Low schistosomiasis and soil-transmitted helminthiasis prevalence and intensities in selected communities in Davao de Oro and Davao del Norte, the Philippines: A setting for interruption of transmission?

Parasitic neglected tropical diseases, such as schistosomiasis and soil-transmitted helminthiasis (STH), remain as significant public health concerns in developing countries such as the Philippines. This study aimed to determine the prevalence and intensity of schistosomiasis and STH among school-age children (SAC) and adults in two co-endemic provinces in Mindanao in southern Philippines as part of monitoring of national control programs. Stool samples were collected, processed using Kato-Katz technique, and examined microscopically for presence of intestinal helminth ova. A total of 776 SAC and 526 adults participated in the study. Low schistosomiasis prevalence was generally observed in SAC (0.8%) and adults (0.4%). Generally low STH prevalence was reported in both SAC (3.9%) and adults (3.4%). Only three SAC had heavy intensity STH, which was not seen in adults. Results indicate a state of good morbidity control, which may be a result of effective implementation of mass drug administration (MDA) strategy for schistosomiasis, STH, and lymphatic filariasis in the last several years. The low prevalence and intensities of infections may also be partly attributed to the low diagnostic sensitivity of Kato-Katz technique in detecting low intensity intestinal helminth infections. While results of this study also indicate similarly low levels of both these infections in previous studies, sustaining high MDA coverage rates and addressing remaining challenges related to intensified case finding and treatment, improvements in safe water, sanitation, and hygiene, veterinary public health, and vector ecology and management will be necessary to interrupt transmission in these areas.

Association between occupational noise exposure level and pure-tone audiometry abnormalities among Metropolitan Manila Development Authority employees: A cross-sectional study.

Traffic enforcers are exposed to various occupational health and safety hazards, including noise pollution, which may lead to occupational hearing loss. This cross-sectional study aimed to estimate the prevalence of hearing loss and to assess the relationship between occupational noise exposure level (ONEL) and abnormalities in air conduction thresholds among Metropolitan Manila Development Authority (MMDA) employees along Epifanio delos Santos Avenue, Philippines. Eight-hour ONELs were measured among 108 participants working with greater than 5 years of service. Participants had hearing evaluations using pure tone audiometry (PTA) to calculate the prevalence of hearing loss. Generalized linear models with a Poisson distribution were fitted to estimate the association between ONEL and audiologic abnormalities, controlling for confounding factors. Approximately 16% of employees had hearing loss. The prevalence of hearing loss was higher with ONEL exposures greater than 85 A-weighted decibels (dBA), with traffic enforcers exposed to higher ONELs than office workers. ONELs greater than 85 dBA were related to audiologic abnormalities at different frequencies in PTA. The prevalence of audiologic abnormalities at 4000 Hz and 6000 Hz was 48% higher (adjusted prevalence ratio [aPR], 1.48; 95% CI, 1.12-1.96) and 25% higher (aPR, 1.25; 95% CI, 1.00-1.55), respectively, among participants with ONELs greater than 85 dBA than with ONELs less than or equal to 85 dBA. Participants exposed to ONELs greater than 85 dBA, more likely traffic enforcers, may have increased risk of audiologic abnormalities. Regular ONEL monitoring is warranted for occupational risk assessment of traffic enforcers. A hearing conservation program may need to be considered for this population. Additional studies are needed to determine trends in hearing deterioration among traffic enforcers.

Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines.

