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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Psychological status and physical disabilities of permanently disabled Sri Lankan servicemen(Scientific Communications International Ltd., 2004) Kasturiaratchi, S.K.; Jayawardana, P.L.OBJECTIVE: To describe the physical disabilities and to determine the prevalence of psychological ill health among permanently disabled servicemen. PATIENTS AND METHODS: 430 disabled servicemen were selected by stratified sampling from the 8 regiments of the Sri Lanka army. A self-dministered questionnaire was used to collect personal data and details of physical disabilities. The General Health Questionnaire and Bradford Somatic Inventory were used to detect psychological distress and the presence of somatic symptoms, respectively. RESULTS: Thirty-four (8.3%) of the 408 servicemen included in the analysis had more than 1 injury, giving a total of 442 injuries. The two most common disabilities were limb amputation (49.7%) and nerve injury (27.5%). 201 servicemen (49.3%) had a positive General Health Questionnaire result and 119 (29.2%) had a positive Bradford Somatic Inventory result. Of the 119 servicemen positive for Bradford Somatic Inventory, 109 (91.6%) had a positive General Health Questionnaire result (odds ratio, 23.3; 95% confidence interval, 11.2-49.9). CONCLUSIONS: The findings of this study may be useful for the adoption of a holistic approach for rehabilitation of disabled servicemen, and they emphasise the need for early diagnosis and treatment of psychological distress. AUTHOR KEYWORDS: Disabled persons; Military personnel; Psychological; Stress. INDEX KEYWORDS: adolescent; adult; army; article; controlled study; demography; disease severity; distress syndrome; emotional stress; General Health Questionnaire; health status; human; limb amputation; major clinical study; male; mass screening; nerve injury; physical disability; prevalence; psychiatric diagnosis; Sri LankaItem Effectiveness of a community based health educational intervention in reducing unmet need for modern methods of family planning among ever married reproductive age women in the Kalutara district, Sri Lanka(Insight Medical Publishing, 2012) Malwenna, L.I.; Jayawardana, P.L.; Balasuriya, A.INTRODUCTION: Unmet need is defined as the percentage of all fecund women who are married or living in union and thus presumed to be sexually active but are not using any method of contraception, either do not want to have any more children or want to postpone their next birth at least for two more years or do not know when or if they want another child 1. Unmet Need for Modern Methods includes all in the unmet need group and those who are using natural and traditional methods at the time of survey (The Westoff Model) 2. It describes the discrepancy between sexual and contraceptive behaviors and stated fertility preferences of women in the reproductive age. OBJECTIVE: This study was designed to evaluate the effectiveness of a health educational intervention in improving the knowledge and attitudes on family planning (FP) among Public Health Midwives (PHMM) who function as community health workers and acceptance of modern FP methods planning which eventually reduce the Unmet Need (UMN) and thereby reducing the risk of unintended pregnancy among 15 - 49 year old married women in in the Kalutara district. METHOD: Initially the perceptions on unmet need in community service providers was assessed by three Focus Group Discussions conducted among Medical Officers of Health, Public Health Nursing Sisters and PHMM. It was followed by assessment of the baseline knowledge and attitudes on FP and UMN among all the PHMM and a group of married women in reproductive age (15-49) with unmet need for modern methods selected from cluster sampling of PHM areas in the district using PPS technique, allocating 22 clusters of 12 women in each Intervention (IA) and Control Area (CA).The developed health education intervention was applied on PHMM followed by the selected group of women with unmet need for modern methods only to the IA. The effectiveness was assessed in terms of the change in knowledge and attitudes of PHMM after 2 months of intervention, of target group of women after 6 months of intervention and the reduction of unmet need for modern methods in the IA compared to CA. RESULT: In PHMM, overall percentage mean knowledge score in IA at pre and post intervention were 29.9% and 65.7% respectively with a statistically significant difference (p<0.001) but with no such difference (p=0.10) in CA between pre (20%) and post (30%) scores. Median attitude scores were 37.5% and 86% in