Proceedings - KDU

GENERAL SIR JOHN KOTELAWALA DEFENCE UNIVERSITY (KDU)

8th INTERNATIONAL RESEARCH CONFERENCE Inculcating Professionalism for National Development

27 – 28 August 2015

Proceedings Medicine

General Sir John Kotelawala Defence University Ratmalana 10390 Sri Lanka www.kdu.ac.lk

Proceedings in Medicine, 8th International Research Conference – KDU, Sri Lanka, 2015

© General Sir John Kotelawala Defence University All rights reserved This book contains the proceedings, inclusive of a peer reviewed selection of papers presented at the 8 th International Research Conference 2015 of General Sir John Kotelawala Defence University (KDU), Ratmalana held on 27 and 28 August 2015. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means including electronic, electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without prior permission in writing of the publisher. The contents published in this book do not reflect or imply the opinion of General Sir John Kotelawala Defence University or any other agency of the Ministry of Defence of the government of Sri Lanka. They reflect and imply the opinions of the individual authors and speakers. Editor-in-Chief Dr CL Goonasekara Editors Lt Col PH Premaratne Ms BDK Anandawansa ISBN Number: ISBN 978-955-0301-22-5 Other Proceedings of the Conference: Defence and Strategic Studies : ISBN 978-955-0301-17-1 Engineering, Built Environment and Spatial Sciences : ISBN 978-955-0301-19-5 Computing : ISBN 978-955-0301-20-1 Allied Health Sciences : ISBN 978-955-0301-21-8 Basic and Applied Sciences : ISBN 978-955-0301-24-9 Law : ISBN 978-955-0301-23-2 Management, Social Sciences and Humanities : ISBN 978-955-0301-18-8 Published by General Sir John Kotelawala Defence University Ratmalana 10390 Sri Lanka Tel : +94 113 370105 E-mail : [email protected] Website : www.kdu.ac.lk Publication November 2015

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PATRON, CONFERENCE STEERING COMMITTEE Maj Gen MP Peiris RWP RSP USP ndc psc, Vice Chancellor

PRESIDENT - STEERING COMMITTEE Maj Gen JR Kulatunga RSP psc, Deputy Vice Chancellor (Defence and Administration) -

CONFERENCE CHAIR Dr CL Goonasekara

CONFERENCE CO – SECRETARIES Lt Col PH Premaratne Ms BDK Anandawansa

STEERING COMMITTEE MEMBERS Brig WPAK Thilakarathne psc Col MGWWWMCB Wickramasinghe RWP RSP psc Col PTR Makuloluwa Lt Col YABM Yahampath RWP RSP psc Lt Col P Vithanage Lt Col PH Premaratne

Snr Prof TR Weerasooriya Prof MHJ Ariyarathna Prof AS Karunananda Prof RP Perera Dr SWP Mahanamahewa Dr MM Jayawardana Dr AH Lakmal Dr TL Weerawardane Dr RMNT Sirisoma Dr CL Goonasekara Ms BDK Anandawansa

PLENARY / TECHNICAL SESSION COORDINATORS Defence Engineering and Built Environment and Spatial Sciences

Medicine Basic and Applied Sciences Law Management, Social Sciences and Humanities Allied Health Sciences

Computing

-Maj NC Karunarathne Mr S Satheesmohan -Mr M Vignarajah Mrs S Pussepitiya Dr AR Rupasinghe Mrs RGN Lakmali -Dr AN Senanayaka Dr DH Jayasena -Dr KMGP Premadasa Ms AMTN Adikari -Dr TB Abeyasekara Mr GIM Liyanage -Ms DD Lokuge Ms HMAGK Ekanayake -Dr GU Jayaweera Ms BLC Samanmali Mr Nelumdeniya Dr KDKP Kumari Dr AWMKK Bandara -Mr ADAI Gunasekara

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EDITORIAL COMMITTEE President

-Snr Prof TR Weerasooriya, Deputy Vice Chancellor (Academic)

Defence

-Col MGWWWMCB Wickramasinghe RWP RSP psc Mr S De Silva

Engineering and Built Environment and Spatial Sciences

-Dr TL Weerawardane Sqn Ldr JI Abeygunawardane Dr AH Lakmal Mr M Vignarajah

Computing

-Snr Prof AS Karunananda ADAI Gunasekera PPNV Kumara

Medicine

-Snr Prof N Warnasuriya Snr Prof N De Silva Snr Prof MV Weerasooriya Prof J Welihinda Dr V Navaratna

Allied Health Sciences

-Snr Prof WD Rathnasooriya Snr Prof RN Pathirana

Basic and Applied Sciences

-Dr KMGP Premadasa Dr SHNP Gunawickrama

Law

-Mr M Wijesinghe Dr T Abeysekara

Management, Social Sciences and Humanities

-Dr MM Jayawardana Dr RMNT Sirisoma Mr WAAK Amaratunga

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FOREWORD The General Sir John Kotelawala Defence University successfully held its eighth International Research Conference (KDU IRC-8), on the 27th and 28nd August 2015. This year’s conference was further expanded to gather professionals, researchers and academics from nine disciplines, namely, Defence and Strategic Studies, Engineering, Computing, Medicine, Basic and Applied Sciences, Allied Health Sciences, Law, Management, Social Sciences and Humanities, and Built Environment and Spatial Sciences, to disseminate their research findings/knowledge in their respective field. The conference drew together more than 400 scholars across the country and globe to present their research. The participation of professionals and academics from several Asian and Western countries, namely India, Pakistan, Singapore, Bangladesh, Malaysia, Maldives, USA, UK, Germany and Australia was a highlight at KDU IRC-8. The inaugural ceremony of the two-day conference was held on the 27th August. The ceremony was attended by the chief guest of the event Dr. Wijayadasa Rajapaksha, the Hon. Minister of Justice and Minister of Buddhasasana, and many other distinguished invitees, including representatives from diplomatic missions, members of the Board of Management of KDU and guest speakers. During the session, the honorable chief guest delivered the key note address on the conference theme. As a multi-professional higher educational institute, KDU proposed ‘Professionalization of professionals’ as an important and timely topic to discuss in an international scientific forum such as the KDU International Research Conference. Hence ‘Inculcating Professionalism for National Development’ was selected as the theme of KDU IRC-8. During the key note address, it was highlighted that as a country embarking on various mega national development projects, it is important for Sri Lanka as a nation to identify the importance of professionalism among the country’s stakeholders as well as amongst its trainers of professionals as essential for the production of better professionals geared towards achieving global standards. The academic sessions of KDU IRC-8 were conducted in eight parallel sessions of plenary and technical sessions in the above mentioned disciplines. The technical sessions were held as oral and poster presentations of research papers submitted by academics, scientists and researchers from institutes throughout the country as well as from foreign countries. Altogether, oral presentations were conducted in fourty sessions; four sessions each under Defence and Strategic Studies, Engineering and Built Environment and Spatial Sciences, Computing, Medicine, Basic and Applied Sciences, Allied Health Sciences, and eight sessions each under Law, and Management, Social Sciences and Humanities. Plenary and poster presentations were held on the first day of the conference, whereas oral presentations were held on day-two of the conference. The plenary sessions were highlighted with 36 guest lectures delivered by eminent international and national scientists/professionals, on faculty sub-themes. Two plenary sessions were conducted in Defence and Strategic Studies under the sub-theme Inculcating Professionalism in Defence for National Development. The plenary session of Engineering and Built Environment and Spatial Sciences was held under the sub-theme Inculcating Professionalism in Engineering for National Development, while the sub-theme of the Computing plenary session was Application of Professional Practices in Computing for National Development. The plenary session on Medicine was conducted under the sub-theme Inter-Professional Education and Research Towards Quality Health. The plenary session on Basic and Applied Sciences was held under the sub-theme Pragmatic Research for Development and Prosperity. The sub-theme of the plenary session of Allied Health Sciences was Professionalism in Allied Health Sciences for a Healthier Nation, while the plenary session on Law was conducted under the sub-theme Inculcating Professional Ethics for Legal Practice. The plenary session on Management, Social Sciences and Humanities was held under the sub-theme, Professionalism for National Development in the Domains of Management, Social Sciences and Humanities. The popularity of KDU annual research conference among scholars across the country proved true at KDU IRC-8 as well, and it could go unnoticed that the response for call for research papers for KDU IRC has been annually on the increase. This is highly encouraging. The number of research papers received for KDU IRC-8 was 512, of which 450 abstracts were shortlisted and invited for full papers. After a rigorous review process of both abstracts and extended abstracts or full papers, a total of 306 research papers were accepted to present at the conference. These included 196 oral presentations and 110 poster presentations.

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KDU IRC-8 can be deemed a tremendous success, owing to the great team effort by the academic, administrative and supporting staff who worked whole heartedly to organize the conference. Firstly I thank the Chairman and the members of the Board of Management of KDU without whose blessings KDU IRC-8 would not have become a success. The excellent leadership and support given by the Vice Chancellor, Major General Milinda Peiris provided impetus in the organization of the whole event. The invaluable contribution made by the Deputy Vice Chancellor (Defence and Admnistration) Major General Ruwan Kulathunga, as the president of the steering committee, greatly helped for the smooth organization and operation of the event throughout. I specially appreciate the guidance and advice extended by the Deputy Vice Chancellor (Academic) Prof. Thilak Weerasuriya and the Rector (Southern Campus, KDU) Brig Lal Gunasekara on different occasions. The role played by the deans of the faculties and the faculty coordinators was tremendous in the organization and conduct of the plenary and technical sessions. I am especially thankful to Prof. Jayantha Ariyaratne, the Dean, Faculty of Medicine, and his staff, the Assistant Registrar, Staff Officer, and all the academic and non-academic staff members, for their fullest support and blessings throughout the KDU IRC-8. My sincere gratitude is also extended to the reviewers and the editorial committee members of each faculty, who had to devote a vast amount of time in the selection of research papers and editing of the selected research papers respectively. The support extended by the Dean, Faculty of Graduate Studies, Brig Adeepa Thilakaratne and his staff, then the Dean of Faculty of Defence and Strategic Studies, Lt Col Chandana Wickramasinghe and his staff are also unforgettable. I am thankful to several personnel in various organizing committees of KDU IRC-8, Lt Col Manada Yahampath (Adjutant), Lt Col Priyankara Vithanage (CO Adminitsration), Maj Darshana Abeykoon (Assistant Adjutant), Mr Dayananda Siriwardana (Bursar), Mr Gladwin Canagasabey (Registrar), Cdr Shailendra Jeewakarathna (Deputy Registrar), Wg Cdr Jayalal Lokupathirage, Cdr Amila Amarawardena, Cdr Pradeep Gunathilaka, , Maj Ranjith Kulasiri, Lt Cdr Indika Thlakasiri, Lt (E) Indunil Fernando, for their tremendous effort in organizing the conference. The support by Mr Kithsiri Amarathunga (HOD, English), Dr. Namali Sirisoma (Chair, KDU IRC-7), Mr. Mangala Wijesinghe, Mr Anuradha Nanayakkara and Ms Savindri Weerakoon is also sincerely remembered. KDU IRC-8 is grateful to its sponsors Polytechnologies (Pvt) Ltd, Analytical Instruments (Pvt) Ltd, The Bank of Ceylon, and the Sri Lankan Airlines for their invaluable contribution to the event, and to the media who have projected the event towards success. My heartfelt gratitude is finally given to my two secretaries, Lft Col (Dr) Prasad Premaratne and Ms Krishanthi Anandawansa for their shoulder to shoulder commitment pertaining to all the affairs of KDU IRC-8. Following the symposium held in August, KDU IRC-8 is blessed with the release of this publication on proceedings of the conference in eight separate books under the different disciplines. The current book contains proceedings of the symposium conducted under the discipline of Medicine. It contains the welcome address, Key note address, and all plenary speeches of Medicine session as full papers or transcripts, and full paper articles of some of the research papers presented at technical sessions of Medicine. I sincerely believe this publication would contribute, both locally and globally, to update knowledge of a wider community of researchers, academics and professionals.

