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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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
199 results
Search Results
Item Inhaled beclomethasone in the treatment of early COVID-19: a phase 2, double-blind, placebo-controlled, randomised trial(The College, 2023) Mettananda, C,; Peiris, C.; Abeyrathna, D.; Gunasekera, A.; Egodage, T.; Danthanarayana, C.; Pathmeswaran, A.; Ranasinha, C.No abstract availableItem Measuring antenatal depressive symptoms across the world: A validation and cross-country invariance analysis of the Patient Health Questionnaire-9 (PHQ-9) in eight diverse low-resource settings(American Psychological Association, 2022) Murray, A.L.; Hemady, C.L.; Do, H.; Dunne, M.; Foley, S.; Osafo, J.; Sikander, S.; Madrid, B.; Baban, A.; Taut, D.; Ward, C.L.; Fernando, A.; Thang, V.V.; Eisner, M.; Hughes, C.; Fearon, P.; Valdebenito, S.; Tomlinson, M.; Pathmeswaran, A.; Walker, S.Measures that produce valid and reliable antenatal depressive symptom scores in low-resource country contexts are important for efforts to illuminate risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates analyses of similarities and differences across contexts. To date, however, few studies have evaluated the psychometric properties and comparability of the most widely used antenatal depressive symptom measures across diverse cultural, political, and social contexts. To address this gap, we used data from the Evidence for Better Lives Study-Foundational Research (EBLS-FR) project to examine the internal consistency reliability, nomological network validity, and cross-country measurement invariance of the nine-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low-resource contexts. We found that the PHQ-9 scores had good internal consistency across all eight countries. Correlations between PHQ-9 scores and constructs conceptually associated with depression were generally consistent, with a few exceptions. In measurement invariance analyses, only partial metric invariance held and only across four of the countries. Our results suggest that the PHQ-9 yields internally consistent scores when administered in culturally diverse antenatal populations; however, the meaning of the scores may vary. Thus, interpretation of PHQ-9 scores should consider local meanings of symptoms of depression to ensure that context-specific conceptualizations and manifestations of antenatal depressive symptoms are adequately reflected. (PsycInfo Database Record (c) 2022 APA, all rights reserved).Item Short-term pain trajectories in patients with knee osteoarthritis(Wiley on behalf of the Asia Pacific League of Associations for Rheumatology, 2022) Atukorala, I.; Downie, A.; Pathmeswaran, A.; Deveza, L.M.A.; Chang, T.; Zhang, Y.; Hunter, D.J.Aim: It is unknown if pain in knee osteoarthritis (KOA) follows distinct patterns over the short term. Therefore, the aim of this study was to identify whether persons with a previous history of KOA pain fluctuations have distinct trajectories of pain over 90 days and to examine associations between baseline characteristics and pain trajectories. Method: People with a previous history of KOA were selected from a web-based longitudinal study. Baseline variables were sex, age, being obese/overweight, years of KOA, knee injury, knee buckling, satisfactory Lubben Social Support Score, pain and stress scales, Intermittent Constant Osteoarthritis Pain Score (ICOAP), medication use, and physical activity. Participants completed a Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain subscale (KOOS-p, rated 0 = extreme to 100 = no knee problems) at 10-day intervals for 90 days. Short-term KOOS-p trajectories were identified using latent growth mixture modeling and the baseline risk factors for these pain trajectories were examined. Results: Participants (n = 313) had a mean age of 62.2 (SD ± 8.1) years and and a body mass index of 29.8 (SD ± 6.6) kg/m2 . The three-class latent growth mixture modeling quadratic model with best fit indices was chosen (based on lowest sample-size-adjusted Bayesian Information Criterion, high probability of belonging, interpretability). Three distinct pain trajectory clusters (over 90 days) were identified: low-moderate pain at baseline with large improvement (n = 11), minimal change in pain over 90 days (n = 248), and moderate-high pain with worsening (n = 46). Higher ICOAP (intermittent scale), perceived stress, negative affect score, and knee buckling at baseline were associated with a worse knee pain trajectory (P < 0.05). Conclusions: Persons with KOA showed unique short-term pain trajectories over 90 days, with distinct characteristics at baseline associated with each trajectory.Item Development of size charts of symphysis pubis height measurement for Sri Lankan Population(Wiley-Blackwell, 2015) Dias, T.; Pathmeswaran, A.; Abeykoon, S.; Gunawardena, C.; Pragasan, G.; Padeniya, T.INTRODUCTION Fetal growth restriction is responsible for majority of explained and unexplained intrauterine deaths. Screening and diagnosis of fetal growth restriction is one of the main objectives of the antenatal care. Symphysis pubis height measurement (SFH) is routinely measured to assess the fetal growth during antenatal period. Use of SFH charts made elsewhere may either under or overestimate