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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Retinoblastoma patients treated in Sri Lanka from 2014 to 2020: epidemiology, clinical status and correlates of lag time in seeking tertiary care services(BioMed Central, 2024) Kugalingam, N.; De Silva, D.; Abeysekera, H.; Nanayakkara, S.; Tirimanne, S.; Chandrasekharan, V.; Jayawardana, P.L.BACKGROUND Retinoblastoma (RB) is a tumour of children < 5 years with a incidence of 1 in 20,000. Around 20 RB cases are diagnosed yearly in Sri Lanka, a lower middle-income country with high literacy levels and healthcare free at point of delivery. Incidence, local and systemic severity and mortality related to RB are reportedly high in low- and middle- income countries in comparison to higher income countries. Aims of this study were to describe demographic, socioeconomic, and clinical characteristics of Sri Lankan RB patients attending the designated RB unit at the Lady Ridgeway Hospital (LRH), Colombo between January 2014 to December 2020, and determine correlates of lag time (LT) for first tertiary care visit after detecting the first symptom/sign.METHODS Two descriptive cross-sectional studies (DCSS) were conducted, one on 171 RB patients with demographic and clinical data collected between 2017 and 2020. In 2021, the second DCSS took place where socioeconomic and further demographic data were collected using telephone interviews, recruiting a subgroup of 90 (53%), consenting and contactable RB patient/ parent pairs. Bivariate and multivariable analyses were applied to determine correlates of LT of > 4 weeks for first tertiary care visit. Results were expressed as odds ratios and 95% confidence intervals.RESULTS LRH survey (N = 171): Median age at diagnosis was 15 months (range 1-94 months; IQR: 8-27); 89 (52%) were females. Groups D and E tumours were 25.7% (n = 44) and 62.6% (n = 107) respectively with 121 (71%) enucleations. The number of deaths were 2 (1.2%). Telephone survey (N = 90): Proportion with LT of > 4 weeks for first tertiary care visit was 58% (n = 52). None of the putative risk factors (ethnicity, parental educational level, socioeconomic status, distance from residence to tertiary care unit and receiving financial assistance) were associated with LT in both analyses.CONCLUSION Despite a high proportion with groups D and E tumours and enucleations, mortality rate was low, most likely due to availability of designated tertiary care. No correlates for LT of > 4 weeks for tertiary care presentation were identified. Early RB detection needs rigorous implementation of screening strategies and increased awareness among primary care health workers and parents.Item Risk factors for low resilience among grade 10 adolescents in the Gampaha District(Sri Lanka Medical Association, 2023) Manori, D.M.S.; Jayawardana, P.L.; Godamunne, P.INTRODUCTION: Resilience denotes the ability to withstand adversity and bounce back from difficult life events. OBJECTIVE: To determine risk factors for low resilience among Grade 10 adolescents in the District of Gampaha. METHODS: A case-control study with a computed sample size of 128 in each among cases (low resilience) and controls (high resilience) was conducted. Cases and controls were selected by applying simple random sampling to a descriptive study where the magnitude of resilience was determined. For data analysis bivariate (using chi-square test) followed by multiple logistic regression were applied. Results were expressed as adjusted odds ratios with 95% confidence intervals. RESULTS: Risk factors for low resilience were: one or both parents dead (AOR=3.4; 95% CI [1.1, 10.1]; p=0.031), mother’s educational level ≤GCE A/L (AOR=2.3; 95% CI [1.4, 3.6]; p=0.001), losing temper frequently (AOR=2.5; 95% CI [1.9, 3.4]; p<0.001), having <6 friends (AOR=1.4; 95% CI [1.03;1.9]; p<0.048), having <6 close friends (AOR=1.6; 95% CI [1.06, 2.5]; p=0.024), having conflicts with friends (AOR=2.0; 95% CI [1.03, 3.74]; p=0.040), lack of support from home (AOR=1.5; 95% CI [1.04, 2.20]; p=0.031), not seeking help when facing difficult situations (AOR=1.7; 95% CI [1.2, 2.3]; p=0.001), sleeping for <8 hours/day (AOR=1.4; 95% CI [1.2, 1.8]; p=0.007), lack of religious affiliations (AOR=2.6; 95% CI [1.2, 5.7]; p < 0.015) and non-attending Sunday school (AOR=2.1; 95% CI [1.5, 3.2]; p<0.001). CONCLUSION: Eleven risk factors were identified. Recommend conducting cognitive behavioural therapy-based interventions regularly at the school level targeting to minimize the impact of the above risk factors.Item Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka(BioMed Central, 2017) Gamage, A.U.; Jayawardana, P.L.BACKGROUND: Behaviors established during the adolescence have life-long consequences to the onset of non-communicable diseases (NCDs) in later life. Therefore, it is essential to understand adolescents' knowledge and practices with the intention of developing preventive programs focusing on this age group. The objective of the study was to assess knowledge about selected NCDs, and lifestyle choices among school students aged 17-19 years in state schools of the Maharagama Educational Division, Sri