Dr CL Goonasekara Editor-in-Chief (Conference Chair 2015)

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TABLE OF CONTENTS Forword

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Welcome Address by the Vice Chancellor

1

Key Note Address

4

Plenary Session Summary 8 Plenary Speech Transcripts/ Full Paper Articles

Interprofessional Education (IPE) and Collaborative Practice (IPC): Trends, Issues and Strategies

9

Dr Dujeepa D. Samarasekera

The Emerging Concepts of Mental Health; its Relevance to Personal Growth, Health and Illnesses

12

Professor Nalaka Mendis 15

Nano Biotechnology for Health and Wellbeing Professor Ravi Silva

Management of Breast Cancer, a Multi-Professional Approach

21

Mr. Sheikh Ahmad 23

Technical Session Summary Full Articles of Research Paper presented at Technical Sessions

Clinical Study of Glycyrrhiza glabra Linn and Asparagus racemosus Linn on Menopausal Symptoms

27

MUZN Farzana and A Sultana

Room-Temperature Resin Casting Technique: A Low Cost Effective Teaching Tool in Human Anatomy

30

EAST Edirisinghe, DEH Kotalawala, HDG De Fonseka and SG Yasewardene

Health Status among Female Industrial Workers Related to Ventilation and Overcrowding of the Habitable Room in Boarding Houses in Katunayake Free Trade Zone, Sri Lanka

35

MDC Silva and KN Lankatilake

A Smooth Transition to an Efficient Medical-Legal Management Information System

41

A Jahubar and AN Wijayanayake

Awareness, Attitude and Preventive Measures Practiced towards Dengue Fever by the Teachers of Three Schools in Colombo District M Pavithra, VS Opatha, RC Palliyaguruge and WDN Dissanayake

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Television Viewing Habits and Associated Factors Among G.C.E. O/L Students

55

S Nishanthan, MHM Nuwanthi, S Nishanth and EM Corea

The Knowledge and Adherence among Patients on Warfarin Therapy, the Anticoagulation Control and the Factors Associated with It: A Cross Sectional Study at Cardiology Clinic, National Hospital of Sri Lanka

60

Y Mathangasinghe, MM Ranatunga and P Ranasinghe

Patient Satisfaction on Out Patient Department (OPD) Services at the National Eye Hospital, Sri Lanka

66

DS Warapitiya, NC Wanasinghe, MR Wanniarachchi, CK Liyanage and M Kumaradas

Association Between Thyroid Status and Lipid Levels Among Pregnant Women in Jaffna District

73

T Yoganathan, V Arasaratnam, M Hettiarachchi and C Liyanage

Predictive Factors of Breast Cancer Specific Survival of Patients Who Received Neoadjuvant Chemotherapy

79

HH Peiris, LKB Mudduwa, NI Thalagala, KAPW Jayatilake, U Ekanayake and J Horadugoda

Nutritional Status Based on Mid Upper Arm Circumference and Head Circumference: A Cross Sectional Study among the Children in Jaffna District

83

K Kandeepan, S Balakumar and V Arasaratnam

Physical Activity and Social Participation: Do They Promote Psychological Health in Undergraduates?

91

P Jayasekera, U Edirisinghe, N Fernando, S Fernando and B Perera

Feasibility of Using Electronic Medical Records in a Rural Private General Practice, Sri Lanka

94

A Perera and KNAP De Silva

Knowledge Related to Neonatal Fever and Skills of Measuring Temperature among the Mothers of Neonates in Castle Street Hospital for Women

101

Y Mathangasinghe, GK Manatunga, MIF Masna and Y Walpita

Knowledge on Symptoms, Transmission and Treatment of Pulmonary Tuberculosis- Single Centre Study

106

B Seneviratne, LAM Gunawardena and WRIS Kumara

Comparison of Physical Health Parameters of Cadets and Day Scholars in General Sir John Kotelawala Defence University (KDU)

113

KG Somasiri, BWMTJ Basnayake, MKOK De Silva, WMMS Bandara, AJIS Rathnayake and EPDR Edirisinghe

Correlates of Emotional Intelligence (EI) in Undergraduates N Jayasekara, N Fernando, S Gunawardena and B Perera

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116


The Possible Advantages of Cryoprecipitate Prepared from Fresh Frozen Plasma from Blood Stored for 24 Hours

119

SLS Kumarage and D Dissanayake

Comparison of Efficacy of Two Combinations of Herbal Medicines in Cold Induced Respiratory Symptoms

124

A Vijayakumar, SR Sivapalan List of Reveiwers

131

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WELCOME ADDRESS Major General Milinda Peiris RWP RSP USP ndc psc Vice Chancellor, General Sir John Kotelawala Defence University

Distinguished members of the audience, ladies and gentlemen, it is a great pleasure for me, as the Vice Chancellor of General Sir John Kotelawala Defence University, to deliver the welcome and introductory address of the KDU international Research Conference 2015.

Islamabad Policy Research Institute, Pakistan–Rear Admiral William C McQuilkin, Director, US Navy Strategy and Policy Division, Pentagon, USA – Dr Paul Kapoor, Centre for International Security and cooperation, Stanford University, USA – Dr N Sathiyamoorthy, Director, Observer Research Foundation, India – Maj Gen Muhammad Naeem Ashraf, National Defence University, Pakistan – and Col Mohomed Mukhthar, Maldivian National Defence Force, who will be addressing the Defence plenary session and other distinguish guests.

First, I am greatly honoured and pleased to welcome Dr Wijeyadasa Rajapakshe, Hon Minister of Justice, who graciously accepted our invitation, despite his extremely busy schedule, to be the chief guest and the keynote speaker at this international research conference. Hon Sir, we are glad that we were able to find one of the most appropriate personalities in Sri Lanka – a true professional known for his credentials as an eminent legal expert and a seasoned parliamentarian best known for his honesty and integrity – to address this august gathering on the theme, Inculcating Professionalism for National Development.

I also warmly welcome distinguished Professors and senior academics from Germany, Pakistan, UK, USA and Sri Lanka who will be chairing and addressing other plenary sessions, along with all the other foreign dignitaries and scholars present here today. Let me also welcome senior professors and academics of KDU, and all the presenters and participants whose contribution will be crucial for the success of this Research Conference. Finally, I would like to welcome all the media personnel present here and thank them in advance for a comprehensive coverage for this nationally important event.

Next, I warmly welcome the most distinguished invitees Mr B M U D Basnayake, Secretary to the Ministry of Defence and Chairman of the Board of Management of KDU – Mr D M R B Dissanayake, Secretary to the Ministry of Health – Mrs Kamalani De Silva, Secretary to the Ministry of Justice – the Chief of Defence Staff, Air Chief Marshal Kolitha Gunatilleke – Commander of the SL Army, Lt Gen Chrishanthe De Silva – Commander of the SL Navy, Vice Admiral Ravindra Wijegunaratne – Commander of the SL Air Force, Air Marshal Gagan Bulathsinghala – Additional Secretaries to the Ministry of Defence (Mr S Hettiarachchi, Additional Secretary Defence) – All other additional secretaries of Ministries Your Excellencies of the Diplomatic Corps – Senior Officers – Gen Tan Sri Dato’, Vice Chancellor, National Defence University, Malaysia – Lt Gen Chowdhury Hasan Sarwardy, Commandant, National Defence College, Bangladesh – Vice Chancellors of our fellow universities (Prof Ananda Jayawardane, University of Moratuwa, Prof Chandana Udawatte, Sabaragamuwa University, Dr TA Piyasiri, University of Vocational Technology) – Prof Rohan Gunararatna, renowned expert in security studies – other distinguished scholars and eminent personalities, especially those representing our friendly countries such as, Ambassador (retd) Mr.Sohail Amin, President

Ladies and gentlemen, the desire and the need of the contemporary Sri Lanka is to reach new heights in its national development through a holistic approach, and the country has realized the importance of maintaining a steady economic growth in achieving this goal. The strategy envisioned for achieving the same is the industrial expansion with increased foreign investments and collaborations, which will generate a large number of new employment opportunities in the country. In this backdrop, the theme of our conference, “Inculcating Professionalism for National Development” becomes extremely pertinent because a professional workforce is an essential prerequisite to achieve success in any sphere of work, and it is particularly so when we interact with international entrepreneurs, companies and organizations, and when we are engaged in competitive business in the world. The more professional we are the better would be the chances for success and victory over others.

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Ladies and gentlemen, we in the armed forces in Sri Lanka experienced the value of professionalism when we were able to successfully conclude the humanitarian operations through the professional approach adopted by the security forces, and since then we have been doing our best to inculcate professionalism in the personnel we train to take over the responsibility of national security of the country, and I am glad to mention that today we at KDU have been able to extend our expertise to train native as well as foreign youths with special focus on enhancing skills and inculcating attitudes that would pave the way for professionalism in their future careers in diverse fields.

professionalism among our staff, which we thought was essential to produce graduates geared to achieve professionalism in their careers. So, during the last few years, KDU was able to attract some of the best academics, professionals, administrative officers, and clerical and other supporting staff giving priority for the need for professionalism in each job in the university, and we did so by vetting them through rigorous testing and interview procedures. The result was an overall growth in the professional outlook of the institution, which enabled us to attract increasingly larger number of students both local and foreign for our degree programmes each year. So, KDU could be considered as a microcosm where professionalism is used for its development, thereby sharing the national development effort of the country as well.

Ladies and gentlemen, we believe that the national development of a country largely depends on the degree to which that country would facilitate the growth of professionalism in its workforce, encompassing even those engaged in so called blue collar jobs, which require manual labour. In this sense, the term professionalism needs to be understood in a broader perspective, and not in the restrictive sense that refers to the expertise in a few careers traditionally identified as “professions” such as medicine, engineering, law, management and so on. Why I say so is mainly because one’s contribution to the national development of a country will depend on how well one does one’s job and not on what job one does.

Professionalism cannot be inculcated through the mere provision of an academic qualification. We do need to develop the overall personality of an undergraduate by concentrating on improving an array of character traits such as discipline, positive attitudes to learning and work, sound communication and presentation skills, flair for research, desire for seeking new knowledge, and more importantly honesty and integrity. KDU attempts to inculcate these in its students through diverse programmes such as all kinds of sports activities and competitions, social functions, club activities, syndicate presentations, research studies, military training for officer cadets and appropriate industrial training for dayscholars to name a few. We strongly believe that such initiatives together with well-planned and wellimplemented curricula that provide a high quality learning experience of international standard would pave the way for our products to easily achieve professionalism when they are exposed to the world of work.

So, the nation should give the utmost priority for inculcating professionalism in its workforce through a concerted effort which involves necessary mechanisms especially in the domain of education. And it is the knowledge, attitudes and skills developed in individuals through formal, non-formal and informal education that would be the base for professionalism. We do have to identify the principals and ideals to be upheld in various professions to inculcatethem in those we groom for those professions, to produce men and women who love their professions and their service for their clients. It is in this respect that the responsibility on the part of the tertiary education system is paramount.

Ladies and gentlemen, it is heartening to note on this occasion that the feedback we receive on the professional approach of our first batch of medical graduates serving their internship in various hospitals is extremely encouraging, and we are confidently looking forward to seeing the fruits of what we plant today – The large numbers of students reading for diverse degrees in our nine faculties will soon be making their way into their respective professional fields, and we are quite confident that they would certainly make their alma mater proud, wherever in the world they would be destined to serve. Of course the officer cadets we produce have been of the highest professional standards shouldering the tri-service responsibilities in national security and national development.

KDU as a state university has very clearly identified this responsibility, and it is committed to the task of bridging the gap between the need and the availability of a professional workforce or human resources to adequately support the national development effort of the country, and it is our humble belief that in doing so, KDU exerts a positive influence on other institutions in the country as well. Ladies and gentlemen, I have the most humble pleasure in mentioning on this occasion that we have been able to bring about a positive change at KDU by first ensuring 2


So, ladies and gentlemen, our commitment to professionalism and national development through higher education has been steady and consistent, and this annual international research conference itself is a major contribution we make towards the same.

Finally, let me once again welcome all the dignitaries, intellectuals, and participants both local and foreign, to this international research conference and wish that its deliberations would be highly productive in terms of individual as well as institutional accomplishments in knowledge generation and dissemination, and let me conclude by wishing that this two day International Research Conference would be a fruitful and memorable one for all presenters and participants alike.

The objective is to lead the way in research and provide opportunities for researchers in diverse fields of specialization to showcase their progressive and insightful experiments and research and to sharpen their professional capacities.

Thank you.

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KEYNOTE ADDRESS “Inculcating Professionalism for National Development” Dr Wijeyadasa Rajapakshe, MP Minister of Justice and Minister of Buddhashasana, Government of Sri Lanka

First of all, I warmly extend my heartiest gratitude to the organizers of this 8th international research conference of General Sir John Kotelawala Defence University scheduled to be guided with the theme of ‘Inculcating Professionalism for National Development’. I also observe the importance of this theme, as timely for this country, as we are just passing a period of resurrection, like a phoenix emerging from the ashes. There is no need to emphasize what a difficult period of three decades we passed while fighting against the horrifying terrorism, undoubtedly the world worst and most brutal terrorist organization. It is only now that people have a sigh of relief after defeating the devastating terrorism by the patriotic and extraordinary brilliant defence force of ours. Indeed it is not an exaggeration to state that they display not only their brilliance in their respective professional performances but also in the overall discipline of which they were fine exponents.

strata of the society. Although the said classification of human beings appeared to have been based upon human activities yet it paved the way for the deep routine of the caste system which was inimical to the evolution and development of the society. Specialty or skillfulness of a person had been admired even in one of the oldest books written in ‘Mahabharatha’ namely ‘Bhagawath Geetha’ said to have been written during the contemporaneous period of Vedic literature, which says that “Whenever there is Krishna, the master of all mystics and whenever there is Arjuna, the supreme archer, there will also certainly be opulence, victory and mortality”. Even Ramayana highlights this moral truth encompassing required virtues of righteousness alias dhamma. The society that prevailed at the time of the enlightenment of the Buddha reflected this caste system. It was He who unleash the harmless revolution against that social discrimination and preached that ‘A person becomes a noble or otherwise only by his deeds not by his birth’. Najajjawasalohothi, Najajjahothi Brahmano, Kamanthowasalo hothi, kammantha hothi brahmano.

