Jennifer Kawi

Background: Obesity is associated with adverse cardiac remodeling in heart failure (HF), but changes during dietary weight management are not well described. We examined longitudinal changes in left ventricular (LV) structure and systolic function during a dietary weight-management intervention. Methods: Pro-HEART participants were randomized to high-protein or standard-protein hypocaloric diets. LV end-diastolic dimension (LVEDD), ejection fraction (LVEF), and posterior wall thickness (LVPWT) were assessed at baseline, 3 months, and 15 months. Linear mixed-effects models tested time and diet effects. Results: At 15 months, LVEDD data were available for 31 of 92 participants (33.7%). Achieved protein intake was similar between randomized groups. Among 92 participants, LVEDD changed significantly over time (F(2, 51.20) = 7.45, p = 0.001), with model-estimated mean LVEDD decreasing from 59.00 mm at baseline to 54.56 mm at 15 months. LVEDD decreased from 3 to 15 months (−4.42 mm; 95% CI, −7.52 to −1.33; nominal p = 0.006; Holm-adjusted p = 0.012) and from baseline to 15 months (−4.44 mm; 95% CI, −6.86 to −2.02; nominal p < 0.001; Holm-adjusted p = 0.002). LVEF did not change significantly over time (overall p = 0.074); an exploratory baseline-to-15-month contrast was +4.11 percentage points (95% CI, 0.55–7.67; Holm-adjusted p = 0.072). LVPWT did not change significantly, and no diet group × time interactions were observed. Conclusions: LVEDD was lower at longer-term follow-up. LVEF did not change significantly over time, although an exploratory baseline-to-15-month contrast suggested an increase. Because both groups received hypocaloric diets, there was no non-dietary control group, and longitudinal HF medication data were unavailable, the observed cardiac changes cannot be attributed specifically to weight loss or the dietary intervention.

Noncommunicable diseases (NCDs) are the leading cause of death worldwide and place a heavy burden on people living in low- and middle-income countries. Underserved communities in the Philippines face many challenges that make chronic disease self-management difficult. This secondary analysis examined the burden of NCDs, self-efficacy, provider encouragement, community participation, and perceived barriers among 796 adults with one or more NCDs recruited from underserved communities in several regions of the Philippines. Trained bilingual barangay health workers conducted face-to-face interviews, and descriptive statistics summarized the findings. Cardiovascular disease was reported by 72.5% of participants, diabetes by 23.1%, chronic respiratory disease by 14.9%, and cancer by 1.9%; 44.6% had two or more chronic conditions. Participants reported moderate confidence in managing healthy behaviors but low participation in community health activities. Provider encouragement was more common for blood pressure monitoring than for cholesterol or blood glucose monitoring. The most common barriers were lack of medical insurance, financial instability, time constraints, and limited access to health care. Taken together, these descriptive findings suggest a possible self-management gap at the sample level, with moderate confidence occurring alongside limited community participation, variable provider encouragement, and structural barriers. Strengthening primary care and community-based services may help support chronic disease self-management and reduce health inequities.

Background: Racial and ethnic disparities in heart failure (HF) outcomes are well documented, but little is known about dietary intake and metabolic profiles among individuals with chronic HF and overweight or obesity. This exploratory secondary analysis of baseline data from the Pro-HEART randomized trial compared dietary intake and laboratory biomarkers across racial and ethnic groups. Methods: This secondary analysis used baseline data from the Pro-HEART randomized clinical trial (ClinicalTrials.gov identifier: NCT01423266). Baseline data from 92 adults with chronic HF, type 2 diabetes mellitus (DM), and overweight or obesity were analyzed. Participants self-identified as White (n = 49), Asian/Other (n = 17), Hispanic (n = 14), or Black (n = 12). Dietary intake was assessed using 3-day food records, which were analyzed with the Nutrition Data System for Research. Selected biomarkers included lipid measures, fasting glucose, hemoglobin A1c, albumin, total protein, and creatinine. Group differences were evaluated using one-way analysis of variance and chi-square or Fisher’s exact tests, as appropriate. Because multiple outcomes were examined without a prespecified primary endpoint, p-values were not adjusted for multiplicity and are reported as descriptive. Results: Participants had a mean age of 58.5 ± 9.7 years, were predominantly male (69.6%), married (64.0%), and had New York Heart Association Class II HF (75.0%). Mean age differed across groups (omnibus p = 0.046); no pairwise contrast remained significant after Bonferroni adjustment. No statistically significant between-group differences were identified in the available data for body mass index, waist circumference, left ventricular ejection fraction, dietary intake, or laboratory biomarkers (all p > 0.05); however, the small subgroup sizes and substantial missing dietary data limited the precision of these comparisons. Conclusions: In this exploratory cohort of adults with chronic HF, type 2 DM, and overweight or obesity, no statistically significant racial or ethnic differences were identified in the dietary and laboratory measures examined. However, the small subgroup sizes and substantial missing dietary data limit the precision of these findings, and smaller or clinically meaningful differences cannot be excluded. Larger studies with more complete dietary data are needed to better characterize potential racial and ethnic differences in nutrition and metabolic health in this population.

