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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Human resources for health in Sri Lanka over the post-independence period: key issues(Sri Lanka Medical Association, 2023) de Silva, D.; Chandratilake, M.; de Silva, N.No abstract availableItem Spatiotemporal distribution of cutaneous leishmaniasis in Sri Lanka and future case burden estimates(Public Library of Science, 2021) Karunaweera, N.D.; Senanayake, S.; Ginige, S.; Silva, H.; Manamperi, N.; Samaranayake, N.; Dewasurendra, R.; Karunanayake, P.; Gamage, D.; de Silva, N.; Senarath, U.; Zhou, G.BACKGROUND: Leishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control. METHODS: The nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka. RESULTS: A total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The predicted case number will be 9115 in 2022 and 19212 in 2025. CONCLUSIONS: The drastic upsurge in leishmaniasis cases in Sri Lanka in the last few year was unprecedented and it was strongly linked to precipitation, high burden of localized infections and inter-district dispersal. Targeted interventions are urgently needed to arrest an uncontrollable disease spread.Item Intestinal Nematodes: Ascariasis(Saunders-Elsevier, 2012) Bundy, D.A.P.; de Silva, N.; Brooker, S.Item 100 Years of Mass Deworming Programmes: A Policy Perspective From the World Bank's Disease Control Priorities Analyses(London : Academic Press, 2018) Bundy, D.A.P.; Appleby, L.J.; Bradley, M.; Croke, K.; Hollingsworth, T.D.; Pullan, R.; Turner, H.C.; de Silva, N.For more than 100 years, countries have used mass drug administration as a public health response to soil-transmitted helminth infection. The series of analyses published as Disease Control Priorities is the World Bank's vehicle for exploring the cost-effectiveness and value for money of public health interventions. The first edition was published in 1993 as a technical supplement to the World Bank's World Development Report Investing in Health where deworming was used as an illustrative example of value for money in treating diseases with relatively low morbidity but high prevalence. Over the second (2006) and now third (2017) editions deworming has been an increasingly persuasive example to use for this argument. The latest analyses recognize the negative impact of intestinal worm infection on human capital in poor communities and document a continuing decline in worm infection as a result of the combination of high levels of mass treatment and ongoing economic development trends in poor communities.Item Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition(Elsevier, 2018) Jamison, D.T; Alwan, A.; Mock, C.N.; Nugent, R.; Watkins, D.; Adeyi, O.; Anand, S.; Atun, R.; Bertozzi, S.; Bhutta, Z.; Binagwaho, A.; Black, R.; Blecher, M.; Bloom, B.R.; Brouwer, E.; Bundy, D.A.P.; Chisholm, D.; Cieza, A.; Cullen, M.; Danforth, K.; de Silva, N.; Debas, H.T.; Donkor, P.; Dua, T.; Fleming, K.A.; Gallivan, M.; Garcia, P.J.; Gawande, A.; Gaziano, T.; Gelband, H.; Glass, R.; Glassman, A.; Gray, G.; Habte, D.; Holmess, K.K.; Horton, S.; Hutton, G.; Jha, P.; Knaul, F.M.; Kobusingye, O.; Krakauer, E.L.; Kruk, M.E.; Lechmann, P.; Laxminarayan, R.; Levin, C.; Looi, L.M.; Madhav, N.; Mahmoud, A.; Mbanya, J.C.; Measham, A.; Medina-Mora, M.E.; Medin, C.; Mills, A.; Mills, J.A.; Montoya, J.; Norheim, O.; Olson, Z.; Omokhodion, F.; Oppenheim, B.; Ord, T.; Patel, V.; Patton, G.C.; Peabody, J.; Prabhakaran, D.; Qi, J.; Reynolds, T.; Ruacan, S.; Sankaranarayan, R.; Sepulveda, J.; Skolnik, R.; Smith, K.R.; Temmerman, M.; Tollman, S.; Verguet, S.; Walker, D.G.; Walker, N.; Wu, Y.; Zhao, K.The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.Item Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition(Elsevier, 2018) Bundy, D.A.P.; de Silva, N.; Horton, S.; Patton, G.C.; Schultz, L.; Jamison, D.T.; Disease Control Priorities-3 Child and Adolescent Health and Development Authors GroupThe realisation of human potential for development requires age-specific investment throughout the 8000 days of childhood and adolescence. Focus on the first 1000 days is an essential but insufficient investment. Intervention is also required in three later phases: the middle childhood growth and consolidation phase (5-9 years), when infection and malnutrition constrain growth, and mortality is higher than previously recognised; the adolescent growth spurt (10-14 years), when substantial changes place commensurate demands on good diet and health; and the adolescent phase of growth and consolidation (15-19 years), when new responses are needed to support brain maturation, intense social engagement, and emotional control. Two cost-efficient packages, one delivered through schools and one focusing on later adolescence, would provide phase-specific support across the life cycle, securing the gains of investment in the first 1000 days, enabling substantial catch-up from early growth failure, and leveraging improved learning from concomitant education investments.Item Teaching and learning of communication skills through video consultations(Sri Lanka Medical Association, 1998) de Silva, N.; Mendis, K.; Nowfel, M.J.OBJECTIVE : To help students leam communication skills in a family practice setting through viewing of live video consultations critique of communication skills during a videotape replay of consultations METHOD : The University Family Medicine Clinic at the Faculty of Medicine, University Kelaniya provides the setting for learning of communication skills by third year medical students. During the two week Family Medicine attachment to this clinic, teaching and learning takes place through small group work and video consu Itations. The consultation between the family physician teacher and the patient from whom prior consent has been obtained is viewed live by 14 - 15 students in an adjacent seminar room. After observing a few such consultation's, the students in turn, practice communication skills by talking to patients while the consultation is video taped. The students whose consultation has been recorded on video has it