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1.
J Med Case Rep ; 18(1): 270, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38840233

RESUMO

BACKGROUND: Kikuchi Fujimoto disease is a rare self-limiting disorder mainly affecting young Asian females. The typical presentation is unexplained fever with associated cervical lymphadenopathy. It can mimic many sinister diseases such as lymphoma, tuberculosis, and systemic lupus erythematosus. Aseptic meningitis due to Kikuchi disease is extremely rare, and majority were reported from Japan. There have been no published cases of aseptic meningitis due to Kikuchi disease in Sri Lanka. CASE PRESENTATION: A 29 years old Sri Lankan female presented with a prolonged fever for three weeks with an associated headache for five days duration. She developed painful cervical lymphadenopathy during the hospital stay. She has been previously well and had been vaccinated against COVID-19 six weeks before. Her lumbar puncture showed lymphocytic pleocytosis with marginally elevated protein levels and reduced ratio of serum to CSF sugar. Lymph node biopsy was consistent with necrotizing lymphadenitis. She was subsequently diagnosed with Kikuchi disease complicated with aseptic meningitis. She responded to corticosteroids well and had an uneventful recovery. CONCLUSION: Kikuchi disease is a rare self-limiting disorder that can be complicated with aseptic meningitis on infrequent occasions. Other conditions such as tuberculosis, lymphoma, systemic lupus erythematosus, and adult-onset Still's disease should be considered as differential diagnoses. Knowledge of Kikuchi disease and its complications will prevent unnecessary investigations which delay the early diagnosis and treatment.


Assuntos
Linfadenite Histiocítica Necrosante , Meningite Asséptica , Humanos , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/complicações , Feminino , Meningite Asséptica/etiologia , Adulto , COVID-19/complicações , Vacinas contra COVID-19/efeitos adversos , Sri Lanka , SARS-CoV-2
2.
BMC Prim Care ; 25(1): 200, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844839

RESUMO

BACKGROUND: Outpatient care is central to both primary and tertiary levels in a health system. However, evidence is limited on outpatient differences between these levels, especially in South Asia. This study aimed to describe and compare the morbidity profile (presenting morbidities, comorbidities, multimorbidity) and pharmaceutical management (patterns, indicators) of adult outpatients between a primary and tertiary care outpatient department (OPD) in Sri Lanka. METHODS: A comparative study was conducted by recruiting 737 adult outpatients visiting a primary care and a tertiary care facility in the Kandy district. A self-administered questionnaire and a data sheet were used to collect outpatient and prescription data. Following standard categorisations, Chi-square tests and Mann‒Whitney U tests were employed for comparisons. RESULTS: Outpatient cohorts were predominated by females and middle-aged individuals. The median duration of presenting symptoms was higher in tertiary care OPD (10 days, interquartile range: 57) than in primary care (3 days, interquartile range: 12). The most common systemic complaint in primary care OPD was respiratory symptoms (32.4%), whereas it was dermatological symptoms (30.2%) in tertiary care. The self-reported prevalence of noncommunicable diseases (NCDs) was 37.9% (95% CI: 33.2-42.8) in tertiary care OPD and 33.2% (95% CI: 28.5-38.3) in primary care; individual disease differences were significant only for diabetes (19.7% vs. 12.8%). The multimorbidity in tertiary care OPD was 19.0% (95% CI: 15.3-23.1), while it was 15.9% (95% CI: 12.4-20.0) in primary care. Medicines per encounter at primary care OPD (3.86, 95% CI: 3.73-3.99) was higher than that at tertiary care (3.47, 95% CI: 3.31-3.63). Medicines per encounter were highest for constitutional and respiratory symptoms in both settings. Overall prescribing of corticosteroids (62.7%), vitamin supplements (45.8%), anti-allergic (55.3%) and anti-asthmatic (31.3%) drugs was higher in the primary care OPD, and the two former drugs did not match the morbidity profile. The proportion of antibiotics prescribed did not differ significantly between OPDs. Subgroup analyses of drug categories by morbidity largely followed these overall differences. CONCLUSIONS: The morbidities between primary and tertiary care OPDs differed in duration and type but not in terms of multimorbidity or most comorbidities. Pharmaceutical management also varied in terms of medicines per encounter and prescribed categories. This evidence supports planning in healthcare and provides directions for future research in primary care.


