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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The Impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries(Elsevier/North-Holland Biomedical Press., 2021) Brown, R.H.; Eisner, M.; Walker, S.; Tomlinson, M.; Fearon, P.; Dunne, M.P.; Valdebenito, S.; Hughes, C.; Ward, C.L.; Sikander, S.; Osafo, J.; Madrid, B.; Baban, A.; Van Thang, V.; Fernando, A.D.; Murray, A.L.BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage. KEYWORDS: Adverse childhood experiences; Birth cohort; Depressive symptoms; Maternal-foetal-attachment; Prenatal.Item Cultural adaptation, translation and validation of the ISPCAN Child Abuse Screening Tool - Retrospective Version (ICAST-R) for young adults in Sri Lanka(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.The aim of the present study was to adapt and validate the ISPCAN child abuse screening tool-retrospective version (ICAST-R) in Sri Lanka with a view to investigating the experiences of physical, sexual and emotional abuse during childhood. The adaptation was performed using qualitative research methods with young adults, parents, teachers, and a multidisciplinary group of experts. The translation to Sinhala (the local Sri Lankan dialect) was carried out by a nominal group technique. A multidisciplinary team of experts assessed the Sinhala ICAST-R (SICAST-R) for its content validity. Moreover, acceptability, reliability and construct validity were determined by conducting a validation study among 200 schooling young adults. The principal component analysis (PCA) technique was used to assess the construct validity. Response rates for each item were taken as evidence of acceptability. The internal consistency was assessed by Cronbach's alpha, and test-retest reliability after two weeks was assessed using Cohen's kappa coefficient. The adaptation of ICAST-R included the introduction of an objective manner by which to measure severity of abuse and the inclusion of a set of questions regarding help-seeking behavior following physical and emotional abusive experiences. The SICAST-R showed adequate content validity and high acceptability, with response rates ranging from 90.3% to 99.5%. The minimum Cohen's kappa coefficient was 0.76, indicating good test-retest reliability. The internal consistency (Cronbach's alpha) for the total tool was 0.708, with the three constructs being 0.398, 0.844 and 0.637 for physical, sexual and emotional abuse, respectively. The PCA demonstrated good reproducibility for sexual and emotional abuse with the hypothesized structure. Overall, the SICAST-R showed adequate validity for the assessment of experiences of physical, sexual and emotional abuse during childhood among Sri Lankan young adults.Item The Intergenerational effects of intimate partner violence in pregnancy: mediating pathways and implications for prevention.(Sage Publications, 2020) Murray, A. L.; Kaiser, D.; Valdebenito, S.; Hughes, C.; Baban, A.; Fernando, A.D.; Madrid, B.; Ward, C. L.; Osafo, J.; Dunne, M.; Sikander, S.; Walker, S.; Van Thang, V.; Tomlinson, M.; Eisner, M.Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPVItem Physical, sexual and emotional abuse during childhood: Experiences of a sample of Sri Lankan young adults(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.Abuse during childhood is a human tragedy leading to lifelong adverse health, social, and economic consequences for survivors. This descriptive, cross-sectional study aimed to determine the prevalence of childhood physical, sexual and emotional abusive experiences among students (aged 18-19 years) in a Sri Lankan district. Multistage cluster sampling was used to select a sample of 1500 students. Experiences of physical, sexual and emotional abuse and age at abuse, perpetrators, consequences and severity were assessed using a version of ISPCAN Child Abuse Screening Tool-Retrospective Version (ICAST-R) which was culturally adapted and validated by the authors for use amongst Sinhalese students. The prevalence of the various forms of abuse during childhood was as follows: