Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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The attitudes and practices, regarding pre hospital care and emergency medicine, among ambulance drivers and minor employees accompany patients in ambulances
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe, the attitudes and practices, regarding pre hospital care and emergency medicine among the ambulance drivers and minor employees. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka from 15th August to 13th October 2008. The staff arrived in 409 ambulances (from any part of the country), consisting of 335 drivers and 675 minor employees were recruited. All were given an interviewer administered questionnaire to assess attitudes and practices. Likert scale was used to assess the level of attitudes. Practices were self reported ones. The analysis was done by using chi square test. RESULTS: Good attitudes towards, training needed in pre hospital care among drivers was 99.7% (n=334), low cost involved in adopting certain life saving measures, 50.4% (n=169) and positive outcome of pre hospital care in terms of survival, 4.8% (n=16). Among minor employees the respective figures were 96.8%(n=654), 36%(n=243) and 2.4%(n=16). Twenty four percent (n=164) of minor employees has had training in pre hospital care. Of them 84.8% ^=139) have used their knowledge to assist other ambulance staff in emergencies. Twenty three percent (n=95) of drivers wore seat belts and 6.4%(n=26) wore gloves. Among minor employees, 53%(n=360) used gloves, 45.2%(n=305) face masks, 5.9%(n=40) safety boots and 2.2% (n=15) safety caps. There is no statistically significant difference in attitudes of drivers and minor employees according to age, sex, education level, hospital they work, or training they had received. CONCLUSION: Attitudes towards training needed in pre hospital care were good, but with regard to low cost and positive outcome of pre hospital care, attitudes were relatively poor. The use of personal protective equipment during work was poor among all staff categories.
Availability of facilities and equipment, in ambulances that provide care in pre hospital set up
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe available facilities and equipment, in ambulances that provide care in pre hospital set up. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka (NHSL) from 15th August to 13th October 2008. All ambulances that arrived at the NHSL during the study period with an emergency patient were selected as study sample (n=409). A check list was used to assess in situ facilities and equipment that are available in the ambulance. RESULTS: Most of the ambulances were equipped only with very basic facilities such as wheeled stretcher (95.4%; n=390), ABC fire extinguishers (75.3%; n=308) and warning sirens (94.4%; n=386). Among ventilation and air way equipment required for basic life support, oxygen cylinders showed highest percentage (68.7%; n=281) of availability where as oropharyngeal air ways were available only in 4.9% (n=20) of ambulances. Availabilty of ventilation and air way equipment required for advanced life support ranged from 0.7% each (n=3) of adult endotracheal tubes and portable ventilators to 0.2% each (n=l) of peadiatric endotracheal tubes and Magill forceps. Patient assessment equipment such as pen lights and blood pressure apparatus were available only in 19.6%(n=80) and 2.2%(n=9) respectively. Communication equipment, obstetric supplies, splinting equipment, surgical items, drug delivery devices, and intravenous equipment, were available only among less than 5% of all ambulances. Most of the ambulances were equipped with safety and accessory equipment, except child safety seat 0.5% (n=2), triage tags 1.7% (n=7) and hack saw 0.7% (n=3), which were available only in less than 2% of all ambulances. Body substance isolation equipment were available only in less than 30% of all ambulances. CONCLUSION: The facilities that should be available for basic and advanced life support were poor in ambulances. From equipment that should be available for basic life support, most of the ambulances contained more basic elements only, which have no direct impact on patient care. Most of the equipments required for advanced life support were available only in less than 1% of ambulances.
Energy expenditure and pregnancy outcome
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Abeysena, C.; Jayawardana, P.; Seneviratne, R.
