Browsing by Author "Wickremasinghe, A.R."

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ABO-blood-group types and protection against severe, Plasmodium falciparum malaria
(Academic Press, 2005) Pathirana, S.L.; Alles, H.K.; Bandara, S.; Phone-Kyaw, M.; Perera, M.K.; Wickremasinghe, A.R.; Mendis, K.N.; Handunnetti, S.M.
Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice
(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.
INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.
Adolescent pregnancy: maternal weight effects on fetal heaviness: possible route to improved outcomes
(Human Sciences Press, 1991) Cherry, F.F.; Rojas, P.; Sandstead, H.H.; Johnson, L.K.; Wickremasinghe, A.R.; Ebomoyi, E.W.
In a previous report of a zinc supplementation trial in pregnant adolescents zinc effect varied according to maternal weight (wt) status--normal (90-110% of expected wt), light or heavy, prompting this analysis of effects of wt status and gestational wt gain on fetal heaviness relative to length and gestational age (GA) and other pregnancy outcomes. One-third of adolescents shifted in or out of normal wt by delivery, creating seven outcome groups--light-light, light to normal, normal to light, normal-normal, normal to heavy, heavy to normal, and heavy-heavy. These wt class change groups varied significantly as to intrauterine growth (SGA, low AGA, high AGA, and LGA); by weekly grams gain per cm height (ht), birth wt, infant wt/length ratio, and occurrence of low birth wt (LBW). Infants with above average intrauterine growth had an advantage in: absolute size, length of hospital stay, rates of LBW, fetal demise, rates of low Apgar score, and "other" complications. This association between intrauterine growth and maternal wt class change suggests that promotion of wt gain might lower rates of LBW. Birthwt varied by quartiles of weekly wt change (gm) per cm ht in women grouped by their percent of expected wt: in the lowest quartile (Q1) only one group in seven reached average Bwt (3025 grams); with Q4 gain all groups did. Thus, the parameter wt gain/wk/cm ht deserves study as a tool for monitoring wt status and gain to identify those pregnant adolescents in greatest need for nutritional counseling and to set wt gain goals.
Adolescent pregnancy: zinc supplementation and iron effects
(Wiley-Blackwell, 1993) Cherry, F.F.; Sandstead, H.H.; Wickremasinghe, A.R.
No Abstract Available
Adolescent pregnancy; weight and zinc supplementation effects
(Wiley-Blackwell, 1993) Cherry, F.F.; Sandstead, H.H.; Wickremasinghe, A.R.
No Abstract Available
Aetiological factors of oral cancer in Sri Lanka
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Ariyaratne, M.A.Y.; Wickremasinghe, A.R.
OBJECTIVE: To determine aetiological factors of oral cancer in three provinces in Sri Lanka DESIGN, SETTING AND METHODS: A matched case-control study on incident cases of oral cancer and age-sex matched neighbourhood controls was conducted in three provinces of Sri Lanka. Risk factors were analysed using matched pair analyses and conditional logistic regression. RESULTS: Among 658 subjects (329 pairs) [males= 82.1%, mean age = 61.6 (30=12.2) years], a higher monthly income, regular betel chewing, age at starting chewing, duration of a chew, retaining the quid in the mouth at night, regular smoking, duration of smoking, amount smoked daily, type of smoke used, regular alcohol consumption and amount of illicit liquor consumed daily were significantly associated with oral cancer on bivariate analysis. Past history of cancer, family history of cancer and family history of cancer of head and neck were also associated with oral cancer. A higher income (OR=0.65; 95% CI 0.44-0.96) and high consumption of raw fruits (OR=0.64; 95% CI 0.46-0.89) were protective. Regular betel chewing (OR=1.94; 95% CI 1.23-3.07), retaining the quid in the mouth at night (OR=20.45; 95% CI 7.23-57.89), consumption of illicit liquor (OR=4,65; 95% CI 2.49-8.71) and the amount smoked per day (OR=1.04 95% CI 1.01-1.07) were significantly associated with oral cancer on multivariate analysis. CONCLUSIONS: Betel chewing is the most important determinant of oral cancer. Retaining the quid in the mouth should be discouraged. The importance of family history demands for preventive programmes for family members of patients.
Age, sex and hyperlipidemia: Is it a simple association?
