| 1 |
Author(s):
Ruvelinda Grace Uy, Norvie T. Jalani.
Page No : 1-18
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Referral Appropriateness and Structural Barriers in Basic Emergency Obstetric and Newborn Care Implementation: Evidence from Zamboanga City Medical Center, Zamboanga Peninsula, Philippines
Abstract
Background. The Basic Emergency Obstetric and Newborn Care (BEMONC) program equips lower-level facilities to manage uncomplicated deliveries and stabilize obstetric emergencies, reducing unnecessary transfers to tertiary hospitals. Despite sustained training coverage in the Philippines, tertiary facilities continue to absorb high obstetric referral volumes. This study determined the prevalence, clinical profile, institutional sources, and structural determinants of non-indicated and potentially avoidable obstetric referrals received by a tertiary government hospital in Southwestern Mindanao from February 2024 to April 2025.
Methods. A retrospective cross-sectional chart review examined 300 consecutive obstetric referral records from the Department of Obstetrics and Gynecology Referral Census. Non-indicated referrals were defined as uncomplicated normal spontaneous vaginal deliveries without a documented tertiary-level indication. A broader potentially avoidable category captured uncomplicated vaginal deliveries transferred for weak, non-medical, or capacity-related reasons. Referring facilities were cross-referenced against the institutional BEMONC training registry. Descriptive statistics, exploratory odds ratios, and sensitivity analyses were performed.
Results. Of 300 referrals, 27 (9.0%) were strictly non-indicated and 35 (11.7%) were potentially avoidable. Cesarean section accounted for 40.7% of outcomes. Generic escalation (42.7%), absence of an obstetrician (18.0%), lack of incubator/neonatal support (17.0%), and absence of an anesthesiologist (15.7%) accounted for 93.4% of referral reasons. Primary care facilities had higher odds of avoidable referral than hospital-level facilities (OR 7.26, 95% CI 2.91–18.10). Training volume showed no significant correlation with referral appropriateness (Spearman's rho = 0.02, p = .94), and facility training status was not significantly associated with avoidable referral after adjusting for facility level (OR 2.47, 95% CI 0.51–11.89).
Conclusion and Implications. Strictly non-indicated referrals were uncommon. Avoidable transfers reflected structural resource limitations rather than poor clinical judgment. These findings suggest BEMONC training alone is unlikely to reduce avoidable obstetric referrals unless matched by personnel, equipment, and referral governance. Program evaluation should incorporate facility-level referral performance alongside training coverage.
Keywords: BEMONC, maternal health, obstetric referral, referral appropriateness, structural barriers
| 2 |
Author(s):
Annie Laine Luat.
Page No : 19-50
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Assessing Sagittal Jaw Disproportion Using New Tau Angle Analysis
Abstract
Background. Accurate assessment of sagittal jaw relationships is fundamental to orthodontic diagnosis and treatment planning; however, no single cephalometric parameter can completely describe the complexity of skeletal jaw disproportion. Although the ANB angle remains the gold standard, its accuracy may be affected by growth, jaw rotation, and anatomical variations. This study investigated the relationship between the conventional ANB angle and the novel Tau angle in assessing sagittal jaw disproportion among Filipino patients with skeletal Class I, II, and III malocclusions. Methods. This descriptive-correlational study included 80 lateral cephalometric radiographs of Filipino male and female patients with skeletal Class I, II, and III malocclusions obtained from a dental clinic in Quezon City, Philippines. Each radiograph was analyzed using both the conventional ANB angle and the novel Tau angle. Interpretations were based on established Filipino and Asian normative values, and all landmark identification, tracing, and interpretations were validated independently by three certified orthodontists. Statistical analyses were performed to determine differences according to age and sex and to evaluate the relationship between the two cephalometric analyses using Kendall's Tau-b correlation. Results. No significant differences in sagittal jaw disproportion were observed across age groups or between males and females using either the ANB or Tau angle analyses, indicating that age and sex did not influence skeletal classification. A strong positive correlation was found between the ANB and Tau angle analyses (Kendall's Tau-b = 0.79, p < 0.01), demonstrating comparable reliability in classifying sagittal jaw relationships. Conclusion. The Tau angle showed comparable reliability to the conventional ANB angle in classifying sagittal jaw disproportion and may serve as a dependable alternative when ANB landmarks are obscured or difficult to identify. These findings support the incorporation of the Tau angle into routine orthodontic diagnosis, education, and artificial intelligence-assisted cephalometric analysis, while further studies are recommended to establish normative Tau angle values for the Filipino population.
