Browsing by Author "Peiris-John, R."

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Accumulation of toxic metals in ectopic endometrial tissue
(Sri Lanka Medical Association, 2011) Silva, N.; Senanayaka, H.; Peiris-John, R.; Wickremasinghe, R.; Waduge, V.
INTRODUCTION AND OBJECTIVES: Aim of this study was to determine the association between heavy metals and endometriosis. METHODS: A case-control study was conducted in a tertiary care hospital comparing 50 cases of endometriosis with 50 age matched controls confirmed by laparoscopy or laparotomy. Blood samples and ectopic endometrial tissue samples were obtained and digested with supra pure 65% HNO3. Samples were analysed for cadmium by graphite furnace atomic absorption spectroscopy (GFASS). In a subset of cases (n=30) and controls (n=40) samples were analyzed for nickel, lead and zinc by Total Reflection X-ray Fluorescence (TXRF) technique. T-tests and Spearman's correlation coefficient were used for analysis. RESULTS: Cases had significantly higher (p=0.011) mean (+SD) blood nickel levels (1.69+1.18 ug/1) as compared to controls (0.96+0.94 ug/1). Blood levels of cadmium (0.75±0.46 ug/I vs 0.77 ±0.37 ug/1) lead (5.8S±1.25 ug/1 vs 3.45±1.25 ug/1) and zinc (123.02±2.49 ug/1 vs151.35 ±2.46 ug/1) were similar in the two groups (p=0.289, p=0.123s and p=0.339, respectively). Tissue samples had significantly higher (p=0.001, p<0.001, p=0.049 respectively) mean (+SD) levels of cadmium (2.86±0.61 ug/1 vs 0.8±0.48 ug/1) nickel (8.64±0.4.12 ug/Lvsl.58±1.21ug/l) and lead (11.22±4.67 ug/1 vs 5.86±3.38 ug/1) compared to blood levels. Mean (+SD) blood levels of zinc (117.48 ±2.64 ug/1) was higher (p<0.001) than that in tissues (27.54±6.65 ug/1). There was a positive correlation between blood zinc levels and tissue zinc levels (r=0.417;p= 0.034) but there was no correlation between blood and tissue levels of cadmium, nickel and lead (r=0.237,p=0.085; r=0.372,^=0.113; r=0.70,/?=0.067, respectively). CONCLUSIONS: Cadmium, nickel and lead but not zinc accumulate in ectopic endometrial tissue.
The Alcohol marketing policy environment and adolescent drinking in Sri Lanka: A qualitative exploration of stakeholder perspectives
(Wiley-Blackwell, 2022) Athauda, L.; Peiris-John, R.; McCool, J.; Wickremasinghe, R.; Ameratunga, S.
ABSTRACT: Adolescents continue to be exposed to alcohol marketing, despite the existence of alcohol control policies in Sri Lanka. National-level policies restrict all forms of alcohol advertising, promotions, and sponsorship and sale to minors. The act calls for the need to protect children and adolescents from exposure to the harm of alcohol. This article investigates stakeholders' perceptions of the alcohol marketing policy environment in Sri Lanka, with a specific focus on policies designed to prevent or curtail adolescent drinking. Between May and July 2019, in-depth interviews were conducted with policy stakeholders in Colombo, Sri Lanka. Thematic analysis was conducted on the audio-recorded interviews that were transcribed and translated and imported to NVivo12. Fifteen policy stakeholders from government and nongovernment organizations participated in this study. The overarching theme identified a lukewarm alcohol marketing policy environment. This situation was facilitated by the alcohol industry acting as the vector, an amber light approach towards public health programs, and other factors contributing to the perceived ineffectiveness of the alcohol marketing policy environment. A unified public health approach supported by policy and political commitment may pave the way for better alcohol control in Sri Lanka.
Association between heavy metals and endometriosis
(Sri Lanka Medical Association, 2010) Silva, N.L.; Senanayaka, H.; Peiris-John, R.; Wickremasinghe, R.; Waduge, V.
OBJECTIVE: To determine the association between heavy metal concentrations in whole blood and ectopic endometrial tissue in endometriosis. METHODS: A case-control study was conducted in a tertiary care hospital. Endometriosis was confirmed by laparoscopy or laparotomy in 14 patients, There were 11 age-matched controls with no evidence of the disease. Informed written consent was obtained pre-operatively. Blood samples were collected from all participants. In 10 patients ectopic endometrial tissue samples were obtained by a single surgeon. After measuring the wet weight, whole blood samples and ectopic endometrial tissues were digested with supra pure 65% HNO3 and analysed for heavy metals by the Total Reflection X-ray Fluorescence (TXRJF) technique in parts per billion (PPB). Means of the log transformed metal levels were compared using t-tests. RESULTS: Mean (+SD) blood levels of nickel in the cases (2.19±0.45 PPB) was significantly higher than in the controls (0.65±0.14 PPB, p =0.029). The mean (+SD) lead levels in the cases (21.85±1.99 PPB) and controls (17.85 ±1.5 PPB) were similar (p=0.378). Tissue samples had higher mean (+SD) levels of nickel (9.3±15.31 PPB) and lead (66.60±10.37 PPB) as compared to blood levels of nickel (0.502±0.406 PPB) and lead (18.16 ± 1.58 PPB) which were statistically significant (p=0.003 and p=0.025 respectively). CONCLUSIONS: Patients with endometriosis had higher levels of nickel, which is known to exert oestrogenic effects. There is evidence that nickel accumulates in endometrial tissues.