physical: 45.4% (95% CI: 42.9-7.9); sexual: 9.1% (95% CI: 7.6-10.5); emotional: 27.9% (95% CI: 25.7-30.2). The corresponding percentages of individuals categorized as having experienced severe or very severe abuse were as follows, physical: 0.3% (2/672); sexual: 4.05% (3/135); emotional: 8.8% (36/412). Experience of physical abuse was more prevalent amongst male students (54.8% vs. 38.3%) as was emotional abuse (33.9% vs. 23.2%), whereas experience of sexual abuse was more prevalent amongst female students (11.5% vs. 6.4%). Parents and teachers were the commonest perpetrators of physical and emotional abuse. Most of the sexually abusive acts were committed by neighbors or strangers. Some physically abusive acts were more frequent at earlier ages than emotional and sexual abusive acts, which were more common in late adolescence. The results indicate the necessity of targeted interventions to address this public health issue.Item Prevalence and severity of abusive experiences during childhood among a group of young adults from Gampaha District(Sri Lanka Medical Association, 2016) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.S.INTRODUCTION: Abuse during childhood is a public health problem leading to adverse health, social and economic consequences. OBJECTIVES: The study aims to determine the prevalence and severity of physical, sexual and emotional abuse during childhood among young adults aged 18-20 years schooling in the Gampaha District. METHOD: A descriptive cross-sectional study was conducted among 1500 schooling young adults selected by multistage cluster sampling. The prevalence of physical, sexual and emotional abuse was ascertained using the validated version of ICAST-R (ISPCAN Child Abuse Screening Tool-Retrospective Version). The severity of abusive experiences was assessed using a tool developed by the researchers based on modified Delphi technique. RESULTS: Prevalence of physical abusive experiences during childhood was 45.4% (95%CI = 42.9–47.9) (males- 54.8%, 95%CI = 51.1–58.8, females- 38.3%, 95%CI = 35.0–41.3), prevalence of severe physical abuse was 0.1%.. Being 'beaten by an object' was the commonest experience among both males (45.9%, 95% CI = 42.8–49.8) and females (32.0%, 95% CI = 28.7-35.6). Prevalence of sexual abuse during childhood was 9.1% (95% CI=7.6-10.5) (males: 6.4%, 95%CI=4.6–8.3, females: 11.5%,95%CI = 9.4–13.7), prevalence of severe sexual abuse was 0.2%. ‘Someone exposing their genitals’ was the commonest act (9.1%, 95%CI = 7.1-11.1) experienced by females and ‘Someone touching the genitals’ was the commonest act (4.0%, 95%CI = 2.5-5.7) experienced by males. Prevalence of emotional abuse during childhood was 27.9% (95%CI = 25.7–30.2) (males: 33.9%, 95%CI = 30.4–37.3, females: 23.2%,95% CI = 20.3–26.1) severe emotional abuse was seen among 2.4%. Insulting or criticizing was the most common abusive act among both males (29.5%, 95%CI = 26.2-33.1) and females (20.1%, 95%CI = 17.2-22.9). CONCLUSIONS: Prevalence of physical, sexual and emotional abusive experiences during childhood were high among schooling young adults in the Gampaha District. This calls for targeted interventions.Item Association of attachment with parents and abusive experiences during childhood(Sri Lanka Medical Association, 2016) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.S.INTRODUCTION: Improving parent-child attachment is considered to be an effective intervention in preventing child abuse. OBJECTIVES: This study is aimed at determining the association between parent-child attachment and experience of abuse during childhood. METHOD: A cross sectional analytical study was conducted among a representative sample of 1479 schooling young adults aged 18-20 years in Gampaha District, selected using a multi-stage cluster sampling method. Experience of abuse during childhood were determined using the self-administered locally validated tool SICAST-R. Parent-child attachment was determined using Inventory of Parent and Peer Attachment (IPPA), a self-administered tool, which measures the attachment to parents during childhood in the dimensions