Content Validation and Pilot Testing of the Promoting Active Lifestyle Among Children With Disability Questionnaire in Filipino and English.

BACKGROUND: Primary carers, school teachers, and administrators are key influencers in promoting active lifestyle among children with disabilities (CWD). Guided by the Capability, Opportunity, Motivation, Behavior Model, the Promoting Active Lifestyle among CWD (PALS) Questionnaire aims to determine these influencers' perceptions, capabilities, opportunities, and motivations in active healthy lifestyle promotion. This study evaluated the content validity and feasibility of the PALS Questionnaire in Filipino and English. METHODS: Six experts rated the relevance of the items in the Filipino and English versions of the PALS Questionnaire. Item and scale content validity indices and agreement among raters (modified kappa k*) were computed. The questionnaires were revised and pilot tested among 11 participants comprising primary carers, and special education teachers and administrators using 3 methods of administration: online survey, phone interview, and pen-and-paper survey. RESULTS: Scale-level content validity index indicated excellent content validity (0.96-0.97). Item-level content validity index ranged between 0.67 and 1.00. Interrater agreement on the relevance of all items was excellent (k* = .82-1.00), except for the item on teaching assistants (k* = .56). Most participants found the items easy to understand. The average time needed to complete a questionnaire was 30 minutes. The online version of the questionnaire was identified as the most feasible mode of administration. CONCLUSION: The PALS Questionnaire is a useful instrument for understanding Filipino primary carers' and educators' perceptions on promoting CWD's active healthy lifestyle. Information from the PALS Questionnaire could inform initiatives toward better CWD health and quality of life.

Impact of dry eye disease on psychological symptoms among Chinese doctoral students studying abroad.

This study aimed to evaluate the impact of dry eye disease (DED) on depression, anxiety, and stress among Chinese doctoral students studying abroad. This is a cross-sectional study. This study enrolled 185 Chinese doctoral students pursuing education in the Philippines. DED was assessed using the Ocular Surface Disease Index, while psychological symptoms were evaluated using the abbreviated version of the Depression, Anxiety, and Stress Scale-21 questionnaire. A survey encompassing demographic information, potential DED risk factors, and individual habits was also administered. Of the 185 students, 129 completed the survey, of which 40 (31.0%) were male and 89 (69.0%) were female. The average age was 36.3 ±â€…7.0 (mean ±â€…SD; range, 22-57) years. The prevalence of DED, depression, anxiety, and stress was 73.6% (95/129), 43.4% (56/129), 50.4% (65/129), and 22.5% (29/129), respectively. Univariate analysis revealed that aging (P < .001), prolonged visual display terminal (VDT) use (P = .004), extended paperwork time (P < .001), higher depression score (P = .006), higher anxiety score (P < .001), and higher stress score (P < .001) were associated with increased influence of DED. After adjusting for age, duration of VDT use, duration of paperwork, and depression score, age (P = .030) had significant association with DED. Additionally, after adjusting for age, duration of VDT use, duration of paperwork, and anxiety score, age (P = .026) and anxiety score (P = .047) were significantly associated with DED. Moreover, after adjusting for age, duration of VDT use, duration of paperwork, and stress score, age (P = .035) and stress score (P = .028) showed significant associations with DED. In the multivariate analysis of variance, there was a significant impact of DED severity classification on psychological distress (V = 0.19, F(9, 375) = 2.83, P = .003). Univariate analysis of variances indicated that DED severity had a significant impact on anxiety F(3, 125) = 6.06, P = .001 and stress F(3, 125) = 3.00, P = .033. A higher influence of DED was related to stress and anxiety. Anxiety and stress levels increase with the severity of DED.

Socio-economic risk factors for intestinal helminthiases in selected endemic communities in Mindanao, the Philippines: a cross-sectional study.