replayed in the presence of the teacher and peers. A self-critique and constructive feedback by the group helps the student to learn from the strengths and weaknesses of his skills in communication. Learning through role pay by the students acting as the patient and doctor is dealt with a similar manner. RESULTS : At the end of appointment evaluation, the students rated this as the most preferred learning and teaching method(78%). Consent was refused by only two patients. CONCLUSION : This modern teaching and learning method which promotes active learning in a non threatening and supportive environment is interesting and suitable to use in the Sri Lankan context.Item Effect of mebendazole threapy in pregnancy on birth outcome(Sri Lanka Medical Association, 1998) de Silva, N.; Sirisena, J.; Gunasekera, D.; de Silva, J.OBJECTIVES : A prospective, unmatched, case-control study was done to assess the safety of mebendazole threapy in pregnancy, a hitherto uninvestigated factor. DESIGN : All women delivering in the University Obstetrics Unit of the Ragama Teaching Hospital between May 1996 and, March 1997 were administered a questionnaire soon after delivery. Details of the birth and the baby were recorded; suspected defects were confirmed by a paediatrician. The incidence of congenital defects in babies of mothers who had taken mebendazole during the pregnancy was compared with the incidence among those who had not taken an anthelmintic (controls). Data analysis was done using Epi Info 6.03. RESULTS : Of 3688 women, 73.5% had taken mebendazole, 24.8% had not taken any any anthelmintic , 1.1% had taken an anthelmintic but could not identify it and 0.6% had taken pyrantel or albedazole. The incidence of birth defects was 2.36% {64/2711) in the mebendazole group compared with 2.3% (21/913) in the controls (odds ratio 1.03, 95% confidence limits 0.61 - 1.75). This difference was not statistically significant even when corrected for other known risk factors by stratified analysis . Data regarding timing of mebendazole threapy was available for 2660 women; 6.9% in the first trimester, 83.8% in the second, and 9.2% in the third. The incidence of birth defects among women who had taken mebendazole in the first trimester was 3.24% (6/185). giving an odds ratio of 1.42 against the controls; this was also not statistically significant.CONCLUSIONS : The use of mebendazole in pregnancy does not lead to a significant increase in the risk of congenital defects.Item One day general practice morbidity survey in Sri Lanka(Sri Lanka Medical Association, 1998) de Silva, N.; Mendis, K.OBJECTIVE : To identify people's needs from the reasons for encounter with family physicians, to illustrate the pattern of morbidity in general practice and determine the workload of general practitioners(GPs) in Sri Lanka METHOD : A random sample of GPs completed a Practitioner Profile Questionnaire (PPQ) and recorded in an encounter from (EF) the rcason/s for encounter (RFE) and problems defined during consecutive consultations on the fourth of July 1996. Central coding of the RFEs and problems defined \vas done using the International Classification of Primary Care (ICPC). RESULTS : Forty GPs (53.3%) completed the PPQ, while the response to the EF was 43.3%. The GP profile showed none below 35 years and none qualified after 1984. The average daily workload was 74. It was estimated that GPs handle 26.5% of the primary care morbidity. Children accounted for 32% of consultations. There was a significantly higher proportion of children (pO.OOOI) and the elderly (p<0.05) in the consulting population compared to national statistics. In 2068 encounters, 3448 RFEs and 2087 problems had been recorded. By ICPC rubrics, 27 of the top thirty RFEs were for common symptoms. Acute illness, asthma, hypertension, diabetes and preventive care were among top twelve problems defined. CONCLUSION : The findings indicate the necessity to include family medicine/general practice in the undergraduate curriculum of all medical schools. Care of children and the elderly should receive priority in family training programmes. Suitable incentives may be necessary to motivate younger doctors to become GPs to meet the medical care needs of the community.Item Limitations of current measures used for selection of students to medical schools in Sri Lanka(Sri Lanka Medical Association, 2005) Pathmeswaran, A.; de Silva, N.R.; de Silva, N.; Edirisinghe, S.; Parameswaran, S.C.; Seneviratne, R.; Warnasuriya, N.; de Silva, H.J.INTRODUCTION: Policy regarding selection of students for admission to medical school in Sri Lanka is considered unsatisfactory by many. This study was carried out across all six medical schools in the country, to assess the extent to which selected factors at point of entry predict success in medical School. METHODS: The study sample consisted of all students selected by the University Grants Commission to study medicine in two consecutive entry cohorts. The 'A' level aggregate marks of these students, the district of entry, gender and candidate type (school/private) we're identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first Summative examination and the final examination at the first attempt, and the ability to obtain a class in either. Multiple logistic regression was used to assess the extent to which these entry point factors Could predict variability in outcome measures. RESULTS: The mean 'A' level aggregate among the 1740 students in the study sample was 282 (range: 212-356). The male: female ratios were 1.5 and 1.3 respectively in the two cohorts. 22% of students were private candidates, who were probably attempting the 'A' levels for the third time. Having a high A'level aggregate, being female, and being a school candidate were all independent predictors of success in all outcome measures. However, the aggregate score alone and candidate type each accounted for only 1-7% of the variation in performance in medical school. CONCLUSION: The only measure of academic performance used for selection of medical students is a weak predictor of success in our medical schools.