Assessment of energy and nutrient intake of sri lankan mothers with prior gestational diabetes mellitus at 6-week postpartum: A community-based study.

Background: Gestational diabetes mellitus (GDM) is one of the leading causes for the future diabetes. Diet modification is an imperative part in attenuating this progression. Objectives: This study assessed energy and nutrient intakes of Sri Lankan mothers at 6 weeks after delivery, with the aim of developing specific dietary guidelines for postpartum mothers with GDM. Materials and Methods: A community-based, descriptive cross-sectional survey was conducted as a part of a quasi-experimental study. Nutrient and energy intakes were assessed among 100 mothers using 24-h dietary recall and a validated food frequency questionnaire. Energy and nutrient intakes were analyzed using NutriSurvey 2007 (EBISpro, Germany) which was modified for native food recipes and food composition tables for Sri Lanka. Results: The mean ± standard deviation intakes of total calories, carbohydrate, protein, and fat were 2817 ± 984 kcal, 445 ± 186 g, 95 ± 39 g, and 87 ± 58 g, respectively. The total calorie intake was significantly higher when compared to recommended levels based on the body mass index in both normal weight (3033 ± 1122 vs. 2300 kcal/d; P < 0.00) and overweight or obese (2759 ± 944 vs. 1800 kcal/d; P < 0.00) postpartum women. In the obese group, daily carbohydrate, fat, and protein intakes were significantly higher than the recommended values (P < 0.00). Folic acid intake was lower in both normal (23.7 vs. 400; P < 0.001) and obese or overweight (63 vs. 400; P < 0.001) groups. Conclusion: The study indicated that in majority of the mothers with GDM, the daily calorie and carbohydrate intakes were higher than the recommended. The findings suggest the need for developing a scientifically feasible and culturally acceptable dietary modification program. All macronutrients were taken more than the recommended amounts, especially in the overweight/obese group.

Disability and caregiver burden: Unique challenges in a developing country.

PURPOSE: This study aimed to identify factors, including degree of disability, that contribute to the caregiver burden of raising children with cerebral palsy in Sri Lanka. METHODS: Participants were caregivers of children with cerebral palsy attending the pediatric neurology clinic of the only tertiary care center in southern Sri Lanka. The locally validated Caregiver Difficulties Scale (CDS) was administered, and demographic information was obtained in a structured interview. Disability data was accessed through the medical record. RESULTS: Of 163 caregivers who participated in this study, 133 (81.2%) demonstrated a moderate to high level of burden, and 91 (55.8%) were at high risk for psychological burden. In the bivariate analysis, caregiver burden significantly correlated with degree of physical disability based on the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), the presence of medical co-morbidities, and having two or more children. However, only the GMFCS level and number of children remained significant predictors of caregiver burden after controlling for confounding effects. CONCLUSION: Raising a child with cerebral palsy in Sri Lanka is likely to cause caregiver burden, particularly if they have a high level of disability or one or more siblings. Monitoring caregiver burden as part of routine cerebral palsy management is important, which allows targeting psychosocial support to families most in need.

The Chinese version of the Caregiver Difficulties Scale: Psychometric evaluation.

BACKGROUND: Evaluating caregiver burden and its health impact is an essential component of long-term care plan for children with disabilities; the Caregiver Difficulties Scale (CDS) has high conceptual sensitivity. The aim of this study was to adapt the CDS to Chinese and investigates the psychometric properties of this tool. METHODS: The study was carried out among caregivers of children with cerebral palsy (n = 194). The CDS, Caregivers Burden Inventory (CBI) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) were used for data collection. Twenty experts were consulted to evaluate the content validity of the scale. The confirmatory factor analysis was conducted to measure the construct validity of CDS. The Spearman correlation coefficients were calculated among CDS, CBI and WHOQOL-BREF to examine the convergent validity and discriminant validity. The reliability was evaluated by examining internal consistency and test-retest reliability. RESULTS: The result of expert consultation showed that the S-CVI was 0.894 and the I-CVI ranged from 0.70 to 1.00. The fit indices showed that the original correlated four-factor model of CDS was adequate: χ2 = 268.397; df = 243; χ2 /df = 1.105; RMSEA = 0.023; CFI = 0.985; NNFI = 0.869; TLI = 0.982; IFI = 0.986. The score of CDS was positively strong associated with the scores of CBI (r = +0.764); negatively correlating with the scores of WHOQOL-BREF (r = -0.627). The Cronbach's alpha was 0.840; intraclass correlation coefficient (ICC) value was 0.843. CONCLUSIONS: The Chinese version of the CDS is a valid and reliable tool to evaluate burden for caregivers of children with CP in China.

Assessment of Characteristics and Exposure to Vulnerable Factors for Drug use among Male Illicit Drug Users in Sri Lanka: A Multicenter Cross-Sectional Study.