Lanka. METHODS: A descriptive, cross-sectional study was conducted among students aged 17-19 years attending state schools in Maharagama Education Division. A total of 634 students were selected from 9 schools conducting Advance Level classes. Stratified sampling was done based on stream of study and the number needed from each stratum was decided according to probability proportionate to size which was followed by cluster sampling within the strata to select the classes included. Data were collected using a self-administered-questionnaire on socio-demographic characteristics and economic status; lifestyle-related practices; knowledge on Non-Communicable -Diseases. Logistic regression was used to assess the associations. RESULTS: Proportion students with good overall knowledge was 43%(n = 272). Forty-three percent (n = 275) consumed a healthy diet, and 20%(n = 129) engaged in adequate physical activity 3%(n = 18) of students were current smokers and 12%(n = 73) current alcohol users 12%(n = 73). Overall "good" knowledge about NCDs was associated with being a science stream student(OR = 3.3; 95%CI:2.1-5.2). Healthy diet was associated with female sex (OR = 2.1; 95%CI: 1.5-3.0), and adequate physical activity with male sex (OR = 2.1; 95% CI:1.4-3.2), non-science-stream (OR = 2.1; 95%CI:1.2-3.7) and upper socio economic status (OR = 2.0; 95%CI:1.3-3.0). Non-smoking was associated with overall good knowledge (OR = 4.1; 95%CI:1.2-13.7) and female sex (OR = 0;95%CI:1.5-infinity). Abstinence from alcohol was associated with being a female (OR = 6.9; 95%CI:3.4-13.9), and with mother and fathers' education level of > General-Certificate of Examinations Ordinary Level (GCE O/L) (OR = 2.9; 95%CI:1.1-8.4 and OR = 3.5; 95%CI:1.1-11.2 respectively). CONCLUSION: Knowledge about NCDs and healthy lifestyle-practices were poor among school students aged 17-19 years. Lack of knowledge about healthy and unhealthy behaviors highlights the importance of carrying out regular surveillance for NCD risk factors, and initiating programs for the prevention of NCDs amongst adolescents.Item Validity of the Sinhala version of the general health questionnaires item 12 and 30: Using different sampling strategies and scoring methods(Ibn Sina Academy of Medieval Medicine & Sciences, 2016) Abeysena, H.T.C.S.; Jayawardana, P.L.; Peiris, M.U.P.K.; Rodrigo, A.OBJECTIVE: To determine the criterion validity of the Sinhala version of the General Health Questionnaire-12 (GHQ-12) and GHQ-30 employing different sampling designs and scoring methods. METHODS: This was a descriptive cross-sectional study including 374 patients. The GHQ-30 was completed by the participants using likert scale and then converted into standard score. The ‘Clinical Examination’ was done blindly to the GHQ score as the reference standard. Total study sample was considered as a representative sample taken consecutively. Case-reference design included 126 cases and 126 randomly selected controls based on reference standard. Test result-based designs included two groups of positive and negative GHQ, based on the optimal cut-off level. Cut-off levels were determined by using three criteria. In addition stratum specific likelihood (SSLR) ratio also considered. RESULTS: Applying consecutive sampling design, for the GHQ-12, the optimal cut-off levels were 9/10 using likert score and 2/3 using standard score and for the GHQ-30, 25/26 using likert score and 6/7 using standard score. The optimal cut-off level depends on the different sampling designs employed in addition to criteria for determining cut-off levels. The SSLR of>1 was useful for determining optimal cut-off level. Irrespective of the scoring methods, application of case-reference design tends to be overestimation of the specificity with high threshold values and test result-based design tends to be overestimation of the sensitivity, compared to consecutive sampling. Using likert scoring method, the sensitivities were higher than standard scoring method. CONCLUSIONS: The optimal cut-off levels depend on the sampling design and the scoring method employed and criteria to determine cut-off levels.Item Public health midwives’ perception on breast cancer early detection services provided through well woman clinics in the Gampaha District, Sri Lanka(College of the Community Physicians of Sri Lanka, 2013) Vithana, P.V.S.C.; Hemachandra, D.K.N.N.; Ariyarathne, M.A.Y.; Jayawardana, P.L.INTRODUCTION: Being most common cancer diagnosed in Sri Lanka, breast cancer accounts for 27% of female cancer-mortality. Early-detection of breast cancer is conducted using clinical breast examination (CBE) and increasing awareness on breast self-examination through well woman clinics (WWCs). OBJECTIVE: To identify Public health midwives' (PHMs') perception on the importance and deficiencies of the breast cancer early-detection services provided through WWCs, and their suggestions on improving the breast cancer early-detection services. METHODS: A qualitative study using four focus group discussions (FGDs) consisting of 8-10 participants per each FGD were conducted among 38 PHMs in the Gampaha District during July to September 2008. FGD guide included