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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Analysis of theoretical and strategic underpinnings of facebook content used for COVID prevention in Sri Lanka(Sri Lanka Medical Association, 2023) Wanasinghe, T.; Athauda, L.K.INTRODUCTION: With the spread of the COVID-19 pandemic, health communication content educating the public were launched at a mass scale. Ministry of Health Sri Lanka took the lead role in communicating the new normal and lifestyle changes. OBJECTIVES: To describe the theoretical and strategic underpinnings of selected COVID-19 related video content METHODS: A team of two researchers, with experience in communication and Public Health, analyzed selected videos (excluding documentaries and animations) on Facebook. Videos produced from 2020 to 2023, shared on an official government institution page were purposively selected for content analysis. User engagement, the overall theme and the adaptation to Social marketing mix, Laswell’s Communication model and Health Belief Model were used to deductively analyze the videos. Each component was scored between zero to three. RESULTS: Among the 24 videos, length varied from 30 seconds to 22 minutes. They addressed various topics such as vaccination, hand washing, physical distancing. A prominent sentiment conveyed was social responsibility. Views ranged from 1400-5,600,000. Scores for health communication strategies ranged from 18(full score) to 9 while scores for the use of health communication theory ranged from zero to 13(out of 18). Cue to action was very clear in most videos and the strategic approach included the use of partnerships and promotions to communicate the messages. CONCLUSIONS: Sound theoretical underpinnings and health communication strategies have been observed in COVID prevention content with moderate engagement levels. Their reception by the viewer and persuasion needs to be further explored to fully understand the success of the material studied.Item Traffic light labelling system on packaged solid food products in Ragama town area: A policy evaluation study(Sri Lanka Medical Association, 2023) Rathnapriya, K.G.R.S.; Rajapaksha, R.T.D.; Randil, M.K.S.; Rathnayake, R.M.L.M.; Athauda, L.K.; Rashmith, M.K.S.INTRODUCTION: The Traffic Light Labelling System (TLLS) for packaged solid and semi-solid foods was implemented in Sri Lanka in 2019 as a measure to reduce the Non-Communicable Disease burden related to nutrition in Sri Lanka. OBJECTIVES: To describe the level of implementation of the TLLS in packaged solid food products and its awareness among the adult population in Ragama town. METHODS: A descriptive cross-sectional study was conducted under two arms as Study I and II. Study I: Snacks and Confectionary Isles of four supermarkets were examined to observe all packaged food products that complied with the Food (Color coding for sugar, salt and fat) Regulations of 2019. A pre-tested checklist based on the TTLS legislature was used to assess the implementation level with a score from 0-10. Study II described the awareness of TLLS among the adult population in public areas using an interviewer-administered questionnaire. RESULTS: Among 412 items assessed, 75%(n=311) had completely adhered to TTLS legislature while 10%(n=42) had completely violated it. The most violated regulation was inaccurate main logo size (n=67,16.26%) Among 385 adults, majority (n=222,57.7% were not aware of the TLLS. The most considered factor when purchasing a food product was the expiry date (n=217,56.4%) and food purchase was mostly influenced by income (n=175,45.5%). CONCLUSION: Although a high level of adherence to TLLS was seen among snacks and confectionary items, their nutritional labels were not a decisive factor for purchase. As buyer awareness regarding TLLS was poor, this study calls for increasing awareness and creating a culture of reading food labels during shopping.Item Parents’ attitudes and experiences related to speech and language therapy among Sinhala-speaking children with down syndrome attending the Ayati Center for children with disabilities.(University of Kelaniya, Sri Lanka, 2023) Kiriella, K.Y.W.; Athauda, L.K.BACKGROUND: Down syndrome is the most common genetic disorder associated with speech and language delay. From the time a child with Down syndrome is born, parents struggle to develop their child's speech as it is one of the most important components that need to be developed in this population. OBJECTIVE/S: This study aims to describe parents’ attitudes and experiences regarding speech and language therapy for their Sinhala-speaking child with Downs Syndrome attending the Ayati Centre. METHODS: This study included fifteen parents of Sinhala-speaking children with Down syndrome between birth to 5 years of age attending Speech and language therapy clinics at the Ayati Centre. Data was collected through 30–45-minute face-to-face semi structured interviews with each