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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Environmental pollution by traffic noise in the city of Colombo, Sri Lanka(IOS Press, 2016) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Wickremasinghe, A.R.; Sathiakumar, N.Traffic noise levels in most cities of the world are higher than the recommended levels. Exposure to high levels of noise may cause adverse health effects such as ischemic heart diseases and noise induced hearing loss. We conducted a cross-sectional study to determine road traffic noise levels at 60 selected locations in the city of Colombo, Sri Lanka. On randomly selected days we measured equivalent continuous sound pressure level (LAeq) for six hours during the day. From these measurements LAeq for eight hours were calculated and used as the average noise level of a particular location. LAeq (8 hrs) within Colombo ranged 76.6 to 84.0 dB; well above the Sri Lankan recommendation of 63.0 dB (an increase of 13.3 to 21.0 dB), and the WHO recommendation of 55.0 dB (an increase of 21.6 to 29.0 dB). These levels translate into increase of sound pressure level by 21.4 to 794.3 times above the recommendations on the logarithmic scale of dB. Thirty-eight of 60 locations recorded levels more than 80.0 dB. Road traffic noise levels in Colombo were well above the recommended levels. Though the increase in measured decibels might not appear to be too high, in reality this translates into an increase manifold times in the sound pressure level that reaches the earItem Environmental noise levels in the city of Colombo, Sri Lanka(Sri Lanka Medical Association, 2013) Nagodawithana, N.S.; Pannila, A.S.; Gurusinghe, R.D.; Kalansuriya, C.; Sathiakumar, N.; Wickremasinghe, A.R.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Noise is a physical pollutant, which causes adverse health effects. Noise levels in most cities are higher than that recommended by environmental regulatory authorities of the relevant countries. Objective of this study was to determine the level of environmental noise at identified locations in the city of Colombo. METHODS: Colombo Municipal Council area is divided into 15 divisions. Sixty places with high traffic density, four from each of the 15 divisions, were purposively selected. At each selected site, equivalent continuous sound pressure level (LAeq) was measured for six hours during day time (three hours each from peak and non-peak traffic hours) using a Class-I Sound Level Meter on week days. LAeq for eight hours (LAeq [8hrs]) was calculated and taken as the average noise level of that place. L10, L50, and L90 measurements were also taken. RESULTS: LAeq (8hrs) within the Colombo city ranged from 76.6dB (at BOC roundabout, Colombo 12) to 84.0dB (at Lipton’s roundabout, Colombo 07), well above the maximum permissible noise level (63dB) for municipal council areas. All recorded LAeq values were more than 80dBs in Colombo 5, 9, 10, 13 and 14. Median LAeq value for the entire city was 81.0dB. Median LAeq value for peak traffic hours was 81.1dB and for off-peak traffic hours 80.4dB. Median values for L10, L50 and L90 for the city were 83.1dB, 76.6dB and 71.9dB respectively. CONCLUSIONS: Environmental noise levels in Colombo city are well above (13.3dB to 21.0dB) the levels recommended in the National Environmental (Noise pollution) Act of Sri Lanka.Item Noise levels of vehicles in the city of Colombo(Sri Lanka Medical Association, 2013) Nagodawithana, N.S.; Pannila, A.S.; Gurusinghe, R.D.; Kalansuriya, C.; Sathiakumar, N.; Wickremasinghe, A.R.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: Though there is concern that vehicular traffic contributes to noise pollution in the city of Colombo there is no reliable data on the noise emitted by different types of vehicles. Objective of this study was to determine the noise emitted by vehicles within the city of Colombo. METHODS: Vehicles in the city of Colombo could be classified into sixteen categories based on the type (bus, motor-car, three-wheeler etc), technology (two-stroke, four-stroke, petrol, diesel) and size (light, heavy etc). Nine to 16 vehicles from each category were selected by quota sampling. Sound pressure level (SPL-the magnitude of sound) and maximum sound level (LAmax) of the engine and horn of the selected vehicles were measured according to ISO 5130:2007(E) standards. RESULTS: Diesel three-wheelers recorded the highest SPL (105.2dB) while cars recorded the lowest SPL (80.2dB). SPL of six categories of vehicles were more than 100dB. SPL of four and two stroke petrol three-wheelers and diesel three-wheelers were 97.2, 102.1 and 105.2dB respectively. SPL of large-buses with turbo and normal engines were 95.0dB and 103.6dB respectively. Ranking order of the LAmax level of engines were the same as for SPLs. LAmax of horns ranged from 100.1dB to 113.3dB. Maximum permissible noise level in a municipal council area during day time is 63dB. CONCLUSIONS: Diesel three-wheelers, two stroke petrol three-wheelers and large buses with normal engines are the noisiest vehicles in the city of ColomboItem Prevalence and correlates of noise induced hearing loss among traffic policemen in the city of Colombo(College of the Community Physicians of Sri Lanka, 