OBJECTIVE: To determine the effect of energy expenditure on pregnancy outcome. Methodology: A prospective cohort study was carried out at Ragama and Ja-ela MOH areas. Eight hundred and seventy five pregnant mothers were recruited at 16 weeks of gestation (POA). Daily energy expenditure was assessed based on the activities indicated by the pregnant mothers in the Activity Record1 on two occasions during 20 (371 subjects) and 32weeks of POA (271 subjects) at home by housewives and both at home and at work by working mothers. On each occasion activities related to 3 different days were recorded. Average energy expenditure was calculated and >2550 kcal/day was considered as the cut off. Information on potential confounding factors was gathered on average at 12th, 28s11 and 36 POA. Pregnancy outcome was assessed in terms of maternal complications (MC) such as pre-eclampsia, ante-partum haemorrhage and gestational diabetes, pre-term birth , low birth weight (LEW), small for gestational age <10dl (SGA<1O) and <5th (SGA<5) centiles. Logistic regression analysis was applied and the results are expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Results: Univarite analysis revealed that >2550 kcal/day energy expenditure during 20 weeks of POA was significantly associated with subsequent development of MC (OR6.86, 95% CP=2.38-19.76) and with MC (OR=1 1.03, 95%CFI.36-89.24), LBW (OR=O.05, 95% CI-O.006-0.36) and SGA<5 (OR=O.29, 95% CIO.10-0.87) during 32" xveek of POA. On multivariate analysis subsequent development of MC (OR=6.305 95% CI 21.94} and SGA<5 (OR=0.29, 95% CI = 0.09-O.96), remained significantly associated with high energy expenditure during 20 ' week of POA and 32"d week of POA respectively. CONCLUSION: High energy expenditure was a risk factor for maternal complications and a protective factor against the birth of a small for gestational age infant.
Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2
(College of Community Physicians of Sri Lanka, 2021) Abeysena, C.; Gamage, A.U.
Introduction: Diagnostic tests are never perfect, leading to inaccurate decisions by healthcare workers. Study aimed to compile the evidence and facilitate the epidemiological interpretation of testing available for the COVID-19. Methods: Published systematic reviews, especially Cochrane reviews and evidence summaries were used. Positive-predictive-values (PPV), negative-predictive-values (NPV), and its 95% confidence intervals (CI) were calculated following application to a hypothetical cohort of 1000 patients, the reported sensitivities and specificities and assumed pre-test probability levels. Results: At a low pre-test probability level, PPV is 63.6%(95%CI: 37.8%-83.5%) when assumed 72%sensitivity of the antigen test among symptomatic patients and 60.0% 95%CI: 33.3%-81.8%) when assumed 58% sensitivity of the antigen test among asymptomatic patients. If the sensitivity is low, PPV will become a low value. PPV is high with a higher pre-test probability level; however, the NPV is 78%(95%CI: 75.5%-80.4%) among symptomatic and 70.3%(95%CI: 68%-72.4%) among asymptomatic patients. PPV is 44.4% (95%CI: 28.6%-61.5% at a low pre-test probability level) when assumed 80% sensitivity for the RT-PCR test. Further, assuming that the sensitivity of 95%, PPV is 47.4% (95%CI: 32%-63%). At a higher pre-test probability level, the NPV is 83.2% (95%CI: 80.6%-85.5%) when assumed 80% sensitivity. Further, the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). Conclusions: With a low pre-test probability, positive results should be interpreted cautiously and need a second specimen tested for confirmation for both Ag and PCR testing. With higher pre-test probability, the confidence in negative COVID-19 test results is low. Therefore, a combination of symptoms, signs, laboratory investigations can be used with antigen and RT-PCR tests, for diagnosis of COVID-19.
Evidence-based and epidemiological interpretation of the diagnosis of SARS-COV-2
(Sri Lanka Medical Association, 2021) Abeysena, C.; Gamage, A.
