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Papers by Yasara Samarakoon
Rural and Remote Health, 2013
Knowledge and self-reported practices regarding leptospirosis among adolescent school children in... more Knowledge and self-reported practices regarding leptospirosis among adolescent school children in a highly endemic rural area in Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
Journal of the Postgraduate Institute of Medicine
Background and objectives Many risk prediction models have been developed globally to identify sp... more Background and objectives Many risk prediction models have been developed globally to identify specific populations at high risk for colorectal cancer in specific settings. Documentation of available evidence from existing studies will serve as a useful information base. We performed a scoping review, to review and analyse published risk prediction models for colorectal cancer the world over. Methods A scoping review was undertaken to address the following question 'what are the existing risk prediction models to identify the risk of developing colorectal cancer among individuals in different countries and settings?' using the framework developed by Arksey and O'Malley for scoping reviews. Forty-one articles were included in this review from database searches and from additional searches. The titles and abstracts were reviewed using predetermined screening criteria. We limited our search to existing literature in English language and included both observational and interventional studies. Results Out of the 58 risk prediction models identified, most were developed for colorectal cancer followed by advanced colorectal cancer. Most of the articles reviewed were cross sectional studies or cohort studies. Statistical methods such as multiple logistic regression was used by a majority, while few have incorporated non-statistical methods such as consensus method and extracting data from published literature. The authors of the 58 risk prediction models have considered 77 different risk factors excluding the genetic variants. Conclusions This comprehensive scoping review demonstrates the capacity of the existing risk models to stratify the general population into risk categories, detailing the studies conducted, location, study design, outcome, overview of the methods, data source and the identified risk predictors. While striving to build on existing knowledge, the review also identifies the research gaps and the need for further improvement.
Journal of the College of Community Physicians of Sri Lanka
Though considered as a disease in the West, the incidence of colorectal cancer in Sri Lanka has i... more Though considered as a disease in the West, the incidence of colorectal cancer in Sri Lanka has increased markedly in recent years. The latest data (2014) indicate that colorectal cancer is ranked as the fourth common cancer among men (ASR of 6.9/ 100,000 population) and the fifth among women (ASR of 6.9/ 100,000 population) (3). The incidence of colorectal cancer has reported an alarming increase, when considering its change over the years (Figure 3). When considering mortality, globally, colorectal cancer was the second leading cause of cancer deaths in 2018 among both sexes (2).
Journal of the College of Community Physicians of Sri Lanka
Background: Colorectal cancer is the fourth leading cancer among men and sixth leading cancer amo... more Background: Colorectal cancer is the fourth leading cancer among men and sixth leading cancer among women in Sri Lanka. Objective: To estimate the prevalence of 'being at risk' of developing colorectal cancer among adults using a colorectal cancer risk prediction model developed and validated to the Sri Lankan setting. Methods: A community-based cross-sectional descriptive study was conducted among a representative sample of 811 adults aged 30 years and above in the districts of Colombo and Gampaha, selected using a multi-stage cluster sampling technique. The validated risk prediction model in the form of an interviewer-administered questionnaire was used to gather information. The prevalence of those 'at risk' of colorectal cancer was assessed based on a validated cutoff score, and those 'at risk' were further divided as 'moderate' and 'high risk' based on cutoff values agreed upon by the experts. Results: The age-adjusted prevalence of those 'at risk' was 12.5% (95% CI=12.3, 12.7). Age-adjusted prevalence of those at 'moderate' and 'high' risk were 11.8% (95% CI=11.6, 12.0) and 0.72% (95% CI=0.7, 0.8), respectively. Conclusions: The high prevalence of being 'at risk' of colorectal cancer indicates the necessity of screening for colorectal cancer as a programme in Sri Lanka. Considering the logistic difficulties in offering follow-up diagnostic colonoscopy examinations for all, the study recommends that those found as 'high-risk' be referred for colonoscopy.
