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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo.(Sri Lanka College of Paediatricians, 2017) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.This is the correspondence to the article appeared in Sri Lanka Journal of Child Health. 2016; 45 (2):95-102. by same authors,Item Neurocognitive skills in children with congenital hypothyroidism attending the endocrine clinic of the Professorial Unit of the Lady Ridgeway Hospital for Children, Colombo(Sri Lanka College of Paediatricians, 2016) Sumanasena, S.P.; Gunawardena, N.; Dissanayake, B.; Dilanka, S.; de Silva, S.BACKGROUND: Early thyroxine replacement prevents intellectual impairment due to congenital hypothyroidism (CHT). There is minimal evidence on neurodevelopmental outcome of children commenced on thyroxine during early infancy from countries not screening for CHT. OBJECTIVE: To assess the neurocognitive skills of children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH compared to age matched controls and to assess the influence of age at diagnosis, initial thyroid stimulating hormone (TSH) levels, thyroxine commencement dose and number of clinic visits in the first year on neurocognitive skills. METHOD: A retrospective study was carried out from 1st January 2010 to 1stJanuary 2011 on children with CHT of age group 6-10 years, followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH. Age matched healthy children aged 6-10 years were selected from similar socioeconomic backgrounds to compare the neurocognitive attainments. Neurocognitive skills were assessed using an age appropriate battery of instruments. Children older than 10 years were excluded as the assessment tools were designed only for the age range 6-10 years. Children with other co-morbidities adversely affecting their neurocognitive development were also excluded. RESULTS: Twenty three children with CHT of age group 6-10 years were followed up in the endocrine clinic of the Professorial Paediatric Unit, LRH during the study period and 2 were excluded. Forty two age matched controls of age group 6-10 years also participated in the study. The mean age of the children was 2.42±2.59 years. The mean TSH levels at diagnosis was 43.17± 34.25mU/L. Starting dose of thyroxine in the majority was less than 10µg/kg/day. Children with CHT performed less than their peers in all age ranges and in all areas of skills. Statistically significant differences were documented in the total performance percentiles at ages of 8 (p=0.0001) and 9 years (p=0.0002). Similarly, they performed less in literacy at 8 (p=0.015) and 9 years (p=0.004), verbal performance at 8 years (p= 0.0002) and numeracy in 9 years (p=0.035). There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or the number of clinic visits in the first year. CONCLUSIONS: Children with CHT of age group 6-10 years, attending the endocrine clinic of the Professorial Paediatric Unit, LRH had significantly reduced neurocognitive skills compared to age matched controls. There was no significant correlation between the neurocognitive scores and age at diagnosis, initial TSH levels, thyroxine commencement dose or number of clinic visits in the first year.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 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 Knowledge on health promotion approach among Public Health Midwives in a district in Sri Lanka(Postgraduate Institute of Medicine, University of Colombo, 2015) Perera, M.; Guruge, N. D.; Gunawardena, N.BACKGROUND: The Ottawa Charter defines Health Promotion as the "process of enabling people to increase control over, and to improve, their health". The National Health Promotion Policy recognizes health promotion as an efficient and cost effective approach to promote health in Sri Lanka. The Public Health Midwife (PHM) is the grass root level health worker responsible for promoting the health of communities in Sri Lanka. Their knowledge regarding health promotion has not been assessed. The main aim of this study was to describe their knowledge on health promotion and associated factors. METHODS: A cross sectional descriptive study was conducted among all PHMM (N=364) in the Kandy District who were eligible, using a self-administered questionnaire. Level of knowledge was based on scores obtained for responses to close ended questions and case scenarios. RESULTS: Knowledge on health promotion was „poor‟ among 238 (65.4%). Incorrect labeling of other activities as activities using a health promotion approach was common 257(70.6%). Training programmes 285(73.9%) were the commonest source of knowledge while 95(26%) were never trained on health promotion approach during their career. The factors that were significantly associated with a level of „good‟ knowledge on health promotion in multivariate analysis were; experience in the public health field less than 20 years (p=0.012), participating in training programmes on health promotion (p=0.03) and experience in implementing health promotion programmes (p=0.04). CONCLUSIONS: The study concludes that PHMM in the Kandy District have a "poor" level of knowledge on health promotion and recommends increasing training opportunities and improving opportunities for application to improve the situation.