BACKGROUND: Parasitic neglected tropical diseases (NTDs) or 'infectious diseases of poverty' continue to affect the poorest communities in the world, including in the Philippines. Socio-economic conditions contribute to persisting endemicity of these infectious diseases. As such, examining these underlying factors may help identify gaps in implementation of control programs. This study aimed to determine the prevalence of schistosomiasis and soil-transmitted helminthiasis (STH) and investigate the role of socio-economic and risk factors in the persistence of these diseases in endemic communities in the Philippines. METHODS: This cross-sectional study involving a total of 1,152 individuals from 386 randomly-selected households was conducted in eight municipalities in Mindanao, the Philippines. Participants were asked to submit fecal samples which were processed using the Kato-Katz technique to check for intestinal helminthiases. Moreover, each household head participated in a questionnaire survey investigating household conditions and knowledge, attitude, and practices related to intestinal helminthiases. Associations between questionnaire responses and intestinal helminth infection were assessed. RESULTS: Results demonstrated an overall schistosomiasis prevalence of 5.7% and soil-transmitted helminthiasis prevalence of 18.8% in the study population. Further, the household questionnaire revealed high awareness of intestinal helminthiases, but lower understanding of routes of transmission. Potentially risky behaviors such as walking outside barefoot and bathing in rivers were common. There was a strong association between municipality and prevalence of helminth infection. Educational attainment and higher "practice" scores (relating to practices which are effective in controlling intestinal helminths) were inversely associated with soil-transmitted helminth infection. CONCLUSION: Results of the study showed remaining high endemicity of intestinal helminthiases in the area despite ongoing control programs. Poor socio-economic conditions and low awareness about how intestinal helminthiases are transmitted may be among the factors hindering success of intestinal helminth control programs in the provinces of Agusan del Sur and Surigao del Norte. Addressing these sustainability gaps could contribute to the success of alleviating the burden of intestinal helminthiases in endemic areas.

Phylogeny and ultrastructure of a non-toxigenic dinoflagellate Amphidoma fulgens sp. nov. (Amphidomataceae, Dinophyceae), with a wide distribution across Asian Pacific.

Amphidoma languida, a marine thecate dinoflagellate that produces the lipophilic toxin azaspiracids (AZAs), is primarily found in the Atlantic. Although this species has not been recorded in the Asian Pacific, environmental DNAs related to Am. languida have been widely detected in the region by metabarcoding analysis. Their morphology and AZA production remain unclear. In this study, the morphology, ultrastructure, phylogeny, and AZA production of nine Amphidoma strains isolated from Japan, Malaysia, and Philippines were investigated. Phylogenetic trees inferred from rDNAs (SSU, ITS, and LSU rDNA) showed monophyly of the nine Pacific strains and were sister to the Am. languida clade, including the toxigenic strains from the Atlantic. Cells were ellipsoid, 8.7-16.7 µm in length and 7.4-14.0 µm in width, with a conspicuous apical pore complex. A large nucleus in the hyposome, parietal chloroplast with a spherical pyrenoid in the episome, and refractile bodies were observed. Thecal tabulation was typical of Amphidoma, Po, cp, X, 6', 6'', 6C, 5S, 6''', 2''''. A ventral pore was located on the anterior of 1' plate, beside the suture to 6' plate. The presence of a ventral depression, on the anterior of anterior sulcal plate, was different from Am. languida. A large antapical pore, containing approximately 10 small pores, was observed. Cells were apparently smaller than Am. trioculata, a species possessing three pores (ventral pore, ventral depression, and antapical pore). TEM showed the presence of crystalline structures, resembling guanine crystals, and cytoplasmic invaginations into the pyrenoid matrix. Flagellar apparatus lacking the striated root connective is similar to peridinioids and related dinoflagellates. AZAs were not detected from the Pacific strains by LC-MS/MS. This non-toxigenic Amphidoma species, here we propose as Amphidoma fulgens sp. nov., is widely distributed in the Asian Pacific. Moreover, molecular comparison also suggested that most of the environmental DNA sequences previously reported as Am. languida or related sequences from the Asian Pacific were attributable to Am. fulgens.

Investigating the IGF axis as a pathway for intergenerational effects.

Early nutritional and growth experiences can impact development, metabolic function, and reproductive outcomes in adulthood, influencing health trajectories in the next generation. The insulin-like growth factor (IGF) axis regulates growth, metabolism, and energetic investment, but whether it plays a role in the pathway linking maternal experience with offspring prenatal development is unclear. To test this, we investigated patterns of maternal developmental weight gain (a proxy of early nutrition), young adult energy stores, age, and parity as predictors of biomarkers of the pregnancy IGF axis (n = 36) using data from the Cebu Longitudinal Health and Nutrition Survey in Metro Cebu, Philippines. We analyzed maternal conditional weight measures at 2, 8, and 22 years of age and leptin at age 22 (a marker of body fat/energy stores) in relation to free IGF-1 and IGFBP-3 in mid/late pregnancy (mean age = 27). Maternal IGF axis measures were also assessed as predictors of offspring fetal growth. Maternal age, parity, and age 22 leptin were associated with pregnancy free IGF-1, offspring birth weight, and offspring skinfold thickness. We find that free IGF-1 levels in pregnancy are more closely related to nutritional status in early adulthood than to preadult developmental nutrition and demonstrate significant effects of young adult leptin on offspring fetal fat mass deposition. We suggest that the previously documented finding that maternal developmental nutrition predicts offspring birth size likely operates through pathways other than the maternal IGF axis, which reflects more recent energy status.

