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Introduction: Religious and spiritual support reduces distress in patients with cancer. Accurate and reliable data on religious and spiritual support received and perceived by patients with cancer would assist health authorities in planning health promotion strategies targeted at patients with cancer. In this study, a new measurement tool of religious and spiritual support for patients with cancer in Sri Lanka was developed and validated. Methods: A new tool, the Religious and Spiritual Support Scale (RSSS) was developed based on the previous questionnaire and evaluated using 40 patients with cancer. Cross-cultural adaptation was made using WHO guidelines. Reliability was checked using Cronbach’s alpha. Intra-class correlation coefficient (ICC) was used to examine the test-retest reliability of the tool. Convergent and divergent validity of the tool was examined using the World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and the Centre for Epidemiological Studies–Depression scale (CES-D). Exploratory factor analysis (EFA) was performed to test the construct validity of the RSSS. Results: The RSSS showed a high internal consistency (Cronbach’s alpha-0.874). The test-retest reliability of the scale was good (ICC = 0.981). As expected, the overall RSSS score correlated negatively with CES-D (r= - 0.338, p

Introduction: Globally breast cancer (BC) is the most common cancer among women and Sri Lanka is not an exception. Cancer influences the quality of life (QoL) of cancer patients. The survival rates and the QoL of BC patients have improved significantly over the last few decades. However, factors associated with the QoL of patients with BC have not been well studied in Sri Lanka. The aim of the study was to assess the QoL and its correlates among patients with BC treated at a tertiary care hospital in Southern Sri Lanka. Methods: Ninety-seven BC patients were investigated using an interviewer-administered questionnaire. The World Health Organization- Quality of Life- Brief (WHOQOL-BREF) was used to measure QoL. The WHOQOL-BREF measure QoL in four domains: physical, psychological, social, and environmental. Scores range from 0 to 100, and higher scores indicate a greater QoL. Results: The mean age of the sample subjects was 52 years (SD = 8.7), and the majority were married (78%). Physical (60.97±11.56), psychological (63.52±11.63), and environmental (69.05 ±8.79) domains of QoL were at a satisfactory level whereas QoL score related to social relationships was found to be low (47.86±13.89) in this sample. Physical QoL was higher in young participants and psychological QoL was higher among those with a fewer number of comorbidities and disabilities and those with no body image changes. Social QoL was higher among married and environmental QoL was higher among those who reported having no disabilities. Conclusion: Social support in the form of family support and emotional support seems to play a major role in lowering the QoL of BC patients. Psycho-social support services should target patients experiencing physical disabilities, a higher number of comorbidities, and those who were subjected to changes in their body image.

Background: Coping strategies are essential in the cancer management/recovery process and play an integral role in patients with cancer globally. In Sri Lanka, validated scales to measure coping are scarce. This study examined the Sinhalese version of the Brief COPE for its psychometric properties. Methods: This scale is self-administered (28 items) and consists of adaptive and maladaptive coping strategies divided into 14 subscales. Cancer patients were registered on a ‘first come - first serve’ basis using their appointment register at the Radiotherapy Unit, Oncology ward, Teaching Hospital, Karapitiya, Galle, Sri Lanka. They were requested to complete the Sinhalese version of the Brief COPE and demographic details. Test-retest reliability was checked using the same subjects two weeks later. Factorial validity was assessed using exploratory factor and principal component analysis. The results were regarded as statistically significant if p < 0.05. Results: The mean (±SD) age of the sample was 61 (±12) years. The mean adaptive coping (±SD) and maladaptive coping were 37.50 (±8.14) and 17.10 (±2.44), respectively. The internal consistency of the overall scale was good (Cronbach’s alpha - 0.819). Adaptive and maladaptive coping showed a high Cronbach’s alpha (0.861 and 0.396). The test-retest reliability was found to be 0.66. The Sinhala version of BC was found to have a negative correlation with the CES-D scale but was positively correlated with the WHOQOL-BREF questionnaire. Seven factors were extracted. Conclusion: The Sinhala version of the Brief COPE is a valid and reliable tool to assess coping strategies among patients with cancer. The findings of this study will allow health authorities to gain an understanding of coping strategies among patients with cancer and the impact on cancer victims and family members to relieve their suffering.

