Validation of Adolescent Suicide Assessment Protocol-20 (ASAP-20) to Sri Lankan adolescents.

PURPOSE: Youth suicide rates are rising worldwide, including Sri Lanka, where 46.5/100,000 among 15-19yrs was reported in 1986. Identifying high risk adolescents is vital. Dearth of trained professionals, demands an instrument utilizable by non-psychiatrists. Such was not available in Sinhalese. Adolescent Suicide Assessment Protocol (ASAP-20) and its' manual was translated and validated to Sri Lankan adolescents. METHOD: A validation study. Forward/back translations followed by cultural adaptation. Face validity, operational equivalence were assessed. Panel of Psychiatrists assessed semantics, conceptual, content/construct validity using external criticism. Final Sinhalese version was applied to 100 Sinhalese speaking 10-19yr olds referred to Psychiatry units of two Teaching Hospitals following a suicide attempt or with suicidal ideation (cases) excluding psychotic disorder, acute emergencies or special needs and compared with same aged adolescents on treatment for respiratory problems as controls. Discriminant ability was calculated using area under the Receiver Operating Curve (AUC). Reliability was calculated using Cronbach's alpha. RESULTS: Sinhalese version showed satisfactory face/contents/construct validity and operational equivalence. Median suicide risk score was 18 and mean 17.99 (SD = 7.56) for cases, median = 4 and mean = 4.86 (SD = 2.41) for controls. AUC was 0.969 (SE = 0.11), indicating a high ability to discriminate moderate/high from low suicidal risk. Cut off value, 8.5 was lower than original tool at a sensitivity of 91% and a specificity of 91%. Cronbach's alpha was 0.811 indicating high reliability and consistency. CONCLUSION: Sinhalese version of ASAP-20 is a successful screening instrument to detect high suicide risk among adolescents in clinical and non clinical settings.

Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains.

UNLABELLED: Objective This study was conducted to determine the most effective thermal modality; heat or contrast therapy-in reducing pain, reducing swelling, and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Design Randomized control trail. Methods One hundred and fifteen participants of both genders who were diagnosed as having grade I or II lateral ankle sprain were randomly assigned to the study on the fifth day of injury. Pain, volume, and ROM were recorded before and after treatment continuously for 3 days. Results Effects were evaluated as "Immediately after application" and "3 days after continuous application." Immediately after application, there was no difference between the 2 modalities on ankle ROM; heat reduced pain over contrast therapy, and both modalities increased swelling. When considering the effects after continuous application for 3 days, no difference was found between the 2 modalities on ROM and the reduction of pain. Contrast therapy reduced swelling while heat caused increased swelling even after 3 days. Conclusion The use of different thermal modalities during the transition from the acute to chronic phase of injury can be suggested as effective treatment options according to the objectives of injury management: pain reduction, improve ROM, and swelling management. LEVELS OF EVIDENCE: Therapeutic, Level II: Randomized clinical trial.

Prevalence of behavioral and emotional problems among seven to eleven year old children in selected schools in Kandy District, Sri Lanka.

BACKGROUND: Behavioral and emotional problems comprising internalizing, externalizing and mixed disorders consist of psychiatric disorders in childhood and adolescents. Prevalence rates of 8.3% for preschoolers, 12.2% for preadolescents and 15.0% for adolescents have been reported from around the world. This study aimed to measure the prevalence of emotional and behavioral disorders in 7-11 year-old school children studying in Kandy District Sri Lanka which was a first for the geographic area. METHOD: This was a community based study at the primary section of the selected schools. The questionnaire, Child behavior Checklist-Sinhala (CBCL-S) was administered in a group setting to the main caregiver of 562 subjects selected randomly. The questionnaire identified problems in 8 subscales under three main sub categories : internalizing, externalizing and other. Data were analyzed using The Syndrome Scales for Boys and Girls developed for analyzing the questionnaire CBCL. RESULTS: Indicated a prevalence of 13.8% of emotional and behavioral problems in the study population. 8.8% of children showed internalizing problems and 8.8% externalizing problems. These findings are in line with the prevailing rates from previous studies of the world. Children in school types 1AB and 1C had less emotional and behavioral problems compared to type 2 and 3 schools. LIMITATIONS: Only 20 schools in KEZ and Sinhala speaking population of the Kandy were studied. CONCLUSIONS: This study showed the extent of childhood emotional and behavioral problems and also confirms that the schools with advanced level classes have lesser problems amongst primary children.

The development and validation of the Peradeniya Depression Scale (PDS)--a culturally relevant tool for screening of depression in Sri Lanka.

BACKGROUND: Cultural factors may influence the manner in which a given population interprets and conceptualizes their experience of depression. The aim of this study is to validate the Peradeniya Depression Scale (PDS), a locally created, culturally relevant tool for detection of depression in Sri Lanka. METHOD: Fifty currently depressed patients (diagnosed via the Structured Clinical Interview for DSM Disorders) and 50 (non-depressed) controls were administered the PDS. RESULTS: At a score of 10/25 the PDS showed a sensitivity 88.5% and specificity of 85.0% with regards to the detection of depression. Culturally appropriate statements, which referred to international criteria of depression and somatic symptoms, showed significantly higher odds of being positive in depressed patients compared to controls. LIMITATIONS: The PDS was validated among an outpatient population presenting to a psychiatry clinic in a government hospital in Peradeniya, Sri Lanka. While this is fairly representative of patients presenting to government hospital clinics in this country, further multi-centre studies in different areas of the country maybe useful. CONCLUSION: The PDS is the first screening tool for depression developed and validated in Sri Lanka, written in Sinhalese, taking into account cultural expressions and idioms of the illness. It shows satisfactory sensitivity and specificity as a screening tool for depression. The findings also suggest that it maybe worthwhile for Asian countries to consider adopting scales which are based on internationally accepted diagnostic criteria for depression, but which incorporate expressions that are more appropriate to their own culture and language.