INTRODUCTION AND OBJECTIVES: Diagnostic tests are never perfect; hence cannot definitely tell whether the disease is present or absent which leads to inaccurate decisions by healthcare workers. The key metrics in interpreting the accuracy are sensitivity and specificity and the test performance measures of positive-predictive-value(PPV) and negative-predictive-value (NPV). Positive and negative predictive values of diagnostic tests vary depending upon the pre-test probability. This paper aims to compile the evidence generated and facilitate the epidemiological interpretation of diagnostic laboratory testing available for COVID-19 pandemic. METHODS: We searched systematic reviews published, especially Cochrane reviews and evidence summaries. Diagnostic accuracy studies were searched when there were no published systematic reviews. PPV, NPV and its 95% confidence intervals (CI) were calculated for the reported sensitivities and specificities and assumed pre-test probability levels. RESULTS: At a low pre-test probability level, PPV is 50%(95%CI: 28%-72%) when we assume 56% sensitivity of the antigen test. If the sensitivity is low, PPV will be low and vice versa; however, the NPV is 69.3% (95%CI: 67%-71%). Considering RT-PCR test PPV is 28.6%(95%CI: 13%-52% at a low pre-test probability level) when we assume 40% sensitivity. Assuming RT-PCR sensitivity is 95%, PPV is 47.4% (95%CI: 32%-63%), NPV is 62.3%(95%CI: 60.6% to 63.9%). Further, assuming that the sensitivity of the RT-PCR is 95%, NPV is 95.2%(95%CI: 93.1% to 96.7%). CONCLUSION: In low resource settings symptoms, signs, basic laboratory and other investigations can be used to screen COVID-19 patients and interpretation of the results of the antigen and RT-PCR test for better diagnosis.
Knowledge about acute coronary syndrome of patients admitted to National Hospital of Sri Lanka
(Sri Lanka Medical Association, 2010) Ariyarathne, A.M.N.; Abeysena, C.; Liyanage, D.L.D.C.
OBJECTIVES: To describe knowledge about ACS, secondary prevention of ACS and selected risk factors and sources of knowledge of patients with ACS, admitted to NHSL. METHODS: This was a hospital based descriptive cross sectional study carried out in two settings at NFISL, cardiology unit and medical wards during September to October 2009. A sample consisting of 345 patients were recruited in to the study, who were diagnosed as ACS. Data was collected by using a self administered questionnaire and it was used to collect data about knowledge on ACS, secondary preventive measures, smoking, alcohol and life style change. There were 17.6% (n=61) non respondents for the self administered questionnaire. RESULTS: Knowledge about ACS was good among 32.7% (n=93) study subjects. Good knowledge on smoking, alcohol and lifestyle change was 61.3% (n=174), 53.6% (n=155) and 60.9% (n=173), respectively. Patients treated at cardiology unit had statistically significant good knowledge about ACS, compared to medical wards. Total knowledge score in relation to the age, education level of the study subjects was statistically significant (p<0.05). Many of the patients gathered their knowledge from medical officers who were working at NHSL and TV/Radio and printed media were also good sources of knowledge. CONCLUSIONS: Patients' knowledge about acute coronary syndrome, secondary prevention of acute coronary syndrome and selected risk factors were poor. Medical officers working at NHSL were a good source of knowledge.
Mental health status among females aged 15 to 45 years in Medical Officer of Health area, Kayts
(College of the Community Physicians of Sri Lanka, 2007) Thatparan, R.; Abeysena, C.