The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the Hail region are scarce. Such data are imperative to develop effective strategies to control the epidemic in the region. A cross-sectional study of diabetes patients attending diabetes health care facilities in Hail was conducted using a sample of 392 patients. An interviewer-administered questionnaire was used. A slightly higher proportion of female participants (54.1%) were included in the sample. Most of the participants were from rural areas (73.9%), and 70.9% of the participants were from the middle-age (30–50 years) category. A close proximity to the diabetes clinic (OR = 1.98; 95% CI: 1.08–3.44), good transport facilities (OR = 1.67; 95% CI: 1.11–2.78) and feeling contented with supportive services (OR = 2.03; 95% CI: 1.12–4.04) were associated with patients’ satisfaction with the overall quality of the diabetes clinic services. The presence of good-quality health care professionals working in these treatment centers also seemed to contribute to patients’ satisfaction with the services they received. These structural factors associated with patients’ satisfaction with the services they received from diabetes clinics must be considered in diabetes control programs in the region. The minimization of structural barriers will eventually assist the national strategic plan, Vision 2030, which aims to improve the quality of life of the Saudi people by 2030.

The severe acute respiratory syndrome coronavirus 2 (COVID-19) outbreak has had a profound psychological impact on university undergraduates. Feelings, behavioral actions, and depressive symptoms related to COVID-19 in undergraduates in Hail, Saudi Arabia, were assessed using an online survey. Eighteen feelings and six behavioral acts were assessed. The Center for Epidemiological Studies Depression Scale was used to measure depressive symptomatology. Descriptive statistics and logistic regression techniques were used. The mean age of the participants (n = 418) was 20.2 years (standard deviation (SD) = 1.8 years), and 52.9% (n = 221) were males. Elevated levels of depressive symptoms were reported by 47.1% of male and 51.3% of female participants. Social isolation, loss of interest, obsessive monitoring of symptoms, concentration difficulties, recurrent negative thoughts, and worries about health services emerged as vital negative feelings related to COVID-19 that were expressed by the participants. Younger age (odds ratio (OR) = 0.636, 95% confidence interval (95% CI) = 0.428–0.946) and coming from the middle-income category (OR = 0.388, 95% CI = 0.151–0.994) were found to be protective factors against developing depressive symptoms. Frequent cleaning of hands, wearing masks when going out, and adherence to social distancing rules were practiced by 71.5% (95% CI = 67.2–75.8%), 78.7% (95% CI = (74.4–82.5%) and 66.0% (95% CI = (61.3–70.5%) of the participants, respectively. These behavioral acts were not associated with the development of depressive symptoms. Although the practice of COVID-19 precautionary measures by the participants was satisfactory, nearly half of the participants reported depressive symptoms. Innovative educational strategies are needed to curb concentration difficulties and social isolation experienced by undergraduates during outbreaks such as COVID-19.

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.

The COVID-19 pandemic has greatly affected the personal and academic lives of undergraduates in Saudi Arabia. Although studies have suggested that COVID-19 increased the prevalence of psychological health problems among undergraduates, the associations between the risk of depression and safety practices and the influence of gender on these associations have not been studied in detail. A cross-sectional online survey was conducted among preparatory-year undergraduates in a large public university in Saudi Arabia during the outbreak. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) Scale, and the practice of eight precautionary behaviors was also assessed. Data analysis was performed using the chi-square test, multiple linear regression and Spearman’s correlation coefficient. In total, 3044 undergraduates were surveyed. The mean age was 18.6 years (SD = 0.84), and 61.9% (n = 1883) of the participants were female. Overall, 47.7% of the participants reported having elevated depressive symptoms. Overall mean values of CES-D scores were higher among female undergraduates than that of male undergraduates (18.08 versus 15.56, p &lt, 0.01). There were inverse and weak but significant relationships between the CES-D score and frequent cleaning of hands (male: r = −0.116, p &lt, 0.01, female: r = −0.098, p &lt, 0.01), wearing a mask when going out (male: r = −0.172, p &lt, female: r = −0.135, p &lt, 0.01), keeping social distance (male: r = −0.117, p &lt, female: r = −0.147, p &lt, 0.01), and covering the nose when sneezing (male: r = −0.202, p &lt, female: r = −0.115, p &lt, 0.01). Regression analysis indicated that adherence to precautionary measures was a strong predictor of reduction of depressive symptoms in the target population. Male gender was also found to be an independent predictor of reduction of depressive symptoms. Depressive symptoms were highly prevalent in this target group, and female undergraduates seemed to be more vulnerable to developing such symptoms. Results also indicated that female undergraduates were more likely to implement the protective measures for COVID-19. The promotion of precautionary measures seems to be effective in reducing distress in this target population, but further research is needed to confirm our assertions.

