Study purposeThe aim of this study was to determine the fractional exhaled nitric oxide (FeNO) levels, exhaled breath carbon monoxide (eCO) levels, blood pressure, blood lipid levels between smokers and non-smokers and to determine the association of smoking intensity with the above parameters.MethodsThis descriptive study was conducted in selected periurban areas of the Colombo District, Sri Lanka. Adult male current tobacco smokers (n=360), aged between 21 and 60 years were studied and compared with anthropometrically matched male non-smokers (n=180). Data were collected by interviewer-administered questionnaire, clinical assessment and measurement of FeNO by FENO monitor and eCO bySmokerlyser.ResultsSmokers had significantly lower mean FeNO levels and higher mean eCO values compared with non-smokers. Presentation of palpitations was higher among the smokers and a significantly positive correlation was identified between palpitations and eCO levels. There was a significantly positive correlation between the systolic blood pressure of smokers with the duration of smoking (DS), Brinkman Index (BI), Body Mass Index (BMI) and there was a significantly negative correlation with FeNO levels. The mean arterial pressure was positively correlated with the DS, BI and BMI. There was a significantly negative correlation between FeNO and the number of cigarettes smoked per day, DS and BI of smokers. Significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), very LDL-C, TC: HDL ratio and low high density lipoprotein cholesterol (HDL-C) level was observed among smokers compared with the non-smokers.ConclusionsTobacco smoking was found to impact blood pressure and serum lipid levels thus enhancing the cardiovascular risk among smokers. The levels of eCO and FeNO are useful biomarkers for determining the intensity of smoking. The results indicate the necessity for urgent measures to stop cigarette smoking in Sri Lanka.

Objective Previous studies have shown that high socioeconomic status (SES) is significantly associated with inhibitory control, working memory, verbal comprehension and IQ. However, in the Asian setting, with its prevailing poverty, information about the influence of SES on cognitive development of female adolescents is limited. This study was aimed to investigate the association between SES and neurocognitive performance of early female adolescents in Sri Lanka. Methods Female adolescents aged 11-14 years (n = 200) of low and middle SES were studied to assess neurocognitive function. After obtaining baseline data, eight subtests of the Wechsler Intelligence Scale for Children (WISC - IV), Test Of Nonverbal Intelligence (TONI-3) and two computer-based executive function tests (inhibition and visuo-spatial working memory) were administered to assess neurocognitive measures of the above adolescents. The results were compiled into a data base and analyzed using SPSS version 20 statistical software. Results Higher SES was associated with higher performance in all neurocognitive tests. Low SES adolescents obtained significantly poor test scores for executive function test (inhibitory control: p < 0.0001) and for WISC [verbal comprehension index (VCI): p < 0.0001), working memory index (WMI): p < 0.0001 and estimated full scale IQ (EFSIQ): p < 0.0001)] when compared with middle SES adolescents. Maternal education alone significantly predicts VCI and EFSIQ than the combined influence of parental education, occupation and income. Psychosocial adversities of adolescents were inversely correlated with VCI (r = -0.30; p < 0.001) and EFSIQ (r = -0.20; p < 0.001) of WISC and mathematics performance (r = -0.34; p < 0.001) at examination in school. Conclusion Findings of the study revealed the importance of upliftment of SES of the society to improve the cognitive and academic outcomes of low SES individuals.

Type 2 diabetes mellitus is a chronic condition, a global concern, and a serious issue in Sri Lanka, where there is little data regarding the influence of dietary control, exercise, and adherence to medication behaviors among adults diabetes. In this cross-sectional, descriptive study, we identified current factors influencing glycemic control and glycemic control behavior among adults with diabetes. A total of 230 people attending diabetes clinics in a tertiary hospital and a primary care institute were administered the self-report Diabetes Information Form, assessing their socioeconomic and medical information and glycemic control behaviors. Data were analyzed by frequency distribution, percentages, mean scores, and standard deviation. The results indicated that most participants had not achieved the recommended fasting blood glucose level (< 126 mg/dL). Although dietary control was practised by 72%, regular exercise was not practised by 85%, and while 77% reported adhering to regular medication, they still had poor glycemic control. The findings highlight the need for health professionals to adopt new strategies for diabetes education to overcome issues related to misconceptions and barriers in providing diabetes care in Sri Lanka.

