Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
48 results
Search Results
Item Development and validation of a cardiovascular risk prediction model for Sri Lankans using machine learning.(Public Library of Science, 2024-10) Mettananda, C.; Sanjeewa, I.; Arachchi, T.B.; Wijesooriya, A.; Chandrasena, C.; Weerasinghe, T.; Solangaarachchige, M.; Ranasinghe, A.; Elpitiya, I.; Sammandapperuma, R.; Kurukulasooriya, S.; Ranawaka, U.; Pathmeswaran, A.; Kasturiratne, A.; Kato, N.; Wickramasinghe, R.; Haddela, P.; De Silva, J.INTRODUCTION AND OBJECTIVES Sri Lankans do not have a specific cardiovascular (CV) risk prediction model and therefore, World Health Organization(WHO) risk charts developed for the Southeast Asia Region are being used. We aimed to develop a CV risk prediction model specific for Sri Lankans using machine learning (ML) of data of a population-based, randomly selected cohort of Sri Lankans followed up for 10 years and to validate it in an external cohort.MATERIAL AND METHODS The cohort consisted of 2596 individuals between 40-65 years of age in 2007, who were followed up for 10 years. Of them, 179 developed hard CV diseases (CVD) by 2017. We developed three CV risk prediction models named model 1, 2 and 3 using ML. We compared predictive performances between models and the WHO risk charts using receiver operating characteristic curves (ROC). The most predictive and practical model for use in primary care, model 3 was named "SLCVD score" which used age, sex, smoking status, systolic blood pressure, history of diabetes, and total cholesterol level in the calculation. We developed an online platform to calculate the SLCVD score. Predictions of SLCVD score were validated in an external hospital-based cohort.RESULTS Model 1, 2, SLCVD score and the WHO risk charts predicted 173, 162, 169 and 10 of 179 observed events and the area under the ROC (AUC) were 0.98, 0.98, 0.98 and 0.52 respectively. During external validation, the SLCVD score and WHO risk charts predicted 56 and 18 respectively of 119 total events and AUCs were 0.64 and 0.54 respectively.CONCLUSIONS SLCVD score is the first and only CV risk prediction model specific for Sri Lankans. It predicts the 10-year risk of developing a hard CVD in Sri Lankans. SLCVD score was more effective in predicting Sri Lankans at high CV risk than WHO risk charts.Item Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka(BMJ Publishing Group Ltd, 2024) Herath, T.; Perera, M.; Guruge, D.; Kasturiratne, A.OBJECTIVE Healthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess the effectiveness of a participatory intervention to empower communities in improving HLC utilisation.DESIGN A quasi-experimental study based on the principles of community-based participatory research SETTING: Six rural communities each as the intervention (IG) (Gampaha district) and comparison (CG) groups (Kalutara district) from the capital province of Sri Lanka.PARTICIPANTS Study population was healthy individuals aged 35-65 years, the target group of HLCs in Sri Lanka. A random sample of 498 individuals was selected from each group for evaluation.INTERVENTIONS Community support groups (CSGs) were established and empowered using health promotion approach from August 2019 to February 2020. Group discussions and participatory mapping were conducted to identify determinants of underutilisation of HLCs, design activities to address prioritised determinants and develop indicators to monitor the progress of CSGs.PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was improvement of HLC utilisation and the secondary outcome was initiation of lifestyle modifications.RESULTS Significant improvements were seen in the IG, compared with the CG in the seven determinants that contribute to HLC utilisation. The largest differences were seen in reducing negative perceptions of susceptibility for NCDs (pre=64.7%; post=33.3%; p<0.001) and usefulness of screening (pre=66.6%; post=17.3%; p<0.001). The HLC utilisation in IG increased by 29.5% (pre=5.85%; 95% CI 3.74 to 7.95, post=35.3%; 95% CI 30.9 to 39.8, p<0.001), while the utilisation of the CG showed no difference. Furthermore, there was an improvement in the proportion of users who initiated lifestyle modification (pre=64.3%; post=89.9%; p=0.039) in IG, which was not observed in CG.CONCLUSION HLC utilisation and initiation of lifestyle modification can be improved by a community-based health promotion intervention through empowering CSGs.TRIAL REGISTRATION NUMBER SLCTR/2019/028.Item OP59 Ultra-processed food consumption in South Asia: quantification of regional variation in intakes and the assessment of their sociodemographic correlates. Findings from the South Asia Biobank in four South Asian countrie(BMJ, 2024) Bhagtani, D.; Adams, J.; Imamura, F.; Lahiri, A.; Irfan, K.