Browsing by Author "Gunathilake, R."

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    Non-adherence to chelation therapy and associated psychosocial factors among transfusion-dependent thalassaemia patients in Kandy, Sri Lanka
    (Sri Lanka College of Paediatricians, 2021) Baminiwatta, A.; Gunathilake, R.; Arambepola, S.; Arambepola, M.
    BACKGROUND: Poor adherence to iron chelation may underlie the detrimental levels of iron overload previously reported among transfusion-dependent thalassaemia (TDT) patients in Sri Lanka. Given the many challenges faced by these patients and families, psychosocial factors may have a significant impact on medication adherence. OBJECTIVE: To assess chelation adherence among TDT patients and explore associated psychosocial factors. METHOD: TDT patients, aged over 4 years, admitted for blood transfusion to a tertiary care hospital, as well as their mothers, were recruited. Medication adherence was assessed using a questionnaire adapted from Brief Adherence Rating Scale. Serum ferritin (SF) values were recorded as objective measures of non-adherence. Mental health status of patients and their mothers was assessed using Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire-30 (GHQ) respectively. Associated psychosocial factors were analysed using multiple linear regression. RESULTS: Fifty-two patients aged 4 to 28 years participated. Thirty-four (65%) were female. The average adherence rate was 90%. One fifth of patients had an adherence percentage less than 80%. The mean ferritin level was 3260 ng/ml, whereas 46.2% of patients had SF levels exceeding 2500ng/ml. SF levels correlated positively with non-adherence (r=0.34, 95%CI: 0.071-0.606, p=0.014). Based on multivariate analysis, increasing age and lower SDQ score of patient, lower educational level and greater GHQ-30 score of mother were independent predictors of higher SF levels, but not of adherence rates. CONCLUSIONS: In the paediatric unit of National Hospital, Kandy, 46% of patients had SF levels >2500 ng/ml. There was a significant correlation between SF levels and medication non-adherence (r=0.34, p=0.014). On multivariate analysis, increasing age and lower SDQ score of the patient, lower educational level and greater GHQ-30 score of the mother were independent predictors of higher SF levels, but not of adherence rates.
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    Remarks documented on medico-legal examination forms on sexual abuse cases; are they properly comprehended by the police?
    (College of Forensic Pathologists of Sri Lanka, 2013) Kitulwatte, I.D.G.; Rajapaksha, W.R.A.S.; Edirisinghe, P.A.S.; Perera, W.N.S.; Wijerathne, N.A.S.P.; Sihanada, A.A.S.; Bulathsinhala, B.A.A.R.; Gunathilake, R.
    INTRODUCTION: Expert medical evidence is widely used in sexual abuse cases, but its contribution to the progress of legal cases is unclear. Poor understanding of the remarks given by the medical officers in a Medico Legal Examination Form (MLEF) in alleged sexual abuse cases by the police officers may affect effective administration of justice. OBJECTIVE: This study is mainly aimed at assessing the degree of understanding by the police officers’ when reading three commonly expressed medico-legal remarks in cases of alleged sexual abuse. Secondly, to identify the areas of poor understanding, for which interventions need to be carried out. STUDY DESIGN: Cross sectional descriptive study was conducted among 64 police officers, in the rank of police constables and sergeants from western province, who are attending to routine work of a police station (criminal investigations, children and women’s desk and traffic unit). Data collection was done by self administered questionnaire after a briefing regarding the study and instructions on how to fill the questionnaire. RESULTS: 72% of the officers believed that they understood the statements written on Medico-Legal Examination Form (MLEF) when it is in native language while only 32% believed so for statements in English. However the analysis of the correct responses revealed that only 28.9% of officers understood the exact meaning in native language while it was 10.4% for English. The understanding about the statement on absence of medical evidence to confirm or exclude the allegation when given in Sinhala was 26.6% while it was 10.9% in English. The statement on evidence of vaginal penetration has been correctly understood by 20.3% in Sinhala while it is 7.8 % in English. CONCLUSION: Statements made in native language are approximately three times better understood than the ones made in English. However, overall understanding of the remarks made by doctors was very poor. It is high time we take necessary actions to intervene if our goal is effective administration of justice.