Indirect effectiveness of a novel SARS-COV-2 vaccine (SCB-2019) in unvaccinated household contacts in the Philippines: A cluster randomised analysis.

BACKGROUND: Though observational evidence supports indirect effects of SARS-CoV-2 vaccines, randomised experiments are lacking. To address this gap, the double-blinded, prospective follow-up of the household contacts (HHCs) of Philippine participants of the individually-randomised, placebo-controlled trial of the adjuvanted-subunit protein COVID-19 vaccine, SCB-2019, (EudraCT, 2020-004272-17; ClinicalTrials.gov, NCT04672395) was analyzed in a cluster-randomised fashion. METHODS: Over an eight-week period, HHCs were followed by rRT-PCR and paired rapid antibody tests (RATs) to detect symptomatic (SCI, primary) and all (ACI, secondary) SARS-CoV-2 infection. A standard analysis estimated the indirect effectiveness of SCB-2019 for each endpoint, excluding HHC RAT-positive at enrollment. A secondary analysis employed enzyme-linked immunosorbent assay (ELISA) results to correct for suspected bias. FINDINGS: SCB-2019 (N = 3470) and placebo (N = 3225) exposed HHCs contributed to at least one analysis. The standard analysis estimated that SCB-2019 reduced the risk of SCI by 83% (95% confidence/credible interval [CI: 32% to 96%), with no effect against ACI. The bias-corrected relative risk reduction was 97% (95% CI: 74% to 100%) for SCI and 79% (95% CI: 14% to 96%) for ACI, with an estimated one SARS-CoV-2 infection prevented per 4.8 households where one member received SCB-2019. INTERPRETATION: SCB-2019 demonstrated bias-corrected indirect effectiveness against SARS-CoV-2 infection among HHC, even at a modest coverage level in the household (approximately 25%). Further research into the indirect effects of SARS-CoV-2 vaccines is needed to optimize the impact of limited doses in low and middle-income settings.

Distribution of total mercury in coastal sediments of Honda Bay, Palawan Island, the Philippines.

Honda Bay is considered as one of the mercury hotspots in the world due to its proximity to the abandoned Palawan Quicksilver Mine. In this study, a detailed sediment sampling conducted in between 2021 and 2022 where a total of 166 sediment samples were collected along the coast and analyzed for total mercury (THg) concentration. The study assessed mercury toxicity using the geoaccumulation index and compared Hg levels to sediment quality guidelines. The findings revealed a wide range of THg concentrations, from 0.0040 to 11.4702 mg/kg, with hotspots identified at the Honda Bay wharf and Tagburos River mouth. Mercury spreads to a large coastal area brought by tidal currents and the wave energy actions. The geoaccumulation index indicated moderate to strong Hg contamination in the vicinity of the hotspots and around 24.7-36.1 % of samples exceeded the sediment quality guidelines suggesting adverse biological effects in aquatic biota will frequently occur.

Assessment of low impact development (LID) strategies under different land uses in an urban sub-catchment in the Philippines.

Lack of studies in developing countries with tropical climate such as the Philippines limit local LID adoption. This study compared the performance of different LID scenarios across different urban land use types at the sub-catchment level using peak flow, runoff volume and flood reductions as performance criteria. Results showed that the most effective strategies for each land use are: 1) combined green roof and bioretention for low-density residential (reduction up to 10% peak flow, 11% runoff volume and 33% flood volume); 2) green roof for high-density residential (8% peak flow, 6% runoff volume and 18% flood volume); 3) combined rain barrel, bioretention and permeable pavement for industrial (23% peak flow, 41% runoff volume and 56% flood volume), and 4) combined vegetative swale and detention pond for urban open spaces (81% peak flow, 8% runoff volume and 84% flood volume). While effective for most low intensity storms, the observed sharp decrease in LID performance with increased rainfall intensity poses a major challenge, especially in the context of the Philippines frequented by high intensity storms. This study also examined how differences in land use characteristics influence LID performance, unlike most studies that focused on LID type comparisons. It showed that low urban density setting positively affected peak flow and flood reduction performance of rain barrels and green roofs, while good drainage infrastructure quality positively affected peak flow and flood reduction performance of rain barrels and bioretention. Decision-makers may use these findings to conduct rapid assessments on LID selection and siting, provided similarities between land use characteristics described in this study and those at their localities are justified. This can lead to increased LID adoption towards building water resilient, and sustainable cities.

