This study compared the diagnostic performance of different ultrasound-based models in discriminating between benign and malignant ovarian masses in a Filipino population. This was a prospective cohort study in women with findings of an ovarian mass on ultrasound. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation using the different International Ovarian Tumor Analysis (IOTA) Group’s risk models. Serum CA-125 and a second-generation multivariate index assay (MIA2G) were also determined for all patients. The ovarian imaging and biomarker results were correlated with the histological findings. A total of 260 patients with completed ultrasound, CA-125, MIA2G, and histopathologic results was included in the study. The presence of papillae with blood flow and irregular cyst walls during the ultrasound were significantly associated with a 20-fold (OR: 20.13, CI: 8.69–46.67, p < 0.01) and 10-fold (OR: 10.11, CI: 5.30–19.28, p < 0.01) increase in the likelihood of a malignant lesion, respectively. All individual sonologic procedures performed well in discerning malignant and benign ovarian lesions. IOTA-LR1 showed the highest accuracy (82.6%, 95% CI: 77.5–87%) for identifying ovarian cancer. IOTA-ADNEX showed the highest sensitivity (93.3%, 95% CI: 87.2–97.1%) while IOTA-LR2 exhibited the highest specificity (84.4%, 95% CI: 77.3–90%). Among the different serial test combinations, IOTA-LR1 with MIA2G and IOTA-LR2 with MIA2G showed the highest diagnostic accuracy (AUROC = 0.82). This study showed that all individual ultrasound-based models performed well in discerning malignant and benign ovarian lesions, with IOTA-LR1 exhibiting the highest accuracy.

Objective: The objective of the study is to describe the work-related quality of life (WRQOL) among nurses and explore its association with performance evaluation ratings. Methods: A cross-sectional design was utilized measuring the WRQOL scale and the previous performance appraisal rating. Multistage sampling approach was utilized with nurses stratified based on their position and then systematically random sampled based on their unit assignment. Results: One hundred and eighty-two nurses were included. About half reported a high quality of work life (101; 55.5%). Low scores were noted on the subscale working conditions (100; 54.9%), low to average responses for home-work interface (109; 59.9%), control at work (100; 54.9%), and stress at work (90; 49.5%). A higher proportion of nurses reported positive responses toward the areas of general well-being (113; 62.1%) and job-career satisfaction (112; 61.5%), than in the other subscales. There were notable differences between WRQOL ratings: (1) Head nurses had the highest perceived quality of work life, followed by nurse supervisors and charge nurses (F = 6.1, P < 0.01) and (2) Nurses in the pay-patient services reported lower quality of working life, while those in office and outpatient services had more positive scores (F = 4.6, P < 0.01). Conclusion: Only more than half of the nurses reported a high quality of work life, some of its dimensions, particularly job and career satisfaction and working conditions, appeared to vary in the perceived degree across years in service, work hours, and position. The assessment of the quality of work life may serve as an important tool to address staff burnout, absenteeism and other issues that affect job performance among health-care professionals.

Objective: Our study determined the association of pregnancy with various clinical outcomes among women with COVID-19 infection. Methods: We conducted a retrospective, cohort, subgroup analysis of the Philippine CORONA Study datasets comparing the clinical/neurological manifestations and outcomes of pregnant and nonpregnant women admitted in 37 Philippine hospitals for COVID-19 infection. Results: We included 2448 women in the analyses (322 pregnant and 2.126 nonpregnant). Logistic regression models showed that crude odds ratio (OR) for mortality (OR 0.26 [95% CI 0.11, 0.66]), respiratory failure [OR 0.37 [95% CI 0.17, 0.80]), need for intensive care (OR 0.39 [95% CI 0.19, 0.80]), and prolonged length of hospital stay (OR 1.73 [95% CI 1.36, 2.19]) among pregnant women were significant. After adjusting for age, disease severity, and new-onset neurological symptoms, only the length of hospital stay remained significant (adjusted OR 1.99 [95% CI 1.56,2.54]). Cox regression models revealed that the unadjusted hazard ratio (HR) for mortality (HR 0.22 [95% CI 0.09, 0.55]) among pregnant women was statistically significant; however, after adjustment, the HR for mortality became nonsignificant. Conclusion: We did not find a significantly increased risk of mortality, respiratory failure, and need for ICU admission in pregnant women compared with nonpregnant women with COVID-19. However, the likelihood of hospital confinement beyond 14 days was twice more likely among pregnant women than nonpregnant women with COVID-19.