Professionalism is not a new concept as it goes back to the origin of human civilization. As it was preached by the Buddha in “Agganga Suddha” in “Deeganikaya” when the state was formed first, the society was categorized in to three as – rulers, the rule and the jayakas which means once were engaged in the ecclesiastical activities. They were the present day members of the clergy. When it comes to Vedic philosophy namely rig, atharva, yajur and sama, believed to be written between 1700 to 1100BC, there had been a classification of the society into four carders popularly known as four-fold “Warna dharma” which led to the categorization of the society into four namely ‘Brahamins, Shaththriya, Waishya and Shudras’. Such a categorization in a bygone era could be understood in terms of the activities that they were engaged in. With the passage of time this division resulted in the emergence of the caste system. According to Vedic philosophy the category of Brahmin comprised of those who were engaged in scriptural education and teaching while Shaththriya comprised of those who were engaged in all forms of state administration. Waishya means the people engaged in commercial activities. Shudra meant to be both semi-skilled and unskilled workmen who were considered to be forming the lowest

Although Athens and Rome were considered the cradles of civilization in the occidental world, there human society had been classified into two broad divisions as masters and slaves with the former having full possession of the lives of the serves. That feudalistic system was so ingrained, that slaves were considered marketable. So much so that there were fast growing cities which gained momentum purely because of the sales of slaves. It is in such a scenario that Jesus Christ went to the extent of whipping money lenders and slave dealers in Jerusalem. History records that during the time of that great emperor Dharmashoka who was considered the most righteous ruler in the world, there had been classification of human beings depending upon their skills and vocations they were pursuing. Mahawansha chronicles that when nun Sanghamiththa, daughter of emperor Asoka brought a sapling of the Sri Maha Bo Tree to Anuradhapura in 245 BC, she was accompanied by eight

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types of skilled persons in their respective fields such as farmers, sculptures, architects, irrigational experts, carpenters, blacksmiths, etc. Their advent to our country gave birth to professionalism. It is that professionalism which eventually enabled our country to be called the “Granary of the East”. It is relevant to mention here that irrigation, irrigational experts the world over pay glowing tribute to the irrigation system we had in Polonnaruwa era, where huge canal at only 1 inch slope for every one mile, which is undoubtedly a great irrigational feet that astonishes us even now. Today world still marvels that architectural skills displayed at Sigiriya rock and its environment built by King Kashyapa. To the eternal credit to our professionals, it must be said that the Dhagabas likes Ruwanwalisaya, Abayagiriya, Jetawanaramaya in Anuradhapura and constructional sites like Hatadhageya, Watadhageya in Polonnaruwa are to mention a few outstanding constructions of theirs. They bear ample testimony to the astonishing engineering skills of those professionals.

reminds us of what Aristotle in his wisdom said centuries ago. According to him an ideal ruler should be a happy blend of a philosopher and a king. At present no profession is immune to the influence of the west be it by law, medicine, science, engineering, architecture, education, defence, diplomacy, etc. Every branch or field of professionalism is now intertwined with a global setup as the globe has now shrunk into a global village. During the period prior to World War I, many Americans living in the country were moving to cities creating overcrowded conditions. There were number of radical solutions for solving some of their problems inter alia providing food, clothing, education and healthcare. It was in this new progressive era that a number of professions were organized in USA. Later on they started creating standards and criteria for qualifications of its members. Professionalism is defined as the skill, good judgment and polite behaviour that is expected from a person who is trained to do a particular job well. Professionalism in its expanded vision includes rectitude, competence, steadiness, thoroughness, expertise, respectability, civility and probity, etc. In the preamble of the Charter introduced by the American college of physicians for medical professionalism in the new millennium, professionalism is the basis of medicine’s contract with the society and it demands place in the interest of patients above those of the physicians setting and maintaining standards of competence and integrity and providing expert advice to society on matters of health. Hippocrates oath encapsulates all these virtues. The principals and responsibilities of medical professionalisms must be clearly understood by both the profession and the society. The essential components of this contract is the public trust. At present medical profession is confronted with an explosion of technology, changing market forces, problems in healthcare delivery, bioterrorism and globalization. Above all medical professionalism is meant for the ultimate goal of achieving patients’ welfare.

Although Polonnarauwa kingdom was the most prosperous era, the kings had to retreat to Dambadeniya due to South Indian invasions, which took place continually from Anuradhapura kingdom. As a result of such South Indian invasion into our country, the caste system which was prevalent in India got gradually inculcated into our Sinhala society. The consequences of it were the caste system taking hold our professionalism thereby leading the society to primitive level. In other words, during Dambadeniya era the caste system superseded professionalism with its attended evils. It is noteworthy that professionalism of the highest caliber prevails even in defence setup even during the period of Anuradhapura. When king Elara who invaded this country from South India was killed in a battle by king Dutugamunu, the latter ordered that due respect should be given to the deceased king Elara and that none should pass his tomb without paying due honours and respect. This amply demonstrates the supply in professionalism upheld even at war affairs. The prevalence of an advanced health service is proved by the fact that even some kings themselves were physicians. History records that king Buddhadasa was also a veterinary surgeon who cured a snake suffering from an ailment.

A lawyer as a member of the legal profession is a representative of clients and officer of the legal system and a public citizen having special responsibilities for the quality of justice. A lawyer seamlessly asserts the client’s position under the rules of adversary system and seeks results, advantages to the client but consistent with the requirement of honest dealing with others. In the early era, individuals were supposed to plead their own case. But in the 4th century they were permitted to seek the help of a friend who is skilled in oratory. Orators in the ancient Athens were later described as lawyers. But the rule was that they should render their service free and cannot charge any fee. Later Emperor Claudius abolished

There are historical instances where kings had upheld the rule of law fairly and squarely in an exemplary manner. A case in point was king Elara passing a capital sentence on his own son for negligent riding of a cart causing a death to a calf. King Parakramabahu II in Dambadeniya was a great philosopher and a prolific writer and was bestowed with the honorary title “Kalikalasahithya Sarwaghghna Panditha” in recognition of his profound learning. That 5


that rule and legalized advocacy as a profession and allowed to charge fees but subject to a ceiling. Roman advocates as well as judges were trained in rhetoric not in law. Later advocates were recognized by law and legal system was developed in and organizational structure. Notaries appeared in the later Roman Empire but they were not law-trained, they were barely literate hacks who rapped the simplest transaction with mountains of legal jargon. After the fall of western empire the legal profession also collapsed but some professional canonized began to practice canon law as lifelong profession in itself. In 1231 French council mandated that lawyers should swear an oath of admission before practicing in Bishop’s court. In 1237 similar oath was promulgated by a paper legatee in London. By 1250 nucleus of a new legal profession had clearly formed. In 1275 a statute was enacted prescribing punishment for professional lawyers guilty of deceit. Later on it was evolved as a Nobel profession and with expansion of European colonization legal profession had been gradually established in many parts of the world. In the field of law in our country the influence of the Dutch rule had been tremendous. In that we imbibe the principles of Roman Dutch law substantially which had their impact upon the whole gamete of disciplines. Although it was confined to the practicing court in our early era at present legal professionals dominate in various fields such as commercial venchers including companies, banks, insurers, secretaries, stock brokers, etc. Opportunities are been fastly expanded in the international commerce too. At the same time lawyers shall uphold the professional standard and act in the fearless advocacy within the established canals of service. Recent surveys indicate deep decline of professional ethics in almost all the professions all over the world. Every professional worth calling one should rise head and shoulders above amateurism and should be an exponent of the elegant and finer points of professionalism, whatever the profession he represents. The golden thread that runs through the fabric of diplomacy is in this professionalism pure and simple. The role of professionalism played in national and international diplomacy cannot be obscured and still less denied. Lamentably our country has paid a heavy toll for departing from well established norms and principles due to lack of professionalism especially in the diplomatic arena during the recent past.

We are now in the process of surmounting that sorry state of affairs. If a person is not endowed with the required qualities of a particular profession he represents he may behave like a bull in a China ware shop. A true professional should never take anything for granted which mental condition arises from senses of complacency. The efficacy of professionalism looms very large even in war affairs. The unique example of it was the six-day war fought by Israel against Arab in 1967. The one night general Moshe Dayan, ministry of defense, celebrating Israel victory said that he won the war because of strict professionalism he brought into play. Laxity in the adherence to professionalism could cause enormous and incalculable harm as was proved in Hitler’s case. His eccentric habit of getting up late in the morning was exploited by the enemies who knew that German forces would not be able counterattack forthwith due to non availability of précised order from the commanders. It is also pertinent to remind that Winston Churchill, Prime Minister of UK who fought for World War II displayed a remarkable professionalism which enables him to galvanize the British nation to have the mindset to face the war. At present diversification of professions in its vague has made specialization a must. Today major profession has a cluster of semi skill professionals, for an example, the medical profession has its offshoots such as nursing technicians, laboratory analysts and therapists, etc, which have become an intregal part of the main profession. These phenomena necessitates the conducting of research in all fields as every innovation, minor it may be, would still contribute its share to the upliftment of the society. By looking at subject to be dealt with in this conference I am all the more pleased as they cover of wide range of diversified fields such as Medicine, Law, Engineering, Computing, Education, Political Science as well as current political issues of diplomacy, defense, maritime security, terrorism, nuclear terrorism and weapons, international trade and national reconciliation and conflict resolution, power and energy to mention of few. I should like to avail myself this opportunity to wish all of you greater success and many more accomplishments in all your future endeavors. Thank you very much.

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6


Plenary Session Inter-ProfessionalEducation and Research Towards Quality Health

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Session Summary The plenary session on Medicine was carried out under the sub theme of ‘Inter-professional education & research towards quality health”. The session was chaired by Prof Anula Wijesundere, Honorary professor in clinical Medicine, KDU and Surgeon Commodore (Rtd) I Y Amarasinghe, Consultant Oncological Surgeon, National Cancer Institute, Maharagama.

importance of multi disiciplinary team effort in the management of breast cancer and using examples from his practice in the UK, how it could be implemented in the Sri Lankan health sector. The second presentation was by Dr Dujeepa D Samarasekara on “Interprofessional Education (IPE) and Collaborative Practice (IPC): Trends Issues and Strategies”. An experienced medical educationist, Dr Samarasekara introduced the audience to new trends and techniques available to improve the Medical Curriculum and thereby the education of students studying medicine. The presentation highlighted the need for more interprofessional education and collaboration, where students from different professions learn from each other and collaborate towards effective health care provision.

The following eminent speakers presented on topics related to the sub theme: 1.

Dr Dujeepa D. Samarasekera MBBS(Col) MHPE(Maast) FAMS(Sing) FAcadMEd(UK) Director Centre for Medical Education (CenMED) Yong Loo Lin School of Medicine National University of Singapore, National University Health System, Singapore.

2.

Professor S. Ravi P. Silva FREng FRSA Director, Advanced Technology Institute, and, Head, Nano-Electronics Centre, University of Surrey, UK.

3.

Mr Sheikh Ahmad MB MCh (UK), FRCS (Eng.), FRCSI (Ire.), FRCS Eng (Gen.Surgery) Consultant Surgeon Cosmetic Breast & soft tissue Surgeon Aesthetic & Oncoplastic Breast Surgeon & General Surgeon, Royal Cornwall Hospital Trust, Cornwall UK.

4.

The third presentation was by Prof Ravi Silva on “Nanobiotechnology for Health and Wellbeing”. An eminent scientist and award winner in the field of nanotechnology, Prof Silva explained the potential uses and benefits of nano-biotechnology in improving diagnostics and treatment of diseases. The presentation gave the audience a glimpse in to the future of disease management with the use of nanodevices and nanoparticles. The fourth presentation was by Prof Nalaka Mendis on “The emerging concept of Mental Health: its relevance to personal growth, health and illness”. A well respected clinician and a founder member of National Council for Mental Health, Prof Mendis introduced the audience to the current thinking behind factors contributing to mental ill health and new interventions that may help to improve it. He also outlined the need for effective public health interventions to help improve mental health.

Prof Nalaka Mendis MBBS, FRCPsych Emeritus Professor of Psychiatry, University of Colombo, Sri Lanka.

The first presentation was by Mr Sheikh Ahmad on “The Management of Breast cancer, a multi professional approach”. In his presentation he focused on the

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Inter-professional Education (IPE) and Collaborative Practice (IPC): Trends, Issues and Strategies Dr Dujeepa D. Samarasekera Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore [email protected]

Abstract— Interprofessional Education (IPE) occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes (WHO 2010). Interprofessional Collaborative Practice (IPC) happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care (WHO 2010). IPE and IPC are becoming important and core to a health professional’s practice as well as in the delivery of quality patientcare. Incorporating IPE during the formative years of learning and training of a health professional student is an essential step in preparing a 'collaborative practice‐ready' health workforce. However, to develop meaningful and practical IPE and IPC during training as well as in one’s practice setting can be challenging. Way to circumvent these challenges need careful thought, good planning, adhering to evidence based contemporary best practices. The paper will provide an overview of an approach taken to incorporate IPE and IPC practically and contextually in an Asian setting.

collaborative practice to provide integrated and efficient patientcare have become critical and indispensable. II. IPE AND IPC The medical education system and the healthcare delivery system are closely interlinked; the two represent complementary interdependent systems in which the education system provides the healthcare workforce (e.g. doctors, nurses and allied health professionals) to the healthcare delivery system. The close link between the two systems should enable the training to align with relevant competencies such as teamwork and collaboration with other healthcare professionals in the work environment to improve patient care. IPE is an essential element in developing this core attribute, especially during the formative years of training of a health professional. It occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes (WHO 2010). Relevant and carefully planned IPE incorporated meaningfully from the early years as well as throughout the health professional students’ learning journey has shown to develop Interprofessional Collaborative Practice (IPC) later during their professional practice. IPC happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care (WHO 2010). IPE and IPC are becoming important and core to a health professional’s practice as well as in the delivery of quality patientcare.

