Current Status and Challenges in Dementia Care in the Philippines: A Scoping Review.

Background: Dementia prevalence is increasing in low- and middle-income countries such as the Philippines. Objective: This study aimed to give an overview of dementia care in the Philippines and to identify gaps in terms of local epidemiology, research, financial coverage, diagnostics, pharmacotherapy, manpower, and caregiver support. Methods: This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines extension for scoping reviews. Six international and two local databases, and government and non-government websites were searched. Data published in the English or Filipino language on dementia epidemiology, research, diagnostics, management, manpower, and training were extracted from the earliest indexed record until June 2022. Results: The prevalence of dementia in the Philippines is high and research output on all aspects of dementia is low. Cost is a major barrier as health care coverage is limited, with reliance mainly on out-of-pocket payments, leading to challenges in the proper diagnosis and treatment of dementia. There is a low specialist-to-population ratio, with shortages beyond manpower and training. Conclusions: Gaps in dementia care include limited published local data, high healthcare costs, inadequate health financing, and limited manpower.

A Bibliometric Analysis on Viral Central Nervous System Infection Research Productivity in Southeast Asia.

Research productivity on viral infections of the nervous system in Southeast Asia (SEA) is unknown. We aimed to determine the research productivity of SEA in terms of bibliometric indices and PlumX metrics and their correlation with socioeconomic factors. A comprehensive search of major electronic databases was done to identify studies on viral infections of the nervous system with at least one author from SEA. Socioeconomic factors and collaborations outside SEA were determined. Correlational analysis was done on bibliometric indices and socioeconomic factors. A total of 542 articles were analyzed. The majority came from Thailand (n = 164, 30.2%). Most articles used a descriptive study design (n = 175, 32.2%). The most common topic was Japanese encephalitis (n = 170, 31.3%). The % gross domestic product allotted for research, number of neurologists, and number of collaborations outside SEA correlated with the bibliometric indices and PlumX metrics. In conclusion, the number of research from SEA was low but the quality was comparable to the global benchmark. Improving resource allocation and collaboration between SEA nations and other countries may support this endeavor.

Research Productivity among Filipino Neurologists Associated with Socioeconomic, Healthcare, and Disease Burden Factors: A Bibliometric Analysis.

Philippine research productivity in neurology has not been fully characterized. We investigated the research output of adult and child neurologists in the Philippines and correlated this to the Philippine socioeconomic and healthcare indices among different regions. We used electronic databases to retrieve studies published by Filipino neurologists using the 2022 Philippine Neurological Association website as reference. We included all studies published until December 2021. Official government region-specific socioeconomic indices were used. Correlational analysis was completed on bibliometric indices and collected data. We retrieved 746 articles from 274 of 526 Filipino neurologists which were published in 245 publications over 45 years with 12,409 citations. The National Capital Region (NCR) had the most publications (n = 662, 88.7%) and citations (n = 10,377, 83.6%). Research productivity was positively correlated with population, gross domestic product (GDP), health expenditure, number of healthcare establishments, neurologists, and research personnel. The Philippine research landscape is dominated by articles of neurologists belonging to institutions in the NCR, which has the greatest number of neurologists, training institutions, and highest GDP. There is a need to address the disparity seen in other regions to bridge gaps in healthcare, health human resources, and health information through research.

Google search behavior for meningitis and its vaccines: an infodemiological study.

BACKGROUND: The internet has made significant contributions towards health education. Analyzing the pattern of online behavior regarding meningitis and vaccinations may be worthwhile. It is hypothesized that the online search patterns in meningitis are correlated with its number of cases and the search patterns of its related vaccines. METHODS: This was an infodemiological study that determined the relationship among online search interest in meningitis, its worldwide number of cases and its associated vaccines. Using Google Trends™ Search Volume Indices (SVIs), we evaluated the search queries "meningitis," "pneumococcal vaccine," "BCG vaccine," "meningococcal vaccine" and "influenza vaccine" in January 2021, covering January 2008 to December 2020. Spearman rank correlation was used to determine correlations between these queries. RESULTS: The worldwide search interest in meningitis from 2008 to 2020 showed an average SVI of 46 ± 8.8. The most searched topics were symptoms, vaccines, and infectious agents with SVIs of 100, 52, and 39, respectively. The top three countries with the highest search interest were Ghana, Kazakhstan, and Kenya. There were weak, but statistically significant correlations between meningitis and the BCG (ρ = 0.369, p < 0.001) and meningococcal (ρ = 0.183, p < 0.05) vaccines. There were no statistically significant associations between the number of cases, influenza vaccine, and pneumococcal vaccine. CONCLUSION: The relationships among the Google SVIs for meningitis and its related vaccines and number of cases data were inconsistent and remained unclear. Future infodemiological studies may expand their scopes to social media, semantics, and big data for more robust conclusions.