Assuntos
Atenção Primária à Saúde , Atenção Terciária à Saúde , Humanos , Sri Lanka/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Atenção Primária à Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Assistência Ambulatorial , Multimorbidade , Idoso , Centros de Atenção Terciária , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/tratamento farmacológico , Comorbidade , Morbidade
3.
BMC Public Health ; 24(1): 1472, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824505

RESUMO

BACKGROUND: Social media has evolved beyond its conventional purpose of communication and information sharing to become a potent tool for disseminating health and oral health awareness. This study seeks to assess the patterns and related factors of using social media platforms to access health and oral health information among Sri Lankan adults, with special emphasis to promotion of oral health awareness. METHODS: In March 2023, individuals aged ≥ 18 years residing in Sri Lanka, who are users of social media participated in this electronic questionnaire-based survey. Statistical analyses of the collected data were done using the SPSS version 21 software, with a p-value of < 0.05 set to determine the level of statistical significance. RESULTS: A total of 421 persons participated in this survey. Majority (68.4%) belonged to the age category of 18 to 30 years, and 55.5% were females. WhatsApp (96.8%) was the most frequently used social media platform across all age groups and both genders. Statistically significant differences were identified between genders in the usage of Telegram, Twitter, and Viber within the 18-30 years age category, with a higher percentage of males using these platforms (p ≤ 0.05). Similar significant differences were observed in the 31-40 years age group for WhatsApp and Telegram (p ≤ 0.05). Among 95.4% of online health information seekers, YouTube (74.9%) was the most popular platform. One-quarter of the respondents preferred social media platforms, and 22.3% preferred websites for obtaining oral health information. Furthermore, 74.9% had positive opinions on obtaining oral health information via social media, while only 17% reported pleasant experiences with social media platforms for oral health promotion. In assessing the reliability of oral health information on social media, 48% relied on the quality of the information. The most preferred source of oral health information was short videos from professionals (43.1%). Additionally, 69.5% reported changes in their oral health behaviours after accessing information through social media. CONCLUSION: Social media is a viable platform for promoting public oral health awareness in Sri Lankan; hence, workable strategies need to be employed, to further ensure its effective and wider use in a culturally and socioeconomically diverse country like Sri Lanka.


Assuntos
Promoção da Saúde , Saúde Bucal , Mídias Sociais , Humanos , Mídias Sociais/estatística & dados numéricos , Masculino , Sri Lanka , Adulto , Feminino , Saúde Bucal/estatística & dados numéricos , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Inquéritos e Questionários , Promoção da Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Informação de Saúde ao Consumidor/estatística & dados numéricos , Idoso
4.
Glob Heart ; 19(1): 49, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38854432

RESUMO

Background: There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs. Objectives: To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES. Methods: We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies. Conclusions: We estimated prevalence of History+ of 3.9% (95% CI 3.3%-4.4%) and Angina+ of 3.0% (95% CI 2.4%-3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.


Assuntos
Isquemia Miocárdica , Humanos , Masculino , Feminino , Sri Lanka/epidemiologia , Prevalência , Isquemia Miocárdica/epidemiologia , Pessoa de Meia-Idade , Idoso , Fatores de Risco , Adulto
5.
PLoS One ; 19(6): e0304690, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38861513

RESUMO

BACKGROUND: Antimicrobial overprescription is common for lower respiratory tract infections (LRTI), as viral and bacterial infections generally present with similar clinical features. Overprescription is associated with downstream antimicrobial resistance. This study aims to identify the prevalence and predictors of antibiotic prescription among patients hospitalized with viral LRTI. METHODS: A prospective cohort study was conducted among patients aged ≥1 year hospitalized with viral LRTI in a tertiary care hospital in Southern Province, Sri Lanka from 2018-2021. Demographic, clinical, and laboratory data were recorded. Nasopharyngeal and blood samples were collected for multiplex polymerase chain reaction testing for 21 respiratory pathogens and procalcitonin (PCT) detection, respectively. Demographic and clinical features associated with antibiotic prescription were identified using Chi Square and t-tests; significant variables (p<0.05) were further included in multivariable logistic regression models. The potential impact of biomarker testing on antibiotic prescription was simulated using standard c-reactive protein (CRP) and PCT cut-offs. RESULTS: Of 1217 patients enrolled, 438 (36.0%) had ≥1 respiratory virus detected, with 48.4% of these patients being male and 30.8% children. Influenza A (39.3%) and human rhinovirus/ enterovirus (28.3%) were most commonly detected. A total of 114 (84.4%) children and 266 (87.8%) adults with respiratory viruses were treated with antibiotics. Among children, neutrophil percentage (median 63.6% vs 47.6%, p = 0.04) was positively associated with antibiotic prescription. Among adults, headache (60.6% vs 35.1%, p = 0.003), crepitations/crackles (55.3% vs 21.6%, p<0.001), rhonchi/wheezing (42.9% vs 18.9%, p = 0.005), and chest x-ray opacities (27.4% vs 8.1%, p = 0.01) were associated with antibiotic prescription. Access to CRP and procalcitonin test results could have potentially decreased inappropriate antibiotic prescription in this study by 89.5% and 83.3%, respectively. CONCLUSIONS: High proportions of viral detection and antibiotic prescription were observed among a large inpatient cohort with LRTI. Increased access to point-of-care biomarker testing may improve antimicrobial prescription.