Association between heavy metals and endometriosis; results of a preliminary study
(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Senanayake, H.; Peiris-John, R.; Wickremasinghe, A.R.; Wadugtf, V.
OBJECTIVE: To determine the association between heavy metal concentrations in whole blood and ectopic endometrial tissue in endometriosis. DESIGN, SETTING, METHODS: A case-control study was conducted in a tertiary care setting to compare heavy metal concentrations in whole blood among those with and without endometriosis. Endometriosis was confirmed by laparoscopy or laparotomy (n=14). There were 11 age matched controls who had no evidence of the disease. Informed written consent was obtained pre-operatively. Blood samples were collected from all participants. Ectopic endometrial tissue samples were obtained from 10 cases by a single surgeon. After measuring the wet weight, whole blood samples and ectopic endometrial tissues were digested with supra pure 65% HNO3 and analyzed for heavy metals by the Total Reflection X-ray Fluorescence (TXRF) technique. Means of the log transformed metal levels were compared using t-tests. RESULTS: Mean (+SD) blood levels of nickel in the cases (2.19±0.45 PPB) was significantly higher than in the controls (0.65±0.14 PPB, p=0.029). The mean (+SD) lead levels in the cases (21.85±1.99 PPB) and controls (17.85 ±1.5 PPB) were similar (p=0.378). Tissue samples had higher mean (+SD) levels of nickel (9.3±15.31 PPB) and lead (18.16 ±1.58 PPB) as compared to blood levels of nickel (0.502±0.406 PPB) and lead (66.60+10.37 PPB), respectively, which were statistically significant {p<0.05 for both nickel and lead). CONCLUSIONS: Nickel is known to exert oestrogenic effects. Patients with endometriosis had higher levels of nickel; there is evidence that nickel accumulates in endometrial tissues. Further studies with a larger sample size are needed to determine if nickel is an aetiological factor of the disease in our population.
Cadmium a metalloestrogen: are we convinced?
(Wiley, 2012) Silva, N.; Peiris-John, R.; Wickremasinghe, R.; Senanayake, H.; Sathiakumar, N.
Metalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen-dependent diseases such as cancers of the breast and endometrium as well as endometriosis. Cadmium is one of the most studied metalloestrogens. In this review, scientific evidence for the oestrogenic effects of cadmium is critically evaluated to determine if there is sufficient evidence to support cadmium as an aetiological factor of oestrogen-dependent disease in humans. Results of the review indicated that, although the in vitro and in vivo evidence of the oestrogenic properties of cadmium was persuasive, evidence from population-based human studies remains conflicting. Considerable knowledge gaps exist on the potential oestrogenic effect of cadmium in humans. Research that focuses on bridging these knowledge gaps would be useful in preventing and managing oestrogen-dependent disease in humans
Capacity building in environmental and occupational health in Sri Lanka
(Wiley-Blackwell, 2013) Wickremasinghe, A.R.; Peiris-John, R.; Nandasena, S.; Delzell, E.; Tipre, M.; Sathiakumar, N.
BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country .CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.
Demographic, biological and dietary characteristics associated with endometriosis in a group of Sri Lankan women
(Sri Lanka College of Obstetricians and Gynaecologists, 2011) Silva, N.; Senanarake, H.; Peiris-John, R.; Wickremasinghe, R.
OBJECTIVE: To identify demographic, biological and dietary factors associated with endometriosis in a group of Sri Lankan women. METHODS: A case-control study was conducted at two tertiary care hospitals. Women with endometriosis (n=150) were compared with age-matched controls (n=150) with no evidence of endometriosis, both confirmed by laparoscopy or laparotomy. Data were collected using an interviewer-administered questionnaire and a food frequency questionnaire. Means were compared using paired t-tests and chi square tests and odds ratios (OR) were used to determine associations between dichotomous variables. Conditional logistic regression analysis was done to adjust for potential confounding variables. RESULTS: The ethnic distribution, age at menarche, average length of the menstrual cycle and body mass index were similar in the two groups. The mean (+SD) duration of menstruation in the cases (4.11±0.11 days) was significantly higher than in the controls (3.47±0.16 days, p=0.01). Endometriosis was commoner among those with regular menstrual cycles (OR=3.108; 95% CI=1.473-9.627) and those having an education above Advanced Level (OR=1.729; 95% CI=1.041- 2.87). None of the food items was significantly associated with endometriosis. The risk of endometriosis was 2.084 times greater among those with an education above Advanced Level as compared to those having an education below Advanced Level (p=0.021) after adjusting for confounding factors. CONCLUSION: Among Sri Lankan women, endometriosis is commoner among those who are more educated.