Keywords: ANB Angle, cephalometric analysis, orthodontic diagnosis, sagittal jaw disproportion, skeletal malocclusion, Tau angle, ANB angle
| 3 |
Author(s):
Jennifer D. Araneta, Norvie T. Jalani.
Page No : 51-67
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Grand Multiparity as the Dominant Correlate of Non-Institutional Delivery Among Women Discharged in Latent Labor at a Philippine Tertiary Hospital
Abstract
Background. Non-institutional delivery remains a preventable source of maternal and neonatal morbidity in the Philippines. Grand multiparity accelerates labor progression and is a recognized risk factor for delivery outside healthcare facilities. The labor pattern correlates of non-institutional delivery at a Philippine tertiary emergency department have not been systematically characterized. Methods. A cross-sectional analytical study was conducted at Zamboanga City Medical Center (ZCMC), a Department of Health retained tertiary government hospital in Zamboanga City, Philippines, from January 1, 2023, to December 31, 2024, using emergency room (ER) records and structured telephone interviews. Eligible participants were pregnant women discharged during the latent phase of labor who subsequently delivered outside the facility. Advanced cervical dilation at ER discharge was defined a priori as ≥6 cm. The primary outcome was non-institutional delivery. Bivariate associations were assessed using Fisher's exact test, with odds ratios (OR) and 95% confidence intervals (CI). This report follows the STROBE guideline for cross-sectional studies. Results. Of an initial 5,270 records, 1,514 (28.7%) were excluded for unreachable outcome data, leaving 1,336 classified records; of these, 41 (3.1%) were non-institutional deliveries. Grand multiparity was significantly associated with increased odds of non-institutional delivery (OR 3.76, 95% CI 1.41 10.03; p = 0.018), while nulliparity was associated with reduced odds (OR 0.36, 95% CI 0.17 0.74; p = 0.004); given the low overall incidence of non-institutional delivery (3.1%), this comparison was estimated to have approximately 55% power. Maternal age of 35 years or older (OR 1.16, 95% CI 0.45–3.02; p = 0.796) and advanced cervical dilation at discharge (OR 0.35, 95% CI 0.04–2.76; p = 0.317) were not significantly associated with non-institutional delivery. Mean age of women with non-institutional delivery was 26.1 ± 7.3 years, and teenagers comprised 19.5% of this group. Conclusion and Implications. Parity, not maternal age or cervical dilation at discharge, was the primary correlate of non-institutional delivery in this setting. These findings support consideration of parity-stratified triage protocols, investment in ER labor documentation, and community-level rapid labor recognition programs targeting grand multiparous women, pending confirmation in larger, multivariable-adjusted, multicenter studies. Keywords: Emergency room, Grand multiparity, Labor patterns, Non-institutional delivery, Obstetric triage, Philippines
| 4 |
Author(s):
Moh. Khairul S. Hassan, Norvie T. Jalani.
