Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item The Impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries(Elsevier/North-Holland Biomedical Press., 2021) Brown, R.H.; Eisner, M.; Walker, S.; Tomlinson, M.; Fearon, P.; Dunne, M.P.; Valdebenito, S.; Hughes, C.; Ward, C.L.; Sikander, S.; Osafo, J.; Madrid, B.; Baban, A.; Van Thang, V.; Fernando, A.D.; Murray, A.L.BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage. KEYWORDS: Adverse childhood experiences; Birth cohort; Depressive symptoms; Maternal-foetal-attachment; Prenatal.Item Cultural adaptation, translation and validation of the ISPCAN Child Abuse Screening Tool - Retrospective Version (ICAST-R) for young adults in Sri Lanka(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.The aim of the present study was to adapt and validate the ISPCAN child abuse screening tool-retrospective version (ICAST-R) in Sri Lanka with a view to investigating the experiences of physical, sexual and emotional abuse during childhood. The adaptation was performed using qualitative research methods with young adults, parents, teachers, and a multidisciplinary group of experts. The translation to Sinhala (the local Sri Lankan dialect) was carried out by a nominal group technique. A multidisciplinary team of experts assessed the Sinhala ICAST-R (SICAST-R) for its content validity. Moreover, acceptability, reliability and construct validity were determined by conducting a validation study among 200 schooling young adults. The principal component analysis (PCA) technique was used to assess the construct validity. Response rates for each item were taken as evidence of acceptability. The internal consistency was assessed by Cronbach's alpha, and test-retest reliability after two weeks was assessed using Cohen's kappa coefficient. The adaptation of ICAST-R included the introduction of an objective manner by which to measure severity of abuse and the inclusion of a set of questions regarding help-seeking behavior following physical and emotional abusive experiences. The SICAST-R showed adequate content validity and high acceptability, with response rates ranging from 90.3% to 99.5%. The minimum Cohen's kappa coefficient was 0.76, indicating good test-retest reliability. The internal consistency (Cronbach's alpha) for the total tool was 0.708, with the three constructs being 0.398, 0.844 and 0.637 for physical, sexual and emotional abuse, respectively. The PCA demonstrated good reproducibility for sexual and emotional abuse with the hypothesized structure. Overall, the SICAST-R showed adequate validity for the assessment of experiences of physical, sexual and emotional abuse during childhood among Sri Lankan young adults.Item The Intergenerational effects of intimate partner violence in pregnancy: mediating pathways and implications for prevention.(Sage Publications, 2020) Murray, A. L.; Kaiser, D.; Valdebenito, S.; Hughes, C.; Baban, A.; Fernando, A.D.; Madrid, B.; Ward, C. L.; Osafo, J.; Dunne, M.; Sikander, S.; Walker, S.; Van Thang, V.; Tomlinson, M.; Eisner, M.Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal-fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPVItem Physical, sexual and emotional abuse during childhood: Experiences of a sample of Sri Lankan young adults(Elsevier Science Inc, 2018) Chandraratne, N.K.; Fernando, A.D.; Gunawardena, N.Abuse during childhood is a human tragedy leading to lifelong adverse health, social, and economic consequences for survivors. This descriptive, cross-sectional study aimed to determine the prevalence of childhood physical, sexual and emotional abusive experiences among students (aged 18-19 years) in a Sri Lankan district. Multistage cluster sampling was used to select a sample of 1500 students. Experiences of physical, sexual and emotional abuse and age at abuse, perpetrators, consequences and severity were assessed using a version of ISPCAN Child Abuse Screening Tool-Retrospective Version (ICAST-R) which was culturally adapted and validated by the authors for use amongst Sinhalese students. The prevalence of the various forms of abuse during childhood was as follows: physical: 45.4% (95% CI: 42.9-7.9); sexual: 9.1% (95% CI: 7.6-10.5); emotional: 27.9% (95% CI: 25.7-30.2). The corresponding percentages of individuals categorized as having experienced severe or very severe abuse were as follows, physical: 0.3% (2/672); sexual: 4.05% (3/135); emotional: 