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Mridha, M.; Anjana, R.M.BACKGROUND Escalation of ultra-processed foods (UPFs) sales has been recorded in low-to-middle-income countries, including in South Asia. However, individual consumption levels and sociodemographic characteristics influencing UPF consumption remain largely unknown in South Asia. We aimed to quantify UPF consumption and investigate its sociodemographic correlates in South Asia.METHODS We analysed data from 60,714 participants in the South Asia Biobank that recruited adults in Bangladesh, Pakistan, Sri Lanka, North India, and South India. Dietary assessment was conducted using interviewer-led 24h dietary recalls with a South Asia-specific digital tool. Foods were classified by the degree of industrial processing using the NOVA classification. Adjusted two-part multivariable regression models examined associations between sociodemographic factors and any UPF consumption and quantity of UPF consumption in consumers.RESULTS In Bangladesh, Sri Lanka and North India, approximately 75% of the participants reported consuming any UPFs in the previous 24h while in South India and Pakistan this was 40%. Median contribution of UPFs to total energy among UPF consumers ranged between 17% in Pakistan, 15% in North India, and 13% in Bangladesh, Sri Lanka, and South India. Biscuits were a common source of UPF across all regions. Other commonly consumed UPFs among consumers included sweetened beverages in Pakistan, packaged salty snacks in South India, and breakfast cereals in Bangladesh. Diverse associations between sociodemographic factors and any UPF consumption were seen across regions. Younger age was associated with any UPF consumption in Pakistan and Sri Lanka whereas in Bangladesh and North India, older age was. In all regions except Bangladesh, female sex was associated with any UPF consumption. Higher education was associated with UPF consumption in Bangladesh (odds ratio 2.01; 95% confidence interval 1.71 to 2.35), Pakistan (1.69; 1.55 to 1.85), and North India (1.40; 1.13 to 1.73). Paid employment was not associated with UPF consumption in any region. Among UPF consumers, in all regions, UPF consumption was lower in married or cohabitating than in single people. In Bangladesh and Sri Lanka UPF consumption was higher in rural residents, while in Pakistan, consumption was higher in urban participants.CONCLUSION Younger age, female sex, higher education, employment, and income exhibited associations with UPF, but this varied across South Asia. This heterogeneity should be considered when developing regionally specific interventions to support dietary public health. Our findings of regional consumption of specific UPFs, such as biscuits, breakfast cereals, sweetened beverages, and salty snacks, provide valuable insights for targeted interventions.Item Policy implementation and recommended actions to create healthy food environments using the healthy food environment policy index (Food-EPI): a comparative analysis in South Asia(Elsevier Ltd, 2024) Pineda, E.; Atanasova, P.; Wellappuli, N.T.; Kusuma, D.; Herath, H.; Segal, A.B.; Vandevijvere, S.; Anjana, R.M.; Shamim, A.A.; Afzal, S.; Akter, F.; Aziz, F.; Gupta, A.; Hanif, A.A.; Hasan, M.; Jayatissa, R.; Jha, S.; Jha, V.