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 Prevalence and correlates of asthma among selected garment factory workers at the Free Trade Zone, Ekala(College of Community Physicians of Sri Lanka, 2015) Jayawardana, P.; Abeysena, C.Objective To determine prevalence of bronchial asthma (BA) and its correlates and respiratory functions among selected garment factory workers (GFW) at the Free Trade Zone, Ekala. Methods This consisted of a cross sectional descriptive and an analytical study. It was conducted at three selected garment factories and a clinic setting in Ekala. Study group for first component included 674 GFW who have worked for 1 or more years at the current garment factories. Control group for second component included 100 participants who have never worked in garment factories. Study instruments consisted of an interviewer administered questionnaire and spirometry. Bivariate analysis was followed by multiple logistic regressions. Results were expressed as odds ratios (OR) and 95% Confidence intervals (CI). Results Overall prevalence of BA among GFW was 32.3% (95% CI:28.8-36.0%). Prevalence of “probable occupational asthma” among asthmatic GFW was 49.5% (95% CI:42.7-56.4%). Being a GFW (OR=3.5, 95% CI:1.9-7.2) and age >30 years (OR=1.5; 95% CI:1.1-2.1) were significantly associated with prevalence of BA. Among GFW, FEV1.0 and PEFR were significantly lower among asthmatics compared to non asthmatics, and FVC, FEV1.0, and PEFR among those exposed to dust for >3 years compared to ≤3 years. Conclusions Prevalence of bronchial asthma was higher among Garment Factory Workers. However, respiratory functions were lower only among those who were asthmatics.Item Qualitative assessment of breast cancer early detection services provided through well woman clinics in the district of Gampaha in Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2013) Vithana, P.V.; Hemachandra, N.N.; Ariyaratne, M.; Jayawardana, P.BACKGROUND: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. MATERIALS AND METHODS: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. RESULTS: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. CONCLUSIONS: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.Item Educational intervention on breast cancer early detection: effectiveness among target group women in the district of Gampaha, Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2015) Vithana, P.C.; Ariyaratne, M.; Jayawardana, P.PURPOSE: The present study concerns the effectiveness of an educational intervention for improving knowledge, attitudes and practices (KAP) of breast cancer early detection among target group women (TGW) in the district of Gampaha, Sri Lanka. MATERIALS AND METHODS: The study was a community-based intervention. Two medical officer of health areas in Gampaha district were selected using random sampling as intervention (IA) and control (CA). Public health midwives (PHMs) in the IA were exposed to the educational intervention first, conducted the same among the TGW through PHMs. KAP was assessed using an interviewer- administrated questionnaire among 260 TGW from each area selected using cluster sampling before and six months after the intervention. RESULTS: The overall median scores for KAP among TGW in IG increased significantly from pre intervention level of 54% (IQR: 46-59%), 50% (IQR: 41-59%), and 0% (IQR: 0-20%) to post intervention level of 77% (IQR: 72-82%), 68% (IQR: 59- 76 %) and 40% (IQR: 20-60%) respectively. In CG, overall median scores for KAP remained almost the same at pre intervention 54% (IQR:44-59%), 50% (IQR:36-59%) and 0% (IQR: 0-20%) and post intervention 54% (IQR:46-59%), 50% (IQR:36-64%) and 0% (IQR: 0-20%) respectively. CONCLUSIONS: The educational intervention was found to be effective.Item Quality of breast cancer early detection services conducted by well woman clinics in the district of Gampaha, Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2013) Vithana, P. V.; Ariyaratne, M.; Jayawardana, P.BACKGROUND: Breast cancer is the most common cancer diagnosed in females in Sri Lanka and early detection can lead to reduction in morbidity and mortality. AIM: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: The study consisted of two components. A retrospective descriptive arm assessed clinical breast examination (CBE) coverage of target age group women (TGW) of 35-59 years in all the WWCs in Gampaha district over 2003- 2007. A cross sectional descriptive study additionally assessed quality of breast cancer early detection services. The Lot Quality Assurance Sampling (LQAS) technique was used to decide on the lot size and threshold values, which were computed as twenty and six clinics. Checklists were employed in assessing coverage, physical facilities and clinic activities. Client satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaire. RESULTS: CBE coverage in the Gampaha district increased only from 1.1-2.2% over 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35- 90%). The items that were lacking included dust bins, notice boards, stationary, furniture and linen, and cleanliness of outside premises and toilets. With regard to clinic activities, punctuality of staff, late commencement of clinics, provision of health education, supervision, CBE and breast self-examination (BSE) were substandard in 7- 20clinics (35-100%). Client