Keywords— Interprofessional education, Interprofessional collaborative practice, curriculum development, Best evidence medical education. I. INTRODUCTION We live in an era of rapidly changing times. Practice of medicine has also changed over the years to better align to the rapid changes as well as to deliver better care to our patients. Advanced practices in disease management based on cutting edge modern medical science knowledge and technology; changing population demographics with an increasing aged population who are experiencing long-term chronic illnesses, new emerging virulent diseases need innovative and sustainable healthcare resources. In this context, a multidisciplinary approach based on interprofessional

III. APPLICATION OF IPE AND IPC With the recent government focus to strengthen the primary and first contact care in Singapore, public healthcare providers have initiated new healthcare delivery programs such as family medicine group practices, homecare and hospice care projects involving multi professional teams. These programs are built on the foundational principles of IPC. In order to prepare the future health professionals for effective IPC, National

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University of Singapore (NUS) initiated the IPE initiative in 2010. Five academic units (AUs) of NUS, namely Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, Department of Pharmacy in the Faculty of Science, Department of Social Work (Medical Social Work) in the Faculty of Arts and Social Sciences and Faculty of Dentistry came together to incorporate IPE into their respective professional training programmes (Jacobs, Samarasekera etal 2013). The IPE committee after much deliberations and consultation with other IPE training units internationally, developed the competency framework for IPE at NUS as illustrated in figure 1.

figure 2, was conceptualised and developed as the second step (Jacobs, Samarasekera etal 2013). The IEAs are student driven and faculty (AU) supported activities which must have two or more health professional groups coming together for learning and reflection. The IEA activities are optional for students. However participants are encouraged by NUS IPE steering committee by formally recognising the contributions by the participants through an official letter and or a certificate if they fulfil certain criteria set by the committee. The IEAs consist of student led community health projects, overseas volunteer projects, annual faculty key note address, local dialect training (languages) and sign language courses etc

The major challenge was to align multiple curricula and teaching-learning activities of five health professional training programs. To bypass this issue, NUS IPE initiative developed a two stepped curricular model to operationalise IPE within the five AUs.

IP ENRICHMENT (IEA)

IPCORE (IPC)

Figure 2. Two step curricular model to IPE Figure 1. Six IPE Core competency framework

To maintain learning quality, modified Kirkpatrick framework for program evaluation was adapted. (Kirkpatrick 1994). All AU specific IPC and IEA programs are evaluated using this model and at present a much larger overall impact evaluation of NUS IPE initiative has begun with the patronage of NUS Provost office.

Interprofessional learning opportunities in medical, nursing, medical social work, pharmacy and dentistry academic programs were identified and redeveloped with inputs from all AUs to reflect and enhance the interprofessional nature. These were identified as Interprofessional Core Curricula (ICC). The main criterion for ICCs is that they should address one or more of the six IPE competencies. Each AU identified their own ICCs. This prevented any changes to the existing professional training curricula or major disruptions to the teachinglearning activities of different academic programs. However, since the respective ICCs may not necessarily bring different health professional student groups together the second step was introduced. The Interprofessional Enrichment Activities (IEA) illustrated in

IV. LESSONS LEARNT Both IPE and IPC must take into account contextual nature of the learning and practice environments. The initiatives must be relevant and practical, taking into account the local resource availability. A best practice is to start with a manageable pilot which could be scalable based on the learnings from the initial pilot program as well as the resource availability. Organisational constrains such as hierarchical administrative and educational structures must be 10


removed by discussing with relevant stakeholders as well as monitoring the ground closely to quickly resolve any issues arising during the operational process. Continued student and faculty development in IPE and IPC through training should be maintained and the results must be highlighted to the administrative, educational and clinical leadership for their strong support.

contextually relevant IPE initiatives to provide the necessary guided exposure to our students and trainees. REFERENCES Jacobs JL., Samarasekera DD, Chui WK, et al (2013) Building a successful platform for interprofessional education for health professions in an Asian university, Medical Teacher, 35(5), 343-347.

The benefits of meaningfully incorporated and contextually relevant IPE and IPC programs have been identified by many educational research studies. The main benefits are: increased clarity of roles and responsibilities, improved communication as well as enhanced mutual respect/trust between different health professionals leading to higher efficiency hence cost savings in the delivery of education and patientcare. Furthermore, relevant IPC initiatives have shown to improve recruitment and retention of staff leading to higher levels of well-being and job satisfaction amongst health professionals in collaborative practice settings (WHO 2013). Many international studies have also shown that these IPE and IPC gains have contributed to improved patientcare outcomes and patient satisfaction.

Kirkpatrick DL (1994) Evaluating Training Programs. San Francisco: Berrett-Koehler Publishers, Inc. World Health Organization (2010) Framework for Action on Interprofessional Education & Collaborative Practice. World Health Organization (2013) Interprofessional collaborative practice in primary health care: nursing and midwifery perspectives: Six Case Studies. ACKNOWLEDGMENT The author would like to acknowledge the National University of Singapore Interprofessional Education (IPE) Steering Committee and Professor Matthew C.E. Gwee of CenMED for their support and contributions. I would also like to acknowledge the gracious invitation extended to me by the Organising Committee of the International Research Conference, Dr. Asela Senanayake and Professor Rohini Senevirante of Kotelawala Defence University.

V. CONCLUSIONS To manage multifaceted contemporary and future healthcare challenges, our practice environments are undergoing rapid changes. One of the main areas of focus in modern practice of medicine is IPC. To best prepare collaborative practice ready health workforce, the training institutions must design practical and

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The Emerging Concepts of Mental Health; its Relevance to Personal Growth, Health and Illnesses Transcribed speech of

Professor Nalaka Mendis Professor of Psychiatry Emeritus, University of Colombo, Sri Lanka [email protected]

Good morning everybody. I am very happy to be here on this occasion.

hospital pola. These are the people who are attending the mental health clinic. There is a visiting psychiatrist.

I would like you to take 4 messages home from this lecture. As my first message is that wellbeing is an important human aspiration .Remember it is an aspiration, and an important component of human development .Second message is health, wellbeing and mental health are rich holistic concepts, central to personal growth.Then the third message is how to determine and enhance these concepts in our society using social and individual approaches. And the last message is how these issues are being perceived in Sri Lanka.

These are some of the fascinating things that are happening. You probably may not know there is a positive mind club in Sri Lanka. These are people who get together and talk about positive mental health. However it doesn’t happen in university or in the formal health sector but does happen in informal sector. One of the oldest mental hospitals in Colombo was the, Independent Arcade. Now it is a wellbeing centre. Everybody comes there to enjoy themselves. In fact one of the oldest hospitals which used to be the the mental asylum in Angoda has also changed its name to the National institute of Mental Health. (NIMH)

During the last 40 years that I have been working here, I have never felt bored. It is because all the time I am learning things. As I mentioned earlier, there are so many things that are happening all around the world. There are so many things happening in each of our lives as well as the subject area that we are working in.

We have had research in areas like ‘social capital’ which you may not have heard of.This is an area of activity which many of us are not familiar with. UN global action report 2015 lists mental health promotion is one of the key goals. Following the millennium development goals, all 25 human development reports refer to wellbeing. All these reports aim to improve the wellbeing of individuals. Not merely improve the wealth, but the wellbeing.

Every single person who comes to me is an individual, a separate person. There are very different people with different problems which you need to understand. During the last 30 years meditation has become popular. When Deepak Chopra came to Sri Lanka he drew such a big crowd that could not be accommodated in the hall. These are all people who want something to fulfil their lives. When Deepal Sooriyarachchci, the corporate guru conducts a session people attend mainly to alleviate the stress and strain in their work place.

People are now aware of mental wellbeing as an emerging major issue because of its importance in promoting personal growth. Without the wellbeing you will not move forward. Productivity, creativity, resilience, connectivity, community orientation all are pre requisites for a meaningful and purposeful life, based on the foundation of mental wellbeing. This is quite distinct from absence of mental illness which was talked about all the time. Now people talk about the positive aspects of mental wellbeing and community development. They are interlinked.

There is a beautiful centre close to our house in Diyathalawa run by a German national, where Germans come for 3 weeks of mental relaxation. Diyathalawa hospital a very beautiful place where every month the people get-together and start talking about their problems. Some come from Colombo. People seem to be wanting somewhere to get together and interact. And once a month people come and sell their stuff in the

There is a good evidence to suggest that mental wellbeing is a major factor in all these areas. And we know mental, physical, and social functions are all inter dependent. Cartesian concept of the dualism of mind and body is no longer tenable.

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All societies have something similar to mental health although they do not use the term mental health. I was unable to find a Sinhala word for wellbeing inspite of speaking to many experts. That does not mean that the concept of wellbeing is not there in Sri Lankan culture. We are talking about mental wellbeing of the individuals, families and communities. All of us have to talk about mental health issues not only psychiatrists or other mental health professionals. Mental health issues are not compartmentalized. It does not arise in one situation.

They are the gang of four who were really behind the establishment of World Health Organization in 1940s. They were all socially conscious humanists with a common vision on what the health is meant to be. Still we are getting the benefit of their vision. When Mahler was the Director General of WHO he met Chiholm in India. Mahler asked him what he meant by the term health. His answer is a very important statement. He said “I will tell you what was told to me by the person who really proposed this concept”. It is the complete physical, mental and social wellbeing. I have experienced this concept personally many times as a participant in World War II. I thought that freedom from occupation is vitally important. I had complete physical well-being in that as an individual and I could make a difference against a huge army. Complete mental wellbeing enabled me to risk my life for something vitally important for me. Complete social wellbeing is that I knew I should not come back alive somebody from my group would take care of my family. In facing death he had experienced the innate and transient meaning of WHO health definition. That was the fascinating revelation by the the first Director General of the WHO. Of course people reflect on an old idea which was further developed over the years by various people. Brock Chisholm was a part of both World War I and II. Sigerist was imprisoned by Nazis during World War II. They were both humanistic psychologists. They really believed in human will and human power. They did not rely on God. They believed in human potential the innate ability of the person to live and work within the community and develop its potential for health and wellbeing

I wish to talk of evolving concepts of mental well-being, in the second part of my lecture. What do you really mean by mental well-being? What do you really mean by health? What do you really mean by mental health? All three terms are used without realizing what these mean and how it is originated. And many of these studies have come from west in 1930-1940s. However they are the basis of knowledge accumulated over centuries. Many of these are influenced by eastern concepts. Carl Jung one of the prominent thinkers on psychiatry had stayed in Kandy, for about three weeks in 1903. He went back and wrote a poem called “Buddha”. Although they were based in the West they had a lot of input from this part of the world. Now we talk about social determinants and inequities in health as important factors. We talk about the public health approach to mental health, a very different concept. Martin Seligman in the 1970’s developed this idea of positive psychology. It is now explained with neurochemistry or neuroplastisity. We can no longer say the brain stops growing. The brain continuously grows till you die. Neuroplasicity depends to some extent on social circumstances.

What do you mean by wellbeing? Again there are two points of view. One group says that wellbeing is happiness and joy. This is the hedonistic view. The eudemonic view is that there is more to wellbeing than pleasure and pain. It means having a purpose in life where the person manifests as a fully functioning individual.

In epidemiology as much as maternal mortality or infant mortality, we talk about disabilities. About eight of the twenty causal conditions of disabilities are related to mental health. Many centres of excellence globally are now involved in multidisciplinary colloborative research on mental wellbeing involving different fields such as neurochemistry, psychology and epidemiology.

Wellbeing is not mere transient joy or happiness. It is much more than that. Martin Seligman the key thinker behind the positive psychology movement quotes the concept of 'sukha' in Buddhism namely cultivation of the mind, and understanding the nature of wisdom and morality. And he also talks of ones kinship with other bees living as a part of a community. These concepts are very similar to what we have all known. Asian philosophy is very much community oriented and not highly individualized like in the west. But these diverse concepts have been ingrained together into the modern concept of mental wellbeing.

My second take home message is that mental health and wellbeing are rich holistic concepts central to the human activities. There were four people I like to refer, Henry Sigerist from Switzerland, pioneer of the concept of national health insuarance, Andrija Stampar from Croatia, President of the 1st World Health Assembly, Brock Chisholm a psychiatrist from Canada the first Director-General of the World Health Organization and Abraham Maslow a Humanist from the United States. 13


However there are different models depending on the centres. Basically it is a dynamic concept. Seligman talks about the fuel or energy that people needs to develop their innate potential, work productively and creatively. Being strong and positive in a relationship contributes to the community and also enhance the social and personal goals and purpose of life. Wellbeing in other words connect and energizes people, giving them a sense and purpose. So it is a state of being in alignment of body, mind and spirit.

determining health. This is the supreme individual that we are talking about. Then there is another theory behind creativity, bravery, kindness, perseverance and optimism. There is an interesting man called Richard Davidson, who said that you can learn things in the same way as you trained your muscles. As you develop your emotions positively, you enlarge your thinking, grow your wisdom, sharpened the alerteness and judgment becomes wiser. Jon Kabat-Zinn, a professor of medicine from Massachusetts, introduced the Therawada Buddhist concept of mindfullness in to his teaching. The report on mental capital and wellbeing in UK which I referred to earlier started by asking the question “what should we do to improve the mental capital of British people who are living in Britain at the moment?”

