-100%], specificity: 85.2% [95% CI: 72.4-100%]) regardless of geographic location, sample collection method and HIV status. Overall, our results identify plasma cfRNA as a promising host response biomarker to diagnose TB.

Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study.

Objective: This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. Methodology: One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. Results: The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. Conclusion: The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

Validation of the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) among Filipino Patients in a Tertiary Medical Center.

Objectives: Gestational diabetes mellitus (GDM) is a common pregnancy complication with adverse fetal and maternal outcomes. Currently, there are only a few validated tools available that address knowledge in GDM. Recognition of the inconsistencies will provide an effective learning program to achieve optimal results. This study aimed at validating the "Gestational Diabetes Mellitus Knowledge Questionnaire" (GDMKQ). Methodology: A cross-sectional validation study on GDMKQ among 51 GDM patients aged at least 18 years was conducted in the outpatient clinics of a tertiary hospital. Excluded were those with pre-existing diabetes. The questionnaire was submitted for peer review for translation to Filipino and back-translation. Concurrent validity, internal consistency and test-retest reliability of the questionnaire were undertaken as part of the validation process. Descriptive analysis was used for data elaboration by using SPSS v23. Results: The Filipino version of GDMKQ demonstrated sensible content and face validity. As measured, respondents obtained higher total and domain scores with better knowledge levels of GDM compared to its English version. Overall adequate knowledge was observed among those married and college subgroups as compared to single women and those with secondary levels of education. The reliability of the questionnaire was calculated at 0.632 using the Kuder-Richardson 20. The test-retest scores using the Filipino-translated questionnaire have a Pearson correlation coefficient of 0.853 with moderate to good level of agreement with each other, and Cohen's kappa of 0.564 with an intra-class correlation coefficient of 0.828. Conclusion: The Filipino-translated version of GDMKQ is a valid screening tool that assesses a patient's knowledge on gestational diabetes. Identifying the level of their understanding will enable clinicians to develop an individualized, effective learning program to improve pregnancy outcomes.

Characteristics and Prevalence of Metabolic Syndrome Among Adult Filipinos with Hypothyroidism: A Cross-sectional Study.

Objectives: We determined the clinical characteristics and prevalence of metabolic syndrome among adult Filipinos with overt hypothyroidism. Methodology: This is a cross-sectional study of 151 adults. Patients were recruited by sequential enrollment. Anthropometric and blood pressure measurements were performed followed by blood extraction for metabolic parameters and thyroid function tests. Clinical and laboratory characteristics were compared between patients with and without metabolic syndrome. Results: The prevalence of metabolic syndrome is 40.4% (95%CI: 32.5%, 48.7%). Patients with metabolic syndrome have a waist circumference of 88.4 ± 7.7 cm in females and 93.3 ± 9.0 cm in males. The median fasting blood glucose was 111.4 (52.2) mg/dL, median systolic blood pressure of 120 (30) mm Hg and diastolic blood pressure of 80 (20) mmHg, median serum triglycerides of 174.3 (114.2) mg/dL, median HDL-C of 42.3 (19.2) mg/dL and a proportion of patients with diabetes (23.0%) and hypertension (44.3%), respectively. The presence of increased waist circumference is the most prevalent component seen among hypothyroid patients. There were no differences in terms of age, sex, etiology of hypothyroidism and anti-TPO levels in those with and without metabolic syndrome. Conclusion: The prevalence of metabolic syndrome in adult Filipinos with hypothyroidism is high. Emphasis must be placed on early screening using waist circumference and metabolic parameters among hypothyroid patients who are at high risk of developing metabolic syndrome.

Prevailing Food Intake, Physical Activity and Health Beliefs in a Rural Agricultural Community in the Philippines: Factors to Consider Prior to a Diabetes Prevention Program.

Objective: A diabetes prevention program is being proposed in the rural agricultural town of San Juan, Batangas, Philippines. This study aims to determine the prevailing level of food intake, physical activity, and health beliefs prior to any intervention. Methodology: Adults were recruited via random sampling with proportional allocation. Interviews were done to determine food intake and physical activity. Small group discussions were held to determine prevailing health beliefs. Results: The average energy intake (1,547 kcal/d) is only 72% of the recommended values for Filipinos. Only 12% of the respondents achieved the recommended energy intake. Carbohydrates comprise a large part (71%) of calorie intake. A majority (91%) already have moderate to high levels of physical activity. There are prevailing health beliefs that need to be considered when dietary modifications and physical activity interventions are to be done. Conclusion: Internationally recommended diabetes prevention interventions such as reducing calorie intake and increasing physical activity may not be directly applicable here. We recommend that the features of a diabetes prevention program for this locale must include the following: 1) introduction of affordable plant sources of proteins; 2) decreasing the proportion of rice as a source of carbohydrates in the diet; 3) maintaining the level of physical activity; and 4) being sensitive to the prevailing health beliefs.

Teaching Literacy to Filipino Deaf Students in Multilingual Classrooms Amid a Pandemic.

This article describes the current landscape of teaching literacy to Filipino Deaf students in a multilingual, multi-cultural classroom amid the pandemic. The article highlights the uniqueness of Filipino Deaf students as multilingual learners in a multi-cultural classroom and the lack of literature and research on Deaf multilingualism both locally and globally. Moreover, the article focuses on the role of Deaf teachers in teaching Filipino Deaf students, especially in their literacy development. The steps being done to ensure that the curriculum is inclusive of Deaf learners who use Filipino Sign Language (FSL), teacher preparation and materials development, and the challenges in the shift to distance learning amid the COVID-19 pandemic are also discussed. Future directions and recommendations include review of curriculum and adaptation, enhancement of teacher preparation, promotion of collaborative teaching and research efforts, and the production of more appropriate and accessible instructional materials for Deaf students.

Visualizing a Framework in Teaching Literacy to Filipino Deaf Students in Multimodal Learning Spaces.

In this article, we visualize a framework of the intersectionality of literacy, spatial justice, and multimodality in teaching literacy to Filipino Deaf students. We propose a metaphor-based framework and discuss how it can be used in teaching literacy to Filipino Deaf students through classroom examples as well as suggestions and recommendations for teachers. We do this mainly through redefining the term literacy, allowing students access to different modalities, and restructuring learning spaces. We also explore the relationship between spatial justice and the concept of Deaf Space and how this applies in the "new normal" of online learning due to the pandemic. We also address the issue of how classroom and education structure may inadvertently produce spatial injustice, especially for Deaf students. Implications and additional questions in teaching Filipino Deaf students are also discussed.

Deaf on the Prairie: Combining Traditional and Contemporary Learning Theories.

This single case study concerns an 11-year-old girl, Agata, who recently moved to a rural community in the United States from the Philippines. Agata is profoundly deaf, has had no access to amplification, and has had very limited access to language and formal school. The journey through the next year, including the COVID-19 pandemic, saw Agata's language and literacy skills blossom at an unexpected rate. The study examines the how and why of Agata's progress by using multiple sources of both quantitative and qualitative data. A conceptual framework of both direct instruction theory (Engelmann & Carnine, 1982) and resilience theory (Garmezy, 1993) was used to systematically analyze the factors that contributed to Agata's growth and offer a more thorough understanding of the complex challenges and potential successes in supporting students from Asian communities who are d/Deaf or hard of hearing (d/DHH).

Older Chinese and Filipino American Immigrants with Type 2 Diabetes and their Adult Child: A Qualitative Dyadic Exploration of Family Support.

Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.

Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review.

PURPOSE: Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS: We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS: Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION: Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.