Sampath Tennakoon

Vitamin D status in Sri Lankans living in Sri Lanka and Norway

Vitamin D deficiency is common in non-Western immigrant groups living in Western countries. A comparison of vitamin D status in individuals who have emigrated and individuals who remain in their country of origin is needed in order to provide information about the effect of moving to northern latitudes. A total of 196 participants aged 30-60 years in a cross-sectional population-based study in Kandy, Sri Lanka (latitude 7 degrees north) and 242 Sri Lankans aged 31-60 years participating in a cross-sectional population-based study in Oslo, Norway (latitude 60 degrees north) were included in the analysis. All serum samples were analysed for serum 25-hydroxyvitamin D (s-25(OH)D) in the same laboratory. Sri Lankans living in Norway had substantially lower s-25(OH)D (mean 31.5 nmol/l) compared with those living in Sri Lanka (mean 54.2 nmol/l), and the prevalence of s-25(OH)D < 25 nmol/l was 9.3 times higher (95 % CI 4.4, 19.6) in Norway compared with Sri Lanka. In Sri Lanka there was a clear seasonal variation with the lowest s-25(OH)D levels in August-September and the highest levels in November-December. We conclude that vitamin D status among Sri Lankans living in Kandy, Sri Lanka was considerably higher than that among Sri Lankans living in Oslo, Norway. The low vitamin D status commonly observed in non-Western immigrant groups living at northern latitudes should not be regarded as normal levels for these groups. However, also in Sri Lanka we found a profound seasonal variation with the lowest levels in August and September after the Monsoon.

Comparison of cardiovascular risk factors between sri lankans living in kandy and oslo

BackgroundSouth Asians living in western countries are known to have unfavourable cardiovascular risk profiles. Studies indicate migrants are worse off when compared to those living in country of origin. The purpose of this study was to compare selected cardiovascular risk factors between migrant Sri Lankans living in Oslo, Norway and Urban dwellers from Kandy, Sri Lanka.MethodsData on non fasting serum lipids, blood pressure, anthropometrics and socio demographics of Sri Lankan Tamils from two almost similar population based cross sectional studies in Oslo, Norway between 2000 and 2002 (1145 participants) and Kandy, Sri Lanka in 2005 (233 participants) were compared. Combined data were analyzed using linear regression analyses.ResultsMen and women in Oslo had higher HDL cholesterol. Men and women from Kandy had higher Total/HDL cholesterol ratios. Mean waist circumference and body mass index was higher in Oslo. Smoking among men was low (19.2% Oslo, 13.1% Kandy, P = 0.16). None of the women smoked. Mean systolic and diastolic blood pressure was significantly higher in Kandy than in Oslo.ConclusionsOur comparison showed unexpected differences in risk factors between Sri Lankan migrants living in Oslo and those living in Kandy Sri Lanka. Sri Lankans in Oslo had favorable lipid profiles and blood pressure levels despite being more obese.

Differences in selected lifestyle risk factors for cardiovascular disease between Sri Lankans in Oslo, Norway, and in Kandy, Sri Lanka.

Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.

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.

Differences in predicted cardiovascular risk in Sinhalese and Tamils in Sri Lanka compared with Sri Lankans in Norway.

Using data from 3 cross-sectional studies, the authors compared the estimated risk of cardiovascular diseases between migrant Sri Lankans in Oslo, Norway, and Tamils and Sinhalese in Kandy, Sri Lanka. The authors found that Sri Lankans in Oslo had significantly lower Framingham coronary heart disease (CHD) risk. Among men, the prevalence with estimated 10-year risk of a CHD event ≥10% was 20.6% in Oslo, 31.1% in Kandy Tamils, and 44.2% in Kandy Sinhalese. The corresponding figures in women were 10.4% in Oslo, 19.2% in Tamils, and 14.9% in Sinhalese. Risk of fatal cardiovascular disease estimated by the SCORE model showed a similar pattern. The Oslo group had a higher body mass index (BMI), but the differences were observed in all BMI categories. In conclusion, despite a lower BMI, Tamils and Sinhalese in Sri Lanka had higher estimated cardiovascular risk compared with Sri Lankans in Norway, mainly because of poorer lipid profiles.

