Browsing by Author "Thulani, U.B."

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Patterns and predictors of mortality in a semi-urban population-based cohort in Sri Lanka: findings from the Ragama Health Study
(BMJ Publishing Group Ltd, 2020) Kasturiratne, A.; Ediriweera, D.S.; de Silva, S.T.; Niriella, M.A.; Thulani, U.B.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Chackrewarthy, S.; Ranawaka, U.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
OBJECTIVE: To describe patterns and predictors of mortality in a semi-urban population in Sri Lanka. DESIGN: A prospective population-based cohort study. Setting: Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. PARTICIPANTS: Adults between 35 and 64 years of age were recruited using an age stratified random sampling technique in 2007. MEASURES: At baseline, we recorded socio-demographic, lifestyle, anthropometric, biochemical and clinical data of the participants. Over 10 years, we obtained the cause and date of death from the death registration documents of deceased participants. We determined the survival probability of the cohort over 10 years and estimated Hazard ratios (HRs) for all-cause mortality (ACM), cardiovascular mortality (CVM) and cancer-related mortality (CRM) using Cox's proportional hazards model. We also estimated the survival probabilities for men and women in each 10-year age group and standardised mortality ratio relative to the source population. RESULTS: There were 169 deaths over 10 years with standardised mortality rates of 5.3 and 2.4 per 1000 years of follow-up for men and women, respectively. Independent predictors of: ACM were older age, lower income, smoking and diabetes mellitus while gender, education, occupation, harmful alcohol use, waist circumference and hypertension were not; CVM were older age, lower income, smoking, diabetes and hypertension while gender and harmful alcohol use were not; CRM was older age while gender, smoking and diabetes were not. Those engaged in clerical and technical occupations or unemployed had a lower risk of CRM as compared with those engaged in elementary occupations. CONCLUSIONS: Older age, lower income, smoking, diabetes and hypertension strongly predict mortality in this cohort. Addressing the identified modifiable predictors through behavioural modification will improve longevity in similar populations. Keywords: coronary heart disease; epidemiology; public health.
Use of Library and Internet Facilities for Seeking Information among Medical Students at Faculty of Medicine, University of Kelaniya
(Faculty of Computing and Technology, University of Kelaniya, Sri Lanka, 2016) Solangaarachchi, D.I.K.; Marasinghe, M.P.L.R.; Abeygunasekera, C.M.; Hewage, S.N.; Thulani, U.B.
Information plays a vital role in education. Students are always seeking information as an aid for their studies. With the development of the internet, which is proving to be an incomparable information resource for learning and research, students are more inclined to use it for finding information. For medical students, many of the tools that support medical education and transmit health research are now available online. There are e-books, e-journals, subject-specific databases, academic and professional websites with numerous educational resources. Therefore, the internet is considered as a rich information resource that can support medical education worldwide. The study was conducted with the objective of assessing the frequency and purposes of using the faculty library and internet facilities by medical students of Faculty of Medicine, University of Kelaniya. A survey was carried out from May to June 2016 on MBBS students at Faculty of Medicine, University of Kelaniya. Students who are in their second to fifth academic years were included in the study while first year students were excluded as they were considered to be still in a period of adjustment to the system. Data collection was done using a self-administered questionnaire distributed among the students that visited the Information and Communication Technology (ICT) centre and medical library of the faculty. Two hundred forty six (85%) students responded to the questionnaire. This consisted of 27% (n=67), 20% (n=48), 30% (n=75) and 23% (n=56) from year 2 to 5 respectively. According to the responses provided in the survey, information required by medical students are mainly sought by library material (70.3%), the internet (59.3%), using personal text books (54.9%) and discussions with colleagues (37.4%). Only 13.9% of the students stated that they visited the library at least once a day, while 33.9% goes there several times a week. Those that visit the library once a week or less, but more than once a month represented 30.2% of the responders. A considerable proportion (22%) visits the library less than once a month (or never goes there). The main resources accessed in the library by students were: textbooks (92.7%), past papers (36.2%) and journals (4.9%). When it comes to frequency of internet usage 82.8% of the medical students stated that they accessed it several times per day. While 11.9% accessed internet only once a day and 5.3% accessed internet less frequently than that. Devices used by the responders for accessing the internet included smartphones (55.7%), tablets (32.9%), laptops (32.9%) and desktops (13.0%). When it comes to data access method for connecting to the internet, mobile data (75.8%) and Wi-Fi (73.2%) were most prominently featured, whereas dongle connections (20.3%) and wired connections (3.7%) were less popular. The most frequent reasons noted for accessing the internet were: for finding information related to studies (53.3%), for emailing (30.1%) and using social media such as Facebook (37.0%). Based on the responses of the sampled students, the faculty internet facilities (Wi-Fi or wired) were used by 80.9%. The times of the day for logging on to the faculty internet for most students were ‘12 noon-2 pm’ period (47.5%) and ‘after 4 pm’ period (22.8%). When inquired about problems faced while finding information via the internet: 55.3% noted connection being too slow as an issue, while 34.6% found the inability to access faculty network E-resources outside of the faculty as a hindrance. The other issues expressed were: not having enough time (16.7%), lack of ICT knowledge (6.9%), inadequate information searching skills (6.9%) and not having a device to connect to the internet (2.4%). The results show that even though less than 50% of the sampled students are regular (at least several times a week) visitors to the library, over 70% seek information related to their studies from library material. In contrast, while nearly 95% of the students were daily internet users, only around 60% used it as a source of information. Only about 53% utilised the internet for their academic requirements. The efforts of the university in providing internet facilities appears to have been worthwhile, with over 80% stating that they are consumers of the faculty Wi-Fi and/or wired internet connections. Yet, mobile data connections were the most frequently noted method of obtaining web access. This is reflected by the finding that smartphones and tablets were the most frequently used devices when accessing the web compared to laptops and desktops. The finding of the study that; more than one fifth of the students rarely visit the library could probably mean that they rely on personal text books in their studies. In addition it could also be a reflection of the influence of ICT in academic activities of students. These findings could be explained by the ever increasing influence of ICT in education as well as day-to-day life. Especially, availability of Wi-Fi within the faculty, affordability of mobile internet connections and, handheld devices like smartphones and tablets becoming versatile while also becoming accessible for most people has clearly made an impact in this regard. Recent upgrades to the faculty internet facilities may alleviate the complaint of slowness in connection. Expanding the Wi-Fi network to student hostels and the North Colombo Teaching Hospital at Ragama would help in addressing unavailability of faculty network E-resources outside of the faculty. Even though library based information seeking is still prominently featured, findings of the study show a possible shift towards the internet becoming the main source for information among medical students. The faculty medical library and ICT centre have to be sensitive when it comes to student information source preferences. By working together and adapting to the changing landscape, these two departments of the faculty could play an ever increasing role in improving students’ use of educational resources online.
Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
(Public Library of Science, 2021) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chakrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected 40-64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007-2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. RESULTS: Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10-19%, 20%-29%, 30-39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). CONCLUSIONS: WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.
Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.