BMC Gastroenterology
Background: Due to finite resources, the clinical decision to subject a patient to colonoscopy ne... more Background: Due to finite resources, the clinical decision to subject a patient to colonoscopy needs to be based on the evidence, regardless of its availability, affordability and safety. This study assessed the appropriateness of colonoscopies conducted in selected study settings in Sri Lanka. In the absence of local guidelines, audit was based on European Panel on Appropriateness of Gastrointestinal Endoscopy II (EPAGE II) criteria. Methods: This cross-sectional study assessed consecutive patients who underwent colonoscopy between June to August 2015 at four main hospitals in Sri Lanka. Interviewer administered questionnaire and secondary data were collected by trained health staff. Indications were assessed according to EPAGE II criteria. Results: Out of 325 patients, male female proportions were 57.2 and 42.8%. Mean (SD) age was 54.9 (12.1) years. Colonoscopies were appropriate in 61.2% (95% CI 55.8-66.3), uncertain in 28.6% (95% CI 23.9-33.7) and inappropriate in 10.2% (95% CI 7.3-13.9). Colonoscopy to evaluate abdominal pain has highest percentage of inappropriateness of 10.0%. However, 9.5% of these colonoscopies revealed Colo-Rectal Cancer (CRC), reflecting differences in the profile of local CRC patients. Colonoscopies with appropriate or uncertain indications are three times more likely to have a relevant finding than inappropriate indications (42.5% vs. 18.2%; OR 3.32, 95% CI 1.33-8.3; P = 0.008). Conclusions: Majority of colonoscopies are appropriate. However, it cannot be neglected that every one in ten patients undergo inappropriate colonoscopy. Proportion of inappropriateness was highest for the indication of chronic abdominal pain, of which, 9.5% of patients were diagnosed with CRC. This may reflect the different profile of local CRC patients in terms of symptom manifestation and other characteristics. In conclusion, the authors recommend formulation of national guidelines for colonoscopy indications based on current best evidence and local patient profile. Use of such prepared local guidelines will improve the efficient use of finite resources.
Journal of Gastrointestinal Oncology
Background: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men an... more Background: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men and the second in women. Use of a simple, validated risk prediction tool will offer a low-cost mechanism to identify the high-risk individuals for CRC. This will increase efficient use of limited resources and early identification of patients. The aim of our study was to develop and validate a risk prediction model for developing CRC for Sri Lankan adults. Methods: The risk predictors were based on the risk factors identified through a logistic regression model along with expert opinion. A case control design utilizing 65 CRC new cases and 65 hospital controls aged 30 years or more was used to assess the criterion validity and reliability of the model. The information was obtained using an interviewer administered questionnaire based on the risk prediction model. Results: The developed model consisted of eight predictors with an area under the curve (AUC) of 0.849 (95% CI: 0.8 to 0.9, P<0.001). It has a sensitivity of 76.9%, specificity of 83.1%, positive predictive value (PPV) of 82.0%, negative predictive value (NPV) of 79.3%. Positive and negative likelihood ratios are 4.6 and 0.3. Test re-test reliability revealed a Kappa coefficient of 0.88. Conclusions: The model developed to predict the risk of CRC among adults aged 30 years and above was proven to be valid and reliable and it is an effective tool to be used as the first step to identify the high-risk population who should be referred for colonoscopy examination.
Rural and remote health
Leptospirosis is a zoonotic disease, which has become a major public health threat in Sri Lanka. ... more Leptospirosis is a zoonotic disease, which has become a major public health threat in Sri Lanka. A majority of patients are farmers in rural endemic areas. The purpose of the present study is to describe the level of knowledge and frequencies of risky practices related to leptospirosis among a sample of rural school adolescents in Galgamuwa, Kurunegala district, a highly endemic area in Sri Lanka. A descriptive cross-sectional study was conducted among 460 adolescents studying in grades 9 and 10 of government schools. Study participants were selected using a multistage cluster sampling technique. A structured, pretested, self-administered questionnaire was used to collect data on sociodemographic characteristics, knowledge on leptospirosis, and frequency of associated risky practices related to leptospirosis. The response rate was 100%. Fifty-two percent of respondents had a 'good' level of knowledge of leptospirosis. In the assessment of practices, 62% were involved in rice...
