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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study(BMJ publishing group Ltd, 2024-11) Leung, J.; Casswell, S.; Randerson, S.; Athauda, L.; Banavaram, A.; Callinan, S.; Campbell, O.; Chaiyasong, S.; Dearak, S.; Dumbili, E.; Garcia, L.; Gururaj, G.; Kalapat, R.; Karki, K.; Karlsson, T.; Kong, M.; Liu, S.; Vargas, N.D.M.; Mejia, J.; Nthomang, T.N.; Oladunni, O.; Owino, K.; Palacio, J.; Phatchana, P.; Pradhan, P.; Rossow, I.; Shorter, G.; Sibounheuang, V.; Stelemėkas, M.; Son, D.T.; Vallance, K.; Dalen, W.V.; Wettlaufer, A.; Zamora, A.; Jankhotkaew, J.Background The alcohol industry uses many of the tobacco industry’s strategies to influence policy- making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross- section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy- makers from undue industry influence. Methods As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards. Results There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID- 19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration. Conclusion Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.Item Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.Item A Study on the knowledge and attitudes on examination of patients for drunkenness among doctors involved in such examinations(College of Forensic Pathologists of Sri Lanka, 2022) Appuhamy, H.D.S.C.P.; Kitulwatte, I.; Vaasuthevaa, K.; Shanker, K.; Senarathna, U.; Gangahawatte, S.D.S.Introduction: Driving after consumption of alcohol is an offence in Sri Lanka according to the Motor Traffic Act. When a police officer suspects that the driver of a motor vehicle on the highway has consumed alcohol, he may request such person to submit himself immediately to a breath test for alcohol or to an examination by a government medical officer. Hence, the knowledge and attitude of doctors who perform examinations for drunkenness play a crucial role in the administration of justice. The objectives were to study knowledge and attitudes on examination of patients for drunkenness among doctors with different levels of expertise/experience who are engaging in such examinations. Study design: A cross-sectional descriptive study was performed using an interviewer-administered questionnaire, on doctors who engage in an examination of people for drunkenness. The knowledge was assessed by 8 comprehensive questions on the procedures and subjects scoring ≥75% were considered as having ‘satisfactory’ knowledge on the matter. Results: Out of the 306 doctors who participated in the study, 80% (n=246) were ordinary medical officers while there were 9.5% (n= 29) postgraduate trainees in Forensic Medicine and 10% (n = 30) specialists. One-third 34% (n=105) believed that their knowledge on examination procedures is poor. The procedure to be followed in the finger nose test was correctly identified by a majority 95% (n= 290) while only 35% (n= 107) were aware of the procedure to be followed in the one-leg stand test. Conclusions: According to this study, ordinary medical officers who perform a majority of medico-legal examinations for drunkenness in Sri Lanka were found to have poor knowledge on examination procedures. This can adversely affect the results of the tests in the examination of drunk and hence can lead to wrongful convictions. Thus, it is high time to fill the gaps in their knowledge through special professional training programs and by introducing a guideline.Item Knowledge, attitudes, and prevalence of alcohol dependence and alcohol withdrawal among male patients who use harmful amounts of alcohol in the medical and surgical wards at NHSL(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Thilakarathna, S.; Thevapalan, A.; Thevathasan, K.; Jayawardana, A.Introduction: Alcohol dependence and subsequent burden related to morbidity and mortality have a significant impact on the healthcare and socio-economic status of the country. Objectives: To assess the knowledge, attitudes, prevalence, and associated socio¬demographic factors of alcohol dependence and withdrawal among male harmful users of alcohol in an inward setting at NHSL. Methods: A hospital based cross-sectional study was carried out. In a sample of 120 harmful users of alcohol who were selected by administering AUDIT (who scored >8). Interviewer administered questionnaires that included socio-demographic details, knowledge about alcohol dependence and withdrawal, attitudes about dependence were used. Knowledge was graded as adequate and inadequate. Attitudes were classified as positive and negative. Prevalence was found from the scores in AUDIT. Chi square tests were applied to assess association of prevalence with demographic factors. Results: Most were middle aged males (54.2%, n=65) and from Colombo district (61.7%, n=74). They had a moderate level of knowledge regarding dependence and withdrawal (66.7%, n=80). Most had a mean revealing positive attitudes (60%, n=3) towards alcohol dependence and a negative attitude (71.43%, n=5) towards other alcohol dependent populations. From the AUDIT scores, prevalence of alcohol dependence (score of > 15) was 39.2% (n=47). A significant association (p<0.05) between low education and alcohol dependence was established. Conclusions: Participants had moderate levels of knowledge on alcohol dependence and withdrawal, non-favouring attitudes towards alcohol dependence, negative attitudes towards alcohol dependents, and a higher prevalence of dependence. Study also revealed a significant correlation between alcohol dependence and lower educational status.Item Prevalence of alcohol, tobacco and illicit narcotic substances usage and associated factors among patients attending mental health clinics conducted by a group of hospitals in Sri Lanka(ClinMed International Library, 2018) Abeysena, C.; Hapugoda, C.BACKGROUND: Consumption of alcohol, tobacco and illicit narcotics affects the quality of life among mental health patients. The objective of this study was to describe prevalence of alcohol, tobacco and illicit narcotic substances usage and associated factors among patients attending mental health clinics. METHODS: A descriptive cross sectional study was carried out in mental health clinics from July to November in 2013. All mental health patients who had registered and followed up ≥ 1 year were the study population. Using systematic sampling, 404 patients were recruited. A pre-tested interviewer administered questionnaire was used. Results were expressed as prevalence and 95% confidence interval (CI). Chi-squared test was applied for assessing the associations. RESULTS: Lifetime prevalence of usage of alcohol, tobacco and illicit narcotic were 53.7%, (95% CI = 48.8-58.6), 24.3%, (95% CI = 20.1-28.5) and 5.9%, (95% CI = 3.6-8.2) respectively. Current usage of alcohol, tobacco and illicit narcotic were 42.6% (95% CI = 38.2-47), 15.3% (95% CI= 11.8-18.8) and 2.7% (95% CI = 1.1-4.3) respectively. Statistically significant relationships were found between male patients and current usage of alcohol, tobacco and illicit narcotic substances. Patients with monthly income > LKR 5000 had a significant relationship with current usage of alcohol and tobacco. Current alcohol usage of patients was significantly associated with the alcohol consumption of the caregivers. There are no statistically significant relationships between the number of clinic attendance ≤ 8 during last 12 months and age, marital status, education level, consumption of alcohol, tobacco or illicit narcotics usage of the patients or family members, monthly income, and distance between clinic and residence.CONCLUSION: Alcohol usage was higher among mental health patients. Being a male patient, alcohol consumption of caregiver and high family income were associated with alcohol usage of patients. Usage of those substances did not significantly affect the clinic attendance.