(College of Community Physicians of Sri Lanka, 2009) Pathmeswaran, A.; Pinidiyapathirage, J.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: Hyperlipidemia is a known cardiovascular disease risk factor. There are effective lifestyle, dietary and pharmacological interventions to treat hyperlipidemia. It is important to target testing for hyperlidemia for the most appropriate age sex groups to optimize resource utilization. Identifying such groups is not easy when there is an interaction between age and sex. OBJECTIVE: To describe the association between age, sex and hyperlipidemia among 35 to 64 year old residents of Ragama. METHODS: Residents aged 35-64 years in the Ragama MOH area were randomly sampled from the voters list after stratification into 10 year age groups. Blood for lipid profile was collected after a 14 hour overnight fast for analysis. Bivariate and multiple logistic regression were performed using Stata 8.2. Results are expressed as odds ratios and relevant 95% confidence intervals (OR; 95% Cl). RESULTS: Total sample analysed was 2987; 45% (n=1338) were males, 17% (n=515), 38% (n=1140) and 45% (n=1332) were in the age groups of 35-44, 45-54 and 55-64 years respectively. The prevalence of hyperlipidemia was 36%. In bivariate analysis, females (OR 1.3; 95% Cl 1.1-1.5) and the age groups of 45-54 (OR 1.7; 95% Cl 1.3-2.1) and 55-64 years (OR 1.5; 95% Cl 1.2-1.9) when compared to 35-44 years were at a higher risk of hyperl[pidaemia . In multiple logistic regression too females (OR 1.2; 95% Cl 1.1-1.4) and the same age groups ( 45-55 [OR 1.7; 95% Cl: 1.3-2.1] and 55 to 64 years OR 1.5; 95%CI: 1.2-1.9) respectively) had higher risk of hyperlipideamia. When an age sex interaction term was added to the above model, 35-44 year old females had the lowest risk. In comparison to the latter, the OR (95%CI) of females of 45-54 and 55-64 years were 2.4(1.8-3.4) and 2.8(2.1-3.9) respectively. The same for males of 35-44, 45-54, and 55-64 years were 2.0(1.3-2.9), 2.3(1.6-3.2) and 1.5(1.1-2.1) respectively. CONCLUSION: The risk of hyperlipidemia increased with increasing age among females but among males the lowest risk was in the 55-64 year age group. Attempts to portray a simple picture are likely to obscure important details and may even be misleading.
Age, sex variation among patients treated with percutaneous transluminal coronary angioplasty (PICA) in Sri Lanka: a retrospective study
(Sri Lanka Medical Association, 2014) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Hettiarachchi, V.S.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Coronary heart diseases (CHD) remain a major cause of death worldwide, ft is a growing burden for the Sri Lankan health sector. Age and sex has been identified as risk factors for CHD. The private health sector contributes significantly to curative care of CHD. The aim of this study was to determine the variation of age and sex of patients who have been treated with PTCA during the last decade at a private hospital in Colombo. METHODS: A retrospective study was conducted on patients treated with PTCA in a private hospital in Colombo from 2003 to 2013. Details of patients were extracted from medical records and age and sex variations were analyzed. RESULTS: 4578 patients (3315 men; 72.4%) were included. There was significant reduction in mean age at PTCA from 2003 to 2013 (p<0.01). Overall it had declined from 56.4 years (SD=10.5) in 2003 to 50.9 years (SD=12.4) in 2013. From 2003 to 2013 the mean ages of men had reduced by 7 years (p<0.01), while in females the mean age had reduced by 2.2 years (p<0.01) Male to female ratio was 2.58 in 2003 and 2.45 in 2013- Linear regression analysis showed that with each increment year the age at PTCA reduced by 0.54 years (95%Ci =0.64 to -0.44). CONCLUSIONS: Higher proportions of patients were men. Age at PTCA had decreased in both males and females. But sex ratio of patients had not significantly changed during the last decade.
Air pollution and health in Sri Lanka: a review of epidemiologic studies
(BioMed Central, 2010) Nandasena, Y.L.S.; Wickremasinghe, A.R.; Sathiakumar, N.
