Effect of different forms of coconut on the lipid profile in normal free-living healthy subjects: A randomized controlled trial (Phase II)

Background

It has been postulated that the lipid effects of coconut could be mediated by its fatty acids, fiber and lysine/arginine ratio. Hence, the lipid effects of coconut oil could be different from the effects of the kernel flakes or milk extract because the constituents could be different in each coconut preparation. The present research investigated the lipid effects of different modes of coconut used in food preparation.

Methods

This study involved a total of 190 participants, randomized into four groups, which received coconut oil supplement (30 ml) (n = 53), kernel flakes (30 g) (n = 52) or coconut milk powder (30 g) (n = 44) for a period of 8 weeks. The control group (n = 41) received no supplement. Lipid assays were performed at baseline and at the end of the 4th and 8th weeks. The generalized estimating equations (GEE), ANOVA, and paired and independent t-tests were used in the analysis.

Result

The age range of the participants was 25-60 years, and 52.6% of them (n = 100) were men. Coconut milk supplementation induced beneficial changes in the lipid profile in that the LDL and non-HDL levels decreased while the HDL levels increased. The subgroup whose baseline LDL level was elevated appeared to benefit most from coconut milk supplementation. Coconut oil and kernel flakes failed to induce favorable lipid changes comparable to coconut milk supplementation.

Conclusion

Differing concentrations of protein, fat and fiber in coconut preparations could possibly explain the dissimilar effects on the lipid profile caused by the different coconut preparations. The benefits of coconut milk seen in the high basal LDL subgroup warrant a detailed study.

Development and validation of a Religious and Spiritual Support Scale in Sri Lanka: A psychometric study

Introduction: Religious and spiritual support reduces distress in patients with cancer. Accurate and reliable data on religious and spiritual support received and perceived by patients with cancer would assist health authorities in planning health promotion strategies targeted at patients with cancer. In this study, a new measurement tool of religious and spiritual support for patients with cancer in Sri Lanka was developed and validated. Methods: A new tool, the Religious and Spiritual Support Scale (RSSS) was developed based on the previous questionnaire and evaluated using 40 patients with cancer. Cross-cultural adaptation was made using WHO guidelines. Reliability was checked using Cronbach’s alpha. Intra-class correlation coefficient (ICC) was used to examine the test-retest reliability of the tool. Convergent and divergent validity of the tool was examined using the World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and the Centre for Epidemiological Studies–Depression scale (CES-D). Exploratory factor analysis (EFA) was performed to test the construct validity of the RSSS. Results: The RSSS showed a high internal consistency (Cronbach’s alpha-0.874). The test-retest reliability of the scale was good (ICC = 0.981). As expected, the overall RSSS score correlated negatively with CES-D (r= - 0.338, p<0.05) and positively with overall QoL scores of the WHOQOL-BREF; (r=0.421, p<0.001), confirming satisfactory divergent and convergent validity of the RSSS. EFA revealed a structure comprised of two factors: Religious practice and religious support. Conclusions: The RSSS is a reliable and valid scale to assess religious and spiritual support received and perceived by patients with cancer in Sri Lanka.

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (β = .52, p < .01) and reduces the time required to complete physical functions (β = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Prevalence of diabetes and pre-diabetes in Sri Lanka: a new global hotspot-estimates from the Sri Lanka Health and Ageing Survey 2018/2019

INTRODUCTION

This study's objective was to produce robust, comparable estimates of the prevalence of diabetes and pre-diabetes in the Sri Lankan adult population, where previous studies suggest the highest prevalence in South Asia.

RESEARCH DESIGN AND METHODS

We used data on 6661 adults from the nationally representative 2018/2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS). We classified glycemic status based on previous diabetes diagnosis, and either fasting plasma glucose (FPG), or FPG and 2-hour plasma glucose (2-h PG). We estimated crude and age-standardized prevalence of pre-diabetes and diabetes and by major individual characteristics weighting the data to account for study design and subject participation.

RESULTS

Crude prevalence of diabetes in adults was 23.0% (95% CI 21.2% to 24.7%) using both 2-h PG and FPG, and age-standardized prevalence was 21.8% (95% CI 20.1% to 23.5%). Using only FPG, prevalence was 18.5% (95% CI 7.1% to 19.8%). Previously diagnosed prevalence was 14.3% (95% CI 13.1% to 15.5%) of all adults. The prevalence of pre-diabetes was 30.5% (95% CI 28.2% to 32.7%). Diabetes prevalence increased with age until ages ≥70 years and was more prevalent in female, urban, more affluent, and Muslim adults. Diabetes and pre-diabetes prevalence increased with body mass index (BMI) but was as high as 21% and 29%, respectively, in those of normal weight.

CONCLUSIONS

Study limitations included using only a single visit to assess diabetes, relying on self-reported fasting times, and unavailability of glycated hemoglobin for most participants. Our results indicate that Sri Lanka has a very high diabetes prevalence, significantly higher than previous estimates of 8%-15% and higher than current global estimates for any other Asian country. Our results have implications for other populations of South Asian origin, and the high prevalence of diabetes and dysglycemia at normal body weight indicates the need for further research to understand the underlying drivers.