BACKGROUND: New HIV infections in the Philippines are increasing at an alarming rate. However, over three quarters of men who have sex with men (MSM) have never been tested for HIV. HIV self-testing (HIVST) may increase overall testing rates by removing barriers, particularly fear of stigmatization and mistrust of providers. This study aimed to determine if these factors are associated with preference for HIVST among Filipino cisgender MSM (cis-MSM), and whether there is an interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST. METHODS: We conducted secondary analysis of a one-time survey of 803 cis-MSM who were recruited using purposive sampling from online MSM dating sites and MSM-themed bar locations in Metro Manila, Philippines. Summary statistics were computed to describe participant characteristics. Multivariable modified Poisson regression analyses were conducted to determine if anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST among cis-MSM. Other variables such as age, education, monthly income, relationship status, HIV serostatus, and knowing where to get HIV testing were the minimal sufficient adjustment set in the analyses. RESULTS: Average age of participants was 28.6 years (SD = 8.0); most had received college degrees (73%) and were employed (80%). Most respondents (81%) preferred facility-based testing, while 19% preferred HIVST. A high percentage of participants reported anticipated HIV testing stigma (66%) and provider mistrust (44%). Anticipated HIV testing stigma (aPR = 1.51; 95% CI = 1.01-2.25, p = 0.046) and provider mistrust (aPR = 1.49; 95% CI = 1.07-2.09, p = 0.020) were independently associated with a preference for HIVST. There was a positive, additive interaction between provider mistrust and anticipated HIV testing stigma on preference for HIVST (RERI = 1.13, 95% CI: 0.20-2.06; p = 0.017), indicating that the association between anticipated HIV testing stigma and preference for HIVST is greater among those with provider mistrust compared to those without provider mistrust. CONCLUSIONS: HIVST should be offered as a supplement to traditional facility-based HIV testing services in the Philippines to expand testing and reach individuals who may not undergo testing due to anticipated HIV testing stigma and provider mistrust.

Evaluation of loop-mediated isothermal amplification assay and enzyme-linked immunosorbent assay in detecting Schistosoma japonicum in Siargao Island, Surigao del Norte, the Philippines.

OBJECTIVES: This study aimed to describe the prevalence and seroprevalence of schistosomiasis in Siargao Island, Surigao del Norte and to compare the performance of enzyme-linked immunosorbent assay antibody test (ELISA Ab) and loop-mediated isothermal amplification assay (LAMP) for diagnosis of schistosomiasis. METHODS: The study was conducted in selected barangays (villages) in five municipalities in Siargao Island, Surigao del Norte and included school-age children (SAC) who submitted stool and blood samples. Stool samples were examined using the Kato-Katz technique. Blood samples were collected through venipuncture. The stool samples and the blood samples collected were tested using LAMP assay and polymerase chain reaction (PCR). The blood samples were examined using ELISA Ab. Diagnostic performance of LAMP assay using stool specimen was evaluated using Kato-Katz technique and PCR assay as the composite reference standard, while PCR assay was used as the reference standard to evaluate LAMP assay and ELISA Ab using blood specimens. RESULTS: A total of 417 stool samples from SAC were examined. The prevalence of schistosomiasis and moderate-heavy intensity (MHI) schistosomiasis were 3.8% and 1.4%, respectively. Schistosomiasis and soil-transmitted helminthiases (STH) coinfection prevalence were 2.6%. A total of 425 blood samples were examined using ELISA Ab. Seroprevalence was 61.6%. The municipality of San Isidro had the highest seroprevalence at 84.8%, while Burgos had the lowest seroprevalence at 48.5%.LAMP assay had higher sensitivity and positive predictive value but lower specificity when using stool than when using blood samples. Its negative predictive value was similar regardless of the specimen used. ELISA Ab has higher sensitivity and negative predictive value than LAMP assay although it has lower specificity and positive predictive value. This may be due to ELISA Ab measuring Schistosoma exposure and is thus unable to distinguish past from active infection. CONCLUSIONS: Schistosomiasis remains a public health concern in Siargao Island, Surigao del Norte. The locally developed LAMP assay offers a simpler diagnostic test for schistosomiasis compared with PCR, while minimizing the risk of misdiagnosis compared with Kato-Katz technique. It could serve as a point of care diagnostics for schistosomiasis. ELISA Ab is more useful in surveillance particularly in low-endemicity areas where determination of exposure is more important than differentiating past from active infection. ELISA Ab may be helpful in the clinical setting when coupled with the expertise of a physician who is familiar with schistosomiasis.

