Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia(F1000 Research, 2024) Talagala, I.; Abeysena, C.; Wickremasinghe, R.BACKGROUND: Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies. The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. METHODS: The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the ‘Analysis of determinants of policy impact’ model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. RESULTS: Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. CONCLUSION: Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.Item Healthy lifestyle profile scale for elderly: A novel tool to assess healthy lifestyle among young elderly live in South Asian settings(Medknow Publications, 2024) Jayasinghe, V.; Ferdinando, R.; Abeysena, C.BACKGROUND: Many lifestyle modification interventions have been introduced for young elderly population (aged from 60 to 74 years) in Sri Lanka to improve their health and well being. However, little is known about the outcome of those interventions as there is no valid tool available to measure the level of a healthy lifestyle. This study was conducted to develop and validate a new tool to assess the level of healthy lifestyle among young elderly in Sri Lanka. MATERIALS AND METHODS: An operationalized definition of the healthy lifestyle was formulated. Items for the tool were identified following a literature review, key informant interviews, and focus group discussions. The content validity of the tool was ensured by the panel of experts. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore factor structure and construct validity, respectively. The internal consistency, test–retest, and interobserver reliabilities of the tool were also assessed. RESULTS: Sixty two items were identified initially, and they were reduced to 31 based on experts’ opinion. Out of those, 28 items were loaded into 8 factors during the EFA. The results of the CFA showed a satisfactory model fit. Internal consistency (Cronbach’s alpha >0.7), test–retest, and interobserver reliabilities (Interclass correlation coefficients >0.7) were also found to be satisfactory. CONCLUSIONS: The tool was named the Healthy Lifestyle Profile Scale for Elderly (HLPSE). The HLPSE is a valid and reliable tool to assess the level of healthy lifestyle among Sri Lankan young elderly.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 Availability of facilities and equipment to provide emergency care in ambulances, which transport patients to the National Hospital of Sri Lanka(Journal of the College of Community Physicians of Sri Lanka, 2018) Nandasena, G.; Abeysena, C.ABSTRACT: Objective To describe available facilities and equipment in ambulances, to provide essential emergency care, which transport patients to the National Hospital of Sri Lanka Methods A descriptive cross-sectional hospital based study was carried out at the National Hospital of Sri Lanka from August to October 2008. All ambulances that arrived at the hospital during the study period with an emergency patient were selected as study sample (n=409). A Check list was used to assess in situ facilities and equipment that should be available for basic life support (BLS) and advanced life support (ALS). Results Most of the ambulances were equipped only with very basic facilities such as wheeled stretcher 95.4% (n=390), ABC fire extinguishers 75.3% (n=308) and warning siren 94.4% (n=386). Among ventilation and air way equipment, ‘oxygen cylinders’ showed highest percentage {68.7%; n=281) of availability in ambulances and oropharyngeal air ways were available only in 4.9% (n=20). Ventilation and air way equipment required for ALS were available only in less than 1% of all ambulances. Among patient assessment equipment, pen lights were available in 19.6% (n=80) and blood pressure apparatus in 2.2% (n=9) of ambulances. Obstetrical supplies, splinting equipment, surgical dressings except bandages, drug delivery devices, intravenous equipment except IV hook were available among < 5% of all ambulances. Most of the ambulances were equipped with safety and accessory equipment, except child safety seat 0.5% (n=2), triage tags 1.7% (n=7) and hack saw 0.7% (n=3), which were available in <2% of all ambulances. Conclusion The facilities and equipment that should be available in both basic and advanced life support ambulances were poor.Item Does routine episiotomy for vaginal births prevent major degree perineal tears? Summary of the evidence and its application to Sri Lanka(Postgraduate Institute of Medicine, University of Colombo, 2018) Hewage, S.A.; Abeysena, C.; Ziard, H.; Rishard, M.An updated Cochrane Review concluded that in addition to increasing the risk of major perineal/vaginal trauma by 30%, routine episiotomy does not play a role in lowering the risk of many other outcomes including blood loss at delivery, perineal pain, delivering a non-asphyxiated baby or urinary incontinence at six months compared to selective episiotomy.This review evaluated 12 randomized controlled trials carried out on 6177 women from Europe, North America, South America, South Asia and South-East Asia.Following critical evaluation of the systematic reviews conducted so far in this field along with local evidence and the aptness of this evidence to local setting, we strongly recommend changing the current practice of routine episiotomy to selective episiotomy in vaginal delivery, in accordance with the National Guidelines of Sri Lanka.Item 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.Item Sri Lankan clinical practice guidelines: A methodological quality assessment utilizing the AGREE II instrument.