Examining the quality of life of patients living with breast cancer in Southern Sri Lanka: A descriptive cross-sectional study

Introduction: Globally breast cancer (BC) is the most common cancer among women and Sri Lanka is not an exception. Cancer influences the quality of life (QoL) of cancer patients. The survival rates and the QoL of BC patients have improved significantly over the last few decades. However, factors associated with the QoL of patients with BC have not been well studied in Sri Lanka. The aim of the study was to assess the QoL and its correlates among patients with BC treated at a tertiary care hospital in Southern Sri Lanka. Methods: Ninety-seven BC patients were investigated using an interviewer-administered questionnaire. The World Health Organization- Quality of Life- Brief (WHOQOL-BREF) was used to measure QoL. The WHOQOL-BREF measure QoL in four domains: physical, psychological, social, and environmental. Scores range from 0 to 100, and higher scores indicate a greater QoL. Results: The mean age of the sample subjects was 52 years (SD = 8.7), and the majority were married (78%). Physical (60.97±11.56), psychological (63.52±11.63), and environmental (69.05 ±8.79) domains of QoL were at a satisfactory level whereas QoL score related to social relationships was found to be low (47.86±13.89) in this sample. Physical QoL was higher in young participants and psychological QoL was higher among those with a fewer number of comorbidities and disabilities and those with no body image changes. Social QoL was higher among married and environmental QoL was higher among those who reported having no disabilities. Conclusion: Social support in the form of family support and emotional support seems to play a major role in lowering the QoL of BC patients. Psycho-social support services should target patients experiencing physical disabilities, a higher number of comorbidities, and those who were subjected to changes in their body image.

Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka

Background and aim

Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka.

Methods

A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis.

Results

The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults.

Conclusions

Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.

Patient's Perception of Diabetes Care Services in Hail, Kingdom of Saudi Arabia

Globally, 643 million people will be affected by 2030, and 783 million by 2045 with diabetes mellitus (DM), a severe disease that affects 537 million people worldwide in 2021. Kingdom of Saudi Arabia (KSA) has the highest prevalence of diabetes mellitus among the top ten countries worldwide. Therefore, the present study aimed to identify the factors influencing diabetes care and assess their relative importance. Research was conducted in the Hail region of the Kingdom of Saudi Arabia. The study recruited 258 diabetes patients visiting the Primary Health Centers in Hail City as part of their routine healthcare. Analyzing the data was performed using the Statistical Package for Social Sciences (SPSS-22). As far as Cronbach's Alpha is concerned, it was 0.717, and Kaiser-Meyer-Olkin (KMO) was 0.705. The study has found that the six factors including accessibility of diabetes care (p = .024), availability of diabetes services (p = .029), quality of diabetes care (p = .024), disease management strategies (p = .037), basic amenities of health system (p = .028) and health education resources (p = .030) play a significant role in providing diabetes care services to patients. According to the adjusted R2 of 0.773 (p 0.001), diabetes care is significantly influenced by these six variables. The comparative importance of the factors indicates that, out of six, quality of diabetes care is the most influential; the availability of diabetes services and health education resources are the second and third most influential factors. In order to provide better care for diabetic patients, healthcare organizations should focus on these factors.

Patient knowledge about diabetes: Illness symptoms, complications and preventive personal lifestyle factors

AIMS

Knowledge plays a vital role in making better decisions for treatment. Patients should be educated about the knowledge of the disease. This study aimed to know patient knowledge about diabetes illness symptoms, complications, and preventive personal lifestyle factors.

METHODS

A cross sectional research design was used to know diabetes knowledge among 261 diabetes patients. Descriptive analysis and logistic regression were used to analyze collected data.

RESULTS

A total 261 respondents were included in this study. 71.26 % were male and 28.74% were females, and their mean age was 30.41 ±7.4 years. About 45.2 % of the respondents earned excellent knowledge ratings. The study concluded that frequent urination (94.6%), increased thirst (86.6%) and slow healing of cuts and wounds (88.5%) were the common symptoms of diabetes. Respondents knew that a family history of diabetes mellitus is the most significant risk factor, followed by being overweight /obesity (89.7%). Most respondents indicated that insulin injection (92%) and avoiding sugary foods (91.6%) were the best ways to control blood sugar. Even though work related to the medical field (p=001) and age (p=0.018) were significantly and positively associated with knowledge, the association of gender, income, level of education, medical field related education, nationality, and marital position with knowledge were not significant.

CONCLUSIONS

Our study findings has confirmed that respondents have good level of knowledge about diabetes mellitus (DM) and the associated risk factors, symptoms and chronic complications. Age and work related to the medical field have displayed a significant association with respondent's knowledge about risk factors, symptoms and complications of diabetes.

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization

Background

Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.

Methods

A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.

Results

Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.

Conclusions

Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03249-3.

Validation of the Sinhalese Version of Brief COPE Scale for patients with cancer in Sri Lanka

Background

Coping strategies play a vital role in cancer management and has been an integral part in the recovery process of cancer patients worldwide. Coping refers to specific efforts; both behavioral and psychological, that diminishes stresses emerged in cancer patients. This study evaluated the psychometric properties of the Sinhalese version of the Coping Orientation to Problems Experienced Inventory (S-BC) which was developed based on the Brief COPE scale  for cancer patients in Sri Lanka.