Assuntos
Antibacterianos , Infecções Respiratórias , Humanos , Masculino , Feminino , Sri Lanka/epidemiologia , Antibacterianos/uso terapêutico , Criança , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/virologia , Infecções Respiratórias/epidemiologia , Adulto , Adolescente , Pré-Escolar , Pessoa de Meia-Idade , Estudos Prospectivos , Prevalência , Lactente , Hospitalização , Adulto Jovem , Pró-Calcitonina/sangue , Idoso , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo
6.
J Diabetes ; 16(5): e13559, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38708437

RESUMO

OBJECTIVES: To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria. METHODS: This post-hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria. RESULTS: We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow-up period of 1.8 (1.4-2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6-10.0)/100 women-years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18-2.54; p = .005) and 3.56 (95% CI, 2.46-5.16; p < .001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70-4.00; p < .001), compared to isolated abnormal FPG. CONCLUSIONS: Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions.


Assuntos
Glicemia , Diabetes Gestacional , Teste de Tolerância a Glucose , Período Pós-Parto , Humanos , Feminino , Gravidez , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/sangue , Adulto , Glicemia/análise , Glicemia/metabolismo , Fatores de Risco , Incidência , Sri Lanka/epidemiologia , Índia/epidemiologia , Bangladesh/epidemiologia , Prognóstico , Seguimentos
7.
Environ Geochem Health ; 46(6): 201, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38696114

RESUMO

The study's objective was to determine the air quality in an asbestos-related industry and its impact on current workers' respiratory health. Seventy-seven air and 65 dust samples were collected at 5-day intervals in an asbestos roofing sheets production factory in Sri Lanka having two production facilities. Sampling was performed in ten sites: Defective sheets-storage, Production-plant, Pulverizer, Cement-silo, and Loading-area. A detailed questionnaire and medical screening were conducted on 264 workers, including Lung Function Tests (LFT) and chest X-rays. Asbestos fibres were observed in deposited dust samples collected from seven sites. Free chrysotile fibres were absent in the breathing air samples. Scanning Electron Microscopy confirmed the presence of asbestos fibres, and the Energy Dispersive X-ray analysis revealed Mg, O, and Si in depositions. The average concentrations of trace metals were Cd-2.74, Pb-17.18, Ni-46.68, Cr-81.01, As-7.12, Co-6.77, and Cu-43.04 mg/kg. The average Zn, Al, Mg, and Fe concentrations were within 0.2-163 g/kg. The highest concentrations of PM2.52.5 and PM1010, 258 and 387 µg/m3, respectively, were observed in the Pulverizer site. Forty-four workers had respiratory symptoms, 64 presented LFT abnormalities, 5 indicated chest irregularities, 35.98% were smokers, and 37.5% of workers with abnormal LFT results were smokers. The correlation coefficients between LFT results and work duration with respiratory symptoms and work duration and chest X-ray results were 0.022 and 0.011, respectively. In conclusion, most pulmonary disorders observed cannot directly correlate to Asbestos exposure due to negligible fibres in breathing air, but fibres in the depositions and dust can influence the pulmonary health of the employees.


Assuntos
Amianto , Exposição Ocupacional , Humanos , Sri Lanka , Exposição Ocupacional/análise , Amianto/análise , Masculino , Pessoa de Meia-Idade , Adulto , Poluentes Ocupacionais do Ar/análise , Poeira/análise , Testes de Função Respiratória , Monitoramento Ambiental/métodos , Feminino , Indústria Manufatureira
8.
Indian J Med Microbiol ; 49: 100617, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38763381

