Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item The Feasibility of new HPV/DNA test as a primary cervical cancer screening method among 35- years- old ever-married women in Kalutara district; a cross-sectional study(BioMed Central, 2021) Perera, K.C.M.; Mapitigama, N.; Abeysena, H.T.C.S.BACKGROUND: Cervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka. METHOD: A community based descriptive cross-sectional study was conducted from 1stof July 2018 to 30th November 2018 in the public health divisions called Medical Officer of Health (MOH) areas of Kalutara district. The study population is comprised of ever-married women 35 years of age. Three women from each cluster (n = 413) were selected by consecutive sampling. A total of 918 women were recruited. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by two cytoscreeners with the cobas 4800 PCR based screening machine. Clients' perceptions and prevalence were assessed. The follow-up of women with positive HPV/DNA screening results was carried out. The operational and technical feasibility of the screening test were assessed. Data entry was done by using the statistical package IBM SPSS version 20. RESULTS: Overall response rate was 91.1% (n = 836). Clients' perception was highly positive for HPV/DNA screening test procedure (99.9%, n = 821) and 99.6% (n = 819) of clients had mentioned that the HPV/DNA screening test is worthwhile to be incorporated into the National Cervical Cancer Screening program. The prevalence of HPV was 6.2% (95%CI: 6.18-6.22%). The coverage of the HPV/DNA screening was 89.5%(n = 822). Invalid results reported were 0.12% (n = 1). The percentage of HPV/DNA test positive women who underwent pap test within 3 months of the initial screening was 100% (n = 51), while the percentage of women who attempted to get a colposcopy within the 1 month of referral was 86.7% (n = 13). CONCLUSIONS: HPV/DNA test implementation as a primary cervical cancer screening method is feasible among the 35- year age cohort of ever- married women in Kalutara district. It is necessary to further attempt alternative methods of cobas 4800 HPV/DNA test, which would be much suitable for resource-limited settings. KEYWORDS: Cervical cancer; Feasibility; HPV/DNA test; Implementation; Screening.Item Validity of the Sinhala version of the general health questionnaires item 12 and 30: Using different sampling strategies and scoring methods(Ibn Sina Academy of Medieval Medicine & Sciences, 2016) Abeysena, H.T.C.S.; Jayawardana, P.L.; Peiris, M.U.P.K.; Rodrigo, A.OBJECTIVE: To determine the criterion validity of the Sinhala version of the General Health Questionnaire-12 (GHQ-12) and GHQ-30 employing different sampling designs and scoring methods. METHODS: This was a descriptive cross-sectional study including 374 patients. The GHQ-30 was completed by the participants using likert scale and then converted into standard score. The ‘Clinical Examination’ was done blindly to the GHQ score as the reference standard. Total study sample was considered as a representative sample taken consecutively. Case-reference design included 126 cases and 126 randomly selected controls based on reference standard. Test result-based designs included two groups of positive and negative GHQ, based on the optimal cut-off level. Cut-off levels were determined by using three criteria. In addition stratum specific likelihood (SSLR) ratio also considered. RESULTS: Applying consecutive sampling design, for the GHQ-12, the optimal cut-off levels were 9/10 using likert score and 2/3 using standard score and for the GHQ-30, 25/26 using likert score and 6/7 using standard score. The optimal cut-off level depends on the different sampling designs employed in addition to criteria for determining cut-off levels. The SSLR of>1 was useful for determining optimal cut-off level. Irrespective of the scoring methods, application of case-reference design tends to be overestimation of the specificity with high threshold values and test result-based design tends to be overestimation of the sensitivity, compared to consecutive sampling. Using likert scoring method, the sensitivities were higher than standard scoring method. CONCLUSIONS: The optimal cut-off levels depend on the sampling design and the scoring method employed and criteria to determine cut-off levels.Item Musculoskeletal symptoms, skin disorders and visual impairment among fishermen in the Divisional Secretariat Division of Kalpitiya(Sri Lanka Medical Association, 2015) Harshani, S.R.A.P.; Abeysena, H.T.C.S.INTRODUCTION: To describe musculoskeletal symptoms, skin disorders and visual impairmentamong fishermen in the Divisional Secretariat Division of Kalpitiya. METHODS: This was a community based descriptive cross sectional study conducted from August to October 2011. The sample consisted of 465 fishermen with ≥ 6 months experience in fishing selected using the cluster sampling technique. An