Quantifying urbanisation as a risk factor for non-communicable disease

Aim of this study was to investigate the poorly understood relationship between the process of urbanization and non-communicable diseases (NCDs) in Sri Lanka using a multi-component, quantitative measure of urbanicity.NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study comprising a representative sample of people from seven of the nine provinces in Sri Lanka (n=4,485/5,000; response rate=89.7%). We constructed a measure of the urban environment for seven areas using a seven-item scale based on data from study clusters to develop an ―urbanicity&rdquo; scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urbanicity and chronic disease risk factors.Among men, urbanicity was positively associated with physical inactivity (OR: 3.22; 2.27 &ndash; 4.57), high body mass index (OR: 2.45; 95% CI: 1.88 &ndash; 3.20) and diabetes mellitus (OR: 2.44; 95% CI: 1.66 &ndash; 3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR: 2.29; 95% CI: 1.64 &ndash; 3.21), high body mass index (OR: 2.92;95% CI: 2.41 &ndash; 3.55) and diabetes mellitus (OR: 2.10; 95% CI: 1.58 &ndash; 2.80).There is a clear relationship between urbanicity and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults.<br /

Prevalence of retinopathy among adults with self-reported diabetes mellitus: the Sri Lanka diabetes and Cardiovascular Study

Background - At present there are no large scale nationally-representative studies from Sri Lanka on the prevalence and associations of Diabetic Retinopathy (DR). The present study aims to evaluate the prevalence and risk factors for DR in a community-based nationally-representative sample of adults with self-reported diabetes mellitus from Sri Lanka. Methods - A cross-sectional community-based national study among 5,000 adults (≥18 years) was conducted in Sri Lanka, using a multi-stage stratified cluster sampling technique. An interviewer-administered questionnaire was used to collect data. Ophthalmological evaluation of patients with ‘known’ diabetes (previously diagnosed at a government hospital or by a registered medical practitioner) was done using indirect ophthalmoscopy. A binary-logistic regression analysis was performed with ‘presence of DR’ as the dichotomous dependent variable and other independent covariates. Results - Crude prevalence of diabetes was 12.0%(n=536),of which 344 were patients with ‘known’ diabetes.Mean age was 56.4 ± 10.9 years and 37.3% were males. Prevalence of any degree of DR was 27.4% (Males-30.5%, Females-25.6%; p = 0.41). In patients with DR, majority had NPDR (93.4%), while 5.3% had maculopathy. Patients with DR had a significantly longer duration of diabetes than those without. In the binary-logistic regression analysis in all adults duration of diabetes (OR:1.07), current smoking (OR:1.67) and peripheral neuropathy (OR:1.72)all were significantly associated with DR. Conclusions - Nearly 1/3rd of Sri Lankan adults with self-reported diabetes are having retinopathy. DR was associated with diabetes duration, cigarette smoking and peripheral neuropathy. However, further prospective follow up studies are required to establish causality for identified risk factors

Food consumption of Sri Lankan adults: an appraisal of serving characteristics

Objective: The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics. Design: Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods. Setting: Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study. Subjects: Six hundred non-institutionalized adults. Results: The daily intake of fruit (0.43), vegetable (1.73) and dairy (0.39) portions were well below national recommendations. Only 3.5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3.5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2.78. Conclusions: Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits

Can we bridge the gap? Knowledge and practices related to Diabetes Mellitus among general practitioners in a developing country: A cross sectional study

<p>Abstract</p> <p>Background</p> <p>Diabetes mellitus is becoming a serious public health problem in Sri Lanka and many other developing countries in the region. It is well known that effective management of diabetes reduces the incidence and progression of many diabetes related complications, thus it is important that General Practitioners (GPs) have sound knowledge and positive attitudes towards all aspects of its management. This study aims to assess knowledge, awareness and practices relating to management of Diabetes Mellitus among Sri Lankan GPs.</p> <p>Methods</p> <p>A cross-sectional study was conducted among all 246 GPs registered with the Ceylon College of General Practitioners using a pre-validated self-administered questionnaire.</p> <p>Results</p> <p>205 responded to the questionnaire(response rate 83.3%). Their mean duration of practice was 28.7 ± 11.2 years. On average, each GP had 27 ± 25 diabetic-patient consultations per-week. 96% managed diabetic patients and 24% invariably sought specialist opinion. 99.2% used blood glucose to diagnose diabetes but correct diagnostic cut-off values were known by only 48.8%. Appropriate use of HbA1c and urine microalbumin was known by 15.2% and 39.2% respectively. 84% used HbA1c to monitor glyceamic control, while 90.4% relied on fasting blood glucose to monitor glyceamic control. Knowledge on target control levels was poor.</p> <p>Nearly 90% correctly selected the oral hypoglyceamic treatment for obese as well as thin type 2 diabetic patients. Knowledge on the management of diabetes in pregnancy was poor. Only 23.2% knew the correct threshold for starting lipid-lowering therapy. The concept of strict glycaemic control in preference to symptom control was appreciated only by 68%. The skills for comprehensive care in subjects with multiple risk factors were unsatisfactory.</p> <p>Conclusions</p> <p>The study was done among experienced members of the only professional college dedicated to the specialty. However, we found that there is room for improvement in their knowledge and practices related to diabetes. We recommend continuing medical education and training programs to update GP's knowledge in order to improve health outcomes in this group of patients.</p

High dietary diversity is associated with obesity in Sri Lankan adults: An evaluation of three dietary scores.