Methods

The original Brief COPE is a self-administered tool with 28 items designed to measure coping methods used by people in stressful life events. It consisted of statements related to adaptive and maladaptive coping strategies. Forty patients with cancer who were registered at the Oncology ward, Teaching Hospital, Galle, Sri Lanka were included in the study. A cross-cultural adaptation of the Brief COPE was done using WHO guidelines. Reliability of the S-BC was assessed using test–retest and internal consistency procedures. The construct validity of the tool was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity of the S-BC was tested using World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and Centre for Epidemiological Studies-Depression scale (CES-D).

Results

The mean (± SD) age of the sample was 61(± 12) years, and 52.5% (n = 21) of the participants were men. Eighty percent (n = 32) of the participants were more than one year of treatment from diagnosing as a cancer patient. The test–retest reliability of the S-BC was 0.66, and the internal consistency of the S-BC was good (Cronbach’s alpha - 0.819). Both EFA and CFA revealed a structure comprised of seven factors. Such factors were Avoidance/Behavioral disengagement, Religious faith/Acceptance, Seeking support, Planning, Substance use/Venting, Self-blame and Active/positive coping. The scores of the adaptive coping of the S-BC was negatively and the scores of the maladaptive coping of the S-BC was positively correlated with the CES-D score.   The scores of the adaptive coping of the S-BC was  positively correlated with the total score of the WHOQOL-BREF questionnaire indicating the S-BC’s convergent and discriminant validity properties.

Conclusion

The Sinhalese version of the Brief COPE is found to be a valid and a reliable measure to assess coping strategies used by  patients with cancer in Sri Lanka.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00863-z.

ADHD and Intellectual Disability: using ADHD medication

Introduction

Mental disorders and ADHD in people with ID are higher than in the general population.Clinicians may be reluctant to diagnose ADHD in people with ID. They could be denied effective treatment.

Objectives

The purpose of the study was to ascertain antipsychotic use in people with ID before and after the a diagnosis of ADHD.

Methods

A casenote review in an ID service for aduls with ADHD. Data collected on psychotropic use before and after the diagnosis.

Results

Forty-eight aduls with ADHD-ID were identified. 38(79%) were male and 10(21%) were female. 19 to 58 years of age. Four (8%) had mild ID; 44 (92%) had moderate to severe ID. 27(56%) had anxiety, mood disorders or psychosis. 21(44%) had ADHD only. Challenging behaviour was reported in 24 (50%) of cases. Thirty-three (68%) used psychotropic medication prior to the diagnosis of ADHD and after the diagnosis. Post-diagnosis, 20(60%) continued to use antipsychotic medication indicating the elimiation of antipsychotic use in 13(40%) of people. The level of medication use remained the same in spite of the reduction of antipsychotic medication. The diagnoses of challenging behaviour was not affected by the reduction in antipsychotic medication and the increase in ADHD medication use.

Conclusions

The use of antipsychotic medication in people with intellectual disaibilities and ADHD is high. ADHD should be considered when people present wtih challenging behaviour. ADHD medication can be effective in treating ADHD-ID and can lead to a significant reduction in the use of antipsychotic medication.

Disclosure

No significant relationships.

Prisoners with Attention Deficit Hyperactivity Disorder: Co-morbidities & Service Pathways

Introduction

Effective diagnostic and treatment pathways for ADHD are needed in prison settings due to the high prevalence of ADHD and comorbidities in the prison population.

Objectives

In this presentation, we will describe two studies conducted in seperate London prisons in England. In the first study, the aim was to identify prisoners with ADHD with a focus on describing comorbidity. In the second study, using QI (quality improvement) methodology, the aim was to measure the practicability and effectiveness of a specialist ADHD diagnostic and treatment pathway for prisoners.

Methods

Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.

Results

Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.

Conclusions

Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

Disclosure

No significant relationships.

Feelings, Behavioral Actions and Depressive Symptoms Related to COVID-19 among Undergraduates in Hail, Saudi Arabia

The severe acute respiratory syndrome coronavirus 2 (COVID-19) outbreak has had a profound psychological impact on university undergraduates. Feelings, behavioral actions, and depressive symptoms related to COVID-19 in undergraduates in Hail, Saudi Arabia, were assessed using an online survey. Eighteen feelings and six behavioral acts were assessed. The Center for Epidemiological Studies Depression Scale was used to measure depressive symptomatology. Descriptive statistics and logistic regression techniques were used. The mean age of the participants (n = 418) was 20.2 years (standard deviation (SD) = 1.8 years), and 52.9% (n = 221) were males. Elevated levels of depressive symptoms were reported by 47.1% of male and 51.3% of female participants. Social isolation, loss of interest, obsessive monitoring of symptoms, concentration difficulties, recurrent negative thoughts, and worries about health services emerged as vital negative feelings related to COVID-19 that were expressed by the participants. Younger age (odds ratio (OR) = 0.636, 95% confidence interval (95% CI) = 0.428-0.946) and coming from the middle-income category (OR = 0.388, 95% CI = 0.151-0.994) were found to be protective factors against developing depressive symptoms. Frequent cleaning of hands, wearing masks when going out, and adherence to social distancing rules were practiced by 71.5% (95% CI = 67.2-75.8%), 78.7% (95% CI = (74.4-82.5%) and 66.0% (95% CI = (61.3-70.5%) of the participants, respectively. These behavioral acts were not associated with the development of depressive symptoms. Although the practice of COVID-19 precautionary measures by the participants was satisfactory, nearly half of the participants reported depressive symptoms. Innovative educational strategies are needed to curb concentration difficulties and social isolation experienced by undergraduates during outbreaks such as COVID-19.

