Human ; Aging ; Population

Clinical research either directly involves a particular person or group of people or uses materials from humans such their behavior or samples of their tissue. It can involve epidemiological and behavioral research, health services research and patient-oriented research like drug trials or accuracies of diagnostic tests. It is a series of steps that lead from question to answer. There is an organized structure by which we formulate questions, develop methods to gather information and answer clinical problems. The purpose of organizing the structure is to allow studies to be repeated and validated by other researchers. There are several research designs, and the choice should be influenced by the main objective of the research. The methodology is the manner of collection of data that will give confidence in the results and conclusion. This requires identifying all sources of bias and uncertainty, and developing a method that can minimize them. Actual data collection can be obtained by inspecting the records, by conducting interview or physical examination or laboratory/ imaging investigations, or by a combination of these data-eliciting methods. Lastly, the final report should be concise but contain all the details in relation to the objective of the research. The format of the written report depends on the methodology and the requirement of the journal where it is intended to be published.

A case control study is a type of observational study. In this study design, participants are selected to participate depending on their outcome status. Cases are participants with outcome of interest whereas controls are participants who do not have the outcome of interest. These studies estimate the odds ratio or the odds between the exposure and health outcome, however they cannot prove causality. Advantages of case control studies include the following: inexpensive, easy to design and implement, and are used to study rare outcomes. Case control studies are prone to certain research bias but can be addressed by the investigator through careful designing and planning. This paper describes the case control studies, their advantages, bias in case control studies and how to address them, and discuss the steps in how to conduct this type of study design.

Human ; Community Medicine ; Family

BACKGROUND

Family and Community Medicine is a medical specialty that plays a crucial role in the healthcare system and will be in the best capacity to provide primary care services, coordinate referrals to specialists when needed, and promote continuity of care across different healthcare settings in the implementation of the Universal Health Care Law. These are policy recommendations on how family and community medicine can play a significant role in the successful implementation of the UHC.

Recommendation #1. The undergraduate curriculum in Family and Community Medicine must be competency based.

Recommendation #2. The competency outcome of Family and Community Medicine undergraduate curriculum must be aligned with the need of the Philippine health system in the context of Universal Health Care reform.

Recommendation #3. The process of delivery of Family and Community Medicine undergraduate curriculum must adopt to new technology and teaching innovation.

Recommendation #4. Family and Community Medicine must develop strategies to make it as career choice.

Recommendation #5. Family and Community Medicine must develop and implement an effective and sustainable faculty development program.

Recommendation #6. Family and Community Medicine must be socially accountable to the community it serves.

Recommendation #7. Family and Community Medicine must be one of the major core competencies of a licensed physician ready to practice as primary care provider in the UHC.

Recommendation #8. Early placement for Family and Community Medicine practice must be available for newly licensed physicians.

Recommendation #9. Family and Community Medicine practitioners must be provided with continuing professional education and training to provide quality patient care.

Recommendation #10. Family and Community Medicine postgraduate education and training must adopt to new technology and training innovation.

Recommendation #11. Family and Community Medicine postgraduate training should cover urban and rural community health service.

Recommendation #12. Family and Community Medicine continuing professional education and training programs must meet the prescribed standards.

Recommendation #13. Regulation of Family and Community Medicine practice must be a public-private partnership.

Health economic analyses are comparative analysis of healthcare technologies or health strategies and their alternative options in terms of their costs and consequences.1 By doing health economic analysis, we can obtain incremental cost-outcome ratios, the relation of the estimated additional costs, and the estimated additional outcomes saved or lost using alternative healthcare technology.2 They can provide useful data to doctors, patients, policymakers, and the public about choices that can affect health, especially the use of resources.

In essence, economic evaluation aims to characterize the efficiency of healthcare interventions. It provides a structured approach to measuring and comparing the health outcomes and costs of competing alternative interventions over time and across populations.