High TB burden and low notification rates in the Philippines: The 2016 national TB prevalence survey.

SETTING: The 3rd national tuberculosis (TB) survey in the Philippines in 2007 reported a significant decline in the prevalence of TB. Since then, more significant investments for TB control have been made, yet TB burden estimates from routine surveillance data remain relatively stable. OBJECTIVE: To estimate the prevalence of bacteriologically confirmed pulmonary TB in the Philippines amongst individuals aged ≥15 years in 2016. DESIGN: In March-December 2016, we conducted a population-based survey with stratified, multi-stage cluster sampling of residents in 106 clusters aged ≥15 years. Survey participants were screened for TB by symptom-based interview and digital chest X-ray. Those with cough ≥2 weeks and/or haemoptysis and/or chest X-ray suggestive of TB were requested to submit 2 sputum specimens for Xpert MTB/RIF, direct sputum smear microscopy using LED fluorescent microscopy, and mycobacterial solid culture (Ogawa method). Bacteriologically confirmed pulmonary TB was defined as MTB culture positive and/or Xpert positive. RESULTS: There were 46,689 individuals interviewed, and 41,444 (88.8%) consented to a chest X-ray. There were 18,597 (39.8%) eligible for sputum examination and 16,242 (87.3%) submitted at least one specimen. Out of 16,058 sputum-eligible participants, 183 (1.1%) were smear-positive. There were 466 bacteriologically confirmed TB cases: 238 (51.1%) Xpert positive, 69 (14.8%) culture positive, and 159 (34.1%) positive by both Xpert and culture. The estimated TB prevalence per 100,000 population aged ≥15 years was 434 (95% CI: 350-518) for smear-positive TB, and 1,159 (95% CI: 1,016-1,301) for bacteriologically confirmed TB. CONCLUSION: This nationally representative survey found that the TB burden in the Philippines in 2016 was higher than estimated from routine TB surveillance data. There was no evidence of a decline in smear and culture positive TB from the 2007 survey despite significant investments in TB control. New strategies for case-finding and patient-centered care must be intensified and expanded.

Comparative effectiveness of probiotic strains for the treatment of pediatric atopic dermatitis: A systematic review and network meta-analysis.

BACKGROUND: The current evidence on the use of probiotics in treating atopic dermatitis is inconclusive. This study determined the comparative effectiveness of the different types of probiotic strains in treating pediatric atopic dermatitis. METHODOLOGY: Systematic and manual search for all randomized controlled trials available from inception until January 31, 2020, was done. Two independent authors conducted the search, screening, appraisal, and data abstraction. Network meta-analysis was conducted using STATA 14 software. RESULTS: Twenty-two studies involving 28 different probiotic strains were included. The top three ranked probiotic strains in terms of efficacy are Mix1 (Bifidobacterium animalis subsp lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104); Lactobacillus casei DN-114001; and Mix6 (Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius). Compared with placebo, Mix1 reduces atopic dermatitis symptoms with high certainty evidence (SMD -1.94, 95% CI -2.65 to -1.24; 47 participants). Mix6 compared with placebo probably reduces atopic dermatitis symptoms based on moderate certainty evidence (SMD -0.85, 95% CI -1.50 to -0.20; 40 participants). Lactobacillus casei DN-114001 compared with placebo may reduce atopic dermatitis symptoms based on low certainty evidence (SMD -1.35, 95% CI -2.04 to -0.65). In terms of safety, the highest ranked strain is Lactobacillus fermentum VRI-003, while the lowest ranked strain is Lactobacillus rhamnosus GG. CONCLUSION: Certain probiotic preparations show benefit in reducing allergic symptoms in pediatric atopic dermatitis.

Identification of suspected paragonimiasis-endemic foci using a questionnaire and detection of Paragonimus ova using the Ziehl-Neelsen technique in Zamboanga Region, the Philippines.