In very simple terms we talk about, taking notice of other people, being alert, giving back, being compassionate, being grateful, connecting with other people, work ing with other people and learning all the time. Mental health is the foundation for mental wellbeing. Mental wellbeing is a dynamic and functional state. They are the resources for effective functioning individuals and community. The individual who has realized his or her own potential can cope with the normal stresses in life. They work productively, fruitfully, and make a contribution to the community.

In Sri Lanka there is an emerging awareness about mental health and wellbeing. There is no doubt that people desire it and are curious about it. They ask 100 questions for many of which we have no clear answers. May be no one can answer them at present. We have to enhance the value attached to the mental health. If we do not value it, we will not have it. If you value a building, you will have many buildings. But if you value human beings who are able to think positively and creatively, you invest in people. We talk a lot about the knowledge development in Sri Lanka. From kinder garden to university we give knowledge but we don't develop the vessels in which knowledge is accumulated. We do not develop their creative ability. Creaivity is not high in the Sri Lankan educational agenda at present.

Abraham Maslow said there is stress in all of us, that we are not able to recognize and understand. When they interviewed a large no of people to see how many make use of their innate potential to meet this stress, majority did this even without knowing that they had that potential. Positive mental health considers it as a resource. It is the energy or the fuel which enable people to cope with stress. There was a study in UK originating from a department of science which asked people what kind of Britain they should have during the next twenty years.Their report highlighted the need to devlop mental capital as much as economic capital and social capital. Social environment , social resources , health, education and employment, housing, the basis of social capital network together with shared norms, values, and understanding which constitute the glue which holds society together.

Albert Einestien said “an interesting and intuitive mind is a sacred gift and the rational mind is an important servant”. I close with the words of the Buddha. “The mind when undeveloped and uncultivated entertains great suffering.”

How do you promote mental health of a population? The evidence suggests that the best approach is offering individuals and community to control the factors

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Nano Biotechnology for Health and Wellbeing transcribed plenary speech of

Professor Ravi Silva Director, Advanced Technology Institute, University of Surrey, UK [email protected] In a time where Sri Lanka actually needs everyone in all disciplines to work together, I think with this theme that has been taken up by KDU on professionalism and national development, this is as good an opportunity as ever to show what Sri Lanka as a nation, we as people can achieve when usually bring working together. So in interest of time and trying to bring this together what I am going to talk about is how nano technology can actually bring together many of these disciplines. I’m going to focus particularly on the non bio end of things for health and well being. But since this talk is all about as part of national development and inter professionalism I need to say a little bit about it. So I will do that too. But before starting I will take a minute just to tell something about university of Surrey. I joined there in 1993.

Food, security, water, climate change. But with national development each of these contribute in their own way to these various fields. We can actually lift the world in that sense. It really does mean much for everyone. So within that, what I am going to talk about how bio technology can help you to reach some of these economic and social objectives. According to a recent world bank report that came out this month, it said that human beings are the centre of concern for suitable development. They are entitled to a healthy and productive life in harmony with nature. So from a symphosia point of view having health and wellbeing as part of that national development is absolutely crucial and paramount as discussed earlier. What is nano technology? If I had a nano meter sized particle in my hand, now how big it would be? Interestingly if you want to try and examine this I can take my hand and if I start expanding that magnifying that by 10, I can start looking at the cell and smaller cell cultures. That is a bit boring. But if I then start magnifying it by thousand fold, then it becomes very exciting. With electronic microscope I can do this expansion and this is the hundred nano meter of a human cell. Can go further and start looking at composition of various cells. So we are now looking at the nano world, the DNA of us. Our blue print. In nano technology what we try to do is can we understand these small various cellular structures and make use of it in a structured way. See whether we can start using the physical world of electronics to work together with the biological world and see whether we can get better systems. But it can be used in many other applications. If we were to start putting that in to a time line or scale line what you see from one side, on your left hand side are the natural world where the nano technology goes below the red blood cells and then start looking at your DNA and the ATP synthesis and how that can be connected up to the physical world. And that’s what I am trying to do, how we are going to optimize physical devices with biological entitities by meshing them together. In terms of the nano scale, if you want to see optimization, what you see is huge enhancement of signals. Because you have got much larger surface to volume ratios once you start going in to the nano scale which means previously where you had the surface area of few centimeters, that suddenly becomes 100 square

The university 2 years ago was ranked 8th in the UK according to the guardian lead table and last year it was ranked as 6th and this year its 4th. It is predominantly in the top 10 universities and we are actually working pretty much at the cutting edge of the activities currently. My own institute got the Queens anniversary award for contribution to semi conductors and electronic engineering. But getting back to the key theme of the conference I thought yesterday I needed to look and see how and why KDU has come up with a national theme. And it's very interesting when you start looking for a definition of national development many people have come up with many definitions. And there is no one that’s similar in nature but what’s important is its certainly not per capita income. It's not economical. Its social and cultural. And what’s most important about national developmental aspect is that it is about the quality of life that people should get used to. And it’s a part of a human right that everyone deserves a suitable quality of life. So interestingly when you start looking strictly at the definition of national development it has national defense in there because every person has a right to have a secure environment. Engineering comes in order to improve life style, community, health, legal development, prosperity and just see in that whole theme setup by KDU was ready made for the national development aspect. So within that prospect itself, you not only are talking about some of the world's most important addressing problems. Energy is number one. 15


meters. So to take an example, if I take a spoon full of sugar and I make that in to a nano surface, that spoon full of sugar is enough to cover 3 foot ball pitches. That's the surface area we are talking about, compared to spoon full of sugar that you have. Now if I start thinking of that from a physical point of view in trying to sweeten something just imagine instead of having sweetness associated with one tea spoon but a hundred of tea spoons if you can open up those nano scale properties of materials. And that's possible simply because of the physics or the catalytic properties that you can get with surfaces once you start getting it smaller and smaller. So we need to try to do is to be able to start using properties in everyday applications.

developmental point of view, and start reducing the stress levels and start increasing the productivity, certainly you got a more friendly work force surrounding you. Another area that there is a lot of work going on currently is on e-skin. So this is electronic skins, wearable skins that can sit on your clothing, it can be just a part that you use and within this it allows you to, once more monitor things, it allows you to put growth factors in if there are broken bones. All of this is possible by using nano technology and embedding various particles, various things in to the technology that is being used currently for health monitoring. So from this context I am trying to get 2 examples of work that we have done in bio potential monitoring and some work on looking at potential drug delivering methods for cancers and show how this can be used. But typically from a nano point of view you can have sensors, you can have drug delivery systems, imaging improvements and all of these are possible purely by looking at small scaled enhancement in to the structures.

Let’s take for example of a café scenario, such as that you see here. Now if you look at that, just looks like an ordinary cafe. But what we might not know is that within that cafe seen, you might have people who are having jackets that are actually monitoring your bio potential on a day today basis, hour to hour basis, minute to minute basis, second to second basis. Your jacket might know that you are going in to cardiac arrest, 10 min before it actually happens simply by looking at the rhythms that are coming out and analyzing it appropriately. In nano technology what you are trying to do is to see where we can start by putting these non invasive sensors in to your body, in to the clothing, in to your vicinity in order to be able to make this predictive behavior when it comes to health and wellbeing. So in the case of this scenario it could be looking at an ordinary scene, but within that scene you could have all of this technologies embedded within the clothing, within the hat that you are wearing, it could be on a plaster, it could be an embedded capsule. We could even put this technology in to your glasses or lenses. So this is the sort of scene that we want to try to do, to make it a reality in the next few years. So people can start looking at sensors. The simple glucose sensors that you can embed or that you can connect up to your i phones. For example by using plasmic resonances. You can start looking at diseases such s diabetes, once it starts being able to monitor blood sugar levels you can then start contributing from a societal point of, cardiovascular diseases, amputations, complications in pregnancy. These are monitoring of these activities, these patients on a daily basis with everyday technology. So much like now in the case of i phones you have, in I bands that you can wear looking at your exercise routines you can now start trying to think about that going the next step looking at bio potential monitoring. By doing this from a national exceptive you can start saving a lot of days in UK according in the data. There was 11 million days lost due to stress and other reasons of work place illnesses. So again once more from a national

So first of all let me take one example on intelligent plasters. Purely as a result of having a discussion with a friend of mine I was challenged one day saying "Can help in doing some EEG monitoring?". And in this case this is a friend of mine working on sleep disorders. About 10% of world population who have some sort of sleep or stress based disorder that needs EEG monitoring. Now in his case he calls his patients and he tells them to sit down one evening and when we put 128 or 256 of these sensors on the head if we can't get a good connection we shave them off and put some electro gel and put this. Then he instructs them to relax in order to monitor them. So this guy has 200 wires flowing down and he is trying to relax in order for them to have some monitoring of his EEG signal. So the idea was, can I come up with something that is slightly easier to do than having all of these wires trailing around. So the target was, lets come up with some intelligent plasters. In order to do this we need to think about not just being able to monitor the potentials of your body but also being able to wirelessly transmit that information appropriately, so that it could be properly gathered. And again transmission of data is also very very important. Because all of you may have 4G enabled phones that give you huge amounts of data but there is not enough actual band width. At the moment if everyone to put their 4G on, you find that actually no one can work very well. So there has to be some sort of management of big data too that has to come within this programme. In our case we have to 1st come up with the interphase of the potential monitoring in to your electronics. So we came up with this thing, that if I could 16


get some sort of spikes based that went through your dead skin layer, the stratum cornium, enter in to the epidermis was able to get a signal loud in a non invasive way, this would be useful. So we looked around and technology that was being used was micro machine technology. If you look at those dimensions at the base are about 40 microns by about 100 microns. That's about the size of human hair. So it's quite lage and every time you put a plaster with this sort of structure in, it does hurt, it gives an inflammation. The question was can we do better? We were working on entrails called "carbon mono tubes" at that time & these materials have tensile strength, that is 20 times stronger than steel. Electrical conductivity of carbon is better than copper. So it's seemed to be the ideal structure.

with these patches that more than put for testing. So these tests were done and compared to the best censors out there. They were actually highly comparative. The company that worked with us, which is the company called "The start lab" are selling this based in Barcelona. And the 1st test was done in UK, we didn't have ethical approval to use this sort of nano bio systems, but in Barcelona they got through that faster. And after they did their testing and were able to show that you could get very good bio potential signals. And the signals were without any electro gel, without any preparation of surface. Again it's interesting being able to monitor and being able to predict whether someone is going to be ill or going to start having symptoms of various things is very important. Within UK in 2000 it was estimated that there would be a GDP 1.5% spent on health type applications from the government. Reports have just come out from this which is business and innovation skills department in UK that says that the health cost for aging population will go up and it will probably reach out 5% GDP. So it’s a huge area that is being looked at in order to examine things. So within our programme we were able to have these bio sensors that had a base that was electronic, that communicated with the central activity and then was able to pass on information. Within this whole thing, this was the whole idea that you have this thing called the "guardian angle project", where these bio sensors talking to a central unit that would transmit information to your medical team or public health monitoring systems. So its a system that can be implemented and we are looking to see how can that be done in the future. We also did some work on looking at different nano sensors to be able to monitor brain communication but I am not going to say much about that.

In order to do this normally carbon nano tubes grow at about 700◦C, and heat something up to 700◦C and put some metal catalysts on top and then you put plasma in there, its methane plasma & you can grow carbon nano tubes that are aligned. Clearly 700◦C is not compatible with electronic application of plastic etc. So we ended up with a new technology that allowed you to grow carbon nanotubes at room temperature. Once you did that, they had to put that plastic substrate. What you see in here is plastic substrate that has got these squares. Each of these squares are about 100 microns by 100 microns. That's the size of human hair. But if you start looking at this magnified view, what you see is millions of tubes instead of one tube. So previously when you had old technology, that you had one silicon tube that used to hurt people that went in. Now you have got million of these tubes on each of these patches basically. And you can have large number of patches if you start seeing carbon nano tubes. Now one of the problems with nano materials is that there is a fear it could be toxic if it goes in to the body and is retained in it. Clearly if a tube with metal surface is scratched the particles can break off. So we needed to make sure that this didn't happened. In order to do that what we did was a very simple thing; we heat it. And once you do that it lets the epoxy sink down, it is a bio compatible surface and it secures your nano tubes to your base. Now you have a secure base in which you can do this sort of test. So you have your surface, if you look at this cross section, you can see millions of nano tubes that are sticking out. These can be used for biopotential monitoring. So using some electronic knowledge you can start looking at amplifier circuits and how you can use silver chloride on top of the surfaces in order to increase iron associated with bodily fluids. In order to make it bio compatible rather than having carbon nano tubes surface we made this surface silver chloride. So you can see these tiny silver chloride nano particles on the surface decorating your material and this allowed us to come up

Moving on to the last part on cancer, one of the areas we wanted to try and work with was to see whether we can contribute in cancer treatment. And in this case with friends from oncology department, what we wanted to do was whether we could use nano vehicles effectively to deliver drugs to cancerous cells. So within this process what you need typically to do is functionalize your nano particles with certain aspects and in this case we wanted first to monitor whether we were delivering drugs and secondly what was happening to the drugs. So to do this we came up with strategy on functionalizing and visualizing the nano vehicles that were using carbon nano tubes. Once you have delivered the drugs you can do the chemotherapy type looking at treatment and or you could do hypothermia or chemotherapy by looking at various schemes on knock down process. So first of all we have to design the nano vehicle . Iin this case what we 17


did was, we functionalized the nano tubes. It had to be connected to a BSA because it had to have a vehicle on which could put anti bodies. And using this vehicle we were able to show that we could start delivering the drugs to the various cells. These are all done within cellular structures, they haven't been done on animal testing yet. We look at colonic cancer here. We also looked at other cancer systems. These are prostate cancer cells, what we are able to show is that we can, not only deliver these drugs accurately to your cancer cells but you can also remove the vehicle in which you deliver them. So to do that you needed to able to look at the fictionalization and the efficacy of the fictionalization. And the efficacy of delivery of drugs and also whether your cells were stressed or not. Just to end let me show some of the stuff using this technology.

good image that shows how it could happen in the future. Nano bio technology has the potential certainly to improve health care and quality of life. It can certainly provide personalized medicine for the future. It allows you to tackle some of these problems that our society is facing with and certainly from national developmental perspective. It is absolutely paramount that it is part of that process. You do have to be careful of the life cycle when you start such activities. In countries such as Sri Lanka, universities such as KDU can also start this. So you don’t need muti million dollar facilities to start nano bio technology. You can do it any where at anytime. What you really need is to open your imagination and you know its all about getting an idea, getting a group of people together who have multi disciplinary skills and start working together.

