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Unintentional injuries are common among children of Sri Lanka and globally. These can be prevented by identification and modification of risk factors. A pre-tested, structured-observation and an interview were carried out in 270 households with children less than five years in three districts. A high prevalence of risk factors for falls(58.l%), burns(51.6%), sharps injuries(51.3%), choking(65.9%) and animal-bites(53.2%) were observed. Parental identification of risk factors was less. Parents educational level significantly affected both the prevalence of risk factors(P < .05) and parental awareness(P < .05). Only 38% has received injury prevention education and the attending physician has counseled only 5% of the parents. A high prevalence of risk factors, low parental awareness and inadequate counseling by primary care physicians was noted. Primary health-care providers should be educated to encourage counseling of parents during office visits. [ABSTRACT FROM AUTHOR]

Identifying the directed connectivity that underlie networked activity between different cortical areas is critical for understanding the neural mechanisms behind sensory processing. Granger causality (GC) is widely used for this purpose in functional magnetic resonance imaging analysis, but there the temporal resolution is low, making it difficult to capture the millisecond-scale interactions underlying sensory processing. Magnetoencephalography (MEG) has millisecond resolution, but only provides low-dimensional sensor-level linear mixtures of neural sources, which makes GC inference challenging. Conventional methods proceed in two stages: First, cortical sources are estimated from MEG using a source localization technique, followed by GC inference among the estimated sources. However, the spatiotemporal biases in estimating sources propagate into the subsequent GC analysis stage, may result in both false alarms and missing true GC links. Here, we introduce the Network Localized Granger Causality (NLGC) inference paradigm, which models the source dynamics as latent sparse multivariate autoregressive processes and estimates their parameters directly from the MEG measurements, integrated with source localization, and employs the resulting parameter estimates to produce a precise statistical characterization of the detected GC links. We offer several theoretical and algorithmic innovations within NLGC and further examine its utility via comprehensive simulations and application to MEG data from an auditory task involving tone processing from both younger and older participants. Our simulation studies reveal that NLGC is markedly robust with respect to model mismatch, network size, and low signal-to-noise ratio, whereas the conventional two-stage methods result in high false alarms and mis-detections. We also demonstrate the advantages of NLGC in revealing the cortical network-level characterization of neural activity during tone processing and resting state by delineating task- and age-related connectivity changes., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate prevalence and risk factors of posttraumatic stress disorder (PTSD) and depression among directly exposed (DE) and indirectly or nonexposed (INE) populations in Sri Lanka 8 y after the Indian Ocean Tsunami in 2004., Methods: Population-based structured survey study was conducted among Sri Lankan adults living in 5 coastal districts, Hamboantha, Matara, Galle, Kalutara, and Colombo in 2012-2013. A total of 430 individuals, 325 in DE, 105 in INE, participated in the survey. DE and INE groups were compared for demographics and outcomes. Bivariate and multiple logistic regressions with backward selection were used to identify risk factors for partial PTSD and depression., Results: The prevalence of PTSD, partial PTSD and depression were 2.8%, 10.5%, and 18.8% in DE group, respectively. In multivariable analyses tsunami exposure, female gender, subjective physical health before the tsunami, previous trauma, and depression were significantly associated with partial PTSD. Female gender, high frequency of religious activity, previous trauma, social support, and PTSD were significantly associated with depression., Conclusions: The psychological impacts of the tsunami did wane over time, but still present at lower rate even in 8 y. It is important to address these lingering sequelae and expand access to at risk individuals.

Background: Acne vulgaris is one of the commonest skin disorders affecting up to 80% of the world population at least during adolescence. Significant psychosocial effects such as depression and poor personality development have been linked with acne, especially in female adolescents. Various causative factors, including cosmetic exposure, have been attributed toward acne., Objective: To analyze the association between frequent exposure to cosmetics and severity of acne in adolescent females., Method: A cross-sectional analytical study was performed on 140 girls from three schools in Colombo, Sri Lanka. A self-administered questionnaire was utilized to assess the patterns of cosmetic usage. Grading acne of the participants was performed by the researchers utilizing a standard acne grading scale., Results: The overall prevalence of acne in our study population was 91.4% with a mean acne grade of 3.09. At least one cosmetic type was used by 126 (90%) of the population. A Pearson correlation coefficient (r) value of .452 (P < .001) was obtained between cosmetic exposure and acne grade, which indicates a statistically significant correlation. A chi-square value of 22.875 was obtained at a degree of freedom of 2 (P < .001), enabling us to reject the null hypothesis that there is no significant association between cosmetic usage and acne severity., Conclusion: Our results convey a significant positive association between frequent exposure to cosmetics and severity of acne in adolescent females. Girls of this age group must be made aware that cosmetic usage may be a potential aggravating factor for their facial acne., (© 2017 Wiley Periodicals, Inc.)

Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs., (© 2013 APJPH.)

There has been dramatic advancement in health status in the Asia-Pacific region (APR) over the past 50 years. This ever-changing paradigm of public health calls for continuous review and quality improvement of public health education (PHE). Since its founding in 1984, the mission of the Asia-Pacific Academic Consortium for Public Health (APACPH) has been to improve the quality and relevance of PHE to combat the diverse, dynamic, and unique challenges in the APR. Prof Walter Patrick was a forerunner in this movement and played an instrumental role in establishing APACPH's position in accreditation and improvement of PHE., (© 2014 APJPH.)

We developed, implemented and evaluated a web-based continuing professional development (CPD) programme on medical genetics. Development of the CPD programme followed the ADDIE model, i.e. Analysis, Design, Develop, Implement and Evaluation. An invitation to participate in a needs analysis survey was sent to all doctors on the email list of the Sri Lanka Medical Association. A total of 129 completed surveys was received (57% of the 228 who accessed the online survey). The average age of respondents was 42 years (range 27-81). The male: female ratio was approximately 2 : 1. Almost all respondents (96%) selected web-based CPD programmes, or web-based and conventional lectures, as their preferred method of learning. The programme was piloted on a group of 10 doctors. The average pre-knowledge score was 40.3 and the post-knowledge score was 62.1 marks out of 100 (P = 0.002). We conclude that a web-based CPD programme on medical genetics is feasible in Sri Lanka.

Background: The migration of health-care workers contributes to the shortage of health-care workers in many developing countries. This paper aims to describe the migration of medical specialists from Sri Lanka and to discuss the successes and failures of strategies to retain them., Methods: This paper presents data on all trainees who have left Sri Lanka for postgraduate training through the Post Graduate Institute of Medicine, University of Colombo, from April 1980 to June 2009. In addition, confidential interviews were conducted with 30 specialists who returned following foreign training within the last 5 years and 5 specialists who opted to migrate to foreign countries., Results: From a total of 1,915 specialists who left Sri Lanka for training, 215 (11%) have not returned or have left the country without completing the specified bond period. The majority (53%) migrated to Australia. Of the specialists who left before completion of the bond period, 148 (68.8%) have settled or have started settling the bond. All participants identified foreign training as beneficial for their career. The top reasons for staying in Sri Lanka were: job security, income from private practice, proximity to family and a culturally appropriate environment. The top reasons for migration were: better quality of life, having to work in rural parts of Sri Lanka, career development and social security., Conclusions: This paper attempts to discuss the reasons for the low rates of emigration of specialists from Sri Lanka. Determining the reasons for retaining these specialists may be useful in designing health systems and postgraduate programs in developing countries with high rates of emigration of specialists.

The Democratic Socialist Republic of Sri Lanka is an island in the Indian Ocean that has achieved a unique status in the world with health indicators that are comparable with those of developed countries. This is illustrated, among others, by the reduction in both child and maternal mortality in the country. This achievement is the result of a range of long-term interventions, including providing education and health care free of charge, training of health care workers, developing public health infrastructure in rural areas, and adopting steps to improve sanitation, nutrition, and immunization coverage.