RESUMO

PURPOSE: This study investigated to detect serotypes and virulence genes of Group B Streptococcus (GBS) isolated from pregnant women. METHODS: Forty-five samples of GBS isolates from January to August 2019 at antenatal clinics of 4 teaching hospitals in Western Province, Sri Lanka were included. Isolated GBS were carried to identify 9 serotypes by multiplex PCR. Different virulence determinants, including bac, rib and scp(B) have been detected by PCR. RESULTS: Among GBS-positive culture isolates most abundant serotype detected was type III 12/45 (26.7%) while serotype VII, VIII and IX were not seen. Furthermore, serotype Ia (15.6%); II (20%); V (17.8%); VI (15.6%); Ib (2.2%) and IV (2.2%) were identified. Among 5 rectal isolates, 1 isolate was serotype Ia, 2 isolates were serotype II and 2 isolates were serotype III. Forty (40/45) isolates expressed scpB gene (88.8%). Presence of rib gene was confirmed in 17.8%, bac in 13.3% isolates. ScpB, rib and bac were identified in 4.4% isolates, 8.9% isolates were scpB, rib positive and bac negative, 8.9% isolates were scpB, bac positive and rib negative. These three-virulence genes did not express in 8.9% isolates. ScpB gene was found once in serotype Ib and IV and all serotype VI expressed scpB gene. Rib gene was more common among serotype II and it was not found in serotype Ib, IV and VI. Bac gene was more common in serotype V and it was not found in serotype Ia, Ib and IV. There was not significant association between serotypes and virulence gene (p > 0.05). CONCLUSION: Serotype III is the most abundant serotype. In formulation of vaccine against GBS for Sri Lanka, serotype III should be targeted. Prevalence of vaccine candidate virulence protein such as ß antigens of the C protein (bac) and surface protein Rib (rib) genes were low in this study.


Assuntos
Sorogrupo , Infecções Estreptocócicas , Streptococcus agalactiae , Centros de Atenção Terciária , Fatores de Virulência , Streptococcus agalactiae/genética , Streptococcus agalactiae/patogenicidade , Streptococcus agalactiae/classificação , Streptococcus agalactiae/isolamento & purificação , Humanos , Feminino , Sri Lanka/epidemiologia , Fatores de Virulência/genética , Gravidez , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/epidemiologia , Adulto , Complicações Infecciosas na Gravidez/microbiologia
9.
Front Public Health ; 12: 1360210, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38711768

RESUMO

Background: The problem of sedentary behavior among primary school children is alarming, with numbers gradually increasing worldwide, including Sri Lanka. Physical activity interventions within classroom settings have been acknowledged as a critical strategy to increase students' movement behaviors while enhancing their academic achievement and health. Yet, the busy curriculum and challenging educational demands encourage more sedentary classroom behavior. Hence, this study aims to develop and evaluate an in-classroom physical activity breaks (IcPAB) intervention among fifth graders in Sri Lanka. Methods: The study will adopt a randomized controlled trial (RCT), comprising an in-classroom physical activity breaks program group and a control group to evaluate the effects of IcPAB on academic achievement, movement behaviors and health outcomes. The intervention design is based on the capability (C), opportunity (O) and motivation (M) behavior (B) (COM-B) model. A least 198 fifth graders will be recruited from two schools in Uva province, Sri Lanka. The recruitment process will start in late 2022. Class teachers of the intervention group will implement 5-min activity breaks at least three times a day after completing a training session. The primary variables include mathematics and reading achievement. The secondary variables include physical activity levels, steps count, sedentary behavior, body mass index, aerobic fitness, and perceived stress. Data collection will be implemented at pre-test and post-test, respectively. Intervention fidelity and the process will also be evaluated. Discussion: The IcPAB is designed to prevent pure educational time loss by introducing curriculum-integrated short bouts of physical active breaks into the classroom routine. If the IcPAB is effective, it can (1) improve the mathematics and reading achievement of fifth-grade girls and boys, which is a significant factor determining the performance at the Grade Five National Scholarship Examination in Sri Lanka; (2) improve movement behaviors as well as physical and mental health outcomes among primary school students. Sequentially, the IcPAB will enrich school-based physical activity intervention approaches which can in turn bring academic and health benefits to primary school children in Sri Lanka. Trial registration: The first version of the trial was registered with the ISRCTN registry (Ref: ISRCTN52180050) on 20/07/2022.


Assuntos
Exercício Físico , Instituições Acadêmicas , Estudantes , Humanos , Sri Lanka , Criança , Feminino , Masculino , Comportamento Sedentário , Serviços de Saúde Escolar , Promoção da Saúde/métodos
10.
Support Care Cancer ; 32(6): 361, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38753165

RESUMO

PURPOSE: Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. METHODS: An exploratory descriptive qualitative study was carried out among 14 purposively selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed. RESULTS: All participants referred to radiotherapy as "current" with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances for information, often based on second or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent. CONCLUSION: Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save healthcare resources that would otherwise be wasted on patient preparation for radiotherapy.


