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Abstract Background Cognitive tests have been used in population surveys as first stage screens for dementia but are biased by education. However functional ability scales are less biased by education than the cognitive scale and thus can be used in screening for dementia. Objective To validate Activities of Daily Living (ADL) scale appropriate for use in assessing the presence of dementia in an elderly population living in care homes in Sri Lanka. Method Sinhalese version of the modified Bristol and Blessed scale was administered to subjects aged 55 years and above residing in 14 randomly selected elders' homes. Receiver Operating Characteristic (ROC) was used to determine the cut-off scores of both the scales. Results Based on the ROC analysis, optimal cut off score of the modified Bristol scale was 20 with a sensitivity of 100%, specificity of 74.2% and the area under the curve 0.933(95% CI: 0.871-0.995) while the optimal cut off score of the modified Blessed scale was 10.5 with a sensitivity of 100%, specificity of 71% and the area under the curve 0.892 (95% CI: 0.816-0.967). Conclusion The findings confirm that both the scales can be used in screening for dementia in the elderly living in care homes in Sri Lanka.

Background: Geriatric Depression Scale (GDS) has not been validated for the elderly population in Sri Lanka. Aim: To translate, validate, and examine the effectiveness of GDS and to suggest the optimal cut-off scores for elderly Sri Lankans attending a psychogeriatric clinic. Materials and Methods: The Sinhalese translation of GDS (GDS-S) was administered to people aged 55 years and above, attending a psychogeriatric outpatient clinic. The diagnostic performance of the instrument was compared against the ICD 10 diagnosis of a consultant psychiatrist, which was considered the 'gold standard'. Receiver operating characteristic (ROC) analysis was carried out to compare the diagnostic performance of the GDS-S. Optimal cut-off scores for depression and sensitivity and the specificity of the instrument was determined. Results: A total of 60 subjects formed the final sample (male/female=16/44) of which 30 were depressed, while 30 were age- and sex-matched controls. The optimal cut-off score for GDS-S was 8 for differentiating non-depressed from mildly depressed, while the cut-off score for moderate depression was 10. Sensitivity and specificity of GDS-S was 73.3% for differentiating depressed from non-depressed. Conclusion: GDS is culturally acceptable, easy to use, sensitive, and a valid instrument to diagnose depression and to differentiate mild from moderate depression in an elderly Sri Lankan clinic population. [ABSTRACT FROM AUTHOR]

The article presents the findings of a study that aims to assess the impact on health related quality of life (HRQOL) of diabetes mellitus among South Asian men who have erectile dysfunction (ED). The International Index of Erectile Function (IIEF5) was used to assess ED. It mentions the association of ED with a significantly poorer quality of life when assessed by both generic and disease specific HRQOL measures.

OBJECTIVES To determine the extent of depressive disorder and associated factors among patients with epilepsy in Sri Lanka. DESIGN Cross-sectional, analytical study. PLACE AND DURATION OF STUDY Teaching Hospital of Colombo district, Sri Lanka. SUBJECTS AND METHODS 123 Sri Lankan patients with epilepsy were randomly selected from neurology clinics of two teaching hospitals in Colombo district, National Hospital of Sri Lanka and Teaching Hospital Colombo South. Data collection was carried out using a study specific self-administrated questionnaire and a diagnostic interview conducted by senior registrar in psychiatry, using ICD-10, diagnostic criteria for research, after obtaining written informed consent from participants. RESULTS Of the study sample 28.5% had depressive disorder. Findings of this study showed that, there was a statistically significant correlation between co-morbid depression with some factors, income (P= 0.019), low mood at the interview (P= 0.0001), last seizure activity (P=0.012), degree of control of seizures (P=0.023), somatic symptoms. (p=0.0001) and side of the foci (p=0.046). There was a significant association at p<0.1 significant level between co-morbid depression and age (p=0.098). There were no significant association formed between co-morbid depression and other selected factors. CONCLUSIONS It was revealed that nearly one third of the epileptic patients in the study population suffer from co-morbid depression, which has a significant correlation with income, low mood at the interview, degree of control of seizures, duration of last seizure activity and with somaticsymptoms. [ABSTRACT FROM AUTHOR]

