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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 How do Men who Choose Not to Participate in Healthy Lifestyle Centres Reason About Their Decision?(Sri Lanka Medical Association, 2020) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.INTRODUCTION AND BJECTIVES: In Sri Lanka, both women and men are expected to visit a cost-free population-based cardio-vascular screening programme held at a specific centre called the Healthy Lifestyle Centre (HLC) at their nearest primary health care institution. However, screened male to female ratio in 2016 first quarter was approximately 3:7 portraying that many men choose not to visit HLC compared to their female counterparts. This study explored how men who declined participation in the healthy lifestyle centre reasoned out their choice. METHODS: This qualitative study was conducted using constructivist grounded theory in Gampaha and Kalutara districts in Sri Lanka. Three focus group discussions (n= 7) and six interviews from men who actively declined participation in the healthy lifestyle centre were analysed using thematic analysis. RESULTS: Factors related to men’s decision not to participate in HLC included masculine perceptions such as male having a lower risk for diseases compared to a female, poor perceived susceptibility due to absence of symptoms, previous negative experiences related to health care services, lack of confidence in the tests conducted at the HLC and barriers due to their employment as HLC is being conducted in a fixed day and a time. CONCLUSION: Men’s decision not to participate in screening at HLC is linked with individual attitudes and influence by masculinity. The existing male-unfriendly nature of the health-care services also had a significant impact on the decision. Thus, targeted interventions are urgently needed to improve utilization of HLCs by men addressing these identified reasons.Item Reasons for underutilization of healthy lifestyle centers: Perceptions of health care providers(Sri Lanka Medical Association, 2019) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.INTRODUCTION & OBJECTIVES: Healthy lifestyle centers (HLC) for screening for non-communicable diseases (NCDs) and providing referrals for management and lifestyle modification advice are a response to the growing burden of NCDs in Sri Lanka. Currently HLCs are underutilized by its target population (adults >35 years). The aim of this study was to explore the health care providers' perceptions reasons for underutilization of HLCs in Gampaha district of Sri Lanka. METHODS: Ten key informant interviews were held with health care providers of HLCs in Gampaha district selected by judgmental sampling. The data collected via semi-structured interviews were analyzed using thematic analysis. RESULTS: Perceived reasons emerged in-eight categories: Sense of healthiness - absence of symptoms stimulating deviations from a healthy lifestyle; Negative past experiences - related to individual health seeking behaviours and outcomes; Clients' attitudes - dissatisfaction and mistrust towards the services provided; Client's employment related - loss of income for daily wagers and difficulties in obtaining leave; Lack of awareness - as promotions have been confined in health care setup and no community level mechanisms; Service provider related - opening times of the center and lack of basic facilities for screening; Gender and social norms such as falling ill being an insult to masculinity and elderly women exercising being considered strange; Private sector - clients being able to afford and feasibly access private sector services. CONCLUSION: Service providers believe underutilization of HLCs is due to a diverse range of individual, service related, and societal level factors, some of which can be easily addressed.Item Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.Item Health related quality of life and its correlates among elderly in a selected MOH area of Colombo(Sri Lanka Medical Association, 2016) Wijesundara, C.R.; Kasturiratne, K.T.A.A.INTRODUCTION AND OBJECTIVES: Ageing is a universal phenomenon and enhancement of healthy life expectancy is an issue of immense public health importance. The objective of the study was to describe health related quality of life (HRQoL) and its correlates among elderly in the Kaduwela MOH area. METHOD: A community based descriptive cross sectional study was conducted on 460 elders selected through a cluster sampling method. WHOQOL-BREF questionnaire was the instrument used. t- test and multiple linear regression were used for the univariate and multivariate analysis respectively. RESULTS: The mean score for physical health domain was 58.84, and its individual correlates (R2=0.457) were age (p<0.001), employment (p<0.001), morbidity (p<0.001) and ADL (p<0.001). The psychological domain had a mean of 46.75 and its individual correlates (R2=0.324) were age (p=0.013), income (p<0.001), morbidity (p<0.001) and ADL (p<0.001) while co- residency (p=0.029) and standard of living were significant household correlates (R2=0.172). The mean of the social relationships domain was 45.93 and civil status (p=0.024) and ADL (p<0.001) were determined to be its individual correlates (R2=0.185), while co-residency (p<0.001) and standard of living (p<0.001) were the household correlates (R2=0.103). Environment domain reported a mean of 50.02. Its individual correlates (R2=0.282) were income (p<0.001), morbidity (p<0.001) and ADL (p<0.001), while the household correlates (R2=0.217) were ownership of the house (p<0.001), co-residency (p<0.001) and standard of living (p<0.001). CONCLUSIONS: The level of HRQoL among elders appears to be relatively low. The individual and household factors both seems to play a vital role for most of the facets of HRQoL, but the individual correlates varied according to the domains.Item Stress level and associated factors among parents having a child with congenital heart disease less than six years of age attending the Lady Ridgeway Hospital for children(Sri Lanka Medical Association, 2016) Athukorala, K.M.; Kasturiratne, K.T.A.A.INTRODUCTION: Parents of children with Congenital Heart Disease (CHD) are easy victims of psychological ill-health. Assessment of stress level and its associated factors among them is vital to recognize high risk parents and to prevent them from becoming psychologically ill persons so that planning long term care for children for better outcome is feasible. OBJECTIVES: To determine the level of stress and associated factors among parents who are having children with congenital heart disease less than six years of age attending the cardiology clinic at the Lady Ridgeway Hospital for children (LRH). METHOD: A descriptive cross-sectional study was conducted among 380 parents of children with congenital heart disease less than six years of age attending the cardiology clinic at LRH, using an interviewer administered questionnaire based on the parental stress scale, perceived stress scale and the cardiologists’ perception on the medical severity scale. RESULTS: In the unemployed female predominate sample, the mean score on the parental stress scale was 29.95 (SD 7.3), while the mean score on the perceived stress scale was 14.37 (SD 5.1). Parental stress level was significantly higher with advanced age of parents and children, poor parental knowledge on CHDs and presence of extra cardiac deformities (p<0.01). CONCLUSIONS: Parents of children with CHDs are experiencing varying degrees of stress levels which are related to their age, age of the child, knowledge on CHDs and co-existing genetic disorders. When long term care for children with CHDs is planned, these parent related factors should be considered for better outcome.Item Safety of low dose subcutaneous adrenaline used as prophylaxis against acute reactions to anti-venom serum (AVS) in patients bitten by snakes(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.INTRODUCTION: Low dose subcutaneous adrenaline significantly reduces acute adverse reactions to AVS in patients envenomed following snake bite. OBJECTIVES: To further study the safety of low dose subcutaneous adrenaline. METHODS: We prospectively studied patients with snake bite envenoming in two units of the Colombo North Teaching Hospital, Ragama, from April 2000 to October 2001. Patients who satisfied inclusion criteria were given 0.25ml 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were recorded before and at frequent intervals for one hour after giving adrenaline. In patients who developed reactions to AVS, subsequent pulse and BP measurements were not included for analysis. Results: 51 patients [M:F=35:16; mean age 34.8yrs (SD 14)] were included in the study. No significant changes in mean pulse rate or BP were observed following administration of subcutaneous adrenaline. Adverse reactions to AVS occurred in 15 (29.4%) patients. There were 4 (7.8%) other complications: one (2%) death due to suspected intracerebral haemorr-hage in a 65yr old man who also had coagulopathy, and developed an adverse reaction to AVS which required treatment with adrenaline; 3 (5.9%) patients, who also had coagulopathy, developed small haematomas at the subcutaneous injection site. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. The 3 small haematomas could be directly attributed to the injection. Although the death is unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before recommending its routine use.Item Awareness on dengue and solid waste management among selected school students in Gampaha District of Sri Lanka(Moleclar Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Radhika, N.M.L.; Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Kasturiratne, K.T.A.A.BACKGROUND: Community mobilization is often respected as a powerful tool in ensuring the effective controlling of dengue via promoting effective and sustainable dengue vector control strategies. The current study attempts to investigate the level of awareness on dengue and solid waste management, among selected school students in Gampaha District which is the second highest dengue reported district in Sri Lanka. METHODOLOGY: Awareness programmes on dengue (transmission, vector ecology and preventive measures) and solid waste management were conducted in 10 schools belong to Kelaniya Medical Officer of Health (MOH) area selecting a minimum group of 200 students from each school within the age of 13 - 15 years. Tools such audio-visual presentations, leaflets and videos were used for the awareness programmes. A questionnaire was given to each student prior to the awareness and after the awareness programs as pre and post evaluations respectively in order to assess the general awareness on dengue and solid waste management before and after the awareness programme. One-Way ANOVA, paired t-test and multiple regression techniques were utilized in evaluation of the degree of awareness and