Depression among older people in Sri Lanka: With special reference to ethnicity.

AIM: To ascertain if the factors associated with depression differ among ethnic groups in community-dwelling older people in Kandy District, Sri Lanka. METHODS: A cross-sectional survey was carried out of people aged ≥60 years living in a single divisional secretariat of Kandy District. The participants were asked about ethnicity (Sinhalese, Tamil and Muslim), sociodemographic characteristics and depression status by face-to-face interviews with a structured questionnaire. Depression was measured by the 15-item Geriatric Depression Scale, and the total score of ≥6 was considered as depression. The χ2 -test and multivariate logistic regression with two-way interaction terms between sociodemographic characteristics and ethnicity were carried out. RESULTS: Participants (n = 778) consisted of 56.6% Sinhalese, 22.1% Tamils and 21.3% Muslims. Of the participants, the prevalence of depression was 31.8% (27.3% in Sinhalese, 42.1% in Tamils and 32.9% in Muslims). Multivariate analyses showed that there were no significant interactions between sociodemographic characteristics and ethnicity. However, low economic status, low perceived social support and more than two self-reported diseases were significantly associated with depression in all ethnic groups. CONCLUSIONS: Some factors were found to be significantly associated with depression, but did not differ among ethnic groups. The findings would help practitioners to identify older people with a high risk of depression, and to intervene in its development or exacerbation. Geriatr Gerontol Int 2017; 17: 2414-2420.

Trends in the growth of literature of telemedicine: A bibliometric analysis.

Over the past two decades, the use of telemedicine as a way to provide medical services has grown as communication technologies advance and patients seek more convenient ways to receive care. Because developments within this field are still rapidly evolving, identifying trends within telemedicine literature is an important task to help delineate future directions of telemedicine research. In this study, we analyzed 7960 telemedicine-related publication records found in the Science Citations Index - Expanded database between 1993 and 2012. Bibliometric analyses revealed that while the total growth in telemedicine literature has been significant in the last twenty years, the publication activity per country and over time has been variable. While the United States led the world in the cumulative number of telemedicine publications, Norway ranked highest when we ordered countries by publications per capita. We also saw that the growth in the number of publications per year has been inconsistent over the past two decades. Our results identified that neuroscience neurology and nursing as two fields of research in telemedicine that have seen considerable growth in interest in this field, and are poised to be the focus of research activity in the near future.

Outcomes of a school-based intervention on rabies prevention among school children in rural Sri Lanka.

BACKGROUND: In Sri Lanka, one of the major challenges in rabies control is to manage the dog population and subsequently to protect people, especially young children, from dog bites. METHODS: In 2009, an educational-entertainment campaign called 'Rabies Edutainment 4 Kids' was introduced in the school curricula in rural Sri Lanka to improve practices on rabies prevention and pet care among school children, and to evaluate its effectiveness through pre- and post-tests. RESULTS: The level of rabies knowledge, attitude and practice among the pupils was dependent on their responses to a survey, and scores were significantly improved both among the study and control groups after the intervention. A lecture accompanied by a rabies awareness leaflet was much more effective in improving knowledge than the leaflet alone. The type of intervention and language used was significantly associated with the score increment (p<0.001). CONCLUSIONS: The threat of rabies to pupils in Sri Lanka would be reduced if they are given appropriate information on rabies prevention as a part of the school curricula. Close collaboration with local education offices is key to successful implementation of school-based rabies control programmes, which is, in turn, crucial to the eradication of rabies from Sri Lanka.

Mental Health and Its Associated Variables Among International Students at a Japanese University: With Special Reference to Their Financial Status.

We attempted to identify the risk factors that may affect mental health status of the international students and we conducted the survey using a self-administered questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The students were divided into two groups; (1) those who received scholarships and (2) those who didn't since we thought the division represented practical patterns of their financial status. The associations of socio-demographic characteristics with depressive symptoms were examined. Of the 726 students, 480 (66.1%) responded and 207 (43.1%) had depressive symptoms. The logistic regression analysis indicated that quality of sleep, amount of exercise, and housing conditions--but not financial status--were statistically associated with the risk of developing depressive symptoms. Although the inversion of the cause and effect is yet to be ascertained, the students who are unsatisfied with their housing conditions, quality of sleep and less exercise need more attention.

Awareness and attitudes towards HIV/AIDS among residents of Kandy, Sri Lanka.

