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Pediatric cranial trauma is the leading cause of acquired death and disability in children worldwide. However, trauma resources vary widely among countries. We sought to compare management and timely access to care between a level 1 U.S. pediatric trauma center and a tertiary referral hospital in a lower-middle-income country to assess whether system and resource differences influence care and outcomes. We compared data from 214 pediatric head trauma admissions to Philippine General Hospital (Manila) with 136 children from the TRACK-TBI pediatrics study cohort at Massachusetts General Hospital (MGH). Admitted MGH patients were compared with the Philippine cohort regarding demographics; mechanism of injury; times to neurosurgical consult, imaging, and surgery; in-hospital mortality; and length of hospitalization. Age (9 years), gender distribution (67% male), and presenting Glasgow Coma Scale scores were similar (P = 0.10) between sites. More children had intracranial injury in the Philippine cohort (73% vs. 60%; n = 319) and more underwent neurosurgery (27% vs. 4%). Times to consult, imaging, and surgery were longer in the Philippines (12.3 vs. 6.5, 12.0 vs. 2.8, and 45.4 vs. 5.6 hours, respectively). In-hospital mortality across all admissions was similar between cohorts (3% vs. 0%; P = 0.09), but significantly higher in the most severe Philippines cases (31% vs. 0%, P =0.04). Length of stay was longer (5 vs. 2 days; P < 0.001) in the Philippine cohort. High-income country status correlated with faster care, shorter hospitalizations, and better outcomes among severe cases. Prompt care through sophisticated trauma system implementation may improve pediatric health in resource-limited settings. [ABSTRACT FROM AUTHOR]

Operative neurosurgical skills education is a vital part of neurosurgical training, and these skills are usually obtained through operating room experience and supplemented by textbooks and other resources. We aimed to determine the resources used by trainees in the Philippines, both prior to and after the onset of the coronavirus disease 2019 pandemic. An online survey was sent to neurosurgical trainees in the Philippines from January to March 2021. Data on demographics, educational resources used, and weekly hours spent on each were collected, for both the pre– and post–coronavirus disease 2019 periods. A total of 37 neurosurgical trainees (60% response rate) participated in the survey. Most respondents were female (70%), in their senior levels (58%), and undergoing training in a public institution (65%). The main resources for operative neurosurgical education were operative experience, online academic resources, and neurosurgical textbooks. After the onset of the pandemic, the overall time spent decreased to 61.2 hours/week from 67.7 hours/week, with a significant reduction in the hours spent on operative experience (27.3 vs. 21.3 hours/week, P < 0.0001) and a significant increase in the time spent on webinars (0 vs. 3.2 hours/week, P < 0.0001) and online resources as a whole (14.9 vs. 16.4 hours/week, P = 0.0003). Operative experience, online academic resources, and neurosurgical textbooks were the main resources for operative neurosurgical education among trainees in the Philippines. After the onset of the pandemic, the hours spent on operative experience decreased and online academic resources increased significantly. New avenues of neurosurgical education, particularly webinars, also became available locally. [ABSTRACT FROM AUTHOR]

