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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Item It’s normal to drink, isn’t it? a qualitative study on factors influencing adolescent drinking in Sri Lanka(Sri Lanka Medical Association, 2021) Athauda, L.K.; Pereis-John, R.; McCool, J.; Ameratunga, S.; Wickremasinghe, A.R.Introduction and Objectives In Sri Lanka, adolescent drinking behaviour has been linked to parental, family influence as well as culture and living location. While proximal level social determinants play an important part in influencing adolescent drinking, determinants operating at the distal level have not been discussed adequately. This study aimed to describe the factors influencing adolescent drinking among school going adolescents in the Colombo District. Methods Focus Group Discussions (FGD) were conducted separately for males and females in selected Public Health Midwife (PHM) areas in the Colombo District. A semi structured interview guide facilitated the discussion. Transcripts were translated, transcribed and managed on NVivo 12. Inductive thematic analysis was used to interpret the ideas expressed in the FGDs. Results Fifty adolescents (24 females and 26 males) aged between 16-17 years participated in eight FGDSs. The findings elaborate one overarching theme: it’s normal to drink, isn’t it? Media, culture and society contributed towards building social norms around adolescent drinking. Based on the perception of normalcy around drinking, adolescents were inclined to test their limits and experiment with alcohol, while being influenced by peers. However, they also experienced some restraints, in terms of law, family and culture, which made them question the normalcy around drinking. Conclusion Adolescents engage in social learning, through their distal environment which creates norms and aspirations. Peer engagement facilitates social capital which also contributes towards their decisions to drink. Distal level social determinants are important contributory factors of adolescent alcohol use. Restrictions within this environment may restrict their drinkingItem Association between faecal incontinence, child abuse, somatisation and health related quality of life(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN), 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.AIMS : Faecal incontinence (FI) is an important lower gastrointestinal disease. Bad aroma around children with FI leads to rejection by peers, psychosocial isolation and learning difficulties. Aim of this study was to evaluate the association between FI, child abuse and health related quality of life (HRQoL) in children and adolescents. METHODS : Children aged 13-18 years were selected from four semi-urban schools in Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection after obtaining consent from school authorities, parents and children themselves. Information regarding socio-demographic factors, gastrointestinal symptoms, child abuse, HRQoL and somatisation were collected. FI was defined as at least one episode of leaking of faeces in to the underwear per month. RESULTS: A total of 1807 children were included in the analysis [males/9.3 vs 53.8%), mean age 14.4years, SI.) 1.4 years]. Forty seven (2.6%) had FI. FT was significantly higher in boys (-74.49S vs. 25,6%% in girls, p < 0.0001)1. Prevalence of FI was significantly higher in those exposed to sexual abuse (17%.,. vs. 2.3% in non abused, p < 0.0.001)., emotional abuse i40.4% vs. 22.7%, p < 0.0001), and physical abuse (51% vs. 24:3.'%', p < 0.0001). Children with FI had higher mean somatisation score [mean 20.1, SD 14.5 vs. mean 9.3, SD 9.2 in those without FT (controls), p < 0.0001J. Children with FI had lower HRQoL scores for physical functioning (78.1 vs.'9:1:2.in controls, p < 0.0001), social functioning (78.4 vs. 92.6, p < 0.0001), emotional functioning (70.5 vs. 82.3, p < 0.0001) and school functioning (69.1 vs- 82.3, p < 0.0001) domains, and a lower overall HRQoL score (74.6 vs. 87.1, p < Q .0.001). CONCLUSIONS : FI in children shows a significant association with physical, sexual and emotional abuse. Children with FT have a range of somatic symptoms and a poor HRQoL score in physical, emotional, social and school functioning domains.Item Epidemiology of cyclical vomiting syndrome in a cohort of Sri Lankan children(The Korean Society of Neurogastroenterology and Motility, 2013) Devanarayana, N.M.; Rajindrajith, S.BACKGROUND/AIMS: Cyclic vomiting syndrome (CVS) is characterised by recurrent episodes of intense nausea and vomiting or unremitting retelling lasting for hours to days. Very little is known of its epidemiology in paediatric age group. The aims of this study were to assess the prevalence, clinical profile and risk factors of CVS m Sri Lankan children and adolescents. METHODS: This is a school-based cross sectional survey conducted in 8 randomly selected schools in 4 randomly selected provinces of Sri Lanka. Data were collected