satisfaction for WWC services was 45.2% (IQR: 38.7-54.8%) and only 11% had a score of ≥70%, the cut off set for satisfaction. CONCLUSIONS: Breast cancer early detection service coverage in the Gampaha district remained low (2.2%) in 2007, 11 years after commencing WWCs. All 20 clinics were substandard for overall CBE and BSEItem Factor structure and reliability of the 12-item Sinhala version of General Health Questionnaire(DRUNPP Sarajevo, 2012) Abeysena, C.; Jayawardana, P.; Peiris, U.OBJECTIVE: To determine the factor structure and the reliability of the Sinhala version of GHQ 12. METHODS: This was a descriptive study including 385 patients with in the age range of 18 to 75 years, attending the Out Patient Department of Colombo North Teaching Hospital, Ragama, Sri Lanka, between June 2009 to September 2010. Sinhala version of GHQ312 was completed by the participants. Each item of the GHQ was rated on a four 3 point scale (0313233). Factor analyses were performed by applying Generalized Least Squares method using oblimin rotation. The internal consistency was assessed by calculating Cronbach’s α coefficient. RESULTS: Median age of the study population was 32.5 years (IQR= 21years) and the median GHQ score was 9 (IQR=7). The GHQ 12 yielded two factor solutions. Factor I (Depression and Anxiety) accounted for 88% of the total explained variance and Factor II (Social dysfunction) 12%. Forty five percent (45%) of the total variance could be explained by the two extracted factors. There was a clear distinction between the items that loaded on the two factors. The correlation coe fficient between the factors I and II was 0.65. The Cronbach's alpha of GHQ 12 was 0.88, which indicated satisfactory internal consistency. CONCLUSIONS: GHQ 12 displays adequate reliability and validity f or use in the Sinhala speaking primary care attendees of Colombo North Teaching Hospital for assessing psychiatric disorders.Item Validation of the Sinhala version of 30-item General Health Questionnaires(DRUNPP Sarajevo, 2012) Abeysena, C.; Peiris, U.; Jayawardana, P.; Rodrigo, A.BACKGROUND: The General Health Questionnaire (GHQ) is a widely used instrument to detect non potential psychotic psychological problems. The Sinhala translation of GHQ 30 has been widely used for research purposes in Sri Lanka, but details pertaining to the validation procedure have not been published. Objective: To determine the criterion validity of Sinhala versions of GHQ 30. METHODS: This was a descriptive cross sectional study including 374 patients aged 18 to 75 years ,attending Out Patient Department of Colombo North Teaching Hospital between June 2009 to September 2010. Self administered Sinhala version of GHQ 30 was completed by the participants. Clinical Examination was done blindly to the GHQ score by a Psychiatrist based on ICD 10 classification of Depression/Anxiety/social dysfunction as reference standard. Cutoff values for GHQ 30 was determined by applying Receiver Operation Characteristic (ROC) curves. RESULTS: Optimal cutoff levels were 5/6 for GHQ 30 with a sensitivity of 67.5% (95%CI: 59%–76%) and a specificity of 80% (95%CI: 75%–85%). Optimal cutoff levels were not changed by sex, age and educational levels. The area under the ROC curve for GHQ 30 was 0.79. Despite above, multilevel likelihood ratios of >1 were obtained only for total scores of ≥7 for GHQ 30. CONCLUSIONS: GHQ 30 displays adequate validity for use in the Sinhala speaking primary care setting attendees for assessing psychiatric disorders.Item Factor structure and reliability of the 30-item Sinhala version of General Health Questionnaire (GHQ)(Elsevier, 2012) Abeysena, C.; Jayawardana, P.; Peiris, U.OBJECTIVE: To determine the factor structure and the reliability of the Sinhala version of the General Health Questionnaire-30 (GHQ-30). METHODS: This was a descriptive study including 368 patients with in the age range of 18-75 years, attending the Out Patient Department (OPD) of Colombo North Teaching Hospital, Ragama, Sri Lanka during the period between June 2009 and September 2010. Sinhala version of GHQ-30 was given to be completed by the participants. Each item of the GHQ was rated on a four-point scale (0-1-2-3). Factor analyses were performed by applying Generalized Least Squares method using oblimin rotation. The internal consistency was assessed by calculating Cronbach's α coefficient. RESULTS: Median age of the study population was 32.5 years (Inter quartile range [IQR]=21 years) and the median GHQ score was 9 (IQR 7). GHQ-30 produced a five factor solution which accounted for 51.6% of the total variance (TV). Factor I (Depression) accounted for 38% of TV, Factor II (Loss of confidence) 5%, Factor III (Insomnia) 4%, Factor IV (Social dysfunction) 2.7% and Factor V (Anxiety) 2%. The Cronbach's alpha coefficients of GHQ-30 was 0.94 indicating satisfactory internal consistency. CONCLUSIONS: GHQ-30 comprises five factors/sub scales and it displayed adequate reliability for assessment of psychiatric disorders among Sinhala speaking primary care attendees in Sri Lanka.Item Sleep deprivation, physical activity and low income are risk factors for inadequate weight gain during pregnancy: a cohort study(Wiley-Blackwell Pub. Asia, 2011) Abeysena, C.; Jayawardana, P.AIM: To determine the possible risk factors for inadequate gestational weight