1,720,988 research outputs found
Discrimination in Workplace, Health Care, Family Settings and Mental Health among Transgender People in Sri Lanka
No full textDespite numerous studies demonstrating high rates of discrimination and poor mental health among transgender people in Western countries, little research has been conducted on this population in Sri Lanka. As such, the primary objective of this study was to assess the prevalence of discrimination experienced by transgender people in the workplace, health care, and family settings. Additionally, we investigated the potential association between discrimination and adverse mental health outcomes, including current depression, anxiety disorders, and low self-esteem. In Galle, 100 transgender participants were recruited through snowball sampling and then completed the survey through face-to-face interviews. The survey consisted of five sections: sociodemographic information, mental health scales, and discrimination experience in the workplace, health care, and family settings. We reported the prevalence of discrimination and adverse mental health outcomes. We also estimated the prevalence ratios of current depression and anxiety disorder, which are associated with work inaccessibility and workplace discrimination, adjusting for age, education, and gender identity in separate Poisson regression models.
The study found that school harassment (67%), workplace insults (63.5%), and work inaccessibility (47.4%) were the most commonly reported types of discrimination among transgender participants. Among them, the prevalence of current depression, anxiety disorder, and low self-esteem were 44%, 38%, and 81%, respectively. Furthermore, work inaccessibility was associated with a 16% increase in the prevalence of depression. Workplace discrimination, as measured by two categories (1 or 2 types of discrimination, ≥3 types of discrimination) was associated with greater prevalence (41%-56%) of depression and anxiety (22% - 46%) than non-discrimination, although all of those associations were not statistically significant.
The high prevalence of discrimination against transgender people presented in the study highlights the urgent need for legislative changes to protect their rights. Future studies should aim to identify coping resources and develop evidence-based interventions to minimize the adverse mental health consequences of discrimination. It is expected that the researchers and transgender voluntary groups who had been involved in the study may transform the study results into meaningful real-world interventions.</p
Predictors and occurrence of antenatal depression in Galle, Sri Lanka
No full textAntenatal depression is a serious mental health issue that can affect both mother and baby. Findings risk factors across a biopsychosocial model for antenatal depression are still inconsistent across context. The purpose of this study is to explore individual and health system factors associated with antenatal depression in Sri Lanka using a cross-sectional mixed methods approach. The quantitative portion included 505 patients from Galle, Sri Lanka, with health record data and responses to psychometric questionnaires. For the qualitative portion, public health midwives working in this district were interviewed about their experiences and typical clinical practices with antenatal depression patients. The estimated prevalence of antenatal depression in this region was 7.5%, with 4.4% reporting self-harm ideation (depression assessed using Edinburgh Postpartum Depression Scale). Prevalence was highest in patients who were over the age of 30 (n = 184, OR = 3.88, 95%CI = 1.71 – 9.97), diabetic (n = 32, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclamptic in a previous pregnancy (n = 31, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (n = 211, OR = 0.29, 95%CI = 0.12 – 0.64) employed (n = 197, OR = 0.33, 95%CI = 0.13 – 0.72), or lower-middle class (n = 172, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed patients (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). Risk factors elucidated by qualitative data were consistent with the quantitative findings. Additionally, interviewed public health midwives described poor inadequate education and no official clinical guidelines for antenatal depression within their practice, leaving diagnosis up to the midwives’ discretion based on subjective measures. The prevalence of antenatal depression is low in this community compared to other communities in Sri Lanka and the global average. Biological, psychological, and social factors are all involved and must be considered to improve antenatal mental healthcare.</p
The Association between Workplace Ergonomic Factors and Low Back Pain-related Disability among Nurses in Sri Lanka
