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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study(Public Library of Science, 2021) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chakrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected 40-64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007-2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. RESULTS: Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10-19%, 20%-29%, 30-39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). CONCLUSIONS: WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.Item Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.Item Incidence and prevalence of stroke and time trends in vascular risk factors among urban/semi-urban Sri Lankans: A population-based cohort study(Ceylon College of Physicians, 2020) Mettananda, K.C.D.; Ranawaka, U.K.; Wickramarathna, K.B.; Kottahachchi, D.C.; Kurukulasuriya, S.A.F.; Matha, M.B.C.; Dassanayake, A.S.; Kasturiratne, K.T.A.A.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Incidence of stroke is declining in developed countries, but is increasing in developing countries. There is no data on incidence of stroke in Sri Lanka, and only limited data on prevalence of stroke. METHODS: We studied a population-based cohort (35-64 years) selected by stratified random sampling from an urban/semi-urban health administrative area (Ragama Health Study) in 2007, and evaluated them again in 2014 with regard to new onset stroke and prevalence of vascular risk factors. Possible stroke patients were independently reviewed by a neurologist and a physician with regard to the diagnosis of stroke. The prevalence of stroke (at baseline) was estimated. Prevalence of vascular risk factors in the population were compared between 2007 and 2014. RESULTS: The baseline cohort in 2007 consisted of 2985 individuals (females 54.5%, mean age 52.4 ± 7.8 years). Of them, 2204 attended follow-up in 2014 (female 57.6%, mean age 59.2±7.6 years). 19 had a history of strokes at enrolment (stroke prevalence 6.37/1000 population) and 24 episodes of strokes occurred over the 7 years (annual incidence of stroke 1.56/1000 population). Risk factor prevalence in 2007 and 2014 were; hypertension 48.7% and 64.3%; hyperlipidaemia 35.5% and 39.3%; diabetes mellitus 28.2% and 35.7%; and obesity 2.6% and 17.9%, respectively. CONCLUSION: Stroke incidence and prevalence rates of Sri Lanka lie between those of developed and developing countries. Prevalence of vascular risks have increased over time in this urban/semi urban Sri Lankan population.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 Barriers for cataract treatment among elderly in Sri Lanka(Hindawi Publication Corporation, 2019) Nishad, N.; Hewage, S.A.; Arulmoly, K.; Amaratunge, M.S.; de Silva, J.; Kasturiratne, K.T.A.A.; Abeysundara, P.K.; Wickremasinghe, A.R.Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.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 Mortality in an urban cohort in Ragama, Sri Lanka(BMJ Publishing Group, 2011) Vithanage, P.V.T.S.; Panapitiya, P.A.S.; Padmakumara, N.; Hemantha, S.; Kasturiratne, K.T.A.A.; Wickremasinghe, A.R.; Pathmeswaran, A.; Pinidiyapathirage, M.J.INTRODUCTION: The leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed over 3 years. METHODS: A follow-up study was conducted among 2986 35–64 year olds randomly selected from the Ragama Medical Officer of Health area, Sri Lanka. A baseline survey was conducted from January to September 2007 and a follow-up survey was conducted from March to November 2010. Mortality data were obtained from next of kin and cause of death was verified from death certificates. RESULTS: There were 49 deaths during 9186.46 person years of observations. Of the 49 deaths, 11 were due to myocardial infarctions, 5 were due to strokes, 5 were due to other ischaemic heart disease and the rest included 6 due to cancer and 2 due to train accidents. The increase in mortality in men occurs after 45 years and in females it is observed later on. Mortality among men was more than twice as much as females (RR 7.96 vs 3.17 per 1000 person years). All cause mortality was significantly higher in diabetics. Mortality was not associated with hypertension, dyslipidaemia, smoking, central obesity, obesity or physical activity. Conclusions Diabetes Mellitus was significantly associated with all cause mortality. Other associations may have not been significant due to the small number of deaths.