8.8% (36/412). Experience of physical abuse was more prevalent amongst male students (54.8% vs. 38.3%) as was emotional abuse (33.9% vs. 23.2%), whereas experience of sexual abuse was more prevalent amongst female students (11.5% vs. 6.4%). Parents and teachers were the commonest perpetrators of physical and emotional abuse. Most of the sexually abusive acts were committed by neighbors or strangers. Some physically abusive acts were more frequent at earlier ages than emotional and sexual abusive acts, which were more common in late adolescence. The results indicate the necessity of targeted interventions to address this public health issue.Item Posterior reversible encephalopathy syndrome in a survivor of valproate-induced acute liver failure: a case report(BioMed Central, 2013) Mettananda, S.; Fernando, A.D.; Ginige, N.INTRODUCTION: Posterior reversible encephalopathy syndrome is an extremely rare radiological diagnosis that has not been reported previously in association with acute liver failure. CASE PRESENTATION: A 6-year-old Sri Lankan girl developed acute liver failure with severe hepatic encephalopathy due to sodium valproate. She was successfully treated medically with N-acetylcysteine and L-carnitine. During recovery she again developed features of encephalopathy and had repeated convulsions associated with moderate hypertension. The diagnosis of posterior reversible encephalopathysyndrome was made on clinical and radiological grounds and she showed a gradual improvement with control of blood pressure. CONCLUSIONS: This report adds to the evidence behind treatment of valproate-induced acute liver failure with N-acetylcysteine and L-carnitine and illustrates a rare but interesting association between acute liver failure and posterior reversible encephalopathy syndromeItem Impact of corticosteroid therapy on lifestyles in asthmatic children from Sri lanka(Indian Pediatrics, 2010) Karunasekera, K.A.W.; Fernando, A.D.; Jayasinghe, C.Y.This study was conducted to ascertain the impact of inhaled corticosteroids therapy (ICS) in alleviation of lifestyle restrictions in 200 asthmatic children. 90 children on ICS were reviewed at 3 months. Restrictions on bathing, food, play activities and school attendance were found in <70%. These were not related to asthma severity. Following ICS, reduction in symptoms, hospital admissions, outpatient visits and nebulizations were noted between 67% -73%. Restrictions on bathing, food, play activities and school attendance had been waived off in 23% -55%. We conclude that ICS significantly alleviated symptoms and lifestyle restrictions. However, the reduction on lifestyle restrictions was less than symptom control.Item Juvenile victimisation in a group of young Sri Lankan adults(Sri Lanka Medical Association, 2009) Fernando, A.D.; Karunasekera, W.OBJECTIVE: To study the prevalence of juvenile victimisation in a group of young adults. METHOD: A juvenile victimisation questionnaire was distributed among 1322 Sri Lankan undergraduates. The questionnaire consisted of different modules (child maltreatment, conventional crime, peer-sibling victimisation, indirect victimisation, introduction to substances and parental deprivation). RESULTS :The response rate was 90%. The mean age of the cohort was 21.8 years. 59% were females. 44% and 36% had experienced sexual and physical maltreatment respectively. In both categories males were affected more than females (p < 0.001). Physical abuse had commonly taken place at school (51%) and home (40%). Witnessing violence at home was the highest form of indirect victimisation (66%). 10% were introduced to substances in childhood. Usage of substances (cigarettes, alcohol and drugs) was significantly higher in children whose fathers used substances compared to children whose fathers did not (p < 0.001). CONCLUSION: Many children in Sri Lanka are exposed to victimisation. They seem to suffer these in the very environments that should be nurturing and protecting them.Item A Child with Morquio syndrome and mixed mitral valve disease(Sri Lanka Medical Association, 2008) Mettananda, D.S.G.; Fernando, A.D.No Abstract AvailableItem Strategies in the management of child maltreatment: should reporting be mandatory or voluntary?(Sri Lanka Medical Association, 2007) Fernando, A.D.No Abstract AvailableItem Do schools promote violence in Sri lanka?(Sri Lanka Medical Association, 2004) Fernando, A.D.No Abstract Available