Primary headache research output and association with socioeconomic factors in Southeast Asia: a bibliometric analysis.

BACKGROUND: Although headache is one of the most common neurologic conditions with a high disease burden, primary data on headache research from Southeast Asia (SEA) was hypothesized to be inadequate. This study aimed to evaluate research productivity among the different countries in SEA and to determine the association between specific bibliometric indices and socioeconomic factors. METHODS: A systematic search was conducted until June 10, 2020 in Scopus, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Index Medicus for South-East Asia Region to include all primary headache studies on migraine, tension-type headache, and trigeminal autonomic cephalalgia, with at least one author affiliated with a SEA country. Bibliometric indices, such as the number of publications and PlumX metrics, were obtained and correlated with the country-specific socioeconomic factors. RESULTS: We identified 153 articles. Most of the publications (n = 43, 28.1%) were epidemiologic studies and case reports/series (n = 25, 16.3%). Migraine was the most studied primary headache subtype. Malaysia, Singapore, and Thailand were the major contributors to primary headache research in SEA. Only the percent gross domestic product for research and development correlated significantly with research productivity. CONCLUSION: Despite the high global burden of disease, research productivity on primary headache was low in SEA. The move towards a knowledge-based economy may drive research productivity in SEA.

Stroke Research Disparity in Southeast Asia: Socioeconomic Factors, Healthcare Delivery, and Stroke Disease Burden.

BACKGROUND: Cerebrovascular disease is the second leading cause of death worldwide and provides a heavy burden of disease in Southeast Asia (SEA). Contribution to the collective knowledge of this disease is necessary to address practice and treatment disparities. There is limited data on research productivity in the region. This study aimed to determine research productivity on stroke and other cerebral and spinal vascular diseases among the SEA countries and determine its relationship with bibliometrics, socioeconomic parameters, healthcare delivery indices, and burden of disease. METHODS: A comprehensive literature search was conducted using five major healthcare databases. We included studies published until June 2020 on cerebral and spinal vascular disease with at least one author from SEA. Country-specific socioeconomic parameters, the burden of disease, healthcare delivery indices, and the number of neurologists were collected from international databases and published data. Correlational analysis was done on bibliometric indices and collected data. RESULTS: A total of 2577 articles were included. Singapore had the most publications (n=1095, 42.5%) and citations (PlumX n=16,592, 55.2%; Scopus n=22,351, 56.7%). Gross domestic product per capita, percent gross domestic product for research and development, universal health care effective coverage index overall and for stroke treatment, and the number of neurologists had a positive correlation to bibliometric indices. CONCLUSIONS: There is a disparity in stroke research productivity among high-income and low-income countries in SEA. Priority must be given to scientific research output and its role in socioeconomic development and policy formulation.

Treatment gaps and challenges in epilepsy care in the Philippines.

OBJECTIVE: Epilepsy is a neurologic disease that carries a high disease burden and likely, a huge treatment gap especially in low-to-middle income countries (LMIC) such as the Philippines. This review aimed to examine the treatment gaps and challenges that burden Philippine epilepsy care. MATERIALS & METHODS: Pertinent data on epidemiology, research, health financing and health systems, pharmacologic and surgical treatment options, cost of care, and workforce were obtained through a literature search and review of relevant Philippine government websites. RESULTS: The estimated prevalence of epilepsy in the Philippines is 0.9%. Epilepsy research in the Philippines is low in quantity compared with the rest of Southeast Asia (SEA). Inequities in quality and quantity of healthcare services delivered to local government units (LGUs) have arisen because of devolution. Programs for epilepsy care by both government and nongovernment institutions have been implemented. Healthcare expenditure in the Philippines is still largely out-of-pocket, with only partial coverage from the public sector. There is limited access to antiseizure medications (ASMs), mainly due to cost. Epilepsy surgery is an underutilized treatment option. There are only 20 epileptologists in the Philippines, with one epileptologist for every 45,000 patients with epilepsy. In addition, epilepsy care service delivery has been further impeded by the coronavirus disease of 2019 (COVID-19) pandemic. CONCLUSION: There is a large treatment gap in epilepsy care in the Philippines in terms of high epilepsy disease burden, socioeconomic limitations and inadequate public support, sparse clinico-epidemiologic research on epilepsy, inaccessibility of health care services and essential pharmacotherapy, underutilization of surgical options, and lack of specialists capable of rendering epilepsy care. Acknowledgment of the existence of these treatment gaps and addressing such are expected to improve the overall survival and quality of life of patients with epilepsy in the Philippines.