There is now an epidemiologic shift in the burden of illness from infectious diseases in the last century to lifestyle diseases in the current. Mortality due to lifestyle diseases like diabetes, hypertension and heart disease is now ranked higher than infections. The medical community is now realizing the importance of lifestyle intervention to address the problem. We hope that this issue of our journal focused on lifestyle medicine will help inform our colleagues in family and community practice the necessity and available strategy of lifestyle intervention. Lifestyle Medicine is the use of evidence-based lifestyle therapeutic approaches, including a whole food, plant-based eating pattern, regular physical activity, restorative sleep, stress management, the avoidance of risky substances, and positive social connection as a primary modality delivered by trained and certified clinicians, to prevent, treat, and often reverse chronic disease.1 It is distinct from other disciplines, such as functional, integrative, complementary, and alternative medicine. Lifestyle medicine focuses on conditions that consume 80% of healthcare visits, hospitalizations, and costs. Hence, it is recommended as the first line and the foundational intervention for non-communicable diseases that address the modifiable lifestyle and behavioral risk factors impacting the disease trajectory, quality of life, and overall health outcomes.2 Despite the advances and increasing availability of medical care, these chronic lifestyle-borne diseases continued to increase exponentially, causing 74% of all deaths globally.2 However, healthcare providers do not receive adequate education, foundational skills, and personal experiential references to efficiently prescribe the recommended lifestyle therapy in primary and specialty care. Thus, lifestyle medicine initiatives align with the quadruple healthcare aims to deliver better patient experience, better outcomes, lower costs, and better clinician satisfaction.3 Through the lifestyle medicine lens and the empowerment of patients, healthcare providers often bring whole health management and disease remission into the scope of care at a lower cost. Lifestyle is an individual’s choice. The study by Longakit reveals an individual choice of lifestyle practice for wellness elements like physical, social and emotional state. While the study of Alimorong is a an individual’s choice when he or she has health risk like hypertension. Physicians should be able to influence this patient’s choice and there are several strategies available. The case studies of Solijon, Acero and Tan are different strategic methods to promote lifestyle change. The interventions given are usually structured and conducted face-to-face. On the other hand, the studies of Cristobal and Ngo uses digital health interventions to promote lifestyle change. While the studies on lifestyle interventions presented in this issue are not robust evidence like randomized trials, these are experiences by local physicians with their patients. These experience may be a good enough basis to increase awareness and provide training for family and community physicians on lifestyle medicine, as advocated by the study of Palma.

The COVID-19 pandemic has resulted into issues on occupational health, especially in health care services sector. Due to the nature of their work, this sector is at an increased risk of exposure to the virus. In this issue, we further discuss the importance of occupational health as our special theme. Occupational Health is an area of work in public health to promote the highest degree of physical, mental, and social well-being of workers in all occupations. Occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. The Philippine College of Occupational Medicine (PCOM), which is an affiliate specialty society of the PAFP, is responsible for promoting occupational health in the country. PCOM, formerly known as the Philippine Occupational and Industrial Medical Association (POIMA), was established in 1977 through the merger of three occupational health associations, namely the Industrial Medical Association of the Philippines (IMAP), the Philippine Association of Occupational Health (PAOH), and the Philippine Association of Compensation Medicine (PACOM). As a medical specialty society and a DOLE-accredited safety and health training organization, PCOM is a prime mover in the preservation, promotion, protection, and enhancement of health, safety and wellness of workers in all occupations through its active members nationwide and collaboration with various stakeholders both locally and internationally.

Background: Dyspnea also referred to as shortness of breath or breathlessness is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a symptom of the disease, rather than a disease itself. Its etiology can be designated as arising from four primary categories: respiratory, cardiac, neuromuscular, psychogenic, systemic illness, or a combination of these. Objective: The general objective in developing this guideline is to improve the quality and outcomes of care to adult patients with dyspnea or shortness of breath in primary care and outpatient setting. Methods The ADAPTE process was utilized in the development of the initial guideline recommendations where the following steps were followed: 1) definition of clinical questions, 2) searching, screening and appraisal of guidelines, 3) decision and selection of evidence and 4) iterative drafting of guideline recommendation was done. The retrieved guidelines were systematically evaluated for their quality and validity using the Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument, which is a tool developed to assess the methodological quality of practice guidelines. If the adopted guideline did not have recommendations for our clinical question, we developed the recommendations de novo using the GRADE approach. We prioritized retrieving systematic reviews and meta-analysis articles that are relevant to our clinical questions. In the development of recommendations, the guideline development team prioritized the interventions that address the following outcomes i.e., decrease in severity of dyspnea, resolution of dyspnea, improved quality of life and decrease mortality. Data from the articles were extracted and the evidence was then summarized and appraised based on the type of study. The recommendations were then developed by the team as the initial draft that was subjected to external review and consensus panel discussion for finalization.
Outpatients ; Dyspnea ; Primary Health Care

While the definition of EBM can be straightforward in other medical field, family and community medicine practitioners take on very different roles in different health systems. Despite the challenges presented, EBM is still necessary in family and community practice. Family and community medicine practitioners must be able to obtain, assess, apply and integrate new knowledge based on available evidence throughout their professional life. From the definition of EBM and the nature of family practice described previously, we propose to define “Evidence-based Family Practice as the conscientious and judicious use of the current, relevant, applicable and best available evidence in making shared clinical decisions for patient care. Such decisions must account for the capacity and setting of the family practitioner and patient preference”. The proposed steps are: 1) Framing the Clinical Problem, 2) Searching for the Evidence, 3) Critical Appraisal, 4) Informing the Patient About the Evidence, 5) Shared Decision Making, and 6) Evaluation of the Decision.
Evidence-Based Medicine ; Evidence-Based Practice