interviewer administered questionnaire and a record sheet were used for data collection. Prevalence of the above conditions with 95% confidence Intervals (CI) were calculated. Chi square test was applied for the investigation of the factors associated with the above conditions. RESULTS: The prevalence of musculoskeletal symptoms was 61% (95% CI: 56.6%-65.4%). The commonest symptom was back pain (37.6%). The prevalence of skin disorders was 24% (95% CI: 20.1-27.8) and visual symptoms were 38.9% (95% CI: 34.5%-43.3%). The prevalence of visualimpairment of either eye was 24.3% (95% CI: 20.3%- 28.3%) low vision of either eye 22.4% (95% CI: 18.6%- 26.2%) and blindness of either eye was 1.9% (95% CI: 1.1-2.7). The prevalence ofvisual impairment of better eye was 16% (95% CI: 12.7-19.3), low vision of better eye 15% (95% CI: 12-18.3) and blindness of better eye were 0.9% (95% CI: 0.05-1.75). The prevalence ofmusculoskeletal symptoms, skin disorders or visual impairment did not vary according to service duration in the fishing industry, number of days spent in the boat for a trip or type of boat. CONCLUSIONS: Prevalence of musculoskeletal and skin disorders and visual impairment were relatively higher among the fishermen.Item Secondary preventive measures adopted in the management of patients with Acute Coronary Syndrome admitted to the National Hospital of Sri Lanka(Postgraduate Institute of Medicine University of Colombo, 2014) Ariyarathna, N.; Abeysena, H.T.C.S.OBJECTIVE: To describe the secondary preventive measures adopted in the management of patients with Acute Coronary Syndrome (ACS) admitted to the National Hospital of Sri Lanka (NHSL), in comparison with standard guidelines. METHODS: A hospital based, descriptive cross-sectional study was carried out in the Cardiology Unit and medical wards of the NHSL during September to October 2009. A sample of 345 patients diagnosed with ACS was included in the study. Medical records were used as the source of data regarding secondary preventive measures during the in-ward period. RESULTS: Among ACS recruited, 168 (48.7%) were diagnosed with unstable angina, 92 (26.7%) with NSTEMI and 85 (24.6%) with STEMI. Acetyl Salicylic Acid (ASA) was given within 3 hours and documented in only 175 (53.7%). Although a twelve-lead ECG within 20 minutes of arrival at hospital is recommended in the guidelines, ECG was performed after 20 minutes in 203 (59%). In 85 with STEMI 66 (77.6%) received re-perfusion/streptokinase therapy. The time of commencing streptokinase was noted in only 49 (57.6%) and only 9 (18%) received streptokinase within 30 minutes of arrival in hospital. Left ventricular function was assessed in only 53 (15.4%) patients. Continuity of treatment with ACE inhibitors was seen in 298 (86.4%), beta- blockers in 213 (61.7%) and statins in 326 (94.5%). In 337 (97.7%) a maintenance dose of ASA was given during the hospital stay. CONCLUSIONS: Some processes in the management of patients with ACS at NHSL did not meet the standard set by local and international guidelines on secondary preventive measures. DOI: http://dx.doi.org/10.4038/jpgim.7330Item The Quality of interaction between Public Health Nursing Sister and Public Health Midwife during supervision in maternal and child health care settings in Sri Lanka(Postgraduate Institute of Medicine, University of Colombo, 2014) Samaraweera, N.Y.; Abeysena, H.T.C.S.; Liyanage, T.; Taft, A. J.Objective To measure the quality of interaction between the Public Health Nursing Sister (PHNS) and the Public Health Midwife (PHM) during supervision. Methods This was a cross-sectional study, using triangulation of data obtained from structured observations and audio tape records of supervisor-supervisee interactions and written records of all supervision activities. Twenty four PHNS participated in the study. This study was undertaken in the district of Kalutara. Results Supervisors spent less time on supervising client care issues than on supervising facility level issues and interacting with clients. The weakest skills among the PHNS were ‘seeking client input’ and ‘discussing the next visit’ and the strongest skills were ‘giving feedback’, ‘discussing/interpreting data’ and ‘developing rapport’. Skills of supervision increased with the service duration of the PHNS but none were able to achieve the cut-off mark for satisfactory overall quality of interaction. Conclusions This study indicates that the overall quality of interaction between the PHNS and the PHM during supervision was poor. PHNS lacked skills in prioritisation of supervision activities and time management. They also lacked other necessary skills that ensure a higher quality of PHNS-PHM interaction. DOI: http://dx.doi.org/10.4038/jpgim.7607Item Evidence update on the use of inhaled corticosteroids in the management of bronchial asthma(Postgraduate Institute of Medicine University of Colombo, 2014) Perera, M.N.; Abeysena, H.T.C.S.