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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Comparison of selected occupational health problems among coir industry and coconut estate workers in the Puttalam District(College of the Community Physicians of Sri Lanka, 2007) Mohotti, S.; Jayawardana, P.OBJECTIVE: To compare the prevalence of selected occupational health problems among coir industry (SG) and coconut estate (CG) workers in Puttalam District. METHODOLOGY: A descriptive cross sectional study was carried out in the MOH areas of Dankotuwa, Marawila and Chilaw, in the Puttalam district. Sample size computed was 190 for each group. Sample was selected using Simple random sampling method. Interviewer administered questionnaire was used to determine the socio-demographic characteristics and prevalence of selected occupational health problems among the two groups. RESULTS: The mean duration of service was 12.3 (50:86) years for SG and 13.7(SD=9.9) years for CG. Musculoskeletal symptoms - prevalence of carpal tunnel syndrome (OR =2.8; 95 %Cl: 1.2-6.5) was higher among SG while knee joint pain was higher among CG (OR=O.5; 95% Cl: 0.3 - 0.7). Dermatological conditions - prevalence of fingertip wastage (OR=1.25; 95%Cl: 8.1-53.1), oedema of terminal phalanges (OR=5.5; 95%Cl: 2.9 -10.6) and paronychia (OR=5.4; 95%Cl: 3.2-9.0) were higher among SG, while the CG showed a higher prevalence of callosities (OR=undefined). Occupational injuries - prevalence of abrasions (OR=0.06; 95%Cl: 0.03-0.13), lacerations (OR=0.09; 95%Cl: 0.04-0.18), contusions (OR=0.07; 95%Cl: 0.03-0.15) and cut injuries (OR=0.13; 95%Cl: 0.06-0.27) were higher among the CG. Varicose veins - prevalence of varicose veins was higher among 8G (OR=1.87; 95%Cl: 1.12-3.13). Respiratory conditions - prevalence of sneezing (OR=1.74; 95%Cl: 1.11-2.79) and common cold (OR=2.28; 95%Cl: 1.46-3.57) were significantly higher among SG while nasal Obstruction (OR=0.21; 95%Cl: 0.10 - 0.45), breathlessness (OR=0.26; 95%Cl: 0.12 - 0.53) and asthma were significantly higher among CG (OR=0.34; 95%Cl: 0.18 - 0.62). CONCLUSIONS AND RECOMMENDATIONS: Prevalence of individual musculoskeletal, skin and respiratory conditions differed among coir workers and coconut estate workers. However, varicose veins were more among coir workers while occupational injuries were more among coconut estate workers. Recommend use of protective gear.Item Prevalence and correlates of asthma among selected garment factory workers at the Free Trade Zone, Ekala(College of Community Physicians of Sri Lanka, 2015) Jayawardana, P.; Abeysena, C.Objective To determine prevalence of bronchial asthma (BA) and its correlates and respiratory functions among selected garment factory workers (GFW) at the Free Trade Zone, Ekala. Methods This consisted of a cross sectional descriptive and an analytical study. It was conducted at three selected garment factories and a clinic setting in Ekala. Study group for first component included 674 GFW who have worked for 1 or more years at the current garment factories. Control group for second component included 100 participants who have never worked in garment factories. Study instruments consisted of an interviewer administered questionnaire and spirometry. Bivariate analysis was followed by multiple logistic regressions. Results were expressed as odds ratios (OR) and 95% Confidence intervals (CI). Results Overall prevalence of BA among GFW was 32.3% (95% CI:28.8-36.0%). Prevalence of “probable occupational asthma” among asthmatic GFW was 49.5% (95% CI:42.7-56.4%). Being a GFW (OR=3.5, 95% CI:1.9-7.2) and age >30 years (OR=1.5; 95% CI:1.1-2.1) were significantly associated with prevalence of BA. Among GFW, FEV1.0 and PEFR were significantly lower among asthmatics compared to non asthmatics, and FVC, FEV1.0, and PEFR among those exposed to dust for >3 years compared to ≤3 years. Conclusions Prevalence of bronchial asthma was higher among Garment Factory Workers. However, respiratory functions were lower only among those who were asthmatics.Item A review on contributory factors to role strain among working mothers(College of Community Physicians of Sri Lanka, 2009) Nilaweera, R.I.W.; Jayawardana, P.INTRODUCTION: Despite being employed, women's primary role in life is attending to household chores and rearing children. Therefore, women today have to play multiple roles as a mother, a housewife and as an employee. The conflicting demands of these different roles will lead to role strain which may impose a negative impact on their wellbeing. As a result, they are at a higher risk of developing mental health problems. Thus the consequences of role strain may affect the quality of life of the mother and her children. OBJECTIVE: To describe the factors that have been identified as contributing to role strain among working mothers with children. METHODS: The computer data bases Pubmed Central and Google Scholar and references cited in the journal articles referred were the sources of relevant literature. RESULTS: The studies reported were from Amarica, Canada and India and the participants blonged to different employment categiroes including professionals. Three main groups of contributory factors had been identified: socio demographic, lifestyle and occupational. Being single and young, number of children and having preschoolers were important socio demographic