Currently, interventions for HIV/AIDS control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18-64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/AIDS-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/AIDS but the knowledge on HIV/AIDS was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/AIDS. The participants showed more positive attitudes towards HIV/AIDS and people living with HIV/AIDS (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/AIDS-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/AIDS to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/AIDS-related knowledge score, targeted HIV/AIDS-related health education interventions maybe recommended in this regard.

Gender-based seasonality of suicide in Japan, 2005-2012.

This study aimed to explore the gender-based seasonal patterns of suicide in Japan between 2005 and 2012. With data from Japanese official reports, we carried out Prais-Winsten regression and Wilcoxon signed-rank test analysis with Stata 12.0 and SPSS 14.0. The suicide number was significantly higher in March, April, May, June, July, and October for both genders. The suicide number in men was markedly higher than that in women in every month. The suicide number in 2010 was lower than that in 2009 for men, while that in 2011 was higher than that in 2010 for women. The findings displayed that the nationwide television and publicity intervention campaigns might have positive effects on decreasing suicide of men while women suffered a post-earthquake increase. In terms of interventions, we should not only square up the seasonal patterns but also the gender differences in vulnerability.

Road traffic crashes and fatalities in Japan 2000-2010 with special reference to the elderly road user.

OBJECTIVE: To investigate comparative road user crash and fatality rates in Japan between 2000 and 2010 in the elderly and young. METHODS: Data from the Japan Ministry of Health, Labor and Welfare Vital Statistics Database and the Institute for Traffic Accident Research and Data Analysis were used to calculate crash rates by age group, vehicle, and license category. RESULTS: Fatal crash rates per 100,000 licensed drivers for 4-wheeled motor vehicle drivers decreased by 53, 56, and 42 percent among the 65-69, 70-74, and ≥75 age groups between 2000 and 2010, respectively, compared to 66 and 60 percent among the 16-19 and 20-24 age groups, respectively. Fatal crash rates per 100,000 licensed riders for 2-wheeled motor vehicles decreased by 64, 23, and 33 percent in the 65-69, 70-74, and ≥75 age groups, respectively. Similarly, fatal crash rates per million population among bicyclists and pedestrians decreased in all age groups but were highest in the elderly age group in all years; the annual fatal crash rate for elderly pedestrians was 3 to 10 times higher than that for younger pedestrians. CONCLUSIONS: Despite the overall decrease in the elderly crash and fatal crash rates in all road use categories, elderly pedestrians are more susceptible to road traffic crashes and are more likely to be killed than younger persons. Further research may reduce this risk.

Is the reporting timeliness gap for avian flu and H1N1 outbreaks in global health surveillance systems associated with country transparency?

BACKGROUND: This study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 (IHR 2005) and to explore the association between country transparency and this timeliness gap. METHODS: We recorded the initial release dates of each report related to avian flu or H1N1 listed on the WHO Disease Outbreak News site and the matching outbreak report from ProMED-mail, a non-governmental program for monitoring emerging diseases, from 2003 to the end of June 2009. The timeliness gap was calculated as the difference in days between the report release dates of the matching outbreaks in the WHO and ProMED-mail systems. Civil liberties scores were collected as indicators of the transparency of each country. The Human Development Index and data indicating the density of physicians and nurses were collected to reflect countries' development and health workforce statuses. Then, logistic regression was performed to determine the correlation between the timeliness gap and civil liberties, human development, and health workforce status, controlling for year. RESULTS: The reporting timeliness gap for avian flu and H1N1 outbreaks significantly decreased after 2003. On average, reports were posted 4.09 (SD = 7.99) days earlier by ProMED-mail than by the WHO. Countries with partly free (OR = 5.77) and free civil liberties scores (OR = 10.57) had significantly higher likelihoods of longer timeliness gaps than non-free countries. Similarly, countries with very high human development status had significantly higher likelihoods of longer timeliness gaps than countries with middle or low human development status (OR = 5.30). However, no association between the timeliness gap and health workforce density was found. CONCLUSION: The study found that the adoption of IHR 2005, which contributed to countries' awareness of the importance of timely reporting, had a significant impact in improving the reporting timeliness gap. In addition, the greater the civil liberties in a country (e.g., importance of freedom of the media), the longer the timeliness gap.

Gender gaps in life expectancy: generalized trends and negative associations with development indices in OECD countries.