Study protocol: a pilot randomized controlled trial to evaluate the acceptability and feasibility of a counseling intervention, delivered by nurses, for those who have attempted self-poisoning in Sri Lanka

BackgroundDeliberate self-harm in the form of non-fatal self-poisoning is a major public health problem in Sri Lanka. Previous work suggests that many nurses in Sri Lanka—particularly those who work in primary care in the medical treatment of persons who attempt self-poisoning—already approach their role in a holistic fashion and consider “advising” or “counseling” patients after self-poisoning to be a part of their nursing role. But there is no formal training given to such nurses at present nor has the efficacy or feasibility of such an intervention been assessed in Sri Lanka. The aims of this pilot study are to explore the potential efficacy, acceptability, and feasibility of carrying out a counseling intervention that could be delivered by nurses for persons who present to hospital for medical management of non-fatal self-poisoning.Methods/designThe study will be carried out at the Toxicology Unit of Teaching Hospital Peradeniya, Sri Lanka. A pilot randomized controlled trial will be carried out among participants admitted to Teaching Hospital Peradeniya for medical management of non-fatal self-poisoning. The primary objective of this study is to explore the acceptability and feasibility of a counseling intervention being delivered by nurses. The secondary objectives are to explore the efficacy of the intervention for the improvement of skills to cope with situations of acute emotional distress, and to reduce rates of anxiety, depression, and future repetition and suicidal ideation. A nurse’s experiences and attitudes regarding the acceptability and feasibility of implementing this intervention and participant experiences of the intervention and its effects will be explored via qualitative interviews and focus group discussions.DiscussionIt is anticipated that the findings of this pilot study will help determine and assess the acceptability and feasibility of this counseling intervention, as well as indicate the more useful aspects of this intervention in order to develop it for further exploration in a larger trial.Trial registrationSLCTR/2017/008 Registered on 21st March 2017

Epidemiology and clinical course of inflammatory bowel disease in the Central Province of Sri Lanka: A hospital-based study: Epidemiology and clinical of IBD

There is increasing prevalence of inflammatory bowel disease (IBD) in Asia, but Sri Lankan data on the state of epidemiology and clinical course of IBD are scarce.

Analysis and identification of symptoms and risk factors in a cohort of chronic hypertensive patients in a tertiary care hospital in Sri Lanka

ABSTRACT Background: Hypertension (HT) is identified as a highly prevalent cardiovascular risk factor and also as a separate disease entity, leading to significant mortality and morbidity. The rate of HT is increasing worldwide with a faster rate identified in developing countries. Thus, it is important to evaluate epidemiological patterns of chronic HT in a developing country like Sri Lanka. Methodology: This is a cross-sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka, to assess symptoms and risk factors among patients with chronic HT. Results: In a cohort of 266 chronic hypertensives, the mean values for age of population, age of onset, and duration of HT, respectively, are 63, 45, and 8 years. At presentation, 24.8% were asymptomatic. The commonest presentation at diagnosis was dizziness accounting for 33.8% cases, followed by chest pain, headache, loss of consciousness, and shortness of breath accounting for 7.5%, 13.5%, 2.6%, and 4.5%, respectively. Approximately 36.5% of patients had a positive family history. Fathers of 7.1% patients, mothers of 19.2%, and both parents of 10.2% patients had HT. 38.7% of patients had one or more siblings with HT. 34.6% had diabetes mellitus. Conclusion: Symptoms of those with HT are mostly nonspecific and should be considered as possible warning signs prior to the development of sinister complications of the disease. Family history of HT with affected siblings, or one of the parents, was, observed in more than one-third of patients. Early screening and prevention of modifiable risk factors are important in these patients to prevent debilitating complications.

Value of peripheral blood count for dengue severity prediction

ObjectiveThis retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study.ResultsA total of 515 patients participated in the study. Among them, 333 were DHF patients while 182 patients were managed as DF. There was a significant difference in mean values of platelets and haemoglobin observed during acute phase in non-leakers compared to the patients who progressed to DHF, while no significant difference was observed for white blood cells, neutrophils, lymphocytes and haematocrit values. A significantly higher mean value was observed in white blood cells and hemoglobin in leakers compared to non-leakers during day 5. Mean day 5 platelet value was significantly lower among leakers compared to non-leakers but no significant difference between haematocrit, neutrophil and lymphocyte values were observed. ROC curve performed for acute phase platelet values and haemoglobin values to gain a predictive value for female and male DHF patients and cut off values with high sensitivity and specificity to predict DHF could be obtained for the platelet count.