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Loomba, M.; Mahmood, S.; Mridha, M.K.; Pradeepa, R.; Aarthi, G.R.; Tyagi, A.; Kasturiratne, A.; Sassi, F.; Miraldo, M.BACKGROUND The increasing prevalence of diet-related non-communicable diseases (NCDs) in South Asia is concerning, with type 2 diabetes projected to rise to 68%, compared to the global increase of 44%. Encouraging healthy diets requires stronger policies for healthier food environments.METHODS This study reviewed and assessed food environment policies in Bangladesh, India, Pakistan, and Sri Lanka from 2020 to 2022 using the Healthy Food Environment Policy Index (Food-EPI) and compared them with global best practices. Seven policy domains and six infrastructure support domains were considered, employing 47 good practice indicators to prevent NCDs. Stakeholders from government and non-governmental sectors in South Asia (n = 148) were invited to assess policy and infrastructure support implementation using the Delphi method.FINDINGS Implementation of food environment policies and infrastructure support in these countries was predominantly weak. Labelling, monitoring, and leadership policies received a moderate rating, with a focus on food safety, hygiene, and quality rather than obesity prevention. Key policy gaps prioritized for attention included front-of-pack labelling, healthy food subsidies, unhealthy food taxation, restrictions on unhealthy food promotion, and improvements in school nutrition standards to combat NCDs.INTERPRETATION Urgent action is required to expand food policies beyond hygiene and food security measures. Comprehensive strategies targeting NCD prevention are crucial to combat the escalating burden of NCDs in the region.Item Psychometric properties of the Sinhala version of the Bandura’s exercise selfefficacy scale in women(College of Community Physicians of Sri Lanka, 2024) Herath, D.; Kasturiratne, A.INTRODUCTION Engaging in regular exercise as part of a healthy lifestyle has shown an array of health benefits for many decades. Building confidence in maintaining an exercise routine is essential for success. To support individuals interested in exercise, the availability of appropriate measurement tools is vital. Bandura's Exercise Self-Efficacy Scale (ESE) is an 18- item brief measure that assesses confidence in exercising regularly and is a valuable tool for measuring exercise beliefs. OBJECTIVES To translate and adapt the Banduras ESE scale into Sinhala language and examine its psychometric properties METHODS Data were collected from 225 women who were aged ≥18 years and had an interest in or a reason to watch their weight, in Panadura Medical Officer Health (MOH) Area, Sri Lanka. They were recruited using a purposive sampling method. Standard forward-backward translation was performed to translate the English version of ESE. The construct validity was tested using exploratory factor analysis. Reliability of the scale was determined by Cronbach’s alpha. Data were analysed using SPSS version 22.0. RESULTS Through exploratory factor analysis, 18-item ESE scale showed three factors with eigenvalues ranging from 1.392 to 9.409. The three-factor model explained 70.59% of total variance of the model. All the items in the scale were retained. The reliability of internal consistency, as assessed by Cronbach’s alpha, indicated interpersonal, competing and internal sub factors as 0.92, 0.91 and 0.89 respectively, which were above the threshold level of 0.7. CONCLUSIONS & RECOMMENDATIONS The Sinhala translation of ESE is a reliable and valid scale to assess the level of selfefficacy for exercise among Sinhala-speaking adult women in Sri Lanka.Item Under-utilisation of noncommunicable disease screening and healthy lifestyle promotion centres: A cross-sectional study from Sri Lanka(Public Library of Science, 2024) Herath, T.; Perera, M.; Kasturiratne, A.BACKGROUND Healthy Lifestyle Centres (HLCs) are state-owned, free-of-charge facilities that screen for major noncommunicable disease risks and promote healthy lifestyles among adults older than 35 years in Sri Lanka. The key challenge to their effectiveness is their underutilisation. This study aimed to describe the underutilisation and determine the factors associated, as a precedent of a bigger project that designed and implemented an intervention for its improvement. METHODS Data derived from a community-based cross-sectional study conducted among 1727 adults (aged 35 to 65 years) recruited using a multi-stage cluster sampling method from two districts (Gampaha and Kalutara) in Sri Lanka. A prior qualitative study was used to identify potential factors to develop the questionnaire which is published separately. Data were obtained using an interviewer-administered