Background: Illicit drug use has become a significant public health problem in Sri Lanka. This study was conducted to assess characteristics and exposure to vulnerable factors for drug use among institutionalized male drug users. Methodology: A cross-sectional study was conducted among 431 institutionalized male drug users from five selected rehabilitation centers in Sri Lanka. An interviewer-administered questionnaire was used for data collection. The history of exposure to vulnerable factors was assessed using a series of questions based on existing evidence. Chi-square test was used to identify factors associated with exposure to vulnerable factors for drug use at 0.05 significance level. Results: Experimental usage, peer pressure, being unaware about harmful outcomes of drug use, ability to conceal drug use behavior from family, easy accessibility, previous use of alcohol and tobacco, history of exposure to psychoactive substance use within the usual living set up, being in a family with inadequate protection and an unsatisfactory parenting status were identified as common characteristics of people with illicit drug use disorders and drug use behavior. The age of the first drug use was positively correlated with the age of the first alcohol use (r = 0.687; P < 0.01) and first smoking (r = 0.732; P < 0.01). Ethnicity, area of residence, severity of drug use, and age of initiation of drug use had statistically significant association with exposure to vulnerable factors for drug use (P < 0.05 for all). Conclusion: Characteristics of people with illicit drug use disorders and drug use behavior were varied while the history of exposure to vulnerable factors for drug use was not uncommon in the sample. The study recommends considering these study findings during designing appropriate preventive and harm reduction strategies for illicit drug use.

Migraine, attention deficit hyperactivity disorder and screen time in children attending a Sri Lankan tertiary care facility: are they associated?

BACKGROUND: Headache and Attention Deficit Hyperactivity Disorder (ADHD) are two relatively common, neuropsychiatric conditions seen in children. Recent studies have shown an association between these two disorders, which are otherwise distinct conditions. This study aims to assess the association between migraine and ADHD, as well as the association between screen-time and these two conditions, among children attending a Sri Lankan tertiary care facility. Possible associations will have important implications in the clinical management of these conditions. METHODS: This was a comparative cross-sectional study of 226 children aged 5-14 years, attending clinics at a tertiary care hospital in Galle, Sri Lanka. Of them, 141 had a diagnosis of migraine and 85 did not have migraine. The presence or absence of ADHD and the use of screen-time among the two groups was analysed. Chi-square test and Mann-Whitney U test was used to assess the associations between these variables. RESULTS: Approximately 5% of the children with migraine had clinically diagnosed ADHD, compared to 3.5% of those without migraine (p = 0.862). The median SNAP-IV scores (inter-quartile range) of the children with migraine and without migraine were 0.60 (0.27-1.00) and 0.44 (0.16-0.80) respectively (p = 0.014). There was no significant difference in screen-time hours per day between children with and without clinically diagnosed ADHD. However, a significant difference in median screen-time (hours per day) was observed between children with and without migraine (2.0 h and 1.0 h respectively; p = 0.012). CONCLUSIONS: Our findings suggest that children with migraine are more likely to show features of hyperactivity/impulsivity and inattentiveness than those without migraine. While no association was found between clinically diagnosed ADHD and screen-time, migraine was associated with longer daily screen use. Screening for ADHD in children diagnosed with migraine may be of benefit. Further studies are required to understand the possible benefits of reducing screen-time in children with migraine.

Prevalence, antibiotic sensitivity pattern and genetic analysis of extended spectrum beta lactamase producing Escherichia coli and Klebsiella spp among patients with community acquired urinary tract infection in Galle district, Sri Lanka

Introduction: Community acquired urinary tract infections (CA-UTI) are commonly caused by Escherichia coli and Klebsiella spp which are known extended spectrum beta lactamase (ESBL) producers. Objectives: To determine, the prevalence and characteristics of ESBL producing of E. coli and Klebsiella spp in the community, and the association of risk factors with ESBL CA-UTI. Methods: Descriptive cross-sectional study with urine cultures performed from clinically suspected CA-UTI patients by CLSI standards. Conventional multiplex PCR was performed for gene analysis. Results: Cultures were positive in 178 (38%) patients from 465. Majority were females (103, 58%). Most frequently isolated was E. coli (149, 84%) with 68(46%) ESBL producers followed by 16(9%) Klebsiella pneumoniae with 4 (25%) ESBL producers. Majority of patients with ESBL CA-UTI were >50 yrs (35/72, 49%) and 13 (18%) children <10 years were present. ABST of ESBL producers revealed high resistance rates for quinolones (41%) and >80% sensitivity for nitrofurantoin, fosfomycin, mecillinam, aminoglycosides and carbapenems. Presence of ESBL genes were 83% CTX ­M, 71% OXA, 24% TEM and 9% SHV with one organism often producing more than one gene in 29 isolates (71%). Haematuria and structural abnormalities of urinary tract were significantly associated with increased ESBL CA-UTI (p<0.01). Conclusions: ESBL prevalence of this community was 40% in CA-UTI with E.coli predominance among female majority. >80% ESBL organisms show high sensitivity for aminoglycosides, carbapenems, nitrofurantoin, mecillinam and fosfomycin. Frequently isolated ESBL gene was CTX-M. Haematuria and structural abnormalities of urinary tract were significantly associated with ESBL CA-UTI

Perceptions on Diet and Dietary Modifications during Postpartum Period Aiming at Attenuating Progression of GDM to DM: A Qualitative Study of Mothers and Health Care Workers.