key factors affecting the level of awareness, prior and after the conducting the awareness programmes. RESULTS: The degree of initial awareness on dengue and solid waste management of the target school community was recognized to be significantly characterized by the grade of the students and the Education Zonal Category [EZU] (into which their school belongs to) in accordance with One-Way ANOVA (p < 0.05). A significant increment in post awareness of the target school community was recognized due to the conducting of awareness programmes in accordance with the statistics of paired t-test (p < 0.05). Furthermore, based on the multiple linear regression modelling, the post awareness was significantly influenced by the grade of the students and the initial awareness (p < 0.05), regardless of the EZU (p > 0.05). CONCLUSIONS: The awareness of school students on dengue and solid waste management is significantly affected by the grade of the students and EZCs. Awareness programmes are an effective media of raising the awareness of school communities on dengue and solid waste management, while motivating them to actively contribute for the controlling of dengue, via establishing a strong inter sectorial network among schools and other relevant institutions within the Gampaha District.Item Prevalence and risk factors for metabolic syndrome among aging adults in an urban Sri Lankan population(Sri Lanka Medical Association, 2015) Kasturiratne, K.T.A.A.; Niriella, M.A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is assumed to be of high prevalence in the Asian region. However, its community prevalence and risk factors in South Asia is poorly studied. We determined the prevalence and risk factors for MetS among adults in an urban Sri Lankan population. METHOD: The study population consisted of 42-71 year old adults, selected by stratified random sampling from the Ragama Medical Officer of Health area. MetS was defined by the International Diabetic Federation criteria with ethnic specific cutoffs. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. Glycosylated hemoglobin, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as GFR<60ml/min/1.72m2 (KDIGO/KDOQI classification), USS abdomen was performed to detect fatty liver and non-alcoholic fatty liver disease (NAFLD) was diagnosed on safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. RESULTS: 2155 (1244 [57.7%] women, mean age 59.2 years [SD, 7.7]) participated. 1014 (47.1%) [mean age 59.2 years (SD, 7.7), 256 (28.1%) men; 758 (60.9%) women] had MetS. On multivariate analysis female gender, abnormal total body fat and abnormal visceral fat level (>10%) and presence of NAFLD were independently associated with MetS. Age 65 or more, raised ALT and CKD were not associated with MetS. CONCLUSION: The prevalence of MetS among adults in this aging urban Sri Lankan community was high and is independently associated with female gender, abnormal body fat distribution and presence NAFLD.Item Role of red cell distribution width in screening for Hb Etrait in population ccreening for hemoglobin disorders(Lippincott Williams and Wilkins, 2014) Nishad, A.A.N.; de Silva, I.S.; Perera, H.L.; Pathmeswaran, A.; Kasturiratne, K.T.A.A.; Premawardhena, A.P.The national screening policy for hemoglobinopathies uses the cutoffs for red cell indices mean corpuscular volume >80 and mean corpuscular hemoglobin >27, a strategy known to miss some individuals with Hb E trait (EBT), the most common abnormal hemoglobin in Sri Lanka. We wanted to determine if red cell distribution width (RDW) cutoff values would help in increasing the sensitivity of screening for Hb E trait. High-performance liquid chromatography was carried out as the gold standard to detect hemoglobinopathies and red blood cell parameters with colter counter. Receiver operating characteristic curve was drawn to determine the cutoff value for EBT against β-trait (BTT) and other anemias. Of the 504 patients, 246 had BTT, 110 had EBT, and 151 had other types of anemias. Mean (SD) RDW among patients with BTT was 16 (2.8), with EBT 14.5 (2.9), and with other anemias 15.8 (4.2) (P>0.001). With 14.45 as the cutoff for RDW and considering accepted values for mean corpuscular volume >80 and mean corpuscular hemoglobin >27, it gave a predictive sensitivity of 98.2% for EBT. By using RDW cutoff at 14.45 in addition to the accepted screening indices, sensitivity of Hb E trait detection went up to 98.2% from 86.6%. This study highlights the importance of taking RDW into consideration for screeningItem Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVES: To study the safety of low dose subcutaneous adrenaline given as prophylaxis against acute adverse reactions to anti-venom serum(AVS) in patients bitten by snakes. METHODS: Patients admitted with snakebite envenoming who satisfied inclusion criteria were given 0.25 ml of 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were monitored. RESULTS: 51 patients [35 males, mean age 34.8 years (SD 14)] were included in the study. Adverse reactions to AVS occurred in 15 (29.4%) patients. There was one death from suspected cerebral haemorrhage, and 3 (5.9%) patients developed small haematomas at the subcutaneous injection site. There were no significant changes in mean pulse or BP following administration of subcutaneous adrenaline. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. Although the death was unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before its routine use.