No abstract

IntroductionInternational guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka.Methods and analysisEligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial.Ethics and disseminationEthical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals.Trial registration numberISRCTN13367735

Introduction: Age ranging from 11 to 14 years is regarded as early adolescence. Females are p vulnerable to experience stress with rapid physical, psychological, cognitive and social changes accompanied in adolescence. Stress experienced in adolescence is linked with a range of adverse physical and psychological consequences. The study aimed to determine the level of stress and factors contributing to stress among female adolescents in the Galle educational zone, Sri Lanka. Methods: A school based cross - sectional study was conducted on female adolescents (11 - 14 years, n = 218). A self-administered socio-demographic questionnaire and psychosocial adversity scale were used to assess socioeconomic status and psychosocial adversities respectively. The Body Mass Index (BMI), waist hip ratio (WHR), waist height ratio (WHtR) and fat percentage (FM%) were calculated to assess the nutritional status. Adolescent Stress Questionnaire (ASQ), which measures 9 dimensions of stress, was used to assess stress. Results: Normal nutritional status was observed in 118 (54.1%) while 65 (29.8%) and 35(16.1%) adolescents were underweight and overweight respectively. A majority of adolescents (n = 158, 72.9%) were experiencing stress. An increased stress levels were observed for the domains of school attendance (n = 203, 93.1%), future uncertainty (n = 202, 92.7%), school performance (n = 185, 84.9%), emerging responsibility (n = 186, 85.3%), and conflict of school/leisure time (n = 178, 81.7%). Conclusions: Most adolescents considered future uncertainty and school attendance as the greatest stress inducing factors. Urgent measures to decrease stress levels amongst these adolescents need to be implemented.

No abstract

Background: Biomass fuel smoke is a leading cause of indoor air pollution. It is a known risk factor for respiratory diseases. This study was conducted to determine the prevalence of respiratory symptoms and associated factors among women exposed to biomass fuel smoke in Sri Lanka.Methods: Women (n=600) were assessed using questionnaires to determine base line data, cooking fuel use, respiratory symptoms (MRC respiratory symptoms questionnaire) and diagnosed respiratory diseases. Kitchen characteristics were determined by direct observation. Sample frequencies were calculated. Logistic regression analysis was done to determine the associations.    Results: Majority (64.1%) were biomass fuel users. Their mean age was 47 years ±14 SD. Majority 99.2% were never smokers. Prevalence of cough, phlegm, cough and phlegm, wheeze, breathlessness and diagnosed asthma was 14%, 16%, 9.9%, 22%, 22.3%, and 6.3% respectively. Use of biomass fuel was related to any respiratory symptom (OR=1.9; p<0.05), cough (OR=1.9; p<0.05), phlegm (OR=2.0; p<0.05), cough and phlegm (OR=2.7; p<0.05), wheezing (OR=2.0; p<0.05) and breathlessness (OR=2.0; p<0.05). Use of biomass fuel in an outdoor kitchen was associated with cough (OR=2.8, p<0.05), phlegm (OR=4.6, p<0.05), cough and phlegm (OR=3.1, p<0.05) and breathlessness (OR=2.1, p<0.05). Use of biomass fuel in a kitchen with neither chimney nor windows was associated with phlegm (OR=2.9, p<0.05) and cough and phlegm (OR=3.0, p<0.05).Conclusions: Use of biomass fuel for cooking in an outdoor kitchen and in a kitchen with neither chimney nor windows were positively associated with respiratory symptoms in non-pregnant women exposed to biomass fuel smoke in Sri Lanka.