Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Risk factors for low resilience among Grade 10 adolescents in the Gampaha district, Sri Lanka: a case-control study(BMJ Publishing Group, 2025-01) Manori, S.; Jayawardana, P. L.; Godamunne, P.OBJECTIVE Resilience means the ability to deal successfully with difficult situations, and hence low resilience will lead to many negative outcomes. The aim of this study was to explore risk factors for low resilience among Grade 10 adolescents in Gampaha district, Sri Lanka.METHODS Resilience levels and data related to putative risk factors were obtained by using a validated 14-Item Sinhala Resilience Scale and a questionnaire on putative risk factors (both of which were self-administered) from Grade 10 adolescents by conducting a descriptive cross-sectional study. There were 464 (33.6%) cases with low resilience (score=14-73) and 916 (66.4%) controls with high resilience (score=74-98). For the case-control study, the computed sample size for each case and control group was 128, who were selected by applying simple random sampling. Risk factors for low resilience were determined using bivariate and multivariable analyses by applying χ2 test and multivariable logistic regression. Results were expressed as ORs with respective 95% CIs.RESULTS Among the 33 putative risk factors analysed, 13 were found to be significant in bivariate analysis. In multivariable logistic regression analysis, out of 24 independent variables entered initially into the model, only 9 were retained in the final model. These comprised (1) one or both parents dead (AOR=2.5, 95% CI [1.2, 14.5]; p=0.032), (2) mother's low educational level (AOR=1.9, 95% CI [1.6, 3.8]; p=0.021), (3) sleep <8 hours (AOR=1.6, 95% CI [1.1, 3.8]; p=0.002), (4) having less than six close classmates (AOR=1.5, 95% CI [1.1, 4.3]; p=0.021), (5) not attending Sunday school (AOR=1.8, 95% CI [1.1, 10.6]; p=0.001), (6) being short-tempered (AOR=2.2, 95% CI [1.5, 3.6]; p=0.003), (7) having conflicts with friends (AOR=1.4, 95% CI [1.2, 7.5]; p=0.043), (8) not seeking help when confronted/facing with difficulties (AOR=1.6, 95% CI [1.2, 6.9]; p=0.032) and (9) lack of support from home when in need (AOR=1.6, 95% CI [1.2, 5.8]; p=0.001).CONCLUSION AND RECOMMENDATION Altogether nine risk factors were identified. Interventions focusing on risk factors ascertained should be developed and conducted regularly by the schools, targeting all adolescents of Grade 10 to boost their status of resiliencyItem Nature, prevalence and determinants of mental health problems experienced by adolescents in south Asia: a systematic review(Elsevier Ltd, 2025-01) Mudunna, C.; Weerasinghe, M.; Tran, T.; Antoniades, J.; Romero, L.; Chandradasa, M.; Fisher, J.BACKGROUND Adolescence is a sensitive phase of human development where individuals, aged 10-19 years, are particularly vulnerable to developing mental health problems (MHPs). South Asia, home to 24% of the world's population, is mostly comprised of low- and middle-income countries (LMIC). Most of the world's young people live in LMICs. This systematic review aims to assess the available evidence on the nature, prevalence and determinants of MHPs experienced by adolescents in south Asia. METHODS Following PRISMA guidelines, searches were conducted in four online databases (Ovid Medline, Ovid EMBASE, Ovid Global Health, Ovid PsycInfo), titles, abstracts, and full-texts were screened, data extracted and quality assessed. Extracted data were categorised into school-based studies (SBS) and non-school-based studies (NSBS). Data were further stratified according to country, MHPs and narratively synthesised. FINDINGS Of the 5847 records identified in the searches, 117 met inclusion criteria. Most (n = 87) were SBS. Key MHPs reported across countries include anxiety disorders and depression. Wide ranges of prevalence rates were reported for anxiety in Indian SBS (1.5-81.6%) and NSBS (1.8-88.1%), and for depression, Pakistani SBS (21-79%) and Indian NSBS (0.4-98.5%). Determinants include individual characteristics; violent victimisation; poor family/home/school environment/peer relationships; already experiencing MHPs and substance use/abuse. Increased physical activity, adequate nutrition, safe/positive homes/family environment, being unmarried females, higher maternal education, peer support/friendship, higher education level and engaging in extra-curricular activities were protective of mental