Page No : 68-95
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Effectiveness of Adherence-Focused Interventions and Contemporary Predictors of Treatment Success in Drug-Sensitive Tuberculosis in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis (2018–2023)
Abstract
Background. Drug-sensitive tuberculosis (TB) treatment success in low- and middle-income countries (LMICs) has historically fallen short of the WHO's 85% benchmark. Predictors of treatment success are well described, but newer adherence-focused interventions, including digital tools introduced since 2018, have not been synthesized alongside contemporary evidence on predictors. Methods. A systematic review and meta-analysis followed PRISMA guidelines and covered the period from January 2018 to April 2023 across PubMed, ScienceDirect, EBSCOhost, Cochrane Library, and CINAHL. Eligible studies reported treatment success rates, predictors, or interventions for drug-sensitive TB in LMICs. Random-effects models yielded pooled odds ratios (ORs) and effect sizes (ESs) with 95% confidence intervals (CIs); heterogeneity was assessed using I². Risk of bias was appraised using the Joanna Briggs Institute (JBI) checklist. Results. Eighty-four studies met inclusion criteria (71 observational, 12 controlled interventional, 1 uncontrolled interventional), covering 806,664 participants. Pooled treatment success was 87.6%, exceeding the WHO benchmark. HIV-negative status (OR 2.05, 95% CI 1.76–2.39), new case status (OR 2.23, 1.88–2.63), directly observed therapy (DOTS) receipt (OR 2.93, 1.74–4.93), and absence of smoking or alcohol use were significantly associated with success; residence, TB site, and bacteriological confirmation were not. Five interventions significantly improved success rates: asynchronous video observed therapy (aVOT) (ES 17.99, 2.47–131.03), medication event monitoring systems (MEMS) (ES 3.55, 1.80–7.00), patient support groups (ES 2.15, 1.86–2.48), pharmaceutical care (ES 2.09, 1.01–4.34), and a modified drug regimen (ES 1.75, 1.05–2.92). Conclusion and Implications. This review confirms established predictors and provides the first quantitative synthesis of newer digital adherence interventions, aVOT and MEMS particularly, for drug-sensitive TB in LMICs. Feasibility of digital interventions should be weighed against local digital access and health infrastructure before scale-up. Registration. This review was not prospectively registered in PROSPERO or another public registry, which is disclosed here as a limitation. Keywords: Developing Countries, Medication Adherence, Meta-Analysis, Systematic Review, Treatment Outcome, Tuberculosis
| 5 |
Author(s):
Qaraah, Ahmed Ali Alawi.
Page No : 96-113
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Effect of Commercial Mouthwash Containing Sodium Fluoride And Sodium Monofluorophosphate On The Surface Roughness Of Orthodontic Nickel-Titanium Archwires In Vitro-Informed Considerations
Abstract
Background. Nickel–Titanium (NiTi) orthodontic archwires are widely used because of their superelasticity, shape memory, and ability to deliver light continuous forces. Their surface integrity may be altered by chemical exposure in the oral environment. Fluoride-containing mouthwashes are commonly used for caries prevention, but commercial formulations contain multiple ingredients and their effects on orthodontic materials may vary with formulation and exposure conditions. Methods. This in vitro quantitative experimental study evaluated a commercial Fluocaril mouthwash containing sodium fluoride (NaF) and sodium monofluorophosphate (MFP) on the surface roughness of NiTi orthodontic archwires. Forty-four 0.017 × 0.025-inch NiTi specimens were randomly allocated to a mouthwash group (n = 22) or artificial-saliva control group (n = 22). Specimens were exposed for 21 days. The intervention group received 1 minute 30 seconds of undiluted mouthwash daily, followed by distilled-water rinsing and storage in fresh artificial saliva; control specimens remained in artificial saliva. Surface roughness (Ra) was measured by Atomic Force Microscopy (AFM). Group differences were analyzed using Welch’s independent-samples t-test at α = 0.05. Results. Mean surface roughness was higher in the commercial-mouthwash group (22.76 ± 1.37 nm) than in the artificial-saliva group (11.52 ± 0.74 nm). The between-group difference was statistically significant, t(32.303) = 33.828, p < .001, with a mean difference of 11.24 nm and Cohen’s d = 10.20. Conclusion. Under the conditions of this in vitro study, the tested commercial mouthwash formulation was associated with a substantial increase in NiTi surface roughness compared with artificial saliva. Because the study did not isolate NaF, MFP, pH, or other formulation ingredients, the observed change cannot be attributed to fluoride alone and should not be interpreted as evidence of a clinical effect on friction, treatment duration, or wire failure. Further studies should compare individual and combined fluoride formulations, measure pH and other chemical characteristics, and evaluate corrosion, friction, ion release, and mechanical properties. Keywords. Atomic Force Microscopy; commercial mouthwash; nickel–titanium archwires; orthodontics; sodium fluoride; sodium monofluorophosphate; surface roughness
| 6 |
Author(s):
Doneta Lyn S. Mejasco, Lucy L. Teves.
