PTSD and Depression 8 Years After the 2004 Tsunami in Sri Lanka.

OBJECTIVES: To evaluate prevalence and risk factors of posttraumatic stress disorder (PTSD) and depression among directly exposed (DE) and indirectly or nonexposed (INE) populations in Sri Lanka 8 y after the Indian Ocean Tsunami in 2004. METHODS: Population-based structured survey study was conducted among Sri Lankan adults living in 5 coastal districts, Hamboantha, Matara, Galle, Kalutara, and Colombo in 2012-2013. A total of 430 individuals, 325 in DE, 105 in INE, participated in the survey. DE and INE groups were compared for demographics and outcomes. Bivariate and multiple logistic regressions with backward selection were used to identify risk factors for partial PTSD and depression. RESULTS: The prevalence of PTSD, partial PTSD and depression were 2.8%, 10.5%, and 18.8% in DE group, respectively. In multivariable analyses tsunami exposure, female gender, subjective physical health before the tsunami, previous trauma, and depression were significantly associated with partial PTSD. Female gender, high frequency of religious activity, previous trauma, social support, and PTSD were significantly associated with depression. CONCLUSIONS: The psychological impacts of the tsunami did wane over time, but still present at lower rate even in 8 y. It is important to address these lingering sequelae and expand access to at risk individuals.

An Innovative Telemedicine Initiative From Sri Lanka: The Value of Volunteerism in a Resource-Constrained Scenario During the COVID-19 Pandemic.

The unprecedented rise in COVID-19 cases in Sri Lanka since July 2021 led to a situation where the health system was getting overwhelmed. The priority shifted toward triaging patients and identifying those who need immediate medical intervention and managing the rest in home settings. An integrated patient management system where patients could access a medical professional through a short messages service (SMS) and calling system was established. This service provided telephone triage, patient advice, and coordinated with the national ambulance system to evacuate ill patients. This integrated helpline system had a major impact on the management of the recent surge of COVID-19 pandemic in Sri Lanka by patients needing urgent care were directed for hospitalization and the rest managed at home with support, reassurance, and guidance. The numbers of oxygen-dependent patients and deaths declined rapidly and the number of available beds increased. The system played a major role in bringing the crisis under control. Despite many challenges, this innovative integrated system is a unique example of medical volunteerism. The pandemic catalyzed the utilization of information and communication technologies effectively by providing healthcare with a reduction of the burden on healthcare institutions and professionals.

Admission policies and methods at crossroads: a review of medical school admission policies and methods in seven Asian countries.

Selecting the right applicants is an important part of medical student admission. While one universally accepted selection criterion is academic capacity, there are other criteria such as communication skills and local criteria (e.g., socio-cultural values) that are no less important. This article reviews the policies and methods of selection to medical schools in seven countries with varying socio-economic conditions and healthcare systems. Senior academics involved in medical education in Indonesia, Japan, Malaysia, the Philippines, Singapore, Sri Lanka, and Taiwan completed a pre-agreed pro-forma per each country to describe the country's admission policies and methods. The details were then compared and contrasted. This review identifies tension between many of the policies and methods used in medical school admissions, such as between the need to assess non-cognitive abilities and widen access, and between the need for more medical professionals and the requirement to set high entry standards. Finding the right balance requires careful consideration of all variables, including the country's human resource needs; socio-economic status; graduates' expected competencies; and the school's vision, mission, and availability of resources.

Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group.

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.

Integrating the development agenda with noncommunicable disease prevention in developing countries: a quasi-experimental study on inter-sectoral action and its impact on self-reported salt consumption-the INPARD study.