The current status and challenges in multiple sclerosis management in the Philippines.

BACKGROUND: The provision of adequate services for individuals living with multiple sclerosis (MS) is an important issue since MS has a chronic and debilitating course. OBJECTIVE: We aimed to review the literature on health service delivery for individuals with MS in the Philippines and identify the gaps in adequate provision of healthcare in these individuals. METHODS: We reviewed data from relevant local and international repositories on health service delivery for individuals with MS in the Philippines. RESULTS: The epidemiology of MS in the Philippine setting remains unknown. Approximately 1 neurologist caters to 175,000 Filipinos aged 15 and above, and nearly half are practicing in the National Capital Region. Physical access to magnetic resonance imaging is severely limited at 0.8 MRI unit per million Filipinos. Household out-of-pocket payment and voluntary health care payment schemes contributed 53.9% and 12.2%, respectively, to the current health expenditures. The average monthly income of a Filipino household is only 519 USD which may not be enough to cover treatment of a single relapse let alone costly disease-modifying treatments. CONCLUSION: The Philippines faces challenges in terms of the availability of accurate epidemiologic information, resource allocation, access to services and provision of therapies for individuals with MS.

Corrigendum: Translation, Cultural Adaptation, and Validation of the Hiligaynon Montreal Cognitive Assessment Tool (MoCA-Hil) Among Patients With X-Linked Dystonia Parkinsonism (XDP).

[This corrects the article DOI: 10.3389/fneur.2019.01249.].

Dementia Research Productivity and Associations with Socioeconomic Factors and Burden of Disease in Southeast Asia.

BACKGROUND: Scientific output in Southeast Asia (SEA) on the topic of dementia is postulated to be low in quality and quantity. It is also speculated that certain socioeconomic variables and measures of disease burden for dementia may play a significant role in driving the research output of a particular country. OBJECTIVE: This study aimed to determine the research impact of published journal articles on dementia in SEA and its association with country-level socioeconomic factors and measures of disease burden for dementia. METHODS: A systematic search was conducted using electronic healthcare databases. We included articles published on dementia until August 2019 with at least 1 author affiliated with any SEA institution. We obtained bibliometric indices, relevant socioeconomic factors, and measures of disease burden for dementia from published sources. RESULTS: One thousand six articles fulfilled the inclusion criteria. The majority of publications were related to Alzheimer's disease (n = 775, 77.0%). Singapore contributed the highest number of publications (n = 457, 45.4%). Gross domestic product (GDP) per capita, % GDP for research and development, and total neurologists significantly correlated with several bibliometric indices. On the other hand, the measures of disease burden for dementia in SEA countries were not significantly associated with research productivity. CONCLUSION: Research productivity in SEA on dementia has substantially increased in recent years. Augmenting GDP per capita and expanding the apportionment of resources to research and development (R&D) may have a significant role in the advancement of dementia research in SEA.

Trimetazidine-Induced Parkinsonism: A Systematic Review.

Importance: Trimetazidine (TMZ) is a medication given to patients with stable coronary artery disease. While it is reportedly well-tolerated, there are increasing numbers of reports of adverse events such as parkinsonism. Objectives: The purpose of this study was to systematically review the currently available literature on TMZ-induced parkinsonism. Evidence Review: A search of Scopus, MEDLINE, EMBASE, the Cochrane Library, the Health Technology Assessment Database, PubMed, Science Direct, and Google Scholar was conducted on or before November 7, 2019. The literature search included cohort studies, prospective and/or retrospective studies, meta-analysis, and other systematic reviews published as an original article, including abstracts and full texts. We included patients taking TMZ who developed one or more of the parkinsonian symptoms of bradykinesia, tremors, rigidity, and postural instability, where these symptoms improved after withdrawal of the said medication. Findings: There are currently five studies on TMZ use and associated parkinsonism. The literature included two case reports, one case series, and one retrospective and one prospective study. We found no results from randomized clinical trials. Overall, 88 patients developed TMZ-induced parkinsonism. Regression of parkinsonism was reported in all of the participants after withdrawal of TMZ. A total of 49 patients (55.7%) had complete regression of symptoms, while 39 patients (44.3%) had significant reduction of symptoms. The duration between TMZ (dose, 60-80 mg/day) intake and onset of symptoms ranged from 4 months to 20 years. The most commonly reported extrapyramidal symptoms were akinesia, rigidity, postural disturbances, and gait disorders, which were usually mild and symmetric. Conclusions and Relevance: The current literature suggests that TMZ can induce parkinsonism that is reversible with drug withdrawal. It is warranted to examine patients, especially the elderly, on TMZ for parkinsonian symptoms and those with pre-existing neurodegenerative diseases. Further studies are needed to assess the risk-benefit ratio of this drug, especially in the elderly age group.