Rural and Remote Health, 2013
Knowledge and self-reported practices regarding leptospirosis among adolescent school children in... more Knowledge and self-reported practices regarding leptospirosis among adolescent school children in a highly endemic rural area in Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
Journal of the Postgraduate Institute of Medicine
Background and objectives Many risk prediction models have been developed globally to identify sp... more Background and objectives Many risk prediction models have been developed globally to identify specific populations at high risk for colorectal cancer in specific settings. Documentation of available evidence from existing studies will serve as a useful information base. We performed a scoping review, to review and analyse published risk prediction models for colorectal cancer the world over. Methods A scoping review was undertaken to address the following question 'what are the existing risk prediction models to identify the risk of developing colorectal cancer among individuals in different countries and settings?' using the framework developed by Arksey and O'Malley for scoping reviews. Forty-one articles were included in this review from database searches and from additional searches. The titles and abstracts were reviewed using predetermined screening criteria. We limited our search to existing literature in English language and included both observational and interventional studies. Results Out of the 58 risk prediction models identified, most were developed for colorectal cancer followed by advanced colorectal cancer. Most of the articles reviewed were cross sectional studies or cohort studies. Statistical methods such as multiple logistic regression was used by a majority, while few have incorporated non-statistical methods such as consensus method and extracting data from published literature. The authors of the 58 risk prediction models have considered 77 different risk factors excluding the genetic variants. Conclusions This comprehensive scoping review demonstrates the capacity of the existing risk models to stratify the general population into risk categories, detailing the studies conducted, location, study design, outcome, overview of the methods, data source and the identified risk predictors. While striving to build on existing knowledge, the review also identifies the research gaps and the need for further improvement.
Journal of the College of Community Physicians of Sri Lanka
Though considered as a disease in the West, the incidence of colorectal cancer in Sri Lanka has i... more Though considered as a disease in the West, the incidence of colorectal cancer in Sri Lanka has increased markedly in recent years. The latest data (2014) indicate that colorectal cancer is ranked as the fourth common cancer among men (ASR of 6.9/ 100,000 population) and the fifth among women (ASR of 6.9/ 100,000 population) (3). The incidence of colorectal cancer has reported an alarming increase, when considering its change over the years (Figure 3). When considering mortality, globally, colorectal cancer was the second leading cause of cancer deaths in 2018 among both sexes (2).
Journal of the College of Community Physicians of Sri Lanka
Background: Colorectal cancer is the fourth leading cancer among men and sixth leading cancer amo... more Background: Colorectal cancer is the fourth leading cancer among men and sixth leading cancer among women in Sri Lanka. Objective: To estimate the prevalence of 'being at risk' of developing colorectal cancer among adults using a colorectal cancer risk prediction model developed and validated to the Sri Lankan setting. Methods: A community-based cross-sectional descriptive study was conducted among a representative sample of 811 adults aged 30 years and above in the districts of Colombo and Gampaha, selected using a multi-stage cluster sampling technique. The validated risk prediction model in the form of an interviewer-administered questionnaire was used to gather information. The prevalence of those 'at risk' of colorectal cancer was assessed based on a validated cutoff score, and those 'at risk' were further divided as 'moderate' and 'high risk' based on cutoff values agreed upon by the experts. Results: The age-adjusted prevalence of those 'at risk' was 12.5% (95% CI=12.3, 12.7). Age-adjusted prevalence of those at 'moderate' and 'high' risk were 11.8% (95% CI=11.6, 12.0) and 0.72% (95% CI=0.7, 0.8), respectively. Conclusions: The high prevalence of being 'at risk' of colorectal cancer indicates the necessity of screening for colorectal cancer as a programme in Sri Lanka. Considering the logistic difficulties in offering follow-up diagnostic colonoscopy examinations for all, the study recommends that those found as 'high-risk' be referred for colonoscopy.