No full textLow back pain disability (LBPD) is a pervasive health issue among nurses due to their high exposure of ergonomic risk factors in the workplace. Moderate or severe low back pain disability might impair their work performance and impact daily activities. However, limited study has done among Sri Lankan nurses, who are unprotected by workplace health regulations. Thus, this study aimed to estimate the prevalence of moderate or severe LBPD among nurses in Teaching Hospital Karapitiya (THK), Sri Lanka. Additionally, the study sought to explore the association between workplace ergonomic exposures and moderate or severe LBPD. This cross-sectional study enrolled 200 registered nurses from multiple wards at THK, Sri Lanka in 2022. Measures of interest in the study survey included sample characteristics, workplace ergonomic risk factors, physical activity level, and LBPD level. The data analysis was conducted in two steps. After describing the occurrence of ergonomic risk factors (correlates: lifting more than 20kg loads, bending trunk, long-time sitting, and frequent repetitive movements) and LBPD level (outcome variable) stratified by those correlates, the logistic regression model was built to examine the associations between above workplace ergonomic correlates and moderate or severe LBPD. Both unadjusted and adjusted models, controlling for nurses’ BMI, service years, education, and physical activity level, are reported as odds ratio and 95% confidence interval. As a result, the prevalence of moderate or severe LBPD was 18.5% among the study sample. All workplace ergonomic factors were positively associated with greater odds ratios of moderate or severe LBPD, compared to the non-exposure group. The odds ratio of LBPD was significantly increased from frequent repetitive movements (adjusted odds ratio (AOR): 3.17, CI: 1.45-6.89) to lift more than 20kg loads (AOR: 3.64 CI: 1.52-8.73). These results highlight the problem of moderate or severe LBPD among nurses in Sri Lanka. The result may be attributed to bridge the gap of the leading causes of LBPD among nurses and the findings suggest the need to improving LBPD awareness and policy changes to achieve workplace health. Further studies on large-scale study with the aim of developing a theoretical model in the field of study are needed to provide more empirical evidence and theoretical foundation on the burden of LBPD among nurses. </p
Prehospital Transportation and Care of Externally-Caused Injuries Admitted to Karapitiya Teaching Hospital in Galle, Sri Lanka
No full textBackground: Injuries account for about 13% of all registered deaths in Sri Lanka, and are the leading cause of admission to public hospitals. Each year, about 62,377 people with injuries require inpatient care in the Galle district. The prehospital trauma care system is new to Sri Lanka and a free ambulance service was launched about two years ago, with most ambulances concentrated in the larger cities around major hospitals. Objective: The objective of this study was to describe the prehospital transportation and care of people with externally-caused, acute injuries and examine factors associated with ambulance transport the first health facility. Methods: A cross-sectional survey, with a small longitudinal component was administered to 405 patients that were admitted the emergency trauma center at Teaching Hospital Karapitiya in Galle, Sri Lanka. Information on patients’ medical treatment and length of stay were extracted from the medical records. Descriptive statistics were tabulated to summarize prehospital transportation and care variables. Logistic regression was used to examine predictors of ambulance transport, and negative binomial regression was used to examine transport time, mode of transport, and prior medical care as effect modifiers of injury event and length of stay relationship. Results: Over 50% of people used a tuk-tuk to get to the first health facility, and 20.5% used an ambulance to get to the first health facility. Factors that were significantly associated with ambulance use were age, injury mechanism, alcohol, location type, open wound, abrasion, and chest/abdomen injury. Ambulance transport and prior medical treatment were significant effect modifiers for open wound and fractures. Conclusion: Ambulance transport and prior medical treatment of fractures and open wounds were associated with a reduced length of stay which could help alleviate the burden on already constrained resources at tertiary care facilities.</p
A Clinic Based Survey Investigating Self-Reported Oral Health-Related Quality of Life, Number of Natural Teeth, and Oral Hygiene Habits Among Elderly Singaporeans
No full textBackground: Global aging poses various challenges for both developing and developed countries. The proportion of older adults in developed countries is currently much higher than in developing countries. Health authorities are now confronting increasing public health problems, including a growing burden of oral diseases among older people. Although the percentage of older adults who have retained their natural teeth has increased steadily during the past decades, the number of natural teeth might still contribute vastly to older people’s quality of life. As little research has been conducted in the Southeast Asia area, this study aims to 1) investigate the association of number of natural teeth and oral pain with oral health-related quality of life; 2) discover ethnic disparities in regards to number of natural teeth and oral health-related quality of life; and 3) examine factors related to number of natural teeth retained among elderly Singaporeans. Methods: The study was carried out in a dental clinic conducting a questionnaire survey on patients who visited the clinic. Geriatric Oral Health Assessment Index (GOHAI) was used and the GOHAI total score (ranged from 12 - 60) was measured to describe participants’ oral health-related quality of life from three perspectives: physical, social, and mental health components. Participants’ dental records were linked to the questionnaire survey and data on their dental parameters were also collected. Linear regression analysis was conducted as the main method towards all the three study aims, whereas logistic regression analysis was performed as supplementary evidence especially for Aim 1. Non-parametric