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Introduction and objectives: Sri Lankans do not have a specific cardiovascular (CV) risk prediction model and therefore, World Health Organization(WHO) risk charts developed for the Southeast Asia Region are being used. We aimed to develop a CV risk prediction model specific for Sri Lankans using machine learning (ML) of data of a population-based, randomly selected cohort of Sri Lankans followed up for 10 years and to validate it in an external cohort. Material and methods: The cohort consisted of 2596 individuals between 40–65 years of age in 2007, who were followed up for 10 years. Of them, 179 developed hard CV diseases (CVD) by 2017. We developed three CV risk prediction models named model 1, 2 and 3 using ML. We compared predictive performances between models and the WHO risk charts using receiver operating characteristic curves (ROC). The most predictive and practical model for use in primary care, model 3 was named "SLCVD score" which used age, sex, smoking status, systolic blood pressure, history of diabetes, and total cholesterol level in the calculation. We developed an online platform to calculate the SLCVD score. Predictions of SLCVD score were validated in an external hospital-based cohort. Results: Model 1, 2, SLCVD score and the WHO risk charts predicted 173, 162, 169 and 10 of 179 observed events and the area under the ROC (AUC) were 0.98, 0.98, 0.98 and 0.52 respectively. During external validation, the SLCVD score and WHO risk charts predicted 56 and 18 respectively of 119 total events and AUCs were 0.64 and 0.54 respectively. Conclusions: SLCVD score is the first and only CV risk prediction model specific for Sri Lankans. It predicts the 10-year risk of developing a hard CVD in Sri Lankans. SLCVD score was more effective in predicting Sri Lankans at high CV risk than WHO risk charts. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: The Menopause Rating Scale (MRS) is a widely used tool to assess the health-related quality of life (HRQOL) and severity of menopausal symptoms in postmenopausal women. The objective of the present study was to validate a Tamil translation of the MRS, as a Tamil translation is not available. Methods: The Tamil translation of MRS was developed following standard methodology, and a validation study to assess psychometric properties was done at the community level in Mannar, Sri Lanka. Reliability was assessed through internal consistency and test–rest reliability. Validity was assessed using content, discriminatory, and construct validity. Results: Internal consistency using Cronbach's α coefficient ranged from 0.74 to 0.78 and test–retest reliability assessed by weighted kappa (k) ranged from 0.51 to 0.71. Content validity was evaluated by the acceptability of items for a sample of women and gynecologists conversant in Tamil during the translation process. Discriminant validity between symptomatic and asymptomatic women was significant for all three domains: somato-vegetative, sexual, and psychological (P < 0.05). Factor analysis with exploratory principal component analysis revealed three factors that explained 55.9% of the cumulative variance, demonstrating satisfactory construct validity. A MRS total score ≥6 had a sensitivity of 81% and a specificity of 84.7% to identify symptomatic menopausal women. Conclusion: Tamil translation of MRS retained the psychometric properties of the original questionnaire and will be an invaluable tool to assess menopausal symptoms and HRQOL among postmenopausal tamil-speaking women. [ABSTRACT FROM AUTHOR]

Objectives: To explore associations between type and number of abnormal glucose values on antenatal oral glucose tolerance test (OGTT) with postpartum diabetes in South Asian women diagnosed with gestational diabetes (GDM) using International Association of the Diabetes and Pregnancy Study Groups criteria. Methods: This post‐hoc evaluation of the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, a randomized controlled trial, was conducted among women with GDM in the index pregnancy, across 19 centers in Bangladesh, India, and Sri Lanka. Postpartum diabetes (outcome) was defined on OGTT, using American Diabetes Association (ADA) criteria. Results: We report data on 1468 women with GDM, aged 30.9 (5.0) years, and with median (interquartile range) follow‐up period of 1.8 (1.4–2.4) years after childbirth following the index pregnancy. We found diabetes in 213 (14.5%) women with an incidence of 8.7 (7.6–10.0)/100 women‐years. The lowest incidence rate was 3.8/100 women years, in those with an isolated fasting plasma glucose (FPG) abnormality, and highest was 19.0/100 women years in participants with three abnormal values. The adjusted hazard ratios for two and three abnormal values compared to one abnormal value were 1.73 (95% confidence interval [CI], 1.18–2.54; p =.005) and 3.56 (95% CI, 2.46–5.16; p <.001) respectively. The adjusted hazard ratio for the combined (combination of fasting and postglucose load) abnormalities was 2.61 (95% CI, 1.70–4.00; p <.001), compared to isolated abnormal FPG. Conclusions: Risk of diabetes varied significantly depending upon the type and number of abnormal values on antenatal OGTT. These data may inform future precision medicine approaches such as risk prediction models in identifying women at higher risk and may guide future targeted interventions. [ABSTRACT FROM AUTHOR]

Background Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites. Methods and Findings The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at--risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually. Conclusions Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa. doi:10.1371/journal.pmed.0050218, Introduction Venomous snakes are found throughout most of the world (including many oceans), except for a few islands, frozen environments, and high altitudes [1]. Envenomings and deaths resulting fromsnakebites, however, [...]