IA at pre and post intervention with a statistically significant difference (p<0.001). For CA respective figures were (40%) and (41%) with no significant difference (p=0.09) Regarding the target group, in IA had pre (37.6%) and post (70.6%) mean knowledge scores with a statistically significant difference (p<0.001); but with no significant difference (p=0.06) in CA between pre (39.0%) and post (40.2%) scores. Similarly, between groups comparison shows statistically significant difference (p<0.001) between IA and CA in post intervention, the scores being 70.6% and 40.2% respectively. CONCLUSION: The training conducted on PHMM revealed a significant impact on knowledge and attitudes in both service providers and clients leading to change in the FP practice and reduction in unmet need for modern methods of FP. AUTHOR KEYWORDS: Family planning; Health education intervention; Married women; Reproductive age; Unmet needItem Household expenditure on tobacco consumption in Monaragala district(Sri Lanka Medical Association, 2016) Perera, K.M.N.; Guruge, G.N.D.; Jayawardana, P.L.INTRODUCTION AND OBJECTIVES: The link between tobacco and poverty is well established. Monaragala is the poorest rural district in the southern parts of Sri Lanka and second poorest in the country. The Central Bank statistics state that 2.7% of household expenditure is spent on “liquor, drugs and tobacco”. This figure is much lower than the global estimates and findings in other countries. This study aimed to describe the expenditure on tobacco and its impact on food and education related expenditures at household level in Monaragala District. METHOD: A cross-sectional study design was used. A representative sample of 1160 households was recruited using a four-stage cluster sampling method. A simple random sampling method was used to select an individual aged between 15 to 59 years from the selected household. Data were obtained by a pre-tested, validated questionnaire was administered by trained interviewers. Recall method was used to obtain expenditure related data. RESULTS: Median monthly household income was LKR 20,000 (IQR=LKR 12,000-30,000). The median monthly expenditure on tobacco was LKR 1000 (IQR: 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR 2000-3600). The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR=2.0-10.0). The poorest reported the highest mean proportionate expenditure (9.8%, SD=10) from the household income. Medium and high spenders spent significantly less on children’s education compared to others. CONCLUSION: The household expenditure on tobacco products in rural poor communities in Sri Lanka is probably greater than the current estimates.Item Household expenditure on tobacco consumption in a poverty-stricken rural district in Sri Lanka(SAGE Publications, 2017) Perera, K.M.N.; Guruge, G.N.; Jayawardana, P.L.Tobacco is a determinant of poverty and a barrier for development. Monaragala, a rural, agricultural district, reports the highest poverty-related indicators in southern Sri Lanka. A cross-sectional study was used to describe the household expenditure on tobacco and its association with food- and education-related expenditures at household level. This study used a 4-stage cluster sampling method to recruit a representative sample of 1160 households. Response rate was 98.6%. Median monthly household income was LKR 20 000 (interquartile range [IQR] = LKR 12 000-30 000). The median monthly expenditure on tobacco was LKR 1000 (IQR = LKR 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR = LKR 2000-3600).The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR = 2.0-10.0) and a mean of 7.4% (7.6). The poorest reported the highest mean proportionate expenditure (9.8%, SD = 10) from the household income. Household expenditure on tobacco negatively associated with expenditure on education.Item Risk factors for delivering a small for gestational age infant(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Abeysena, C.; Jayawardana, P.L.; Seneviratne, S.R.A.OBJECTIVE: To determine the risk factors for delivering a small for gestatJonal age (SGA) infant. METHODOLOGY: A prospective study was carried out at two MOH areas in the Gampaha district, during the period of May 2001 to April 2002. Eight hundred and twenty pregnant mothers were recruited at £16 weeks of gestation and followed up until partus. Demographic, socloeconomic and obstetric data of the mothers were gathered at the time of recruitment. Trimester specific exposure statuses along with potential confounding factors were gathered on average at the 12 , 28 and 36 weeks of gestation. Physical activities were assessed by asking the duration of specific