Page No : 114-128
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Transformative Journey of Becoming A Nurse: From Emotional Struggles To Professional Purpose
Abstract
Background. The transition from student life to professional nursing practice is a critical period for newly graduated registered nurses, as they adjust to clinical responsibilities, emotional demands, workplace expectations, and the formation of professional identity. This study explored the lived experiences of newly graduated registered nurses in Surigao City as they transitioned from academic preparation to professional nursing practice. Specifically, it examined how newly registered nurses understood their early professional experiences, how these experiences shaped their meaning of nursing practice, and what essence emerged from their narratives.
Methods. The study employed a qualitative phenomenological design anchored on Husserlian transcendental phenomenology, constructivist ontology, and Giorgi’s descriptive phenomenological approach. Fifteen Paulinian newly registered nurses who graduated from St. Paul University Surigao in school years 2022–2023 and 2023–2024 and who had worked for the first time in clinical settings for six months to one year participated in the study. Data were collected through face-to-face semi-structured interviews, transcribed verbatim, and analyzed using Giorgi’s phenomenological procedures.
Results. Six emergent themes were identified: emotions in early nursing experience, motivation through supportive work relationships, work-related stress, stress coping mechanisms, professional growth through experiential learning, and the essence of nursing through service. The findings revealed that newly registered nurses experienced joy, fear, anxiety, emotional sensitivity, workload pressure, exhaustion, and challenges in gaining the trust of patients and families. Despite these difficulties, supportive senior nurses, positive work environments, prayer, emotional regulation, cognitive reframing, and experiential learning helped them develop confidence, adaptability, accountability, and a service-oriented professional identity.
Conclusion. The transition to professional nursing practice is emotionally demanding but developmentally formative. Newly registered nurses’ early clinical experiences shaped their professional confidence, resilience, and understanding of nursing as a practice grounded in service. The study recommends structured transition support, mentorship programs, emotional resilience preparation, and stronger school-hospital collaboration to improve the early professional adjustment of newly registered nurses.
Keywords: Clinical Adjustment, Newly Registered Nurses, Nursing Identity, Phenomenology, Surigao City, Transition to Practice
| 7 |
Author(s):
Khaled Mubarak Basubeit.
Page No : 129-143
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Effect of Levosalbutamol Bronchodilator Inhaler on the Tensile Strength of Orthodontic Elastomeric Modules: An In Vitro Study
Abstract
Background. Orthodontic elastomeric modules are widely used to deliver continuous forces during orthodontic treatment but may undergo mechanical degradation when exposed to chemical and environmental conditions in the oral cavity. Levosalbutamol is a selective β2-adrenergic agonist commonly administered through inhalers for asthma management. During inhaler use, aerosolized medication and formulation components may contact the oral cavity and potentially interact with orthodontic elastomeric materials. Because these materials are polyurethane-based, repeated exposure to inhaler aerosols may alter their mechanical properties, including tensile strength. However, the effect of repeated levosalbutamol inhaler exposure on the tensile strength of orthodontic elastomeric modules has not been specifically established, warranting further investigation under simulated intraoral conditions. Methods. An in vitro randomized controlled experimental study was conducted using 68 unused clear E-link polyurethane orthodontic elastics randomly allocated into four groups (n = 17): baseline, artificial saliva control, artificial saliva with two puffs/day of levosalbutamol bronchodilator inhaler, and artificial saliva with four puffs/day of levosalbutamol