What I wanted was to just show you that when we do research for big companies what they come up with, this

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Management of Breast Cancer, a Multi-Professional Approach Mr. Sheikh Ahmad Oncoplastic breast and aesthetic surgeon, Royal Cornwall Hospital, Truro, Cornwall, UK [email protected]

Multidisciplinary teams (MDTs) are group of people of different health care disciplines, which meets together at a given time (whether physically in one place, or by video or teleconferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient”

MDT allows all key professionals to jointly discuss individual patients and to contribute to clinical decision and provides consistent, coordinated, and cost-effective care to the patient. Decisions made by MDTs are more likely to conform to evidence-based guidelines than those made by individual clinicians

Previous management of cancer patients before the idea of MDT management involved the referral of patients from one clinician to another at various stages of diagnosis and treatment without an integrated approach, which can be an overwhelming and confusing experience for a patient

MDT meetings are perceived to be effective in the medical management of patients with advanced disease and contributes to a shorter mean time from diagnosis to treatment (29.6 versus 42.4 days; P < 0.0008), as well as increased patient satisfaction (1). Discussion of individual cases by experienced specialists at MDT meetings provides an excellent opportunity for training earlycareer doctors

Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist.

It has been estimated that in 2004 >80% of all cancer patients in the UK were managed in the context of an MDT, up from mean+1SD), fair (between mean+1SD and mean–1SD) and poor (40% of the population) 47


chemical methods and personal protective methods (WHO, November 2012).

II. METHODOLOGY A cross sectional study was conducted among 120 teachers from the three schools: Devi Balika Vidyalaya, Asoka Vidyalaya and Ananda College in Colombo district. After excluding the teachers in the administration and teachers who were not willing to participate, the participants who were present on the data collection day were selected through systematic sampling; every 3rd teacher from the register was included in the study. The total 120 teachers were selected as 40 teachers per school.

About 33.6% of notified Dengue cases were from the school going age group (Epidemiology unit Sri Lanka, 2013). The Aedes sp. Mosquitoes bite people early in the morning and in late afternoon (Bannister et al, 2006). During this time period, school going children stay at school. So the preventive measures must be taken against the mosquitoes at schools. At the same time school is a place where people from different sectors (urban, suburban and rural) gather. School teachers can be used as a tool to provide information to students regarding DF which will disseminate the information throughout the different sectors. Teachers have to implement the preventive measures against DF in schools and at their homes and also they have to motivate the students to do as well. So teachers can contribute in a significant way to reduce the mortality and morbidity of DF in the community.

The self-administered typed questionnaires were available in all three languages (English, Sinhala and Tamil) and included awareness, attitudes and preventive measures as study variables. They were distributed to all participants and were collected on the same day after giving adequate time to fill the forms. Investigators were available for clarifications. The awareness and preventive practices were scored separately where each of the correct answer was given one mark and each of the wrong or unknown answer was given zero mark. The scores were added together to get a total mark of 22 in awareness section and 17 in prevention section. They were then grouped into good (>mean+1SD), fair (between mean+1SD and mean–1SD) and poor (0.05). Watching TV while taking meals significantly increases TV time. (p 0.05).

The average child and/or adolescent watches an average of nearly three hours of television per day (Villani, 2001). These numbers have not decreased signiﬁcantly over the past 10 years (Pack, 1999). In a nationwide survey on the daily screen time of Iranian children and adolescents, it was found that overall 33.4% of the students watched television more than 2 hours a day in their leisure time during school days and holidays (Jari et al., 2014). Meanwhile, a study done among Mexican children concluded that on average, children engaged in 3 hours/day of screen time, irrespective of gender and age. (Janssen et al., 2013) Adolescents who view television during late night hours average more television viewing than other adolescents (Thompson and Austin, 2003). Parents' failure to provide guidelines for television viewing has a lot to do with the attitudes and values of today's children (Thompson and Austin, 2003). Parents are often not familiar with what their children are viewing on television, nor do they control the television which they watch. Furthermore, two surveys in 1997, with a sample size of nearly 1500 parents, found that less than half of them report “always watching” television with their children. (Strasburger and Donnerstein, 1999). Co-viewing is thought to be an effective mechanism for mediating untoward effects of television viewing: an adult, watching a programme with a child and discussing it with him/her, serves simultaneously as a values ﬁlter and a media educator (Strasburger, 1995). Parent television time is associated with child television time and had a stronger relationship to child time than access to television in the home or the child's bedroom, as well as parental rules about television viewing and co-viewing. This pattern persisted across all age groups of children. (Bleakley et al., 2013).

Keywords— Television, Children, School Performance I. INTRODUCTION Television has a vital impact on children and adolescents and it is important to verify the content and duration of TV viewing. The relationship between TV viewing and academic achievement, age and other variables is complex, multidimensional, and inconclusive. (Thompson and Austin, 2003)

Generally, time spent in front of a television set is about equal for boys and girls (Beentjes et al., 2001) There is no significant association between the number of hours of watching television per day and academic

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performance as measured by marks in examinations. (Kumar et al., 2013).

half of the study population (n=60; 49.6%) had a cable or satellite connection for their TVs at home.

Viewing habits typically increase throughout elementary school years, and decrease during high school years. The years right before and after adolescence are the most opportune times to shape TV viewing habits (Thompson and Austin, 2003).

B. Description of the pattern of TV viewing 1) Average duration of TV viewing per day: Participants of the study view television at a mean of 16.50 hours per week (Range: 0.00 to 60.00 hours) which is equal to an average of 2.36 hours per day. Further breakdown shows an average of 2.05 hours per day during weekdays and 3.11 hours per day during weekends.

Research has been done globally regarding television viewing in children. However, data on television viewing patterns of the paediatric population and their associations is limited in in Sri Lankan literature. Therefore this study was conducted to describe the television viewing habits of O/L children in selected urban schools of Sri Lanka, to identify associations between selected factors and television viewing habits and any association between television viewing habits and academic performance.

2) Variation of average TV time by the entire population against time bands: Peak viewing is observed between 8.00 p.m and 9.00 p.m during weekdays (0.53 hours per day per subject) and weekends (0.49 hours per day per subject). This is described in Figure 1.

II. METHODOLOGY This descriptive cross-sectional study was approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo and was conducted in two schools in the Colombo city, namely Devi Balika Vidyalaya (Colombo 08) and Hindu College (Colombo 04). Cluster sampling method was used. G.C.E. Ordinary Level (Grade 10 & 11) classes were listed and selected using a random number generator. All students from the selected classes were included in the study. There were no specific exclusion criteria. Figure 1. variation of average duration of TV viewing against time bands

Study was carried out at individual student level. Information sheets with consent forms were sent to the parents through the class teachers. Self-administered questionnaires were provided to each student who volunteered to participate and returned signed consent from parents. A total of 121 questionnaires were distributed and 100% response (n=121) was obtained.

3) Types of TV programmes watched:

Data analysis was performed using SPSS statistics version 21 and Microsoft Excel 2010. Data were categorized and compared using charts, grading systems and significance tests. III. RESULTS A. Description of the study population Out of the total study population (n=121), 59.6% (n=72) were females and 40.4% (n=49) were males. The subjects belonged to a median age of 16.12 years (range=15.17 to 16.58 years). All (100%) of the study population (n=121) had at least one television set at home, while 22% of them (n=27) had 2 or more television sets. Approximately

Figure 2. average durations of TV viewed against types of programme 56


Figure 2 describes the average duration spent on each type of TV programme by the entire study population. Movies, soft sports, news and teledrama are viewed more than the other types. Cartoons, teledrama, news, educational, comedy and other unlisted programmes are viewed slightly more during weekdays than during weekends.

Watching TV while taking meals shows a significant association with increased TV time. (t=0.001; p 0.05).

The most viewed type of programme during weekdays is soft sports (1.01 hours). During weekends however, movies are viewed more than all other types (1.40 hours). C. Associations between increased TV viewing time and selected factors 1) Gender: Mean TV time of males for the whole week is significantly higher than that of females (t=0.013; p0.05).

2) Variation of average TV time by the entire population against time bands: Adolescents who view television during late night hours average more television viewing than do other adolescents (Thompson and Austin, 2003). Our study shows that the peak viewing is observed between 8.00 to 9.00 p.m. during weekdays. This is also contrary to popular belief that children watch TV mostly during early evenings. During weekends there are two extra peak viewings that can be observed between 1.00 to 2.00 pm and 6.00 – 7.00 pm which are not seen on weekdays. This may be due to children returning home late in the evening on weekdays.

3) Parental supervision: Majority of the study population (88.4%; n=107) are supervised by their parents when watching TV. Mean TV time of those who are supervised is 2.32 hours. Mean TV time of those who are not supervised is 2.68 hours, which is 16% greater than the former. However, this increase is not statistically significant (t=0.462; p>0.05). 4) Parental accompaniment: In the study population (n=121), only 7.44% (n=9) are always accompanied by the parents when viewing TV; 27.27% (n=33) are accompanied often, 53.72% (n=65) are accompanied occasionally and 3.31% (n=4) are accompanied rarely; 3.31% (n=4) are never accompanied.

3) Types of programmes watched: Though the mostwatched type is soft sports through the week (1.01 hours per day), there is a drastic increase of 55% in duration viewing movies, towards weekends (0.90 hours during weekdays and 1.40 hours during weekends).

Parental accompaniment during TV viewing does not show a significant correlation with TV time (ᵡ2 (4, n=121) = 6.503, p > 0.05). However, there was a tendency towards viewing more TV when not accompanied by parents.

B. Associations between increased TV viewing time and selected factors 1) Gender: Prevailing literature suggests that time spent in front of a television set is about equal for boys and girls (Beentjes et al., 2001). But according to our study, boys spend a significantly higher time on TV than girls. Girls viewing lesser TV than boys may be due to Sri Lankan cultural norms.

5) Watching TV while taking meals: A majority of 81.8% (n=99) watch TV while taking meals and 18.2% (n=22) do not. The former view TV for 2.55 hours per day. This is 72.3% greater than the latter (1.48 hours per day). 57


2) Availability of a cable / satellite connection: A cable or satellite connection gives an opportunity to view a vast number and variety of channels. It is generally believed that having cable or satellite access will make the adolescents watch more TV. However, our study shows that having a cable or satellite connection will not have an impact on the TV time.

V. CONCLUSIONS AND RECOMMENDATIONS In this sample, television viewed per subject is 2.05 hours per day during weekdays and 3.11 hours per day during weekends. 8 – 9 pm during both weekdays and weekends, and 1 – 2 pm and 6 – 7 pm during weekends are the time bands during which the children watch more TV. Therefore it is recommended that more child-friendly programmes are telecast during the above time bands.

3) Parental supervision: Globally, parents are often not familiar with what their children are viewing on television, nor do they control the television which they watch (Strasburger and Donnerstein, 1999). But majority of our study population (88.4%; n=107) are supervised by their parents when watching TV. However, there is no significant association between parents’ supervision and children’s TV time.

Time viewing movies is drastically increased during weekends. Therefore it is recommended to telecast childfriendly movies during weekends. Parental supervision does not decrease children’s TV time. However, parental accompaniment tends to reduce children’s TV time. Therefore, parents must be encouraged to accompany their children while viewing TV.

4) Parental accompaniment: It is further evident that less than half of the parents report “always watching” television with their children (Strasburger and Donnerstein, 1999). Our study also shows that only 7.44% (n=9) of the study population are always accompanied by the parents when viewing TV; 3.31% (n=4) are never accompanied and 53.72% (n=65) are accompanied occasionally. Sri Lankan culture may have an impact on parental supervision. Most of these children are under the supervision of their parents through childhood and adolescence. But because of the busy life styles, both parents might be unable to accompany their children while watching TV.

Adolescents watch more TV during mealtimes. This may interrupt family interactions. Therefore it is recommended that TV viewing is discouraged during mealtime. Further studies are recommended to cover a wider population, including students of other grades and students from rural schools. ACKNOWLEDGEMENTS We thank the Department of Community Medicine, Faculty of Medicine, University of Colombo for the research training and the opportunity given to conduct this study as part of the curriculum.