Introduction: Chronic lymphoedema (CL) of lymphatic filariasis causes severe psychosocial burdens (PSB) to its victims. Currently-established scales to measure PSB of CL are not culturally adaptable to Sri Lankan patients. In this study, we developed and assessed the psychometric properties of a disease-specific questionnaire (15 item PSB-CL). Methods and Results: A detailed literature search was done to identify scales related to PSB of CL patients. Questions were developed through collected expressions from semi-structured interviews with 46 CL patients. A response scale was developed from the collected pool of possible responses, and they were scored using a visual analogue scale. Face and content validity were carried out using an initial questionnaire (31 questions). They were reduced to 27 by removing unclear, ambiguous, double-stranded ones and those with value-laden words. This new questionnaire was administrated on 92 patients by a group of doctors for item reduction by the analysis of internal consistency (Cronbach’s alpha > 0.7) and factor analysis (Principal Component Analysis; Eigenvalues > 1). After the patient survey and factor analysis, the final questionnaire PSB-CL was formed with 15 questions that had four subscales (factors), physical, social, fear and humiliation. Patients (n=92) reported quite a large percentage (42% - 69%) of problems under each dimension. Conclusion: The scale to measure the psychosocial burden of chronic lymphoedema in lymphatic filariasis patients in Sri Lanka. Further validation of the tool is needed.

Questionnaire to assess the knowledge of the antenatal mothers on birth defects, associated factors, prevention and management. This is a self-administered questionnaire used to collect data from the antenatal mothers. In the development of the questionnaire for the present study, the questionnaire developed by Bello et al., (2013) was used as a reference [3]. Additional questions were added to address the aims of the study. The questionnaire consisted of two parts; part A and part B. Part A of the questionnaire was used to gather socio-demographic data including age, ethnicity, highest educational qualification, monthly income, parity, previous children with birth defects, and the number of clinics attended. Data was obtained on prior awareness on birth defects and the sources of such information. An added question was included to inquire on the preconceptional FA intake. If FA was taken preconceptionally, the reason for them to take preconceptional FA supplementation was inquired. Part B of the questionnaire consisted of three sections; knowledge on BD, knowledge on associated factors of BD and knowledge on prevention and management of BD. Respectively, 10, 21 and 7 statements were included in each section. In all 3 sections mothers were asked to mark their responses stating whether the given statement is true, false or do not know. (DOCX 22 kb)

Objective To identify the validity of surveillance cultures in predicting causative organism(s) of late onset neonatal sepsis. Results Prospective analytical study was conducted from January to April 2011 at the Neonatal Intensive Care Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka. Fifty neonates were screened on admission and weekly thereafter for colonization with potential pathogens. On suspicion of infection, relevant samples were cultured and tested for antibiotic sensitivity. There were 55 episodes of clinically suspected infections including 33 nosocomial infections. One-third (17/55) of all clinically suspected infections were culture positive. Out of 55, only 33 episodes were clinically suspected nosocomial infections. Clinically suspected nosocomial infection rate was 50/1000 patient-days. Culture proven nosocomial infection rate was 13.61/1000 patient-days. Coliforms were the commonest clinical isolate (76%) and 2/3 of them produced extended spectrum β lactamase. More than 80% of the isolates causing late onset sepsis were sensitive to carbapenems and aminoglycosides. Sensitivity, specificity, positive predictive value and negative predictive value of surveillance cultures were 77.8, 37.5, 31.8 and 81.8%, respectively. Surveillance samples can be used to predict pathogens of late-onset sepsis. Broad-spectrum antibiotics (carbapenems, aminoglycosides) are recommended as empirical therapy for late-onset neonatal sepsis.