bronchodilator inhaler. Tensile strength was measured using a calibrated Universal Testing Machine. Data were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's Honestly Significant Difference (HSD) post hoc test, with statistical significance set at p < 0.05. Results. Repeated levosalbutamol bronchodilator inhaler exposure significantly reduced the tensile strength of E-link orthodontic elastics. The baseline group demonstrated the highest mean tensile strength, whereas the four-puff exposure group showed the lowest. One-way ANOVA revealed significant differences among the four experimental groups (p< 0.001), and Tukey's HSD test demonstrated significant pairwise differences between all groups. Conclusion. Repeated exposure to levosalbutamol bronchodilator inhaler aerosols significantly reduced the tensile strength of the tested polyurethane orthodontic elastomeric modules under simulated intraoral conditions. These findings indicate a potential effect of inhaler exposure on the mechanical integrity of the tested material in vitro. However, the findings cannot establish effects on clinical force delivery, replacement intervals, or patient outcomes. Further in vivo studies are needed to determine the clinical significance of these findings. Keywords: Bronchodilator inhaler; in vitro; levosalbutamol; orthodontic elastomeric module; orthodontic materials; polymer degradation; tensile strength
| 8 |
Author(s):
Ghader Ali Ata, Galahad T. Perea.
Page No : 144-158
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Effect of Alcoholic and Energy Drinks on the Shear Bond Strength of Orthodontic Brackets: Proposed Guidelines
Abstract
Background. Bracket bond failure is a common challenge in orthodontic practice that may prolong treatment duration and increase clinical workload. Hence, this study aimed to evaluate the effect of alcoholic and energy drinks on the shear bond strength (SBS) of orthodontic brackets bonded to bovine enamel.
Methods. An in vitro experimental design was conducted using sixty bovine teeth randomly assigned into three groups (n = 20): artificial saliva (control), alcoholic beverage (San Miguel Pale Pilsen, 5% ABV), and energy drink (Cobra). The teeth were bonded with Optimus Metal Twin Brackets using the Ormco Enlight Light-Cure Adhesive System after surface etching with 37% phosphoric acid for 30 seconds. All specimens were stored in artificial saliva at 37°C between immersion cycles to simulate intraoral conditions. Samples underwent cyclic immersion four times daily for five minutes over 21 days. SBS was measured using a Universal Testing Machine (Instron 4467), and data were analyzed using One-Way Analysis of Variance (ANOVA) and Tukey's post-hoc test at a 0.05 level of significance. Results. Significant differences in SBS were found among the groups (p < .001). The artificial saliva group demonstrated the highest mean SBS (6.65 ± 0.29 MPa; 95% CI: 6.51–6.78), followed by the alcoholic beverage group (4.99 ± 0.19 MPa; 95% CI: 4.90–5.08), representing a 25.0% reduction compared to the control. The energy drink group exhibited the lowest mean SBS (3.88 ± 0.11 MPa; 95% CI: 3.83–3.93), representing a 41.6% reduction compared to the control. One-Way ANOVA confirmed a statistically significant difference among groups, F (2,57) = 895.71, p < .001. Post-hoc pairwise comparisons confirmed that all groups differed significantly from each other (p < .001), with a very large effect size (ηp² = 0.969). The mean SBS values for the alcoholic (4.99 MPa) and energy drink (3.88 MPa) groups fell below the clinically acceptable threshold of 5.9–7.9 MPa, indicating an increased risk of clinical bracket failure. Conclusion. Alcoholic and energy drinks significantly reduce the shear bond strength of orthodontic brackets and may increase the risk of bracket debonding during treatment. These findings underscore the importance of targeted dietary counseling, advising patients to limit the consumption of both beverages to minimize treatment interruptions, clinical visits, and bracket failure. Further studies using different beverages, bracket materials, and in vivo conditions are recommended. Keywords: alcoholic beverages; bracket debonding; energy drinks; orthodontic brackets; orthodontic materials; shear bond strength