the fetal size in our population. The aim of this study was to construct new size charts for SFH for Sri Lankan population. METHODS This was a prospective, cross-sectional study carried out at the District General Hospital Ampara. In order to increase generalisability 1220 women with normal nutritional and health status and minimal environmental constraints on fetal growth were enrolled during first trimester. Fetal crown–rump length measurement between 11+0 and 13+6 was considered for gestational age assessment in all patients. Each mother considered only once for measurement of SFH for the purpose of this study at gestations between 24 and 41 weeks. SFH was measured using non-elastic, blinded tape using standard technique. For SFH measurement separate regression model was fitted to estimate the mean and standard deviation at each gestational age. Centiles were derived from this mean and standard deviation, assuming that the measurements have a normal distribution at each gestational age. RESULTS A total of 387 mothers had their SFH measured directly. New charts were created for SFH. 10th, 50th and 90th centile values for SFH at 40 weeks are 34, 37 and 41 cm. CONCLUSIONS We have constructed new size chart for SFH. This chart can now be used to assess the fetal size of Sri Lankan population.Item Development and validation of a reintegration index to assess the status of reintegration among returnee Middle-East Migrant workers in Kurunegala District(College of Community Physicians of Sri Lanka, 2021) Wijeratne, P.D.; Pathmeswaran, A.Background: Reintegration is the least explored phase of the migration cycle. Yet, the reintegration process has a strong influence on the socio-economic and health-related outcomes of returnee migrant workers. The objective of this study was to develop and validate an Index of Reintegration to assess the status of reintegration among returnee Middle-East migrant workers in the Kurunegala District. Methods: A mixed-method consist of qualitative and quantitative approaches were followed for the tool development. In the first-phase primary pool of items was generated following a comprehensive literature review. Further, key informant interviews and Focus Group Discussions were conducted with experts, returnee migrant workers, and their family members to validate and to compliment the developing index. In the second phase, principal component analysis was performed on the collected dataset from a survey involving returnee Middle-East migrant workers(n=232). In the third phase, the constructed tool was evaluated and validated using multiple methods. The tool was tested for reliability. Results: The items and domains of the index demonstrated acceptable validity and reliability (25items, α=0.7). The finalized tool consisted of 25 items distinguished under eight (08) factors: economic self-sufficiency, belongingness, support networks, social adaptation, cultural acceptance, access to health services, physical-psychological distress, etc. and explained 60.1% of the total variance during the factor analysis. Conclusions: Reintegration Index is a reliable and valid tool to measure the status of reintegration of returnee migrant-workers. This tool could be applied for different occupational context returnees in determining socio-economic, migration-related, and health-related factors influencing their reintegration into the home-country.Item Place of cardiovascular risk prediction models in South Asians; Agreement between Framingham risk score and WHO/ISH risk charts(Wiley Publishing, 2021) Mettananda, K.C.D.; Gunasekara, N.; Thampoe, R.; Madurangi, S.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: There are no cardiovascular risk prediction models developed in South Asian cohorts. Therefore, different risk models not validated in South Asians are being used. We aimed to compare cardiovascular risk predictions of Framingham risk score (FRS) and World Health Organization/International Society of Hypertension (WHO/ISH) charts for agreement in a sample of South Asians. METHODS: Ten-year cardiovascular risk predictions of patients without previous cardiovascular diseases attending a non-communicable disease clinic were calculated using FRS (with BMI and with cholesterol) and WHO/ISH charts (with and without cholesterol). Patients were categorised into low (<20%) and high (≥20%) cardiovascular risk groups on risk predictions. Agreement in risk categorisation with different prediction models was compared using Cohen's kappa coefficient (κ). RESULTS: One hundred sixty-nine patients (females 130 (81.1%)) mean age 65 ± 6.9 years were studied. Of the participants, 80 (47.3%), 62 (36.7%), 18 (10.7%), 16 (9.5%), were predicted high risk by FRS BMI-based, FRS cholesterol-based, WHO/ISH without-cholesterol and WHO/ISH with-cholesterol models, respectively. Agreement between the two FRS models (κ = 0.736, P < .0001) and the two WHO/ISH models (κ = 0.804, P < .0001) in stratifying patients into high and low-risk groups, was "good." However, the agreements between FRS BMI-based and WHO/ISH without-cholesterol models (κ = 0.234, P < .0001) and FRS cholesterol-based and WHO/ISH with-cholesterol models (κ = 0.306, P < .0001) were only "fair." CONCLUSION: Cardiovascular risk predictions of FRS were higher than WHO/ISH charts and the agreement in risk stratification