Objectives: To examine the unique contribution of generative leisure activities, defined as activities motivated by a concern for others and a need to contribute something to the next generation. Design: Cross-sectional survey. Setting: Peri-urban and rural area in southern Sri Lanka. Participants: Community-dwelling adults aged 60 and older (N = 252). Measurements: The main predictors were leisure activities, grouped into generative, social, or solitary. The main outcome was cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: More-frequent engagement in generative leisure activities was associated with higher levels of cognitive function, independent of the effect of other social and solitary leisure activities. In a fully adjusted model combining all three leisure activities, generative activities independently predicted cognitive function as measured using the MoCA (β = 0.47, 95% confidence interval (CI) = 0.11–0.83) and the IQCODE (β = −0.81, 95% CI = −1.54 to −0.09). In this combined model, solitary activities were also independently associated with slower cognitive decline using the MoCA (β = 0.40, 95% CI = 0.16–0.64) but not the IQCODE (β = −0.38, 95% CI = −0.88–0.12); the association with social activities did not reach statistical significance with either measure. These associations did not differ meaningfully according to sex. Conclusion: Generative leisure activities are a promising area for the development of interventions aimed at reducing cognitive decline in elderly adults.

Introduction: Chronic ill health due to non-communicable diseases have already posed a great threat to the well-being of older people in Sri Lanka impairing their quality of life to a greater extent. This study was aimed to examine the impact of some chronic disease conditions on quality of life (QOL) of older people in Galle, Sri Lanka. Methods: This cross-sectional study was conducted in 70 older people (male=21, female=49) aged 60 years. Validated self-reported version of World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire which measures QOL in four dimensions; physical, psychological, environmental and social was used to assess the QOL. Results: The age range of the participants was 60-90 years (mean = 70.3 years, SD = 6.2 years). Of the total, 41 subjects were living with their spouse and 22 were widowed. Visual impairment (67%), hypertension (47%) and arthritis (34%) were the most prevalent chronic diseases reported. QOL mean scores for all the four domains which measured in a 1 - 100 scale were all higher than 65 for both men and women. Further, mean scores of QOL in all the domains in both sexes were found to be low among those who were suffering from chronic conditions, although significant differences were found in physical and psychological domains between those with and without cardiovascular diseases and hypertension (p Conclusions: QOL of older people in Galle is relatively higher compared to the QOL of community dwelling older people in many other countries. Although NCDs and other chronic conditions are prevalent in this study population, cultural and environmental factors may have contributed to improve the QOL of this population group.

The elderly population in Sri Lanka is growing rapidly. Elders are traditionally cared for in the homes of their adult children, but the shifting socio-economic environment in Sri Lanka challenges this arrangement. This paper describes the dynamics of elder–care-giver relationships in Southern Sri Lanka. Data included four focus group discussions and five in-depth interviews with elderly, and ten in-depth interviews with adult children of the elderly. Discussion guide topics included care-giving arrangements, and roles/responsibilities of elders and care-givers. Using a grounded theory approach, a comprehensive analytic memo was developed and discussed to explore emerging themes on the care-giver dynamic. Both elders and care-givers felt that elders should be taken care of in the home by their children. They pointed to a sense of duty and role modelling of parental care-giving that is passed down through generations. Even as elders desired support from their children, they feared losing their independence, and saw financial autonomy as important for maintaining relationship balance. Care-giving challenges included: households where both the adult child and his/her spouse worked outside the home; households where elders had a disproportionate amount of household work; economically stressed households; and lack of direct communication between elders and care-givers regarding conflicts. Results point to strong values around caring for elderly in the home, but identify challenges to this arrangement in the future.