2013) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Sathiakumar, N.; Wickremasinghe, A.R.INTRODUCTION: Noise induced hearing loss (NIHL) is a high frequency sensory-neural hearing loss in subjects who are exposed to environmental noise, but this diagnosis is made only after excluding other reasons for the hearing. Traffic policemen are exposed to environmental noise due to the nature of their duty and are susceptible to develop NIHL. OBJECTIVE: The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen in the city of Colombo. METHODS: This was a cross sectional study and traffic policemen working in the city of Colombo were selected for study. Cluster sampling method was adopted to select 350 participants. Pure tone audiometry test was performed to assess the level of NIHL. The test was performed in an audiology laboratory or in a sound treated, air-conditioned conference hall. Hearing levels of participants were classified according to a classification obtained by modifying the Clark’s classification. Correlates of NIHL were assessed using information collected using an Interviewer Administered Questionnaire (IAQ). RESULTS: Pure tone audiometry was performed on 287 policemen. High frequency hearing of, 169 participants (58.9%) was normal. Seventy nine participants (27.5%) had minor NIHL and 39 participants (13.6%) had major NIHL. In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL of traffic policeman in the city of Colombo. However according to multi-variate analysis only age had statistically significant association with major NIHL with odds-ratio (OR) of 1.088 while only “duration of work as a policeman” had statistically significant association with any NIHL (major or minor) with OR of 1.007. CONCLUSIONS AND RECOMMENDATIONS: Prevalence of NIHL among traffic policemen working in the city of Colombo was 41.1% (95% CI=35.5%–46.9%). A third of those having NIHL had major NIHL. Traffic policemen should undergo periodic hearing assessment. The police department should explore the feasibility of reducing the number of hours per day spent on the road by traffic policemen. Traffic policemen with NIHL must be transferred to a different division immediately.Item Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability and prognosis among 12,195 workers from 18 countries(Elsevier-North-Holland, 2016) Sarquis, L.M.; 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.; 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.; Tiina; Freimann; 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.; Salazar Vega, E.J.To inform case-definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9,150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The one-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs. 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs. 1.3) and poor mental health (PRR 1.3 vs. 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs. 61.7%). Our findings highlight important epidemiological distinctions between sub-categories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain which is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.Item Effect of indoor air pollution due to solid fuel combustion on childhood respiratory diseases(Sri Lanka Medical Association, 2014) Ranathunga, R.A.N.; Perera, K.P.J.; Nandasena, Y.L.S.; Kasturiratne, A.; Sathiakumar, N.; Wickremasinghe, A.R.Introduction and objectives: To determine the association between indoor air pollution and respiratory symptoms in children under 5 years of age. Methods: A prospective study was conducted over a 22 month period in the Ragarna MOH area. All children under 5 years in the selected households were followed up for 12 months and data on respiratory symptoms were extracted from a symptom diary. Sodoeconomic data of the households and main fuel type used for cooking was recorded. Air quality measurements were made in a sub sample of househords. Results: 262 children were followed up. The incidence of lower respiratory tract infections (RR-1.513, 95% C.t= 1.071-2.158) and infection induced asthma (RR-1.758, 95% C.l= 1.159-2.718) were significantly higher among in children resident in households using biomass fuel compared to children resident in households using LPG and electricity. The incidence of asthma attacks, rhinitis exacerbations and rhino conjunctivitis exacerbations were not associated with exposure to indoor air pollution. Houses which used biomass fuel had significantly higher concentrations of CO (3.27 vs. 1.49) and PM2.5 (1.14 vs. 0.31} compared to houses using LPG and electricity for cooking but CO2 concentration was not higher. Conclusions: CO and PM2.5 concentrations are significantly higher in households which use biomass fuel for cooking. There is a 1.5 times higher risk of lower respiratory tract infections and 1.8 times higher risk of infection induced asthma among children resident in households using biomass fuel for cooking compared to children in households using LPG or electricity.Item Fine particle air quality levels of Sri Lankan households and associated respiratory conditions: preliminary findings of an ongoing longitudinal study(Lippincott Williams & Wilkins, 2011) Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N.BACKGROUND/AIMS: Data on fine particle (PM2.5) air pollutant levels in Sir Lankan households are scarce. A high proportion of households