Personal Determinants for Physical Activity Behavior of Urban-Dwelling Older Adults in Sri Lanka

Physical inactivity is a vital risk factor for the development and maintenance of chronic ill-health conditions among older adults. This study examined personal factors associated with physical activity (PA) behavior of urban-dwelling older adults in Sri Lanka, a middle-income country in South Asia. A total of 880 older adults (aged ≥60 years) participated in this cross-sectional study. They responded to anthropometrical, health, and socio-demographic data pertaining to their current physical and behavioral status. The mean age of the participants was 70.1 years (SD ±6.0), and the majority (75%) were women. Increasing age, male gender, middle income, having cardiovascular diseases or arthritis, deficiencies in muscle strength and balance, pain, and lower self-rated health were associated with insufficient PA behavior among the participants. Old-age physical activity promotion programs should target older adults in advanced ages and men in particularly, as they are highly vulnerable to sedentary lifestyles. Muscle strength and balance, a neglected area in PA promotion in older adults, seem to play an important role in older adults' participation in physical activities. Incorporation of pain management, and muscle strength and balance techniques into older adults' PA promotion programs would probably increase adherence rates of the participants in such programs.

Depressive Symptomatology and Practice of Safety Measures among Undergraduate Students during COVID-19: Impact of Gender

The COVID-19 pandemic has greatly affected the personal and academic lives of undergraduates in Saudi Arabia. Although studies have suggested that COVID-19 increased the prevalence of psychological health problems among undergraduates, the associations between the risk of depression and safety practices and the influence of gender on these associations have not been studied in detail. A cross-sectional online survey was conducted among preparatory-year undergraduates in a large public university in Saudi Arabia during the outbreak. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) Scale, and the practice of eight precautionary behaviors was also assessed. Data analysis was performed using the chi-square test, multiple linear regression and Spearman's correlation coefficient. In total, 3044 undergraduates were surveyed. The mean age was 18.6 years (SD = 0.84), and 61.9% (n = 1883) of the participants were female. Overall, 47.7% of the participants reported having elevated depressive symptoms. Overall mean values of CES-D scores were higher among female undergraduates than that of male undergraduates (18.08 versus 15.56, p < 0.01). There were inverse and weak but significant relationships between the CES-D score and frequent cleaning of hands (male: r = -0.116, p < 0.01; female: r = -0.098, p < 0.01), wearing a mask when going out (male: r = -0.172, p < 0.01; female: r = -0.135, p < 0.01), keeping social distance (male: r = -0.117, p < 0.01; female: r = -0.147, p < 0.01), and covering the nose when sneezing (male: r = -0.202, p < 0.01; female: r = -0.115, p < 0.01). Regression analysis indicated that adherence to precautionary measures was a strong predictor of reduction of depressive symptoms in the target population. Male gender was also found to be an independent predictor of reduction of depressive symptoms. Depressive symptoms were highly prevalent in this target group, and female undergraduates seemed to be more vulnerable to developing such symptoms. Results also indicated that female undergraduates were more likely to implement the protective measures for COVID-19. The promotion of precautionary measures seems to be effective in reducing distress in this target population, but further research is needed to confirm our assertions.

Psychological experiences of healthcare professionals in Sri Lanka during COVID-19

BACKGROUND

The upsurge of COVID-19 has caused numerous psycho-social challenges for healthcare professionals because of its ability to spread rapidly in the community and high mortality rate. The seriousness of the disease has led many healthcare professionals plagued by stigma as well as discrimination. In this study, depressive symptomatology, levels of anxiety, and related psychosocial and occupational factors experienced by healthcare professionals in Sri Lanka during COVID -19 were investigated.

METHODS

A total of 512 healthcare professionals were surveyed using an online survey. The Generalized Anxiety Disorder 7-item scale, the Center for Epidemiologic Studies Depression Scale-Revised-10, and psychosocial and occupational factors predictive of depression and anxiety were included in the survey questionnaire. Logistic regression determined the factors associated with the presence of depressive symptoms and anxiety.