Factors influencing alcohol use among adolescents in South Asia: A Systematic review
(Piscataway, NJ, 2020) Athauda, L.K.; Peiris-John, R.; Ameratunga, S.; McCool, J.; Wickremasinghe, R.
OBJECTIVE: Alcohol is the leading cause of disability-adjusted life years among 15- to 19-year-olds globally; yet, social and structural determinants of alcohol use among adolescents in low- and middle-income countries are largely unknown. Given that a quarter of the global adolescent population lives in South Asia, this systematic review aims to identify factors influencing alcohol use among 10- to 19-year-olds living in South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka). METHOD: We systematically searched eight databases (SCOPUS, MEDLINE, EMBASE, CINAHL Plus, Cochrane Library, PsycINFO, AMED, EBSCO Host), gray literature, and relevant websites for studies reporting influences at psycho-individual, family, school, peer, neighborhood, or country levels. QATSDD (Quality Assessment Tool for Studies with Diverse Designs) was used for quality assessment. The study protocol was registered with PROSPERO (CRD42017084773). RESULTS: Twenty-three studies were eligible for inclusion. Male gender, age greater than 14 years, depression, religious belief, parental/family members' drinking, reduced parental attention, peer-drinking/pressure/approval, and urban neighborhood were associated with increased risks of adolescent drinking. No information was available from Afghanistan, Bhutan, Bangladesh, Pakistan, and Maldives. There is little evidence available on the determinants at a national (legislature, industry, and media), school, and personality level. CONCLUSIONS: The distal determinants of alcohol use among adolescents living in South Asia are largely unknown. As adolescent drinking behaviors change in response to social media and industry influence, more evidence is needed to reflect the South Asia context.
Fetal effects of environmental exposure of pregnant women to organophosphorus compounds in a rural farming community in Sri Lanka
(Informa Healthcare, 2008) Samarawickrema, N.; Pathmeswaran, A.; Wickremasinghe, R.; Peiris-John, R.; Karunaratna, M.; Buckley, N.A.; Dawson, A.; de Silva, J.
BACKGROUND: The possible deleterious effects of low-grade, chronic environmental and occupational exposure to organophosphorus compounds (OPCs) are not well documented. OBJECTIVE: To investigate the possible effects of low-level, chronic exposure of pregnant mothers to OPCs on the fetus by measuring OPC levels, and using markers of OPC exposure, oxidative stress and oxidative tissue damage. METHODS: Toxicity was assessed by measuring (i) OPC levels in breast milk and plasma from maternal and cord blood using gas chromatography, (ii) maternal and fetal butyrylcholinesterase (BChE) activity using inhibition assays, (iii) antioxidant status of the fetus using superoxide dismutase activity assays, (iv) oxidative stress in the fetus by determining malondialdehyde (MDA) concentrations, and (v) examining for fetal DNA fragmentation using electrophoresis. Samples were obtained from consenting mothers living in a farming community in southern Sri Lanka at the end of the pesticide spray season (study group) and just before the commencement of the spray season (in-between spray season; control group). RESULTS: Organophosphate residues were detected in only two subjects (chlorpyrifos in maternal and cord blood of one during the spray season and dimethoate in breast milk of another during the in between spray season), but the test employed was capable of only detecting concentrations above 0.05 mg/l. However, cord blood obtained during the spray season showed significant inhibition of BChE activity, increased oxidative stress and more DNA fragmentation when compared with cord blood obtained during the in-between spray season. CONCLUSIONS: Inhibition of cord blood BChE activity indicates fetal exposure to organophosphorus compounds during times when there is a high probability of environmental drift. This provides a plausible explanation for the increased oxidative stress and high DNA fragmentation in the fetus. Long-term outcomes of such exposures are unknown.
Perceived travel constraints of older people and people with disabilities in the Colombo district: A qualitative research study
(Sri Lanka Medical Association, 2018) Thennakoon, V.; Peiris-John, R.; Wickremasinghe, R.; Amerathunga, S.