of communication, trust and alienation. RESULTS: The prevalence rates for abusive experience during childhood were 45.4% (95% CI=42.9–47.9), 9.1% (95% CI=7.6-10.5) and 27.9% (95% CI=25.7–30.2) for physical, sexual and emotional abuse respectively. All three dimensions that describe the attachment with the mother were significantly associated with being physically (poor trust:OR=3.71, 95% CI=1.52-9.05; poor communication: OR=1.72, 95%CI=0.89-3.35; presence of alienation: OR=2.63, 95%CI=1.72-4.00), sexually (poor trust: OR=3.62, 95%CI=1.07-12.25; poor communication :OR=2.44, 95% CI=1.01-5.92; presence of alienation: OR=3.89, 95% CI=2.22-6.81) and emotionally (poor trust: OR=6.56, 95% CI=2.88-14.91; poor communication: OR=3.19, 95% CI=1.78-5.71; presence of alienation: OR=3.32, 95% CI=2.21-4.98) abused during childhood. Similarly, aall three dimensions that describe the attachment with the father were significantly associated with being physically (poor trust: OR =3.16, 95%CI = 1.92-5.19; poor communication: OR=2.72, 95%CI=1.57-4.72; presence of alienation: OR=2.53, 95%CI=1.80-3.56), sexually (poor trust: OR=2.49, 95%CI = 1.18-5.29; poor communication: OR = 3.28, 95%CI = 2.27-4.74; presence of alienation: OR = 2.55, 95%CI = 1.54-4.22) and emotionally (poor trust: OR = 3.29, 95%C I= 2.00-5.39; poor communication:OR = 4.47, 95%CI = 2.05-9.73; presence of alienation: OR=3.21, 95%CI = 2.30-4.48) abused during childhood. CONCLUSIONS: Poor attachment with parents is associated with abusive experience during childhood. Public Health Programmes should focus on improving parent-child attachment.Item Profile of paediatric respiratory diseases requiring hospital admission(Sri Lanka Medical Association, 2012) Subasinghe, V.; Karunasekera, W.; Fernando, A.D.; Lakmini, C.; Weerasooriya, L.; Hathagoda, W.INTRODUCTION: Respiratory tract disorders cause significant mortality and morbidity in children worldwide. OBJECTIVES: To study the pattern of respiratory diseases and its seasonal variation among children. METHODS: A descriptive study was conducted at University Paediatric Unit, Colombo North Teaching Hospital in 2010 and 2011. All children below 12 years admitted with respiratory tract diseases (ICD-10 classification) were recruited into the study. Data collection forms were filled by medical officers using patient records. RESULTS: Total of 2651 (1370 in 2010; 1281 in 2011) were admitted with respiratory diseases. In respective years, 53% (2010) and 55%(2011) were males. Highest number of admissions was during infancy (27.2%). During consecutive years 2010 and 2011, 43.0% and 45.2% had unspecified lower respiratory tract infections (LRT1); 29.9% and 29.4% had upper respiratory tract infections (URTI); 10.7% and 12.4% had bronchial asthma; 1.8% and 2.2% had pneumonia; 5.9% and 8.9% had bronchiolitis. Stabilization at ETU was needed in 8.5%. Median duration of hospital stay was 3 (range 1-60) days. No follow-up was required in a majority (82.5%). Admissions due to respiratory diseases peaked in June (2010-20.1% and 2011-16.0%) and were mainly due to LRTI-52.0%, URTI-28.4%. Admissions with bronchial asthma were higher during the first half of the year (2010-86.3% and 2011-80.5%). Deaths were 18 (1.3%) in 2010 and 6 (0.5%) in 2011. CONCLUSIONS: Respiratory tract infections peak in June whereas asthma is precipitated in early months of the year. Over one-fourth of patients had URTI and was unnecessarily admitted.Item Child abuse and neglect; who gets abused and who abuses them?(Sri Lanka Medical Association, 2005) Fernando, A.D.; Karunasekera, K.A.W.; Fernando, L.; Samarasekera, A.OBJECTIVES: To study the socio-demographic characteristics of victims of child abuse and characteristics of the perpetrators. Study Design: A descriptive study. METHOD: A prospective study of 112 victims of child abuse presenting to the University Paediatric Unit, Ragama from January 2000 to August 2004. The study evaluated characteristics of victims and perpetrators. Ethical approval was obtained. Data Analysis: Epi info version 6. RESULTS: Mean age of the victims was 9.7 years. 