BACKGROUND: Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoor and indoor air pollution, and health effects are important to identify the burden, develop and implement interventions and to fill knowledge gaps in Sri Lanka.METHODS: PUBMED and Medline databases, local journals and conference proceedings were searched for epidemiologic studies pertaining to air pollution and health effects in Sri Lanka. All the studies pertaining to air pollution and health effects were considered. RESULTS: Sixteen studies investigated the association between exposure to ambient or indoor air pollution (IAP) and various health outcomes ranging from respiratory symptoms, low birth weight and lung cancers. Of the sixteen, three used a case control design. Half of the studies collected exposure data only through questionnaires. There were positive associations between air pollution and adverse health effects in all studies. Methodological limitations in most of the studies resulted in poor quantification of risk estimates. CONCLUSION: A limited number of epidemiological studies in Sri Lanka have investigated the health effects of air pollution. Based on findings of studies and reported air quality levels, air pollution may be considered a neglected public health problem in Sri Lanka.
Air pollution and public health in developing countries: Is Sri Lanka different?
(College of Community Physicians of Sri Lanka, 2012) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.
Indoor and outdoor air pollution is a major public health challenge in developing countries and much concern has been raised among policy makers, public health experts, clinicians, and the general public in recent years. A spectrum of health outcomes has been shown to be associated with exposure to air pollution in epidemiological studies and by laboratory investigations. It is estimated that indoor air pollution resulting from exposure to solid fuel accounts for over 1.5 million premature deaths and 38.5 million Disability-Adjusted Life Years. Globally, it is estimated that outdoor air pollution accounts for over 800,000 premature deaths and 6.4 million years of life lost; of these numbers, 65% is from Asia alone. There is emerging evidence that the actual burden is much larger than the estimated values. The World Health Organization has estimated the number of deaths attributable to indoor air pollution and outdoor air pollution in Sri Lanka to be 4200 and 1000 deaths, respectively. Although country information is limited, a few epidemiological studies gives us the opportunity to understand and compare the Sri Lankan situation vis a vis other countries. This includes the 16 epidemiological studies identified by a scientific review in 2010 and several other published studies and preliminary data from ongoing studies.
Alanine Transaminase (ALT) levels in normal adult Sri Lankans
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.; Kalubowila, U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND : Alanine transaminase (ALT) levels are widely used in screening for liver disease.The upper limit of normal (ULN) of ALT (males 30 IU/l, females 19 IU/l) have been definedfor western populations. Normal levels have not been established for Asian populations. OBJECTIVES: To establish levels of ALT for a normal, adult Sri Lankan population METHODS: This study was part of a community based investigation - Ragama Health Study (RHS). The study population consisted of 35-64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, liver ultrasound and collection of 10 ml venous blood. The “normal” population was defined as those not using potentially hepatotoxic drugs, safe alcohol consumption (14 units/week for males, 7 units/week for females), absence of fatty liver, and being HBsAg and anti-HCVab negative. ALT levels were estimated by a kit using the Bergmeyer method. The 95th percentile of the ALT levels was taken as the ULN. RESULTS: 3012 subjects participated in the study. The ALT level (U/l) among 831 normal males (mean 36, median 30, SD 20, ULN 68) was significantly higher than that of the 885 normal females (mean 29, median 25, SD 13, ULN 53) (p<0.001,Student's t-test ). CONCLUSION: The ULN for ALT levels of a “normal” Sri Lankan population was higher than observed in western populations. The levels were higher in males. ULN for ALT may need to be redefined for different population groups.
Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka
(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.
Anopheline breeding in river bed pools below major dams in Sri Lanka
(Elsevier, 2006) Kusumawathie, P.H.D.; Wickremasinghe, A.R.; Karunaweera, N.D.; Wijeyaratne, M.J.S.; Yapabandara, A. M. G. M.
Anopheline mosquito larval surveys were carried out from September 2000 to August 2002 in Mahaweli and Kelani river beds, below five major dams in the wet and intermediate zones of Sri Lanka, to study the prevalence of anopheline species in these areas. In each study site, all permanent and semi-permanent pools were surveyed fortnightly by dipping at 6 dips/m(2) surface area of water. Larvae were collected in separate containers, staged and identified at their third and fourth stages. During each survey, the surface area and depth of pools were recorded and each reading was considered as an individual observation. River bed pools below the dams contained stagnant clean water with a little or no aquatic vegetation. The majority of pools were < or =1m(2) in surface area and < or =75 cm in depth. Anopheline mosquito breeding was seen throughout the year in each study site. The average percentage of pools positive for anopheline larvae, the number of larvae per 100 pools and 100 dips were 14.85%, 32.34 and 9.29, respectively. Thirteen anopheline species, including 10 potential vectors, namely, An. barbirostris, An. culicifacies, An. jamesii, An. maculatus, An. nigerrimus, An. peditaeniatus, An. subpictus, An. tessellatus, An. vagus and An. varuna were found breeding in the river bed pools.
