Browsing by Author "Rajapakshe, N.N."

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Do traumatic life events predispose children to develop constipation?
(Lippincott Williams & Wilkins, 2015) Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.
BACKGROUND: The aetiology of functional constipation (FC) in children is not been fully understood. Exposure to physical, emotional and sexual abuse are known to predispose children to develop FC. No paediatric study has evaluated traumatic life events other than abuse as a potential predisposing factor for FC in children. We aimed to assess the association between traumatic life events and development of FC in children. METHODS: We conducted a cross sectional, school based study. Children aged 13-18 years were selected from four semi-urban schools in the Gampaha district, Sri Lanka. A validated, self-administered questionnaires were used for collect data on functional gastrointestinal disease and traumatic life events. FC was defined using the Rome III criteria. RESULTS: A total of1792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years, SD 1.3 years years]. Out of them, 138(7.7%) had FC. Prevalence of FC was significantly higher in those exposed to traumatic life events compared to controls (53.6% vs.32.9%,p < 0.0001). Traumatic life events such as parents living separately (13.4% vs. 7.12%,p = 0.038), living in a boarding house (10.1% vs. 1.6%, p = 0.049), liquor abuse by parents (14,8% vs. 6,3%, p < 0.0001), witnessing a murder (16.7% vs. 3.9%, p = 0.002), child labour (13.9%vs. 7.3%, p = 0.02) and ill-treated by parents (27.5% vs. 7.3%, p < 0.0001) were shown to predispose children to develop FC. Parental substance abuse (12.8% vs. 7.4%), domestic violence (14.8 vs. 7.5%) were not associated with FC (p > 0.05). CONCLUSIONS: FC is associated with childhood traumatic experiences. This provides further insight into how traumatic childhood events are associated with development and perpetuation of FC in children.
Prevalence of functional constipation in infants and toddlers in Sri Lanka.
(Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.
OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.
A randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy
(Sri lanka Medical Association, 2015) de Silva, A.P.; Nandamuni, Y.; Rajapakshe, N.N.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Colonoscopy can cause discomfort and anxiety in patients. Heavy sedation as premedication can lead to complications in elderly and those with co-morbidities. This has led to possible use of audio-visual distraction during the procedure. We compared effects of audio versus visual distraction in reducing discomfort during colonoscopy. METHOD: 131 consecutive patients who underwent colonoscopy were randomized into three groups: allowed to listen to music of their choice during colonoscopy (AD), allowed to watch a film of their choice (VD) and neither as control (C). Patient controlled sedation (PCS) was administered to all three groups; 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of 'top-ups' of sedation, total dose of pethidine and midazolam and patient cooperation and willingness for a repeat procedure. RESULTS: There were 131 patients (AD=43; VD=44; O44). The AD group had significantly less pain and discomfort (p=0.033) compared to VD and Cgroups. There was no significant difference in number of 'top-ups' of sedation, total doses of pethidine and midazolam among the groups. Better patient cooperation (p=0.002) was evident in ADgroup compared with VD and C groups. There was nt> difference between the AD and VD groups in willingness to undergo a repeat procedure. CONCLUSION: Listening to music of your choice during colonoscopy seems to reduce pain and discomfort and increase the patients' cooperation. This may be a useful and simple tool in screening colonoscopy.