Family level dementia care assessment tool’: a tool to assess Quality of care received by dementia patients in Sri Lankan setting

Background: Dementia has become a public health priority along with population ageing worldwide. In the absence of a cure, maintaining the best possible quality of care (QOC) has become the desired outcome for people with dementia.Objectives: To develop a multi-source tool to describe QOC received by patients at family levelMethods: The tool development process was consisted of five steps; item generation, item reduction, formulating the draft tool, translation and finalization. A qualitative study was conducted. Interpretative phenomenological approach was applied to identify items for the tool based on current quality care recommendations, using triangulation of techniques [in-depth and key informant interviews (KI) and focus group discussion (FGD)]. KI were consultant psychiatrists, neurologists, psychiatric social workers and consultant community physicians. In-depth interviews were conducted with patients and FGDs with the caregivers. Purposive sampling was done. Number of interviews was decided on data saturation. Item reduction was done through modified Delphi technique. The tool was translated to Sinhala language and finalized after assessing judgmental validity (face, content and consensual validity).Results: The newly developed ‘Family level dementia care assessment tool’ comprised of 56 items under 7 themes to be used as a multisource tool (observations on home environment, interviews with patient and caregiver). The main themes in the tool are home environment, primary caregiver, availability of a care plan, types of activities in practice, interpersonal relationships, availability of social network and patient’s appearance and behaviour. The tool has demonstrated acceptable level of face, content and consensual validity.Conclusions: ‘Family level dementia care assessment tool’ can be used as an observational checklist even by a grass root level health care worker, to assess the family level care received by dementia patients. This preliminary data on family level dementia care can be used to sensitize policy makers and also to plan interventions towards improving QOC among dementia patients

Determinants of quality of life in people with dementia in a Sri Lankan setting

Background: Dementia has become a public health priority along with population ageing worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) have become the desired outcome for people with dementia.Objectives: To determine the factors associated with good QOL in people with dementia in Sri Lankan setting.Methods: An unmatched case-control study was conducted to identify the factors associated with ‘good’ QOL. Cases were patients with ‘good’ QOL and controls were those with ‘poor/average’ QOL, accompanied by informal primary caregivers of last six months. They were identified using the validated DEMQOL tool, adhering to strict eligibility criteria, from state hospital tertiary care psychiatric clinics in the Colombo district. There were 64 cases and 208 controls. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI).Results: After adjusting for confounders, the significant factors associated with ‘good QOL’ were; education up to GCE O/Level and above (OR=4.02; 95% CI=2.97, 12.0), ever employed(OR=3.21; 95% CI=1.59, 11.06), good social functioning (OR=4.14; 95% CI=3.39, 16.46), mild functional impairment (OR=1.77; 95% CI=1.13, 9.67), little or no caregiver burden (OR=2.96; 95% CI=1.86, 10.94), absence of apathy (OR=2.22; 95% CI=1.27, 12.48) and absence of irritability (OR=2.17; 95% CI=1.72, 10.34).60% of the variance of ‘good’ QOL among patients with dementia was explained by the factors in the final model.Conclusions: The identified associated factors indicate that QOL improvement programmes should primarily focus on patients’ activities of daily living, social functioning and caregiver burden

Changes in quality of life following initial treatment of oesophageal carcinoma: a cohort study from Sri Lanka

Background Oesophageal carcinoma is one of the leading cancers in Sri Lanka. Recent advances in treatment modalities have drastically improved the survival of these patients. However, the quality of life (QoL) among the survivors needs to be reviewed in order to recognise the need for advocating more focussed rehabilitation for oesophageal carcinoma in Sri Lanka. Methods A prospective cohort study was conducted among 51 incident cases of oesophageal carcinoma recruited consecutively from the National Cancer Institute, Maharagama. Data were collected on their QoL using EORTC QLQ-C30 and EORTC-OES18 questionnaires validated for Sri Lankan oesophageal carcinoma patients, before and one month after the completion of initial treatment. Scoring was based on the EORTC manual. Comparison of baseline and follow-up scores was done using paired t test at significance level of 0.05. Results Response rate was 80%. The majority consisted of squamous cell carcinoma of stage IV. On a scale of 0–100, the overall QoL (mean score = 49.8; SD = 22); and role (42.2; SD = 34), physical (53.1; SD = 29), emotional (53.4; SD = 26) and social (57.2; SD = 23) functioning were relatively low at diagnosis. The scores of functioning scales further deteriorated (difference > 5 points) following the initial treatment (p < 0.05). Dysphagia (mean = 54; SD = 27) was the main symptom at diagnosis, which improved significantly (p < 0.05) in contrast to dry mouth (mean = 39.2; SD = 34) that worsened (p < 0.05) following initial treatment. Family support and financial difficulties were adversely affected (p < 0.05) during the initial treatment. Conclusions The deterioration of several dimensions of QoL of oesophageal carcinoma patients following the initial treatment highlights the need for more targeted tertiary preventive strategies that address the issues identified