Xanthones from roots of Calophyllum thwaitesii and their bioactivity.

Extracts from three Calophyllum species endemic to Sri Lanka were tested for antifungal and antioxidant activities. Of them, only the root methanol extract of Calophyllum thwaitesii showed activity, and the active extract on activity guided fractionation yielded four antifungal active and three inactive xanthones. Antifungal active xanthones were identified as 1,6-dihydroxy-5-methoxyxanthone, 1-hydroxy-5,6-dimethoxyxanthone, 1-hydroxy-5-methoxyxanthone and 1-methoxy-5-hydroxyxanthone, using spectroscopic methods and comparison with literature data. Inactive compounds were identified as 1-hydroxy-7-methoxyxanthone, 1,5-dihydroxy-6-methoxyxanthone and 1,7-dihydroxy xanthone. This is the first report of above xanthones except the latter from C. thwaitesii. Further, five of the above xanthones along with thwaitesixanthone and calothwaitesixanthone, which have been previously reported from the root bark of the same species, showed free radical scavenging properties when tested with DPPH. Further, this is the first report of methylated xanthones from C. thwaitesii. Previous work on stem bark, root bark and the stem of the same species yielded only nonmethylated xanthones, indicating the absence of methylating enzymes in the plant. However, this new finding suggests the presence of methylating enzymes in the root stem of C. thwaitesii.

A geranylated biphenyl derivative from Garcinia malvgostana.

Extracts of root bark, stem bark and the latex collected from the green fruits of Garcinia mangostana gave alpha-mangostin, beta-mangostin, gamma-mangostin, garcinone-E, methoxy-beta-mangostin and a new geranylated biphenyl derivative 3-hydroxy-4-geranyl-5-methoxybiphenyl. The latex of G. mangostana consists of more than 75% of xanthones which have strong antibacterial (anti-MRSA and -VRE), anti-inflammatory, antifungal and a number of other biological activities. Hence the presence of the above highly bioactive compounds in large quantities should be the causative factor for G. mangostana's medicinal value in indigenous medicine.

Granular friction, Coulomb failure, and the fluid-solid transition for horizontally shaken granular materials.

We present the results of an extensive series of experiments, molecular dynamics simulations, and models that address horizontal shaking of a layer of granular material. The goal of this work was to better understand the transition between the "fluid" and "solid" states of granular materials. In the experiments, the material-consisting of glass spheres, smooth and rough sand-was contained in a container of rectangular cross section, and subjected to horizontal shaking of the form x=A sin(omega(t)). The base of the container was porous, so that it was possible to reduce the effective weight of the sample by means of a vertical gas flow. The acceleration of the shaking could be precisely controlled by means of an accelerometer mounted onboard the shaker, plus feedback control and lockin detection. The relevant control parameter for this system was the dimensionless acceleration, Gamma=Aomega(2)/g, where g was the acceleration of gravity. As Gamma was varied, the layer underwent a backward bifurcation between a solidlike state that was stationary in the frame of the shaker and a fluidlike state that typically consisted of a sloshing layer of maximum depth H riding on top of a solid layer. That is, with increasing Gamma, the solid state made a transition to the fluid state at Gamma(cu) and once the system was in the fluid state, a decrease in Gamma left the system in the fluidized state until Gamma reached Gamma(cd)

Family planning performance at a major hospital in Sri Lanka.

PIP: 862 men attending the family health clinic, General Hospital, Kurunegala, Sri Lanka for sterilization over the October 1, 1982-March 1983 period were interviewed to study the characteristics of the men attending the clinic and to assess the popularity of vasectomy over other methods of family planning. For the study to be more comprehensive, the figures of the family planning activities of the hospital from 1977-82 also were examined. 438 (55.5%) of the study subjects were paddy cultivators. 71 of the men were in the 16-25 age group, 422 in the 26-35 age group, 272 in the 36-45 age group, and 97 in the 46 and older age group. 725 (85%) of the men were literate. Middle income groups comprised the major segment of men in this series. In 544 (63.1%) the vasectomy was motivated by friends and relatives; only 15 (2.0%) were motivated by health staff. 821 of the men (95.3%) belonged to the 16-39 age group. A table summarizes the relationship between age of the last living child and vasectomy performance. For 279 of the men, the age of their last living child was less than 1 year; it was 1-2 years for 218 men, 2-3 years for 180 men, and 3 or more years for 185 men. Study observations indicate that a consensus is becoming established about the role played by the male partner in family planning. The incentive scheme, acceptability and safety of the method, and a change in life styles should be considered. In the 862 vasectomies performed, there were no major complications or failures in contraception. Some pertinent factors for the favorable trend in vasectomy at this clinic are: health education talks delivered by a trained staff nurse at this clinic, outpatient department, and wards of the hospital; motivation activities of the community development social workers in the field; this clinic being the leading clinic of the limited number of institutions in Kurunegala conducting regular male sterilization clinics, and personality characteristics of the medical officer, staff, and the facilities available at the clinic. The middle months and the latter part of the year were the most popular periods at this clinic. These months represent the nonharvesting season. The study shows that the small family norm has been preferred by the majority; only 111 had more than 3 living children. Better education, better communication, and better approach methods may improve vasectomy acceptance rates.^ieng