questionnaire and analysed using inferential statistics. RESULTS Forty-two percent (n = 726, 95% CI: 39.7–44.4) had a satisfactory level of awareness on HLCs even though utilisation was only 11.3% (n = 195, 95% CI: 9.80–12.8). Utilisation was significantly associated with 14 factors. The five factors with the highest Odds Ratios (OR) were perceiving screening as useful (OR = 10.2, 95% CI: 4.04–23.4), perceiving as susceptible to NCDs (OR = 6.78, 95% CI: 2.79–16.42) and the presence of peer support for screening and a healthy lifestyle (OR = 3.12, 95% CI: 1.54–6.34), belonging to the second (OR = 3.69, 95% CI: 1.53–8.89) and third lowest (OR = 2.84, 95% CI: 1.02–7.94) household income categories and a higher level of knowledge on HLCs (OR = 1.31, 95% CI: 1.24– 1.38). When considering non-utilisation, being a male (OR = 0.18, 95% CI: 0.05–0.52), belonging to an extended family (OR = 0.43, 95% CI: 0.21–0.88), residing within 1–2 km (OR = 0.29, 95% CI: 0.14–0.63) or more than 3 km of the HLC (OR = 0.14, 95% CI: 0.04– 0.53), having a higher self-assessed health score (OR = 0.97, 95% CI: 0.95–0.99) and low perceived accessibility to HLCs (OR = 0.12, 95% CI: 0.04–0.36) were significantly associated. CONCLUSION In conclusion, underutilisation of HLCs is a result of multiple factors operating at different levels. Therefore, interventions aiming to improve HLC utilisation should be complex and multifaceted designs based on these factors rather than merely improving knowledge.Item Ambulatory blood pressure levels in individuals with uncontrolled clinic hypertension across Bangladesh, Pakistan, and Sri Lanka(Wiley, 2024) Zhu, A.; Ostbye, T.; Naheed, A.; de Silva, H.A.; Jehan, I.; Gandhi, M.; Chakma, N.; Kasturiratne, A.; Samad, Z.; Jafar, T.H.Hypertension is a leading risk factor for cardiovascular disease in South Asia. The authors aimed to assess the cross-country differences in 24-h ambulatory, daytime, and nighttime systolic blood pressure (SBP) among rural population with uncontrolled clinic hypertension in Bangladesh, Pakistan, and Sri Lanka. The authors studied patients with uncontrolled clinic hypertension (clinic BP ≥ 140/90 mmHg) who underwent ambulatory blood pressure monitoring (ABPM) during the baseline assessment as part of a community-based trial. The authors compared the distribution of ABPM profiles of patients across the three countries, specifically evaluating ambulatory SBP levels with multivariable models that adjusted for patient characteristics. Among the 382 patients (mean age, 58.3 years; 64.7% women), 56.5% exhibited ambulatory hypertension (24-h ambulatory BP ≥ 130/80 mmHg), with wide variation across countries: 72.6% (Bangladesh), 50.0% (Pakistan), and 51.0% (Sri Lanka; P < .05). Compared to Sri Lanka, adjusted mean 24-h ambulatory, daytime, and nighttime SBP were higher by 12.24 mmHg (95% CI 4.28-20.20), 11.96 mmHg (3.87-20.06), and 12.76 mmHg (4.51-21.01) in Bangladesh, separately. However, no significant differences were observed between Pakistan and Sri Lanka (P > .05). Additionally, clinic SBP was significantly associated with 24-h ambulatory (mean 0.38, 95% CI 0.28-0.47), daytime (0.37, 0.27-0.47), and nighttime SBP (0.40, 0.29-0.50) per 1 mmHg increase. The authors observed substantial cross-country differences in the distribution of ABPM profiles among patients with uncontrolled clinic hypertension in rural South Asia. The authors findings indicated the need to incorporate 24-h BP monitoring to mitigate cardiovascular risk, particularly in Bangladesh.Item Translation, adaptation and validation of the Sinhala Version of Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) for women(College of Community Physicians of Sri Lanka, 2023) Herath, D.; Kasturiratne, A.INTRODUCTION: The global obesity burden is rising alarmingly due to unhealthy lifestyle behaviours and environmental factors. To date, prevention and treatment efforts to combat obesity mainly focus on lifestyle modifications through diet and physical activity. Eating self-efficacy has been related to weight loss and is considered a significant predictor of weight loss in an individual. The Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) is an American instrument used for research and clinical purposes to measure self-efficacy for