was not satisfactory in Sri Lankans. Therefore, different cardiovascular risk prediction models should not be used interchangeably in the follow-up of South Asians.Item Physical activity tracking among Sri Lankan adults: findings from a 7-year follow-up of the Ragama Health Study(SAGE Publications, 2021) Pinidiyapathirage, J.; Kasturiratne, A.; Bennie, J.A.; Pathmeswaran, A.; Biddle, S.J.H.; de Silva, H.J.; Chackrewarthy, S.; Dassanayake, A.S.; Ranawaka, U.; Kato, N.; Wickremasinghe, A.R.ABSTRACT: Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity. KEYWORDS: Sri Lanka; lower middle-income countries; non-communicable diseases; physical activity; population studies.Item The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study(Elsevier Science Ireland Ltd, 2021) Niriella, M.A.; Ediriweera, D.S.; Kasturiratne, A.; Gunasekara, D.; de Silva, S.T.; Dassanayake, A.S.; de Silva, A.P.; Kato, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.OBJECTIVES: Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. METHOD: In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. RESULTS: Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. CONCLUSIONS: Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD. KEYWORDS: Cardiovascular events; Fatty liver; NAFLD; Outcomes; Ultrasonography; Ultrasound criteria.Item Can pain flares in knee osteoarthritis be predicted?(:Taylor & Francis-Informa Healthcare, 2021) Atukorala, I.; Pathmeswaran, A.; Makovey, J.; Metcalf, B.; Bennell, K.L.; March, L.; Chang, T.; Zhang, Y.; Hunter, D.J.OBJECTIVES: This study examined whether risk factors for knee osteoarthritis (KOA) pain such as age, gender, body mass index (BMI), baseline pain, and other putative risk factors for knee osteoarthritis pain flares (KOAF) (e.g. knee buckling, injury, mood/stress/social support scores, and footwear) could predict KOAF. METHOD: People with KOA and previous history of KOAF were selected from a 3-month web-based longitudinal study. KOAF was defined as an increase of ≥ 2 points on a numeric rating scale (compared with background pain) which resolved within 20 days. Predictors assessed at baseline were gender, age, duration of KOA, BMI, pain, knee injury (7 days before), knee buckling (2 days before), Lubben Social Support, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain score (ICOAP), Positive/Negative Affect Score, and footwear stability/heel height. Outcome was occurrence of any KOAF during the ensuing 30 days. The combined ability of the above variables to predict occurrence of any KOAF was evaluated by multiple logistic regression with a 10-fold cross-validation method to build and internally validate the model. Variables that assessed similar domains were eliminated using receiver operating characteristics curve assessment for best fit. RESULTS: Complete data were available for 313 people (66.6% female, mean ± sd age 62.3 ± 8.2 years, BMI 29.7 ± 6.5 kg/m2). Increasing age, years of osteoarthritis, BMI, background/worst levels of pain, knee injury, knee buckling, ICOAP, and footwear category/heel height significantly predicted the occurrence of KOAF during the following 30 days, with an area under the curve of 0.73 (95% confidence interval 0.67-0.80). Conclusion: A combination of risk factors assessed at baseline, including exposures with potential to vary, successfully predicts the KOAF in the ensuing 30 days.Item Deficiencies in the provision and the barriers in accessing family planning services for women working in Avissawella export processing zone(Sri Lanka Medical Association., 2019) Pathirana, V.P.S.D.; Pathmeswaran, A.; Jayaratna, A.INTRODUCTION & OBJECTIVES: Women working in export processing zones (EPZs) are reported to have risky sexual behaviors leading to unwanted pregnancies. The purpose of this study was to describe the deficiencies in the provision and the barriers in accessing family planning (FP) services for reproductive age women working in Avissawella EPZ. METHODS: Deficiencies in provision and barriers in accessing FP services were explored and described by individual interviews and focus group discussions conducted with a purposively selected sample of 55 comprised of EPZ workers, factory managers and healthcare workers. A semi-structured interviewer guide was used. Thematic analysis of data was done using inductive method. RESULTS: Non-availability of FP services after working hours was the main perceived deficiency in service provision and high opportunity cost for visiting clinics for FP services was the main barrier in accessing FP services among women working in Avissawella EPZ. No major bad comments on the staff, availability of contraceptive items of infrastructure facilities were given although overcrowding and need for improvement of privacy of clients and punctuality of the staff were highlighted by some women. They had more trust on government services than the private sector. Myths and misconceptions were not enormously highlighted as barriers to use of contraceptives. Side effects were seemed to be having a higher impact on non-use of contraceptives. Importance of use of social media to disseminate to be having a higher impact on reproductive health and FP among workers in EPZs was highlighted. CONCLUSION: There is a need for workplace based client friendly FP service integrated with other health services.