OBJECTIVE: To describe mental health status among females aged 15-45 years in Medical officer of Health area, Kayts. METHODOLOGY: This was a descriptive cross-sectional study carried out in Kayts MOH Division during the period between October and November 2006. The study population consisted of 365 females of age 15- 45 years. Data collection was made using the GHQ-30 and a self-administered questionnaire, which included socioeconomic data and exposure to adverse effects of war and social support received. Data analysis was done by applying chi-square test and multiple logistic regression. RESULTS: Of 365, 278 females had a GHQ-30 >5 giving a prevalence of poor mental health status of 76.4%. of them 27(7.7%) experienced loss of a limb, 126(35.9%) complained loss of assets such as jewelry or furniture, 17(4.8%) experienced disappearance of family members or relatives, 94(26.8%) had partially and 84(23.9%) fully damaged houses. There were statistically significant association between poor mental health status and single marital status (OR:2.2; 95% Cl:1.3-3.7; P=0.005), experience of displacement (OR:2.4; 95 % Cl: 1.1-5.2; P=0.03) and receiving of any form of assistances (OR:0.3; 95% Cl: 0.2-0.6; P=O.OO1). There were no statistically significant associations between poor mental health status and age, religion, educational level, employment, income, experience of injury, loss of a family member and property or having partially or fully damaged houses. After controlling for confounding effect by applying multiple logistic regression statistically significant associations were observed between poor mental health status and experience of displacement (OR:3.4; 95% Cl: 1.4-8.2; P=0.006) and receiving any form of assistance (OR:0.3; 95% Cl: 0.1-0.5; P=O.OOO). There was no statistically significant association between poor mental health status and single marital status (OR: 1.7; 95% Cl: 0.9-3.0; P=O.08). CONCLUSION: Prevalence of poor mental health status was very high in the area. It was associated with experience of displacement and receiving assistance.
Physical activity and weight gain during the period from first trimester of pregnancy to six months post partum
(Sri Lanka Medical Association, 2013) Perera, M.G.S.N.S.; Abeysena, C.
INTRODUCTION AND OBJECTIVES: Weight gain from first trimester of pregnancy to six months post partum, places a woman at risk of developing obesity in later life. Objectives were to determine the association between physical activity and weight gain during the period first trimester of pregnancy to six months post partum, in mothers attending child welfare clinics in Biyagama and Kelaniya Medical Officer of Health areas. METHODS: This was a clinic based descriptive cross sectional study, conducted from August to October 2012. International Physical Activity was used in data collection. Low physical activity was defined as no activity or < total 600 MET-min/week (Metabolic Equivalents of Task) for 5 or more days. Results were expressed as percentages, Odds ratios (OR) and 95% confidence intervals (CI). Multivariate logistic regression was performed to control for confounders. RESULTS: Mdian total Physical Activity was 1,087 MET-minutes per week (inter quartile range IQR 240 - 1836). Low level of physical activity was observed in 38.8% (95% Cl 34 -44%) of mothers. Percentage of mothers who gained weight from first trimester of pregnancy to six month post partum was 67.8% (95% CI 63% -72%). Multivariate logistic regression showed low level of physical activity was significantly associated with weight gain from first trimester to six months post partum OR12.0 (95% CI 6.1-23.8, p=0.001). CONCLUSION: Low level of physical activity was associated with weight gain from first trimester of pregnancy to six months postpartum.
Presenting symptoms/conditions and selected aspects of health care quality at the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital, yakkala
(College of the Community Physicians of Sri Lanka, 2007) Wanigasekara, C.; Weerasinghe, P.; Weerasinghe, A.; Weerasooriya, S.; Wellagiriya, S.; Wickramarathne, S.; Wijerathne, B.; Abeysena, C.
OBJECTIVE: To describe the presenting symptoms/conditions and selected aspects of health care quality of the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital. METHODOLOGY: A descriptive cross sectional study was conducted on patients seeking treatment from the CPD oi the Wickramarachchi Ayurvedic Hospital. Yakkala between February to April 2007. A pre-tested interviewer administered questionnaire was used to gather information from 250 patients. RESULTS: Fever, cold and respiratory symptoms (44.2%; n=46), musculoskeletal complaints (28.8%; n=30) and dermatological conditions (14.4%; n=15) were the commonest presentations among persons up to 40 years old. Musculoskeletal complaints (26.8%; n=38). lever, cold and respiratory symptoms (24.6%; n=35) diabetes and hypertension (20.4%; n=29) and eye problems (9.8%; n=14) were the commonest presentations among persons above 40 years. Out of 250 patients, 56(22.4%) had visited the Ayurvedic Hospital as the first preference for the current illness and the balance 194(77.6%) patients had taken treatment from other health care institutions. The majority (86%: =168) sought ayurvedic medicine after taking western medicine. The most common reason for giving up previous treatment methods was treatment failure (69%; n=135). The distance between home and the hospital was <10 km for 52.4%(n=137) patients and >20 km for 11.6%(n=54) patients. Median total expenditure for one visit to the Ayurvedic hospital was Rs.200 (Range Rs. 00500 to 3000.00) and 57.6%(n=144) had spent Rs.100-500 for one visit. Median waiting time for consultation was 90 minutes (Range 5 — 300min). Consultation time was <5 minutes in 52%(n=131) and >10minutes in 24%(n=60) of patients. Two hundred and seven (83%) patients were satisfied with treatment given and 224 (69.6%) on facilities provided by the Ayurvedic hospital. Statistically significant associations were observed between high satisfaction and low educational level (p<0.001) and previous treatment failure from other systems (p<0.001). CONCLUSION: Patients seek ayurvedic treatment for various symptoms/diseases irrespective of their severity. patient's age and the distance to the hospital. The commonest reason for seeking ayurveda treatment was treatment failure at other methods. A majority were satisfied with the treatment provided and facilities available.
Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories
(College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.
INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.
Quality of ambulance care available for transfer of emergency patients to the National Hospital of Sri Lanka
(College of Community Physicians of Sri Lanka, 2009) Nandasena, L.G.S.; Abeysena, C.
OBJECTIVE: To describe quality of ambulance care available for transfer of emergency patients to the National Hospital of Sri Lanka. METHODS: A descriptive cross sectional hospital based study was carried out at the National Hospital of Sri Lanka (NHSL) from 15th August to 13th October 2008. All ambulances that arrived at the NHSL during the study period with-an emergency patient were selected. A self administered questionnaire was used to assess the knowledge, attitudes and skills of medical staff (n=35) who accompanied the patients in the ambulances. Knowledge was assessed according to internationally accepted three levels defined for Emergency Medical Technicians (EMT). Data related to delays during transportation were obtained from drivers (n=395) using an interviewer administered questionnaire. RESULTS: Of the 409 ambulances included, the patient was accompanied by a doctor in 4%(n=16), a nurse in 4%(n=15) and EMTs in 1%(n= 4) of the occasions. Knowledge of medical staff was 74.3 % (n:=26) each for EMT basic and intermediate levels and 65.7%(n=23) for paramedic levels (EMT third level). Self reported skills in performing laryngoscopy and intubation was 31.4 %(n=11) and defibrillation 48.6% (n=17). Good attitudes towards training needed in pre hospital care was 97%(n= 34), low cost involved in adopting certain life saving measures was 77%(n=27) and being optimistic of adopting life saving measures was 25.7%(n= 9). More than 15 minutes each had been spent between receipt of message and transferring the patient from the scene/ward to the ambulance and from latter to commencement of the journey on 19%(n= 75) and 6.9%(n=27) of the occasions respectively. Problems experienced by medical staff during transportation were, traffic delays in 40%(n=10), non availability of necessary equipment/drugs/facilities in the ambulance to manage the patient in 28%(n=7), lack of knowledge and skills regarding patient management in 36%(n=9) and deterioration of patient's condition during transportation in 36%(n=9) of occasions. CONCLUSION: In general, Knowledge in pre hospital and emergency medicine was good among doctors, nurses and EMTs, but some areas of knowledge and skills need to be improved. Attitudes in outcome of pre hospital care were relatively poor, compared to the attitudes in training and cost. Most problems encountered during transit are preventable.
The quality of controlled clinical trial reporting in five leading Sri Lankan medical journals
(Sri Lanka Medical Association, 2012) Pathirana, T.I.; Abeysena, C.