The 2017 Mental Health Act in the Philippines sought to enhance integrated care; nevertheless, rural regions continue to lack sufficient resources. This study aimed to examine the mental health of low-income Filipino men aged 18 years and over residing in rural areas of the Philippines and explore the relationship between their mental health status and lifestyle and self-care behaviors. A convenience sample of 426 men completed a cross-sectional survey capturing sociodemographics, depression and anxiety, psychological distress, health-related quality of life, and a range of lifestyle behaviors. Analyses included descriptive statistics, Pearson’s correlations, t -tests, and one-way analysis of variance (ANOVA). Among 426 rural Filipino men (mean age = 49.3 ± 17.2 years), moderate psychological distress was observed, with 8.2% meeting criteria for depression and 14.8% for anxiety. Distress correlated positively with both depression ( r = .228) and anxiety ( r = .332) and inversely with physical ( r = −.239) and mental quality of life ( r = −.298; all p < .01). Regular exercise and seeing a doctor were linked to lower stress levels, less symptoms of depression, and higher standards of life. On the contrary, using herbs to treat ailments has been linked to more pain and anxiety (all p < .01). The results highlight the importance of integrating community-based mental health promotion with culturally accepted self-care practices. This study provides a foundational framework for increasing mental health care access among Filipino men in rural areas of the Philippines and developing culturally appropriate programs for improving their mental health through culturally accepted self-care practices.

Aims: Dietary interventions can improve outcomes for individuals with heart failure and cardiometabolic comorbidities, yet long-term adherence remains difficult and contributes to high attrition in nutrition trials. Understanding participants’ lived experiences is essential for designing sustainable, patient-centred interventions. This qualitative substudy of the registered Pro-HEART randomized controlled trial explored participants’ reported barriers to adherence to high-protein or standard-protein dietary prescriptions during a 12-week intensive weight-loss phase and 12-month maintenance phase. Methods and results: Twenty-four participants from the parent trial who completed the parent trial participated in semi-structured interviews conducted immediately after the intensive phase. Two researchers conducted reflexive thematic analysis using an inductive approach until thematic saturation was reached. Participants encountered several interrelated challenges, which were categorized into six key themes: (i) psychological distress, stemming from guilt and fear of failure; (ii) tracking burden from extensive weighing and logging; (iii) technological stress related to rigid or unintuitive digital tools; (iv) cultural dissonance, particularly the mismatch between prescribed meal plans and participants’ traditional food practices; (v) social pressures stemming from family dynamics and social events; and (vi) a decrease in motivation, as initial enthusiasm waned throughout the intervention. Conclusion: Participant experiences demonstrate the need for culturally inclusive, emotionally supportive, and behaviourally feasible heart failure nutrition therapies. Future nutrition trials may improve adherence and retention by addressing psychological distress, fatigue, cultural dissonance, and social pressure. Registration: ClinicalTrials.gov: NCT1423266