An analysis of flavor descriptors on tobacco products in the Philippines: Regulatory implications and lessons for low- and middle-income countries.

BACKGROUND: Historically, tobacco companies have used flavored tobacco products to enhance the appeal of tobacco consumption, encourage initiation and experimentation of tobacco use, and contribute to sustained tobacco use. While flavored tobacco products are regulated in several countries, there is no existing regulation on flavored tobacco products in the Philippines, specifically for cigarettes and cigars. This study aims to update evidence on the flavored tobacco product landscape in the Philippines by assessing both the flavor descriptors and flavor imagery featured on cigarette and cigar packaging. RESULTS: We collected 106 cigarette and cigar products from four major cities in the National Capital Region, Balanced Luzon, Visayas, and Mindanao. Of these 106 cigarette and cigar products, 62 (58.49%) had flavor descriptors. Three crushable capsule products did not feature any flavor descriptor but were included for flavor imagery examination. We identified five categories of flavor descriptors: menthol, concept descriptors, tobacco, beverages, and other flavors. Out of 62 packs, ten featured more than one flavor descriptor on the packaging. Menthol flavor descriptors comprised the majority of flavor descriptors. Imagery and other graphic elements closely resonate with and enhance the flavor descriptors found on these packs. CONCLUSIONS: This study aimed to update the evidence on the flavored tobacco product landscape in the Philippines and address their absence of regulation. Regulating flavored tobacco products requires a comprehensive policy approach complemented by complete enforcement. Flavor substances, flavor descriptors, and flavor imagery must be regulated altogether; however, it is ideal to enforce a ban on flavored tobacco products in compliance with the WHO FCTC, to which the Philippines is a signatory. Policymakers should consider plain packaging as an intervention to eliminate the appeals associated with flavored tobacco products.

Automated mortality coding for improved health policy in the Philippines.

In 2016, the Bloomberg Philanthropies Data for Health initiative assisted the Philippine Statistical Authority in implementing Iris, an automated coding software program that enables medical death certificates to be coded according to international standards. Iris was implemented to improve the quality, timeliness, and consistency of coded data as part of broader activities to strengthen the country's civil registration and vital statistics system. This study was conducted as part of the routine implementation of Iris to ensure that automatically coded cause of death data was of sufficient quality to be released and disseminated as national mortality statistics. Data from medical death certificates coded with Iris between 2017 and 2019 were analysed and evaluated for apparent errors and inconsistencies, and trends were examined for plausibility. Cause-specific mortality distributions were calculated for each of the 3 years and compared for consistency, and annual numeric and percentage changes were calculated and compared for all age groups. The typology, reasons, and proportions of records that could not be coded (Iris 'rejects') were also studied. Overall, the study found that the Philippine Statistical Authority successfully operates Iris. The cause-specific mortality fractions for the 20 leading causes of death showed reassuring stability after the introduction of Iris, and the type and proportion of rejects were similar to international experience. Broadly, this study demonstrates how an automated coding system can improve the accuracy and timeliness of cause of death data-providing critical country experiences to help build the evidence base on the topic.

Level of readiness of employees of Systems Plus College Foundation (SPCF) on Disaster Risk-Reduction Management (DRRM).

OBJECTIVE: To determine the level of readiness on disaster risk-reduction management among employees of an educational institution. METHODS: The descriptive, evaluative study was conducted from March to April 2022 at 6 branches of Systems Plus College Foundation, Philippines, in Balibago, Rizal, Miranda, San Fernando, Caloocan and Cubao after approval from the ethics review committee of the Our Lady of Fatima University, Philippines, and comprised employees who were associated with the college for at least 6 months. Data was collected using Google Forms, and a validated tool was used to assess the disaster risk-reduction management readiness. The responses were categorised into 5 groups, ranging from 'very much ready' to 'not ready'. Gathered data was analysed by using SPSS version 20. Mean results were derived and presented with standard deviation. RESULTS: The responses suggested moderate readiness regarding structural safety codes 3.02±0.98, non-structural safety codes 3.02±1.04, availability of emergency supplies and equipment 2.84±1.09, and servicing and maintenance 2.85±1.03. CONCLUSIONS: Increasing the level of readiness related to disaster risk-reduction management must be given priority to ensure the safety of the employees in a higher education institution.