The World Health Organization has recommended the inclusion of human papillomavirus (HPV) vaccines in national immunization programs to address the global problem of cervical cancer. In the Philippines, HPV vaccination was introduced in a phased approach in 2015. This study seeks to estimate the cost of delivery of the HPV vaccination program and its operational context in the Philippines. This was a retrospective, cross-sectional micro-costing study focused on ongoing HPV vaccination delivery and its operational context across all levels of the health system. Using structured questionnaires and data collection from secondary sources, the weighted mean financial and economic costs and costs per dose at the national, subnational, and health facility levels were estimated. The weighted mean financial and economic costs per dose of the HPV vaccination program aggregated across all levels of the health system were $US3.72and $29.74, respectively. Activities contributing most significantly to costs were service delivery and vaccine collection or distribution and storage at the health facility and administrative levels, respectively. The opportunity costs for health worker and non-health worker time accounted for 77% of the economic cost per dose. The total weighted mean financial and economic costs of HPV delivery are within range of those reported in other countries. Costing studies can help identify cost drivers with local operational context to help inform policymakers and program managers in budgeting and planning interventions to improve program implementation.

This study evaluated the clinical performance and overall utility of a multivariate index assay in detecting early-stage ovarian cancer in a Filipino population. This is a prospective cohort study among Filipino women undergoing assessment for an ovarian mass in a tertiary center. Patients diagnosed with early-stage ovarian cancer and who underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation, multivariate index assay (MIA2G), and surgery for an adnexal mass were included in this study. Ovarian tumors were classified as high-risk for malignancy based on the IOTA-LR2 score. The ovarian imaging and biomarker results were correlated with the reference standard: surgico-pathologic findings. The MIA2G exhibited the best overall performance among individual classifiers with a sensitivity of 91.7% and NPV of 84.7%, with a concomitant higher sensitivity in early-stage disease, whether as an individual classifier (93.5%) or in serial combination with ultrasound (85.5%). The performance of biomarkers (specificity, positive predictive values, and AUROC) such as MIA2G and CA-125 significantly improved when combined with an ultrasound risk scoring approach (p < 0.01). MIA2G showed a higher sensitivity for detecting lesions among EOC and late-stage ovarian cancers than otherwise. The application of biomarkers for evaluating ovarian masses in our local setting is secondary to ultrasound but adopting multivariate index assays rather than CA-125 would increase the detection of early-stage ovarian cancers regardless of menopausal status. This is most relevant in areas where level III sonographers or gynecologic oncologists are limited and preoperative referrals to these specialists can improve the survival of our patients.

BACKGROUND: Adolescent pregnancy remains to be a significant social and public health problem in the Philippines, despite the widespread implementation of a comprehensive sexual and reproductive health (SRH) law. The current study explored the perceptions on teenage pregnancy and adolescent-oriented services across different views of stakeholders. MATERIALS AND METHODS: Twelve focus group discussions involving sets of teenage boys and girls, teenage mothers, and parents of the teenage mothers were conducted. Data analysis using a descriptive qualitative approach adopting both inductive and deductive thematic analysis was implemented on the gathered data. RESULTS: Four main themes emerged from the focus groups. First, discussants expressed community perceptions, emphasizing factors perceived to contribute to the occurrence of teenage pregnancy cases. Second, the adolescents expressed the coping responses they used or have observed in others to cope with teenage pregnancy, while the teenage mothers and their parents highlighted their immediate feelings toward the event. Last, the participants verbalized their perceptions of community services including criticisms and suggestions to improve the delivery of these services. DISCUSSION: The findings underscore the importance of stratifying and customizing the delivery of adolescent services as well as the possibility of expanding the content and coverage of community actions. This study also suggests that there is a need to create local ordinances that are culturally specific based on the Republic Act 10354 or the Responsible Parenthood and Reproductive Health Act of 2012. These ordinances must be coupled with other programs on reproductive health including training of personnel, ensuring the availability of resources, and reframing service delivery to the needs of adolescents. Further research is needed to explore variability of perceptions across contexts and cultures and the need for more appropriate service delivery models, thus contributing to a better understanding of teenage pregnancy and more tangible impact toward its reduction.