Assuntos
Neoplasias , Pesquisa Qualitativa , Recusa do Paciente ao Tratamento , Humanos , Sri Lanka , Neoplasias/radioterapia , Neoplasias/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Recusa do Paciente ao Tratamento/psicologia , Radioterapia/métodos , Radioterapia/psicologia , COVID-19 , Entrevistas como Assunto
11.
Health Policy Plan ; 39(6): 552-563, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38758072

RESUMO

Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.


Assuntos
Violência Doméstica , Grupos Focais , Humanos , Feminino , Nepal , Violência Doméstica/prevenção & controle , Sri Lanka , Brasil , Pessoal de Saúde/psicologia , Atenção à Saúde/organização & administração , Pesquisa Qualitativa , Masculino , Entrevistas como Assunto , Adulto , Liderança
12.
PLoS One ; 19(5): e0297880, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768181

RESUMO

INTRODUCTION: Hyperinflation is a common procedure to clear secretion, increase lung compliance and enhance oxygenation in mechanically ventilated patients. Hyperinflation can be provided as manual hyperinflation (MHI) or ventilator hyperinflation (VHI), where outcomes depend upon the methods of application. Hence it is crucial to assess the application of techniques employed in Sri Lanka due to observed variations from recommended practices. OBJECTIVE: This study is aimed to evaluate the application and parameters used for MHI and VHI by physiotherapists in intensive care units (ICUs) in Sri Lanka. METHODOLOGY: An online survey was conducted among physiotherapists who are working in ICUs in Sri Lanka using WhatsApp groups and other social media platforms. RESULTS: A total of 96 physiotherapists responded. The survey comprised of three sections to obtain information about socio-demographic data, MHI practices and VHI practices. Most of the respondents (47%) worked in general hospitals and 74% of participants had a bachelor's degree in physiotherapy; 31.3% had 3-6 years of experience; 93.8% used hyperinflation, and 78.9% used MHI. MHI was performed routinely and as needed to treat low oxygen levels, abnormal breath sounds, and per physician orders while avoiding contraindications. Self-inflation bags are frequently used for MHI (40.6%). Only a few participants (26%) used a manometer or tracked PIP. In addition to the supine position, some participants (37.5%) used the side-lying position. Most physiotherapists followed the recommended MHI technique: slow squeeze (57.3%), inspiratory pause (45.8%), and quick release (70.8%). VHI was practised by 19.8%, with medical approval and it was frequently performed by medical staff compared to physiotherapists. Treatment time, number of breaths, and patient positioning varied, and parameters were not well-defined. CONCLUSION: The study found that MHI was not applied with the recommended PIP, and VHI parameters were not identified. The study indicates a need to educate physiotherapists about current VHI and MHI practice guidelines.


Assuntos
Fisioterapeutas , Respiração Artificial , Humanos , Sri Lanka , Inquéritos e Questionários , Respiração Artificial/métodos , Masculino , Feminino , Adulto , Unidades de Terapia Intensiva , Cuidados Críticos/métodos , Ventiladores Mecânicos/estatística & dados numéricos
13.
PLoS One ; 19(5): e0303023, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38809820

RESUMO

Truth telling processes, initiatives to prosecute war-time perpetrators, and ex-combatant reintegration are examples of common peacebuilding practices after war. Yet, little is known of how women are affected by peacebuilding initiatives such as these, or how they perceive these initiatives for peace. For many women, peace after war does not bring peace to everyday life; research shows that domestic violence increases during and after war. In addition, some peacebuilding measures have been found to increase risk and insecurity, not least for women. To better understand the interconnections between gender and post-conflict attitudes to peacebuilding, we asked 2,041 women and men in Sri Lanka and Nepal of their views on post-war peace initiatives. In line with our expectations, we find that women are more skeptical than men towards peacebuilding measures that involve increased risk in everyday life, such as truth-telling and coexisting with former adversaries and warring groups reintegrating in local communities. There are no gender differences pertaining to peacebuilding initiatives that take place far away at the national level, for example, concerning accountability or, in the case of Nepal, the peace agreement. Our findings suggest that international peacebuilding practice is blind to the everyday insecurities of women after war. That a basic gendered lens is missing from most peacebuilding designs is both alarming and deeply troubling, but identifying this critical aspect provides the opportunity for imperative change. By shedding light on the challenges women face after war, we hope this article contributes to finding ways to mitigate unknown and unintended side-effects of peacebuilding efforts, and thereby to the development of better, evidence-based peacebuilding practice-of benefit to both men and women.