BMC Gastroenterology
Background: Due to finite resources, the clinical decision to subject a patient to colonoscopy ne... more Background: Due to finite resources, the clinical decision to subject a patient to colonoscopy needs to be based on the evidence, regardless of its availability, affordability and safety. This study assessed the appropriateness of colonoscopies conducted in selected study settings in Sri Lanka. In the absence of local guidelines, audit was based on European Panel on Appropriateness of Gastrointestinal Endoscopy II (EPAGE II) criteria. Methods: This cross-sectional study assessed consecutive patients who underwent colonoscopy between June to August 2015 at four main hospitals in Sri Lanka. Interviewer administered questionnaire and secondary data were collected by trained health staff. Indications were assessed according to EPAGE II criteria. Results: Out of 325 patients, male female proportions were 57.2 and 42.8%. Mean (SD) age was 54.9 (12.1) years. Colonoscopies were appropriate in 61.2% (95% CI 55.8-66.3), uncertain in 28.6% (95% CI 23.9-33.7) and inappropriate in 10.2% (95% CI 7.3-13.9). Colonoscopy to evaluate abdominal pain has highest percentage of inappropriateness of 10.0%. However, 9.5% of these colonoscopies revealed Colo-Rectal Cancer (CRC), reflecting differences in the profile of local CRC patients. Colonoscopies with appropriate or uncertain indications are three times more likely to have a relevant finding than inappropriate indications (42.5% vs. 18.2%; OR 3.32, 95% CI 1.33-8.3; P = 0.008). Conclusions: Majority of colonoscopies are appropriate. However, it cannot be neglected that every one in ten patients undergo inappropriate colonoscopy. Proportion of inappropriateness was highest for the indication of chronic abdominal pain, of which, 9.5% of patients were diagnosed with CRC. This may reflect the different profile of local CRC patients in terms of symptom manifestation and other characteristics. In conclusion, the authors recommend formulation of national guidelines for colonoscopy indications based on current best evidence and local patient profile. Use of such prepared local guidelines will improve the efficient use of finite resources.
Journal of Gastrointestinal Oncology
Background: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men an... more Background: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men and the second in women. Use of a simple, validated risk prediction tool will offer a low-cost mechanism to identify the high-risk individuals for CRC. This will increase efficient use of limited resources and early identification of patients. The aim of our study was to develop and validate a risk prediction model for developing CRC for Sri Lankan adults. Methods: The risk predictors were based on the risk factors identified through a logistic regression model along with expert opinion. A case control design utilizing 65 CRC new cases and 65 hospital controls aged 30 years or more was used to assess the criterion validity and reliability of the model. The information was obtained using an interviewer administered questionnaire based on the risk prediction model. Results: The developed model consisted of eight predictors with an area under the curve (AUC) of 0.849 (95% CI: 0.8 to 0.9, P<0.001). It has a sensitivity of 76.9%, specificity of 83.1%, positive predictive value (PPV) of 82.0%, negative predictive value (NPV) of 79.3%. Positive and negative likelihood ratios are 4.6 and 0.3. Test re-test reliability revealed a Kappa coefficient of 0.88. Conclusions: The model developed to predict the risk of CRC among adults aged 30 years and above was proven to be valid and reliable and it is an effective tool to be used as the first step to identify the high-risk population who should be referred for colonoscopy examination.
Rural and remote health
Leptospirosis is a zoonotic disease, which has become a major public health threat in Sri Lanka. ... more Leptospirosis is a zoonotic disease, which has become a major public health threat in Sri Lanka. A majority of patients are farmers in rural endemic areas. The purpose of the present study is to describe the level of knowledge and frequencies of risky practices related to leptospirosis among a sample of rural school adolescents in Galgamuwa, Kurunegala district, a highly endemic area in Sri Lanka. A descriptive cross-sectional study was conducted among 460 adolescents studying in grades 9 and 10 of government schools. Study participants were selected using a multistage cluster sampling technique. A structured, pretested, self-administered questionnaire was used to collect data on sociodemographic characteristics, knowledge on leptospirosis, and frequency of associated risky practices related to leptospirosis. The response rate was 100%. Fifty-two percent of respondents had a 'good' level of knowledge of leptospirosis. In the assessment of practices, 62% were involved in rice...