RESULTS

Results showed that elevated depressive symptoms and anxiety were experienced by 53.3% and 51.3%, respectively, of the participants. No differences in the prevalence of elevated depressive symptoms and anxiety were found between those who were exposed and non-exposed to COVID-19 confirmed or suspected patients. Having a fear of being infected with COVID-19 and spreading it among family members were associated with increased risk of depression. Among those exposed to COVID-19 confirmed or suspected patients, poor occupational safety (OR = 2.06, 95% CI 1.25-3.39), stigmatization (OR = 2.19, 95% CI 1.29-3.72), and heavy workload (OR = 2.45, 95% CI 1.53-3.92) were associated with increased risk of elevated depressive symptoms, whilst poor self-confidence (OR = 2.53, 95% CI 1.56-4.09) and heavy workload (OR = 1.94. 95% CI 1.22-3.12) were associated with increased risk of anxiety.

CONCLUSIONS

Fear of being infected and distress caused by fear of spreading it among family members, stigmatization, poor self-confidence, poor occupational safety and heavy workload are vital risk factors that need to be considered in future psychological support services designed for the healthcare professionals in unprecedented outbreaks like COVID-19.

Physical Activity of Urban- Dwelling Older People in Sri Lanka

There is a paucity of information on physical activity behaviour of older adults in Sri Lanka.  This study determined the physical activity status of urban-dwelling older adults in a district in the country. A cross sectional survey of 880 subjects (aged 60+ years) was conducted using the Global Physical Activity Questionnaire. The prevalence rates of physically inactive, sufficiently active and highly active were 21.5%, 78.5% and 52.7% respectively. Women were more active than men (Women, 80.9% versus men, 75.5%, p < 0.05). Activity at work accounted for the highest portion of physical activity as reported by the participants [Median = 2400 MET/Week, 95% CI: 240, 4800] followed by active transport [Median =120 MET/Week, 95% CI: 0, 560] and leisure-time activity [Median = 0 MET/Week, 95% CI: 0, 270]. Factors contributing for extensively engaging activity at work need further investigations and older adults should be encouraged to do leisure-time physical activities.

Pregabalin use in adults with intellectual disabilities

Introduction

Pregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.

Objectives

To describe the use of pregabalin in adults with intellectual disabilities.

Method

A descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).

Results

Fourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.

Conclusions

Pregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Diagnosis of Attention Deficit Hyperactivity Disorder in Intellectual Disability: Diagnostic and Statistical Manual of Mental Disorder V versus clinical impression

BACKGROUND

Diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disability (ID) remains challenging. The Diagnostic and Statistical Manual of Mental Disorder V (DSM V) classification system is often used to diagnose ADHD in the general population; however, the presence of ID and other associated conditions such as autism and communication difficulties can make it difficult to apply the DSM V criteria in people with ID. Therefore, diagnosing ADHD in people with ID is often made using clinical judgement and/or the application of diagnostic criteria. There are no studies comparing the diagnostic accuracy of clinical judgement and the use of DSM V criteria in people with ID and ADHD.

METHOD

The aims of the study were to compare the accuracy of the diagnosis of ADHD in people with ID according to the DSM V criteria versus clinical judgement and to determine which criteria are more reliable. A questionnaire was developed using five fictional case scenarios of people with ID. Questionnaires were presented to practising psychiatrists chosen as a convenience sample in the United Kingdom over a period of 12 months. Case scenarios were developed and agreed to be positive or negative for ADHD by the study authors prior to rating by clinicians. The clinicians were asked to read the scenarios and to make a judgement on the cases regarding the symptoms of ADHD. They were then presented with the 18 DSM V criteria of ADHD and asked to select the criteria they considered were present in each scenario. Sensitivity, specificity, likelihood ratios and predictive values for both the DSM V criteria and clinical opinions were calculated for correctly identifying the exemplar cases.

RESULTS

The data showed strong sensitivity [0.82 95% confidence interval (CI) 0.74-0.89] and high specificity (1.00 95% CI 0.95-1.00) for the raters' clinical opinion. In contrast, the DSM V criteria alone, as assessed by the raters, did not reliably provide ADHD diagnoses, with a sensitivity of only 0.23 (95% CI 0.15-0.31). This difference in sensitivity between the two was statistically significant at P < 0.001.

CONCLUSION

The study results suggest that clinical opinion is the 'gold standard' at present in diagnosing ADHD in adults with ID in the absence of a validated diagnostic tool in this group. Further studies are needed to understand how symptoms of ADHD can be presented differently in people with ID. DSM V criteria for ADHD may need to be adapted according to the severity of ID and other neurodevelopmental disorders.

A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.

Correlates of knowledge on birth defects and associated factors among antenatal mothers in Galle, Sri Lanka: a cross-sectional analytical study

Background

Birth defects (BD) are considered a leading cause of childhood morbidity and mortality. Personal, cultural, and health care system barriers may increase the incidence of BD in low and middle income countries. In this study we assessed the knowledge of antenatal mothers on BD, associated factors, and prevention and management.

Methods

Three hundred and fifty (350) antenatal mothers were surveyed using a pretested, self-administered questionnaire. The knowledge on BD was evaluated under 3 categories; knowledge on BD, knowledge on associated factors, and knowledge on prevention and management. The total scores were calculated for each category and converted into percentages. A higher percentage score indicates a high level of knowledge. Descriptive statistics and regression models were used for data analysis. Level of significance was considered as p < 0.05.