Prevalence of hepatitis A and E viruses in wastewater in Asian countries.

Hepatitis A and E viruses (HAV and HEV, respectively) remain a significant global health concern despite advancements in healthcare and vaccination programs. Regular monitoring and vaccine efficacy of HAV are still lacking in different countries. This study aimed to investigate HAV and HEV prevalence in developed, developing, and least-developed Asian countries using wastewater as a surveillance tool. A total of 232 untreated wastewater samples were collected from six wastewater treatment plants, a sewage treatment plant, or an open drainage in six countries [Nepal (n = 51), Indonesia (n = 37), Thailand (n = 30), Vietnam (n = 27), the Philippines (n = 17), and Japan (n = 70)] between April and October 2022. Viruses in wastewater were concentrated by simple centrifugation or polyethylene glycol precipitation method, followed by viral RNA extraction and reverse transcription-quantitative polymerase chain reaction. HAV and HEV RNA were detected in the samples from Nepal (51 % for HAV and 2 % for HEV), Thailand (3 % for both viruses), and Japan (1 % for HAV and 24 % for HEV). Only HAV RNA was found in 11 % of the samples in Indonesia, whereas only HEV RNA was detected in Vietnam and the Philippines, with a positive ratio of 15 % and 12 %, respectively. These results highlighted the geographic variability in HAV and HEV prevalence, underscoring the need for localized public health strategies to address specific viral hepatitis challenges in each country.

Neurosurgery in the elderly: Findings from a cohort in the Philippines.

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.

Projected health and economic effects of a pan-tuberculosis treatment regimen: a modelling study.

BACKGROUND: A pan-tuberculosis regimen that could be initiated without knowledge of drug susceptibility has been proposed as an objective of tuberculosis regimen development. We modelled the health and economic benefits of such a regimen and analysed which of its features contribute most to impact and savings. METHODS: We constructed a mathematical model of tuberculosis treatment parameterised with data from the published literature specific to three countries with a high tuberculosis burden (India, the Philippines, and South Africa). Our model simulated cohorts of newly diagnosed tuberculosis patients, including drug susceptibility testing if performed, regimen assignment, discontinuation, adherence, costs, and resulting outcomes of durable cure (microbiological cure without relapse), need for retreatment, or death. We compared a pan-tuberculosis regimen meeting the WHO 2023 target regimen profile against the standard of care of separate rifampicin-susceptible and rifampicin-resistant regimens. We estimated incremental cures; averted deaths, secondary cases, and costs; and prices below which a pan-tuberculosis regimen would be cost saving. We also assessed scenarios intended to describe which mechanisms of benefit from a pan-tuberculosis regimen (including improved characteristics compared with the current rifampicin-susceptible and rifampicin-resistant regimens and improved regimen assignment and retention in care for patients with rifampicin-resistant tuberculosis) would be most impactful. Results are presented as a range of means across countries with the most extreme 95% uncertainty intervals (UIs) from the three UI ranges. FINDINGS: Compared with the standard of care, a pan-tuberculosis regimen could increase the proportion of patients durably cured after an initial treatment attempt from 69-71% (95% UI 57-80) to 75-76% (68-83), preventing 30-32% of the deaths (20-43) and 17-20% of the transmission (9-29) that occur after initial tuberculosis diagnosis. Considering savings to the health system and patients during and after the initial treatment attempt, the regimen could reduce non-drug costs by 32-42% (22-49) and would be cost saving at prices below US$170-340 (130-510). A rifamycin-containing regimen that otherwise met pan-tuberculosis targets yielded only slightly less impact, indicating that most of the benefits from a pan-tuberculosis regimen resulted from its improvements upon the rifampicin-susceptible standard of care. Eliminating non-adherence and treatment discontinuation, for example via a long-acting injectable regimen, increased health impact and savings. INTERPRETATION: In countries with a high tuberculosis burden, a shorter, highly efficacious, safe, and tolerable regimen to treat all tuberculosis could yield substantial health improvements and savings. FUNDING: Bill & Melinda Gates Foundation.