BACKGROUND: Life expectancy (LE) is a major marker of individual survival. It also serves as a guide to highlight both the progress and the gaps in total social and societal health. Comparative LE in concert with measures of gender-specific experience, indices of empowerment and societal happiness and development offer a comparative tool to examine trends and similarities of societal progress as seen through the lens of cross-national experience. METHODS: To determine the gender gaps in LE (GGLE) trends, we performed a longitudinal analysis, covering a period of 49 years (1960-2008). To examine the association of GGLE with development indices, we used the 2007 GGLE data, the newest happiness data mostly drawn from 2006; the 2006 Human Development Index (HDI) data and the 2006 Gender Empowerment Measure (GEM) data. RESULTS: It revealed that most of the Organization for Economic Co-operation and Development (OECD) countries had a GGLE trend that occurred in an inverted U-curve fashion. We divided them into three subgroups based on the peak years of respective GGLE. The earlier the peak year, the happier the countries, the higher the HDI and the smaller the current GGLE are. Association analysis indicates that Happiness, HDI and GEM are all negatively associated with GGLE. CONCLUSION: This pattern suggests that GGLE undergoes three phases of growth, peak and stability and decline. Japan will soon be seeing its GGLE gradually shrinking in the foreseeable future. The continuing increases in Happiness, HDI and GEM are associated with a decrease in GGLE, which should be carefully taken into consideration.

Trends of gender gaps in life expectancy in Japan, 1947-2010: associations with gender mortality ratio and a social development index.

AIM: This study analyzed the trend of gender gaps in life expectancy (GGLE) in Japan between 1947 and 2010, and explored the correlations of GGLE with gender mortality ratio and social development indices. METHODS: Using GGLE and social indices data collected from the official websites, we carried out trends analysis of GGLE by calculating segmented average growth rates for different periods. We explored the association between GGLE and all-cause mortality; and between GGLE and Human Development Index (HDI) while controlling for time trend, by computing the generalized additive models based on the software R (version 2.15). RESULTS: Japan's GGLE increased in a fluctuating fashion. Across 53 years, the average growth rates varied widely: 0.14% (1947-1956), 1.43% (1956-1974), 1.06% (1974-2004) and -0.60% (2004-2010) (overall average 0.87%). The value of GGLE peaked to 7.00 years in 2004, and then has slowly declined (6.75 years in 2010). Age-adjusted all-cause gender mortality ratio had a statistically positive association with GGLE (P<0.01), whereas HDI was found to have no such association. CONCLUSION: The increased trend of GGLE in Japan could be partly explained by increased disease-specific mortality ratios (male/female), especially those involving chronic bronchitis and emphysema, diseases of the liver, suicide and cancer. The recent decline of GGLE might imply that Japanese women have been catching up with the lifestyle of men, resulting in similar mortality patterns. This calls for gender-sensitive approaches to developing policies and programs that will help sustain healthy lifestyles to combat smoking and alcohol intake, and social support to prevent suicide.

Religious leaders as potential advocates for HIV/AIDS prevention among the general population in Sri Lanka.

Religious leaders in Sri Lanka may have a high potential of contributing to HIV/AIDS prevention among the general public because of their social status. In order to assess their current HIV/AIDS-related knowledge and attitude and the possibility of becoming community advocates of HIV/AIDS prevention, we conducted a questionnaire survey among Buddhist, Hindu, Muslim and Christian leaders in Sri Lanka in 2009. There were limited correct responses about HIV/AIDS-related knowledge and attitudes toward people living with HIV/AIDS (PLHIV), and information regarding condoms, HIV testing and counselling were poorly understood. Although a condom was less acceptable as a part of HIV/AIDS prevention, they were willing to learn more about HIV/AIDS and expressed support for both PLHIV and HIV prevention activities. Their experiences, preparedness and willingness of HIV prevention activities were associated with age, knowledge and/or religious background. In conclusion, intensive and systematic learning opportunities should be provided to equip the religious leaders with overall HIV/AIDS knowledge to become key players for HIV/AIDS prevention in their communities.

Leptospira infection at the University of Peradeniya Teaching Hospital, Sri Lanka: clinical and laboratory investigations.