Results

Mean age of the participants was 28.7 years (SD = 5.2). The age range was 17–44 years. Most of the participants (79%) had studied up to secondary or tertiary education. The average scores of knowledge on BD, associated factors, and prevention and management of BD were 57.6% (95% CI = 52.3–62.9%), 55.1% (95% CI = 49.8–60.4%) and 58.8% (95% CI = 53.5–64.1%) respectively. The average score on the overall total knowledge was 56.4% (95% CI = 51.1–61.7%). Mother’s level of education, monthly income of the family and number of clinic visits made by the mother were found to be positively associated with the overall knowledge. About 62% of the participants had taken folic acid (FA) preconceptionally, a major preventive factor of BD associated with the nervous system. Folic acid intake was positively associated with age and educational level, but negatively associated with parity. Media (36.9%) and Public Health Midwives (PHMs) (20%) were found to be the major sources of knowledge on BD, associated factors and prevention in this target group.

Conclusions

The average overall knowledge on BD in this group of antenatal mothers was moderate. Thus, there is a need to improve the knowledge in eligible women to reduce the occurrence of BD, ideally before they become pregnant. Media and PHMs were seem to be the effective and possible resources that can be used to educate the community on BD, associated factors and prevention of BD in Sri Lanka.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2163-9) contains supplementary material, which is available to authorized users.

Re-exploring the value of surveillance cultures in predicting pathogens of late onset neonatal sepsis in a tertiary care hospital in southern Sri Lanka

Objective

To identify the validity of surveillance cultures in predicting causative organism(s) of late onset neonatal sepsis.

Results

Prospective analytical study was conducted from January to April 2011 at the Neonatal Intensive Care Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka. Fifty neonates were screened on admission and weekly thereafter for colonization with potential pathogens. On suspicion of infection, relevant samples were cultured and tested for antibiotic sensitivity. There were 55 episodes of clinically suspected infections including 33 nosocomial infections. One-third (17/55) of all clinically suspected infections were culture positive. Out of 55, only 33 episodes were clinically suspected nosocomial infections. Clinically suspected nosocomial infection rate was 50/1000 patient-days. Culture proven nosocomial infection rate was 13.61/1000 patient-days. Coliforms were the commonest clinical isolate (76%) and 2/3 of them produced extended spectrum β lactamase. More than 80% of the isolates causing late onset sepsis were sensitive to carbapenems and aminoglycosides. Sensitivity, specificity, positive predictive value and negative predictive value of surveillance cultures were 77.8, 37.5, 31.8 and 81.8%, respectively. Surveillance samples can be used to predict pathogens of late-onset sepsis. Broad-spectrum antibiotics (carbapenems, aminoglycosides) are recommended as empirical therapy for late-onset neonatal sepsis.

Contribution of generative leisure activities to cognitive function in elderly Sri Lankan adults

OBJECTIVES

To examine the unique contribution of generative leisure activities, defined as activities motivated by a concern for others and a need to contribute something to the next generation.

DESIGN

Cross-sectional survey.

SETTING

Peri-urban and rural area in southern Sri Lanka.

PARTICIPANTS

Community-dwelling adults aged 60 and older (N = 252).

MEASUREMENTS

The main predictors were leisure activities, grouped into generative, social, or solitary. The main outcome was cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS

More-frequent engagement in generative leisure activities was associated with higher levels of cognitive function, independent of the effect of other social and solitary leisure activities. In a fully adjusted model combining all three leisure activities, generative activities independently predicted cognitive function as measured using the MoCA (β = 0.47, 95% confidence interval (CI) = 0.11-0.83) and the IQCODE (β = -0.81, 95% CI = -1.54 to -0.09). In this combined model, solitary activities were also independently associated with slower cognitive decline using the MoCA (β = 0.40, 95% CI = 0.16-0.64) but not the IQCODE (β = -0.38, 95% CI = -0.88-0.12); the association with social activities did not reach statistical significance with either measure. These associations did not differ meaningfully according to sex.

CONCLUSION

Generative leisure activities are a promising area for the development of interventions aimed at reducing cognitive decline in elderly adults.

Caregiving expectations and challenges among elders and their adult children in Southern Sri Lanka

The elderly population in Sri Lanka is growing rapidly. Elders are traditionally cared for in the homes of their adult children, but the shifting socio-economic environment in Sri Lanka challenges this arrangement. This paper describes the dynamics of elder-caregiver relationships in Southern Sri Lanka. Data included 4 focus group discussions and 5 in-depth interviews with elderly, and 10 in-depth interviews with adult children of the elderly. Discussion guide topics included caregiving arrangements, and roles/responsibilities of elders and caregivers. Using a grounded theory approach, a comprehensive analytic memo was developed and discussed to explore emerging themes on the caregiver dynamic. Both elders and caregivers felt that elders should be taken care of in the home by their children. They pointed to a sense of duty and role modeling of parental caregiving that is passed down through generations. Even as elders desired support from their children, they feared losing their independence, and saw financial autonomy as important for maintaining relationship balance. Caregiving challenges included: households where both the adult child and his/her spouse worked outside the home; households where elders had a disproportionate amount of household work; economically stressed households; and lack of direct communication between elders and caregivers regarding conflicts. Results point to strong values around caring for elderly in the home, but identify challenges to this arrangement in the future.