statistical tests were also used in cased of normality assumption requirements throughout the analytical process. Results: The mean GOHAI total score of the study subjects was 47.72 (SD = 7.45). The mean number of natural teeth was 18.27 (SD = 8.15). A positive association between number of natural teeth and GOHAI total score was found by the linear regression analysis (Coefficient = 0.20, 95%CI: 0.17, 0.44) and a Spearman correlation test (rho=0.22, P Conclusions: The oral health-related quality of life of the investigated population was generally fair. Ethnic disparities existed in oral health-related quality of life and number of natural teeth among older adults in Singapore that Malays had adverse oral health status compared to Chinese and Indians. With more number of natural teeth retained and less oral pain, a person was more likely to have better oral health-related quality of life. Flossing at least once a day might contribute to the retention of more natural teeth.</p
Prevalence of Violence Exposure and Post Traumatic Stress Disorder (PTSD) Among Adolescents in Udugama, Sri Lanka
No full textBackground: Violence exposure in children can lead to psychological problems and poor health outcomes that can be associated with post-traumatic stress disorders (PTSD). This study aimed to estimate the prevalence of full or partial PTSD associated with exposure to community and domestic violence in school-aged children in Sri Lanka. The study aimed to (1a) estimate the prevalence of community violence and domestic violence among school-aged adolescents in Sri Lanka, (1b) estimate the prevalence of community violence and domestic violence overall and by sex among school-aged adolescents in Udugama, Sri Lanka, (2) estimate the prevalence of partial PTSD and full PTSD among those who experience community and/or domestic violence, (3) and does it vary by age, sex, socioeconomic status, and length of exposure to do violence with exposure to domestic and community violence.Methods: This study was a secondary data analysis that utilized a cross-sectional design, using two questionnaires: (1) Child Exposure to Domestic Violence (CEDV) Scale to measure violence exposure, and (2) The UCLA PTSD Reaction Index for DSM IV, a self-report questionnaire to screen for exposure to traumatic events and assess PTSD symptoms in school-age children and adolescents. 346 school children were selected for the study. Children in grades 10 and 11 were selected with a mean age of 14.9 years (SD = 0.02), with a range of 14 to 16 years old were randomly selected from two secondary schools in Udugama MOH area. The two largest schools were non-randomly selected. Within the two schools, four classes were selected randomly. All children present on the day of data collection were selected for the study. As more than 90% of the children are schooling in Sri Lanka, we believe a school-based screening will obtain a representative sample of adolescents in the community. Logistic regression models were used to explore the relationship between sex, age, socioeconomic status, and length of exposure with domestic and community violence. Log-risk regression models were used to explore the prevalence of community and domestic violence and the relationship between violence exposure and full or partial PTSD symptoms. Univariable logistic models were used to estimate associations between individual characteristics (such as age, sex, socioeconomic status, and length of exposure to violence) and partial or full PTSD.
Results: Among the 346 participants, 304 (88%) adolescents reported experiencing some type of violence, whether it was community violence or domestic violence on the CEDV questionnaire. Only those who reported experiencing violence were then asked to take the UCLA PTSD Index. Of these, a total of 203 (68%) met criteria A on the UCLA PTSD index and therefore had experienced at least one traumatic event. Of these a total of 52(26%) did not have PTSD, 53 (26%) had partial PTSD, and 98 (48%) had full PTSD. The results showed that age and sex were not associated with PTSD severity. Sex was not associated with the outcome of partial PTSD (p > 0.682; CI: -0.136, 0.089) and full PTSD (p > 0.682; CI: -0.089, 0.136). Age was not statistically significantly associated with the outcome of partial PTSD (p > 0.924; CI: -0.147, 0.162) and full PTSD (p >0.924; CI: -0.162, 0.147). However, the age range was limited to 14 to 16 years, and further research needs to be done for more definitive conclusions. Duration of violence was the only individual characteristic that was statistically significant in the analysis for two responses 1) two to three years back (OR 5.07 (CI:1.11; 23.21) p = 0.037) and 2) as long as I can remember (OR 11.03 (CI: 1.22; 99.51) p = 0.032).
Conclusions: The most significant finding of this study is that of those who experience domestic or community violence, 61.9% will develop PTSD. Additionally, domestic violence 189 (90.8%) was reported more often by adolescents than community violence 20 (9.57%). This study was limited due to the small study size and the narrow range of age, which limits its generalizability to the wider population of Sri Lanka or adolescents in general. Therefore, conclusions about the significance of individual characteristics such as age, sex, socioeconomic status, and duration of violence exposure resulting in partial or full PTSD could not be determined. More studies are necessary to test the hypothesis of whether individual characteristics of adolescents in Sri Lanka is associated with partial or full PTSD.
