Effect of body image perception and skin-lightening practices on mental health of Filipino emerging adults: a mixed-methods approach protocol.

INTRODUCTION: The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them. METHODS AND ANALYSIS: An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data. ETHICS AND DISSEMINATION: The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

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.

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.

Clinical ramifications of TB stigma in Baguio City, Philippines

OBJECTIVE: Stigmatization due to a disease is a complex process, particularly in the case of tuberculosis (TB) in Baguio City, Philippines. This article reveals findings important to healthcare professionals in the outpatient setting. Complex aspects of stigma vary among people and healthcare professionals in different roles and settings, facilitating behavior that controls TB in some cases and spreads it in others.METHODS: With ethnographic and historical methods, Ladia analyzed a wide range of understandings of 36 healthcare providers and 14 persons affected by TB (PATB). These understandings shape clinical behavior with significant implications for patient outcomes and community health. TB treatment and control historically established concepts and behavioral patterns that have a significant bearing on public understanding today. Comparisons with national survey data supported the analysis.RESULTS AND CONCLUSIONS: Sources of varied understandings of TB include the history of sanitaria, poverty, and incomplete dissemination of current scientific information. While some behavior related to stigma could benefit the health of PATB and their household members, the struggle against stigma leads to counterproductive behavior in a number of cases, sometimes spreading disease and sometimes resulting in unnecessary labor and expense. Healthcare providers can provide accurate, accessible, detailed information to address patients' problems.