Improving paragonimiasis surveillance, which is crucial for disease control, requires adopting new tools and techniques useful in mapping endemic areas. This study aimed to (1) develop a questionnaire to identify suspected paragonimiasis-endemic foci, (2) describe the epidemiology of paragonimiasis, and (3) evaluate Ziehl-Nielsen Staining technique (ZNS) in detecting Paragonimus ova. The questionnaire, which municipal health officers filled out, was based on proposed site inclusion criteria utilized in the integrated tuberculosis (TB)-paragonimiasis surveillance and control project. Newly deployed medical technologists in Zamboanga Region underwent training, which included laboratory diagnosis of paragonimiasis using preserved and fresh specimens and an integrated tuberculosis-paragonimiasis survey in nine selected barangays (villages). Paragonimiasis cases were found in seven out of the nine barangays identified by the questionnaire. Of the 373 patients, three (0.80%) were TB-positive, and 29 (7.77%) were paragonimiasis-positive. The highest paragonimiasis prevalence (27%) was found in Barangay Libato. Ziehl-Neelsen Staining technique (ZNS) correctly detected 8 out of the 29 samples positive (sensitivity - 27.59%; 95% CI: 12.73-47.24%) and all the 334 samples negative (specificity - 100%; 95% CI: 98.90-100%) for Paragonimus ova. The questionnaire may be improved by refining the inclusion criteria. In paragonimiasis-endemic areas, the ZNS and the NaOH concentration technique may be used for detecting Paragonimus ova. Modifying the ZNS, for instance by including a concentration step, may improve its sensitivity. The model for the integrated capacity building of health workers and surveillance and research demonstrated in this project may contribute to improving surveillance and control of paragonimiasis and other neglected tropical diseases.

Child development center-based sentinel surveillance of soil-transmitted helminthiases in preschool-age children in selected local government units in the Philippines.

Soil-transmitted helminthiasis (STH) remains a public health concern in developing countries, such as the Philippines. Preschool-age children (PSAC) are among the high-risk groups for STH. Data on the status of STH in PSAC are needed to help guide policy formulation and program implementation; however, in the usual setting, such data may remain limited. This study aimed to describe the parasitologic status of PSAC in selected local government units (LGUs) in the Philippines through sentinel surveillance methodology in a child-development center (CDC)-based setting. This cross-sectional study, which included 1732 PSAC in selected barangays (a village or the smallest administrative unit in the country) in the provinces of Cavite, Guimaras, Iloilo, Negros Occidental, and Davao del Norte and cities of Iloilo and Lapu-Lapu in the Philippines, utilized Kato-Katz technique to determine parasitologic status. A single Kato-Katz smear was prepared from the adult-thumb sized stool sample submitted by each participant. Ten percent of Kato-Katz slides examined by field microscopists were re-examined by a reference microscopist as part of quality control. Results showed a prevalence of any STH infection and a moderate-heavy ((M-H)) intensity prevalence of 24.9% and 10.3%, respectively. Five cases of schistosomiasis were found in Lapu-Lapu City and Davao del Norte. While the Philippines' Department of Health (DOH) - Integrated Helminth Control Program (IHCP) target for prevalence of any STH of less than 50% was attained, none of the barangays or villages met the World Health Organization (WHO) target for (M-H) intensity STH prevalence of less than 1%, despite the program being implemented for almost a decade. Sentinel surveillance in PSAC, possibly adopting a CDC-based approach, may be implemented biannually in the Philippines and other countries where a similar early child care development system exist to generate data needed to guide policy formulation and program implementation. Preventive chemotherapy through facility-based mass drug administration (MDA), such as CDC-based MDA, may be explored to improve the mode of MDA delivery and coverage in PSAC.

Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort.