BACKGROUND: The determination of behaviours that lead to noncommunicable diseases (NCDs), such as high dietary salt intake, are multifactorial. The prevention of NCDs, including the promotion of healthy dietary choice, including low salt intake, therefore requires multisectoral working. Although the need of a multisectoral approach to risk factor modification has been globally accepted, there is minimal evidence for its application in the real world. METHODS: This quasi-experimental trial was designed to study the impact of a community led multisectoral approach to integrate nutrition prevention into the development agenda, in two districts in Sri Lanka, a lower-middle income country undergoing a phase of rapid socioeconomic development. RESULTS: Results from logistic regression found that those living in the district (Ampara) that identified salt intake as a health issue had significantly higher odds (OR =1.4; 95% CI =1.1, 1.9) of high salt consumption (>5 grams/day) at baseline compared to control areas (Kurunegala), in multivariable models. Post-intervention, individuals in this district had lower odds (OR =0.6; 95% CI =0.4, 0.9) of consuming high levels of salt in all models, including multivariable models whilst controlling for baseline high salt consumption. CONCLUSIONS: The findings from this study demonstrate the positive impact in improved diet, in reduced salt consumption, through a community led multisectoral intervention, in areas in which the community identified high salt consumption as a health issue. These findings demonstrate that multisectoral approaches can be effective in the real world setting and highlight the need to engage with many stakeholders, including targeted communities throughout their development and implementation.

Infant Feeding Guidelines for the Asia Pacific Region.

Good nutrition for infants, during the first 1000 days from conception, is one of the most important determinants of a healthy long life. Breastfeeding is the most important component of infant nutrition and reduces morbidity and mortality. With the changes to the climate currently occurring, issues of nutrition and food supply are only going to increase in importance. The Sustainable Development Goals of the United Nations, place nutrition at the forefront of world development and a sustainable planet. The vision of Asia-Pacific Academic Consortium for Public Health (APACPH) is to "achieve the highest possible level of health of all the people of the nations of the Asia-Pacific region." Much of the burden of disease, early deaths, and disability in the Asia Pacific region could be reduced with public health efforts to address the major risk factors, including nutrition-related causes and smoking. The United Nations Decade of Action on Nutrition 2016-2025 has recently been launched with the aim of reducing the global burden of inappropriate nutrition. The goals include increasing rates of exclusive breastfeeding to 6 months, reducing wasting and stunting, and reducing the rates of low birthweight. This is the position endorsed in these guidelines along with the principles of the Baby Friendly Hospital Initiative. These guidelines expand the information on infants that was included in the 2016 APACPH Dietary Guidelines. APACPH covers many different environments, geographical areas, cultures, and socioeconomic groups. These guidelines are generally applicable to all infants in our region, specific local advice may sometimes be needed.

Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females.

BACKGROUND: Acne vulgaris is one of the commonest skin disorders affecting up to 80% of the world population at least during adolescence. Significant psychosocial effects such as depression and poor personality development have been linked with acne, especially in female adolescents. Various causative factors, including cosmetic exposure, have been attributed toward acne. OBJECTIVE: To analyze the association between frequent exposure to cosmetics and severity of acne in adolescent females. METHOD: A cross-sectional analytical study was performed on 140 girls from three schools in Colombo, Sri Lanka. A self-administered questionnaire was utilized to assess the patterns of cosmetic usage. Grading acne of the participants was performed by the researchers utilizing a standard acne grading scale. RESULTS: The overall prevalence of acne in our study population was 91.4% with a mean acne grade of 3.09. At least one cosmetic type was used by 126 (90%) of the population. A Pearson correlation coefficient (r) value of .452 (P < .001) was obtained between cosmetic exposure and acne grade, which indicates a statistically significant correlation. A chi-square value of 22.875 was obtained at a degree of freedom of 2 (P < .001), enabling us to reject the null hypothesis that there is no significant association between cosmetic usage and acne severity. CONCLUSION: Our results convey a significant positive association between frequent exposure to cosmetics and severity of acne in adolescent females. Girls of this age group must be made aware that cosmetic usage may be a potential aggravating factor for their facial acne.

Tobacco smoking among school children in Colombo district, Sri Lanka.

Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs.

Accreditation of public health education in the Asia-Pacific region.

There has been dramatic advancement in health status in the Asia-Pacific region (APR) over the past 50 years. This ever-changing paradigm of public health calls for continuous review and quality improvement of public health education (PHE). Since its founding in 1984, the mission of the Asia-Pacific Academic Consortium for Public Health (APACPH) has been to improve the quality and relevance of PHE to combat the diverse, dynamic, and unique challenges in the APR. Prof Walter Patrick was a forerunner in this movement and played an instrumental role in establishing APACPH's position in accreditation and improvement of PHE.