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Prevalence and Risk Factors of Postpartum Depression in Two MOH Areas in Sri Lanka: A Mixed Methods Study
No full textBackground: Previous studies in Sri Lanka showed a high prevalence- 30% of postpartum depression (PPD). PPD screening using the Edinburgh Postnatal Depression Scales (EPDS) was included in postnatal care in 2012. This study aimed to estimate the prevalence of PPD in 2017 in two medical offices of health (MOH) areas, identify the association between risk factors and presence of postpartum depression, understand current practice, challenges, and suggestions of PPD screening in Sri Lanka. Methods: The study consists of a population-based quantitative study and a qualitative study. PPD outcomes were assessed by mothers’ responses to the EPDS. Potential factors were extracted from routine paper-based medical records. The association was examined at unadjusted level first, and at adjusted level using multivariate linear regression and multivariate logistic regression models. Individual in-depth interviews were conducted among public health midwives. Framework approach was adopted to analyze the transcripts. Results: The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. PPD was associated with earlier screening time, mothers’ delivery age > 35, >= 4 living children, and mothers’ illness. Mothers who attended prenatal sessions and whose partners were employed were less likely to report potential PPD. Other risk factors of PPD noted from interviews include socio-economic factors, interpersonal relationship, mother’s disease history, delivery method, and baby’s illness. The challenges of screening PPD included social stigma, mother’s difficulty of understanding EPDS and lack of privacy at home. Conclusions: Mothers exposed to various socio-economic, interpersonal, and other risk factors deserve special attention. Family-based interventions, further cultural validation of EPDS, development of risk-assessing instrument could be introduced for future practice. Future research on other risk factors for PPD with larger sample size should be conducted, and qualitative research could engage other stakeholders in maternal mental health care to assess the accessibility, capacity, and quality of PPD care.</p
Resource Needs, Availability and Use Amongst Children with Down Syndrome and their Caregivers in Galle, Sri Lanka
No full textBackground: Down Syndrome (DS) is the most commonly identified aneuploidy amongst children in Sri Lanka, with a prevalence of 76.3%. This study intended to determine the level of disability of children with DS aged 5-12, level of caregiver burden and impacts of family access to external services and social supports in Galle, Sri Lanka. Methods: A cross-sectional survey and interview study was conducted to determine caregiver burden, the level of disability for children with DS, and their access to social supports and external services. Within the study, 125 caregivers took the Caregiver Priorities and Child Health Index of Life with Disabilities (CP-CHILD) and Caregiver Difficulties Scale (CDS) assessments and 15 participated in interviews. Simple bivariate and multivariable regression were used to determine the impacts of resource usage on the child’s level of disability and caregivers burden. Results: The mean level of disability of children with DS was 64.8 and caregiver burden was 50.2. Positively associated predictors of the level of disability include school, type, caregiver gender and income level. Approximately one-third (36.8%) of caregivers reported receiving assistance from external supports, 20% received government assistance, and 92.8% of caregivers relied on assistance from friends and family. Conclusions: Assistance from external sources and behavior therapy was shown to negatively moderate the relationship between the level of disability of the child and caregiver burden. Future longitudinal research, alongside more resource promotion and creation could improve resource access, disability levels and caregiver burden.</p
Drivers of COVID-19 vaccine hesitancy among 20–30-year-olds in the United States - a convergent mixed methods study
No full text In the United States, there has been over 1,000,000 deaths and more than 90 million cases of COVID-19. As of April 19, 2021, all adults aged 16 and older were eligible to receive vaccination. Nevertheless, young adults are being vaccinated at a slower rate than older adults. The current study aimed to identify potential factors associated with young adult vaccine hesitancy through a mixed methods approach comparing vaccinated and unvaccinated through both a quantitative survey and qualitative in-depth interviews. The survey captured 350 responses from young adults aged 20 to 30 living in four states: California, Mississippi, Oregon and Texas. The online survey differentiated between vaccinated and non-vaccinated individuals and analyzed different aspects of vaccine hesitancy from political trust to COVID-19 vaccine beliefs. Sixteen semi-structured in-depth interviews lasting 20 to 30 minutes were performed on Zoom. The main factors associated with vaccine hesitancy in young adults for both the survey and interviews were social drivers, trust in institutions, barriers to vaccination, perceptions of the vaccine, and COVID-19 vaccine information quality. Study findings will increase understanding of COVID-19 vaccination decision-making pathways of young adults with the purpose of informing future interventions and policy for promoting vaccination rates in young adults.</p
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