A scoping review of stroke services within the Philippines.

BACKGROUND: Stroke is a leading cause of mortality and disability. In higher-income countries, mortality and disability have been reduced with advances in stroke care and early access to rehabilitation services. However, access to such services and the subsequent impact on stroke outcomes in the Philippines, which is a lower- and middle-income countries (LMIC), is unclear. Understanding gaps in service delivery and underpinning research from acute to chronic stages post-stroke will allow future targeting of resources. AIMS: This scoping review aimed to map available literature on stroke services in the Philippines, based on Arksey and O'Malley's five-stage-process. A targeted strategy was used to search relevant databases (Focused: MEDLINE (ovid), EMBASE (ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (ebsco); broad-based: Scopus; review-based: Cochrane Library, International Prospective Register of Systematic Reviews (PROSPERO), JBI (formerly Joanna Briggs Institute) as well as grey literature (Open Grey, Google scholar). The searches were conducted between 12/2022-01/2023 and repeated 12/2023. Literature describing adults with stroke in the Philippines and stroke services that aimed to maximize well-being, participation and function were searched. Studies were selected if they included one or more of: (a) patient numbers and stroke characteristics (b) staff numbers, qualifications and role (c) service resources (e.g., access to a rehabilitation unit) (d) cost of services and methods of payment) (e) content of stroke care (f) duration of stroke care/rehabilitation and interventions undertaken (g) outcome measures used in clinical practice. A total of 70 papers were included. Articles were assessed, data extracted and classified according to structure, process, or outcome related information. Advances in stroke services, including stroke ready hospitals providing early access to acute care such as thrombectomy and thrombolysis and early referral to rehabilitation coupled with rehabilitation guidelines have been developed. Gaps exist in stroke services structure (e.g., low number of neurologists and neuroimaging, lack of stroke protocols and pathways, inequity of stroke care across urban and rural locations), processes (e.g., delayed arrival to hospital, lack of stroke training among health workers, low awareness of stroke among public and non-stroke care workers, inequitable access to rehabilitation both hospital and community) and outcomes (e.g., low government insurance coverage resulting in high out-of-pocket expenses, limited data on caregiver burden, absence of unified national stroke registry to determine prevalence, incidence and burden of stroke). Potential solutions such as increasing stroke knowledge and awareness, use of mobile stroke units, TeleMedicine, TeleRehab, improving access to rehabilitation, upgrading PhilHealth and a unified national long-term stroke registry representing the real situation across urban and rural were identified. CONCLUSION: This scoping review describes the existing evidence-base relating to structure, processes and outcomes of stroke services for adults within the Philippines. Developments in stroke services have been identified however, a wide gap exists between the availability of stroke services and the high burden of stroke in the Philippines. Strategies are critical to address the identified gaps as a precursor to improving stroke outcomes and reducing burden. Potential solutions identified within the review will require healthcare government and policymakers to focus on stroke awareness programs, primary and secondary stroke prevention, establishing and monitoring of stroke protocols and pathways, sustainable national stroke registry, and improve access to and availability of rehabilitation both hospital and community. WHAT IS ALREADY KNOWN?: Stroke services in the Philippines are inequitable, for example, urban versus rural due to the geography of the Philippines, location of acute stroke ready hospitals and stroke rehabilitation units, limited transport options, and low government healthcare insurance coverage resulting in high out-of-pocket costs for stroke survivors and their families. WHAT ARE THE NEW FINDINGS?: The Philippines have a higher incidence of stroke in younger adults than other LMICs, which impacts the available workforce and the country's economy. There is a lack of data on community stroke rehabilitation provision, the content and intensity of stroke rehabilitation being delivered and the role and knowledge/skills of those delivering stroke rehabilitation, unmet needs of stroke survivors and caregiver burden and strain, WHAT DO THE NEW FINDINGS IMPLY?: A wide gap exists between the availability of stroke services and the high burden of stroke. The impact of this is unclear due to the lack of a compulsory national stroke registry as well as published data on community or home-based stroke services that are not captured/published. WHAT DOES THIS REVIEW OFFER?: This review provides a broad overview of existing evidence-base of stroke services in the Philippines. It provides a catalyst for a) healthcare government to address stroke inequities and burden; b) development of future evidence-based interventions such as community-based rehabilitation; c) task-shifting e.g., training non-neurologists, barangay workers and caregivers; d) use of digital technologies and innovations e.g., stroke TeleRehab, TeleMedicine, mobile stroke units.

