Browsing by Author "Pinidiyapathirage, J."

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Age, sex and hyperlipidemia: Is it a simple association?
(College of Community Physicians of Sri Lanka, 2009) Pathmeswaran, A.; Pinidiyapathirage, J.; Kasturiratne, A.; Wickremasinghe, A.R.
INTRODUCTION: Hyperlipidemia is a known cardiovascular disease risk factor. There are effective lifestyle, dietary and pharmacological interventions to treat hyperlipidemia. It is important to target testing for hyperlidemia for the most appropriate age sex groups to optimize resource utilization. Identifying such groups is not easy when there is an interaction between age and sex. OBJECTIVE: To describe the association between age, sex and hyperlipidemia among 35 to 64 year old residents of Ragama. METHODS: Residents aged 35-64 years in the Ragama MOH area were randomly sampled from the voters list after stratification into 10 year age groups. Blood for lipid profile was collected after a 14 hour overnight fast for analysis. Bivariate and multiple logistic regression were performed using Stata 8.2. Results are expressed as odds ratios and relevant 95% confidence intervals (OR; 95% Cl). RESULTS: Total sample analysed was 2987; 45% (n=1338) were males, 17% (n=515), 38% (n=1140) and 45% (n=1332) were in the age groups of 35-44, 45-54 and 55-64 years respectively. The prevalence of hyperlipidemia was 36%. In bivariate analysis, females (OR 1.3; 95% Cl 1.1-1.5) and the age groups of 45-54 (OR 1.7; 95% Cl 1.3-2.1) and 55-64 years (OR 1.5; 95% Cl 1.2-1.9) when compared to 35-44 years were at a higher risk of hyperl[pidaemia . In multiple logistic regression too females (OR 1.2; 95% Cl 1.1-1.4) and the same age groups ( 45-55 [OR 1.7; 95% Cl: 1.3-2.1] and 55 to 64 years OR 1.5; 95%CI: 1.2-1.9) respectively) had higher risk of hyperlipideamia. When an age sex interaction term was added to the above model, 35-44 year old females had the lowest risk. In comparison to the latter, the OR (95%CI) of females of 45-54 and 55-64 years were 2.4(1.8-3.4) and 2.8(2.1-3.9) respectively. The same for males of 35-44, 45-54, and 55-64 years were 2.0(1.3-2.9), 2.3(1.6-3.2) and 1.5(1.1-2.1) respectively. CONCLUSION: The risk of hyperlipidemia increased with increasing age among females but among males the lowest risk was in the 55-64 year age group. Attempts to portray a simple picture are likely to obscure important details and may even be misleading.
Comparison of urban diabetics with optimal and suboptimal control
(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION: The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. METHODS: A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. RESULTS: There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. CONCLUSIONS: Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.
Epidemiology of hypertension in an urban Sri Lankan population
(BMJ Publishing Group, 2011) Kasturiratne, A.; Warnakulasuriya, T.; Pinidiyapathirage, J.; Kato, N.; Wickremasinghe, A.R.; Pathmeswaran, A.
INTRODUCTION: Hypertension is a common risk factor for cardiovascular disease. In Sri Lanka, despite the existence of a universal free health system, services are not available for routine screening of hypertension in the general population. This paper aims to describe the epidemiology of hypertension in 35–64 year old residents in Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. METHODS: An age-stratified random sample of 4400 adults between 35 and 64 years of age drawn from the population based electoral list, was invited for a screening programme on cardiovascular risk factors. Socio-demographic and risk factor related data and anthropometric and blood pressure measurements were obtained by trained research assistants. Blood was obtained for relevant biochemical investigations. RESULTS: The prevalence of hypertension (systolic >139 mm Hg and/or diastolic >89 mm Hg) in 2986 subjects (Males 45%), was 30.4% (27.8% in males; 32.5% in females). 31.8% (n=288) were previously undetected. Of the known hypertensives, 19.5% were not on anti-hypertensive medication and only 32.1% were controlled (defined by systolic <140 mm Hg and diastolic <90 mm Hg). Factors associated with hypertension in both males and females were body mass index, waist circumference, fasting blood glucose and serum triglycerides. CONCLUSIONS: The prevalence observed is comparable to the prevalences of developed countries with relatively older populations. A considerable proportion of known hypertensives are not on treatment and the observed poor control indicates problems in drug compliance. Interventions targeting lifestyle modification and drug compliance are essential to control adverse outcomes of hypertension.
Factors associated with osteoporosis among a sub-urban Sri Lankan population
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Karunanayake, A.L.; Pinidiyapathirage, J.; Salgado, L.S.S.
Introduction : Risk factors for osteoporosis can vary from country to country. Objective: To determine the association between osteoporosis and age, physical activity, body mass index (BMI), smoking, alcohol consumption, consumption of milk, level of education and income in a sample of sub-urban Sri Lankan adults. Methodology: A descriptive cross sectional study involving 22 grama niladari divisions of the Ragama MOH area was conducted from March to October 2007. A randomly selected sample of 700 adults, in the age group of 35-64 years, were invited to participate in the study. A structured interviewer administered questionnaire was used to collect demorgraphic data and details of risk factors. Bone mineral density (BMD) was measured with a peripheral Dexa scan. A BMD of < -2.5 was considered as having osteoporosis. Result: Of the 700 subjects studied, 60% (n=421) were females. Using logistic regression analysis, age >50 years (OR 3.5 95% CI 1.9-6.2), female sex (OR 12.2 95% CI 4.8-30.9), low level of education (OR 1.8 95% CI 1.1-2.8), low BMI (OR 3.5 95% CI 1.7-7.3) and smoking (OR 5.8 95% CI 1.9-17.2) had a significant association with osteoporosis. Conclusion: Age, sex, level of education, nutritional status and regular smoking showed a significant association with osteoporosis.