Novel risk factors for primary prevention of oesophageal carcinoma: A case-control study from Sri Lanka

Background Oesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka. Its increasing incidence despite the implementation of various preventive activities addressing the conventional risk factors indicates the possibility of the existence of novel, country-specific risk factors. Thus, the identification of novel risk factors of OC specific to Sri Lanka is crucial for implementation of primary prevention activities. Methods A case-control study was conducted among 49 incident cases of OC recruited from the National Cancer Institute, Maharagama using a non-probability sampling method, and unmatched hospital controls (n = 196) excluded of having OC recruited from the endoscopy unit of the National Hospital of Sri Lanka. Data were collected using an interviewer administered questionnaire. Risk factors for OC were assessed by odds ratio (OR) with 95% confidence interval (CI). The risk factors were adjusted for possible confounding by logistic regression analysis. Results Of the study population, OC was common among males (69%) and the majority presented with squamous cell carcinoma (65%) at late stages (Stage IV: 45%; Stage III: 37%). Following adjusting for confounders, the risk factor profile for OC included; age > 65 years (OR = 4.0; 95% CI: 1.2–14.2); family history of cancer (OR = 5.04; 95% CI: 1.3–19.0); sub-optimal consumption of dietary fibre (OR = 3.58; 95% CI: 1.1–12.3); sub-optimal consumption of anti-oxidants (OR = 7.0; 95% CI: 2.2–22.5); over-consumption of deep fried food (OR = 6.68; 95% CI:2.0–22.6); ‘high risk’ alcohol drinking (OR = 11.7; 95% CI: 2.8–49.4); betel quid chewing (OR = 6.1; 95% CI: 2.0, 20.0); ‘low’ lifetime total sports and exercise activities (MET hours/week/year) (OR = 5.83; 95% CI: 1.5–23.0); agrochemicals exposure (OR = 6.57; 95% CI: 1.4–30.3); pipe-borne drinking water (OR = 5.62; 95% CI:1.7–18.9) and radiation exposure (OR = 4.64; 95% CI: 1.4–15.5). Significant effect modifications were seen between betel quid chewing and male sex (p = 0.01) and between ever exposure to radiation and age over 65 years (p = 0.04). Conclusions Risk profile for OC includes novel yet modifiable risk factors in relation to diet, occupation, environment and health. Primary prevention should target these to combat OC in Sri Lanka

Should nutrient profile models be ‘category specific' or ‘across-the-board'? A comparison of the two systems using diets of British adults

Background/Objectives: Nutrient profile models have the potential to help promote healthier diets. Some models treat all foods equally (across-the-board), some consider different categories of food separately (category specific). This paper assesses whether across-the-board or category-specific nutrient profile models are more appropriate tools for improving diets. Subjects/Methods: Adult respondents to a British dietary survey were split into four groups using a diet quality index. Fifteen food categories were identified. A nutrient profile model provided a measure of the healthiness of all foods consumed. The four diet quality groups were compared for differences in (a) the calories consumed from each food category and (b) the healthiness of foods consumed in each category. Evidence of a healthier diet quality groups consuming more of healthy food categories than unhealthy diet quality groups supported the adoption of across-the-board nutrient profile models. Evidence of healthier diet quality groups consuming healthier versions of foods within food categories supported adoption of category-specific nutrient profile models. Results: A significantly greater percentage of the healthiest diet quality group's diet consisted of fruit and vegetables (21 vs 16%), fish (3 vs 2%) and breakfast cereals (7 vs 2%), and significantly less meat and meat products (7 vs 14%) than the least healthy diet quality group. The foods from the meat, dairy and cereals categories consumed by the healthy diet quality groups were healthier versions than those consumed by the unhealthy diet quality groups. Conclusions: All other things being equal, nutrient profile models designed to promote an achievable healthy diet should be category specific but with a limited number of categories. However models which use large number of categories are unhelpful for promoting a healthy diet

