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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Do fathers develop perinatal depression, anxiety, and stress? Cross-sectional findings from a study in Sri Lanka(Elsevier, 2024-11) Hapangama, A.; Baminiwatta, A.; Kuruppuarachchi, L.No abstract availableItem Improving psychological well-being among healthcare workers during the COVID-19 pandemic with an online mindfulness intervention: A randomised waitlist-controlled trial(Wiley, 2024) Baminiwatta, A.; Fernando, R.; Solangaarachchi, I.; Abayabandara-Herath, T.; Wickremasinghe, A.R.; Hapangama, A.The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.Item Assessing motivation to lose weight: the psychometric properties of the Sinhala version of University of Rhode Island Change Assessment (URICA) scale(Sri Lanka Medical Association, 2023) Niriella, M.A.; de Silva, S.T.; Hapangama, A.; Baminiwatta, A.; Fernando, R.; Ediriweera, D.INTRODUCTION: Weight reduction through lifestyle modifications is an important component in the management of various chronic diseases. The degree of motivation to change has been shown to predict outcomes in weight reduction interventions. Thus, the availability of a validated self-report tool assessing the degree of motivation for weight management would be useful for both clinical and research purposes in Sri Lanka. OBJECTIVES: To examine the structural validity and internal consistency of the URICA for weight management in a sample of Sri Lankan adults with chronic medical conditions. METHODS: Standard procedures for cross-cultural adaptation of a questionnaire were followed in translating the 32-item URICA into Sinhala. The Sinhala version was administered to 208 patients aged 18-60 years attending outpatient clinical services for non-disabling chronic medical diseases. Psychometric testing included confirmatory factor analysis and the assessment of internal consistency (Cronbach α). RESULTS: The commonly accepted four-factor structure of URICA reflecting Prochaska and Di Clemente’s transtheoretical model (pre-contemplation, contemplation, action and maintenance) showed good model fit, after the removal of four items from the pre-contemplation subscale due to inadequate factor loadings (<0.4). In line with theory, factor correlations indicated that the pre-contemplation factor was inversely correlated with the other three factors, while the other three factors were positively correlated with one another. All four subscales showed good internal consistency (Cronbach α ranging from 0.73 to 0.89). CONCLUSIONS: The Sinhala version of a modified 28-item URICA was found to have sound psychometric properties as a measure of motivation for weight management among Sinhala-speaking adult patient.Item Measuring resilience among Sri Lankan healthcare workers: validation of the brief resilience scale in Sinhalese and Tamil languages(Sage Publishing, 2023) Baminiwatta, A.; Fernando, R.; Gadambanathan, T.; Jiyatha, F.; Sasala, R.; Kuruppuarachchi, L.; Wickremasinghe, R.; Hapangama, A.Resilience is the capacity for adaptation and “bouncing back” in the face of adversity.1,2 It protects against mental health problems such as depression, anxiety, and stress and improves well-being. 3 During the COVID-19 pandemic, there was a growing need for studies on protective factors in mental health, such as resilience, particularly among healthcare workers. 4 Psychometric assessment of resilience is a prerequisite for research in this area. A review of 19 resilience scales found a wide variation in their psychometric properties, with all of them posing some challenges. 5 However, the authors noted that the Resilience Scale for Adults, Brief Resilience Scale (BRS), and the Connor-Davidson Resilience Scale had the finest psychometric ratings. BRS may have an exceptional place in behavioral research because other resilience scales tend to assess resources that promote resilience rather than resilience itself. BRS is probably the only measure to assess resilience in its most basic meaning—the ability to “bounce back.” 2 Furthermore, among resilience scales, BRS is short and, therefore, would generate better response rates in research. As BRS was not available in local languages, its validation into Sinhalese and Tamil languages was needed to enable research on resilience in Sri Lanka. METHODS: Approval was obtained from the Ethics Review Committee. The procedure for questionnaire translation followed the recommendations of Beaton et al. (2000). 