Background: Dietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults. Methods: Six hundred adults aged > 18 years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24 hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25 kg.m−2 is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity. Results: Mean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non-obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population. Conclusion: Our data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items

Work-related complaints of arm, neck and shoulder among computer office workers in an Asian country: prevalence and validation of a risk-factor questionnaire

<p>Abstract</p> <p>Background</p> <p>Complaints of arm, neck and/or shoulders (CANS) affects millions of computer office workers. However its prevalence and associated risk factors in developing countries are yet to be investigated, due to non availability of validated assessment tools for these countries. We evaluated the 1-year prevalence of CANS among computer office workers in Sri Lanka and tested the psychometric properties of a translated risk factor questionnaire.</p> <p>Methods</p> <p>Computer office workers at a telecommunication company in Sri Lankan received the Sinhalese version of the validated Maastricht Upper Extremity Questionnaire (MUEQ). The 94 items in the questionnaire covers demographic characteristics, CANS and evaluates potential risk factors for CANS in six domains. Forward and backward translation of the MUEQ was done by two independent bi-lingual translators. One-year prevalence of CANS and psychometric properties of the Sinhalese questionnaire were investigated.</p> <p>Results</p> <p>Response rate was 97.7% (n = 440). Males were 42.7%. Mean age was 38.2 ± 9.5 years. One-year prevalence of CANS was 63.6% (mild-53.7% and severe-10%). The highest incidences were for neck (36.1%) and shoulder (34.3%) complaints. Two factors for each domain in the scale were identified by exploratory factor analysis (i.e. work-area, computer-position, incorrect body posture, bad-habits, skills and abilities, decision-making, time-management, work-overload, work-breaks, variation in work, work-environment and social-support). Calculation of internal consistency (Cronbach's alpha 0.43-0.82) and cross-validation provided evidence of reliability and lack of redundancy of items.</p> <p>Conclusion</p> <p>One year prevalence of CANS in the study population corresponds strongly with prevalence in developed countries. Translated version of the MUEQ has satisfactory psychometric properties for it to be used to assess work-related risk factors for development of CANS among Sri Lankan computer office workers.</p

Data Resource Profile: Understanding the patterns and determinants of health in South Asians-the South Asia Biobank.

Funder: Singapore Ministry of Health's National Medical Research CouncilFunder: National Institute for Health ResearchFunder: Wellcome Trust or the Department of HealthFunder: NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme; Grant(s): IS-BRC-1215-2001

Work related complaints of neck, shoulder and arm among computer office workers: a cross-sectional evaluation of prevalence and risk factors in a developing country

<p>Abstract</p> <p>Background</p> <p>Complaints of arms, neck and shoulders (CANS) is common among computer office workers. We evaluated an aetiological model with physical/psychosocial risk-factors.</p> <p>Methods</p> <p>We invited 2,500 computer office workers for the study. Data on prevalence and risk-factors of CANS were collected by validated Maastricht-Upper-extremity-Questionnaire. Workstations were evaluated by Occupational Safety and Health Administration (OSHA) Visual-Display-Terminal workstation-checklist. Participants' knowledge and awareness was evaluated by a set of expert-validated questions. A binary logistic regression analysis investigated relationships/correlations between risk-factors and symptoms.</p> <p>Results</p> <p>Sample size was 2,210. Mean age 30.8 ± 8.1 years, 50.8% were males. The 1-year prevalence of CANS was 56.9%, commonest region of complaint was forearm/hand (42.6%), followed by neck (36.7%) and shoulder/arm (32.0%). In those with CANS, 22.7% had taken treatment from a health care professional, only in 1.1% seeking medical advice an occupation-related injury had been suspected/diagnosed. In addition 9.3% reported CANS-related absenteeism from work, while 15.4% reported CANS causing disruption of normal activities. A majority of evaluated workstations in all participants (88.4%,) and in those with CANS (91.9%) had OSHA non-compliant workstations. In the binary logistic regression analyses female gender, daily computer usage, incorrect body posture, bad work-habits, work overload, poor social support and poor ergonomic knowledge were associated with CANS and its' severity In a multiple logistic regression analysis controlling for age, gender and duration of occupation, incorrect body posture, bad work-habits and daily computer usage were significant independent predictors of CANS</p> <p>Conclusions</p> <p>The prevalence of work-related CANS among computer office workers in Sri Lanka, a developing, South Asian country is high and comparable to prevalence in developed countries. Work-related physical factors, psychosocial factors and lack of awareness were all important associations of CANS and effective preventive strategies need to address all three areas.</p