To help formulate a local intervention for leptospirosis in Sri Lanka, we determined the serogroups of leptospiral species among 97 patients diagnosed with leptospirosis at the University of Peradeniya Teaching Hospital, Sri Lanka. Ninety-two point eight percent of the patients were men; nearly two-thirds were > or = 35 years old; the majority had secondary or higher education level, half were farmers or laborers; and 57.7% presented in the acute-phase of the illness. Twenty-five patients (25.8%) were confirmed to have leptospirosis by a positive laboratory method; 17 and 8 cases were confirmed with a positive test by quantitative MAT and nested PCR, respectively. Of the 17 MAT positive cases, infection occurred in a variety of serogroups, but the predominant groups were Sejroe and Tarassovi. Of the 8 nested PCR positive cases, 7 were seen among those with a MAT titer <200 and 1 occurred in a patient with a MAT titer > or = 200 but <400. Of the 8 PCR positive cases, 7 were infected with the leptospiral species L. interrogans. Approximately 26% of the clinically diagnosed patients were confirmed by the two laboratory methods. Laboratory positivity was based on the time of blood collection after the onset of fever. Further studies are warranted to refine the clinical diagnostic criteria and to develop more efficient and accurate diagnostic tests for leptospirosis in resource limited settings.

Analysis of hospital-based sentinel surveillance data on leptospirosis in Sri Lanka, 2005-2008.

In Sri Lanka, leptospirosis is a notifiable disease. In addition to having a routine disease reporting system, Sri Lanka has implemented a hospital-based sentinel surveillance system since 2004. This report discusses the findings of a descriptive analysis of the sentinel surveillance data collected from 2005 to 2008. Of the 4,000 suspected leptospirosis cases, 46.9% and 26.8% were recorded from the Western and Sabaragamuwa provinces, respectively. Most of the individuals were male (83.5%), and approximately 45.6% were aged 30-49 years. Farmers accounted for 16.5%, and laborers for 16.1%; however, the occupation of nearly half (44.8%) of the study population was unknown. More than half (53.9%) of the individuals worked in paddy fields. Almost all had acute fever (98.8%), myalgia (92.9%), and headache (92.7%), but fewer had other related symptoms. Out of the 4,000 individuals, 2,496 (62.4%) underwent a laboratory test; however, the laboratory test results of only 1,445 (57.9%) and the microscopic agglutination results of 41 (2.8%) were available at the sentinel sites. Less than 2% of the reported individuals underwent prophylactic treatment. These findings will help enhance the ongoing efforts for controlling and preventing leptospirosis in Sri Lanka. Sentinel surveillance is a useful tool, but the data quality needs to be improved by supplementing the findings with adequate laboratory diagnosis data.

Which categories of social and lifestyle activities moderate the association between negative life events and depressive symptoms among community-dwelling older adults in Japan?

BACKGROUND: Social and lifestyle activities may serve as potential moderators of the association between negative life events (NLEs) and depressive symptoms among older adults. In this study, we examined whether social and lifestyle activities moderate the association between NLEs and depressive symptoms among older adults, and which activities are significant moderators. METHODS: The data came from a community-based sample of non-institutionalized adults aged 65 years or older. Of the 731 eligible older adults, 682 completed the Japanese version of the 30-item Geriatric Depression Scale. We measured 15 specific negative life events as well as 17 social and lifestyle activities which were grouped into four categories. RESULTS: Specific NLEs pertaining to human relationships, physical condition and financial status were all or were mostly associated with depressive symptoms. Significant moderating roles of social and lifestyle activities on the association of NLEs with depressive symptoms were observed between "loss of a significant other" and "contact with family members and friends" (ß = -0.282, SE = 0.091, p = 0.002); "change in human relationships" and "contact with family members and friends" (ß = -0.270, SE = 0.137, p = 0.048); and "change in human relationships" and "community involvement" (ß = -0.344, SE = 0.133, p = 0.010). CONCLUSIONS: The most statistically significant variable moderating the associations between negative life events and depressive symptoms was "having frequent contact with family members". Depressive symptoms arising from troublesome interpersonal relationships in one's proximal network might be moderated by positive interpersonal relationships.

Prevalence and carrier status of leptospirosis in smallholder dairy cattle and peridomestic rodents in Kandy, Sri Lanka.