controlling eating in specific situations. OBJECTIVES: Translation, cultural adaptation and validation of the WEL-SF. METHODS: A sample of 100 women aged ≥ 18 years who were attempting to reduce their weight through self-monitored non-therapeutic diet control in Panadura Medical Officer of Health (MOH) Area, Sri Lanka was recruited using a purposive sampling method. Data were collected using a self-administered questionnaire with socio-demographic information and Sinhala version of the WEL-SF. The construct validity was evaluated by Exploratory Factor Analysis (EFA) using Principal Component Analysis (PCA), while the reliability of the scale was determined by Cronbach's alpha. RESULTS: The eight-item WEL-SF showed a one-factor solution by EFA. All the items on the scale were retained. The model explained a total variance of 59.35%. The internal consistency of WEL-SF was 0.905 using Cronbach’s alpha. The test-retest reliability of the instrument had a high Spearman's correlation of more than 0.7. CONCLUSIONS & RECOMMENDATIONS: The Sinhala version of WEL-SF for women to assess self-efficacy levels in overeating appears to be psychometrically valid with high reliability. This instrument can be recommended as a screening tool to assess self-efficacy levels in women striving for a healthy weight.Item Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank(Springer, 2023) Xie, W.; Mridha, M.K.; Gupta, A.; Kusuma, D.; Butt, A.M.; Hasan, M.; Brage, S.; Loh, M.; Khawaja, K.I.; Pradeepa, R.; Jha, V.; Kasturiratne, A.; Katulanda, P.; Anjana, R.M.; Chambers, J.C.INTRODUCTION Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking quit attempts, and smoking cessation among South Asian men. METHODS Data were obtained from South Asia Biobank Study, collected between 2018 and 2022 from 148,944 men and women aged 18 years and above, living in Bangladesh, India, Pakistan, or Sri Lanka. Mixed effects multivariable logistic and linear regression were used to quantify the associations of SLT use with quit attempt, cessation, and intensity. RESULTS Among the four South Asian countries, Bangladesh has the highest rates of current smoking (39.9% for male, 0.4% for female) and current SLT use (24.7% for male and 23.4% for female). Among male adults, ever SLT use was associated with a higher odds of smoking cessation in Bangladesh (OR, 2.88; 95% CI, 2.65, 3.13), India (OR, 2.02; 95% CI, 1.63, 2.50), and Sri Lanka (OR, 1.36; 95% CI, 1.14, 1.62). Ever SLT use and current SLT use was associated with lower smoking intensity in all countries. CONCLUSIONS In this large population-based study of South Asian adults, rates of smoking and SLT use vary widely by country and gender. Men who use SLT products are more likely to abstain from smoking compared with those who do not.Item Prevalence of overweight and obesity among women in two medical officer of health areas in Kalutara district(College of Community Physicians of Sri Lanka, 2023) Herath, D.; Kasturiratne, A.INTRODUCTION: Overweight and obesity are rising burdens in the w orld. Gender disparities in its prevalence are more evident in developing countries compared to developed countries. OBJECTIVES: To determine the prevalence of overweight and obesity among 35-44-year-old women in Bandaragama and Horana Medical Officer of Health (MOH) areas METHODS: This was a community-based descriptive cross-sectional study conducted among 770 women aged 35-44 years residing in two MOH areas of Kalutara District for the l ast six months at the time of data collection. Overweight/obesity were assessed on the Asian cutoff values recommended by the WHO based on body mass index (BMI). The prevalence was estimated with 95% confidence interval (CI). RESULTS: The prevalence of overweight in Bandaragama and Horana MOH areas was 41.35% (95% CI: 37.9, 44.81) and 39.7% (95% CI: 36.3, 43.2), respectively, while the correspondi ng prevalence of obesity was 36.1% (95% CI: 32.8, 39.6) and 26.6% (95% CI: 16.4, 39.1). CONCLUSIONS & RECOMMENDATIONS: The prevalence of overweight /obesity among women aged 35-44 years was relatively high. Barriers to a healthy lifestyle, women's role in the household and existing service gaps at primary healthcare level should be considered when preventive measures ar e introduced to reduce this burden.