BACKGROUND: Brugada syndrome is the mechanism for sudden unexplained death. The Brugada ECG pattern is found in 2% of Filipinos. There is a knowledge gap on the clinical outcome of these individuals. The clinical profile and 5-year cardiac event rate of individuals with the Brugada ECG pattern were determined in this cohort. METHODS: This is a sub-study of LIFECARE (Life Course Study in Cardiovascular Disease Epidemiology), a community based cohort enrolling healthy individuals 20 to 50 years old conducted in 2009-2010. ECGs of all enrollees were screened independently by three cardiologists. The prevalence of the coved Brugada ECG pattern was ascertained, and the 5-year cardiac event rate was determined among those individuals with this pattern. The participants were contacted to determine the occurrence of cardiac events, which included syncope, presyncope, seizures, cardiac arrest and unexplained vehicular accidents. RESULTS: A total of 3072 ECGs were reviewed, and 14 subjects (0.4%) with the coved Brugada ECG pattern were identified. Four had a cardiac event on follow-up at 5 years, but all remained alive. Most of these 14 coved Brugada individuals were healthy and asymptomatic at baseline. CONCLUSION: Cardiac events occurred commonly among initially asymptomatic Filipinos with the coved Brugada ECG pattern. Such patients need to be followed up closely.

Community-based recruitment for clinical trials poses the need for social and ethical considerations.

OBJECTIVE: This article's objective was to describe the processes, strategies, and challenges of community-based recruitment to complement hospital-based recruitment for a global clinical outcomes trial on chronic obstructive pulmonary disease (COPD). STUDY DESIGN AND SETTING: To increase the subject recruitment for the clinical research, field staff were trained on community-based recruitment strategies and activities. Courtesy calls and coordination with community organizations were done before recruitment activities. House-to-house interviews using patient referral checklist, lay fora on COPD, and spirometry camps identified eligible participants in five sites in the Philippines. RESULTS: Of 3,202 individuals interviewed, 27% potentially eligible were referred to hospital sites. Of 55% who were successfully screened, 9% were randomized. Courtesy calls and endorsements identified potential recruits. Issues related to communication, work, health condition, and family members' encouragement affected participation. Complexity of the eligibility criteria contributed to the high screen failure rates. Enabling full subject protection entitlements before informed consent taking was one of the ethical issues identified. CONCLUSIONS: Community-based recruitment may increase the number of subjects for clinical trials depending on the complexity of the requirements. Adopting a community-based recruitment strategy must be decided at the planning stage for efficient coordination of activities. Social preparation should consider socioeconomic and cultural factors. Current ethical guidelines and regulations indirectly address issues on community-based recruitment.

Assessing the residual risk for transfusion-transmitted infections in the Philippine blood supply.

Due to a USAID-funded study on blood banks, a national policy was instituted in 1994 that set standards for Philippine blood services, promoted voluntary donation, and led to a ban on commercial blood banks. In this follow-up study, we assess the safety of the supply by determining the residual risk for transfusion-transmitted infections (syphilis, hepatitis B and C, HIV). We also identified unsafe facility practices and generated policy recommendations. A 1992 study found that transfusion-ready blood was not safe using the LQAS method (P > 0.05). We found that the 2012 residual risk became 0 to 0.9 percent attributable to the national policy. We noted poor to fair adherence to this policy. We identified unsafe practices such as use of rapid tests and lack of random blood retesting. Training and use of regional networks may improve safety. Despite improvement in safety, facilities complain of funding and logistical issues regarding compliance with the policy.

Socio-demographic factors and the prevalence of metabolic syndrome among filipinos from the LIFECARE cohort.