parent. The interviews were coded, categorised and key themes were identified. Initially, the data was transcribed into Sinhala. The narratives were analysed in order to understand the parental attitudes and experiences on the topic. RESULTS: According to the analysis, 12 content codes were identified and the following four main themes emerged; parental commitment to improving speech, the disappointment of being a parent with a child with disability, parents moving forward despite challenges, influence of family towards speech development (both positive and negative). CONCLUSION/S: Parents face many challenges when dealing with their children with Down Syndrome, especially due to the speech delay. All parents are keen to improve their child’s speech abilities and pay special attention to achieving it. Social stigma is an important issue that affects parents. Immediate and extended family support can be crucial for parents when dealing with challenges associated with speech development among babies with Down Syndrome.Item The iHealth-T2D study, prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes: study protocol for a randomised controlled trial(BioMed Central, London, 2021) Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Siddiqui, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Mahmood, S.; Muilwijk, M.; Batool, T.; Burney, S.; Glover, M.; Palaniswamy, S.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, S.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Gage, H.M.; van Valkengoed, I.G.M.; Valabhji, J.; Frost, G.S.; Loh, M.; Wickremasinghe, A.R.; Kooner, J.S.; Katulanda, P.; Jha, S.; Chambers, J.C.Background: People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings.Hypothesis: Compared to usual care, the risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12-month lifestyle modification programme delivered by community health workers.Design: Cluster randomised clinical trial (1:1 allocation to intervention or usual care), carried out in India, Pakistan, Sri Lanka and the UK, with 30 sites per country (120 sites total). Target recruitment 3600 (30 participants per site) with annual follow-up for 3 years.Entry criteria: South Asian, men or women, age 40-70 years with (i) central obesity (waist circumference ≥ 100 cm in India and Pakistan; ≥90 cm in Sri Lanka) and/or (ii) prediabetes (HbA1c 6.0-6.4% inclusive).Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index < 22 kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; and serious illness.Endpoints: The primary endpoint is new-onset T2D at 3 years, defined as (i) HbA1c ≥ 6.5% or (ii) physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are the following: (i) physical measures: waist circumference, weight and blood pressure; (ii) lifestyle measures: smoking status, alcohol intake, physical activity and dietary intake; (iii) biochemical measures: fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and (iv) treatment compliance. Intervention: Lifestyle intervention (60 sites) or usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one sessions, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving a 7% reduction in body mass index and a 10-cm reduction in waist circumference through (i) improved diet and (ii) increased physical activity. Usual care comprised a single 30-min session of lifestyle modification advice from the community health worker. Results: We screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom 3682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between intervention and usual care sites. More than 90% of follow-up visits are scheduled to be complete in December 2020. Based on the follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum). Conclusion: The iHealth-T2D study will advance understanding of strategies for the prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.Item Effects of a lifestyle intervention programme after 1 year of follow-up among South Asians at high risk of type 2 diabetes: a cluster randomised controlled trial(BMJ Publishing Group Ltd, 2021) Muilwijk, M.; Loh, M.; Siddiqui, S.; Mahmood, S.; Palaniswamy, S.; Shahzad, K.; Athauda, L.K.; Jayawardena, R.; Batool, T.; Burney, S.; Glover, M.; Bamunuarachchi, V.; Panda, M.; Madawanarachchi, M.; Rai, B.; Sattar, I.; Silva, W.; Waghdhare, S.; Jarvelin, M.R.; Rannan-Eliya, R.P.; Wijemunige, N.; Gage, H.M.; Valabhji, J.; Frost, G.S.; Wickremasinghe, R.; Kasturiratne, A.; Khawaja, K.I.; Ahmad, S.; Valkengoed, I.G.V.; Katulanda, P.; Jha, S.; Kooner, J.S.; Chambers, J.C.Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D.Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40–70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference −1.10 kg (95% CI −1.70 to −1.06), p<0.001). The adjusted mean difference for waist circumference was −1.9 cm (95% CI −2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessions increased the effect on waist circumference, blood pressure and HbA1c.Item Trend of smoking and tobacco use in Sri Lanka 1960 - 2010: is it affected by cigarette pricing?