using a validated, self-administered questionnaire, which consisted of 3 parts; part 1 - socio-demographic data, part 2 - data on stressful and adverse life events, part 3 - Rome III questionnaire (self report form for children above 10 years) which was translated and validated for Sri Lankan children. It was administered in an examination setting and collected on the same clay. Trained research assistants were present during filling the questionnaire to verify doubts. CVS was diagnosed using Rome III criteria. RESULTS: A total of 2,163 children were recruited for the study (male 1189 (54.9%), age range LO to 16 years, mean 13.4 years, SD 1.8 years). In this study, CVS was seen in 18 (0.8%). There was no gender difference in prevalence of CVS (boys 1.0% vs. girls 0.6%, P > 0-05). A significantly higher prevalence of CVS was observed in children exposed to recent stressful life events such as being bullied at school (3.4% vs. 0.7% in not exposed), major illness in a close family member (1.9% vs. 0.6%), hospital-ization of the child for other illness (2.2% vs. 0.7%), frequent punishment by parents (3.3% vs. 0.7%) and domestic violence (2.9% vs. 0.8%). No association observed between CVS, and age, socio-economic status, family size and birth order. CONCLUSIONS; The prevalence of cyclic vomiting syndrome among Sri Lankan children and adolescents is 0.8%. This condition is more common in those exposed to emotional stress.Item Gastric motility abnormalities in children suffering from cyclical vomiting syndrome(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.AJMS; Cyclical vomiting syndrome (CVS) is an uncommon, but bothersome upper gastrointestinal disorder seen in ap- roximately 0.5% of school aged children. Pathophysiology of this disorder is not fully understood. The aim of this study was to evaluate the gastric motility in children with CVS. METHODS : Consecutive 12 children [6 (50.0%) males, age 4-15years, mean 8.5 years, SD 3.2 years) referred to Gastro-nterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, from January 2008'to December2012, were screened and those fulfilling Rome HI criteria for CVS were recruited. None-had clinical or laboratory vidence of organic disorders or other gastrointestinal disorders. Twenty healthy children were recruited as controls [8 (40%) males, age 4-14 years, mean 8.4 years, SD 3.0 years]. Fasting antral area (FAA), liquid gastric emptying rate GER) and antral motility parameters were assessed using a well-established and validated ultrasound method, RESULTS: Average GER (38.2% vs. 66.2%, in controls), amplitude of antral contractions (51.1% vs. 89%) and antral -lotuty index (4.6 vs. 8.3) were lower and FAA (1.6cm2 vs. 0.6cm2) was higher in patients with CVS (p < 0.0001). Fre-uency of antral contractions (8.8 vs. 9.3) did not show a significant difference (p - 0.07). Scores obtained for severity )f abdominal pain had a negative correlation with GER (r = -0.25, p < 0,0001), amplitude of antral contractions (r = ;030,/5 < 0.0001) and motility index (r = -0.30,;p < 0,0001). A positive correlations were observed between FAA and severity(r= 0.18,p = 0.007). CONCLUSIONS : Gastric emptying rates and antral motility parameters are impaired in children with CVS. Furthermore, we 3served a significant correlation between symptom severity and gastric motility. These findings are suggestive of gastric lotility abnormalities in pathogenesis of CVS.Item Quality of life in teenagers with abdominal pain related functional gastrointestinal disorders who have been exposed to child abuse(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.AIMS: Large number of previous studies conducted in children and adults have shown a significant association between abdominal pain predominant functional gastrointestinal disorders (AP-FGD) and exposure to child abuse. The main objective of this study was to assess the impact of child abuse on quality of life of Sri Lankan with AP-FGD. METHODS: A randomly selected group of 13-18 year olds were screened using the Rome iii questionnaires criteria for AP-FGD were recruited after obtaining consent from school administration, parents and teenagers themselves. Information regarding exposure to abuse and quality of life were assessed using previously translated and validated questionnaires. The questionnaires were administered in an examination setting to ensure confidentiality and privacy. Research assistants were present during filling the question¬naires and verifications were provided. They were collected on the same day. RESULTS: A total of 290 children with AP-FGD were recruited [males 128 (44.1%), mean age 14.6 years and SDI 1.5 years]. The number of children exposed to physical, emotional and sexual abuse, were respectively 90 (31.0%), 101 (34.8%) and 16 (5.5%). Average scores obtained for physical (85.3% vs.89.3% in nonabused), emotional (69.9% vs.79.7%), social (86.3% vs. 92.6%) and school (73.7% vs. 80.6%) functioning domains of quality of life in