Recalibration of Framingham risk for a local population of Sri Lanka

BACKGROUND

Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka.

METHOD

A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations.

RESULTS

Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively.

CONCLUSION

These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.

Pain Level, Range of Motion, and Foot Volume Do Not Differ in Recurrent and First-Time Ankle Sprains

Objective. This study aims to describe the clinical features in terms of pain perception, ankle range of motion, and foot volume in participants with recurrent ankle sprains compared with first-time sprains. Methods. Individuals with grade I and II ankle sprains were referred to physiotherapy care for further rehabilitation by their general practitioner. Primary outcome measures were range of movement, pain, and foot volume. Recurrences were described according to engagement in sport. Results. A total of 115 participants were recruited (age = 22.2 ± 6.9 years; female, 84). Neither pain level (P = .822), nor range of motion (dorsiflexion P = .452; plantar flexion P = .436; inversion P = .383; eversion P = .657), nor foot volume (P = .654) were significantly different between the groups: individuals with first-time sprain or with recurrences. Conclusion. Pain and high existence of other lower-limb injuries were reported disregarding the presence of a recurrence. Clinically, it is difficult to differentiate recurrent sprain from a first-time ankle sprain by means of foot volume, range of movement, or pain intensity.

Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains

Objective This study was conducted to determine the most effective thermal modality; heat or contrast therapy-in reducing pain, reducing swelling, and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Design Randomized control trail. Methods One hundred and fifteen participants of both genders who were diagnosed as having grade I or II lateral ankle sprain were randomly assigned to the study on the fifth day of injury. Pain, volume, and ROM were recorded before and after treatment continuously for 3 days. Results Effects were evaluated as "Immediately after application" and "3 days after continuous application." Immediately after application, there was no difference between the 2 modalities on ankle ROM; heat reduced pain over contrast therapy, and both modalities increased swelling. When considering the effects after continuous application for 3 days, no difference was found between the 2 modalities on ROM and the reduction of pain. Contrast therapy reduced swelling while heat caused increased swelling even after 3 days. Conclusion The use of different thermal modalities during the transition from the acute to chronic phase of injury can be suggested as effective treatment options according to the objectives of injury management: pain reduction, improve ROM, and swelling management.

LEVELS OF EVIDENCE

Therapeutic, Level II: Randomized clinical trial.

Prevalence of behavioral and emotional problems among seven to eleven year old children in selected schools in Kandy District, Sri Lanka

BACKGROUND

Behavioral and emotional problems comprising internalizing, externalizing and mixed disorders consist of psychiatric disorders in childhood and adolescents. Prevalence rates of 8.3% for preschoolers, 12.2% for preadolescents and 15.0% for adolescents have been reported from around the world. This study aimed to measure the prevalence of emotional and behavioral disorders in 7-11 year-old school children studying in Kandy District Sri Lanka which was a first for the geographic area.

METHOD

This was a community based study at the primary section of the selected schools. The questionnaire, Child behavior Checklist-Sinhala (CBCL-S) was administered in a group setting to the main caregiver of 562 subjects selected randomly. The questionnaire identified problems in 8 subscales under three main sub categories : internalizing, externalizing and other. Data were analyzed using The Syndrome Scales for Boys and Girls developed for analyzing the questionnaire CBCL.

RESULTS

Indicated a prevalence of 13.8% of emotional and behavioral problems in the study population. 8.8% of children showed internalizing problems and 8.8% externalizing problems. These findings are in line with the prevailing rates from previous studies of the world. Children in school types 1AB and 1C had less emotional and behavioral problems compared to type 2 and 3 schools.

LIMITATIONS

Only 20 schools in KEZ and Sinhala speaking population of the Kandy were studied.

CONCLUSIONS

This study showed the extent of childhood emotional and behavioral problems and also confirms that the schools with advanced level classes have lesser problems amongst primary children.

Differences in Predicted Cardiovascular Risk in Sinhalese and Tamils in Sri Lanka Compared With Sri Lankans in Norway

Using data from 3 cross-sectional studies, the authors compared the estimated risk of cardiovascular diseases between migrant Sri Lankans in Oslo, Norway, and Tamils and Sinhalese in Kandy, Sri Lanka. The authors found that Sri Lankans in Oslo had significantly lower Framingham coronary heart disease (CHD) risk. Among men, the prevalence with estimated 10-year risk of a CHD event ≥10% was 20.6% in Oslo, 31.1% in Kandy Tamils, and 44.2% in Kandy Sinhalese. The corresponding figures in women were 10.4% in Oslo, 19.2% in Tamils, and 14.9% in Sinhalese. Risk of fatal cardiovascular disease estimated by the SCORE model showed a similar pattern. The Oslo group had a higher body mass index (BMI), but the differences were observed in all BMI categories. In conclusion, despite a lower BMI, Tamils and Sinhalese in Sri Lanka had higher estimated cardiovascular risk compared with Sri Lankans in Norway, mainly because of poorer lipid profiles.

Differences in Selected Lifestyle Risk Factors for Cardiovascular Disease Between Sri Lankans in Oslo, Norway, and in Kandy, Sri Lanka

Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.

Comparison of cardiovascular risk factors between Sri Lankans living in Kandy and Oslo

Background

South Asians living in western countries are known to have unfavourable cardiovascular risk profiles. Studies indicate migrants are worse off when compared to those living in country of origin. The purpose of this study was to compare selected cardiovascular risk factors between migrant Sri Lankans living in Oslo, Norway and Urban dwellers from Kandy, Sri Lanka.

Methods

Data on non fasting serum lipids, blood pressure, anthropometrics and socio demographics of Sri Lankan Tamils from two almost similar population based cross sectional studies in Oslo, Norway between 2000 and 2002 (1145 participants) and Kandy, Sri Lanka in 2005 (233 participants) were compared. Combined data were analyzed using linear regression analyses.

Results

Men and women in Oslo had higher HDL cholesterol. Men and women from Kandy had higher Total/HDL cholesterol ratios. Mean waist circumference and body mass index was higher in Oslo. Smoking among men was low (19.2% Oslo, 13.1% Kandy, P = 0.16). None of the women smoked. Mean systolic and diastolic blood pressure was significantly higher in Kandy than in Oslo.

Conclusions

Our comparison showed unexpected differences in risk factors between Sri Lankan migrants living in Oslo and those living in Kandy Sri Lanka. Sri Lankans in Oslo had favorable lipid profiles and blood pressure levels despite being more obese.