disaggregation: An R Package for Bayesian Spatial Disaggregation Modeling

Disaggregation modeling, or downscaling, has become an important discipline in epidemiology. Surveillance data, aggregated over large regions, is becoming more common, leading to an increasing demand for modeling frameworks that can deal with this data to understand spatial patterns. Disaggregation regression models use response data aggregated over large heterogeneous regions to make predictions at fine-scale over the region by using fine-scale covariates to inform the heterogeneity. This paper presents the R package disaggregation, which provides functionality to streamline the process of running a disaggregation model for fine-scale predictions

Comparison of cardiovascular risk factors between sri lankans living in kandy and oslo

<p>Abstract</p> <p>Background</p> <p>South Asians living in western countries are known to have unfavourable cardiovascular risk profiles. Studies indicate migrants are worse off when compared to those living in country of origin. The purpose of this study was to compare selected cardiovascular risk factors between migrant Sri Lankans living in Oslo, Norway and Urban dwellers from Kandy, Sri Lanka.</p> <p>Methods</p> <p>Data on non fasting serum lipids, blood pressure, anthropometrics and socio demographics of Sri Lankan Tamils from two almost similar population based cross sectional studies in Oslo, Norway between 2000 and 2002 (1145 participants) and Kandy, Sri Lanka in 2005 (233 participants) were compared. Combined data were analyzed using linear regression analyses.</p> <p>Results</p> <p>Men and women in Oslo had higher HDL cholesterol. Men and women from Kandy had higher Total/HDL cholesterol ratios. Mean waist circumference and body mass index was higher in Oslo. Smoking among men was low (19.2% Oslo, 13.1% Kandy, P = 0.16). None of the women smoked. Mean systolic and diastolic blood pressure was significantly higher in Kandy than in Oslo.</p> <p>Conclusions</p> <p>Our comparison showed unexpected differences in risk factors between Sri Lankan migrants living in Oslo and those living in Kandy Sri Lanka. Sri Lankans in Oslo had favorable lipid profiles and blood pressure levels despite being more obese.</p

DIABRISK - SL Prevention of cardio-metabolic disease with life style modification in young urban Sri Lankan's - study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Urban South-Asian's are predisposed to early onset of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There is an urgent need for country specific primary prevention strategies to address the growing burden of cardio-metabolic disease in this population. The aim of this clinical trial is to evaluate whether intensive (3-monthly) lifestyle modification advice is superior to a less-intensive (12 monthly; control group) lifestyle modification advice on a primary composite cardio-metabolic end point in 'at risk' urban subjects aged between 5-40 years.</p> <p>Methods/Design</p> <p>This is an open randomised controlled parallel group clinical trial performed at a single centre in Colombo, Sri-Lanka. A cluster sampling strategy was used to select a large representative sample of subjects aged between 5-40 years at high risk of T2DM and CVD for the intervention study. We have screened 23,298 (males 47% females 53%) healthy subjects for four risk factors: obesity, elevated waist circumference, family history of diabetes and physical inactivity, using a questionnaire and anthropometry. Those with two or more risk-factors were recruited to the intervention trial. We aim to recruit 4600 subjects for the intervention trial. The primary composite cardio-metabolic end point is; new onset T2DM, impaired glucose tolerance, impaired fasting glycaemia, new onset hypertension and albuminuria, following 5 years of intervention. The effect of the intervention on pre-specified secondary endpoints will also be evaluated. The study will be conducted according to good clinical and ethical practice, data analysis and reporting guidelines.</p> <p>Discussion</p> <p>DIABRISK-SL is a large population based trial to evaluate the prevalence of diabetes, pre-diabetes and cardio-metabolic risk factors among young urban Sri-Lankans and the effect of a primary prevention strategy on cardio-metabolic disease end points. This work will enable country specific and regional cardio-metabolic risk scores to be derived. Further if the proposed intervention is successful the results of this study can be translated and implemented as a low-cost primary prevention tool in Sri-Lanka and other low/middle income developing countries.</p> <p>Trial registration</p> <p>The trial is registered with the World Health Organisation and Sri-Lanka clinical trial registry number SLCTR/2008/003</p