INTRODUCTION: The Consolidated Standards of Reporting Trials (CONSORT) statement and the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) checklist help improve the quality of reporting of trials. Report quality is often used as a surrogate measure of methodological quality. AIMS: To assess the quality of reporting of clinical trials published in five leading Sri Lankan medical journals METHODS: Five medical journals published between 1982-2011 were hand searched for randomized (RCT) and non-randomized clinical trials (NRCT) conducted in humans. These were evaluated by two independent observers to assess them against a checklist developed based on CONSORT and TREND recommendations. Outcome measures were presence of checklist items in published reports. Results: Twenty two RCT and 16 parallel group NRCT from 160 journals were included. Out of them, Thirty six (94.7%) clearly described the objectives, 13 (34.2%) the periods of recruitment, 7(18.4%) sample size determination, 12(31.6%) the flow of participants through each stage,19 (50%) baseline demographic and clinical characteristics of each group. Twenty one (55.3%) used statistical methods to compare groups for primary outcome, 21(55.3%) effect size, 4 (10.5%) its precision. Twenty (52.6%) interpreted the results in the context of current evidence. Five (13.2%) described the generalizability of the findings. Of the 22 RCT, only one (4.5%) reported sequence generation, 3(13.6%) allocation concealment, 7(31.8%) blinding status of participants or investigators and 2(9.1%) intention to treat analysis. CONCLUSIONS: Reporting of several essential criteria of remain suboptimal. Awareness of the CONSORT and TREND statements may improve matters quality of reporting.
The quality of reporting of case control studies published in selected Sri Lankan medical journals
(College of Community Physicians of Sri Lanka, 2009) Abeysena, C.; Poddalgoda, I.
BACKGROUND: Incomplete and inadequate reporting of research hampers the assessment of strengths and weaknesses of the studies published in the medical literature. OBJECTIVE: To assess the quality of reporting of case control studies published in selected Sri Lankan medical journals METHODS: Nine medical journals were hand searched for case control studies published since 1980 and all (18) which appeared in the 287 journal issues were included for assessment. A checklist was developed based on STROBE guidelines. Each study was assessed by two independent observers for presence of criteria in the checklist developed. RESULTS: Of the 18 articles, 10 (65.5%) clearly and correctly stated the study design, 16 (89%) the objectives, 11 (61%) described the periods of recruitment, 14 (77.7%) reported comparability of diagnosis of cases and controls clearly, 15 (83.3%) defined exposure and confounding variables clearly, 11 (61%) described comparability of assessment of exposure variables among cases and controls, 11 (61%) data collection methods and 12 (66.6%) sources of data. With regard to statistical issues, 3 (16.6%) included method of sample size determination, 15 (83.3%) presented unadjusted estimates of effects and 6 (33.3%) adjusted estimates and 10 (55.5%) the precision of the estimates. Of the 7 (39%) matched case control studies and only one applied matched analysis. Five (27.7%) studies have attempted to address potential sources of bias but none described the generalizability of the findings. CONCLUSION: None of the studies had fulfilled all criteria recommended by STROBE guidelines. Awareness on the STROBE statement and more attention to details may improve the quality of reporting.
Risk factors for delivering a small for gestational age infant
(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Abeysena, C.; Jayawardana, P.L.; Seneviratne, S.R.A.