children exposed to emotional abuse were significantly lower (p < 0.05, unpaired t-test). Similar decrease was observed in children exposed physical abuse in social (86.4% vs. 92.2%) and school (74.6% vs. 79.9%) functioning domains (p < 0.05), but not in physical and emotional functioning domains (p > 0.05). Exposure to sexual abuse did not show a significant difference in in quality of life (p > 0.05). CONCLUSIONS : Even among teenagers with AP-FGD, those exposed to child abuse have a significantly lower quality of life than those not exposed to abuse.Item The epidemiology of irritable bowel syndrome among children and adolescents in Asia: a systematic review(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Rajindrajith, S.; Gunawardena, N.K.; Abeygunasekara, C.; Devanarayana, N.M.Aims: Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and changing bowel habits including frequency and consistency. The aim of this study was to systematically review published literature on prevalence, risk factors and comorbid factors of IBS among children living in Asia. METHOD: A computer assisted search of PUB MED, CINHAL, and Index Medicus for South East Asia was carried out. Study selection criteria were; 1) Asian population based samples of children/adolescents; 2) Clear diagnostic criteria for IBS (Rome I, II or III); 3) Full manuscripts published in English. Selected articles were reviewed in depth; data were extracted and presented in descriptive form. RESULTS: Thirteen cross sectional studies which reported prevalence of IBS were included in the final analysis. Preva¬lence of IBS among Asian children and adolescents ranges from 2.8% to 25.7%. Nine studies have shown a higher prevalence of IBS in girls compared to boys. Studies from China have indicated untyped IBS as the commonest IBS subtype, while studies from Sri Lanka have shown approximately even distribution of all four subtypes. Clearly identi¬fied predisposing factors to develop IBS in Asian children included psychological stress, anxiety, depression, consump¬tion of alcohol and fatty food, smoking, and exposure to gastrointestinal infections. Comorbid factors of IBS reported among Asian children included an array of somatic symptoms, fatigue and psychological problems such as depression. CONCLUSIONS: According to published data, IBS is a significant problem among Asian children and adolescents. Female gender, exposure to stress, certain food habits, life styles and gastrointestinal infections predispose children to develop IBS in Asia.Item Constipation and exposure to stressful life events in 10–16 year olds: a Sri Lankan experience(BMJ Publishing, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. The majority have functional constipation. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. AIMS AND METHODS: The aim of this study was to assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in five randomly selected schools, in three geographically and socioeconomically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) were included in the analysis (1368 (50.6%) males, mean age 13.17 years, SD 1.72 years). According to Rome III criteria 416 (15.4%) had constipation and they were compared with 2278 children without defaecation disorders (eg, constipation, diarrhoea, functional faecal retention, non-retentive faecal soiling, etc). The prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months (odds ratio (OR) 0.38, p,0.0001). During univariate analysis the stressful life events associated with constipation were change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step-parent, hospitalisation of the child himself/herself for other illness, frequent punishment by parents, father’s alcoholism, domestic fights and living in an area affected by ongoing separatist war (p,0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p = 0.016), severe illness in a family member (adjusted OR 0.588, p = 0.001), loss of job by a parent (adjusted OR 0.55, p = 0.017), frequent punishment by parents (adjusted OR 0.581, p = 0.005) and living in a war-affected area (adjusted OR 0.666, p = 0.0001) remained to be significantly associated with constipation. CONCLUSION: Childhood constipation was significantly higher in those exposed to stressful life events. Modulation of gut motility through the brain–gut axis probably delays colonic transit causing constipationItem Constipation and functional faecal retention in Sri Lankan school children and adolescents(Wiley Blackwell Scientific Publications, 2008) Rajindrajith, S.; Adikari, C.; Pannala, W.