gain. METHODS: A population-based cohort study was carried out in Sri Lanka from May 2001 to April 2002. Pregnant women were recruited on or before 16 weeks' gestation and followed up until delivery; the sample size was 710. Trimester-specific exposure status and potential confounding factors were gathered on average at the 12th, 28th and 36th weeks of gestation. Maternal weight was measured at the first antenatal clinic visit and at delivery. Inadequate weight gain was defined as weight gain below the Institute of Medicine recommendations in 2009. Multiple logistic regression was applied and the results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: The risk factors for inadequate weight gain were low per-capita monthly income (OR 1.63, 95% CI 1.03, 2.58), multiparity (OR 1.96, 95% CI 1.34, 2.87), sleeping <8 h/day during the second, third, or both second and third trimesters (OR 1.60, 95% CI 1.05, 2.46), standing and walking ≥5 h/day during the second trimester (OR 1.50, 95% CI 1.04, 2.15), and the newborn being of the male sex (OR 1.50, 95% CI 1.04, 2.16), controlling for the effect of body mass index and gestational age. CONCLUSIONS: Risk factors for inadequate gestational weight gain were low income, being multiparous, sleep deprivation, physical activity in terms of standing and walking, and the male sex of baby.Item Body mass index and gestational weight gain in two selected Medical Officer of Health areas in the Gampaha District.(College of Community Physicians of Sri Lanka, 2011) Abeysena, C.; Jayawardana, P.OBJECTIVE: To describe gestational weight gain pattern according to the body mass index (BMI) categories. METHODS: This is a descriptive study conducted in two Medical Officer of Health areas of the Gampaha District. Pregnant women were recruited on or before 16 weeks of gestation and followed up until delivery. Maternal weight was measured at the booking visit, during the second trimester and at delivery. Inadequate and excessive weight gain were defined as weight gain below and above the Institute of Medicine (IOM) 2009 recommendations for the BMI categories as well as Ministry of Health (MoH) recommendations. RESULTS: Two hundred and forty seven (30%) of the women were underweight, 432(52%) were normal weight and 131(18%) overweight and obese. According to the Asian BMI classification, 338(41 %) were normal weight and 225(29%) were overweight and obese. Total mean weight gain for the sample was 10.6(SD 3.3) kg and mean rate of gestational weight gain was 0.27(SD 0.08) kg/week. Mean weight gain during second trimester was 6.7(SD 2.7) kg and during third trimester 3.9(SD 2.2) kg. Mean gestational weight gain and rate of weight gain per week was higher among underweight women. Of the 710, 404(57%) women gained less and 62(8.7%) more weight, than recommended by the IOM, whereas 108(15%) gained more weight by MoH standards. CONCLUSIONS: One third of the women were underweight and mean gestational weight gain and rate of weight gain per week were higher amongst them. More than half of the women gained less weight than recommended.Item Reliability of period of gestation determined by ultrasound scan measurements(DRUNPP Sarajevo, 2011) Abeysena, C.; Jayawardana, P.Objective: To determine reliability of period of gestation determined by three independent raters using four different foetal measurements. Methods: One hundred and eighty pregnant women were divided into three equal groups. Each group was assigned a rater to perform ultrasound scan to measure bi-parietal diameter, femur length, abdominal circumference and head circumference and to compute the respective periods of gestation using these four measurements. Reliability between periods of gestation derived by each rater from above four measurements were analysed using repeated measure ANOVA. Results were expressed as intra-class correlation coefficients (ICCs) and coefficients of variation (CsOV). Results: For Raters I (F= 6.47; p=0.001) and II, (F= 4.80; p= 0.003), computations using abdominal circumferences resulted in the lowest mean periods of gestation (PsOG). For Rater III, computations using both femur length and abdominal circumference resulted in the lowest mean periods of gestation (F= 7.5; p=0.001). ICCs were 0.73 (95%CI 0.64–0.81) for Rater I, 0.78 (95% CI 0.70–0.85) for Rater II and 0.87 (95% CI 0.81– 0.91) for Rater III When comparing CsOV, the highest variation for Raters I and III was observed for femur length. For Rater II it was bi-parietal diameter. The lowest variation for Rater I was observed for head circumference and for Raters II and III for abdominal circumference. The highest CsOV of all the PsOG were demonstrated by Rater III. When comparing the differences between the highest and the lowest values for each period of gestation determined, the difference was more than two weeks for 38% (n=23), 24% (n=14) and 22% (n=13) of observations made by Raters I, II and III respectively. Conclusions: Reliability of period of gestation depends on the type of measurement taken, method of assessment and the rater who performs the measurements. Our findings are not conclusive enough to recommend any PsOG based on specific measurement more reliable than others. In-service training of the obstetricians is likely to improve the reliability of PsOG determined using ultra sound scan measurements.