Nursing intensive care skills training: a nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting.

PURPOSE: To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. METHODS: A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. RESULTS: In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. CONCLUSIONS: Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings.

Development and implementation of a web-based continuing professional development (CPD) programme on medical genetics.

We developed, implemented and evaluated a web-based continuing professional development (CPD) programme on medical genetics. Development of the CPD programme followed the ADDIE model, i.e. Analysis, Design, Develop, Implement and Evaluation. An invitation to participate in a needs analysis survey was sent to all doctors on the email list of the Sri Lanka Medical Association. A total of 129 completed surveys was received (57% of the 228 who accessed the online survey). The average age of respondents was 42 years (range 27-81). The male: female ratio was approximately 2 : 1. Almost all respondents (96%) selected web-based CPD programmes, or web-based and conventional lectures, as their preferred method of learning. The programme was piloted on a group of 10 doctors. The average pre-knowledge score was 40.3 and the post-knowledge score was 62.1 marks out of 100 (P = 0.002). We conclude that a web-based CPD programme on medical genetics is feasible in Sri Lanka.

Migration of Sri Lankan medical specialists.

BACKGROUND: The migration of health-care workers contributes to the shortage of health-care workers in many developing countries. This paper aims to describe the migration of medical specialists from Sri Lanka and to discuss the successes and failures of strategies to retain them. METHODS: This paper presents data on all trainees who have left Sri Lanka for postgraduate training through the Post Graduate Institute of Medicine, University of Colombo, from April 1980 to June 2009. In addition, confidential interviews were conducted with 30 specialists who returned following foreign training within the last 5 years and 5 specialists who opted to migrate to foreign countries. RESULTS: From a total of 1,915 specialists who left Sri Lanka for training, 215 (11%) have not returned or have left the country without completing the specified bond period. The majority (53%) migrated to Australia. Of the specialists who left before completion of the bond period, 148 (68.8%) have settled or have started settling the bond. All participants identified foreign training as beneficial for their career. The top reasons for staying in Sri Lanka were: job security, income from private practice, proximity to family and a culturally appropriate environment. The top reasons for migration were: better quality of life, having to work in rural parts of Sri Lanka, career development and social security. CONCLUSIONS: This paper attempts to discuss the reasons for the low rates of emigration of specialists from Sri Lanka. Determining the reasons for retaining these specialists may be useful in designing health systems and postgraduate programs in developing countries with high rates of emigration of specialists.

Computer literacy among first year medical students in a developing country: a cross sectional study.

BACKGROUND: The use of computer assisted learning (CAL) has enhanced undergraduate medical education. CAL improves performance at examinations, develops problem solving skills and increases student satisfaction. The study evaluates computer literacy among first year medical students in Sri Lanka. METHODS: The study was conducted at Faculty of Medicine, University of Colombo, Sri Lanka between August-September 2008. First year medical students (n = 190) were invited for the study. Data on computer literacy and associated factors were collected by an expert-validated pre-tested self-administered questionnaire. Computer literacy was evaluated by testing knowledge on 6 domains; common software packages, operating systems, database management and the usage of internet and E-mail. A linear regression was conducted using total score for computer literacy as the continuous dependant variable and other independent covariates. RESULTS: Sample size-181 (Response rate-95.3%), 49.7% were Males. Majority of the students (77.3%) owned a computer (Males-74.4%, Females-80.2%). Students have gained their present computer knowledge by; a formal training programme (64.1%), self learning (63.0%) or by peer learning (49.2%). The students used computers for predominately; word processing (95.6%), entertainment (95.0%), web browsing (80.1%) and preparing presentations (76.8%). Majority of the students (75.7%) expressed their willingness for a formal computer training programme at the faculty.Mean score for the computer literacy questionnaire was 48.4 ± 20.3, with no significant gender difference (Males-47.8 ± 21.1, Females-48.9 ± 19.6). There were 47.9% students that had a score less than 50% for the computer literacy questionnaire. Students from Colombo district, Western Province and Student owning a computer had a significantly higher mean score in comparison to other students (p < 0.001). In the linear regression analysis, formal computer training was the strongest predictor of computer literacy (ß = 13.034), followed by using internet facility, being from Western province, using computers for Web browsing and computer programming, computer ownership and doing IT (Information Technology) as a subject in GCE (A/L) examination. CONCLUSION: Sri Lankan medical undergraduates had a low-intermediate level of computer literacy. There is a need to improve computer literacy, by increasing computer training in schools, or by introducing computer training in the initial stages of the undergraduate programme. These two options require improvement in infrastructure and other resources.

