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Punyadasa DH, Kumarapeli V, Senaratne W. Development of a risk prediction model to predict the risk of hospitalization due to exacerbated asthma among adult asthma patients in a lower middle-income country. BMC Pulm Med 2023; 23:491. [PMID: 38057750 DOI: 10.1186/s12890-023-02773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Asthma patients experience higher rates of hospitalizations due to exacerbations leaving a considerable clinical and economic burden on the healthcare system. The use of a simple, risk prediction tool offers a low-cost mechanism to identify these high-risk asthma patients for specialized care. The study aimed to develop and validate a risk prediction model to identify high-risk asthma patients for hospitalization due to exacerbations. METHODS Hospital-based, case-control study was carried out among 466 asthma patients aged ≥ 20 years recruited from four tertiary care hospitals in a district of Sri Lanka to identify risk factors for asthma-related hospitalizations. Patients (n = 116) hospitalized due to an exacerbation with respiratory rate > 30/min, pulse rate > 120 bpm, O2 saturation (on air) < 90% on admission, selected consecutively from medical wards; controls (n = 350;1:3 ratio) randomly selected from asthma/medical clinics. Data was collected via a pre-tested Interviewer-Administered Questionnaire (IAQ). Logistic Regression (LR) analyses were performed to develop the model with consensus from an expert panel. A second case-control study was carried out to assess the criterion validity of the new model recruiting 158 cases and 101 controls from the same hospitals. Data was collected using an IAQ based on the newly developed risk prediction model. RESULTS The developed model consisted of ten predictors with an Area Under the Curve (AUC) of 0.83 (95% CI: 0.78 to 0.88, P < 0.001), sensitivity 69.0%, specificity 86.1%, positive predictive value (PPV) 88.6%, negative predictive value (NPV) 63.9%. Positive and negative likelihood ratios were 4.9 and 0.3, respectively. CONCLUSIONS The newly developed model was proven valid to identify adult asthma patients who are at risk of hospitalization due to exacerbations. It is recommended as a simple, low-cost tool for identifying and prioritizing high-risk asthma patients for specialized care.
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Affiliation(s)
| | - Vindya Kumarapeli
- Directorate of Non-Communicable Diseases, Ministry of Health, Colombo, Sri Lanka
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Al-Makki A, DiPette D, Whelton PK, Murad MH, Mustafa RA, Acharya S, Beheiry HM, Champagne B, Connell K, Cooney MT, Ezeigwe N, Gaziano TA, Gidio A, Lopez-Jaramillo P, Khan UI, Kumarapeli V, Moran AE, Silwimba MM, Rayner B, Sukonthasan A, Yu J, Saraffzadegan N, Reddy KS, Khan T. Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary. Hypertension 2021; 79:293-301. [PMID: 34775787 PMCID: PMC8654104 DOI: 10.1161/hypertensionaha.121.18192] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
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Affiliation(s)
- Akram Al-Makki
- Indiana University Health Arnett, Lafayette (A.A.-M.).,Indiana University School of Medicine - West Lafayette (A.A.-M.).,College of Pharmacy, Purdue University, West Lafayette, IN (A.A.-M.)
| | - Donald DiPette
- Department of Medicine, University of South Carolina School of Medicine, University of South Carolina, Columbia (D.D.)
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (P.K.W.)
| | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (M.H.M.)
| | - Reem A Mustafa
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City (R.A.M.).,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada (R.A.M.)
| | - Shrish Acharya
- Indiana University Health Arnett, Lafayette (A.A.-M.).,Department of Internal Medicine, Colonial War Memorial Hospital and National Medicine and Therapeutics Committee, Ministry of Health, Fiji (S.A.)
| | - Hind Mamoun Beheiry
- Faculty of Nursing Sciences, International University of Africa (IUA), Khartoum, Sudan (H.M.B.)
| | - Beatriz Champagne
- Coalition for Americas' Health/Coalición América Saludable CLAS, representing civil society organizations in Latin America, Dallas, TX (B.C.)
| | - Kenneth Connell
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St. Michael, Barbados (K.C.)
| | | | | | - Thomas Andrew Gaziano
- Harvard Medical School, Boston, MA (T.A.G.).,Brigham and Women's Hospital, Boston, MA (T.A.G.)
| | - Agaba Gidio
- Mulago National Referral Hospital, Kampala, Uganda (A.G.)
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia (P.L.-J.)
| | - Unab I Khan
- Department of Family Medicine, The Aga Khan University, Pakistan (U.I.K.)
| | - Vindya Kumarapeli
- Directorate of Non-Communicable Diseases, Ministry of Health, Colombo, Sri Lanka (V.K.)
| | - Andrew E Moran
- Global Hypertension Control, Resolve to Save Lives, an initiative of Vital Strategies, NY (A.E.M.).,Division of General Medicine, Columbia University Irving Medical Centre, NY (A.E.M.)
| | - Margaret Mswema Silwimba
- University Teaching Hospital (Adult), Lusaka, Zambia and Faculty of Pharmacy, Lusaka Apex Medical University (M.M.S.)
| | - Brian Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa (B.R.)
| | - Apichard Sukonthasan
- Department of Medicine, Bangkok Hospital Chiang Mai, Mueang Chiang Mai, Thailand (A.S.)
| | - Jing Yu
- Hypertension Center, Department of Cardiology, Lanzhou University Second Hospital, China (J.Y.)
| | - Nizal Saraffzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Iran (N.S.).,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada (N.S.)
| | | | - Taskeen Khan
- Department of Non-Communicable Diseases, World Health Organization, Geneva, Switzerland (T.K.).,Department of Public Health Medicine, University of Pretoria, Gauteng, South Africa (T.K.)