Context: This review provides a summary of the published literature on the suitability of the long case and its modifications for high-stakes assessment., Methods: Databases related to medicine were searched for articles published from 2000 to 2008, using the keywords 'long case', 'clinical examinations' and 'clinical assessment'. Reference lists of review articles were hand-searched. Articles related to the objective structured clinical examination were eliminated. Research-based articles with hard data were given more emphasis in this review than those based on opinion., Results: Eighteen articles were identified. The main disadvantage of the long case is its inability to sample the curriculum widely, resulting in low reliability. The main advantage of the long case is its ability to assess the candidate's overall (holistic) approach to the patient. Modifications to the long case attempt to: structure the format and the marking scheme; increase the number of examiners; observe the candidate's behaviour, and increase the number of cases., Conclusions: The long case is a traditional clinical examination format for the assessment of clinical competence and assessment at this level is important. The starting point for the majority of recent research on the long case has been an acceptance of its low reliability and modifications to the format have been proposed. Further evidence of the efficacy of these modifications is required, however, before they can be recommended for summative assessment. If further research is to be undertaken on the long case, it should focus on finding practicable ways of sampling the curriculum widely to increase reliability while maintaining the holistic approach towards the patient, which represents the attraction of the long case.

Introduction: The Faculty of Medicine, University of Colombo, Sri Lanka provided voluntary healthcare services during the aftermath of the 2004 tsunami. At that time the faculty recognised the need to prepare the healthcare system for future disasters by enhancing the capability of healthcare workers. The development and implementation of a disaster management course for healthcare workers was identified as a priority., Method: An outcome-based approach was used to develop the curriculum. Qualitative and quantitative methods were used to identify the core competencies and outcomes that healthcare workers need to achieve at the end of the course. The content, teaching learning methods and assessments were aligned with the course outcomes. The course consists of 9 core modules and an elective research module. Formative and summative assessment methods were included., Conclusion: Training is an important component of disaster management. The outcome-based approach provides a useful framework for developing such training programmes and ensures that needs are addressed.

The objective of this study is to evaluate the perceptions of Internally Displaced Persons (IDPs) in tsunami relief camps on provision and quality of health care services, during the aftermath of the disaster. A randomly selected health administrative area in the Southern Province of Sri Lanka is selected. Two approaches using both quantitative and qualitative methods. The study assessed the perceptions of IDPs regarding on provision and quality of health care facilities, using an interviewer administered questionnaire (survey) in 200 family units. In-depth interviews were conducted with IDPs and relevant health authorities. A majority (88%) of the people was satisfied with the immediate medical assistance. However 48% of IDPs and authorities felt that frequency of visits paid by medical teams have decreased over time. Fifty-three percent were dissatisfied with the toilet facilities provided. A majority was satisfied with health education (82%) and supply of drinking water (80%). Tsunami survivors felt that health services provided during the intermediate phase was unsatisfactory compared to the immediate phase. We recommend attention to ensuring ongoing access to health care and to improving the sanitary facilities in the camps.

In 1995, the Colombo Medical Faculty changed its curriculum from a traditional model to an integrated one. The major challenge to the Faculty was obtaining students' feedback on their learning activities. To overcome this, a new method where staff and student groups from different years of study engage in an interactive discussion relating to their learning environment was developed. This feedback was then processed and forwarded to the relevant authorities for necessary action.

Introduction: Problem-based learning (PBL) is used as an instructional method in the system-based modules of the new innovative curriculum of the Colombo Medical Faculty in Sri Lanka. This study was undertaken to assess whether objectives of having PBL to facilitate acquisition of desirable learning skills and generic skills had been achieved. The perceived advantages and disadvantages of PBL were also studied., Materials and Methods: The study population comprised third year medical students who had completed 12 PBL sessions. A self-administered questionnaire, which measured learning outcomes and acquisition of generic skills on a 5-point Likert rating scale, was used., Results: The response rate was 87.2% (n = 188). Eighty per cent of students were aware of the rationale for having PBL and of learning from recommended material. Seventy-five per cent knew the competencies that could be acquired from PBL and two-thirds knew about the importance of small group discussions. PBL had helped to improve communication skills in 57% and problem solving skills in 52%. The main disadvantage was that it was time-consuming. Only 46.6% were satisfied with the participation of colleagues in the group. Seventy-six per cent felt that PBL could be better conducted., Conclusion: Awareness of concepts of PBL, reasons for its inclusion in the curriculum and educational advantage was high. The main disadvantage perceived was that it was time-consuming. There is a need to improve the conduct of PBL and, provide guidance and awareness programme for students.