Background: Chronic low back pain (cLBP) is a prevalent and disabling condition in older adults. Auricular point acupressure (APA), a nonpharmacologic intervention, has shown promise in managing cLBP. However, its impact on daily symptom fluctuations remains unclear. Ecological momentary assessment (EMA), which collects real-time data, offers a method to capture these fluctuations. Objective: This secondary analysis evaluated the effects of APA on EMA-reported pain intensity and pain interference among older adults with cLBP and examined associations among APA practice patterns, recall-based assessments, and EMA engagement. Methods: Data were drawn from a published 3-arm randomized controlled trial of 272 adults aged ≥60 years with cLBP, randomized to targeted auricular point acupressure (T-APA), nontargeted auricular point acupressure (NT-APA), or education control. For this analysis, only participants who completed at least one EMA entry during the 4-week intervention were included. A total of 61 participants were excluded due to missing EMA data, resulting in a final analytic sample of 211 (T-APA: 72; NT-APA: 74; and control: 65). EMA-reported pain intensity and interference were collected using a smartphone app 3 times daily over 29 days. Linear mixed-effects models assessed the effects of group assignment and APA practice behaviors on EMA outcomes, adjusting for demographics, smoking, opioid use, and baseline recall-based pain. Spearman correlations assessed associations between EMA and 7-day recall measures. Results: The overall compliance rate was 44.8%, with an attrition rate of 54%. There were no significant differences in compliance or attrition across treatment groups. Older participants showed significantly lower compliance, though attrition was not associated with age. Pain intensity reported via EMA was significantly lower than recall-based pain, while EMA-reported pain interference was higher. EMA and 7-day recall pain outcomes were strongly correlated (Spearman =0.53–0.95; P<.001). Both T-APA and NT-APA, analyzed as separate randomized groups, significantly reduced EMA-reported pain and interference compared to the control. T-APA reduced worst pain (β=–0.98, SE 0.33; P<.001), average pain (β=–0.93, SE 0.30; P<.001), and current pain (β=–1.01, SE 0.36; P=.006). NT-APA also reduced worst (β=–0.74, SE 0.12; P<.001), average (β=–1.02, SE 0.30; P=.001), and current pain (β=–1.26, SE 0.37; P=.001). For interference, T-APA significantly reduced interference with enjoyment of life (β=–1.72, SE 0.37; P<.001) and daily activity (β=–1.41, SE 0.34; P=.001), with similar reductions seen in NT-APA. Conclusions: APA significantly reduced daily pain and interference among older adults with cLBP. EMA provided valuable insights into treatment response and symptom variability. Future research should enhance EMA adherence and explore sustained APA use for self-management. Trial Registration: ClinicalTrials.gov NCT03589703; https://clinicaltrials.gov/study/NCT03589703 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-4016-x

Background: Chronic pain is a leading contributor to disability worldwide, yet population-based data from rural and medically underserved settings remain limited. Evidence describing the biopsychosocial correlates of chronic pain in rural Filipino communities is particularly scarce. Methods: We conducted a secondary analysis of cross-sectional data from the I-HELP-FILIPINO community cohort, collected between January and June 2017. Participants included 909 adults aged 18–93 years who voluntarily attended barangay clinic days in rural Philippine communities. Pain severity was assessed with standardized self-report tools. Sociodemographic, psychosocial, sleep, and functional health factors were examined using bivariate analysis and hierarchical linear regression. Results are shown with 95% confidence intervals. Results: Chronic pain was very common, affecting 83.8% of participants, with 5.6% experiencing severe pain. In multivariable models, psychosocial distress, sleep issues, and reduced physical functioning were significantly linked to increased pain severity, while demographic factors contributed minimally to the variance. Most of the explained variance in pain outcomes was accounted for by psychosocial and clinical variables. Conclusions: In this rural Filipino cohort, chronic pain was strongly associated with modifiable psychosocial, sleep, and functional health factors. Focusing on community-based and culturally tailored interventions can inspire hope and empower healthcare professionals and policymakers to tackle these issues more effectively.

Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how context affects them. Objective: To identify preferred sources of health education among adults in rural Philippine communities and investigate the contextual factors that influence these preferences. Methods: A cross-sectional mixed-methods study included 1203 adults from disadvantaged Luzon and Visayas barangays. Participants completed a self-administered survey on the importance of neighborhood health fairs, native-language instructional tools, and social media. Descriptive statistics (mean ± standard deviation) were used to aggregate importance ratings, and exploratory comparisons were made using paired and independent-samples t-tests. A subsample of 60 semi-structured interviews was analyzed using thematic analysis to interpret qualitative data. Results: Community health fairs were identified as the primary source of health education, with a mean rating of 8.5 ± 1.6, followed by native-language educational materials, which received a mean rating of 5.5 ± 2.4. In contrast, social media was rated the lowest, with a mean of 3.5 ± 2.3. Preference patterns were consistent across regions and sociodemographic groups, with only slight variation in rating magnitudes. Qualitative analysis revealed four themes influencing source preferences: accessibility and proximity, cultural and linguistic relevance, confidence in local health providers, and structural obstacles to digital access. Conclusions: In rural Philippine communities, intimacy, confidence, and cultural congruence influence health education preferences more than online platforms do. Strengthening community-based, locally integrated health education strategies may enhance the reach and contextual relevance of preventive health communication in underserved settings.