OBJECTIVE: To determine the risk factors for delivering a small for gestatJonal age (SGA) infant. METHODOLOGY: A prospective study was carried out at two MOH areas in the Gampaha district, during the period of May 2001 to April 2002. Eight hundred and twenty pregnant mothers were recruited at £16 weeks of gestation and followed up until partus. Demographic, socloeconomic and obstetric data of the mothers were gathered at the time of recruitment. Trimester specific exposure statuses along with potential confounding factors were gathered on average at the 12 , 28 and 36 weeks of gestation. Physical activities were assessed by asking the duration of specific postures adopted per day by the mothers during each trimester at home for house wives and both at home and during working hours for those who were engaged in paid employment. Shift work and work related physical and chemical exposures were also assessed. Psychosocial stress was ascertained using the Modified Life Events Inventory and the General Health QuestionnaireJJO. Ultrasound scan was performed to determine the gestationai age based on foetal biparietal diameter. SGA was assessed using customized growth centile charts developed by Gardosi et al. Univariate and multivariate logistic regression analysis (sample size=504) were applied and the results are expressed in odds ratios (OR) and 95% confidence intervals (95%CI) with the probability levels (P). RESULTS: When cut off for SGA was considered as <10 centile of the customized birth weight centiles, the proportion of SGA was 16.4%. Although the univariate analysis revealed that sleeping for < 8 hours during 2" or 3 or both trimesters (OR=1.645 95% CI= 1.00-2.67; P=0.04) and work related exposures during 2 or 3 or both trimesters (OR=2.42,95% GUI.19-4.93; P=0.01) were significantly associated with SGA, none of these factors became significant on multivariate logistic regression analysis. When the cut off was considered as <5 centile of the customised birth weight centiles, the proportion of SGA was 8.8%. Sleeping <8 hours during 2 or 3 or both trimesters (OR=2.34,95% CI=1.18-4.61; P=0.01), work related exposures during 2" or 3' or both trimesters (OR=2.91, 95% CM.27-6.65; P=0.01) and alcohol consumption during the 3' trimester {OR=4.33, 95% CI=1.11-16.94; P=0.03) had statistically significant association with SGA in the univariate analysis. Multivariate logistic regression also revealed that sleeping for <8 hours during 2" or 3 or both trimesters (OR=2.14, 95% 01=1.06-4.32; P=0.03), and walking for < 2.5 hours per day (OR=2.40> 95% CM.05-5-51; P=0.04) and alcohol consumption during the 3' trimester (OR=8.01,95% CM.31-49.02; P=0.02) were risk factors. CONCLUSIONS: Risk factors for being SGA when SGA is defined as <5 centile of the customised birth weight centiles are, sleeping for <8 hours during 2 or 3 or both trimesters, walking < 2.5 hours per day and alcohol consumption during 3 trimester. It is recommended that the importance of sleeping >8 hours and walking > 2.5 hours per day and avoidance of alcohol be emphasised to pregnant mothers.
Risk factors for Pregnancy induced Hypertension
(College of the Community Physicians of Sri Lanka, 2007) Perera, N.; Abeysena, C.
OBJECTIVE: TO determine the risk factors for pregnancy induced hypertension (PIH). METHODOLOGY: The study was a case control study which was carried out at Castle Street Hospital for Women during August to September 2006. Hundred mothers newly diagnosed as having PlH. were Chosen as cases and 100 with uncomplicated pregnancies as controls. Both cases and controls had a period of amenorrhoea of >20 weeks. Psychosocial Stress was measured using General Health Questionnaire -30 (GHQ) and Modified Life Event inventory. Maternal socio-demographic information and other data were collected using an interviewer administered questionnaire and a record sheet. Multivariate logistic regression analysis was applied to control for confounders and the results were expressed as odds ratios (OR) and 95% confidence intervals (95%Cl). RESULTS: After adjusting for confounding effect experience of ≥2 life events during pregnancy (OR:2.1, 95%Cl:1.1 - 10.9), a maternal BMl of ≥26kg/m2 (OR:2.4, 95%Cl:1.1- 5.0), maternal age of ≥28 years (OR:3.9, 95%Cl:2.0-7.5), history of ante partum haemorrhage (OR:3.4, 95%Clz1.1 - 10.9) and standing for >1.5 hours at one stretch per day (OR:3.4, 95%Cl:1.6 - 7.4) had statistically significant associations with developing PlH. A GHQ score of >5 was not associated with PlH (OR:3.0, 95%Cl: 1.0 -10.0). CONCLUSION: Experience of 22 life events during pregnancy, BMl ≥26 kg/m2, maternal age of ≥28 years, history of antepartum haemoghage and standing for more than 1.5 hours at one stretch per day were risk factors for PlH.
Risk factors for spontaneous abortions.
(College of the Community Physicians of Sri Lanka, 2007) Samaraweera, N.Y.; Abeysena, C.
