Community Health Workers' Concept and Understanding of Diabetes: A Qualitative Study.

Objectives: Community health workers (CHWs) fill in the insufficiency of health professionals in low-income countries. The CHWs' roles include health education of their constituents whose health they likewise take care. This study aimed to describe the concept and understanding of diabetes among CHWs in the Philippines. Methods: Fifty female CHWs currently working in rural and urban areas participated in six focus group discussions with guidance from Kleinman's eight questions. With the written informed consent of the participants, discussions were recorded and transcribed by the Research Assistant. A multi-disciplinary team manually analyzed the data. Disagreements were discussed among them and the physicians provided clinical analyses and explanations on the results. Quotations of an important point of view were also presented. Pseudonyms were utilized to uphold anonymity. Results: CHWs were aged 32 to 72 years; older participants reside in rural areas. Majority were married, housekeepers, and high school graduates. Some CHWs and their family were suffering from diabetes or dyabetis, the disease of the rich according to them. Its causes were food and lifestyle, and believed to be hereditary. Complications lead to death. Amputation was feared the most. Diabetes is incurable. Persons with diabetes should take maintenance medicines, and seek physicians' and family's help. Together with the patient, the family must decide on its management. Balanced diet, healthy lifestyle, maintenance medicines, food supplements, and herbal plants were perceived treatments. The internist should lower blood sugar level as well as prolong life span. Proper diet and regular check-up prevent diabetes. Conclusions: CHWs' concept and understanding of diabetes reflect some of the biomedical causes, effects, treatment, and prevention of diabetes as well as its social determinants. The efficacy and safety of herbal plants in the treatment of diabetes, however, should be further studied. Training on diabetes care should be provided to address their fears of amputation, insulin injection, and complications.

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.

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.

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.

"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.

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.

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).