To be visible yet remain unseen: An interpretative phenomenological analysis of embodied drug use and recovery of Filipinas.

The experience of drug use is a gendered and culturally embodied phenomenon. This qualitative study aims to unpack the lived experiences of 16 urban, poor, Filipina mothers who used drugs. In-depth interviews were conducted. Data was analyzed using interpretative phenomenological analysis (IPA). Their experiences were divided into drug initiation and recovery. Key findings show embodied experiences of initiation through starting use, losing control, and navigating through public and private spaces of drug use. Their experiences of drug recovery revolved around decoupling relations, avoiding drug use spaces, and healing their strained home. Theoretically, this study contributes to enriching the analytical underpinnings of IPA through a gendered and embodied perspective. In terms of practical implications, findings point to the need for a gender-conscious approach in intervention design and implementation in the community setting considering the life space of Filipinas who use drugs.

Stroke rehabilitation in urban and rural settings in the Philippines: Protocol for an interview and visual elicitation study.

INTRODUCTION: There is a lack of community-based rehabilitation for stroke in the Philippines, and research on this topic is limited. Different challenges may be encountered in urban and rural settings. The aim of the Tulong, Ugnayan ng Lingap At gabaY (TULAY) project is to develop a context-appropriate, community-based stroke support programme, consisting of self-management and training resources to augment the rehabilitation and recovery process. An important stage in the development of this programme is to qualitatively explore the experiences and needs of all stakeholders. MATERIALS AND METHODS: Using co-designed and evidence-based topic guides, in-depth semi-structured interviews will be conducted with people living with stroke, household carers and care providers. We will aim to gain a representation of different regions (within Luzon, Visayas, and Northern Mindanao), socioeconomic levels, and urban and rural locations. For people with stroke and household carers, interviews will be supplemented by auto-photography and visual elicitation to widen access for those that prefer to share their experiences visually or have communication problems. An interpretivist paradigm will be applied across all interview data and the consolidated criteria for reporting qualitative research (COREQ) will be followed. Thematic analysis will be undertaken using guidance by Braun and Clarke. DISCUSSION: To our knowledge, this study is the first of its kind in the Philippines. It has several methodological strengths, including the capture of perspectives from multiple stakeholders in diverse settings, the inclusion of people with communication difficulties, use of visual methods, and analysis in the native language. The findings will have various applications, including the potential to influence policy, practice and guidelines, and to inform the development of the TULAY stroke support programme.

Typhoid fever: the challenging diagnosis of a pseudo-outbreak in Benguet, Philippines.

Objective: The event-based surveillance and response report from the municipality of Buguias in the Philippines covering the period 1 January to 29 October 2022 indicated an unusual increase in the number of typhoid cases that surpassed the epidemic threshold for consecutive weeks. An investigation was conducted to confirm the existence of an outbreak, identify the source(s) of transmission and recommend prevention and control measures. Methods: The investigation employed a descriptive design. Medical records were reviewed to verify diagnoses and to identify cases that met case definitions. Key informant interviews were conducted to identify possible sources of transmission and investigate the reporting of cases in the Philippine Integrated Disease Surveillance and Response (PIDSR) system. Results: A total of 220 cases of typhoid fever were captured by the PIDSR system. Of the 208 suspected cases that were reviewed, only 15 (7.2%) met the case definition used in this investigation. Fourteen of these 15 verified cases were interviewed; five (35.7%) were farmers and 13 (92.8%) reported using springs as their main water source and source of drinking-water. Reporting of cases in the PIDSR system was largely based on the final chart diagnosis or a positive Typhidot or Tubex rapid diagnostic test result. The PIDSR case definition was not followed in the reporting of cases. Discussion: This study provides evidence of endemicity of typhoid fever in Buguias, Benguet, Philippines. However, from January to October 2022, cases were overreported by the surveillance system. Medical record reviews showed that most reported suspected cases did not meet case definition criteria. This finding emphasizes the need to improve typhoid guidelines with regards to diagnosis using rapid diagnostic tests and to investigate the cost-effectiveness of making confirmatory laboratory tests for typhoid available in the Philippines.