Background. The effects of coconut fat and soya fat on serum lipids are controversial. This study was designed to investigate the lipid effects of coconut milk and soya milk supplementation on the lipid profile of free living healthy subjects.Methods.Sixty (60) healthy volunteers aged 18–57 years were given coconut milk porridge (CMP) for 5 days of the week for 8 weeks, followed by a 2-week washout period, subsequent to which they received isoenergetic soya milk porridge (SMP) for 8 weeks.Results. The LDL (low density lipoprotein) levels decreased with CMP and reached statistical significance in the total study population and in the >130 baseline LDL group. The HDL (high density lipoprotein) levels rose significantly with CMP supplementation (P=0.000).Conclusions. We conclude that coconut fat in the form of CM does not cause a detrimental effect on the lipid profile in the general population and in fact is beneficial due to the decrease in LDL and rise in HDL. SMP will be of benefit only in those whose baseline LDL levels are elevated.

Psychometric properties of a new scale that measures motivations towards alcohol use were examined using a sample of 412 male alcohol users in Sri Lanka aged 16–30 years. In addition, associations between drinking motives and drinking frequency were explored. Confirmatory factor analysis showed that a 3-factor model consisting of the factors personal enjoyment, tension reduction, and social pressure fit the data well. Overall, tension-reduction motivation was found to be prominent in the context of young males’ drinking behavior in Sri Lanka. Associations between stress and alcohol use among young males warrant further investigations.

The prevalenceof different neighborhood environmental stressors and associations between the stressors and self-rated health are described in a representative sample of 2,077 individuals, aged 18-85 years, in southern Sri Lanka. Mosquito menace (69.4%), stray dog problems (26.8%), nuisance from neighbors (20.3%), and nuisance from drug users (18.7%) were found to be the most prevalent environmental stressors. None of the stressors investigated were associated with self-rated physical health, but nuisance from neighbors, nuisance from drug users, shortage of water and having poor water/ sewage drainage system were associated with self-rated mental health among the respondents.

Using the Triandis Model of Interpersonal Behavior (TIB), we considered the unique context of Mardi Gras, the annual festival in New Orleans, Louisiana, and how it might influence sexual behavior. This study utilized a two-stage, qualitative and quantitative methodological framework. Focus groups of past Mardi Gras participants were held to gather data to inform the development of the study instruments, and data were subsequently collected from 300 Mardi Gras participants in February 2004 using a pencil-and-paper questionnaire. For women, the TIB model did not significantly predict intentions to engage in sexual behavior at Mardi Gras. Cognitive beliefs and subjective social norms predicted intentions to engage in oral and vaginal sex among male participants. For men and women, peer sexual activity, intentions, and previous sexual experience predicted engaging in sexual behaviors at Mardi Gras. Situational conditions related to Mardi Gras culture predicted anal sex behavior. The TIB, as a guiding framework for the study, makes apparent the importance of cultural context when developing interventions related to sexuality that are to be implemented in a specific setting like Mardi Gras.

Introduction: Population of Sri Lanka is aging fast. Chronic diseases in the elderly have become a vital public health issue. Generativity, concern for teaching and nurturing the next generation, is identified as an important component of well-being of the elderly. This study assessed the generative concern in a sample of elders in Galle, and correlates of the construct. Methods: A cross-sectional survey was conducted using an interviewer administered questionnaire in a sample of elders, aged 60 years and above in Galle. Loyola Generative Scale (LGS) and Kesslar 10 scale was used to assess generative concern and psychological stress respectively. Results: A total of 208 elders were surveyed. The average age of the participants was 71 years (SD=7.5). The overall mean score of the LGS was 47.4 (SD=7.4). Generative concern was found to be higher among those elders whose spouse is alive (p Discussion: The average LGS score of the elders in this sample is higher than that of elders in many countries where the figure was around 40. Thus, a majority of the elders in this target population seems to have a greater generative concern. There is a possibility, therefore to improve health and well-being of the elderly in the area by developing and implementing intergenerational social and community development programmes.