postures adopted per day by the mothers during each trimester at home for house wives and both at home and during working hours for those who were engaged in paid employment. Shift work and work related physical and chemical exposures were also assessed. Psychosocial stress was ascertained using the Modified Life Events Inventory and the General Health QuestionnaireJJO. Ultrasound scan was performed to determine the gestationai age based on foetal biparietal diameter. SGA was assessed using customized growth centile charts developed by Gardosi et al. Univariate and multivariate logistic regression analysis (sample size=504) were applied and the results are expressed in odds ratios (OR) and 95% confidence intervals (95%CI) with the probability levels (P). RESULTS: When cut off for SGA was considered as <10 centile of the customized birth weight centiles, the proportion of SGA was 16.4%. Although the univariate analysis revealed that sleeping for < 8 hours during 2" or 3 or both trimesters (OR=1.645 95% CI= 1.00-2.67; P=0.04) and work related exposures during 2 or 3 or both trimesters (OR=2.42,95% GUI.19-4.93; P=0.01) were significantly associated with SGA, none of these factors became significant on multivariate logistic regression analysis. When the cut off was considered as <5 centile of the customised birth weight centiles, the proportion of SGA was 8.8%. Sleeping <8 hours during 2 or 3 or both trimesters (OR=2.34,95% CI=1.18-4.61; P=0.01), work related exposures during 2" or 3' or both trimesters (OR=2.91, 95% CM.27-6.65; P=0.01) and alcohol consumption during the 3' trimester {OR=4.33, 95% CI=1.11-16.94; P=0.03) had statistically significant association with SGA in the univariate analysis. Multivariate logistic regression also revealed that sleeping for <8 hours during 2" or 3 or both trimesters (OR=2.14, 95% 01=1.06-4.32; P=0.03), and walking for < 2.5 hours per day (OR=2.40> 95% CM.05-5-51; P=0.04) and alcohol consumption during the 3' trimester (OR=8.01,95% CM.31-49.02; P=0.02) were risk factors. CONCLUSIONS: Risk factors for being SGA when SGA is defined as <5 centile of the customised birth weight centiles are, sleeping for <8 hours during 2 or 3 or both trimesters, walking < 2.5 hours per day and alcohol consumption during 3 trimester. It is recommended that the importance of sleeping >8 hours and walking > 2.5 hours per day and avoidance of alcohol be emphasised to pregnant mothers.Item Emotional and behavioral status and associated factors among inmates aged 11-16 years of Children’s Homes in the Gampaha Probationary Division(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Manori, D.M.S.; Jayawardana, P.L.BACKGROUND: Emotional and behavioral disorders are common among inmates of Children’s Homes due to lack of love, affection and care available compared to their counterparts living with parents. OBJECTIVE: To describe the emotional and behavioral status and the associated factors among inmates aged 11-16 years of Children’s Homes in the Gampaha Probationary Division. METHODS: This was a descriptive cross sectional study. All eligible inmates of 14 Children’s Homes in Gampaha Probationary Division were recruited. Study instruments comprised, self-rated Strengths and Difficulties Questionnaire, interviewer administered questionnaire on socio demographic and other relevant factors and a checklist. Associations were tested using chi square test. A probability of <0.05 was considered significant. The results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Response rate was 100% (n=279). The prevalence of abnormal emotional and behavioral status (E&BS) was 26.2% (95% CI: 21.1-31.7). Conduct problems were the highest (28.7%; 95% CI: 23.4-34.4) and prosocial problems were the lowest (3.6%; 95% CI: 1.7-6.5). Female sex (OR= 3.1; 95% CI: 1.7-5.9, p<0.001), living in Children’s Homes for more than six years (OR= 2.1; 95% CI: 1.1–4.0, p= 0.01), having less than 10 friends (OR= 1.8; 95% CI: 1.03-3.1, p = 0.04) and keeping problems to themselves (OR= 8.2; 95% CI: 3.5-19.7, p<0.001) were significantly associated with having abnormal E&BS. CONCLUSIONS: Observed prevalence of E&BS was higher than figures from general population which was 18.9%. Except “sex”, all other associated factors are modifiable. Recommend early screening and establishment of counseling services.Item Knowledge of basic epidemiological and statistical concepts among doctors in selected Sri Lankan hospitals(College of Community Physicians of Sri Lanka, 2010) Abeysena, H.T.C.S.; Jayawardana, P.L.; Wickremasinghe, A.R.; Wickramasinghe, U.INTRODUCTION: This study was conducted to describe the ability to comprehend basic epidemiologic and