BACKGROUND: Metabolic syndrome(MetS) is an aggregation of multiple metabolic risk factors shown to lead to the development of cardiovascular disease. The International Diabetes Federation(IDF) and the modified National Cholesterol Education Program Adult Treatment Panel Ⅲ(mNCEP) criteria are used in identifying MetS. This report will determine the prevalence of MetS and its component risk factors of the Philippine cohort of the LIFE course study in CARdiovascular disease Epidemiology(LIFECARE). METHODS: Our study recruited 3,072 participants aged 20-50 years old from Metro Manila and four nearby provinces. Baseline anthropometric and clinical parameters were measured. Prevalence of MetS and its component factors were determined. Associations with socio-demographic factors were determined. RESULTS: The prevalence of MetS was 19.7% and 25.6% by IDF and mNCEP, respectively(kappa 0.83). Both were associated with increasing age, urban residence, and employed status. It was higher in females by IDF and in males by mNCEP. IDF missed 40% of males and 10% of females identified with MetS by mNCEP. More males were identified by the mNCEP as MetS despite relatively normal waist circumference. CONCLUSION: MetS is common in the Philippines among older, educated, and urban residents. The mNCEP criteria identified more MetS than the IDF criteria.

Prevalence of cardiovascular risk factors in relation to socio-demographic profile of the life course study in cardiovascular disease epidemiology study (LIFECARE) Philippine cohort

OBJECTIVE: To describe the distribution of the clinical cardiovascular risk profile of the LIFECARE Philippine cohort in relation to its socio-demographic factors. METHODS: We recruited a total of 3,072 apparently healthy participants from Manila and nearby provinces of Rizal, Batangas, Bulacan and Quezon. Face-to-face interview was done to obtain socio-demographic data. Baseline clinical parameters and biochemical tests were obtained. Prevalence of cardiovascular risk factors was determined by sex, place of residence, level of education and employment. RESULTS: Overall prevalence of diabetes mellitus was at 5%, similar between sexes, area class, educational attainment and employment status. More smokers were male, employed or with an elementary level of education. Prevalence of hypertension was at 14.5% and was seen more in males, urban dwellers, employed or with an elementary level of education. Dyslipidemia was seen more in males, living in the rural areas, employed or with a college level of education. Lastly, obese participants were seen more in females, living in urban areas, employed with a college level of eduction. CONCLUSION: Older, male and employed participants who are living in the urban areas have more cardiovascular risk factors.

"You are what you eat:" Self-reported preferences for food taste and cooking methods of adult Filipinos (20-50 years old)

OBJECTIVE: To describe the self-reported preferences for food taste and cooking methods of adult Filipinos (20-50 years old). METHODS: This is a cross-sectional community survey of 3,072 adults from Metro Manila, Bulacan, Batangas, Quezon, Rizal. RESULTS AND CONCLUSION: There were differences in preferred tastes of males (food that tasted "just right", spicy) vs. females (salty); younger adults (sweet, spicy) vs. older adults (bland); urban (salty, spicy) vs. rural adults ("just right") adults with higher education (sweet, salty, spicy) vs. those with less schooling who liked food which tasted "just right." Smokers preferred spicy taste vs. non-smokers who liked sweet-tasting food. Adults who reported having had alcohol intake preferred spicy food. Those who reported feeling stressed liked savoury taste (sweet, salty) while those who were not stressed liked food which tasted "just right." Cooking with oil was the usual and the most preferred cooking method. Younger adults and smokers liked to use oil in cooking. Food which tasted "just right"/moderate was most preferred by adult Filipinos with hpertension or MeTS. Diabetics did not prefer sweet tasting food. More diabetics (p=0.05) and those with MeTS (p=0.003) usually use other cooking methods instead of frying. Eliciting self-reported taste preferences as well as the usual and preferred cooking methods is important for nutritional management and relevant lifestyle advice which healthcare providers should incorporate in their management of patients, especially those with hypertension, diabetes, and metabolic syndrome.

