BackgroundChronic abdominal pain is a common worldwide problem and known to be associated with psychological problems. This study evaluated the association between abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs), psychological maladjustment and personality traits in adolescents.MethodsAdolescents aged 13–18 years were recruited from 5 randomly selected schools in Ampara district of Sri Lanka. AP-FGIDs were diagnosed using Rome III criteria. Translated and validated Rome III questionnaire (Child report form), personality questionnaire (PAQ) and PedsQL (Pediatric Quality of Life) inventory were used in data collection. Written consent was obtained from a parent and assent was obtained from every child recruited. The questionnaire was distributed in an examination setting to ensure confidentiality and privacy. Research assistants were present during data collection to assist on any necessary clarifications.ResultsA total of 1697 subjects were recruited [males 779 (45.9%), mean age 15.1 years, SD 1.6 years]. AP-FGIDs were present in 202 (11.9%). Those with AP-FGIDs had significantly higher mean scores for all personality traits (hostility and aggression, negative self-esteem, emotional unresponsiveness, emotional instability and negative world view), except dependency. Affected children had lower scores for all 4 domains of HRQoL (physical, emotional, social and school functioning), compared to controls (p < 0.05). When the cut off value for Sri Lankan children (89) was used, 66.3% with AP-FGIDs and 48.2% controls had PAQ scores within that of psychological maladjustment (p < 0.001). When the international normative value of 105 was used, these percentages were 27.2% and 14.2% respectively (p < 0.0001). The scores obtained for PAQ negatively correlated with scores obtained for HRQoL (r = − 0.52, p < 0.0001). One hundred and seventeen adolescents with AP-FGIDs (57.9%) had sought healthcare for their symptoms. Healthcare consulters had higher PAQ and lower HRQoL scores (p < 0.05).ConclusionsAdolescents with AP-FGIDs have more psychological maladjustment and abnormal personality traits than healthy controls. Affected adolescents with higher psychological maladjustments have lower HRQoL. Greater psychological maladjustment and lower HRQoL are associated with healthcare seeking behaviour in adolescents with AP-FGIDs.

BackgroundIschaemic Heart Disease (IHD) is a major constituent of cardiovascular disease in the world at present and has become the leading cause of death in Sri Lanka. Poor adherence to medication in IHD is related to increased re-hospitalisation and mortality. Therefore, continuous assessment of medication adherence is extremely important among these patients. The Morisky Green Levine Medication Adherence Scale (MGLS) is a widely used instrument to evaluate medication adherence in the clinical setting. The study aimed to translate the MGLS into Sinhala and cross-culturally adapt it to the Sri Lankan setting. Methods A Delphi process was conducted with a panel of experts where content and consensual validity of the scale was assessed after translation, back translation and pre-testing of the original scale. The ratings received from the first round of the Delphi process were noted and the amended translation re-sent for a second round. The re-ratings were evaluated for the degree of consensus and Items for the MGLS Sinhala version were chosen based on the following criteria: (i) the item was reworded or removed if 70% or more of the re-ratings were in category 0-3. If reworded, the Delphi Process was repeated for that item, (ii) the item was kept with no change if 70% or more of the re-ratings were in categories of 4-6 and 7-9. Results No items were removed from the original scale. Some items were reworded according to the experts' suggestions to retain the conceptual meaning when translated into Sinhala. The Sinhala version of the MGLS exhibited adequate content and consensual validity. ConclusionThe Sinhala version of the MGLS can be used in research, medication adherence evaluations and IHD prevention programmes in Sri Lanka.

Background: Ischemic heart disease (IHD) has been identified as the foremost cause of morbidity and mortality in Sri Lanka. Aims and Objectives: The main aim of this study was to develop a socio-culturally appropriate health counseling intervention protocol to enhance the adherence of prescribed physical activity, diet, and medication among IHD patients attending medical clinics in Sri Lanka. Materials and Methods: This protocol was designed to be used by health professionals and consisted of two sections – an assessment and an intervention. The intervention section integrated communication skills with motivational interviewing, goal setting, and problem-solving. A panel of five experts reviewed each section of the protocol, in a Delphi process. The ratings received at Delphi stage one that was evaluated for degree of consensus. The protocol was modified according to the comments received and resent for a second Delphi round. Again, the re-ratings were reevaluated for the degree of consensus. With regard to assessing consensus, each section was revised/removed if 70% or more of the re-ratings were at 0–3 and kept as the same if 70% or more of the re-ratings were at four or above. Results: All the subsections were rated in categories of four and above in both stages. Therefore, none of the sections was removed from the original protocol. Some modifications were done according to the suggestions received in the Delphi review. Conclusion: The finalized protocol would be initially implemented in selected hospitals in Galle district as a quasi-experimental study in the near future.

In most volume of distribution (V D) determinations the drug partitioned in to erythrocytes (C ery) occupying 45% of blood volume is disregarded. The V D determinations can be erroneous on two accounts. The first is the indiscriminate reference to plasma (C p) , whole blood (C b) or serum (C s) concentrations. The second is when C ery values are not considered in calculations. Isolated erythrocytes were incubated in plasma water (C pw) represented by physiological saline drug solutions, the C pw , C ery and C b values were experimentally determined in vitro. Aberrations to the V D determinations are demonstrated using both theoretically and practically determined values of C pw , C ery and C b. Widely varying V D values 125 L to 2.55 L resulted when C p data alone is used while the values differed marginally from 4.56 L to 5.53 L when C b values were used for two setting using same amount of drug.