Rohini Seneviratne

Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic

BACKGROUND Compared with other populations, South Asians have a greater propensity to insulin resistance and the metabolic syndrome (MetS). This is the first study to determine the distribution of phenotypes of polycystic ovary syndrome (PCOS) and their relationship to the MetS among indigenous South Asians. METHOD An evaluation of the phenotype and metabolic characteristics of PCOS was conducted by recruiting consecutive women diagnosed by Rotterdam consensus criteria from an Endocrine clinic in Colombo, Sri Lanka. Prevalence of MetS was determined, in relation to the phenotypic subgroup of PCOS and compared with ethnically matched, BMI- and age-adjusted controls (n =231). RESULTS Acanthosis nigricans (AN) occurred in 64.6% of women with PCOS (n= 469). MetS occurred in 30.6% of the PCOS group compared with 6.34% of controls (P = 0.0001). Those with PCOS and MetS had significantly higher median BMI, blood pressure (BP), fasting plasma glucose, insulin and triglycerides and lower high-density lipoprotein and sex hormone-binding globulin (SHBG), but similar testosterone concentrations compared with those with PCOS alone. Prevalence of MetS was similar in the four PCOS phenotypes, although oligomenorrhoeic women were more obese compared with the normal cycling hyperandrogenic group. Multivariate logistic regression confirmed age ≥35 years, BMI ≥25 kg/m(2) and AN as significant predictors of MetS in PCOS. Case-control comparisons showed that the presence of PCOS results in higher odds of having the MetS, a high waist circumference, elevated diastolic BP, abnormal fasting lipids and high fasting insulin and plasma testosterone concentrations. CONCLUSIONS Young indigenous South Asians with PCOS have greater odds of being centrally obese, with a third having the MetS that bears no relationship to the androgenic phenotype. Significant predictors for MetS within the PCOS cohort are advancing age, obesity determined by the Asian cut off (BMI >25 kg/m(2)) and AN, while family history of diabetes, hyperandrogenism and elevated SHBG have no predictive value.

Maternal sleep deprivation is a risk factor for small for gestational age: A cohort study

Aims: To determine trimester‐specific risk factors for small‐for‐gestational‐age (SGA) infants.

Maternal haemoglobin level at booking visit and its effect on adverse pregnancy outcome

Aims:  To determine the effect of maternal haemoglobin levels at booking visit on pregnancy outcome.

Effect of psychosocial stress and physical activity on preterm birth: A cohort study

Aim:  To determine trimester‐specific effects of risk factors for preterm birth (PTB).

Effect of psychosocial stress and physical activity on low birthweight: a cohort study.

Aim:  To determine the effect of physical activity and psychosocial stress on low birthweight (LBW).

Awareness of breast cancer among adolescent girls in Colombo, Sri Lanka: a school based study.

BackgroundBreast cancer is the commonest cancer in women worldwide. Although programmes promoting breast cancer awareness are being carried out throughout Sri Lanka, few have targeted school students. We conducted this study to assess the knowledge, attitudes and practices regarding breast cancer with reference to screening, services available, breast self-examination, and sources of information, among adolescent schoolgirls in the Colombo District of Sri Lanka.MethodsThe knowledge, attitudes and practices related to breast cancer were assessed among 859 adolescent girls in schools within the Colombo District, using a self-administered questionnaire. Classes and students were selected using multi-stage stratified cluster sampling.ResultsOf the total sample, approximately 60% of respondents identified ‘history of breast lump’, ‘family history of breast cancer’ & ‘exposure to irradiation’ as risk factors for breast cancer. Although most were aware that the presence of a breast lump was an important warning sign, awareness of other warning signs was poor. Only 35.6% identified mammogram as an effective screening method. One third of the sample maintained that they are unaware of symptoms, diagnostics and treatment of breast cancer. Of those who were aware, 90.6% named surgery as a treatment option for breast cancer, 79.4% were unaware that chemotherapy is used. Of the total sample, 17.1% knew how to perform breast self-examination, and only 9.4% were aware of currently available breast cancer screening services. Knowledge was significantly better among students who had a relative with breast cancer.ConclusionsThere were significant deficiencies in knowledge, attitudes and practices on breast cancer in the study population. In particular, knowledge on breast self examination was poor. There is a need for awareness programs aimed specifically at this important target group.