well-being. INTERPRETATION Prevalence of MHPs among south Asian adolescents appears high. Determinants include social, cultural, environmental and socioeconomic factors often beyond individual control. Mental health policies and programs and research appropriate to the cultural context, that address social determinants of MHPs and evidence gaps, are needed to tackle the significant mental health burden among south Asian adolescents. FUNDING Authors CM and MW are supported by a Monash University Research Training Program Scholarship. JF is supported by the Finkel Professorial Fellowship funded by the Finkel Family Foundation.Item Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation(Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.No abstract availableItem Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka(Sri Lanka College of Psychiatrists, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.Item Prediction equation for physical activity energy expenditure in 11-13-year-old Sri Lankan children(MDPI Publishing, 2023) Dabare, P.; Wickramasinghe, P.; Waidyatilaka, I.; Devi, S.; Kurpad, A.V.; Samaranayake, D.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Hills, A.P.; Lanerolle, P.This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.Item Pyrexia of unknown origin (PUO) and the cost of care in a tertiary care institute in Sri Lanka(BioMed Central, 2023) Premathilaka, R.; Darshana, T.; Ekanayake, C.; Chathurangani, K.C.; Mendis, I.; Perinparajah, S.; Shashiprabha, M.; Nishshanka, S.; Tilakaratna, Y.; Premawardhena, A.BACKGROUND: Despite advancements in diagnostic technology, pyrexia of unknown origin (PUO) remains a clinical concern. Insufficient information is available regarding the cost of care for the management of PUO in the South Asian Region. METHODS: We retrospectively analyzed data of patients with PUO from a tertiary care hospital in Sri Lanka to determine the clinical course of PUO and the burden of the cost incurred in the treatment of PUO patients. Non-parametric tests were used for statistical calculations. RESULTS: A total of 100 patients with PUO were selected for the present study. The majority were males (n = 55; 55.0%). The mean ages of male and female patients were 49.65 (SD: 15.55) and 46.87 (SD: 16.19) years, respectively. In the majority, a final diagnosis had been made (n = 65; 65%). The mean number of days of hospital stay was 15.16 (SD; 7.81). The mean of the total number of fever days among PUO patients was 44.47 (SD: 37.66). Out of 65 patients whose aetiology was determined, the majority were diagnosed with an infection (n = 47; 72.31%) followed by non-infectious inflammatory disease (n = 13; 20.0%) and malignancies (n = 5; 7.7%). Extrapulmonary tuberculosis was the most common infection detected (n = 15; 31.9%). Antibiotics had been prescribed for the majority of the PUO patients (n = 90; 90%). The mean direct cost of care per PUO patient was USD 467.79 (SD: 202.81). The mean costs of medications & equipment and, investigations per PUO patient were USD 45.33 (SD: 40.13) and USD 230.26 (SD: 114.68) respectively. The cost of investigations made up 49.31% of the direct cost of care per patient. CONCLUSION: Infections, mainly extrapulmonary tuberculosis was the most common cause of PUO while a third of patients remained undiagnosed despite a lengthy hospital stay. PUO leads to high antibiotic usage, indicating the need for proper guidelines for the management of PUO patients in Sri Lanka. The mean direct cost of care per PUO patient was USD 467.79. The cost of investigations contributed mostly to the direct cost of care for the management of PUO patients.Item Gender dysphoria and morbid sexual jealousy in an adolescent.(Kandy Society of Medicine, 2022) Rathnayake, L.C.; Kuruppuarachchi, C.; Abeyrathne, M.; de Silva Rajaratne, P.K.D.H.J.L.; Chandradasa, M.; Kuruppuarachchi, K.A.L.A.Gender dysphoria is the psychological distress that occurs when an individual’s biologically determined sex and gender identity do not align. Jealousy is likely to occur in any form of intimate partnership, irrespective of sexual orientation. Jealousy in a relationship is affected by sociocultural variables, an individual’s sense of masculinity, femininity, and other factors. We report an 18-year-old assigned female at birth with gender dysphoria presenting with jealous-type delusional disorder. We found no previous reporting of morbid jealousy in adolescents with gender dysphoria.Item Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals(Sri Lanka Medical Association, 2021) Fernando, K.; Jayamanna, S.; Weerasinghe, M.; Priyadarshana, C.; Ratnayake, R.; Pearson, M.; Gunnell, D.; Dawson, A.