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.

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.

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.

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.

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.

Student academic committees: an approach to obtain students' feedback.

In 1995, the Colombo Medical Faculty changed its curriculum from a traditional model to an integrated one. The major challenge to the Faculty was obtaining students' feedback on their learning activities. To overcome this, a new method where staff and student groups from different years of study engage in an interactive discussion relating to their learning environment was developed. This feedback was then processed and forwarded to the relevant authorities for necessary action.