Antenatal care provided and its quality in field clinics in Gampaha district, Sri Lanka
(SAGE Publishing, 2007) Pinidiyapathirage, M.J.; Wickremasinghe, A.R.
A descriptive cross-sectional study was carried out in the Gampaha District in Sri Lanka to assess the quality of care provided at antenatal field clinics. Checklists were used to assess the structure and process attributes of quality. An interviewer administered questionnaire assessed the quality of information provided to the clients and client satisfaction. The findings indicated that several resource components need upgrading in the district. The majority of clinics did not have adequate seating arrangements, lacked a footstool, a height measuring instrument and Vitamin C. Less than 50% of the staff were present at 8.00 a.m. in eight clinics. Health education material was substandard in nine clinics. No supervisory notes were made during the preceding year in fourteen clinics. Testing urine for sugar and albumin was substandard in 11 and eight clinics, respectively. Physical examination of pregnant females was substandard in all 20 clinics. No information was provided on some routine procedures carried out at the clinic such as blood pressure monitoring, weight gain and vaccines given. Client satisfaction exceeded 95% in all aspects except building and infrastructure and time spent at the clinic.
Anthropometric indicators of children's nutrition in two Nigerian communities
(Cambridge University Press, 1991) Ebomoyi, E.W.; Wickremasinghe, A.R.; Cherry, F.F.
On a sample of some 2000 children living in two ecologically different zones (the Wooded and Guinea savanna) in Kwara state, Nigeria, body measurements were taken, to serve as indicators of the state of nutrition. There was more undernutrition in the Guinea savanna than in the Wooded. More males than females were undernourished in the Guinea savanna but not in the Wooded. It is argued that the differences between districts stem from social and cultural variables.
Anti-tuberculosis drug inducd hepatitis:a Sri Lankan experience
(Sri Lanka Medical Association, 2006) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal).RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin over dosage.
Anti-tuberculous drug induced hepatitis in Sri Lankan patients
(Sri Lanka Medical Association, 2007) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To determine the incidence and risk factors of anti-TB drug induced hepatitis (AIH) in Sri Lankan patients and to address management options. DESIGN, SETTING AND METHODS: 783 patients with a confirmed diagnosis of TB who presented to a unit at Chest Hospital, Welisara from April 2001 to April 2002 were recruited for a follow up study. WHO category 1 for new and category 2 for re-treatment cases was commenced using single drug formulations. Doses were based on three weight bands. AIH was diagnosed when patients complained of decreased appetite, nausea/vomiting and elevated serum biliru&n (SB) l.lmg/dl or elevated serum alanine transferase (ALT) 3 times upper limit of normal (ULN). Results: 74 patients (9.5%) out of 783 enrolled patients developed AIH; the majority (58%) developing AIH within the first two weeks of the intensive phase of treatment. AIH was commoner among patients over 60 years (p=0.018), with pulmonary TB (p=0.028) and weighing 33-35 kg (p=0.004). Using regression analysis, age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60 and treatment was modified in six; two defaulted and six died. Conclusions: Incidence of AIH among Sri Lankan patients is 9.5%. They develop symptoms of hepatitis when ALT levels rise to three times the ULN lowering the threshold for diagnosis of AIH. Old age, 33-55 kg weight band and rifampicin over dosage are risk factors for AIH. Majority (81%) of AIH patients could be restarted on standard treatment.
Appearance of Anopheles jeyporiensis James from Sri Lanka; a new species to the mosquito checklist
(The Japan Society of Medical Entomology and Zoology, 2015) Gunathilaka, N.; Abeyewickreme, W.; Hapugoda, M.; Wickremasinghe, A.R.
Previous records of Sri Lankan Anopheles were most imperfect, and even the number and names of the species present were very doubtful. There was no systematic study conducted for Sri Lankan adult anophelines since 1990. Therefore, the objective of this study was to explore the species abundance and morphological variations of anopheline mosquitoes in Sri Lanka. Entomological surveys were conducted on a monthly basis from June 2010 to December 2013 in Trincomalee District, using five entomological techniques. Entomological surveys identified a total of 131,804 mosquito specimens belong to 18 anopheline species. One of which was An. jeyporiensis, a species that was not in the checklist in Sri Lanka. Its basic morphological features are similar to the members in Myzomyia series under the subgenus Cellia. Following characteristics were used to confirm the species as An. jeyporiensis; Centre of the scutum covered with short oblong white scales extending back to scutellum; Vein R 1 usually with accessory pale spot on preapical dark (PD) area; Foretarsomere 1 with apical pale band nearly 2.0 width of tarsomere diameter.