Introduction: Geriatric population in Sri Lanka is a potentially vulnerable group for malnutrition. The present study was carried out to assess the nutritional status of elderly in Galle and to identify the relationships of their nutritional status with gender, age, area of residence, level of education and income. Methods : A cross sectional study was done using a sample of elders aged 60 years and above living in Galle district. An interviewer administered questionnaire was used to collect data. Mini Nutritional Assessment (MNA) tool was used to assess nutritional status. Results : A total of 396 elders participated in the study. Mean age of the participants was 69 years ( SD = 7.2) and the majority were females (n = 268, 67.7%). MNA showed that 0.5% elderly were malnourished and 30.8% were at risk of malnutrition. Older age ( p 0.05), lower monthly family income ( p p p 0.05) were found to be possible risk factors of malnutrition. Conclusions : Nutritional status is considerably poor in the elderly in Galle district. Therefore, geriatric nutritional interventions in low income older age elders in rural population segments in the area are needed.

The adverse health effects of tobacco and alcohol are well known. Alcohol consumption is increasing in Sri Lanka, but few population studies have been conducted. The objective of this study was to document tobacco and alcohol consumption levels among adults in southern Sri Lanka and to identify the main reasons for using or refraining from alcohol and tobacco products. Tobacco and alcohol use within Sri Lanka is relatively common, particularly among adult males. Reasons given for smoking and drinking frequently relate to social and image-based motivators. Women may be especially susceptible to the influence of peer pressure in social situations. Public health efforts should consider the use of demographic-specific anti-tobacco and anti-alcohol messages, as the motivators driving behavior appear to differ across gender and age groups.

To estimate the prevalence of physical and emotional abuse reported by late adolescent school children in southern Sri Lanka, and to identify demographic and behavioural correlates of such abuse.A cross-sectional survey was administered to a sample of 1099 male and 1290 female late adolescents, through schools in the southern province. Self-report anonymous questionnaires were used. Study variables included age, gender, body mass index (BMI), socioeconomic status, deliberate self harm, substance use, school absenteeism and family conflicts.Of the total, 22.4% (n = 246) of males and 15.7% (n = 202) of females reported having been subjected to physical abuse at least a few times in the 3 months preceding the survey (p0.05), and 31.3% (n = 324) of males and 25.4% (n = 328) of females reported having been subjected to emotional abuse at least a few times in the 3 months preceding the survey (p0.05). Logistic regression analyses revealed that school absenteeism, deliberate self-harm, substance use, and family conflict were associated with physical and emotional abuse. Socio-economic status and BMI were not found to be associated with physical and emotional abuse.Physical and emotional abuse are important health issues among late adolescent school children in Sri Lanka. Further research is needed to better understand the causal direction of the associations between physical and emotional abuse experiences, and health-related behaviours.

With decreasing fertility and mortality rates, the population of Sri Lanka is rapidly aging, and this issue will become one of the greatest challenges the government has to face in the near future.Aconsiderable proportion of elders in Sri Lanka depends on their children or relatives for food, shelter and safely.Although caring for elders is an integral and important cultural norm in the country, factors such as urbanization, migration and westernization have meant that many elders today experience poor health and living conditions. In this context, social support and social security of elders are important issues and need urgent attention of the government, non-governmental organizations and general public. Social support and social security systems available today for elders in Sri Lanka need to be investigated thoroughly to identify mechanisms and strategies that are effective and sustainable. Further, unmet needs of elders with respect to social support and social security need to be assessed. Based on such investigations, specific plans of actions should be formulated to reduce future social support and social security problems of elders in Sri Lanka. Key words : Aging; social support; social security DOI: http://dx.doi.org/10.4038/gmj.v16i2.3748 GMJ 2011; 16(2): 20-23