discussion points on availability of guidelines and protocols, training received, time for clinic-sessions, adequacy of resources, support from other sectors, and reasons for low-participation and their recommendations for improving utilization of services. Two experts conducted FGDs as moderator and data recorder. FGDs were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results were presented in narrative form. RESULTS: All the PHMs had a firm realization on the need of breast cancer early-detection. FGDs revealed non-availability of guidelines, lack of training, lack of skills and material to provide health education, inability to provide privacy during CBE, shortage of stationery and lack of community awareness and motivation. The suggestions for the improvements 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 AND RECOMMENDATIONS: The components to be improved in breast cancer early-detection services were identified. Study recommends training programmes at basic and post basic levels on a regular basis and supervision for the sustenance of the program.Item Effectiveness of an educational intervention among public health midwives on breast cancer early detection in the district of Gampaha, Sri Lanka.(Asian Pacific Organization for Cancer Prevention, 2015) Vithana, P.V.; Ariyaratne, M.A.; Jayawardana, P.L.BACKGROUND: Breast cancer is the commonest cancer among Sri Lankan females, accounting for 26% of the cancer incidence in women. Early detection of breast cancer is conducted by public health midwives (PHMs) in the Well Woman Clinics. The aim of the present study was to determine the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on breast cancer screening among PHMs in the district of Gampaha. MATERIALS AND METHODS: Two Medical Officer of Health (MOH) areas in Gampaha district were selected using random sampling as intervention (IG) and control (CG) groups. All the PHMs in the two MOH areas participated in the study, with totals of 38 in IG and 47 in CG. They were exposed to an educational intervention with the objective of using them to subsequently conduct the same among 35-59 year women in the community. Following the intervention, post-intervention assessments were conducted at one month and six months to assess the effectiveness of the intervention. RESULTS: The overall median scores for KAP among PHMs respectively were as follows. Pre-intervention: IG:58%(IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CG: 64%(IQR: 56-69%), 90%(IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention: one month, IG:96%(IQR: 93-96%), 100%(IQR: 100-100%), and 85%(IQR: 81-89%). CG:67%(IQR: 60- 73%), 90%(IQR: 80-100%) and 65%(IQR: 50-73%). Post-intervention: six months, IG: 93% (IQR: 91-93%), 100%(IQR: 90- 100%), and 81%(IQR: 77-89%). CG: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). All the above post-intervention scores of PHMs in the IG were significantly higher in comparison to CG (p<0.001). CONCLUSIONS: This planned educational intervention had a significant impact on improving KAP of PHMs for early detection of breast cancer in the Gampaha district.Item Developing and validating a tool to assess empowerment for tobacco control(Sri lanka Medical Association, 2015) Perera, K.M.N.; Guruge, G.N.D.; Jayawardana, P.L.INTRODUCTION AND OBJECTIVES: Empowerment is defined as the mechanism by which individuals, organizations and communities gain mastery over their lives. Many tobacco control interventions aim to empower individuals but measuring empowerment is a challenge. Study aim was to develop a tool to assess empowerment for tobacco controf at individual level in the Moneragala District. METHOD: indicators were operationalized based on Zimmerman's psychological empowerment definition. Initial interviewer-administered tool was subjected to modified Delphi technique to determine content and consensual validity and a scoring system. Cognitive interviews were conducted to assess applicability to local context. Pre testing (n=30) and validation (n=200) were conducted in the Badulla District. Exploratory factor analysis was performed to assess construct validity. Based on communalities, Scree test and Eigenvalues derived from latter, Delphi technique was used to determine the factor structure which improved interpretability. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and Cohen's kappa coefficient respectively. RESULTS: Components extracted using principle component analysis showed high communalities (0.914 to 0.996). Eigenvalue cut-off taken was 0.3 and six constructs based on the Scree plot converged in 14 iterations in Varimax rotation. Final tool comprised 27 items under seven factors named "Perceived awareness"; "Motivation to involve and perceived mastery"; "Awareness and mobilization of resources"; "Perceived efficacy"; "Perceived competence in society", “perceived competence within network” and “community involvement” for tobacco control. Cronbach’s alpha was 0.91 demonstrating good internal consistency. Cohen’s kappa coefficient was 0.63 indiicating substancial agreement .CONCLUSION: Developed tool can be used in similar contexts to measure empowerment for tobacco control.