Assuntos
Guerra , Nepal , Humanos , Sri Lanka , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Atitude
14.
BMC Med Genomics ; 17(1): 143, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38789983

RESUMO

BACKGROUND: Therapy with anti-cancer drugs remain the cornerstone of treating cancer. The effectiveness and safety of anti-cancer drugs vary significantly among individuals due to genetic factors influencing the drug response and metabolism. Data on the pharmacogenomic variations in Sri Lankans related to anti-cancer therapy is sparse. As current treatment guidelines in Sri Lanka often do not consider local pharmacogenomic variants, this study aimed to explore the diversity of pharmacogenomic variants in the Sri Lankan population to pave the way for personalized treatment approaches and improve patient outcomes. METHODS: Pharmacogenomic data regarding variant-drug pairs of genes CYP2D6, DPYD, NUDT15, EPAS1, and XRCC1 with clinical annotations labelled as evidence levels 1A-2B were obtained from the Pharmacogenomics Knowledgebase database. Their frequencies in Sri Lankans were obtained from an anonymized database that was derived from 541 Sri Lankans who underwent exome sequencing at the Human Genetics Unit, Faculty of Medicine, University of Colombo. Variations in DPYD, NUDT15, and EPAS1 genes are related to increased toxicity to fluoropyrimidines, mercaptopurines, and sorafenib respectively. Variations in CYP2D6 and XRCC1 genes are related to changes in efficacy of tamoxifen and platinum compounds, respectively. Minor allele frequencies of these variants were calculated and compared with other populations. RESULTS: MAFs of rs1065852 c.100 C > T (CYP2D6), rs3918290 c.1905 + 1G > A (DPYD), rs56038477 c.1236G > A (DPYD), rs7557402 c.1035-7 C > G (EPAS1), rs116855232 c.415 C > T (NUDT15*3), and rs25487 c.1196 A > G (XRCC1) were: 12.9% [95%CI:10.9-14.9], 1.5% [95%CI:0.8-2.2], 1.2% [95%CI:0.5-1.8], 37.7% [95%CI:34.8-40.6], 8.3% [95%CI:6.7-10.0], and 64.0% [95%CI:61.1-66.8], respectively. Frequencies of rs1065852 c.100 C > T (CYP2D6), rs7557402 c.1035-7 C > G (EPAS1), and rs25487 (XRCC1) were significantly lower in Sri Lankans, while frequencies of rs116855232 c.415 C > T (NUDT15*3) and rs56038477 c.1236G > A (DPYD) were significantly higher in Sri Lankans when compared to some Western and Asian populations. CONCLUSION: Sri Lankans are likely to show lower toxicity risk with sorafenib (rs7557402 c.84,131 C > G) and, higher toxicity risk with fluoropyrimidines (rs56038477 c.1236G > A) and mercaptopurine (rs116855232 c.415 C > T), and reduced effectiveness with tamoxifen (rs1065852 c.100 C > T) and platinum compounds (rs25487). These findings highlight the potential contribution of these genetic variations to the individual variability in anti-cancer dosage requirements among Sri Lankans.


Assuntos
Antineoplásicos , Variantes Farmacogenômicos , Humanos , Sri Lanka , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Proteína 1 Complementadora Cruzada de Reparo de Raio-X/genética , Pirofosfatases/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Citocromo P-450 CYP2D6/genética , Neoplasias/genética , Neoplasias/tratamento farmacológico , Povo Asiático/genética , Farmacogenética , Frequência do Gene , Nudix Hidrolases
15.
BMC Med Educ ; 24(1): 559, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38778350

RESUMO

BACKGROUND: Feedback is integral to medical education, enabling students to improve their knowledge, skills, and attitudes. Feedback practices may vary according to prevalent cultural and contextual factors. This study aimed to explore how feedback is conceptualized and practised in the clinical education of medical students in Sri Lanka. METHODS: The study was conducted in three medical schools and affiliated hospitals that represent the cultural diversity of Sri Lanka. Purposive sampling was utilized to recruit clinical teachers and students who would provide rich information for the study. The study had three components: an observation study, interviews with clinical teachers and focus group discussions with clinical students. During the observation study, video recording was used as a data collection tool to observe feedback in real-life clinical teaching/learning settings. A constructivist grounded theory approach was adapted for analysis to explore current practices and perceptions inductively. RESULTS: Feedback was conceptualised as spontaneous unidirectional provision of information for the improvement of students. It was often provided in public settings and in student groups. Error correction was the primary focus of feedback, but both teachers and students desired a balanced approach with reinforcement and reflection. Although the direct approach to corrective feedback was found beneficial for student learning, participants agreed that harsh feedback was to be avoided. The hierarchical culture and lack of programmed feedback in the curricula influenced feedback practices, suggesting the need for modification. CONCLUSIONS: This study highlighted feedback practices in the local context, emphasizing the need to address the hierarchical gap in clinical settings, balance reinforcement and correction, and promote dialogue and reflection in the feedback processes. The findings will help clinical teachers from both the global south as well as the global north to recognize cultural and contextual differences in providing feedback.