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding it’s prevalence in Asia. AIMS : To assess prevalence of constipation and functional faecal retention among Sri Lankan school children and adolescents. MATERIALS: This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in 4 randomly selected schools, in 3 geographically and socioeconomically different Provinces in Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. RESULTS: A total of 2770 questionnaires were distributed and 2699 (97.4%) were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria and PACCT, 416 (15.4%) and 353 (13.1%) had constipation respectively [the agreement Cohen’s kappa (k) = 0.895, p < 0.0001]. Prevalence of constipation was higher in males than in females according to both PACCT (15.1% vs. 11%, p = 0.002) and Rome III criteria (16.8% vs. 14%, p = 0.047). The majority had family history of constipation (p < 0.0001). Straining, bleeding per rectum, abdominal pain, nausea, vomiting, anorexia and weight loss were significantly higher in the affected children (p < 0.001). Hundred and ten (4.1%) had functional faecal retention, of them 104 (94.5%) also fulfilled Rome III criteria for constipation (k = 0.402, p < 0.0001). CONCLUSIONS: Chronic constipation is a significant problem affecting 13–15% of Sri Lankan school children and adolescents. Constipation is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studiesItem Bowel habits of Sri Lankan children and adolescents(Wiley Blackwell Scientific Publications, 2008) Rajindrajith, S.; Adikari, C.; Pannala, W.; Devanarayana, N.M.INTRODUCTION: Bowel habits vary greatly around the world, depending on food consumption and genetic factors. Thorough understanding of normal bowel habits is essential for correct diagnosis of defecation disorders which are common in paediatric age group. Main objective of this study was to evaluate normal bowel habits of Sri Lankan school children. METHOD: Normal children aged 10–16 years, without defecation disorders (e.g. diarrhoea, constipation, irritable bowel syndrome and non-retentive faecal soiling), were randomly selected from 5 schools in 4 districts in Sri Lanka. Details regarding their bowel habits of previous two months were collected using a pre-tested, self administered questionnaire. RESULTS: A total of 2273 children were recruited (male 50%, mean age 13.25 years, SD 1.7 years). Of them 1710 (75%) opened bowels once daily, while 153 (6.7%) and 11 (0.5%) had bowel motions less than 3 per week and more than 3 per day respectively. Stool consistency was normal in 1925 (84.6%), hard in 86 (3.7%), and 163 (7%) had changing consistency. Straining was present in 641 (28%), painful defecation in 273 (10.5%) and bleeding in 49 (2%). One hundred and four (4.6%) children reported stool withholding behaviour. Bulky stool was present in 156 (7%), while faecal soiling was seen in 15 (0.6%). Hard stools, bulky stools, faecal soiling and straining were commoner in males, whereas, painful defecation and withholding behaviour were common among females (p < 0.05). CONCLUSION: Hard stools, bulky stools, faecal soiling and straining were commoner in males, whereas, painful defecation and withholding behaviour were common among females (p < 0.05).Item Determinants of healthcare consultation behavior in children with chronic constipation: a school based survey(Lippincott Williams & Wilkins, 2011) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND: Constipation is a common pediatric disorder associated with poor quality of life and high healthcare expenditure. Healthcare consultation patterns in childhood functional gastrointestinal diseases are poorly understood. To date there are no community-based studies to identify factors determining healthcare consultation in children with functional constipation. AIMS: To assess the healthcare consultation patterns in Sri Lankan children with constipation and identifying socio-demographic and clinical factors that predict consultation behavior. METHODS: Island-wide cross-sectional survey was conducted among 10–16 years old children. Five schools were randomly selected from 3 randomly selected provinces of Sri Lanka. From each school, children were randomly selected from academic years (grades) 6–11. Previously pretested questionnaire based on Rome III criteria was used in the survey and questions were included regarding healthcare seeking for symptoms of constipation. RESULTS: Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice for their symptoms during previous 12 months. Children < 0.05). Healthcare consultation in children with stool frequency less than 3 per week, hard stools, painful defecation, large volume stool, fecal incontinence, with-holding posture and blood stained stools were respectively 7.5%, 2.7%, 6.6%, 11.6%, 11.1%, 7.7% and 14.3%. Exposure to stressful life events show no association with healthcare consultation (p=0.82). CONCLUSIONS: Healthcare consultation for chronic constipation in Sri Lankan school children and adolescents is quite low, despite the majority of them having features suggestive of significant constipation. Socio-demographic factors such as younger age and family history of constipation were significantly associated with healthcare seeking. It is essential to educate general public regarding features of chronic constipation and bring their children to medical attention early to avoid complications.