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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Energy expenditure and pregnancy outcome(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Abeysena, C.; Jayawardana, P.; Seneviratne, R.OBJECTIVE: To determine the effect of energy expenditure on pregnancy outcome. Methodology: A prospective cohort study was carried out at Ragama and Ja-ela MOH areas. Eight hundred and seventy five pregnant mothers were recruited at 16 weeks of gestation (POA). Daily energy expenditure was assessed based on the activities indicated by the pregnant mothers in the Activity Record1 on two occasions during 20 (371 subjects) and 32weeks of POA (271 subjects) at home by housewives and both at home and at work by working mothers. On each occasion activities related to 3 different days were recorded. Average energy expenditure was calculated and >2550 kcal/day was considered as the cut off. Information on potential confounding factors was gathered on average at 12th, 28s11 and 36 POA. Pregnancy outcome was assessed in terms of maternal complications (MC) such as pre-eclampsia, ante-partum haemorrhage and gestational diabetes, pre-term birth , low birth weight (LEW), small for gestational age <10dl (SGA<1O) and <5th (SGA<5) centiles. Logistic regression analysis was applied and the results are expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Results: Univarite analysis revealed that >2550 kcal/day energy expenditure during 20 weeks of POA was significantly associated with subsequent development of MC (OR6.86, 95% CP=2.38-19.76) and with MC (OR=1 1.03, 95%CFI.36-89.24), LBW (OR=O.05, 95% CI-O.006-0.36) and SGA<5 (OR=O.29, 95% CIO.10-0.87) during 32" xveek of POA. On multivariate analysis subsequent development of MC (OR=6.305 95% CI 21.94} and SGA<5 (OR=0.29, 95% CI = 0.09-O.96), remained significantly associated with high energy expenditure during 20 ' week of POA and 32"d week of POA respectively. CONCLUSION: High energy expenditure was a risk factor for maternal complications and a protective factor against the birth of a small for gestational age infant.Item Effectiveness of an educational and technical skill development intervention on improving menstrual hygiene management among grade ten school girls in the district of Kalutara, Sri Lanka(Sri Lanka Medical Association, 2015) Fernando, W.M.P.A.; Jayawardana, P.INTRODUCTION AND OBJECTIVES: To determine effectiveness of an educational and technical skill development intervention, to improve knowledge, attitudes and practices towards menstruation and menstrual hygiene (MH) among adolescent school girls in Kalutara district, Sri Lanka. Method: Quasi experimental study was conducted with non-randomfy selected Intervention (IG) and Control (CG) groups. Six schools in each arm were selected purposively based on presence of supportive environments. Computed sample size was 300 from twenty clusters (classes). Each cluster comprised 15 purposively selected students. Those in IG were trained on four modules regarding knowledge and one on preparation of detachable sanitary towel holder (DSTH) by 20 trained teachers. A 'hand book' on MH and preparation of DSTH -was also given. Effectiveness was assessed five months later, by administering a self administered questionnaire at pre and post intervention stages. Chi square test/ Mann Whitney's U test for independent and Me Nemar's test/Wilcoxon Signed Rank test for within group comparisons were used. RESULTS: When comparing IG and CG at post intervention, significant improvement in knowledge on all four sub components, overall knowledge (P<0.001), overall attitudes (P<0.001), 10 among 16 variables on practices (P<0.05) and all eight under activities affected during menstruation (P<0.0001) were observed. When comparing IG between pre and post intervention stages significant (P<0.001) improvement in all above and 11 among 16 variables on practices (P<0.05) were observed. Ninety three percent (n=275) of IG students had prepared DSTH. CONCLUSION: Intervention to promote MH was proven effective with a significant positive impact on knowledge, attitudes, practices and activities affected during menstruation.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 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.Item Assessment of foetal growth retardation: small for gestational age(College of Community Physicians of Sri Lanka, 2010) Abeysena, C.; Jayawardana, P.Growth retardation cannot be described by a single weight measure because, birth weight is dependant on both duration of gestation and intrauterine growth rate. It has also been shown that foetal weight is dependant on constitutional as well as pathological factors. Constitutional factors include maternal height, weight, parity, ethnicity and foetal sex. When assessing foetal growth retardation, it is important to consider constitutional factors as well. Of the different assessments developed small for gestational age defined based on the customised birth weight standards assess foetal growth retardation more accurately.Item Effect of psychosocial stress and physical activity on preterm birth: a cohort study(Wiley-Blackwell Pub. Asia, 2010) Abeysena, C.; Jayawardana, P.; Senevirathne, R. de A.AIM: To determine trimester-specific effects of risk factors for preterm birth (PTB). METHODS: A prospective study was carried out in a district of Sri Lanka. A total of 885 pregnant mothers were recruited at equal to or less than 16 weeks of gestation and followed up until partus. Trimester-specific exposure statuses and potential confounding factors were gathered on average at the 12th, 28th, and 36th weeks of gestation. Physical activities were assessed by obtaining information about the duration of specific postures adopted per day by housewives during each trimester at home and both at home and during working hours for those who were engaged in paid employment. Psychosocial stress was assessed using the Modified Life Events Inventory and the General Health Questionnaire 30. Multiple logistic regression analysis was applied and the results were expressed as adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Standing equal to or less than 2.5 h/day during the first or second or both trimesters (OR 1.83, 95%CI 1.03, 3.25), maternal age of <25 years (OR 1.73, 95%CI 1.02, 2.95), education up to primary school level (OR 3.30, 95%CI 1.3, 8.36) and past history of low birthweight (OR 2.52, 95%CI 1.16, 5.48) were risk factors for PTB. Psychosocial stress was not found to be a risk factor for PTB. CONCLUSIONS: Standing equal to or less than 2.5 h/day during the early trimesters was a risk factor for PTB among uncomplicated pregnancies. Further studies are recommended to assess the trimester-specific effect of psychosocial stress on PTB.
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