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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Psychometric properties of the Sinhala version of the Bandura’s exercise selfefficacy scale in women(College of Community Physicians of Sri Lanka, 2024) Herath, D.; Kasturiratne, A.INTRODUCTION Engaging in regular exercise as part of a healthy lifestyle has shown an array of health benefits for many decades. Building confidence in maintaining an exercise routine is essential for success. To support individuals interested in exercise, the availability of appropriate measurement tools is vital. Bandura's Exercise Self-Efficacy Scale (ESE) is an 18- item brief measure that assesses confidence in exercising regularly and is a valuable tool for measuring exercise beliefs. OBJECTIVES To translate and adapt the Banduras ESE scale into Sinhala language and examine its psychometric properties METHODS Data were collected from 225 women who were aged ≥18 years and had an interest in or a reason to watch their weight, in Panadura Medical Officer Health (MOH) Area, Sri Lanka. They were recruited using a purposive sampling method. Standard forward-backward translation was performed to translate the English version of ESE. The construct validity was tested using exploratory factor analysis. Reliability of the scale was determined by Cronbach’s alpha. Data were analysed using SPSS version 22.0. RESULTS Through exploratory factor analysis, 18-item ESE scale showed three factors with eigenvalues ranging from 1.392 to 9.409. The three-factor model explained 70.59% of total variance of the model. All the items in the scale were retained. The reliability of internal consistency, as assessed by Cronbach’s alpha, indicated interpersonal, competing and internal sub factors as 0.92, 0.91 and 0.89 respectively, which were above the threshold level of 0.7. CONCLUSIONS & RECOMMENDATIONS The Sinhala translation of ESE is a reliable and valid scale to assess the level of selfefficacy for exercise among Sinhala-speaking adult women in Sri Lanka.Item Translation, adaptation and validation of the Sinhala Version of Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) for women(College of Community Physicians of Sri Lanka, 2023) Herath, D.; Kasturiratne, A.INTRODUCTION: The global obesity burden is rising alarmingly due to unhealthy lifestyle behaviours and environmental factors. To date, prevention and treatment efforts to combat obesity mainly focus on lifestyle modifications through diet and physical activity. Eating self-efficacy has been related to weight loss and is considered a significant predictor of weight loss in an individual. The Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) is an American instrument used for research and clinical purposes to measure self-efficacy for controlling eating in specific situations. OBJECTIVES: Translation, cultural adaptation and validation of the WEL-SF. METHODS: A sample of 100 women aged ≥ 18 years who were attempting to reduce their weight through self-monitored non-therapeutic diet control in Panadura Medical Officer of Health (MOH) Area, Sri Lanka was recruited using a purposive sampling method. Data were collected using a self-administered questionnaire with socio-demographic information and Sinhala version of the WEL-SF. The construct validity was evaluated by Exploratory Factor Analysis (EFA) using Principal Component Analysis (PCA), while the reliability of the scale was determined by Cronbach's alpha. RESULTS: The eight-item WEL-SF showed a one-factor solution by EFA. All the items on the scale were retained. The model explained a total variance of 59.35%. The internal consistency of WEL-SF was 0.905 using Cronbach’s alpha. The test-retest reliability of the instrument had a high Spearman's correlation of more than 0.7. CONCLUSIONS & RECOMMENDATIONS: The Sinhala version of WEL-SF for women to assess self-efficacy levels in overeating appears to be psychometrically valid with high reliability. This instrument can be recommended as a screening tool to assess self-efficacy levels in women striving for a healthy weight.Item Empowering women via public health(College of Community Physicians of Sri Lanka, 2023) Perera, M. N.No abstract availableItem Prevalence of overweight and obesity among women in two medical officer of health areas in Kalutara district(College of Community Physicians of Sri Lanka, 2023) Herath, D.; Kasturiratne, A.INTRODUCTION: Overweight and obesity are rising burdens in the w orld. Gender disparities in its prevalence are more evident in developing countries compared to developed countries. OBJECTIVES: To determine the prevalence of overweight and obesity among 35-44-year-old women in Bandaragama and Horana Medical Officer of Health (MOH) areas METHODS: This was a community-based descriptive cross-sectional study conducted among 770 women aged 35-44 years residing in two MOH areas of Kalutara District for the l ast six months at the time of data collection. Overweight/obesity were assessed on the Asian cutoff values recommended by the WHO based on body mass index (BMI). The prevalence was estimated with 95% confidence interval (CI). RESULTS: The prevalence of overweight in Bandaragama and Horana MOH areas was 41.35% (95% CI: 37.9, 44.81) and 39.7% (95% CI: 36.3, 43.2), respectively, while the correspondi ng prevalence of obesity was 36.1% (95% CI: 32.8, 39.6) and 26.6% (95% CI: 16.4, 39.1). CONCLUSIONS & RECOMMENDATIONS: The prevalence of overweight /obesity among women aged 35-44 years was relatively high. Barriers to a healthy lifestyle, women's role in the household and existing service gaps at primary healthcare level should be considered when preventive measures ar e introduced to reduce this burden.Item The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study(Elsevier, 2023) Gupta, Y.; Kapoor, D.; Lakshmi, J.K.; Praveen, D.; Santos, J.A.; Billot, L.; Naheed, A.; de Silva, H.A.; Gupta, I.; Farzana, N.; John, R.; Ajanthan, S.; Bhatla, N.; Desai, A.; Pathmeswaran, A.; Prabhakaran, D.; Teede, H.; Zoungas, S.; Patel, A.; Tandon, N.; LIVING Collaborative GroupAIM: To study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. METHODS: Women with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria. RESULTS: Participants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years]. CONCLUSIONS: A high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM. Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).Item Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes: A Randomized Clinical Trial(American Medical Association, 2022) Tandon, N.; Gupta, Y.; Kapoor, D.; Lakshmi, J.K.; Praveen, D.; Bhattacharya, A.; Billot, L.; Naheed, A.; de Silva, A.; Gupta, I.; Farzana, N.; John, R.; Ajanthan, S.; Divakar, H.; Bhatla, N.; Desai, A.; Pathmeswaran, A.; Prabhakaran, D.; Joshi, R.; Jan, S.; Teede, H.; Zoungas, S.; Patel, A.; LIVING Collaborative Group.Importance: Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective: To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, setting, and participants: This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. Interventions: A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. Main outcomes and measures: The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. Results: A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. Conclusions and relevance: This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals.Item Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.Item An exploratory qualitative study on marriage and pregnancy of adolescent females in the Hikkaduwa Medical Officer of Health (MOH) area(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Kasturiratne, K.T.A.A.INTRODUCTION: Marriage in adolescence before 18 years is prohibited in Sri Lanka. However, marriages of adolescent females are not rare in some areas in Sri Lanka. OBJECTIVE: To describe the factors associated with marriage of and pregnancy among adolescent females (14-17 years) in a village in the Hikkaduwa Medical Officer of Health (MOH) area. METHODS: This exploratory qualitative study was conducted in Angankanda in the Kalupe PHM division in the Hikkaduwa MOH area in November 2007. Data were collected through focus group discussions and key informant interviews and analysed using qualitative content analysis. RESULTS: Fourteen females who had been married during adolescence (14-17 years) and five key informants participated in the study. Marriages of adolescent females have taken place following emotional relationships. Married adolescents have a low level of education and reduced awareness about health issues. Death or separation of a parent, poverty and lack of security within the family unit are important predisposing factors to adolescent marriages. Elopement is common following which parents or relatives from both parties collaborate to register the marriage to avoid litigation on the male partner. Most male partners are above 18 years of age at the time of the marriage. The age of the adolescent provided at registration of the marriage was false. Public health field staff of the area were aware of the problem and have taken preliminary steps to focus on this group. The services provided by the Public Health Midwife for married females are sought and acknowledged but not strictly adhered to, due to negative pressures or lack of motivation from the family. Delaying of the first pregnancy is not a common practice. Exposure to other modes providing awareness on health issues is limited. CONCLUSION: Despite legislature, marriages of adolescent females are a common occurrence in this community. Targetted interventions to prevent these marriages and to upgrade the overall health of adolescent females are necessary in areas where this problem is prevalent.Item Characteristics of menarche in adolescent girls in Sri Lanka(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Salgado, L.S.S.; Abeysuriya, V.; Wickremasinghe, A.R.INTRODUCTION: Menarche is an important biological milestone in girls. The age at attainment of menarche is important for implementing programmes to improve the life skills of girls. OBJECTIVE: To describe the characteristics of menarche, the factors influencing the onset of menarche and to describe the knowledge, beliefs and practices during menarche of adolescent girls in Sri Lanka. Methods: This cross sectional study was conducted among girls 10-16 years of age in four schools situated in the Ragama Medical Officer of Health (MOH) area. Six hundred and sixty two girls were randomly selected and data were collected using a pre-tested, self-administered questionnaire. RESULTS: The median age of our sample was 13 years (range 10-16 years); the mean and median ages of attaining menarche were 12,53 and 11,48 years respectively. The mean BMI of girls who had attained menarche was 17.6 (SEM 0.22) Kg/m2 and those who did not was 16.92 (SEM 0.32) Kg/m2. 47% of the girls had a menstrual cycle length of e" 29 days, 23.4% had irregular cycles and 59% reported that the duration of bleeding was 3-5 days. First borns reported a IcJwer mean age at menarche (12.34 years) than the later borns (12.6 years) (p=0.02). Girls from single child families, who were from higher social categories (Categories 1 & 2) and whose parents were educated beyond 0/L attained menarche earlier. 40.8% stated that menstrual blood is not dirty, 70% admitted that there was no prohibition of having cold or sour foods. The majority of the students had adequate knowledge regarding physical changes during menarche. Girls experienced negative emotions during menstruation. CONCLUSION: The median age of attaining menarche is 11.48 years. Girls experienced negative emotions during menstruation.