(Wiley-Blackwell, 2019) Talagala, I. A.; Samarakoon, Y.; Senanayake, S.; Abeysena, C.RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPG) play a major role in patient care in Sri Lanka. This study evaluates the methodological quality of the Sri Lankan CPGs developed in 2007. METHODS: A total of 94 CPGs developed by several professional colleges in Sri Lanka in the year 2007 were evaluated by 2 independent reviewers using AGREE II instrument for their methodological quality. Item score being ≤3 points was defined as "poor quality". Each domain score was calculated according to AGREE II. A guideline was labelled as "strongly recommended" if 4 or more domains scored above 60%, "recommended for use with certain modification" if only 3 domain scores were above 60% or if 4 or more domain scores were between 30% and 60%, and "not recommended" if 4 or more domains scored less than 30%. RESULTS: Most (22.3%) guidelines were developed by the College of Pathologists. Most of the guidelines (>55%) poorly reported on all the items, except for items 1, 2, and 22 of AGREE II. Median domain scores [range] and the proportion of the guidelines with domain score of <30% were as follows: domain on scope and purpose (33.3% [2.8%-83.3%]; 42.6%), stakeholder involvement (14.9% [0.0%-61.1%]; 81.9%), rigour of development (6.1% [0.0%-49%]; 98.9%), clarity and presentation (30.5% [8.3%-61.1%]; 46.8%), and applicability (8.3% [4.2%-14.6%]; 100%). All CPGs scored 50% for "editorial independence". Reviewers reported the overall quality was poor in 86 (91.5%). Based on the definitions used in the study, of 94 CPGs, 8 (8.5%) could be recommended to be used with modifications, while 86 (91.5%) could not be recommended for clinical practice. CONCLUSIONS: The methodological quality of the CPGs was poor irrespective of the source of development. Major efforts are essential to update the CPGs according to the principles of evidence based medicine.Item Sedentary behavior during leisure time, physical activity and dietary habits as risk factors of overweight among school children aged 14-15 years: case control study(Biomed Central, 2018) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.OBJECTIVE: To determine the risk of sedentary behavior during leisure time, physical activity and dietary habits on overweight among school children aged 14-15 years in Kalutara District, Sri Lanka. RESULTS: School based case-control study was conducted during September to November 2013 including 176 overweight children as cases and 704 children with normal weight as controls. Cases were defined as body mass index for age and sex of ≥ +1SD and controls as those in the range of -2SD to +1SD. Validated instruments were used for data collection. Multiple logistic regression was applied and results were expressed with adjusted odds ratios (OR) and 95% confidence intervals (CI). Risk factors for overweight were insufficient physical activity (OR 1.6, 95% CI 1.1-2.4), watching video/DVD ≥ 2 h (OR 3.1, 95% CI 1.8-5.3), watching television ≥ 2 h (OR 2.6, 95% CI 1.7-3.8) and doing homework ≥ 2 h, (OR 1.8, 95% CI 1.2-2.7). Consuming meat (OR 1.9, 95% CI 1.2-3.1), fish or other sea foods (OR 1.6, 95% CI 1.1-2.8), fast food/fried rice/oily foods (OR 1.9, 95% CI 1.2-2.9), carbonated drinks or sugary drinks (OR 1.9, 95% CI 1.2-2.8), sweets, cookies or ice cream (OR 1.8, 95% CI 1.2-2.9) were dietary risk factors for overweight. Consuming legumes and seeds (OR 0.50, 95% CI 0.3-0.7), vegetables and fruits (OR 0.6, 95% CI 0.4-0.9) were protective factors for overweight.Item Association of poor social support and financial insecurity with psychological distress of Chronic Kidney Disease patients attending National Nephrology Unit in Sri Lanka(Hindawi Limited, 2018) Hettiarachchi, R.; Abeysena, C.BACKGROUND: Chronic kidney disease (CKD) is associated with high morbidity and mortality. Hence, CKD patients are often in chronic psychological distress. The objective of the study was to describe factors associated with psychological distress of CKD patients attendingNational Nephrology Unit. METHODS: A descriptive cross-sectional study was conducted among 382 CKD patientsabove 18 years of age applying systematic sampling. The data was collected using self-administered questionnaires to assess the psychological distress (GHQ-12), social support(SSQ6), coping strategies (BRIEFCOPE), pain (0 to 10 numeric pain rating scale), and physical role limitation due to ill health (SF36QOL). Sociodemographic and disease-related data were collected using an interviewer administered questionnaire and a data extraction sheet. Multiple logistic regression was applied for determining the associated factors. The results were expressed as adjusted odds ratio (AOR) and 95% confidence intervals (95% CI). RESULTS: Percentage of psychological distress was 55.2% (95% CI: 48.4% to 62%). Poorsocial support (AOR = 1.81, 95% CI: 1.14-2.88), low satisfaction with the social supportreceived (AOR = 4.14, 95% CI: 1.59-10.78), stages IV and V of CKD (AOR = 2.67, 95% CI: 1.65-4.20), presence of comorbidities (AOR = 2.38, 95% CI: 1.21-4.67), within one year of diagnosis (AOR = 2.23, 95% CI: 1.36-3.67), low monthly income (AOR = 2.26, CI: 1.26-4.06), higher out-of-pocket expenditure per month (AOR = 1.75, 95% CI: 1.75-1.99), and being a female (AOR = 2.95, 95% CI: 1.79-4.9) were significantly associated with psychologicaldistress. CONCLUSIONS: More than half of the CKD patients were psychologically distressed. Factors such as financial and social support will be worth considering early because of their modifiability.