INTRODUCTION AND OBJECTIVES: Supportive transport systems allow people to maintain quality of life and meaningful participation in the society. Risks for safe transportation for vulnerable road users such as older people and people with disabilities affect their health and well-being. This study explored perceived risks relating to road safety and challenges for safe transportation among older people and people with disabilities in the Colombo district. METHODS: The community-based qualitative research study involved eight focus group discussions conducted older people (60 years and above) and disabled people (physical, sensory, learning impairment; 12 years and above). Transcribed discussions were coded thematically using NVivo 11. RESULTS: The transport challenges perceived by participants included poor road infrastructure, lack of disability-friendly transport services, negative attitudes of people, psycho-social factors and lack of opportunities to voice transport challenges. Suggestions for mitigating perceived risks included improved infrastructure facilities and user-friendly services, awareness programs for service providers and public, greater visibility of these groups in policy frameworks and effective law enforcement. CONCLUSION: The travel experiences of older people and people with disabilities indicated the need for improved road engineering designs, age-and disability- friendly transport modes and rigorous legislative enforcement. To ensure equitable opportunities and well-being of older people and people with disabilities, it is also imperative to foster meaningful relationships and positive societal attitudes towards them.
Prevalence and determinants of Low Back Pain (LBP) among nurses in different health care units in four hospitals in Colombo, Sri Lanka
(University of Kelaniya, 2013) Warnakulasuriya, S.S.P.; Peiris-John, R.; Sivayogan, S.; Sathiakumar, N.; Coggan, D.; Wickremasinghe, A.R.
Introduction: Hospitals are complex systems that rely on nursing care in diverse care settings where many nursing job tasks are physically and psychologically demanding. In healthcare, the highest prevalence of Low Back Pain (LBP) is reported among nurses. There is little information regarding its prevalence and the determinants. Objectives: To determine the prevalence of LBP among nurses in diverse care settings in hospitals and its association with work-related psychosocial and ergonomic risk factors. Method: This analytical cross sectional study comprised 862 female nurses sampled from two teaching hospitals and two base hospitals in the Colombo district. Information on regular physical activity and work-related ergonomic and psychosocial stress factors were collected using a pre-tested self administered questionnaire. Descriptive statistics used to determine the prevalence and associations of risk factors with pain symptoms were assessed by logistic regression analysis adjusting for age, and summarised by odds ratios (ORs) with associated 95% confidence intervals (CIs). Results: The response rate was 70% (n=602). The overall prevalence of LBP among nurses during the past 12 months was 38% (n=229), in nurses in teaching hospitals being 40% and in nurses in base hospitals being 31%. Among the patient care units/wards, nurses in ICU had the highest prevalence of LBP (35%); the lowest prevalence was among nurses in pediatric wards (4.4%). Factors significantly associated with LBP were BMI> 25 (overweight) (OR 1.85; 95% CI 1.20-2.84), working in the ICU (OR 1.55; 95% CI 1.06-2.25), time pressure to complete tasks (OR 1.55; 95% CI 1.10-2.19), perception of poor general health (OR 1.95; 95% CI 1.12-3.38), and history of an accident (OR 1.80; 95% CI 1.17-2.78). Conclusions: Personal, work-related ergonomic and psychosocial factors were significantly associated with LBP among nurses. These need to be taken into consideration when planning strategies to reduce LBP among nurses.
Transport equity in Sri Lanka: Experiences linked to disability and older age
(Elsevier Ltd, 2020) Tennakoon, V.; Wiles, J.; Peiris-John, R.; Wickremasinghe, R.; Kool, B.; Ameratunga, S.
INTRODUCTION: Transport, a well-recognised determinant of health, is particularly salient to well-being and equitable health outcomes amongst older people and people living with disabilities living in low-and middle-income countries. This study explored the facilitators and barriers for safe and accessible transportation from the perspectives of older people and those living with disabilities in Sri Lanka. METHODS: The community-based qualitative research study involved eight focus group discussions conducted among older people (60 years and above) and people living with disabilities (physical, sensory, learning impairment; aged 12 years and above) in the Colombo district, Sri Lanka. Thematic analysis was used to analyse data. RESULTS: The transport challenges perceived by participants were multi-faceted and often inter-related. Participants identified barriers embedded in the built environment and transport infrastructure, such as poorly designed road systems and public vehicles, unsatisfactory services, lack of representation in road development programs, reduced opportunities for meaningful participation in the society and negative attitudes of the general public, as limitations for safe and accessible transportation. Poverty exacerbated the transport inequities experienced by the participants, affecting their quality of life and well-being. CONCLUSIONS: The study findings indicate the need for a national policy and legislative reforms that prioritise age- and disability-inclusive transport systems and infrastructure, and accessible and affordable transport modes in Sri Lanka. To ensure equitable opportunities and wellbeing, it is also imperative to foster meaningful relationships and positive societal attitudes towards older people and those living with disability. © 2020 Elsevier Ltd