Background: Despite the effort to eradicate rabies in the Philippines, human rabies cases have not decreased in the past decade. Rabid dogs pose the most significant hazard in the countries with the highest burden of rabies, and 70% rabies vaccine coverage is recommended for dogs in high-risk areas. Ascertaining the owned dog population and community knowledge on rabies can help improve vaccine coverage and information campaigns. Methodology/Principal findings: We conducted a cross-sectional survey in six randomly selected communities (five urban, one rural) in Central Luzon, Philippines. We first conducted the complete mapping of 9,173 households and then randomly selected 727 households. More than half (54.1%) of the households owned dogs (1.21 dogs/household). In the 727 households, we identified 878 owned dogs and 3256 humans. According to these results, the dog-to-human ratio was approximately 1:3.7. Only 8.8% of households reported a history of dog bite in 2019. Among dog-owning households, 31% reported that they allow their dogs to roam freely. Of the recorded dogs, 35.9% have never been vaccinated, and only 3.5% were spayed or castrated. Factors associated with lower rabies knowledge include (1) no education aOR: 0.30 (0.16–0.59), and (2) only primary school education aOR: 0.33 (0.22–0.49). In contrast, factors associated with higher knowledge include (1) owning a dog and not allowing them to roam freely aOR: 2.01 (1.41–2.87) and (2) owning a dog and allowing them to roam freely aOR: 1.84 (1.17–2.92), when compared to those with no dogs. Conclusions/Significance: We identified a larger dog population in the community than the usual estimates (1:10), suggesting that annual vaccine needs in the Philippines must be reassessed. Our survey shows a relatively good understanding of rabies; however, awareness of the concept of rabies as a disease, and how animals and humans can acquire it, is lacking. Author summary: Rabies is a fatal disease primarily transmitted by rabid dogs. It is estimated that 59 000 human deaths occur worldwide annually because of rabies. Prevention is possible using pre-exposure prophylaxis or post-exposure prophylaxis (PEP). Despite this, rabies remains a neglected disease and a burden, particularly in developing countries. In this study, we found that the current estimated dog to human ratio of 1:10 may be incorrect. Our data show that the ratio of 1:3.7 may more closely reflect real-world figures. This finding is supported by previous studies on dog populations. We provide compelling evidence that there is a need to revise the current guidelines for estimating the dog population to provide adequate vaccine coverage. Our findings on community knowledge about rabies show that there is relatively good understanding regarding rabies; however, awareness of the concept of rabies as a disease and how animals and humans can acquire it is lacking. This should be a point of focus for future education campaigns. [ABSTRACT FROM AUTHOR]

The busy and demanding work schedule of neurosurgeons suggests that they might have type A behavior patterns (TABPs). TABPs are also associated with multiple diseases; hence, their early identification could lead to behavioral changes and disease prevention. We aimed to determine the presence of TABPs among neurosurgeons and trainees in the Philippines and the association between demographic and clinical factors and TABPs. An online survey was sent to neurosurgeons and neurosurgical trainees in the Philippines. Data on age, sex, comorbid conditions, smoking, alcohol use, training institution, level of residency training, and place of practice were obtained. The modified Bortner scale was used to determine TABPs. Univariate and multiple regression analyses were used for analysis. A total of 102 individuals (41 neurosurgeons and 61 trainees) completed the survey. Most of the respondents were men (74%), with a mean age of 36 years. The Bortner scores were normally distributed. TABPs were significantly associated with female sex (P = 0.0006) in the entire cohort. However, the trainee cohort also exhibited a significant association between TABPs and training in a public institution (P = 0.0027). The presence of TABPs followed a normal distribution among neurosurgeons and neurosurgical trainees in the Philippines. A significant association was found between TABPs and female sex for both neurosurgeons and trainees, and training in a public institution was significantly associated with TABPs only among the trainees. [ABSTRACT FROM AUTHOR]

Objective: To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015.Design: Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015.Setting: Eleven large government hospitals from five regions in the Philippines.Participants: One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery.Interventions: A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication.Main Outcome Measures: Sixteen intrapartum and newborn care practices.Results: Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted.Conclusions: Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care. [ABSTRACT FROM AUTHOR]

Background. As part of regional elimination efforts, rubella-containing vaccines (RCV) have recently been introduced in the Philippines, yet the true burden of rubella and congenital rubella syndrome (CRS) in the country is largely unknown. Objective. To provide baseline information on rubella and CRS prior to routine vaccine introduction in the Philippines. Methods. We conducted a systematic literature review on rubella and CRS in the Philippines, including a cross-sectional study conducted in 2002 among 383 pregnant women attending the obstetric outpatient clinic of the Philippine General Hospital to assess rubella susceptibility of women of childbearing age. Results. 15 locally published and unpublished studies were reviewed. Susceptibility to rubella among women of childbearing age was higher in rural communities. Retrospective reviews revealed congenital heart diseases, cataracts, and hearing impairments to be most common presentations in children of CRS. In the cross-sectional study, 59 (15.4%) of the 383 pregnant women enrolled were seronegative for rubella IgG. Conclusion. Similar to other countries introducing RCV, it was only recently that surveillance for rubella has been established. Previous studies show substantial disabilities due to CRS and a substantial proportion of susceptible women who are at risk for having babies affected with CRS. Establishment of CRS surveillance and enhanced awareness on rubella case detection should be prioritized. [ABSTRACT FROM AUTHOR]

Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments (n=56 facilities) revealed gaps in provider’s skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training (n=51 facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings. [ABSTRACT FROM AUTHOR]

Timely administration of hepatitis B vaccine beginning at birth prevents up to 95 per cent of perinatally acquired hepatitis B virus infections in infants of infected mothers. The Philippines changed its national HepB schedule in 2007 to include a dose at birth. We evaluated vaccination schedule change by reviewing infant records at selected health facilities to measure completeness and timeliness of HepB administration and frequency of recommended, simultaneous vaccination with diphtheria-tetanus-pertussis (DTP) vaccine. Of 1431 sampled infants, 1106 (77 per cent) completed the HepB series and 10 per cent followed the national schedule. The proportion with timely vaccination declined with successive doses: HepB1 (71 per cent), HepB2 (47 per cent), and HepB3 (26 per cent). Twenty-six per cent received HepB2 simultaneously with DTP1 and 34 per cent received HepB3 simultaneously with DTP3. If HepB and DTP vaccination were given simultaneously, 10 per cent more infants could have received all HepB doses. Program implementers should monitor vaccination timeliness and increase simultaneous administration to improve vaccination coverage and decrease disease incidence. [ABSTRACT FROM AUTHOR]

Abstract: There has been a gradual evolution in fisheries management over the past decades from a focus on sustainability of a single species or stock and resources to a focus on marine ecosystems. Among the issues to be addressed for effective implementation of ecosystem based fisheries management (EBFM) are the appropriate governance arrangements and scale for management. The purpose of this paper is to examine these issues of governance and scale as related to EBFM in tropical developing countries through an analysis of approaches being taken in the Philippines to manage fisheries on a multi-jurisdictional level. The management of fisheries and coastal resources in a number of bays and gulfs, which represent marine ecosystems, is presented. The opportunities and constraints to ecosystem based fisheries management in the Philippines are discussed and lessons for broader application of these governance structures in tropical developing country marine ecosystems are presented. [Copyright &y& Elsevier]

Many of the leading developers in the Philippines have commenced the development and marketing of farmlot communities in areas surrounding the National Capital Region. Some of the more significant of these are found in nearby outlying provinces as Cavite, and Batangas. The concept behind such developments is the provision of an alternative non-urban residential lifestyle which focuses on an agricultural base of activities. This is targeted on the so-called "gentleman" or "weekend farmer" whose primary urban residence is in Metropolitan Manila and its suburbs. A secondary market also exists among retirees, both local and expatriate, "Balikbayans" and Overseas Filipino Workers (OFWs). The physical development concept comprises the development of "farmlots" as opposed to purely "residential lots" with plot areas in excess of seven-hundred fifty (750) square meters, and generally ranging within the one thousand (1,000) square meter range. The gross footprint of any residential structure is generally limited to twenty percent (20%) of the gross plot area. Other than these basic restrictions, the provisions of the National Building Code remain largely applicable. The Department of Natural Resources (DENR) and the Housing and Land Use Regulatory Board (HLURB) are also responsible for establishing and implementing development guidelines and standards for Farmlot Subdivisions. As in most open-market residential subdivision developments, developers normally draft and issue a Deed of Restrictions that is appended to and is legally integrated with the Lot Title. As such a lot owner is legally bound to abide by the controls and limitations embodied in the Deed of Restrictions. In addition, most subdivisions also issue a set of Subdivision Guidelines which augment and further define the scale and character of residential construction within the subdivision. Though usually enacted by the developer, the Subdivision Guidelines are eventually turned over to the Home Owners' Association (HOA) for implementation and enforcement. Theoretically, there are legal avenues that make it possible for the Subdivision Guidelines Home Owners' Association to eventually revise or modify the Subdivision Guidelines. On the other hand, it is more difficult to enact subsequent revisions to the Deed of Restrictions, since these form a legal component of the Lot Title. In terms of defining or otherwise attempting to regulate the architectural character of owner-built houses, most developers have chosen to avoid any strict imposition of control via the Deed of Restrictions. This consideration has an impact in terms of both the marketability of the project as well as the subsequent enforceability of the controls. Progressive Developments in other countries have shown that a strict imposition of controls relating to architectural character can and will translate to competitive marketability and resulting appreciation in land values. The experience of architect-planners of the Neo-Classicist and Neo-Urbanist genre has shown how a rational, properly organized and ultimately enforceable set of architectural guidelines can result in a markedly consistent community character without overly restricting the creativity and innovation inherent to good architecture. This experience has also brought with it the financial benefit that any real estate market essentially seeks, the appreciation and maintenance of land values. This is so, since it ultimately ensures the preservation of the positive physical, spatial and architectural elements that promote the identity and self-awareness of a community setting. This has not largely been felt in the Philippines. Many communities have found difficulty in the enforcement of even the most simple and basic legal restrictions such as set-backs and easements. Though no research has actually quantified the extent of violations across the various market segments, it is probably safe to say that violations occur from the lowest to the highest segments of the residential market. When it comes to the issue of whether or not to regulate architectural style or character, it is possibly perceived that the market would view such regulation as a curtailment of the freedom to choose the specific style or character of one's home. As such the impact of this on the marketability of a residential project may be considerable. The recent developments of so-termed "Farmlot Subdivisions" present the opportunity to propose new approaches toward the control and regulation of land use and the physical/spatial character of farmlot communities. The basic consideration is obviously centered on the necessity of ensuring that a community develops with a uniquely "farm-home" character and does not eventually transition into the typical urban residential mode. The paper shall discuss and present a set of Architectural/Urban Design Guidelines as well as the related Deed of Restrictions for a Farmlot Subdivision currently being developed in Talisay, Batangas. These were embodied in an Owner's Handbook which was prepared by the author under engagement by the Ledesco, the developer of the Taal View Heights Subdivision. In the course of the effort, Ledesco envisioned a farmlot community that was characterized by an essentially Filipino residential architecture. Though it was understood and accepted that Filipino architecture could be manifested within a continuum ranging from traditionalist to contemporary. The paper discusses how the set of architectural guidelines were structured as suggestive rather than regulatory and thus approached the presentation in a more graphic, qualitative, source-book mode. Furthermore, the paper discusses how the more control and enforcement-oriented Deed of Restrictions attempted to regulate the character of land use, density and scale of development through more quantitative controls, while selectively relaxing other controls on building height to allow optimal access to views and other visual corridors. The paper concludes with recommendations for further evolution and development of more stringent Controls, Covenants and Restrictions that can possibly be considered by both the private development sector and the government regulatory agencies for future application. [ABSTRACT FROM AUTHOR]