Are alanine transaminase (ALT) levels useful to screen for Non-alcoholic Fatty Liver Disease (NAFLD) in the community?
(Sri Lanka Medical Association, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; Rajindrajith, S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND: The value of ALT in screening for NAFLD is controversial. Furthermore, the upper limit of normal (ULN) ALT is defined for western populations but not Asian populations. Objectives: To establish ULN ALT for an urban adult Sri Lankan population, and assess its value in screening for NAFLD in that community. METHODS: This was part of a community based study on non-communicable diseases - the Ragama Health Study. 35-64y adults were selected using stratified random sampling. They were screened by structured interview and liver ultrasound, and 10ml venous blood .was obtained. "Normal" adults were defined as those not using potentially hepatotoxic drugs, drinking alcohol within safe limits, HBsAg and anti-HCV negative, and no fatty liver on ultrasound. NAFLD was diagnosed on established ultrasound criteria, .safe alcohol consumption and being HBsAg and anti-HCV negative. The 95th percentile of ALT was taken as the ULN for this population. RESULTS: 3012 subjects participated in the study. Those with NAFLD (n=930) and "normals" (n=1716) were matched for age and sex. ULN ALT (U/l) was significantly higher in normal males than females (68 vs. 53; p<0.001, Student's t-test). ALT was significantly higher in NAFLD than normals (p<0.001). However, ALT>ULN had a sensitivity [positive predictive value (PPV)] of only 14.5% (58%) for males and 11.5% (60%) for females with NAFLD. When ULN ALT cut offs for western populations (males 30 IU/1, females 19 IU/1) were used, although sensitivity considerably increased, the PPV to detect NAFLD decreased.further [sensitivity (PPV): males 79.4% (42%); females 94.6% (41%)]. CONCLUSIONS: Although ALT was significantly higher in NAFLD than in normal adults, it does not seem a useful test to screen for NAFLD in the community.
Assessing mental well-being in a Sinhala speaking Sri Lankan population: validation of the WHO-5 well-being index
(BioMed Central., 2020) Perera, B.P.R.; Jayasuriya, R.; Caldera, A.; Wickremasinghe, A.R.
PURPOSE: The WHO-5 well-being index is a widely used, short rating scale that measures subjective well-being. We translated the WHO-5 index into Sinhala and tested its psychometric properties including measurement invariance among diverse groups in a community sample in Sri Lanka. METHODS: The sample of 267 persons aged between 16 and 75 years was recruited from a semi-urban area. 219 completed a paper-based questionnaire and 48 responded to an online survey. Construct validity was tested for factorial validity (Confirmatory Factor Analysis -CFA), convergent validity and known group validity. Composite reliability for congeneric measures and test-retest reliability were also tested. Multi-group CFA (MG-CFA) was used to test measurement invariance. RESULTS: The translated Sinhala version demonstrated good content and face validity. Internal consistency reliability of the five items had a Cronbach's alpha of 0.85 and test-retest reliability over 2 weeks was satisfactory (Pearson r = 0.72, p < 0.001, ICC = 0.82). Confirmatory factor analysis supported factorial validity with a [Formula: see text] =4.99 (p = 0.28), a RMSEA of 0.03 (90% C.I. =0.00-0.10), a SRMR of 0.02, a TLI of 0.99 and a CFI of 0.99; factor loadings were between 0.55 and 0.89. Measurement invariance was acceptable for configural, metric and scalar invariance for gender. WHO-5 scores were significantly negatively correlated with the Patient Health Questionnaire (PHQ-9) (Pearson's r = - 0.45, p < 0.001) scores and the Kessler Psychological Distress Scale (K10) scores (Pearson's r = - 0.56, p < 0.001). CONCLUSION: The Sinhala translation of WHO-5 well-being index has shown acceptable psychometric properties and can be used for assessing mental well-being in the community in Sri Lanka. Further testing of the measure with larger and diverse (including different ethnic/cultural) groups are indicated to test measurement invariance of the measure. KEYWORDS: Sri Lanka; Validation; WHO-5 Sinhala version; Well-being.