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Mikkelsen L, de Alwis S, Sathasivam S, Kumarapeli V, Tennakoon A, Karunapema P, Jayaratne K, Jayasuriya R, Gamage S, Hewapathirana R, Wadugedara R, Dissanayake M, Senanayake CH, Mahesh PKB, McLaughlin D, Lopez AD. Improving the Policy Utility of Cause of Death Statistics in Sri Lanka: An Empirical Investigation of Causes of Out-of-Hospital Deaths Using Automated Verbal Autopsy Methods. Front Public Health 2021; 9:591237. [PMID: 34123981 PMCID: PMC8187752 DOI: 10.3389/fpubh.2021.591237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Setting public health policies and effectively monitoring the impact of health interventions requires accurate, timely and complete cause of death (CoD) data for populations. In Sri Lanka, almost half of all deaths occur outside hospitals, with questionable diagnostic accuracy, thus limiting their information content for policy. Objectives: To ascertain whether SmartVA is applicable in improving the specificity of cause of death data for out-of-hospital deaths in Sri Lanka, and hence enhance the value of these routinely collected data for informing public policy debates. Methods: SmartVA was applied to 2610 VAs collected between January 2017 and March 2019 in 22 health-unit-areas clustered in six districts. Around 350 community-health-workers and 50 supervisory-staffs were trained. The resulting distribution of Cause-Specific-Mortality-Fractions (CSMFs) was compared to data from the Registrar-General's-Department (RGD) for out-of-hospital deaths for the same areas, and to the Global-Burden-of-Disease (GBD) estimates for Sri Lanka. Results: Using SmartVA, for only 15% of deaths could a specific-cause not be assigned, compared with around 40% of out-of-hospital deaths currently assigned garbage codes with "very high" or "high" severity. Stroke (M: 31.6%, F: 35.4%), Ischaemic Heart Disease (M: 13.5%, F: 13.0%) and Chronic Respiratory Diseases (M: 15.4%, F: 10.8%) were identified as the three leading causes of home deaths, consistent with the ranking of GBD-Study for Sri Lanka for all deaths, but with a notably higher CSMF for stroke. Conclusions: SmartVA showed greater diagnostic specificity, applicability, acceptability in the Sri Lankan context. Policy formulation in Sri Lanka would benefit substantially with national-wide implementation of VAs.
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Affiliation(s)
- Lene Mikkelsen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Sunil de Alwis
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Vindya Kumarapeli
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Ajith Tennakoon
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Palitha Karunapema
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Kapila Jayaratne
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Rajitha Jayasuriya
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Saman Gamage
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Rangana Wadugedara
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Manoj Dissanayake
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | | | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Alan D Lopez
- University of Washington, Seattle, WA, United States
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Piyasena P, Kumarapeli V, Abeygunathilaka D. Strategies to improve delivery of primary eye care in public health care institutions in Sri Lanka. Community Eye Health 2021; 34:s17-s18. [PMID: 36033399 PMCID: PMC9412129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Prabhath Piyasena
- Medical Officer: Directorate of Policy Analysis and Development, Ministry of Health, Sri Lanka
| | - Vindya Kumarapeli
- Acting Director: Directorate of Policy Analysis and Development, Ministry of Health, Sri Lanka
| | - Dhanushka Abeygunathilaka
- Specialist Registrar in Community Medicine: Directorate of Non-Communicable Diseases, Ministry of Health, Sri Lanka
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Wijeyaratne CN, Seneviratne RDA, Dahanayake S, Kumarapeli V, Palipane E, Kuruppu N, Yapa C, Seneviratne RDA, Balen AH. Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic. Hum Reprod 2010; 26:202-13. [PMID: 21098627 DOI: 10.1093/humrep/deq310] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Compared with other populations, South Asians have a greater propensity to insulin resistance and the metabolic syndrome (MetS). This is the first study to determine the distribution of phenotypes of polycystic ovary syndrome (PCOS) and their relationship to the MetS among indigenous South Asians. METHOD An evaluation of the phenotype and metabolic characteristics of PCOS was conducted by recruiting consecutive women diagnosed by Rotterdam consensus criteria from an Endocrine clinic in Colombo, Sri Lanka. Prevalence of MetS was determined, in relation to the phenotypic subgroup of PCOS and compared with ethnically matched, BMI- and age-adjusted controls (n =231). RESULTS Acanthosis nigricans (AN) occurred in 64.6% of women with PCOS (n= 469). MetS occurred in 30.6% of the PCOS group compared with 6.34% of controls (P = 0.0001). Those with PCOS and MetS had significantly higher median BMI, blood pressure (BP), fasting plasma glucose, insulin and triglycerides and lower high-density lipoprotein and sex hormone-binding globulin (SHBG), but similar testosterone concentrations compared with those with PCOS alone. Prevalence of MetS was similar in the four PCOS phenotypes, although oligomenorrhoeic women were more obese compared with the normal cycling hyperandrogenic group. Multivariate logistic regression confirmed age ≥35 years, BMI ≥25 kg/m(2) and AN as significant predictors of MetS in PCOS. Case-control comparisons showed that the presence of PCOS results in higher odds of having the MetS, a high waist circumference, elevated diastolic BP, abnormal fasting lipids and high fasting insulin and plasma testosterone concentrations. CONCLUSIONS Young indigenous South Asians with PCOS have greater odds of being centrally obese, with a third having the MetS that bears no relationship to the androgenic phenotype. Significant predictors for MetS within the PCOS cohort are advancing age, obesity determined by the Asian cut off (BMI >25 kg/m(2)) and AN, while family history of diabetes, hyperandrogenism and elevated SHBG have no predictive value.