are known to use unclean fuels for cooking, without proper ventilation. The aim of the study was to determine the respiratory health status of children and PM2.5 levels in a sample of home environments (indoors and outdoors). METHODS: A total of 612 children (aged 7–10 years) were selected from 2 study settings (setting 1, n = 408; setting 2, n = 204) for a prospective study. Study “setting 1” was selected from a high outdoor air-polluted area of the Colombo Municipal Council, and “setting 2” from a low-polluted area. The study commenced in March 2009. Measurements were made in the main living room using UCB particle monitors for 24 hours with minute logging. The outdoor 24-hour PM2.5 levels were measured using gravimetric air samplers in 3 selected outdoor locations in each setting at monthly intervals. RESULTS: On the basis of the 124 household measurements, the median PM2.5levels in households of settings 1 and 2 were 66.6 μg/m3 (mean = 104.0, range = 25.5–644.8) and 50.0 μg/m3 (mean = 142.0, range = 5.9–749.5), respectively. The highest PM2.5 concentrations were reported from houses using wood as cooking fuel (mean = 145.2, median = 66.8, range = 5.9–749.5 μg/m3). The prevalences of wheezing during the past 12 months (at least one episode during the last 12 months) were 20.8% (n = 85) and 10.8% (n = 22) (odds ratio = 2.2, confidence interval = 1.3–3.6) in setting 1 and 2, respectively. The prevalences of children ever having asthma were 18.9% (n = 77) and 12.7% (n = 26) in settings 1 and 2, respectively. CONCLUSION: Most of the households had PM2.5 levels exceeding the upper limit recommended by the World Health Organization. Children living in setting 1 had a higher risk of experiencing respiratory ill health than children living in setting 2. © 2011 Lippincott Williams & Wilkins, Inc.Item Noise-induced hearing loss among traffic policemen in the city of Colombo, Sri Lanka(IOS Press, 2015) Nagodawithana, N.S.; Pathmeswaran, A.; Pannila, A.S.; Wickremasinghe, A.R.; Sathiakumar, N.Noise-induced hearing loss (NIHL) is a high frequency sensory-neural hearing loss and exposure to traffic noise by traffic policemen makes them susceptible to develop NIHL. The objective of this study was to determine the prevalence and correlates of NIHL among traffic policemen in the city of Colombo, Sri Lanka. A cross sectional study was carried out using 350 traffic policemen who are working in the city at least six months of duration. Pure-tone audiometry test and interviewer-administered questionnaire were used to assess hearing and correlates of NIHL, respectively. The chi-square test and logistic regression was used to analyze the relationship between risk factors and NIHL. 287 policemen attended pure-tone audiometry test to check their hearing. Of 287 subjects, the prevalence of NIHL was found in 118 policemen (41%; 95% CI: 36%-47%). Of those with any type of NIHL, 33% (39/118) had major NIHL while 67% (79/118) had minor NIHL. In bivariate analysis 23 variables showed statistically significant association with mild and major NIHL. Multivariate logistic regression modelling found statistically significant association between “duration of employment as a policeman” and any type of NIHL (OR = 1.007; 95% CI = 1.005-1.009), adjusted for 23 variables including age. The prevalence of NIHL among traffic policemen in the city was high. Of those with any type of NIHL, one-third had major NIHL. Traffic policemen should undergo periodic hearing assessment. The police department should explore the feasibility of reducing the number of hours per day spent on the road by traffic policemen.Item Comparison of performance of Sri Lankan and US children on cognitive and motor scales of the Bayley scales of infant development(Biomed Central, 2014) Godamunne, P.; Liyanage, C.; Wimaladharmasooriya, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; Patterson, C.; Sathiakumar, N.BACKGROUND: There is no validated scale to assess neurodevelopment of infants and children in Sri Lanka. The Bayley III scales have used widely globally but it has not been validated for Sri Lankan children. We administered the Cognitive and Motor Scales of the Bayley III to 150 full-term children aged 6, 12 and 24 months from the Gampaha District of Sri Lanka. We compared the performance of Sri Lankan children 6, 12 and 24 months of age on the cognitive and motor scales of the Bayley III with that of US children. RESULTS: Compared to the US norms, at 12 months, Sri Lankan children had significantly higher cognitive scores and lower gross motor scores, and at 24 months significantly lower cognitive scores. The test had a high test-retest reliability among Sri Lankan children. CONCLUSIONS: There were small differences in the cognitive and motors scores between Sri Lankan and US children. It is feasible to use Bayley III scales to assess neurodevelopment of Sri Lankan children. However, we recommend that the tool be validated using a larger representative sample of all population groups.Item Capacity building in environmental and occupational health in Sri Lanka(Wiley-Blackwell, 2013) Wickremasinghe, A.R.; Peiris-John, R.; Nandasena, S.; Delzell, E.; Tipre, M.; Sathiakumar, N.BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country .CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future.