Use of and attitudes toward tobacco and alcohol among adults in southern Sri Lanka

The adverse health effects of tobacco and alcohol are well known. Alcohol consumption is increasing in Sri Lanka, but few population studies have been conducted. The objective of this study was to document tobacco and alcohol consumption levels among adults in southern Sri Lanka and to identify the main reasons for using or refraining from alcohol and tobacco products. Tobacco and alcohol use within Sri Lanka is relatively common, particularly among adult males. Reasons given for smoking and drinking frequently relate to social and image-based motivators. Women may be especially susceptible to the influence of peer pressure in social situations. Public health efforts should consider the use of demographic-specific anti-tobacco and anti-alcohol messages, as the motivators driving behavior appear to differ across gender and age groups.

Alcohol use behavior among undergraduates: a cross-cultural comparison between the United States and Sri Lanka

In this study, the alcohol use behaviors and associated factors of US and Sri Lankan undergraduates were compared. A sample of 515 US (63% female) and 583 Sri Lankan (54% female) undergraduates were surveyed using a self-administered, anonymous questionnaire. Significant variations by gender and country existed. In the US sample, 89.5% of males and 76.5% of females were current alcohol users; in the Sri Lankan sample, 30.5% of males and 3.5% of females were current alcohol users. For both sexes, the reported mean monthly consumption rate (units/month) was higher in the US sample (male=25.6, female=16.4) compared to that of the Sri Lankan sample (male=8.1, female=8.4). In the US sample, the mean alcohol consumption rates reported were higher in first-year undergraduates compared to undergraduates in subsequent years of study. In contrast, mean alcohol consumption was lower in junior undergraduates compared to senior undergraduates in the Sri Lankan sample. Living arrangements (on-campus vs off-campus) seemed to be unrelated to alcohol use in the US undergraduates, but living in off-campus residences seems to be a protective factor of alcohol use for the Sri Lankan undergraduates. Those implementing prevention strategies should seriously consider these culture-specific drinking habits and motives, and other factors, such as gender, when formulating undergraduate alcohol-control interventions.

Alcohol use, related problems and psychological health in college students

This study examined the prevalence of alcohol use, alcohol-related problems, psychological distress, anxiety and depression mood and the relationship between these variables in a sample of 534 college students in the USA. In college men, 91% were current alcohol users (those who use alcohol at least once a month) and in college women 80% were current alcohol users (p < 0.01). Current users were further divided into two groups, moderate and heavy, considering the amount and frequency of alcohol use. Beer was more popular among moderate users than heavy users in both sexes. Over 90% of both moderate and heavy users in both men and women had used hard liquor in the 30-day period preceding the survey. College men had more alcohol-related problems than did college women. Blackouts, getting into fights and not being able to meet school responsibilities were the common alcohol-related adverse outcomes reported by the participants. No associations were found between alcohol use and distress and between alcohol use and depressive mood. Mean values of the anxiety scores, however, were higher in moderate users in the male sample compared to that of the female sample. The findings have implications for theories of alcohol-related psychological health in college students.

Sexual behavior of young adults in Sri Lanka: Implications for HIV prevention

While many Asian countries have been challenged by an increasingly high incidence of HIV infection, Sri Lanka has not been among those most impacted to date. However, little is known about sexual behaviors in this country, particularly those of young adults and, as the population of youth grows and becomes more sexually active, there could be implications for the incidence of HIV in this country. Using a two-staged clustered sampling method to achieve a geographically representative sample of young adults in Sri Lanka, data related to sexual behaviors were collected from 3,134 individuals aged 18-20 years. Over half of the males and approximately one-third of the females reported that they were sexually active at the time of the study, with penetrative sexual experiences reported by 20.1% of males and 3.1% of females. Only 26.5% of males and less than 10% of females reported having ever used a condom when participating in vaginal, anal or oral intercourse. The findings of this study suggest that unique partnerships between both governmental and non-governmental entities, both within and outside Sri Lanka and particularly those that involve young adults, may help to maintain this country's low HIV incidence.

Prevalence and correlates of sexual abuse reported by late adolescent school children in Sri Lanka

Despite emerging evidence that child sexual abuse (CSA) is a significant health problem in Sri Lanka, few studies have been undertaken to understand the scope and associated factors of CSA.

OBJECTIVE

To identify the prevalence of and psycho-behavioral and demographic factors related to CSA among late adolescents.

STUDY GROUP

A representative sample of late adolescent school children in Southern Sri Lanka.

METHODS

A regional sample of 2,389 students was surveyed using a self-report anonymous questionnaire. Of the participants, 54% were female and 98% were 18 years of age.

RESULTS

About 14% of both male and female students reported having been subjected to some form of CSA. Students with middle or upper socioeconomic status, not living with parents, and studying science and mathematics were more likely than others to report having been sexual abused during childhood. The odds of CSA among males were significantly higher among those who had low self-esteem, those who reported any use of alcohol, and those who reported family conflict. The odds of CSA among females were significantly higher among those who had suicidal ideation, those who reported any use of alcohol, and those who reported family conflict.