BACKGROUND: Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. METHODS: The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. RESULTS: Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. CONCLUSIONS: This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers.

Caregiver Difficulties Scale (CDS): Translation and Psychometric Evaluation Among Iranian Mothers of Cerebral Palsy Children.

The aim of this study was to investigate of psychometric properties of the Caregiver Difficulties Scale (CDS) for Iranian caregivers of children with cerebral palsy (CP). After a forward-backward translation, the Persian version of CDS (P-CDS) was administered to 151 Iranian mothers of CP children. The confirmatory factor analysis (CFA) was applied to measure the factor structure of P-CDS. The reliability was evaluated by examining internal consistency and test-retest method over a 2-week period using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. The construct validity was assessed by measuring the association between the scores of the P-CDS and Caregiver Burden Scale (CBS), World Health Organization Quality of Life (WHOQOL-BREF), the Beck Depression Index (BDI II), and the Fatigue Severity Scale (FSS). The fit indices showed that the original model of CDS was relatively adequate (χ2/df = 2.03, CFI = 0.90, TLI = 0.88 and RMSEA = 0.08). All domains of P-CDS met the minimum reliability standards (Cronbach'salpha and ICC > 0.7). All subscales of P-CDS were positively correlated with the CBS, BDI-II and FSS and negatively correlated with the WHOQOL-BREF. The results showed that P-CDS is a valid and reliable measure for assessing the burden of care in Iranian mothers of CP children.

Preventing ragging: outcome of an integrated programme in a medical faculty in Sri Lanka.

Ragging is prevalent in higher educational institutes in Sri Lanka and the deaths of some new entrants in the past have been directly linked to physical and emotional torture caused by cruel acts of ragging. Although there are general anti-ragging rules in place, the effectiveness of these measures is unknown. We developed an action plan to prevent ragging by integrating the views of the major stakeholders, implemented the plan and assessed its success. This article highlights the action plan and its success in a medical faculty in southern Sri Lanka.

Exploring the factors that influence the perceptions of disability: a qualitative study of mothers of children with disabilities at a community-based rehabilitation centre in Sri Lanka.

BACKGROUND: The prevalence of disability is growing worldwide; however, perceptions regarding disability are not well understood. The aim of this study was to explore factors that influence the perception of disability among mothers of children with disabilities who were attending a community-based rehabilitation facility in Sri Lanka. METHODS: A descriptive qualitative research design was employed. Thirteen semi-structured interviews were conducted with participants receiving rehabilitation services at a community-based facility. Interviews were recorded, transcribed and coded using software for qualitative data. RESULTS: Three major themes emerged from the analysis: (i) level of family and community support; (ii) spiritual and cultural interpretations of disability; and (iii) outcomes of rehabilitation services. Perceptions of disability appeared to be strongly influenced by the social, community and spiritual/cultural support structure in which the mothers lived. In particular, the support from the participant's spouse emerged as a primary factor exerting strong influence on perception, and future outlook, among the participants. Engagement in community-based rehabilitation programming also reinforced positive perceptions, created a sense of hope among participants regarding their child's future, and established aspirations for future education and employment opportunities alongside social integration. CONCLUSION: Knowledge of factors that influence the perception of disability can inform future implementation of public-health and community-based initiatives, and may improve social integration of children with disabilities in lower-resource settings.

Factors associated with caregiver burden among caregivers of children with cerebral palsy in Sri Lanka.

A cross-sectional study was conducted among 375 caregivers of children with cerebral palsy attending a tertiary care setting in Sri Lanka, to identify factors associated with caregiver burden. Caregiver burden was defined as "caregiver's response to various stressors associated with caregiving" and was measured using Caregiver Difficulties Scale (CDS), developed specifically for this purpose. Multivariate linear regression was used to assess associations between sociodemographic, stressor, and coping factors and caregiver burden; and to examine whether coping reduces the effect of stressors on burden. Low income, rural residence, male sex, and number of functional deficits of the disabled child correlated significantly with higher caregiver burden, while spousal support correlated with lower burden. Seeking social support reduced the increased burden associated with greater functional impairments. Psychosocial interventions focused on evaluating and improving social support for caregivers may help families at high risk for caregiver distress, to minimize negative outcomes.