Where we are: socio-ecological and health profile of the Philippine LIFEcourse study in CARdiovascular disease epidemiology (LIFECARE) study sites

OBJECTIVE: This study aims to describe the socio-ecological and health profile of the Philippine LIFECARE study sites, its health care services and leading causes of mortality and morbidity. METHODS: This is a prospective cohort study that recruited participants aged 20-50 years from Metro Manila and four provinces (Bulacan, Batangas, Quezon, Rizal). Study sites were characterized according to their geographical area, terrain and environmental profile, and available health care system. RESULTS: 3,072 subejects were included, with male-to-female ratio of 1:1.3 and majority aged 30-50 years. Metro Manila was the most congested site. Two-thirds of the 62 villages (barangays) were rural, outside the town proper, and in lowlands. One-fourth were along coastal area. Almost all were accessible by public transportation. Majority have reduced forest cover, but were relatively safe from environmental hazards. Rural health units, hospitals, and professional health care workers were concentrated in Metro Manila. Leading cause of morbidity was respiratory tract infection, while cardiovascular diseases caused most of mortalities. CONCLUSION: Study sites were mainly rural, outside the town proper and in lowlands, with available public transportation. There is an unequal distribution of health resources. Cardiovascular diseases is still the leading cause of mortality. The disparities in geographical access to health care play an important role in shaping human health.

Who we are: Demographic and stress profile of the Philippine LIFECARE cohort

OBJECTIVE: To describe the demographic and stress profile of the participants in the LIFECARE cohort. METHODS: The Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) is a community-based prospective cohort of apparently healthy individuals aged 20 to 50 years old with no preexisting cardiovascular disease. The second phase out of four phases of study involves collection of baseline socio-demographic, anthropometric, biochemical and cardiovascular parameters and stress profiles. It was conducted via face-to-face interview using a survey questionnaire. RESULTS AND CONCLUSION: A total of 3072 participants from Metro Manila and 4 provinces in Luzon were recruited. The female to male ratio was 1.3:1. Majority of the participants were aged 30 years old and above. Most were married, employed and literate. Majority attained at least high school level of education. Loss of job was the most common stressor experienced in the past year. Majority of the cohort reported occasional experience of general stress and moderate level of financial stress. Occurrence of general stress within the past year was higher among females (p < 0.001), younger age-group (p=0.006), and among those who reached college level of education (p<0.001). Furthermore, level of current financial stress was high to severe among older age-group (p=0.004), and among widow/widower/separated (p<0.0001). While the relationship between psychosocial stress and physical illness had not been established in this study, there is a need to investigate demographics and psychosocial stress, and their implications in increasing adverse health outcomes in general, and cardiovascular risk in particular.

A community-based validation study of the short-form 36 version 2 Philippines (Tagalog) in two cities in the Philippines.

OBJECTIVE: To evaluate the validity and reliability of the Philippines (Tagalog) Short Form 36 Health Survey version 2 (SF-36v2(®)) standard questionnaire among Filipinos residing in two cities. STUDY DESIGN AND SETTING: The official Philippines (Tagalog) SF-36v2 standard (4-week recall) version was pretested on 30 participants followed by formal and informal cognitive debriefing. To obtain the feedback on translation by bilingual respondents, each SF-36v2 question was stated first in English followed by Tagalog. No revisions to the original questionnaire were needed except that participants thought it was appropriate to incorporate "po" in the instructions to make it more polite. Face-to-face interviews of 562 participants aged 20-50 years living in two barangays (villages) in the highly urbanized city of Makati City (Metro Manila) and in urban and rural barangays in Tanauan City (province of Batangas) were subsequently conducted. Content validity, item level validity, reliability and factor structure of the SF-36v2 (Tagalog) were examined. RESULTS: Content validity of the SF-36v2 was assessed to be adequate for assessing health status among Filipinos. Item means of Philippines (Tagalog) SF-36v2 were similar with comparable scales in the US English, Singapore (English and Chinese) and Thai SF-36 version 1. Item-scale correlation exceeded 0.4 for all items except the bathing item in PF (correlation: 0.31). In exploratory factor analysis, the US two-component model was supported. However, in confirmatory factor analysis, the Japanese three-component model fit the Tagalog data better than the US two-component model. CONCLUSIONS: The Philippines (Tagalog) SF-36v2 is a valid and reliable instrument for measuring health status among residents of Makati City (Metro Manila) and Tanauan City (Province of Batangas).