Assuntos
Educação de Graduação em Medicina , Pesquisa Qualitativa , Estudantes de Medicina , Humanos , Sri Lanka , Estudantes de Medicina/psicologia , Masculino , Grupos Focais , Feedback Formativo , Feminino , Retroalimentação , Ensino , Docentes de Medicina , Currículo , Teoria Fundamentada
16.
Sci Rep ; 14(1): 11966, 2024 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-38796552

RESUMO

Wolbachia bacteria are common endosymbionts of insects and have recently been applied for controlling arboviral vectors, especially Aedes aegypti mosquito populations. However, several medically important mosquito species in Sri Lanka were present with limited information for the Wolbachia infection status. Therefore, the screening of Wolbachia in indigenous mosquitoes is required prior to a successful application of Wolbachia-based vector control strategy. In this study, screening of 78 mosquito species collected from various parts of the country revealed that 13 species were positive for Wolbachia infection, giving ~ 17% infection frequency of Wolbachia among the Sri Lankan mosquitoes. Twelve Wolbachia-positive mosquito species were selected for downstream Wolbachia strain genotyping using Multi Locus Sequencing Type (MLST), wsp gene, and 16S rRNA gene-based approaches. Results showed that these Wolbachia strains clustered together with the present Wolbachia phylogeny of world mosquito populations with some variations. Almost 90% of the mosquito populations were infected with supergroup B while the remaining were infected with supergroup A. A new record of Wolbachia supergroup B infection in Ae. aegypti, the main vectors of dengue, was highlighted. This finding was further confirmed by real-time qPCR, revealing Wolbachia density variations between Ae. aegypti and Ae. albopictus (p = 0.001), and between males and females (p < 0.05). The evidence of natural Wolbachia infections in Ae. aegypti populations in Sri Lanka is an extremely rare incident that has the potential to be used for arboviral vector control.


Assuntos
Aedes , Mosquitos Vetores , Filogenia , Wolbachia , Animais , Wolbachia/genética , Wolbachia/isolamento & purificação , Aedes/microbiologia , Aedes/virologia , Sri Lanka , Mosquitos Vetores/microbiologia , Feminino , Masculino , RNA Ribossômico 16S/genética , Tipagem de Sequências Multilocus/métodos
17.
BMC Public Health ; 24(1): 1417, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38802834

RESUMO

BACKGROUND: Intimate partner violence is the most common form of violence experienced by women. It has detrimental consequences. A range of determinants cause intimate partner violence and to reduce it, effective interventions are required to address the determinants. Health promotion interventions have been recommended as effective to enable people to control over the determinants and to improve health. Hence, a community based participatory health promotion intervention was developed and tested in a selected study setting. The objective was to evaluate the effectiveness of a health promotion intervention in terms of addressing knowledge, attitudes and practices related to intimate partner violence. METHODS: A quasi-experimental study was conducted by recruiting ninety women aged 15 to 49 years separately from two health administrative areas identified as the intervention area and the control area from the Kandy district of Sri Lanka. A pretested interviewer-administered questionnaire was used in both pre- and post-assessments. Selected groups of women from the intervention area were facilitated with a health promotion intervention to improve knowledge, attitudes and practices related to intimate partner violence. To evaluate the effectiveness of the intervention descriptive summaries and bivariate analysis were used. RESULTS: The response rate was 90.9% (N = 90) during the pre-assessment and 87.9% (n = 87) and 82.8% (n = 82) from the intervention and control areas, respectively, during the post-assessment. Statistically significant improvement was reported in the total mean score comprising knowledge, attitudes, practices and identification of determinants from 59.6 to 80.8 in the intervention area [Pre-assessment: Mean = 59.6 (standard deviation-SD) = 17.5; Post-assessment: Mean = 80.8, SD = 19.0; p < 0.001) compared to the improvement in the control area from 62.2 to 63.0 (Pre-assessment: Mean = 62.2, SD = 17.3; Post-assessment: Mean = 63.0, SD = 18.9; p = 0.654). CONCLUSIONS: The intervention was effective to improve knowledge, attitudes and practices related to intimate partner violence. Hence, the present approach can be used in similar contexts to address the knowledge, attitudes and certain practices related to intimate partner violence.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Violência por Parceiro Íntimo , Humanos , Feminino , Adulto , Promoção da Saúde/métodos , Pessoa de Meia-Idade , Violência por Parceiro Íntimo/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Adulto Jovem , Adolescente , Sri Lanka , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
18.
Intensive Crit Care Nurs ; 83: 103708, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38643605