Parent television time, parental rules about television viewing and co-viewing had a stronger relationship to child time. This pattern persisted across all age groups of children. (Bleakley et al., 2013). But our study shows that parental supervision does not significantly reduce TV time of the adolescents. However, parental accompaniment shows a tendency towards lesser TV time.

REFERENCES Beentjes, J. W., et al. 2001. Children’s use of different media: For how long and why. Children and their changing media environment: A European comparative study, 85-112.

5) Watching TV while taking meals: Watching TV while taking meals is found to be strongly associated with an increased TV viewing time. As families often interact during mealtime together, this may also have an impact on the family time.

Bleakley, A., et al. 2013. The relationship between parents’ and children’s television viewing. Pediatrics, 132, e364-e371.

6) Association with academic performance: Obeying prevalent literature (Kumar et al., 2013), our study shows that there is no association was found between TV time per day and academic performance

Janssen, I., et al. 2013. Screen time in Mexican children: findings from the 2012 National Health and Nutrition Survey (ENSANUT 2012). salud pública de méxico, 55, 484-491. Jari, M., et al. 2014. A nationwide survey on the daily screen time of Iranian children and adolescents: the

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CASPIAN-IV study. International journal of preventive medicine, 5, 224.

Thompson, F. T. & AUSTIN, W. P. 2003. Television viewing and academic achievement revisited. Education, 124, 194.

Kumar, R. S., et al. 2013. Interaction of media, sexual activity and academic achievement in adolescents. medical journal armed forces india, 69, 138-143.

Villani, S. 2001. Impact of media on children and adolescents: a 10-year review of the research. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 392-401.

Pack, C. 1999. Kids and Media at the New Millennium: A Comprehensive National Analysis of Children’s Media Use. TVs, 12, 28.

BIOGRAPHY OF AUTHOR

Strasburger, V. C. 1995. Adolescents and the media: medical and psychological impact, Sage Publications, Inc.

Mr Nishanthan Subramaniam is a final year student of the MBBS degree at Faculty of Medicine, University of Colombo.

Strasburger, V. C. & DONNERSTEIN, E. 1999. Children, adolescents, and the media: issues and solutions. Pediatrics, 103, 129-139.

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The Knowledge and Adherence among Patients on Warfarin Therapy, the Anticoagulation Control and the Factors Associated with it: A Cross Sectional Study at Cardiology Clinic, National Hospital of Sri Lanka Y Mathangasinghe#, MM Ranatunga and P Ranasinghe Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka #[email protected]

Abstract— Warfarin is an anticoagulant with a serious adverse and toxic effects profile. It is known for drug interactions which lead to high morbidity and mortality. The bleeding risk of Warfarin is related to International Normalized Ratio. This cross sectional study was designed to describe the knowledge, adherence, anticoagulation control and factors associated with it among patients on Warfarin followed up in the Cardiology Unit, National Hospital of Sri Lanka. A convenient sample of 156 patients were interviewed using the self-administered Oral Anticoagulation Knowledge (OAK) test and Morisky Medication Adherence Questionnaire. Using 3 consecutive INR values and individualized therapeutic targets, deviation from goal range (mean percentage deviation of INR value from preferred range of anticoagulation) was calculated. Majority of patients (73.2%) in the study population had high adherence. Over 10% of the study population had poor knowledge on anticoagulation therapy. Anticoagulation knowledge shared no statistically significant relationship (p0.05)

Eye Hospital undergo visual acuity check-up and relevant ophthalmoscopic examination. Examining eyes in a patient with eye condition seemed to be satisfied the patient regarding the time spent for examination by the doctor.

IV .DISCUSSION The majority of patients 89.4% (n=118) were satisfied with the overall services provided by the OPD clinics. Most patients reported that they were satisfied with the staff of the OPD (84.8%, n=112) and only 64.4% (n=85) were satisfied with the existing physical facilities in the OPD setting. A higher number of patients reported that they were satisfied with the services provided by doctors compared to those who were satisfied with the services of the nurses and minor staff. Moreover, most claimed services provided by doctors during consultation such as explanations on their conditions and the time spent on examination were satisfactory. Only 28.0% (n=37) claimed that doctors used inappropriate medical jargon. Majority clearly understood the instructions given to them and satisfaction levels towards provided information on illness, treatment, follow-up and investigation were high.

In this study, the majority of patients waited for 1-2 hours before consultations and spent 2-3 hours to obtain complete services. A study conducted in Dhaka Medical College Hospital has shown the waiting time is 31.74 ±SD 3.74. (Islam et al, 2008).This is lower than our findings. However, a study conducted in OPD setting in Sri Lanka has found more than half the study population had waited for more than 30 min to see the doctor. (De silva et al, 2006). Increase in waiting time can result in unnecessary usage of available resources and the low working capacity in hospitals. Therefore administrators should address the issue promptly. (Sudhan et al,2011) Most of the study participants agreed that waiting areas 62.1%(n=82) and corridors 57.6%(n=76) were too crowded. This could be due to the high waiting time that leads to overcrowding. Therefore, hospital administrators should look in to reducing patient waiting time to minimise overcrowding of public areas and wastage of public resources.

These finding are similar to previous studies done in other of Asian countries (Dayasiri M B K C et al,2010) which reported high levels of patient satisfaction of the services provided by most of hospitals in Asia. In our study, more patients were satisfied of the health care services compared to the available physical facilities. A study done in inward patients at the National Hospital of Sri Lanka (Senerath et.al,2013) has found only 59.2% were satisfied of the available physical facilities. This is comparatively lower than our findings possibly due to inward patients being more affected by inadequate physical facilities than outpatients and differences in the expectations of the two study populations. A Similar study done in hospitals in Puttalam district in Sri Lanka has found the similar result (Senarath et al, 2006). The same study has also found that more patients were satisfied with the services provided by doctors than other healthcare workers. Contrary to our findings, previous studies from Sri Lanka report comparatively lower levels of satisfaction regarding adequacy of information provided by doctors (Senarath et al,2013; Senarath et al,2006) . Studies in Bangladesh also report similar findings. (Islam et al, 2008). Our study revealed that the most patients satisfied with the time spent on examination by doctors and with the provided explanations regarding their conditions during consultations. In contrast to this, a study done in an OPD in Sri Lanka has report that consultation time was short in OPD due to large number of patients come to state OPD per day . Furthermore they have reported this caused low level of satisfaction towards consultation time. (De silva et al, 2006). Every patient come to the OPD in National

Based on our findings, the majority of the patients were satisfied regarding the adequacy of sign-boards, ventilation and seating. Awareness of the available facilities like canteens, toilets and drinking water within the hospital was fairly low. However, majority of the patients who were aware of these facilities were satisfied about their cleanliness and availability of safe water. These rates are higher than previous local data from studies done at the National Hospital of Sri Lanka and hospitals in Puttalam district in inward patients. (Senarath et al,2013; Senarath et al,2006 ). Reported rates of satisfaction on cleanliness are also lower than our findings in other developing countries such as India and Bangladesh (Sudhan et al,2011, Islam et al, 2008). ). Out of the 23 patients (17.4%) who gave suggestions to improve OPD services 52.17% (n=12) stated that the physical facilities need improvement. Of the study group 72.1% (n=44) patients who reside out of the Colombo were walk-in patients. Only 27.9% (n=17) coming for referrals from local hospitals. Thus, a majority of those who were residing outside of the Colombo district have opted to come to a tertiary care centre in Colombo by passing all local hospitals. These patients were from Gampaha , Kaluthara , Galle, Rathnapura, Badulla, Kegalle, Kurunegala, Matara, Puttalam, Nuwaraeliya, Mathale, Anuradhapura and Kandy. They 70


have come to the National Eye Hospital; Colombo is in spite ophthalmology services being offered in government hospitals located in those districts. Lack of a properly streamlined referral system in Sri Lanka results in such unequal distribution of patient loads and overtaxing of certain tertiary care centres. These findings are comparable with reports from India and other developing countries. Overcrowding and increased waiting time due to higher demand for tertiary care centres than base/peripheral hospitals is well documented in literature (Sodani et al,2010).

Patient satisfaction regarding services provided by different categories health care workers would be based on competence, conduct and attitudes of the health care workers. In this study, more patients were satisfied with the services provided by doctors compared to nurses and minor staff. Inculcating professionalism in all health care workers through in-service staff training programmes is mandatory to achieve and maintain high standards of health care. ACKNOWLEDGEMENT Authors are grateful to the Staff in the OPD at National Eye Hospital Sri Lanka and to patients who took part in the study.

The study showed that some of patient’s factors are predictor of satisfaction. More males were satisfied regarding the overall services than females. Patients below 30years were least satisfied regarding staff compared to other age groups. Two other studies from Sri Lanka have also found that older patients and males reported higher levels of satisfaction (Dayasiri M B K C et al,2010, Senarath et al, 2013). We did not observe a significant association between patient satisfaction and the waiting time before consultations or the time taken to obtain complete services (p>0.05). However, literature indicates a negative correlation between increased waiting time and the level of patient satisfaction on health care services (Sudhan et al., 2011). A recent study at the National Hospital has found that those who has lower educational levels and were unemployed to be more satisfied with the provided healthcare services.(Senarath et al , 2013) However, we did not find such an association in our study. Satisfaction level towards privacy was not assessed in this study. However, the high satisfaction rate regarding complete services (89.4%) indicates that this is up to a good level. Also eye disease does not need any exposure of body hence privacy is not a major concern. Satisfaction level towards appointment system was not assessed in the study. This is considering as a limitation of the study.

REFERENCES Dayasiri M B K C, Lekamge E L S (2010) Predictors of patient satisfaction with quality of health care in Asian hospitals, Australian Medical Journal, Vol 3 No 11, pp.739-744 Islam M Z, Jabbar M A (2008) Patients’ Satisfaction of Health Care services Provided at out Patient department of Dhaka Medical College Hospital, Ibrahim Medical College Journal, Vol 2, No 2, pp.55- 57 Nandani De Silva, Savitri Abeyasekara, et al (2006) Patient Satisfaction with Consultation in Ambulatory Care Settings in Sri Lanka, Medicine Today ,Vol.4, No.4, pp.125-131 National Eye Hospital of Sri Lanka (2013 ) Annual Report, pp.11 Sodani P R, Kumar R K, Srivastava J, et al (2010) Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities, Indian Journal of Community Medicine, Vol 35 No 1, pp.52-56 Sudhan A, Khandekar R, Deveragonda S, et al (2011) Patient satisfaction regarding eye care services at tertiary hospital of central India, Oman Journal of Ophthalmology, Vol 4, No 2, pp.73- 76

V. CONCLUSION A vast majority of the study population were satisfied about the overall health care services and the staff of the OPD. Comparatively fewer patients were satisfied about the available physical facilities. Cleanliness of the physical facilities including canteens and toilets were satisfactory. However, overcrowding of waiting areas and corridors should be attended to and the hospital administration should explore avenues to reduce the waiting time of patients. Both these factors could be related to the high proportion of patients who opt to seek services from tertiary care centres in Colombo although these services are provided by their local hospitals. This emphasises on the need for a streamlined referral system in the country.

Upul Senarath, Dulitha N Fernando, Ishani Rodrigo (2006) Factors determining client satisfaction with hospitalbased perinatal care in Sri Lanka, Topical Medicine and International Health, Vol ii, No 9, pp. 1442-1451 Upul Senarath, Nalika S. Gunawardena, Benedict Sebastiampillai, et al (2013) Patient satisfaction with nursing care and related hospital services at the National Hospital of Sri Lanka , Leadership in Health Services, Vol. 26, Issue: 1, pp.63 – 77

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BIOGRAPHY OF AUTHOR Dr. D.S Warapitiya is a pre-intern, graduated from Faculty of Medicine , University of Colombo with a Second Class (Upper) Honours with distinctions

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in Medicine, Microbiology, Obstetrics and Gynecology. She is currently employed as a demonstrator at Department of Pharmacology, Faculty of Medicine, University of Colombo .


Association between Thyroid Status and Lipid Levels among Pregnant Women in Jaffna District T Yoganathan1#, V Arasaratnam2, M Hettiarachchi3 and C Liyanage3 1

Nuclear Medicine Unit, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka Department of Biochemistry, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka 3 Nuclear Medicine Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka

2

#[email protected]

Abstract— Thyroid dysfunction during pregnancy is associated with various adverse perinatal and maternal outcomes. Evidence shows that thyroid-stimulating hormone (TSH) may exert extra-thyroidal effects and modify the serum lipid levels. The aim of the study was to assess the thyroid status and its association with serum lipid levels among pregnant women during the third trimester of gestation. Among 477 pregnant women, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) were assayed and also total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein (LDL-C) were measured and analyzed. Statistical analysis was done using SPSS. Mean age, weight, height and gestational age of the study subjects were 28.95(±5.46) years, 63.02 (±11.56) kg, 154.39 (±6.00) cm and 39.33(±1.37) weeks respectively. Median values of the serum TSH and free T4 were 1.9 mIU/L and 12.6 pmol/L respectively. Also, serum TSH level ranged from 0.2 to 16.4 mIU/L whereas serum free T4 level ranged from 10.1 to 28.2 pmol/L. Further, inter-quartile range (IQR) of TSH and free T4 were 1.2 mIU/L and 2.7 pmol/L respectively. Among the study subjects, maternal serum TSH and serum free T4 were not significantly correlated with serum lipid level (TC, TG, LDL-C and HDL-C). Serum TSH among maternal hypothyroid women were positively significantly correlated with serum TC (r=0.649, p=0.004) and LDL-C (r=0.745, p=0.001) and was not significantly correlated with TG (r=0.532, p=0.158) and HDL-C (r=0.327, p=0.186). Further, no correlation was obtained between serum free T4 and serum lipid levels among maternal hypothyroid women. These results indicated that among the study subjects, maternal serum TSH and serum free T4 were not significantly correlated with serum lipid level and significantly elevated serum lipid levels occurred in hypothyroid subjects. However, there is a need for gestational-age dependent reference ranges for TSH and free T4 as well as lipid profile among Jaffna population to adequately assess thyroidal effects.

