The impact of peer-led support groups on health-related quality of life, coping skills and depressive symptomatology for women with PCOS.

Support groups can be a powerful medium in providing psychological support to women with Polycystic Ovary Syndrome (PCOS). The study evaluated the impact of peer support group on Health-Related Quality of Life (HRQoL), depressive symptomatology and coping strategies among women with PCOS. The pre- and post-test experimental design was used. Women with PCOS not receiving psychiatric medication and attending clinics of a teaching hospital in Colombo were recruited. They were randomly allocated based on clinic days to the experimental (n = 20) and control (n = 22) groups. The Intervention group participated in the specific peer support program for 10 weeks, while the control group received general health reading material for 10 weeks through the post. The Modified Polycystic Ovary Syndrome Questionnaire (M-PCOSQ), Centre for Epidemiologic Studies Depression Scale (CES-D) and Brief COPE inventory were administered to both groups before and 1 month after completing the intervention. Before the intervention, there was no significant difference between the two groups regarding the scores of HRQoL, depressive symptomatology and coping skills. One month after the intervention, the support group exhibited improvement in HRQoL, depressive symptomatology and coping skills (p < 0.01) compared to the control group. The peer support group is an effective intervention to uplift the psycho-social wellbeing of women with PCOS through receiving emotional support from those similarly afflicted.

Sinhala translation of the Perinatal Anxiety Screening Scale: a valid and reliable tool to detect anxiety disorders among antenatal women.

BACKGROUND: Anxiety disorders during pregnancy are not routinely assessed in Sri Lanka despite being common and being associated with adverse pregnancy outcomes. Screening can facilitate early detection and management of anxiety and improve pregnancy outcomes. Our aim was to determine the validity of the Sinhala translation of the Perinatal Anxiety Screening Scale (PASS) to detect anxiety among Sri Lankan pregnant women. METHODS: A cross-sectional study was conducted in antenatal clinics of a teaching hospital in Colombo District. The PASS was translated to Sinhala using the standard translation/ back-translation method. Pregnant women (n = 221) were sequentially recruited and assessed by a psychiatrist until 81 women with anxiety disorder were diagnosed using the International Classification of Diseases-10 criteria (gold standard). The Sinhala translation of the PASS (PASS-S) was administered to all recruited women, including 140 women without anxiety. Receiver-Operating- Characteristic (ROC) analysis was performed, the optimal cut-off score for PASS-S was determined, and its validity was assessed using sensitivity, specificity, predictive values and positive and negative likelihood ratios. Internal consistency was assessed using Cronbach's alpha. Test-retest and inter-rater reliability for PASS-S score and anxiety classification were assessed using intra class correlation coefficient (ICC) and Cohen's kappa (k), respectively. RESULTS: The mean age (±SD) of women was 30(±5.8) years, and 53.7% were multiparous. A psychiatrist diagnosed anxiety disorder was made in 37.0% of women, while the PASS-S, at its optimal cut-off of ≥20, classified 37.5% of women as having anxiety disorders. The area under the ROC curve for the PASS-S was 0.96 (95%CI 0.94-0.99). Sensitivity, specificity and positive and negative predictive values of the PASS-S were 0.93 (95% CI 0.84-0.97), 0.90 (95% CI 0.83-0.94), 0.85 (95% CI 0.75-0.90) and 0.95 (95% CI 0.89-0.98), respectively. Positive and negative likelihood ratios were 8.8 (95% CI 5.3-14.5) and 0.08 (95%CI 0.04-0.18), respectively, and the internal consistency was high (Cronbach's alpha 0.95). Four-factor structures obtained by exploratory factor analysis were "acute anxiety and adjustment", "social anxiety, specific fears and trauma", "perfectionism and control" and "general anxiety".Test-retest reliability was high for the PASS-S score (ICC 0.85[95% CI 0.65-0.96]) and anxiety classification (k 0.77[95% CI 0.34-1.2]). Inter-interviewer reliability was also high (ICC 0.92[95% CI 0.81-0.97] for the PASS-S score and (k0.86 [95% CI 0.59-1.1] for anxiety classification). CONCLUSION: The Sinhala translation of the PASS is a valid and reliable instrument to screen for anxiety disorders among antenatal women in Sri Lanka.

'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus.

BACKGROUND: 'Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START)' criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka. METHOD: Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka. RESULTS: Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country. CONCLUSION: A list of 'Modified STOPP/START criteria for Sri Lanka' was developed. These criteria are currently being validated through a multi-centre study.