Awake craniotomy is a technique used to maximize resection of lesions in eloquent areas of the brain and preserve function. Although its use in high-income centers is well documented for tumors and vascular lesions, reports of its use in low-middle-income countries are limited. There are no published series from the Philippines. We performed a retrospective review of all patients who underwent awake craniotomy at a tertiary referral center in Manila, Philippines from 2010 to 2019. Data on demographics, clinical features, diagnoses, intraoperative and postoperative complications, and outcomes were collected. Regression analyses were performed to correlate use of intraoperative adjuncts with outcome measures (extent of resection, complication rate, neurologic status after surgery and on last follow-up, and in-hospital mortality). A total of 65 patients were included in the cohort, who had a male predilection (60%) and a mean age at diagnosis of 40.4 years. The most common indication was tumor excision (90%), followed by excision of arteriovenous malformations (5%) and cavernomas (3%). Of the tumors, the most common histopathologic diagnosis was low-grade glioma (48%). The intraoperative complication rate was 13.8%, with the most common complication being patient intolerance. Gross total excision rate for tumors was 78.3%. Univariate analysis showed that use of a cortical stimulator was associated with improved neurologic status on last follow-up (P = 0.0471). Our experience shows that awake craniotomy is feasible in low-middle-income country settings and is safe and effective for excision of tumors, arteriovenous malformations, and cavernomas. [ABSTRACT FROM AUTHOR]

Primary considerations for adopting an ecosystem approach to fisheries management (EAFM) as a management approach will involve an expanded scope of fisheries management over conventional approaches; specifically, EAFM will involve a broader scale of management. Development of a sub-regional EAFM plan can complement local, national, and regional fisheries management priorities, as well as help to catalyze management action at multiple levels that may not otherwise occur. A sub-regional EAFM policy planning approach has been undertaken for the Sulu-Sulawesi Seascape (SSS), a sub-region of Southeast Asia. This sub-regional policy planning approach illustrates how "scaling up" EAFM can support relevant international, regional, and other sub-regional fisheries management plans and environmental initiatives, while "scaling down" EAF can support relevant national, provincial/state, and local fisheries management plans in Indonesia, Malaysia and the Philippines. • Identifying different scales are important aspects of taking an ecosystem approach to fisheries management (EAFM). • Development of a sub-regional EAFM policy plan can complement and link existing governance scales of fisheries management. • EAFM implementation will need to consider mechanisms to 'scale up' and 'scale down' decision-making and development. [ABSTRACT FROM AUTHOR]