Leptospirosis is an important bacterial zoonotic disease globally and one of the notifiable diseases in Sri Lanka. Other than human leptospirosis, little information is available on leptospirosis in domestic and feral animals in Sri Lanka. Thus, this study attempted to determine the prevalence and carrier status of leptospirosis in smallholder dairy cattle and peridomestic rodents to understand the impact of the disease on public health in Kandy, Sri Lanka. Cattle and rodent samples were collected from the Yatinuwara and Udunuwara divisional secretaries in Kandy. Serum samples were analyzed for the presence of antileptospiral antibodies using microscopic agglutination test. DNA was extracted from cattle urine and rodent kidney tissue samples, in which polymerase chain reaction was carried out to detect the Leptospira flaB gene. The cattle in 19 (38.8%) of the 49 farms harbored antileptospiral antibodies. Out of 113 cattle serum samples, 23 (20.3%) were positive; 17 (73.9%) and 6 (26.1%) reacted with serogroups Sejroe and Hebdomadis, respectively. Out of the 74 rodent samples, 13 (17.5%) were positive; 8 (61.5%) and 4 (30.8%) had reactions to serogroups Javanica and Icterohaemorrhagiae, respectively. Leptospiral DNA was detected in one cattle urine sample and identified as Leptospira interrogans. This study revealed a high prevalence of leptospirosis in cattle and rodents in Kandy. These animals were infected with a wide array of leptospiral serogroups, which are consistent with the research findings observed in humans in Kandy. Overall, serological data indicate that relative to rodents, cattle may be a more significant reservoir for human transmission and a greater source of potential risk to local agricultural communities.

Serological evidence of Thailand virus-related hantavirus infection among suspected leptospirosis patients in Kandy, Sri Lanka.

A cross-sectional study was undertaken to determine the current prevalence of leptospirosis and hantaviral infections, and the socio-demographic characteristics and risk factors of infected patients, in Kandy, Sri Lanka. This report discusses the serological evidence of hantavirus infections among 105 suspected leptospirosis patients, 8 of whom had hantavirus antibodies. Serotyping ELISA showed that these 8 patients had high optical density values for Thailand virus. Most of the sera showed that the focus reduction neutralization test titer against Thailand virus was higher than that against Seoul virus, thereby suggesting that the hantaviral antibodies found in Sri Lanka are different from Seoul virus but closely related to Thailand virus. These findings imply that the hantaviral infection found in Kandy, Sri Lanka appears to be due to a virus similar to Thailand virus. Epidemiological analysis revealed that the association between hantavirus infection and socio-demographic characteristics was not statistically significant.

Fear of falling and falls self-efficacy and their relationship to higher-level competence among community-dwelling senior men and women in Japan.

AIM: This cross-sectional study examined the relationships of fear of falling and falls self-efficacy with higher-level competence among community-dwelling senior citizens in Japan. METHODS: Of the 822 registered senior citizens, 731 (89%) community dwellers were requested to participate in the survey using a mailed self-accomplished questionnaire. Data from 648 respondents with duly accomplished questionnaires were analyzed using R(2) , the coefficient of determination, based on a multivariate regression analysis. RESULTS: Fear of falling, low falls self-efficacy and higher-level functional disability were observed among respondents. Of the hypothesized relationships examined by sex, fear of falling was significantly associated with disability among male respondents and low falls self-efficacy among both sexes. Several confounding variables were strongly associated with competence. CONCLUSION: While the data underscore the strategic importance of promoting higher-level competence among the senior citizens, there is much to suggest that their competence is likely to be maintained if their fear of falling and falls self-efficacy were modified. Programs must also consider a wide array of intervening factors.

Accelerating the development of an AIDS vaccine: the AIDS vaccine for Asia Network (Avan).

HIV/AIDS is a major public health problem worldwide, especially in developing countries. The development of a safe and effective HIV vaccine is central to stopping the epidemic and would be a great public health tool. The AIDS Vaccine for Asia Network (AVAN) is a group of concerned investigators committed to assisting regional and global HIV vaccine efforts. AVAN's focus on improving the coordination and harmonization of research, ethical reviews, clinical trial capacity, regulatory frameworks, vaccine manufacturing, community participation, and government advocacy could help accelerate HIV vaccine efforts in the region. At a meeting in November 2010, researchers from various countries in Asia presented their progress in HIV vaccine research and development. Six working groups discussed the current status, gaps and methods to strengthen capacity and infrastructure in various areas related to AIDS vaccine research and development. These discussions led to the development of prioritized action plans for the next 5 years. This report describes the gaps and challenges HIV vaccine research faces in the region and recommends improvement and standardization of facilities, and coordination and harmonization of all activities related to AIDS vaccine research and development, including possible technology transfer when a vaccine becomes available.