Translation, Cultural Adaptation, and Validation of the Hiligaynon Montreal Cognitive Assessment Tool (MoCA-Hil) Among Patients With X-Linked Dystonia Parkinsonism (XDP).

Background: X-linked dystonia parkinsonism (XDP) is a neurodegenerative disease endemic to Filipinos with maternal lineage from Panay Island, Philippines. Patients present with dystonia concurrent with or followed by parkinsonism. Non-motor symptoms also predominate, affecting behavior and cognition. We aimed to translate and do cross-cultural adaptation and validation of the Montreal Cognitive Assessment Tool (MoCA) into Hiligaynon (MoCA-Hil), the language spoken in Panay Island, to perform baseline cognitive screening of XDP patients. Methods: Forward translation to Hiligaynon was done by two translators, then back translation of a single version was adapted and approved by a committee. A pilot testing was done yielding the final translated version, which was then tested on 46 XDP patients. The test-retest reliability was measured for 11 patients. The XDP-MDSP (Movement Disorder Society of the Philippines) rating scale was used to assess disease severity. Results: The MoCA-Hil showed an acceptable test-retest reliability [intraclass correlation (ICC) 0.74] and internal consistency (Cronbach's alpha 0.86 at baseline, 0.81 at 12 weeks). The two subscales with low ICC at 0.09 and 0.21 were delayed recall and orientation, respectively. Conclusion: Translation, cultural adaptation and validation of the MoCA to Hiligaynon was successfully done. This tool may now be used in clinical practice and in research for Hiligaynon-speaking subjects.

Cost-Analysis of the Different Treatment Modalities in X-Linked Dystonia-Parkinsonism.

Background: X-linked dystonia-parkinsonism (XDP) is a debilitating disease endemic in the Philippines. Several oral medications as well as botulinum toxin A (BoNT-A) injection and deep brain stimulation (DBS) surgery appear to be the cornerstone of treatment in XDP, which are commonly used in combination. Being a chronic progressive disease, it is an economic burden to the patient and their families. Thus, we aim to perform a comparative analysis of the associated healthcare costs for the therapeutic options used in XDP. Methodology: A questionnaire assessing the healthcare costs in the management of XDP was designed and administered through an interview with the XDP patients or their caregivers. We analyzed the data and a bootstrap analysis was also done to obtain a more generalizable estimation of the costs. Results: A total of 110 gene-positive XDP patients were included in this study. The mean total annual cost per patient was USD 4,861.23 (USD:PHP 1:50, as of January 8, 2018). More than half of the patients (n = 61, 55.5%) received both oral medications and BoNT-A injection while 42 patients (38.2%) received oral medications alone. Only seven patients underwent DBS with a reported estimated cost of USD 50,931.43. The bootstrap analysis confirmed the estimates done in this study. Conclusion: The estimated costs in the management of XDP was shown to be 30 times the average annual health expenditure of an average Filipino. This calls for more government effort to provide comprehensive care for chronic and debilitating diseases such as XDP.

Treatment gaps in Parkinson's disease care in the Philippines.

Neurological services and resources are scarce in low-income and developing countries, such as the Philippines. We looked into the treatment gaps in Parkinson's disease (PD) care in the Philippines in the following areas: epidemiology, healthcare, financial coverage, pharmacotherapy, surgical treatment and manpower. We collected relevant data on the above-mentioned areas. There is no available Philippine data on PD prevalence. Philippine healthcare is paid through user fees at the point of service. The average consultation fee in Manila ranges from US$10.57-31.74. The average minimum daily wage is US$9.39-10.17. Philippine healthcare is devolved to the local government units. Deep brain stimulation surgery is only available in Manila. Most PD medications are available in the Philippines. There are only nine movement disorder specialists for a population of 100.98 million. Gaps and challenges in PD care in the Philippines still exist.