The article offers an update on the University of the Philippines College of Architecture (UPCA). The college has decided to integrate environmentally-sound architecture as the core focus of its curriculum in both the undergraduate Bachelor of Science in Architecture/B Landscape Architecture programs and its graduate Master of Architecture and Master of Tropical Landscape Architecture programs. The 13th Inter-University Seminar on Asian Megacities was also hosted by the UPCA in March 2008.

Our study aimed to determine the ability of hematologic markers (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio, and red cell distribution width [RDW]) in predicting delayed cerebral ischemia (DCI), modified Rankin Scale scores, and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). A retrospective observational 6-year review of medical records was conducted to identify all consecutive patients with aSAH admitted to the largest training hospital in the Philippines. Univariable and multivariable regression analyses were performed to determine the association of the biomarkers with the respective outcomes. Receiver operating characteristic curves were used to detect overall predictive accuracy. A total of 222 patients with aSAH were included, of whom 11.71% developed DCI. Most patients with NLR ≥5.9 subsequently died (77 vs. 52%; P = 0.03). DCI was also associated with poor functional outcomes with higher modified Rankin Scale scores (3–6) on discharge (92% vs. 49%; P < 0.01), and longer duration of hospitalization (median, 20 vs. 13 days; P = 0.01). In receiver operating characteristic analyses, the value of RDW was predictive for DCI (area under the curve, 0.70; 95% confidence interval, 0.62–0.79; P < 0.01). The values of NLR (area under the curve, 0.67; 95% CI, 0.59–0.74) potentially predict functional outcome. RDW, NLR, and their combinations were poor discriminators of mortality. Our study showed that some hematologic parameters analyzed could be of potential value as prognostic biomarkers in patients with aSAH. Hematologic biomarkers are widely available and practical parameters that may be of considerable clinical value in aSAH management, especially in lower-middle-income countries such as the Philippines. [ABSTRACT FROM AUTHOR]

A new type of modified Bonner sphere spectrometer called In-MuNS (Indium-based MUltishell Neutron Spectrometer) was developed at the Philippine Nuclear Research Institute (PNRI). It consists of concentric high-density polyethylene spherical shells which can be combined to obtain Bonner Spheres with diameters from 5 to 30 cm. Indium activation foils are used as central detectors. The induced activity in the Indium foils is analyzed post-irradiation with a portable NaI(Tl) gamma spectrometer. The measured specific saturation activities are unfolded using the FRUIT code together with a previously validated In-MuNS response matrix. A measurement campaign was performed at three locations in the treatment room of a 15 MV medical LINAC: the isocenter, 70 cm from the isocenter, and the maze-room junction (5.4 m from the isocenter). Ambient dose equivalent values of 2.24 mSv/Gy, 0.72 mSv/Gy and 0.076 mSv/Gy, respectively, were derived from the measured spectra. These results are coherent with literature data. Relying on the In-MuNS spectrometer, neutron dosimetry studies in medical facilities are now possible also in the Philippines. [ABSTRACT FROM AUTHOR]

Originally, the kwashiorkor is a pathology justified by the low consumption of proteins and high carbohydrates in weaned children. However, today, it can appear due to multifactorial causes, one of the hypotheses being the presence of aflatoxins in foods consumed by the child population and detected in biological fluids. The objective of this work is to scoping review the presence of aflatoxins in kwashiorkor, marasmus and marasmic-kwashiorkor from organs and biological samples in children. Results reflected that the presence of aflatoxins in kwashiorkor is greater compared to marasmic-kwashiorkor and marasmus in the organs and biological samples analyzed. The relationship of this mycotoxin with the pathology shows that it can affect both genders, even up to 12 years, in addition they are detected in eight biological samples and organs, except in the spleen, and in ten African countries and in the Philippines. The appearance of this pathology has been associated in children when after weaning they consume foods with low protein content and rich in carbohydrates, but coincidentally coincides with foods where the growth of aflatoxigenic fungi is more prevalent, and even the presence of other fungi that can generate other mycotoxins, such as ochratoxin A and fumonisin B1. • Presence of aflatoxins in children affected by malnutrition is reviewed. • Presence of aflatoxins is higher in kwashiorkor. • A flatoxins in kwashiorkor is shown in 10 countries. • All literature is carried out in Africa, and one of them in the Philippines. [ABSTRACT FROM AUTHOR]