A Model of Substance Abuse Risk: Adapting to the Sri Lankan Context

This study translated and validated the Substance Use Risk Profile Scale (SURPS) among 13 to 18 year old Sri Lankan adolescents attending school. A standard systematic translation procedure was followed to translate the original SURPS into Sinhala language. A Delphi process was conducted to determine judgmental validity of Sinhala SURPS. Confirmatory factor analysis was performed to test the translated version against the original theoretical model of the SURPS. Test-retest and internal consistency were used to ensure reliability. A few terms in one of the items posed some difficulty in translating into Sinhala. Adequate judgmental validity was determined except for one item, which was modified to suit the Sri Lankan setting. The four subscales introversion/ hopelessness, impulsivity, sensation seeking and anxiety sensitivity showed satisfactory test-retest reliability estimates of .74, .68, .76, and .88, respectively. The Sinhala SURPS is applicable in Sri Lankan context. Several implications based on the results are discussed.

Prevalence and predictors of self-medication in a selected urban and rural district of Sri Lanka

Background: Self-medication is widely practised in many developing countries. The determinants of self-medication need to be understood to design adequate medicine information policies and patient-dispenser education strategies. Hence, the prevalence of medicine use and predictors of self-medication were determined in Sri Lanka. Methods: In a community-based cross- sectional study, data were collected from 1800 adults selected from Gampaha and Polonnaruwa districts respectively. Study participants were sampled using a multistage cluster sampling technique. Trained public health midwives administered the questionnaire. Two Likert scales provided information on access to medical care and satisfaction with available pharmacy services. About 95% of the sampled population participated in the study. Results: Overall, prevalence of medication use (allopathic, traditional, home remedies) in urban and rural population was 33.9% and 35.3%, respectively. Self-medication prevalence of allopathic drugs in the urban sector (12.2%) was significantly higher than in the rural (7.9%) sector(p<0.05). In the urban sector, small household size and preference to have medicines from outside the pharmacies predisposed to self-medication. The higher acceptability of medical services and regularity of medical care decreased the likelihood of self-medication. In the rural sector, lower satisfaction about the healthcare providers’ concern for clients, lower satisfaction about affordability of medical care and higher satisfaction with technical competence of the pharmacy staff increased the likelihood of self-medication. In both urban and rural sectors, when symptom count increased, tendency to self-medicate decreased. Conclusions: Self-medication prevalence was higher in urban compared to rural areas in Sri Lanka. Some aspects of access to medical care, satisfaction with pharmacy services and perceived severity of the disease were found to be important determinants of self-medication.

Prosthetic Outcome of Unilateral Lower Limb Amputee Soldiers in Two Districts of Sri Lanka

The purpose of this study was to evaluate the prosthetic outcome of unilateral lower limb amputee soldiers and to identify factors affecting prosthesis use. Selected unilateral above-knee (AK) and below-knee (BK) amputee soldiers of the Sri Lanka Army (n = 461) who had completed prosthetic training were evaluated using an interviewer-administered questionnaire. The theoretical model, PRECEDE (predisposing, reinforcing, and enabling factors in educational diagnosis and evaluation), was used as the framework to identify factors affecting prosthetic use. A majority was BK amputees (413, 89.6%). Mean age of amputees at the time of the study was 30.2 (± 4.6) years. All 48 (100%) AK amputees and 410 (99.3%) of 413 BK amputees were wearing prostheses at least 1 day per week. BK amputees showed higher mean hours of wearing per day (11.0 ± 3.9) compared with AK amputees (8.2 ± 4.2; P <.001). Of the prosthesis wearers, 196 (42%) performed all indoor mobilizations and 292 (62.8%) performed all outdoor mobilizations wearing a prosthesis. Wheelchair use for indoor and outdoor mobilizations was minimal (<5%). A majority did not use any technical aid for walking indoors (308, 66.4%) or outdoors (270, 58.2%). Higher level of amputation, presence of problems in the residual limb, and problems with the unaffected leg were factors that significantly reduced prosthesis use indoors and outdoors. The inability to wear a prosthesis alone was a factor associated with less use indoors, and nonparticipation in sports/social work was a factor significantly associated with less prosthesis use outdoors. It was concluded that prosthesis use was satisfactory but could be improved.

Adaptation and validation of a self-report measure to evaluate substance use among Sri Lankan adolescents.

This study translated and validated the model Student Questionnaire (SQ) among 13- to 18-year-old Sri Lankan adolescents. A systematic procedure was followed to translate the SQ into Sinhala language. The Sinhala version was titled Adolescent Substance Use Student Questionnaire (ASUSQ). A Delphi process was conducted to evaluate consensual validity of ASUSQ. Test–retest study (N == 120) ensured reliability. Contrasted group technique study (N == 200) among users and nonusers established construct validity. Data collection instruments were SQ, its Sinhala version, structured-interview schedule, and focus group discussion guide. Sinhala-speaking students were randomly selected from schools in a semi-urban area. Applicability of the ASUSQ and further research are discussed. The studys limitations are noted.