6 Firstly, BRS was translated into each local language (Sinhalese and Tamil) independently by two bilingual experts, and a consensus translation was prepared. The translated version was back-translated into English by two independent bilingual translators. They were compared with the original BRS for semantic, idiomatic, experiential, and conceptual equivalence by a group of experts comprising several Sinhalese- and Tamil-speaking psychiatrists, bilingual experts, and a methodologist. A few phrases in the original English version, such as “bounce back” and “snap back,” were replaced with conceptually equivalent phrases in the local languages. Face and content validity were discussed, and a consensus translation was prepared. After conducting a pre-test and cognitive debriefing with a purposive sample of 10 healthcare workers for each language, and further minor modifications, the translated scales were administered to 150 Sinhalese- and 110 Tamil-speaking healthcare workers (nurses, doctors, and other categories), after obtaining informed consent (see Table S1 for the sociodemographic profiles; the translated questionnaires are provided as supplementary files). Confirmatory factor analysis (CFA) was used to test the model fit for the one-factor structure of BRS, 2 using the following fit indices: comparative fit index (CFI), Tucker Lewis index (TLI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). Depression, anxiety, and Stress Scale -21 (DASS-21) was administered to test expected inverse correlations with resilience. RESULTS: According to CFA, the six-item BRS formed a unitary construct, with satisfactory model fit for both the Sinhalese (CFI = 0.99, TLI = 0.99, RMSEA = 0.09, SRMR = 0.05) and Tamil versions (CFI = 0.98, TLI = 0.97, RMSEA = 0.14, SRMR = 0.07). Factor loadings of individual items ranged from 0.59 to 0.86 in the Sinhalese and 0.61 to 0.82 in the Tamil version (see Table S2 for item-level statistics). Cronbach alpha of the Sinhalese and Tamil BRS were 0.82 and 0.80, respectively, indicating good internal consistency. Removal of any single item did not significantly improve internal consistency. The Sinhalese BRS score had significant negative correlation with depression (r = –0.29, P = 0.002), anxiety (r = –0.27, P = 0.005), and stress (r = –0.20, P = 0.033), whereas the Tamil BRS score had significant negative correlation with anxiety (r = –0.18, P = 0.028) and stress (r = –0.25, P = 0.002) but not with depression. DISCUSSION: Our findings support the construct validity and internal reliability of the BRS as a measure of resilience. The one-factor structure proposed by the original developers 2 and replicated in subsequent studies 7 was observed in the present study. BRS has been previously translated and validated in several languages, including German, Polish, Spanish and Dutch.7–10 Similar to the observations in the original validation sample 2 and the Spanish validation, 7 resilience, as measured using BRS, showed significant inverse correlations with depression, anxiety, and stress in the present analysis. This provided further support for its construct validity through hypothesis testing. The absence of a significant inverse correlation of the Tamil BRS score with depression may be due to the comparatively small sample size available for the Tamil validation. Although our findings were based on healthcare workers, we expect the scale’s validity to extend to the general population. Thus, the Sinhalese and Tamil BRS can be used in future large-scale research on resilience in Sri Lanka. As high rates of mental health issues were reported among healthcare workers in Sri Lanka during the COVID-19 pandemic, 11 and the country is currently going through an unprecedented economic crisis, it is important to take measures to enhance resilience among Sri Lankan healthcare workers. The availability of a validated tool in both Sinhalese and Tamil languages would enable research on mental health and resilience among culturally-diverse populations in Sri Lanka, which would provide useful information to guide health policy development. Limitations of this study include the small sample sizes and the lack of test-retest reliability assessments to ascertain the temporal stability of the BRS scores.Item A case of hypotension and heart rate changes on rechallenge with a low dose of clozapine with no apparent secondary cause(Sri Lanka College of Psychiatrists, 2022) Harshini, M.L.; Fernando, A.I.W.; Abayawickrama, H.M.T.S.; Ikram, M.I.N.; Rajapakse, S.; Hapangama, A.Clozapine is known to cause innocuous as well as severe and or fatal cardiovascular side effects. These side effects are commonly reported at the initiation of clozapine therapy. We report a patient who was stable on clozapine for several years but in whom we had to withhold clozapine for medical reasons and subsequently developed significant hypotension and heart