factors. Common lifestyle factors were, inadequate social support and unsatisfactory child care arrangements. Common occupation related risk factors were fixed workimg hours and lack of support from supervisors and coworkers. CONCLUSION: Several factors have been incriminated as contributory to role strain. Identification of these would minimize its' impact on the individual employed females as well as their families. Recommend research on this subject, as this is an area hitherto unexplored in Sri Lanka.Item Knowledge and practices regarding selected aspects of sexual abuse among mothers of adolescent children in the Medical Officer of Health area, Udubaddawa(College of Community Physicians of Sri Lanka, 2009) Makawita, M.U.M.; Jayawardana, P.INTRODUCTION: Emergence of child sexual abuse of adolescents is one of the major issues encountered globally. Inadequacy of preventive measures undertaken by mothers as a result of poor knowledge would make their children vulnerable to this horrendous experience which may have disastrous consequences on their physical, psychological and social well being. OBJECTIVE: To determine the knowledge and practices related to selected aspects of sexual abuse among mothers of adolescent children in the Medical Officer of Health (MOH) area, Udubaddawa. METHODS: A descriptive cross sectional study was conducted in all 13 Public Health Midwife areas in the MOH area, Udubaddawa. Seven hundred and fifteen mothers, 55 from each PHM area, having an adolescent child/children were selected through cluster sampling. Knowledge and practices were assessed using a self administered questionnaire. A score of ^50% was selected to define "good" knowledge and practices. Chi squared test was applied to determine factors associated with "good" knowledge and practices. RESULTS: The proportions of mothers with good overall knowledge and practices were 52.3% (n=374) and 39.2% (n=280) respectively. The variables that were significantly associated with good over all knowledge were educational level of >GCE O/L (60%; n=206) in comparison to Rs. 15,000 (63%; n=64) in comparison toItem Knowledge and practices on selected non communicable diseases among GCE Advanced Level students in state schools, Maharagama(College of Community Physicians of Sri Lanka, 2009) Gamage, A.U.; Jayawardana, P.OBJECTIVE: To assess the knowledge on selected non communicable diseases (NCDs) and practices related to prevention of selected NCDs among GCE Advanced Level (A/L) students attending government schools in the Maharagama education division. METHODS: A descriptive cross sectional study was conducted among year 13 students (A/L) attending state schools in Maharagama education division. A total of 634 students were selected from 9 schools which had at least one class in a given stream. Stratified sampling was done according to stream of study and the number needed from each stratum was decided according to probability proportionate to size. Cluster sampling was conducted when the number of classes in each stream was more than one. A self administered questionnaire was used to gather information on socio demographic data, practices, knowledge on NCDs and sources of information. Height and weight measurements were recorded. Each practice was analysed separately, either based on the indulgence or on a cut off score. A composite score of >60% was considered as good overall knowledge. RESULTS: Of the 634 respondents 45.3% (n=287) were males. The mean age was 18.4(SD±0.38) years. Knowledge: The proportion with good overall knowledge was 43% (95%CI: 39%-46.9%) [n=272]. Good overall knowledge was significantly higher among non Sinhalese (88%; n=5) and science stream students (65%; n=85) (p< 0.001). Practices: Proportion of students who had a healthy diet was 43% (n=275) and adequate physical activity was 20% (n=129). Three percent (n=18) were current smokers, all of whom were males and 10% (n=61) of males and 2% (n=12) of females were current users of alcohol. Proportion of females was significantly higher in relation to healthy dietary habits (52.2%; n=181 versus 32.8%; n=94 ), non smoking (100%; n=347 versus 93.7%; n=269) and non alcohol consumption (96.5%; n=335 versus 78.7%; n=226) and males in relation to adequate physical activity (27.5%; n=79 versus 14.4%; n=50). Schools (41%; n=233) were the major source of information on NCDs and preferred sources were healthcare workers (34%; n=201) and schools (32%; n=192). CONCLUSION: Proportion of year 13 A/L students with good knowledge and practices was low and recommend awareness raising programs.Item Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories(College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.Item Incidence, types and associated factors of occupational injuries among sewing machine operators in selected garment factories at the Export Processing Zone, Awissawella(College of the Community Physicians of Sri Lanka, 2013) Fernando, E.H.K.; Jayawardana, P.INTRODUCTION: Occupational injuries are a major entity which is on the rise in the whole world. For timery interventions it is necessary to identify the reasons for the injuries to reduce the burden. OBJECTIVE: To determine the incidence, types and associated factors of occupational injuries among sewing machine operators in selected garment factories at the Export Processing Zone. Awissawella. METHODS: A retrospective descriptive study was conducted between August to September 2012 to determine the incidence during the three month period immediately prior to the survey. Sample size computed was 423. Sample was selected randomly from each of the four selected factories. Total number included from individual factory was based on probability proportionate to size of total number of sewing machine operators in each factory. A pre tested self administered Sinhala questionnaire was administered, Chi square test was used to test for associations and a probability of less than 0.05 was selected as the significant level. Bivariate analysis was done and the results were expressed as Odds Ratios (OR) and 95% Confidence Intervals (CI). RESULTS: Response rate was 99.8% (n=422). The incidence of occupational injuries was 52.1 (95% CI: 33.0 - 77.9) per 1000 workers for the three month period with an estimate of 208.4 (95% CI: 170.7 - 250.5) per 1000 workers per year. The commonest mode of injuries was needle pricks (40.9%; n=9J. Fingers (72.7%; n=16J were commonly affected resulting in cut injuries or puncture wounds (36.4%; n=8J. Being a male (OR 2.7; 95% CI: 1.2 - 6.1, p = 0.04J, being ever married (OR 2.8; 95% CI: 1.05 - 8.3, p = 0.04) and having experience in the garment field (OR 3.5; 95% CI: 1.2 – 12.5, p = 0.02) were significantly associated with sustenance of injuries. CONCLUSIONS AND RECOMMENDATIONS: Incidence observed is considered high despite probable under reporting. The associated factors were non modifiable. Therefore recommend appropriate preventive measures with emphasis on regular in service training sessions. Future research should focus on conducting prospective studies.Item Qualitative assessment of breast cancer early detection services provided through well woman clinics in the district of Gampaha in Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2013) Vithana, P.V.; Hemachandra, N.N.; Ariyaratne, M.; Jayawardana, P.BACKGROUND: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. MATERIALS AND METHODS: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. RESULTS: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. CONCLUSIONS: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.Item Educational intervention on breast cancer early detection: effectiveness among target group women in the district of Gampaha, Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2015) Vithana, P.C.; Ariyaratne, M.; Jayawardana, P.PURPOSE: The present study concerns the effectiveness of an educational intervention for improving knowledge, attitudes and practices (KAP) of breast cancer early detection among target group women (TGW) in the district of Gampaha, Sri Lanka. MATERIALS AND METHODS: The study was a community-based intervention. Two medical officer of health areas in Gampaha district were selected using random sampling as intervention (IA) and control (CA). Public health midwives (PHMs) in the IA were exposed to the educational intervention first, conducted the same among the TGW through PHMs. KAP was assessed using an interviewer- administrated questionnaire among 260 TGW from each area selected using cluster sampling before and six months after the intervention. RESULTS: The overall median scores for KAP among TGW in IG increased significantly from pre intervention level of 54% (IQR: 46-59%), 50% (IQR: 41-59%), and 0% (IQR: 0-20%) to post intervention level of 77% (IQR: 72-82%), 68% (IQR: 59- 76 %) and 40% (IQR: 20-60%) respectively. In CG, overall median scores for KAP remained almost the same at pre intervention 54% (IQR:44-59%), 50% (IQR:36-59%) and 0% (IQR: 0-20%) and post intervention 54% (IQR:46-59%), 50% (IQR:36-64%) and 0% (IQR: 0-20%) respectively. CONCLUSIONS: The educational intervention was found to be effective.Item Validation of the Sinhala version of 30-item General Health Questionnaires(DRUNPP Sarajevo, 2012) Abeysena, C.; Peiris, U.; Jayawardana, P.; Rodrigo, A.BACKGROUND: The General Health Questionnaire (GHQ) is a widely used instrument to detect non potential psychotic psychological problems. The Sinhala translation of GHQ 30 has been widely used for research purposes in Sri Lanka, but details pertaining to the validation procedure have not been published. Objective: To determine the criterion validity of Sinhala versions of GHQ 30. METHODS: This was a descriptive cross sectional study including 374 patients aged 18 to 75 years ,attending Out Patient Department of Colombo North Teaching Hospital between June 2009 to September 2010. Self administered Sinhala version of GHQ 30 was completed by the participants. Clinical Examination was done blindly to the GHQ score by a Psychiatrist based on ICD 10 classification of Depression/Anxiety/social dysfunction as reference standard. Cutoff values for GHQ 30 was determined by applying Receiver Operation Characteristic (ROC) curves. RESULTS: Optimal cutoff levels were 5/6 for GHQ 30 with a sensitivity of 67.5% (95%CI: 59%–76%) and a specificity of 80% (95%CI: 75%–85%). Optimal cutoff levels were not changed by sex, age and educational levels. The area under the ROC curve for GHQ 30 was 0.79. Despite above, multilevel likelihood ratios of >1 were obtained only for total scores of ≥7 for GHQ 30. CONCLUSIONS: GHQ 30 displays adequate validity for use in the Sinhala speaking primary care setting attendees for assessing psychiatric disorders.