I. INTRODUCTION Pregnancy is a state of significant dynamic changes in metabolism, with accumulation of lipids and nutrients during the first half; whereas during late pregnancy and lactation, these accumulated reserves are used for fetal growth and subsequently for milk synthesis (Hapon, et al., 2003). The regulation and coordination of lipid metabolism in pregnancy is very important because of the sudden and profound physiological changes occurring during these states (Hapon, et al., 2005). It is known that undiagnosed hypothyroidism during pregnancy will lead to irreparable central nervous system defects in the newborn because the development of the child in utero is critically affected by the mother’s thyroid status (Gartner, 2009). The patients with subclinical hypothyroidism (TSH > 4.8 mIU/L) have higher serum TG levels and lower serum HDL-C levels than euthyroid subjects (Lai, et al., 2011) and its prevalence among women of childbearing ages is 4-5% (Glinoer, 1997). Further, cholesterol is an essential constituent of most biological membranes and is also a precursor of bile acids, steroid hormones, and certain vitamins. The liver is central in cholesterol metabolism, balancing hepatic cholesterol synthesis and hepatic uptake of plasma lipoproteins from the circulation against the excretion of hepatic cholesterol and bile acids in the bile. Thyroid hormone is an important regulator of cholesterol metabolism and T3 can influence the metabolism of cholesterol at several critical steps in the liver: 1- the lowdensity lipoprotein receptor (LDL-R), which mediates cholesterol uptake from the circulation, 2,3-hydroxy-3methylglutaryl coenzyme-A reductase, controlling cholesterol biosynthesis, and 3-cholesterol 7αhydroxylase (CYP7A1), the rate-limiting enzyme in the synthesis of bile acids where cholesterol is used as substrate (Gullberg, et al., 2002). When sterols accumulate, the 2-3-hydroxy-3-methylglutaryl coenzyme A reductase is rapidly degraded, resulting in the

Keywords - Pregnant Women, Lipid Level, Thyroid Profile

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termination of sterol synthesis (Eberlé, et al., 2004; Dong & Tang, 2010).

(5 minutes seated rest, mean of two readings) were recorded at baseline using a sphygmomanometer.

Reduced binding activity of hepatic LDL receptors is generally considered as a major mechanism of hyperlipidemia in hypothyroidism and clearly effects of T3 on LDL receptor mRNA, but they could not be distinctly ascribed to TRα1 or TRβ. Further, T 3 rapidly regulates the transcription of the LDL receptor gene; no specific TRE (thyroid response element) has so far been described in the lDL receptor gene promoter. The suppression of CYP7A activity would lead to downregulation of LDL receptor mRNA, however, it cannot be concluded that T3 directly regulates the LDL receptor transcription (Lopez, et al., 2007).

B. Statistical Analysis The results were presented as mean, standard deviation, median, inter-quartile range (IQR) or observed range. Simple linear regression analysis was used to test for correlations between these variables. A p value less than 0.05 were considered as significant. All data processing was conducted using the SPSS Version 16.0 software for Windows. C. Ethical considerations Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka. Permission was obtained from the Director, Teaching Hospital and Regional Director of Health Services (RDHS), Jaffna, Sri Lanka and Consultants of the Obstetric wards in relevant hospitals in Jaffna District to recruit mothers for the study.

Worldwide, limited studies have been conducted among pregnant women on serum lipid profile and its association with serum thyroid status. Further, no such type of published data is available especially in war affected regions of Jaffna District in Sri Lanka. Therefore, this study was carried out to provide information regarding the serum lipid status and the impact of thyroid profile on lipid level in pregnant women in Jaffna district at the third trimester of gestation.

III. RESULTS A. Baseline characteristics of the women Among the 500 pregnant women, who were recruited for the study, 20 of them were excluded because of missing data or being lost during the study period (e.g., shifted their residence before delivery of the baby and baby delivered elsewhere in Jaffna) and three newborns died immediately after the delivery. Therefore finally, the investigator included 477 pregnant women in the sample. Of the 477 pregnant women, 98% (n=467) delivered their babies at one of the government hospitals in Jaffna district and only 2% (n=10) had chosen a private hospital. All the subjects have followed their antenatal clinic regularly for routine medical checkup. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 105.53 (±10.30) and 69.40 (±7.05) mm Hg respectively. Pregnant mothers were considered hypertensive if SBP was ≥140 mm Hg or DBP was ≥ 90 mm Hg and only 1.0 % (n=5) of them had gestational hypertension. According to the neck examination which was carried out among these women by inspection and palpation for goiter, 3% (n=15) of them had goiter. From the questionnaire, 4% (n=19) of the pregnant women reported to suffer from asthma. Of the study subjects, 18 women had gestational diabetes and only two women reported to be vegetarians throughout the gestation.

II. MATERIALS AND METHODS A. Experimental design The study population consisted of randomly selected 477 pregnant mothers at third trimester of gestation in six selected Medical Offices of Health (MOH) Divisions (Jaffna, Uduvil, Nallur, Kopay, Karaveddy and Kayts) out of 12 MOH in Jaffna District. Once enrolled, all the subjects were advised to attend their antenatal clinic at 0800 hours in the morning with 12 or 14 hours overnight fasting. A fasting sample of 5 mL of venous blood was drawn before taking any oral drugs. Blood sample was centrifuged at 5000 rpm for 10 minutes and serum was separated and stored in acid washed polystyrene tubes at -80oC until the analysis for serum lipid profile was carried out at the Department of Biochemistry, Faculty of Medicine, University of Jaffna. Remaining portion of the serum was stored in other aliquots at -80oC until transported to the Nuclear Medicine Unit, Faculty of Medicine, University of Ruhuna for analysis of serum thyroid stimulating hormone (TSH) and free thyroxine (fT4). Maternal serum TSH and free T4 were measured among 477 women using Enzyme-Linked Immuno Sorbant Assay (ELISA) technique and serum lipids (TC, HDL-C, LDL-C and TG) were measured using fully automatic biochemical analyzer (ERBA XL-200, Germany). Further, systolic (SBP) and diastolic (DBP) blood pressures

B. Socio-demographic characteristics Other baseline characteristics of the study subjects are given in Table1. Maternal age was categorized as 81%).Quantifying the degree of disturbance it was found that in 20% of the consultations in the study there was no disturbance to the clinic work flow. But in nearly 60% the consultations there was 0-20 times some form of disturbance to the flow of consultation. According to the literature, the range of activities provided in general practice has increased considerably with GPs2 . The time factor for a primary care doctor should be a great concern. I n addition doctor`s perception of disturbance of his normal practice work is also the biggest concern. Our results are in agreement with the study done in Australia,2013 2. But the difference was, our study done in rural general practice set up and the Australian study was done two years back in the emergency department where they practiced not only the primary care but also secondary and tertiary care.

this study the continuation of the system was 96.5 % and the continuation of the program was 89.5%( figure 8 and 9). A study done on barriers for EMR adoption found technological barriers to be very important10 . But it was not a major barrier in this study though the study done in a rural setup in third world country. The findings of this study clearly establish the feasibility of adopting an EMR in a rural private general practice in Sri Lanka. Discussion In summary Most of the consultations have been conducted within 510 minutes ( Table and Figure 1. ) Table 2 shows that the author's perception of work disturbance was fair. In 4.5% of the consultation there was major disturbance to the consultation. In 80% of the consultations there was some degree of disturbance . Quantifying the degree of disturbance it was found that in 20% of the consultations in the study there was no disturbance to the clinic work flow. But in nearly 59% the consultations there was 0-20 times some form of disturbance to the flow of consultation was felt. Overall rating of consultation satisfaction was good in nearly 95% of the patients and poor in 5% ( table 3 ) Live data entry was possible in 70% of the consultations. Rest of the consultations was entered at the end of the day referring to the manual notes made by the author. Data retrieval was required in 76% of patients(table 5) Average time spent on consultations requiring data retrieval was below ten minutes. Programme and the system crashes were very limited( table 8 and 9). Data was entered in 91.5% of patients.

As there is evidence that clinician documentation effectively improves patient care 9 and also that privacy and confidentiality were better in EMR implementation live data entry ay serve to enhance patients' rights as well. Data retrieval was required in 76% of patients. (Figure 5) . Of them the average time spent on retrieval of date was below five minutes(figure 6). Though the author needed extra time on retrieval of data , the perception of disturbances of the normal work was minimal . Really it was a doctor`s talent on house keeping according to the Neighbour`s 1987 model of consultation. Gordon D. S., David W. B. in 2010 found electronic systems should do more to help with follow-up and the systematic oversight of feedback on diagnostic accuracy9.

VII CONCLUSION A. Conclusion These data show the feasibility of using an EMR in the author`s practice, like in rural other Sri-Lankan primary care practice.

There are basics “Principles” in family practice. One of them is the providing of continuity of care or follow up care. Majority (56 %) were given the follow up care in our study. Our study findings are in agreement with those of Gordon D. S., David W. B. in 2010 9 . But this study was not done on primary care set up. Really the follow up care needed on chronic problems. Only 56% was given follow up care might be due to less number of chronic patients came to the author’s practice who need follow up .

B. Limitations This study was done in one rural general practice set up in a limited number of study subjects within limited time duration. C. Recommendations Should be done in many GP set ups number of patients.

The system crashes and less program crashes in the course of the study were minimal. When using EMR the continuation of the system and the programme are very important. It enhances , the feasibility in using the EMR in the practice and the patient`s satisfaction. According to 99

with increased


American 1986.

REFERENCES Academy of Family Physician Publication,

Royal College of General Practitioners , Square, London. 2013

Robert H,. Miller and Ida S, Physicians’ Use Of Electronic Medical Records: Barriers And Solutions, 2004.2005: 141–145.

30 Euston

Britt, H; Valenti, L; Miller, G,Australian Physician ,2002 Volume 31 Issue 9 .

Paul D. C., Physician use of electronic medical records: Issues and successes with direct data entry and physician productivity. Pub Med. 2005. 112- 117

Family Blitz J. Rosochacki Z. General practice in South Africa 2006, 2 nd Volume.

Walters L, et al, Medical Education, Australia, 2008, Volume 42, Issue 1, pages 69–73, British Medical Journal, 2000; 320.7248.1517., http://dx.doi.org/10.1136/bmj, 24/03/2015.

Business dictionary,2013 http://www.businessdictionary.com/definition/feasibility -study.html#ixzz3S7UCvc2e, 22/04/2015 BIOGRAPHY OF AUTHORS

Carlsen B.,and. Polit , Aakvik A. Social Anthropology; 2006 DOI: 10.1111/j.1369-7625.2006.00385.x. Likourezos A. , Physician and Nurse satisfaction with an Electronic Medical Record system, New York. 2003. Ralston J D, Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study; USA. BMJ . 2004. 328: 7449.1159. Gordon D. S., David W. B. USES OF EMR ; Can Electronic Clinical Documentation Help Prevent Diagnostic Errors. N Engl J Med; 2010. 362: 1066-1069.

Dr. K.N.A.P. De Silva is Consultant Family Physician at Divisional Hospital, Kandana. She got her Doctor of Medicine in Family Medicine by Clinical Training as well as the Diploma in Family Medicine from the Post Graduate Institution of Medicine, University of Colombo. She has many publications in locally and internationally. The majority based on Family Medicine. Current researches are on Electro Medical Records along with Post Natal Depression.

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Knowledge Related to Neonatal Fever and Skills of Measuring Temperature among the Mothers of Neonates in Castle Street Hospital for Women Y Mathangasinghe#, MM Ranatunga and P Ranasinghe Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka #[email protected]

Abstract— Fever in the newborn is crucial to detect since it may be the only symptom of an underlying pathology. This cross sectional study was designed to determine the knowledge related to neonatal fever and skills of measuring temperature among mothers of neonates in Castle Street Hospital for Women. We interviewed a convenient sample of 122 in-ward mothers of newborns. An interviewer-administered questionnaire and an observational checklist were used to assess knowledge on neonatal fever and temperature measuring technique using an electronic thermometer. The mean knowledge score was 52.72 (n=111, sd=10.12) and 20.6% (n=23) had scores above 60% (n=67). Mean temperature measuring score was 50.9% (n=111, sd=26.0) and only 40.4% (n=45) correctly performed more than 5 steps out of 9. A multiple regression using hierarchical method demonstrated that the highest education level and knowledge score of mothers explained a significant amount of the variance in the value of temperature measuring technique score (F(1,109)=4.65,p 0.05) more likely to experience poor mental health than the female counterparts with a GHQ score of 7.46 (SD =7.2). There was a significant negative correlation between the scores of SSEIT and GHQ 30 (r = -.164, p