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Affiliation(s)
- Chandrika N Wijeyaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Dharmaratne SD, Gamage O, Gaspe GMNS, Weeratunge NC, Kumarapeli V. Road fatalities in Kandy, Sri Lanka: 2000 to 2008. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dharmaratne SD, Gamage O, Gaspe GMNS, Weeratunge NC, Kumarapeli V. Road traffic crashes in Kandy, Sri Lanka: the effect of a policy change the on the spot insurance scheme. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gaspe GMNS, Weeratunge NC, Dharmaratne SD, Gunatilake J, Dassanayake DMGS, Gamage O, Kumarapeli V. Analysis of fatal road traffic crashes in Kandy, Sri Lanka using GIS. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kumarapeli V, Awerbuch-Friedlander T. Human rabies focusing on dog ecology-A challenge to public health in Sri Lanka. Acta Trop 2009; 112:33-7. [PMID: 19540826 DOI: 10.1016/j.actatropica.2009.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 05/28/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
Sri Lanka is among the top ten countries in the world that report the highest rate of human rabies deaths (2.8 per 1,000,000 in 2007) and animal bites requiring anti-rabies post-exposure treatment (PET) (755 per 100,000 in 2003). Dogs are the main reservoir and transmitters of rabies in Sri Lanka. Present study evaluates the effectiveness of dog rabies control strategies on reducing incidence of human rabies deaths. Analysis is based on data from last three decades and showed strong correlations between the interventions and human rabies incidence. GIS maps provided a method for illustrating the district distribution of human rabies deaths and dog population density and for recognizing districts at risk. Interrupting the natural transmission cycle of rabies in dogs would be a logical approach in eliminating dog rabies in Sri Lanka. However, interventions implemented so far, such as dog vaccination, elimination of stray dogs (abandoned in 2005), and animal birth control have been inadequate to do so. Better understanding of the ecology of stray and owned dogs (e.g. population density, population structure, confinement status) in the context of the human environment and culture, are needed to strategize the control activities, requiring coordination among regional Public Health and Veterinary services.
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Kumarapeli V, Seneviratne RDA, Wijeyaratne CN, Yapa RMSC, Dodampahala SH. A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka. Am J Epidemiol 2008; 168:321-8. [PMID: 18550559 DOI: 10.1093/aje/kwn137] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In most of South Asia, prevalences and phenotypes of polycystic ovary syndrome (PCOS) among women in the community are unknown. The authors aimed to estimate prevalence and phenotype in a community setting in Sri Lanka and to test a valid, feasible screening approach to early diagnosis. A community-based, cross-sectional study was carried out in 2005-2006. A random sample of 3,030 women aged 15-39 years was selected by cluster sampling proportionate to population size. An interviewer-administered questionnaire was utilized to screen for "probable cases" of PCOS based on menstrual history and clinical manifestations of hyperandrogenism. Selected "probable cases" underwent clinical, biochemical, and ovarian ultrasound assessment. The response rate was 96.2% (n = 2,915). A total of 220 (7.5%) "probable cases" were identified: 209 women with oligo/amenorrhea (95%) and 11 women with hirsutism (5%). Further evaluation of the 220 probable cases confirmed 164 newly diagnosed cases of PCOS based on the 2003 Rotterdam diagnostic criteria. With 19 previously diagnosed cases already present, total prevalence was 6.3% (95% confidence interval: 5.9, 6.8). Of the women with "oligo/amenorrhea and/or hirsutism," 91.1% were confirmed to have PCOS; 99.4% of women with "regular cycles in the absence of clinical hyperandrogenism" were confirmed as normal. The most common phenotypes of PCOS were oligo/amenorrhea and polycystic ovaries (91.4%) and oligo/amenorrhea and hirsutism (48.3%).
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Affiliation(s)
- V Kumarapeli
- Public Health Complex, Ministry of Health, Colombo, Sri Lanka.
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