Health changes in Sri Lanka: benefits of primary health care and public health.

The Democratic Socialist Republic of Sri Lanka is an island in the Indian Ocean that has achieved a unique status in the world with health indicators that are comparable with those of developed countries. This is illustrated, among others, by the reduction in both child and maternal mortality in the country. This achievement is the result of a range of long-term interventions, including providing education and health care free of charge, training of health care workers, developing public health infrastructure in rural areas, and adopting steps to improve sanitation, nutrition, and immunization coverage.

The long case and its modifications: a literature review.

CONTEXT: This review provides a summary of the published literature on the suitability of the long case and its modifications for high-stakes assessment. METHODS: Databases related to medicine were searched for articles published from 2000 to 2008, using the keywords 'long case', 'clinical examinations' and 'clinical assessment'. Reference lists of review articles were hand-searched. Articles related to the objective structured clinical examination were eliminated. Research-based articles with hard data were given more emphasis in this review than those based on opinion. RESULTS: Eighteen articles were identified. The main disadvantage of the long case is its inability to sample the curriculum widely, resulting in low reliability. The main advantage of the long case is its ability to assess the candidate's overall (holistic) approach to the patient. Modifications to the long case attempt to: structure the format and the marking scheme; increase the number of examiners; observe the candidate's behaviour, and increase the number of cases. CONCLUSIONS: The long case is a traditional clinical examination format for the assessment of clinical competence and assessment at this level is important. The starting point for the majority of recent research on the long case has been an acceptance of its low reliability and modifications to the format have been proposed. Further evidence of the efficacy of these modifications is required, however, before they can be recommended for summative assessment. If further research is to be undertaken on the long case, it should focus on finding practicable ways of sampling the curriculum widely to increase reliability while maintaining the holistic approach towards the patient, which represents the attraction of the long case.

A study of risk factors for non-intentional domestic injuries among preschoolers in three suburban areas of Sri Lanka.

Unintentional injuries are common among children of Sri Lanka and globally. These can be prevented by identification and modification of risk factors. A pre-tested, structured-observation and an interview were carried out in 270 households with children less than five years in three districts. A high prevalence of risk factors for falls (58.1%), burns (51.6%), sharps injuries (51.3%), choking (65.9%) and animal-bites (53.2%) were observed. Parental identification of risk factors was less. Parents educational level significantly affected both the prevalence of risk factors (P < .05) and parental awareness (P < .05). Only 38% has received injury prevention education and the attending physician has counseled only 5% of the parents. A high prevalence of risk factors, low parental awareness and inadequate counseling by primary care physicians was noted. Primary health-care providers should be educated to encourage counseling of parents during office visits.

Outcome-based approach in development of a disaster management course for healthcare workers.

INTRODUCTION: The Faculty of Medicine, University of Colombo, Sri Lanka provided voluntary healthcare services during the aftermath of the 2004 tsunami. At that time the faculty recognised the need to prepare the healthcare system for future disasters by enhancing the capability of healthcare workers. The development and implementation of a disaster management course for healthcare workers was identified as a priority. METHOD: An outcome-based approach was used to develop the curriculum. Qualitative and quantitative methods were used to identify the core competencies and outcomes that healthcare workers need to achieve at the end of the course. The content, teaching learning methods and assessments were aligned with the course outcomes. The course consists of 9 core modules and an elective research module. Formative and summative assessment methods were included. CONCLUSION: Training is an important component of disaster management. The outcome-based approach provides a useful framework for developing such training programmes and ensures that needs are addressed.