79% were females. Ethnicity-91% Singhalese, 5%Muslims and 4%Tamils. 82% resided in Gampaha District. Education of father and mother respectively - 5% and 11%-not attended school, 32% and 34%-primary education, 52% and 50%-ordinary level and 11% and 9%-advanced level. Social class -46%-unskilled, 26%-poorly skilled, 18%-skilled and 10%-lesser professionals. Monthly income (Rs.) -6% <2000, 37% 2000-5000, 33% 5000-10,000 and 24% >10,000. Marital status- 64%-married, 27%-divorced, 6%-unmarried and living together, 3%-single. Amongst married parents, 20% of mothers and 6% of fathers were abroad. Caregiver to the victim- 47%-both parents, 15%-mother, 15%-father, 14%-relatives and 9%-others. Consumption of alcohol by father -59%. Characteristics of perpetrators- 98% were known to the victims and in 24% the perpetrator was the father. Number of perpetrator/s- 86%-one, 5%-two, 5%-three, 4%-more than 3. Perpetrator being drunk at the tine of abuse in 31%. Amongst sexually abused, 26% were acts of incest. Of those 70% by father. CONCLUSIONS: The most vulnerable victims of abuse are shown to be 10-year-old females. Majority came from low social and educational backgrounds, In <5Q%, both parents cared for the child. 98% of perpetrators were trusted persons and in nearly a quarter it was the father.Item A profile of child abuse and neglect in a tertiary care hospital(Sri Lanka Medical Association, 2005) Fernando, A.D.; Karunasekera, K.A.W.; Fernando, L.; Samarasekera, A.OBJECTIVES: To study the pattern of child abuse and neglect. To evaluate the management and the Outcome of such victims STUDY DESIGN: A descriptive study METHOD: The sample consists of 112 victims of child abuse referred to the University Paediatric Unit, Ragama Hospital, from January 2000 to August 2004. The study prospectively evaluated types of abuse, their characteristics, management of victims and outcome. Ethical approval was obtained. RESULTS: 24% had more than one type of abuse. Categories of abuse were: 70% -sexual, 33% -physical, 16% -neglect, 14% -emotional and 6% -child labour. Amongst sexually abused, 62% had penetrative sex, 8% became pregnant, 4% had sexually transmitted diseases, 5% had severe degree perineal/peri-anal tears, and 37% had psychological disturbances at the time of presentation. 39% came for follow up assessment after 6 months. Amongst them, 60% had psychological disturbances, amongst physically abused, 19% had fractures. Amongst all victims, the mean duration of hospital stay was 29 days. Management outcome: 46% sent back to parents, 11% to extended family member/s, 38% to Children's Homes and 5% to others. CONCLUSIONS: 24% had more than one type of abuse. The commonest type was sexual abuse. The majority of them had penetrative sex and 8% became pregnant. Psychological disturbances were found in the majority of victims of sexual abuse on follow up. 57% of victims were able to continue to live with their parents/extended family.Item Posterior reversible encephalopathy syndrome in a survivor of valproate-induced acute liver failure: a case report(BioMed Central, 2013) Mettananda, S.; Fernando, A.D.; Ginige, N.INTRODUCTION: Posterior reversible encephalopathy syndrome is an extremely rare radiological diagnosis that has not been reported previously in association with acute liver failure. CASE PRESENTATION: A 6-year-old Sri Lankan girl developed acute liver failure with severe hepatic encephalopathy due to sodium valproate. She was successfully treated medically with N-acetylcysteine and L-carnitine. During recovery she again developed features of encephalopathy and had repeated convulsions associated with moderate hypertension. The diagnosis of posterior reversible encephalopathysyndrome was made on clinical and radiological grounds and she showed a gradual improvement with control of blood pressure. CONCLUSIONS: This report adds to the evidence behind treatment of valproate-induced acute liver failure with N-acetylcysteine and L-carnitine and illustrates a rare but interesting association between acute liver failure and posterior reversible encephalopathy syndrome