(Sri lanka Medical Association, 2015) Athauda, L.K.; Wickremasinghe, A.R.Introduction and objectives: The prevalence of smoking among adults in Sri Lanka in 2012 was estimated as 9.3%, with prevalences being 18.6% for males and 0.2% for females. This study aimed to describe smoking and tobacco use trends from 1960-2010 and the influence of pricing on trends. METHOD: Tobacco consumption data was obtained from the Food and Agricultural Organization database, cigarette consumption from the World Bank database, population data from the UN database and cigarette pricing and current prevalence of smoking from the Alcohol and Drug Information Centre. Correlation and regression analysis were carried out. Results: The average cigarettes sticks smoked from 1960-2004, were 289+ 58.66 sticks/capita/year and average tobacco use from 1960-2010 was 560.87+223.43 kg/capita/year. Between1960-1977, the number of cigarettes smoked increased on average at a rate of 11.5 per capita/year; and since 1978 smoking decreased by 2.33sticks/capita/year. If only males are considered as smokers In Sri Lanka, the number of cigarettes smoked per male per year increased on average by 22.9 between 1960 and 1977; the average decrease after 1978 among males was 4.17 cigarettes per male per year. Between 2000 and 2012, the smoking prevalence is negatively correlated with the increase in cigarette pricing (r=0.469, p=0.034: R2=0.408). There was a decrease in mortality due to respiratory neoplasms beginning in 1995; this decrease corresponds to the decrease in smoking since 1978, having a lag period of about 15 years (r= 0.002 p=0.021, R2=0.151). CONCLUSION: Smoking and total tobacco consumption has been decreasing since 1978, similar to the trend observed globally. Tobacco pricing negatively influences smoking.Item King coconut water, tender coconut water, Gatorade and ORS: which rehydrates athletes best?(Sri lanka Medical Association, 2015) Athauda, L.K.; Kasturiratne, A.; de Silva, A.P.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: A randomized controlled, crossover trial was conducted to assess the rehydrating ability of exclusive consumption of king coconut water (KC) tender coconut water (TCW), Gatorade (G) and ORS as rehydration fluid. METHOD: Purposively selected 15 (M=13, F=2) middle distance runners with a mean age of 26.46 (+3.95) years with a BMI of 18.77(+1.53) were recruited from the National pool. Each fluid was given ad libitum during one hour training session and two hours of recovery on four different days with a wash out period >72 hours. Total fluid consumption and urine out¬put over three hours was assessed. Following parameters were assessed at baseline and two hours post-recovery: venous blood gas (VBG) and urine full report. A self-administered questionnaire assessed perception on each fluid. Differences between VBG findings (2 hours post recovery - baseline) were analyzed to compare different fluids using one-way AN OVA. RESULTS: KC was the most consumed fluid (mean 3325+769.77ml; p=0.016). Urine output was highest with Gatorade (mean365.77+246.49ml; p=0.16). There were significant differences in blood phi haematocrit (Hct), Sodium, Potassium Glucose, Lactate, BEecf, and urine pH, between baseline and post recovery among the four fluids. ORS at 2 hours post recovery had the largest decrease in Lactate (~0.353mmol/L) and Hct (-2.266) and highest increase in Sodium 2.46mmol/L and glucose 8.8mmol/L from baseline. Compared to other groups, the decrease in urine pH was significantly greater in Gatorade (-0.346; p<0.01). CONCLUSION: Although athletes' preference for rehydration was KC, biochemical markers indicate that ORS is the most suitable fluid for rehydration of athletes compared to the other three.Item An ecological study for Sri Lanka about health effects of coconut(Sri Lanka Medical Association, 2015) Athauda, L.K.; Wickremasinghe, A.R.; Kumarendran, B.; Kasturiratne, A.An ecological correlation study was conducted to determine the association between consumption of coconut products and cardiovascular disease (CVD) deaths in Sri Lanka. Data on coconutconsumption patterns from 1961 to 2006 were abstracted from the FAO database, and mortality data from reports of the Department of Census and Statistics, and UN databases. Correlational and regression analyses were carried out. There was no increase in the per capita consumption ofcoconut products from 1961 to 2006 (range 54.1-76.2kg/ capita/year). The CVD death rates and the proportionate mortality rate due to CVD increased from 1961 to 2006. CVD death rates were significantly associated with per capita GDP, percentage of urban population, and elderly dependency ratio but not consumption of coconut products after adjusting for the other variables (R2=0.94). The results do not provide evidence at the population level that consumption of coconutproducts increases mortality due to cardiovascular diseases.