The extent and interrelations of diabetes related sexual problems are not well documented. Purpose of this study was to assess prevalence and inter relationships of erectile dysfunction (ED), problems with sexual desire, and premature ejaculation (PE) among men with type 2 diabetes in Sri Lanka. Two hundred and fifty three men with type 2 diabetes, aged between 20-80 years, who had opportunity for sexual activity and attending a diabetic clinic in Sri Lanka were recruited in the study. Data were collected using a structured interviewer administered questionnaire and the erectile function was assessed using a translated version of International Index of Erectile Function (IIEF5). Those who had IIEF score ≤22 were considered to have normal erectile function while others were categorized as follows 21-17 mild ED,16-12 mild-to-moderate ED, 11-8 moderate-to-severe ED and 1-7 severe or complete ED.Participants were asked to grade their general sexual desire from a four category scale according to their subjective experience. Those who suffer from persistent rapid ejaculation causing distress to themselves and to their partners were considered as having PE. Relevant physical examination and biochemical investigations were carded out. Mean age 55.9 (SD±10.7)years, duration of diabetes 7.2 (SD±6.5) years. Mean HbA1c and cholesterol were 7.2 %(SD±1.6) and 5.0 mmol/l(SD±l.2) respectively.185(73.1%) had any degree of ED, 60(23.7%) had mild, 51(20.2%) mild to moderate, 25(9.9%) moderate and 49(19.4%) had severe ED. Only 87(33%) graded their desire for sexual activity as good, 102(43%) as fair, 31(12%) as poor, and 33(13%) as very poor. 96(37.9%) of the patients had PE. ED is significantly associated with PE (p<.001) and poor libido (p<.001). Sexual desire progressively reduced with increasing severity of ED. However association of PE and ED shows a non linier relationship with 70% of those who had mild to moderate ED having PE as opposed to only 20% of the men with normal erectile function having PE. ED, poor libido and PE are significant complication among men with diabetes in Sri Lanka. Awareness of close association between ED, poor sexual desire, and PE could have significant beating in managing sexual dysfunction among men with diabetes. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric comorbidities are common in physical illness and significantly affect health outcomes. Attitudes of general hospital doctors toward psychiatry are important as they influence referral patterns and quality of care. Little is known about these attitudes and their cultural correlates. The aim of this study was to identify attitudes toward psychiatry among general hospital specialists in relation to culture of the practice setting and other clinician factors (gender, age, seniority and specialty)., Methods: A cross-sectional, descriptive study was carried out in seven countries (New Zealand, China, Sri Lanka, Russia, Israel, Brazil, the Netherlands). Data were collected from senior medical staff of various disciplines using an updated version of Mayou and Smith's (1986) self-administered questionnaire., Results: A total of 889 hospital doctors participated. While favourable attitudes toward both psychiatric consultation and management were endorsed by a majority, significant differences were also observed between countries. Subgroup differences were mostly confined to gender, acuity of practice setting and specialty. For example, female doctors in Russia (χ 2 =7.7, p=0.0056), China (χ 2 =9.2, p=0.0025) and the Netherlands (χ 2 =5.7, p=0.0174) endorsed more positive attitudes compared with their male counterparts, but this gender effect was not replicated in the total sample. Chronic care specialists were overall more inclined to manage patients' emotional problems compared with those working in acute care (χ 2 =70.8, p (adjusted)<0.0001), a significant finding seen also in individual countries (China, New Zealand, the Netherlands, Russia). Physicians were more favourably disposed toward psychiatry compared with other specialists, especially surgeons, in all countries except Israel., Conclusions: This study adds to evidence for the association of medical attitudes with individual clinician factors and demonstrates that the influence of these factors varies by country. Understanding these issues may help to overcome barriers and improve quality of care provided to general hospital patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Dementia is poorly recognized even by physicians. This study compares three instruments used to assess dementia in a community setting in Sri Lanka., Method: Translated and culturally adapted versions of the Mini Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Clinical Dementia Rating (CDR) were administered to 363 individuals selected by stratified random sampling in a periurban community in Sri Lanka. The results on the three instruments were compared with the independent psychiatric evaluation done on a concentrated sample of 37 individuals from the study population., Results: Culturally adapted MMSE, IQCODE and CDR can be used to screen dementia in Sri Lanka. IQCODE is the best among the three instruments with a sensitivity of 71.4% and a specificity of 82.6% when 3.5 is the cut-off. In addition, IQCODE is culturally acceptable, easy to administer and can be used in those with a low level of literacy as well as in those with hearing or visual impairment., Conclusion: IQCODE was found to be more effective and culturally acceptable as a screening tool for dementia in Sri Lanka, compared with MMSE and CDR.