rate changes when rechallenged with a small dose of clozapine.Item Why are we still living in the past? Sri Lanka needs urgent and timely reforms of its archaic mental health laws(Cambridge University Press, 2023) Hapangama, A.; Mendis, J.; Kuruppuarachchi, K.A.L.A.Mental health legislation protects the rights of people with mental illnesses. However, despite major social, political and cultural changes, Sri Lankan mental health services still operate on laws enacted mostly during the British rule more than a century ago, in the pre-psychotropics era, and focusing more on the detention of people with mental illnesses than on their treatment. It is high time all stakeholders made efforts for the much-awaited new Mental Health Act to pass through parliament urgently to meet the needs and protect the rights of patients, their caregivers and service providers.Item Sri Lankan medical officers’ attitudes towards the elderly: a pilot study(Postgraduate Institute of Medicine University of Colombo, 2022) Fernando, R.; Ratnayake, G.; Liyanage, N.; Fonseka, M.; Perera, I.; Kuruppuarachchi, K.A.L.A.; Hapangama, A.Ageism among doctors influences treatment options and care of the elderly. Attitudes of Sri Lankan doctors towards the elderly have not been studied previously. This descriptive cross-sectional study using Fraboni’s scale of ageism explored doctors' attitudes towards older people in three selected hospitals in Sri Lanka and the relationship of such attitudes with demographic, employment, education and training-related factors. No association between the attitude of doctors toward the elderly and the factors studied in this pilot study were found.Item Cross-cultural adaptation and validation of the Liebowitz Social Anxiety Scale (LSAS-SR) Tamil Version(The Sri Lanka Medical Association, 2022) Hapangama, A.; Premaratne, I.; Thilaxshan, T.; Gadambanathan, T.; Wickremasinghe, R.Background: Despite being the third most prevalent psychiatric disorder, social anxiety disorder remains under-diagnosed due to multiple reasons. Although many screening instruments are available in the English language, to date no instrument has been translated into Tamil. Objective: To translate and validate the Liebowitz Social Anxiety Scale (LSAS-SR) into Tamil among a group of Sri Lankan university students whose mother tongue is Tamil. Method: The process of translation and validation involved standard procedures. DSM- 5 was used as the gold standard to diagnose social anxiety disorder. As part of the psychometric study, test-retest reliability and analysis of items for internal consistency of the instrument were assessed. Results: A cut off of55.5had the optimum sensitivity and specificity for the Tamil version of the LSAS-SR. The Cronbach’s alpha between the avoidance subscaletotal and the fear subscale total was 0.860 while the figures for Cronbach’s alpha between the total score and fear subscale total score and the avoidance subscale total score were 0.880 and 0.855, respectively. The test- retest reliability correlation coefficients for the fear subscale, avoidance subscale and the total score were 0.890, 0.925 and 0.918, respectively (p<0.001 for all). Conclusions: The cut off score of 55.5had the optimum sensitivity and specificity for the LSAS-SR Tamil version. It had good internal consistency and test-retest reliability. Further studies will enable the assessment of the prevalence of social phobia and investigation of cultural and environmental factors associated with social phobia in Sri Lanka.Item Psychological impact of COVID-19 among a cohort of Sri Lankan medical students: Preliminary results(Sri Lanka College of Psychiatrists, 2022) Abayabandara-Herath, T.; Premaratne, I.; Ediriweera, D.; Chandratilake, M.; Hapangama, A.Previous studies report that the COVID-19 pandemic has a negative effect on the psychological wellbeing of medical students. We aimed to determine the psychological impact of COVID-19 and its associated factors among a cohort of Sri Lankan medical students, using online versions of a demographic questionnaire and the validated Sinhala and Tamil versions of the DASS-21. Of the 418 students, majority were females, aged between 20-25 years. In the study group, 40 (9.6%), 105 (25.1%) and 7 (1.6%) of participants scored above the cut-offs for the depression, anxiety and stress subscales of the DASS-21 respectively. The COVID-19 pandemic appears to be associated with a negative impact as measured by the DASS-21 scale among this group of medical students.Item Sri Lanka's response to prescribed drug misuse: is it enough?(Cambridge University Press, 2023) Hapangama, A.; Kuruppuarachchi, K.A.L.A.A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.