Sero-prevalence of virus neutralizing antibodies for rabies in different groups of dogs following vaccination.

BACKGROUND: Mass vaccination of dogs is considered fundamental for national rabies control programmes in Sri Lanka, as dog is the main reservoir and transmitter of the disease. METHODS: Dogs were followed to determine the sero-prevalence of antibodies to the rabies virus. Altogether 510 previously vaccinated and unvaccinated dogs with owners (domestic dogs) and dogs without owners (stray dogs) of the local guard dog breed in different age groups recruited from Kalutara District, Sri Lanka. The dogs were vaccinated with a monovalent inactivated vaccine intramuscularly and serum antibody titres on days 0, 30, 180 and 360 were determined by the Rapid Fluorescent Focus Inhibition Test (RFFIT). RESULTS: The results indicated, a single dose of anti-rabies vaccination fails to generate a protective level of immunity (0.5 IU/ml) which lasts until 1 year in 40.42% of dogs without owners and 57.14% of previously unvaccinated juvenile (age: 3 months to 1 year) dogs with owners. More than one vaccination would help to maintain antibody titres above the protective level in the majority of dogs. The pattern of antibody titre development in annually vaccinated and irregularly vaccinated (not annual) adult dogs with owners is closely similar irrespective of regularity in vaccination. Previously vaccinated animals have higher (2 IU/ml) antibody titres to begin with and have a higher antibody titre on day 360 too. They show a very good antibody titre by day 180. Unvaccinated animals start with low antibody titre and return to low titres by day 360, but have a satisfactory antibody titre by day 180. CONCLUSIONS: A single dose of anti-rabies vaccination is not sufficient for the maintenance of antibody titres for a period of 1 year in puppies, juvenile dogs with owners and in dogs without owners. Maternal antibodies do not provide adequate protection to puppies of previously vaccinated dams and puppies of previously unvaccinated dams. Immunity development after vaccination seems to be closely similar in both the groups of puppies.

Physical and psychological morbidities among selected antenatal females in Kegalle district of Sri Lanka: A cross sectional study.

While motherhood is often a positive and satisfying experience, for some women, it is linked with suffering and ill-health. A woman should be able to feel physically and mentally content during pregnancy. Discomforts in pregnancy may be considered as insignificant by the physician. Therefore, the objective of this study was to determine physical and psychological morbidities among primigravid antenatal females in the Kegalle District, Sri Lanka. A sample of 1017 second and third trimester primigravid antenatal females selected by a two-stage probability proportional to size cluster sampling method, were assessed for physical and psychological problems. Data analysis was done using SPSS 16 package and associations were found using Chi square test with p values. The presence of any physical health problem during the preceding 14 days was reported by 75.7% (95% CI 73.0-78.2) of females though each individual physical problem was reported by less than or around one-third. Prevalence of psychological distress and depression was 22.7% (95% CI 20.2-25.4) and 10.4% (95% CI 8.7-12.4), respectively. The self-rated health was very good in 24.7% and good in 55.9%. Older employed females had significantly higher physical problems. It is concluded that although the self-rated wellbeing during pregnancy is high, the presence of physical and psychological ill-health is substantial. Impact statement Pregnancy is a time of intense physical change and is associated with emotional upheaval in many women. Obstetric morbidity is defined as morbidity in a woman who has been pregnant regardless of the site or the duration of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. It is classified into three categories namely; direct, indirect and psychological obstetric morbidity. For one maternal death, there can be between 9 and 16 females with obstetric morbidity depending on the level of development of a country. As a country with good health indicators, this study was conducted to determine physical and psychological problems among primigravid antenatal females in the Kegalle District,p Sri Lanka to improve service quality further. The presence of any physical health problem during the preceding 14 days was reported by a quarter of females and backache, fatigue, body aches, psychological distress, urinary incontinence and headache was commonly reported individual problems. Older employed females had significantly higher physical problems. Though trivial for health workers, physical and psychological problems are prevalent. These should be actively sought and remedied by health workers to improve the quality of life.

Processes involved in assisted reproduction technologies significantly increase sperm DNA fragmentation and phosphatidylserine translocation.