Background: Better living conditions and health care advancements have improved life expectancy worldwide, increasing the number of older patients who require neurosurgery. We would like to report our experience with geriatric neurosurgical patients at our institution., Methods: This is a retrospective study on geriatric patients (aged ≥ 65 years) who underwent neurosurgery at our center between 2015 and 2022. Data on age, sex, comorbidities, pre-morbid status, type of admission, diagnosis, operation, complications, short-term outcome, hospital length of stay (LOS), and 30-day readmission were collected. Descriptive statistics and multiple regression analysis were used., Results: A total of 327 patients were included. The mean age was 70.4 years and 51.3 % were female. Majority (70.6 %) had at least one comorbid condition, most commonly hypertension. Most patients were admitted through emergency systems (80.1 %), with 40.4 % consulting for traumatic brain injury. The top diagnoses were chronic subdural hematoma (35.2 %), ruptured intracerebral aneurysm (15.6 %), and meningioma (10.1 %). The most common procedures were burrhole drainage of hematoma (34.8 %), brain tumor excision (16.7 %), and aneurysm clipping (14.6 %). The post-operative complication rate was 15.2 %, and mean LOS was 16.7 days. Majority of patients (86.9 %) were discharged home, and 2.8 % were readmitted within 30 days. The 30-day mortality rate was 13.1 %. Lower pre-operative GCS, certain comorbidities, and intra- and post-operative complications were significantly associated with mortality and LOS., Conclusion: Advanced age alone should not be a contraindication to surgery; other factors such as frailty and comorbid conditions should also be considered. Proper patient selection and preoperative preparation are key to achieving good outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive lesioning technique used to treat movement disorders such as essential tremor (ET), Parkinson's disease (PD), and X-linked dystonia-parkinsonism (XDP). We would like to report our experience in establishing and developing our MRgFUS program and preliminary results. Adult patients with tremor-dominant PD (TDPD), ET, and XDP were considered for initial screening (neurologic evaluation, skull density ratio [SDR] determination). Eligible patients underwent secondary screening (neurosurgical and neuropsychological evaluation, psychiatric and medical clearance). During the procedure, a neuro-anesthesiologist and neurologist were also present to monitor the patient and perform neurologic evaluation, respectively. Clinical follow-up was scheduled at 2 weeks post-treatment, then at every 3 months. A total of 30 patients underwent MRgFUS treatment: 22 TDPD, 6 XDP, and 2 ET. The mean age was 55.7 years, and majority were male (86.7%). Mean disease duration was 8.6 years. Mean SDR was 0.46. The targets for TDPD and ET were the contralateral ventral intermediate nucleus of the thalamus; for XDP, it was the pallidothalamic tract. The mean maximum temperature was 59.8 o C; number of sonocations, 7.3; and treatment time, 64.6 min. Majority of patients improved after the procedure. Transient intraprocedural adverse events (headache, dizziness) were reported in 20% of patients while post-procedural events (mild weakness, numbness) were seen in 16.7%. Only 26.7% of patients had follow-up data. Despite the unique challenges encountered, MRgFUS treatment is feasible in resource-limited settings. Additional steps would have to be made to develop and improve the program., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The success of global health interventions heavily relies on reaching populations in a way that aligns with their priorities and needs. This warrants novel approaches to determine the design of meaningful interventions and targeted delivery pathways. To date, global health scholarship and practice have largely underused approaches already established in fields that emphasize customer satisfaction, such as quality management or consumer psychology., Methods: In our study, we apply Kano methodology-originally designed to understand how product attributes nonlinearly influence customer satisfaction-to inform design decisions regarding a video-based vaccine intervention in the Philippines. Between September 2021 and April 2022, we administered a Kano questionnaire to 205 caregivers of small children. Data were analyzed following routine Kano approaches, supplemented by cultural consensus analysis (CCA), which is an approach used largely in anthropology to identify distinct cultural groups and competencies., Results: Applying Kano and CCA methodologies allowed us to make informed design decisions in terms of optimizing accessibility and credibility of an intervention that ultimately proved successful in bolstering vaccine intentions. Results guided us to include national and international logos, to appreciate the value of summarizing key messages, and to recognize the importance of fact- or story-based communication as attributes that influenced respondent satisfaction one-dimensionally. We found that involving trusted messengers and including text-based information were required to avoid dissatisfaction. Interacting with someone after viewing the product and creating opportunities to share the promotional material via social media were attractive attributes whose presence would increase satisfaction but would not spark severe dissatisfaction if omitted. Other attributes (short duration, video- or animation-based intervention, delivering the intervention at health centers or in group settings) played a limited role in respondent satisfaction., Conclusions: Global health research and practice can benefit from applying approaches established in other fields when making evidence-based prioritization decisions to tailor interventions., (© Wachinger et al.)