CONCLUSIONS

Sexual abuse of children is an important public health issue in Sri Lanka. Causal relations between CSA and related psycho-behavioral risk factors investigated in this study should be further investigated using longitudinal and qualitative studies.

Motivations for alcohol use among men aged 16-30 years in Sri Lanka

Psychometric properties of a new scale that measures motivations towards alcohol use were examined using a sample of 412 male alcohol users in Sri Lanka aged 16-30 years. In addition, associations between drinking motives and drinking frequency were explored. Confirmatory factor analysis showed that a 3-factor model consisting of the factors personal enjoyment, tension reduction, and social pressure fit the data well. Overall, tension-reduction motivation was found to be prominent in the context of young males' drinking behavior in Sri Lanka. Associations between stress and alcohol use among young males warrant further investigations.

Neighborhood environment and self-rated health among adults in Southern Sri Lanka

The prevalence of different neighborhood environmental stressors and associations between the stressors and self-rated health are described in a representative sample of 2,077 individuals, aged 18–85 years, in southern Sri Lanka. Mosquito menace (69.4%), stray dog problems (26.8%), nuisance from neighbors (20.3%), and nuisance from drug users (18.7%) were found to be the most prevalent environmental stressors. None of the stressors investigated were associated with self-rated physical health, but nuisance from neighbors, nuisance from drug users, shortage of water and having poor water/sewage drainage system were associated with self-rated mental health among the respondents.

Inhalant use among indiana school children, 1991-2004

OBJECTIVE

To examine the prevalence and trend of inhalant use among Indiana public school students.

METHODS

The Alcohol, Tobacco, and Other Drug Use among Indiana Children and Adolescents surveys conducted annually between 1991 and 2004 were reanalyzed using 2-way moving average, Poisson regression, and ANOVA tests.

RESULTS

The prevalence had increased during 1991- 1997, decreased during 1997- 2002, and increased again since 2003. Poisson model estimated an average annual decrease rate of 5.6%. The intensity of inhalant use had also decreased. More males and Hispanics use inhalants.

CONCLUSION

Inhalant use needs to be addressed in drug prevention programs.

Depressive symptoms among adolescents in Sri Lanka: prevalence and behavioral correlates

A cross-sectional study conducted on a sample of 891 adolescents in Sri Lanka revealed that 57.7% of the participants were having elevated depressive symptoms. Alcohol use, smoking, and low physical activity were found to be associated with elevated depressive symptoms.

A theory-based approach to understanding sexual behavior at Mardi Gras

Using the Triandis Model of Interpersonal Behavior (TIB), we considered the unique context of Mardi Gras, the annual festival in New Orleans, Louisiana, and how it might influence sexual behavior. This study utilized a two-stage, qualitative and quantitative methodological framework. Focus groups of past Mardi Gras participants were held to gather data to inform the development of the study instruments, and data were subsequently collected from 300 Mardi Gras participants in February 2004 using a pencil-and-paper questionnaire. For women, the TIB model did not significantly predict intentions to engage in sexual behavior at Mardi Gras. Cognitive beliefs and subjective social norms predicted intentions to engage in oral and vaginal sex among male participants. For men and women, peer sexual activity, intentions, and previous sexual experience predicted engaging in sexual behaviors at Mardi Gras. Situational conditions related to Mardi Gras culture predicted anal sex behavior. The TIB, as a guiding framework for the study, makes apparent the importance of cultural context when developing interventions related to sexuality that are to be implemented in a specific setting like Mardi Gras.

Smoking in adults in Sri Lanka: prevalence and attitudes

A questionnaire was administered to 1565 adults to identify the prevalence of smoking and to assess respondents' attitudes toward smoking. Of men 41% were yearly smokers, 27.8% were monthly smokers and 21% were daily smokers. The corresponding figures for women were 3.4%, 2% and 0.6% respectively. Higher prevalence rates were observed among less educated, middle-aged men who were from underprivileged families. About 23% of men and 0.9% of women were monthly alcohol users. Alcohol use seems to be positively associated with smoking. A considerable portion of both smokers and non-smokers expressed a favorable attitude towards smoking habits of adult males (40.1% of smokers and 12.8% of non-smokers) and towards the tobacco industry (25.1% of smokers and 13.1 of non-smokers). Since the majority of people in Sri Lanka are non-smokers, attitudinal support given by them in promoting smoking in the society needs to be addressed effectively in smoking control interventions.

Preliminary study of smoking and alcohol use among students in southern Sri Lanka

455 students, ages 15-19 years and living in a southern district of Sri Lanka, were self-administered a questionnaire to identify the prevalence of tobacco and alcohol use and to assess student attitudes toward the alcohol and tobacco industries. The current prevalence of smoking was 10.6% among men and 0.0% among women. The current prevalence of alcohol use was 21.2% among men and 3.3% among women. A significantly higher proportion of men than women expressed favorable attitudes toward the alcohol industry (27% versus 7%) and the tobacco industry (13% versus 5%). Given that aggressive marketing strategies are used by these industries to promote their products among young people, epidemiological studies of the substances using scientifically sound methods to formulate effective prevention strategies are essential.

Cardiac tamponade due to actinomycosis

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