statistical concepts among doctors in selected hospitals in the Western Province. METHODOLOGY: A cross-sectional descriptive study was conducted during January to February, 2008. The study population consisted of 315 doctors - 43 (13.7%) specialists, 50 (16%) postgraduate trainees (PG) and 222 (70.3%) grade medical officers. A self administered questionnaire was used to assess perceived knowledge on selected epidemiologic and statistical concepts/parameters and two problem based questions which tested the ability to apply knowledge were used. Data were analyzed calculating the proportion who perceived to have good knowledge regarding each concept. Logistic regression was applied to test for differences in good knowledge between different groups of subjects. RESULTS: More than 75% of the respondents claimed to have good knowledge on prevalence, sensitivity, specificity and case control studies. Less than 50% of them had good knowledge on risk difference, number needed to treat, systematic reviews, meta-analysis, p-value and 95% confidence intervals. Male doctors had a significantly higher good knowledge than female doctors (p<0.001), and those who read medical journals regularly than those who did not (p<0.05). Specialists and PG trainees had a significantly higher good knowledge (p<0.001) than grade medical officers. Correct answers of the respondents to the two problem based questions were 25% (n=79) and 15.8% (n=50), respectively. CONCLUSION : Even though some doctors claimed to have a good knowledge with regard to selected epidemiologic and statistical concepts, their ability to apply their knowledge was poor.Item Stemming TB: the Sri Lankan experience(2007) Jayawardana, P.L.; Sarukkali, C.; Wickremasinghe, A.R.No Abstract AvailableItem Audiometry in brass workers(College of Community Physicians of Sri Lanka, 2003) Jayawardana, P.L.; de Alwis, W.R.OBJECTIVES : To compare hearing impairment among brass workers with that of the general population. Study DESIGN - A cross sectional analytical design METHODOLOGY : One hundred and seventy male brass workers and 170 controls from the general population were selected as subjects. The control group was matched for the age of the brass workers. A questionnaire was used to extract socio demographic and relevant data related to hearing impairment. Pure tone audiometry was carried out in the order of 1000, 1500, 2000, 3000, 4000, 6000, 8000, 250, 500 and 1000 Hz for both ears. Noise levels were measured in 10 randomly selected brass workshops. RESULTS : The number of pairs included in the analysis was 154. Tinnitus and subjective hearing impairment were present in 1 (0.6%) and 18 (1 1.7%) respectively among brass workers while the respective figures in the control group were 3 (1.9%) and 13 (8.4%) the differences of which were not significant. Brass workers had ORR of 3 (95%CI of 1.6 -5.8) and 4.9 (95% CI = 2.3-10.4) for overall hearing impairment in the left and right ears respectively. On multiple logistic regression, being a brass worker in all frequencies except 1000 Hz. and advancing age in the frequencies of 3000 to 6000 Hz. were found to be risk factors . The duration of service was found be a risk factor in the frequencies of 3000 and 4000 Hz when data pertaining to brass workers alone were analysed. The noise levels in the workshops ranged between 84 dB to 103 dB. CONCLUSIONs : Brass workers were at a higher risk of hearing impairment due to the prevalent high noise levels. Cheap and effective preventive measures are recommended.Item Ventilatory function in brass workers of Gadaladeniya Sri Lanka(Oxford University Press, 1997) Jayawardana, P.L.; de Alwis, W.R.; Fernando, M.A.A cross sectional study was conducted to determine the respiratory hazards of brass workers. The study group was selected randomly. The control group was selected from the general population matched for age by cluster sampling. There was a total of 154 pairs for the final analysis. A questionnaire was administered to determine the prevalence of respiratory symptoms. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1.0), forced expiratory flow rate in the mid 50% of the FVC(FEF25%-75%) and peak expiratory flow rate(PEFR) were measured. Chest radiography was performed on those with 5 or more years of service. Cough, phlegm, chronic bronchitis and dyspnoea were significantly higher among brass workers. The ventilatory capacity was significantly lower in all the indicators except FVC. Smoking had no significant effect and a dose response relationship could not be demonstrated after inclusion of age in the regression model. Five point five per cent had evidence of septal lines while 6.4% had emphysema.