RESUMO

OBJECTIVES: To explore patients' and nurses' views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units. DESIGN: A qualitative, descriptive study. RESEARCH METHODOLOGY: Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting. SETTING: A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units. FINDINGS: Four categories reflecting patients' and nurses' anticipated use of the board were found. The first category described patients' and nurses' 'readiness to use the communication board' and their positive attitudes towards it. The second category focused on the 'potential benefits of the communication board', while the third category emphasised the 'individual patient characteristics' that should be taken into consideration when implementing communication boards. The final category described practical aspects related to 'integrating communication boards into routine practice'. CONCLUSION: This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings. IMPLICATIONS FOR CLINICAL PRACTICE: An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients' needs during mechanical ventilation.Understanding patients' and nurses' views is beneficial when designing patient-centred communication interventions in intensive care units.


Assuntos
Comunicação , Unidades de Terapia Intensiva , Pesquisa Qualitativa , Humanos , Sri Lanka , Masculino , Unidades de Terapia Intensiva/organização & administração , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Entrevistas como Assunto/métodos
19.
Am J Trop Med Hyg ; 110(6): 1110-1116, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38593788

RESUMO

Leishmaniasis in Sri Lanka was first reported in the early 1990s. Cutaneous leishmaniasis (CL) cases have markedly increased in recent years, demanding due attention from health authorities. The spatial distribution of CL is not homogeneous. This case-control study investigated factors that may contribute to this heterogeneous distribution through a nationwide study. Information on sociodemographic, economic, and environmental characteristics was collected from study participants (cases, n = 303; controls, n = 2,762). All individuals were followed up for 3 years, and signs of CL or associated complications were recorded. Differences in possible risk factors between cases and controls were analyzed. Individuals <18 years old, electricity supply, spending >2 hours outdoors, visiting jungles/water bodies, and living near CL patients were identified as risk factors. Household members of 1.3% of cases, 2.3% of controls residing within a perimeter of 500 m from a patient, and 0.8% of controls living beyond 2 km from a case developed CL. Thus, CL in Sri Lanka appears intertwined with living environment and host behavior. Common environmental factors may be responsible for the higher risk of CL in individuals living in close proximity to CL patients. This may at least partly explain the clustering of CL cases in selected areas of the country.


Assuntos
Leishmaniose Cutânea , Humanos , Sri Lanka/epidemiologia , Leishmaniose Cutânea/epidemiologia , Fatores de Risco , Feminino , Masculino , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Lactente , Idoso
20.
Environ Pollut ; 350: 123944, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38608854

RESUMO

This is the first attempt that investigate the abundance of plasticizers in leachate sediment in the scientific literature, alongside the debut effort to explore the abundance of microplastics and plasticizers in landfill leachate and sediment in Sri Lanka. Microplastics in sizes ranging from ≥2.0-5.0, ≥1.0-2.0, and ≥ 0.5-1.0 mm were extracted from the leachate draining from ten municipal solid waste open dump sites and sediment samples covering seven districts. Microplastics were extracted by density separation (Saturated ZnCl2) followed by wet peroxide digestion and the chemical identification was conducted by Fourier Transform Infrared spectroscopy. Plasticizers were extracted to hexane and analyzed by high-performance liquid chromatography. The total mean microplastic abundance in leachate was 2.06 ± 0.62 mg/L whereas it was 363 ± 111 mg/kg for leachate sediments. The most frequently found polymer type was polyethylene (>50%), and white color was dominant. The average concentration of bisphenol A (BPA), benzophenone (BP) and diethyl-hydrogen phthalate (DHEP) in leachate was 158 ± 84.4, 0.75 ± 0.16 and 170 ± 85.8 µg/L respectively. Furthermore, BP and DHEP in leachate sediment was 100 ± 68.3 and 1034 ± 455 µg/kg respectively. As landfill leachate is directly discharged into nearby surface and groundwater bodies that serve as sources of drinking water, the study highlights the potential concerns of microplastic and plasticizer exposure to the surrounding Sri Lankan community through consumption of contaminated drinking water. Therefore, there is a timely need of develop the effective waste management and pollution control measures to minimize the possible threats to both the environment and human health.


Assuntos
Monitoramento Ambiental , Microplásticos , Plastificantes , Instalações de Eliminação de Resíduos , Poluentes Químicos da Água , Sri Lanka , Plastificantes/análise , Microplásticos/análise , Poluentes Químicos da Água/análise , Fenóis/análise , Compostos Benzidrílicos/análise , Eliminação de Resíduos , Benzofenonas/análise
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