OBJECTIVE: TO determine risk factors for spontaneous abortions. METHODOLOGY: A hospital based case control study was carried out at the gynecological wards and antenatal Clinics of the De Soysa Maternity Hospital during the period between August to December 2004. Cases were selected from mothers who had partial or full expulsion of foetus up to 28 weeks period of amenorrhoea (POA), which had been diagnosed by a Consultant Obstetrician. Controls were selected from the antenatal Clinics who were having a viable foetus after completion of 28 weeks of POA. Two hundred and thirty-eight cases and 496 controls were selected. A pre-tested interviewer administered questionnaire and modified life events inventory were administered to gather data. Univariate and multivariate logistic regression was applied and the results were expressed as Odds ratios (OR) and 95% confidence intervals (95%Cl). RESULTS: After controlling for confounding by multivariate logistic regression it was revealed that sleeping <8 hours/day (OR:3.9, 95%CI:2.7-5.7, p<0.001), walking >5 hours/day (OR:2. 4, 95%Cl: 1.6- 3.3, p<0. 001), standing >4 hours/day (OR: 2.3, 95%Cl: 1.6- 3.3, p<0. 001), exposure to kitchen smoke (OR: 3.,1 95%Cl: 1 .6-6. 1, p< 0.01), BMI of >26kg/m2 (OR:2.1, 95%Cl:1.3 - 3.6, p<0.01), drugs taken other than routine antenatal vitamins and supplements (OR:2.9, 95%Cl:1.3-6.4, p<0.01) were risk factors and a maternal height <153 cm was a protective factor (OR: 0.5, 95%Cl:0.3-0.7, p<0.001) for spontaneous abortions. CONCLUSIONS: Exposure to kitchen smoke, drugs taken other than routine ante natal supplements, sleeping <8 hours/day, standing >4 hours/day and walking >5 hours/day and maternal BMI of >26 kg/m2 were risk factors for spontaneous abortions. Maternal height < 153cm was a protective factor for spontaneous abortions.
Selected aspects of inward patients' care adopted in the management of patients with acute coronary syndrome, admitted to National Hospital of Sri Lanka (NHSL)
(Sri Lanka Medical Association, 2010) Ariyarathne, A.M.N.; Abeysena, C.
OBJECTIVE: To describe selected aspects of inward patients' care adopted in the management of patients with acute coronary syndrome (ACS) admitted to NHSL. METHODS: This was a hospital-based descriptive cross sectional study carried out in two settings of NHSL, cardiology unit and medical wards, during September to October 2009. The sample consisted of 345 patients, who were diagnosed as ACS. A record data sheet was used to collect the data related to the inward care. Accepted indicators based on the national and international guidelines were used to describe the management. RESULTS: Median duration of the hospital stay was 3 days (range 1 to 12 days). Most of the patients (93.6%) were given aspirin within 3 hours of arrival to the hospital. But a statistically significant difference was observed with regards to the time of start and continuity of aspirin in the two settings and both values were low in-medical wards. Twelve-lead ECG was not done in 59.1% (n=153) within 20 minutes of arrival to the hospital, exceeding the target value in the guidelines. Fibrinolytic therapy was given to 77.6% (n=66) out of 85 eligible patients and only in 18.4% (n=9) patients within 30 minutes after arrival to the hospital. Fifty four patients (87.1%) in the medical wards and 12 patients (52.2%) in the cardiology unit were given fibrinolytic therapy and this difference was statistically significant. Assessment of left ventricular function was done only in 15.3% (n=53) patients and a statistically significant low number was observed in medical wards 10.3% (n=27) while in the cardiology unit it was 31% (n=26). Beta blockers 61.7% (n=213), ACE inhibitors 86.4% (n=298), statins 94.5% (n=326) and aspirin 97.7% (n=337) were given during the hospital stay and the figures were in par with the guidelines except for beta blockers. CONCLUSIONS: Some of the processes of inward care in the management of ACS did not meet the guideline recommendations and adherence to the guidelines was dissimilar in the two settings.