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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Epidemiological differences between localized and nonlocalized low back pain(Lippincott Williams & Wilkins, 2017) Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.STUDY DESIGN: Cross-sectional survey with longitudinal follow-up OBJECTIVES.: To test the hypothesis that pain which is localised to the low back differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analysed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability and potential risk factors, in 47 occupational groups (office workers, nurses and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localised LBP in the past month, and 3,820 (31.3%) non-localised LBP. Non-localised LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, non-localised LBP was differentially associated with risk factors, particularly female sex, older age and somatising tendency. There were also marked differences in the relative prevalence of localised and non-localised LBP by occupational group. CONCLUSIONS: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP which occurs in association with pain at other anatomical locations.Item Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study(Public Library of Science, 2016) Vargas-Prada, S.; Coggon, D.; Ntani, G.; Walker-Bone, K.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Sarquis, L.M.; Marziale, M.H.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Harris, E.C.; Serra, C.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Freimann, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Herbison, P.; Gray, A.; Vega, E.J.Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.Item Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?(Biomed Central, 2011) Wanigasuriya, K.P.; Peiris-John, R.J.; Wickremasinghe, R.BACKGROUND: The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. METHODS: Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. RESULTS: Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. CONCLUSIONS: Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.Item Additional perspectives on chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka-lessons learned from the WHO CKDu population prevalence study(BioMed Central, 2014) Redmon, J.H.; Elledge, M.F.; Womack, D.S.; Wickremasinghe, R.; Wanigasuriya, K.P.; Peiris-John, R.J.; Lunyera, J.; Smith, K.; Raymer, J.H.; Levine, K.E.The recent emergence of an apparently new form of chronic kidney disease of unknown aetiology (CKDu) has become a serious public health crisis in Sri Lanka. CKDu is slowly progressive, irreversible, and asymptomatic until late stages, and is not attributable to hypertension, diabetes, or other known aetiologies. In response to the scope and severity of the emerging CKDu health crisis, the Sri Lanka Ministry of Health and the World Health Organization initiated a collaborative research project from 2009 through 2012 to investigate CKDu prevalence and aetiology. The objective of this paper is to discuss the recently published findings of this investigation and present additional considerations and recommendations that may enhance subsequent investigations designed to identify and understand CKDu risk factors in Sri Lanka or other countries.Item The CUPID (Cultural and Psychosocial Influences on Disability) study: methods of data collection and characteristics of study sample(Public Library of Science, 2012) Coggon, D.; Ntani, G.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Serra, C.; Bonzini, M.; Solidaki, E.; Merisalu, E.; Habib, R.R.; Sadeghian, F.; Kadir, M.; Warnakulasuriya, S.S.; Matsudaira, K.; Nyantumbu, B.; Sim, M.R.; Harcombe, H.; Cox, K.; Marziale, M.H.; Sarquis, L.M.; Harari, F.; Freire, R.; Harari, N.; Monroy, M.V.; Quintana, L.A.; Rojas, M.; Salazar Vega, E.J.; Harris, E.C.; Vargas-Prada, S.; Martinez, J.M.; Delclos, G.; Benavides, F.G.; Carugno, M.; Ferrario, M.M.; Pesatori, A.C.; Chatzi, L.; Bitsios, P.; Kogevinas, M.; Oha, K.; Sirk, T.; Sadeghian, A.; Peiris-John, R.J.; Sathiakumar, N.; Wickremasinghe, A.R.; Yoshimura, N.; Kielkowski, D.; Kelsall, H.L.; Hoe, V.C.; Urquhart, D.M.; Derrett, S.; McBride, D.; Gray, A.BACKGROUND: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. METHODS/PRINCIPAL FINDINGS: A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI). CONCLUSIONS/SIGNIFICANCE: The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.