Sperm preparation techniques in assisted reproduction technologies (ART) are potential generators of exogenous stresses that cause additional DNA damage. DNA fragmentation tests, such as the sperm chromatin structure assay, involve freezing sperm samples in the absence of cryoprotectant. Thermal, oxidative stress (OS) and freezing are detrimental to sperm DNA fragmentation and phosphatidylserine (PS) translocation. The primary aim of this study was to subject mature sperm to environmental insults that normally occur during ART. We tested the hypotheses that OS, thermal stress and freeze-thawing caused sperm nuclear and membrane damage and that a positive correlation exists between PS translocation and DNA fragmentation. Sperm DNA integrity deteriorates in semen samples from men with advancing age and a sperm concentration of <15 m ml(-1) . The significant increase in sperm DNA fragmentation at 37 °C after merely 1 h is important clinically as semen liquefaction and short-term sperm storage in an ART cycle involve incubating samples at this temperature. Freezing without a cryoprotectant significantly increases the level of sperm nuclear damage, so it is important not to freeze neat semen prior to DNA fragmentation testing. This study highlights the importance of minimising the production of exogenous stresses during sperm preparation in ART.

Molecular detection and partial characterization of Tomato Yellow Leaf Curl Virus in Sri Lanka.

Tomato Yellow Leaf Curl Virus (TYLCV) is an important plant virus on one of the economically most important vegetable crops; tomato (Lycopersicon esculentum Mill.). This had not been molecularly detected before, in Sri Lanka. TYLCV-GN-SL was isolated from apparently infected tomato plants using modified Cetyltrimethyl Ammonium Bromide (CTAB) method in Gannoruwa. Associated Begomoviruses were detected using Deng 541/Deng 540 and AV 494/AC 1048 primer pairs. TYLCV was detected for the first time in tomato in Sri Lanka using P1V/P4C, TYLCV specific primer pair. Nucleotide sequence of coat protein of isolated TYLCV-GN-SL proved that the Indian strain of ToLC virus was closely related to Tomato Leaf Curl Sri Lanka Virus (TLCV-SL: 97%) and Tomato leaf curl Geminivirus (TLCGV: 93%) through direct sequencing data. TLCV-SL was confirmed as TYLCV isolate. TYLCV was molecularly detected from major tomato growing districts like Badulla, Nuwara-Eliya, Kandy and Matale in Sri Lanka.

Sperm chromatin dispersion test in the assessment of DNA fragmentation and aneuploidy in human spermatozoa.

Sperm DNA damage is thought to be increased in men with male factor infertility. Previous studies suggest a correlation between sperm DNA fragmentation and aneuploidy. The sperm chromatin dispersion (SCD) test was modified to produce the Halosperm Kit. The SCD-fluorescent in-situ hybridization (FISH) test allows the simultaneous detection of DNA fragmentation and aneuploidy on the same sperm cell. The objectives of this study were to validate the SCD, SCD-FISH and Halosperm tests for the analysis of sperm DNA fragmentation and compare them to the sperm chromatin structure assay (SCSA). Semen samples from 20 males undergoing IVF/intracytoplasmic sperm injection were processed using FISH, SCD-FISH, SCD and Halosperm, and compared with SCSA results. There was a significant difference between FISH and SCD-FISH results in the detection of aneuploidy (P=0.000) and the level of sperm DNA fragmentation in the samples subjected to SCSA and SCD (P=0.001) or SCSA and SCD-FISH (P=0.001). There was no significant correlation between DNA fragmentation and aneuploidy. If sperm aneuploidy is to be determined, more reliable results will be obtained if FISH is performed rather than SCD-FISH. A lack of validation and unknown clinical significance question the value of DNA fragmentation assays. DNA damage in the male germ line may result in adverse clinical outcomes and the pathophysiology and clinical consequences of sperm DNA damage are being actively researched. Many DNA fragmentation assays such as the Halosperm Kit have been developed recently and are now available at a commercial level. Unfortunately, aimed at vulnerable couples with difficulty conceiving, many of these tests have not been clinically validated. Despite its plausible appeal and fervour of its supporters, the benefits of widespread DNA testing that only achieves the distressing of couples with the knowledge that effectual therapeutic strategies are absent are questionable. Commercially, however, it is no doubt lucrative. Analysis of gametes prior to the initiation of an IVF cycle may improve the quality of embryos transferred. The clinical and scientific community considers it a matter of urgency to translate the basic science behind how a cell prepares for fertilization into routine clinical practice. However, it is equally important, if not more, to allow the science behind such applications to draw level with its practice before its widespread implementation.