Background: The public's confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. 'Salubong', a Filipino term, refers to welcoming someone back into one's life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes., Methods: Using human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure., Results: Although the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher's exact, p<0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen's d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p<0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher's exact, p<0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen's d=0.35 with 95% CI -0.01 to 0.70, two-sided t-test, p=0.06)., Conclusions: Our results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive method for controlling tremor and has recently been used in patients with X-linked dystonia-parkinsonism (XDP). This study aims to determine the improvement in dystonia and parkinsonism in patients with XDP after MRgFUS pallidothalamic tractotomy. This prospective study will be conducted at the Philippine General Hospital, University of the Philippines Manila. The primary outcome measure is the change in the pre- and post-treatment XDP-Movement Disorder Society of the Philippines Scale scores. In addition, demographic and clinical data will be collected, including the Burke-Fahn-Marsden Dystonia Rating Scale, Part III of the Movement Disorder Society-Unified Parkinson's disease Rating Scale score, XDP clinical and functional stage, the five-level EuroQol five-dimensional questionnaire, Montreal Cognitive Assessment scores, MRgFUS treatment parameters, and adverse events. Patients will be assessed within 24 hours of treatment, then at 2 weeks, 3 months, 6 months, 9 months, and 12 months post-treatment. This protocol was approved by the University of the Philippines Manila Research Ethics Board (UPMREB 2022-0271-01). Data collection began in January 2023. This protocol has been registered with ClinicalTrials.gov: Trial Registration number: NCT05592028., (© 2023. BioMed Central Ltd., part of Springer Nature.)

We used KoBo Collect and KoBo Toolbox as an electronic data capture platform for a dog population and rabies knowledge and practices community survey in the Philippines. It has allowed for easy design and deployment of an electronic form with minimal technical knowledge from the investigators. Using this platform allowed for shorter training for data collectors, minimal errors during data collection, and faster turn-around time for data cleaning and analysis.

Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the outcomes of surgical neuro-oncology patients worldwide. We aimed to review the practice patterns in surgical neuro-oncology in low- and middle-income countries (LMICs). We also present a situational report from our own country., Methods: A scoping review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines., Results: Twelve studies were included in the review. Most of the studies were from Asia (India, China, Iran, and Turkey), and 1 was from Brazil. Quantitative reports showed a decrease in the number of surgical neuro-oncology operations between pre-COVID-19 and post-COVID-19 time frames, but similar proportions of neuro-oncology procedures. Qualitative review showed similar practice patterns between LMICs and high-income countries, except for limitations in resources such as negative-pressure operating rooms and intensive care units, and maintenance of face-to-face consults despite the adoption of telemedicine. Limited data on adjuvant therapy were available in LMICs., Conclusions: In our review, we found that the practice patterns in surgical neuro-oncology in LMICs during the COVID-19 pandemic are similar to those in high-income countries, except for a few modifications because of resource limitation and patient preferences., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Objective: High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument., Methods: Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of <75.0% on either of the criteria implied that the CPG needed revision., Results: Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable., Conclusion: AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool., Findings: Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months)., Conclusion: Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines., (© 2019 John Wiley & Sons, Ltd.)