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.; Knipe, D.Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.Item Translation, cultural adaptation and validity of the Adolescent Sedentary Activity Questionnaire among school children aged 14-15 years(College of Community Physicians of Sri Lanka, 2020) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.INTRODUCTION: Sedentary behaviour is a risk factor for several diseases. Validation of questionnaires on sedentary activity is a great challenge. OBJECTIVES: To translate, culturally adapt and validate the Adolescent Sedentary Activity Questionnaire (ASAQ) among school children. METHODS: Back translation method was used to translate ASAQ into Sinhala language (ASAQ-S). Cultural adaptation and judgmental validity were ensured using a panel of experts. Criterion validity was assessed by comparing ASAQ-S data with the reference standard, which was the ActiGraph GT1M accelerometer worn on the waist. The study population consisted of 42 school children aged 14-15 years. Sedentary activity time was taken from the accelerometer recorded data as total hours per day. The ASAQ-S has 14 items and then total sedentary time was calculated by summing up the activities of all seven days. Intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were calculated. RESULTS: The average sedentary time was 11.7 (SD=3.4) hours per day recorded by an accelerometer and from the ASAQ-S 9.0 (SD=2.3) hours per day. An ICC for total sedentary activity time between the accelerometer and ASAQ-S was 0.52 (95% CI=0.08, 0.78) and Pearson correlation coefficient was 0.55 (p<0.01). CONCLUSIONS: The validity of ASAQ-S was satisfactory and can be used as a tool to assess adolescent sedentary behaviour. KEYWORDS: Adolescence, Cultural, Questionnaire, Reliability, Sedentary, ValidityItem Pattern of physical activity among school children aged 14-15 years in the district of Kalutara(College of Community Physicians of Sri Lanka, 2018) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.BACKGROUND: Physical inactivity is a major risk factor for NCD related global mortality. Sri Lanka is on the verge of an epidemic of NCDs. It is imperative that the pattern of physical activity is assessed among adolescents.OBJECTIVE: To describe the pattern of physical activity among school children aged 14-15 years in the district of KalutaraMETHODS: A cross-sectional survey was carried out in a sample of 1795 children in government schools in the district of Kalutara. The sample was selected using a multistage cluster sampling method with probability proportionate- to the size. A total of 90 class rooms (clusters) were included and the average cluster size was 20. The pattern of physical activity was assessed using the validated Physical Activity Questionnaire-S. Moderate to vigorous physical activities for at least 60 minutes per day for ≥5 days per week were categorized as ‘sufficiently active’. Chi-squared test was applied to compare the physical activity level with selected factors.RESULTS: Only 33.1% (n=595) of the adolescents were sufficiently active. Of them, 30.6% (246/805) females and 35.1% (349/990) males were sufficiently active (p=0.04). Of the overweight adolescents, 26.7% (48/176) were sufficiently active, which was significantly different from the normal (35.1%, 412/1175) and underweight (30.4%, 135/144) groups (p=0.04). Only 13.9% (n=249) adolescents participated on three or more days a week in sport clubs, aerobics, dancing or martial art during out-of-school hours; and 66.4% (n=1195) in one or more sport clubs during the previous year. Only 4.8% (n=86) adolescents were active on three or more days during school physical exercise period and 46.8% (n=842) traveling by bicycle to school and back during the previous week. Almost 80% (n=1407) of the adolescents learnt about benefits of physical exercise; 66.2% (n=1187) to develop a plan of physical exercise to improve it; and 80% (n=1434) on injury prevention of physical exercise during the previous year from the schools.CONCLUSIONS: Only 33.1% of the adolescents were sufficiently active. Males were more active than females. Participation of physical exercise activities within school and out-of-school hours was low.