Impact of risk factors for non-fatal acute myocardial infarctions among Sri Lankans
(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Wickremasinghe, A.R.
INTRODUCTION: The impact of risk factors for acute myocardial infarctions (AMI) differs across populations. The aim of this study was to determine the impact of established risk factors for the occurrence of non-fatal AMI within a population based case control study of urban Sri Lankans. METHODS: Cases were patients consecutively admitted to the cardiology and general medical wards of the National Hospital of Sri Lanka with a confirmed diagnosis of AMI and discharged alive. Age and sex matched community controls were recruited within 20–30 km distance from National Hospital of Sri Lanka using the electoral lists. Basic demographic information, smoking habits, physical activity and dietary patterns, anthropometric indices, fasting glucose and serum lipid measurements were done on all participants. RESULTS: During the study period, 262 cases and 246 controls were recruited. Of the non-fatal acute myocardial infarct patients, 18% were female. Compared to males, females with non-fatal events were significantly older (58 years, SD 6.6). Mean age among cases and controls were similar (∼54 years). Cases were significantly more likely to have diabetes mellitus, a family history of AMI, abnormalities in lipid profile and report poor vegetable and fruit consumption (consumption was defined as “poor” if the individual did not usually consume some fruit/vegetable at least once on a given day). Physical activity patterns, education level and smoking habits were similar between cases and controls. CONCLUSION: Results indicate a high prevalence of modifiable risk factors among AMI patients. It is vital that the health system identify these patients early and provide them with optimal treatment.
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.
Prevalence and predictors of default with tuberculosis treatment in Sri Lanka
(SEAMEO Regional Tropical Medicine and Public Health Project, 2008) Pinidiyapathirage, J.; Senaratne, W.; Wickremasinghe, R.
The objectives of this study were to determine the default rate and predictors for default in patients undergoing antituberculosis treatment. All consenting patients with a confirmed diagnosis of tuberculosis admitted to a unit of the Chest Hospital, Welisara, Sri Lanka from April 2001 to April 2002 were recruited into the study. Personal and follow-up data were recorded on a pre-tested questionnaire and data sheet, respectively. A defaulter was defined as a patient who interrupted treatment for more than two consecutive months before the end of the course of treatment. Of the 892 patients recruited, 770 were new cases and 122 were relapses. The default rates were 10.3% (95% CI: 8.3-12.6) and 30.3% (95% CI: 22.7-38.1) among new cases and retreatment cases, respectively, during the intensive phase of treatment and 10.9% (95% CI:8.7-13.3) and 16.5% (95% CI:9.7-25.5), respectively, during the continuation phase. Ninety percent of new cases and 94% of retreatment cases were sputum positive for acid-fast bacilli at diagnosis. Two hundred five patients (22.9%) defaulted on treatment (95% CI: 20.3-25.8). Using logistic regression analysis, regular smokers (OR = 1.9), smear positive patients who were previous defaulters (OR = 2.4) and patients having involvement of less than 3 zones of the lung on chest x-ray (OR = 0.5) were more likely to default compared to patients who did not smoke regularly, smear positive patients who had relapsed after taking the full course of treatment and patients with less lung involvement. Skilled and unskilled laborers were the most likely occupation to default (OR = 2.03) followed by sales personnel (OR = 2.00), compared to the unemployed or home-bound. A high default rate of 23% was observed among the study participants. Smoking status, occupation, history of treatment compliance of the patient, and extent of lung involvement were predictors for defaulting
The Ragama Health Study: the methodology of the prospective cohort study for the establishment of diagnostic criteria for metabolic syndrome in Sri Lankans
(Sri Lanka Medical Association, 2008) Wickremasinghe, A.R.; de Silva, H.J.; de Silva, H.A.; de Silva, N.R.; Kasturiratne, A.; Pinidiyapathirage, J.; Chackrewarthy, S.; Pathmeswaran, A.; Weerasinghe, G.A.K.; Abeyewickreme, W.; Makaya, M.; Mizoue, T.; Kato, N.
BACKGROUND: Sri Lanka is in the midst of the epidemiologic transition with non-communicable diseases being a leading cause of death and hospitalization. This pilot study is a part of an international study conducted by the International Medical Centre of Japan (IMCJ) in collaboration with the Faculty of Medicine, University ofKelaniya. OBJECTIVE; To determine the prevalence of major metabolic disorders and to establish diagnostic criteria for metabolic syndrome in the Sri Lankan population as a pilot study. DESIGN, SETTING AND METHODS: A random sample of 3500 adults 35-64 years was selected from the electoral register. Houses of selected subjects were visited and the selected subject invited to participate in the study. Subjects were instructed to fast for 12 hours and refrain from smoking and consumption of alcohol overnight prior to presenting at the Family Medicine clinic of the Faculty of Medicine, University of Kelaniya. At the clinic, subjects were assigned an unique identification number and a detailed history taken and investigations carried out. Heights, weights, blood pressure and waist and hip circumference were measured using standard techniques. Subjects underwent an ultrasound scan of the liver and a sample of blood was obtained for full. blood count, blood picture, lipid profile, serurn insulin, serum alanine transferase, fasting blood sugar and for genetic analysis. Samples of blood for genetic analysis have been stored at -30° C until further analysis. In addition, subjects were administered a food frequency questionnaire and an assessment of daily physical activities recorded. All subjects with abnormal results of investigations are being followed up.