Having sex is one of the most pleasurable experiences a person can have if done in a proper behavior and a healthy way. Unfortunately, unhealthy sexual behavior is common in many communities across the world today, and they are a great threat to the health of the people (1-3). Globally, curable sexually transmitted infections (STIs) accounts for 340 million new cases each year which cause unnecessary ill health and deaths which could be avoided by better education, earlier diagnosis and treatment (4).An estimated 20 million unsafe abortions took place in the year 2003, 98% of them in developing countries with restrictive abortion laws (5).Worldwide, approximately 15% to 25% of women and 5% to 15% ofmenwere sexually abused when they were children (4-6). Not only the victims of these ill-health conditions suffer, but, each of these problems carries with it the potential for lifelong consequences for families, communities, and the nations as a whole. Sexual health is a fundamental part of human life and a core component of personality and it requires a positive and respectful approach to sexuality and sexual relationships. The WHO affirms that to attain and maintain sexual health, the sexual rights of all persons must be protected, respected and fulfilled (2,7). However, there are serious disparities among the populations affected by sexual health problems. The economically disadvantaged, racial and ethnic minorities, persons with different sexual identities, and adolescents often bear the heaviest burden.

Introduction: Psychological problems pose a significant threat to health and well-being of medical undergraduates in many countries. Less is known about psychological health issues of medical undergraduates in Sri Lanka. This study assesses and compares the prevalence of depressive symptoms between first year medical and non-medical undergraduates in a southern university in Sri Lanka. In addition, the predictors of depressive symptoms in this target population were explored. Methods: A self-report, anonymous questionnaire that contained the Center for Epidemiological Studies- Depression Scale (CES-D) was administered to a sample of 392 first year undergraduates from the faculties of Agriculture, Medicine, Business Administration and Science. Results: The mean score of the CES-D scale was 21.2 (SD = 11.0), higher when compared to similar studies conducted in other countries. About 76% of medical and 60% of non-medical undergraduates reported elevated depressive symptoms (p Conclusions: Depressive symptoms appear to be more prevalent among first year medical students when compared to their non-medical peers. Physically and socially active lifestyles may reduce the chances of developing depressive symptoms in undergraduates. More research is needed to understand the behavioral and social factors associated with these elevated levels of distress and the behaviors and other strategies employed by these undergraduates to manage it. SD Key words: Depressive symptoms, Behavior, Undergraduates, Sri Lanka DOI: 10.4038/gmj.v16i1.2901 Galle Medical Journal , Vol 16: No. 1, March 2011 pp.1-5

Introduction: Sexual behavior and reproductive health of adolescents in Sri Lanka is getting increasing attention. Factors associated with sexual behavior among adolescents are not adequately understood. Objectives: To investigate the prevalence of sexual experiences among school age adolescents and assess demographic and behavioral correlates of sexual experience. Methods: A study was conducted among late adolescents in public sector schools in southern Sri Lanka. A self-administered questionnaire was used to obtain relevant information. Results: Data from a total of 2385 subjects (1104 males and 1281 females) were analyzed. Among these, 15.5% of males and 7.9% of females reported some sexual experience with another person ( Conclusion: A considerable proportion of late adolescents in the Southern Province have been sexually active. There is a need to address sexual health issues of this group through student education and parent education. Improving sexual life skills of students is an important component in sex education programs. DOI: 10.4038/gmj.v14i1.1172 Galle Medical Journal Vol.14(1) 2009 39-44

Objectives: To present the rationale and design of the Southern Province A-level School Health Survey, to identify health status and health behaviour patterns, and to examine gender differences in these factors, among late adolescent school children in Southern Sri Lanka. Methods: A self-administered, anonymous questionnaire was used to obtain information on demographics, perceived health status, psychological well-being, substance use, physical activity, school violence, and sexual health. A two-stage cluster sampling method was used to select students from the three districts in the Southern Province. Results: A total of 908 females and 903 males participated in the study. The majority (about 98%) was aged 18 years and 99% were Sinhalese. Over 80% of both male and female participants reported self-perceived physical and ment~l h-11th r"very pcd" or ' ' ~n? l . ' ' Ncnrly 50% of both male and female respondents had experienced severe or moderate psychological distress in the 30-day period preceding the survey. Males were more likely to report substance use than females (Alcohol use: 10.5% verses 1.8%; Smoking: 5.1 % verses < I % ; Illegal drug use: 1.5% verses