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Background and objective Carotid artery intima media thickness (CIMT) is a strong predictor of Coronary Heart Disease (CHD) and independent phenotype of early atherosclerosis. The global variation of CIMT and its demographic association is yet unclear. We evaluated regional variations of CIMT based on WHO regions and assessed the differences by age and sex. Methods A systematic search was conducted on studies published between 1980 January up to December 2020. PubMed, Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase data bases were used for searching. Supplementary searches were conducted on the Web of Science and Google Scholar. Grey literature was searched in \"Open Grey\" website. The two major criteria used were \"adults\" and \"carotid intima media\". The search strategy for PubMed was created first and then adapted for the Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase databases. Covidence software (Veritas Health Innovation, Melbourne, Australia; Results Of 2847 potential articles, 46 eligible articles were included in the review contributing data for 49 381 individuals (mean age: 55.6 years, male: 55.8%). The pooled mean CIMT for the non-CHD group was 0.65mm (95%CI: 0.62-0.69). There was a significant difference in the mean CIMT between regions (p = 0.04). Countries in the African (0.72mm), American (0.71mm) and European (0.71mm) regions had a higher pooled mean CIMT compared to those in the South East Asian (0.62mm), West Pacific (0.60mm) and Eastern Mediterranean (0.60mm) regions. Males had a higher pooled mean CIMT of 0.06mm than females in the non CHD group (p = 0.001); there were also regional differences. The CHD group had a significantly higher mean CIMT than the non-CHD group (difference = 0.23mm, p = 0.001) with regional variations. Carotid artery segment-specific-CIMT variations are present in this population. Older persons and those having CHD group had significantly thicker CIMTs. Conclusions CIMT varies according to region, age, sex and whether a person having CHD. There are significant regional differences of mean CIMT between CHD and non-CHD groups. Segment specific CIMT variations exist among regions. There is an association between CHD and CIMT values.

Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites. The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually. Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

Background Reactive case detection (RACD) and foci investigation are key strategies in malaria elimination and prevention of its re-establishment. They are a key part of surveillance that has been recommended by the World Health Organization (WHO) to be considered as a core intervention and as one of the three pillars of the Global Technical Strategy for Malaria 2016–2030. Methods A search using the key words “Reactive Case Detection”, “RACD”, “RCD” and “Malaria” was carried out in PubMed, Scopus, Taylor and Francis online databases for studies published until 31st July 2019. The inclusion criteria for selection of articles for review included (1) how RACD is implemented in each country; (2) challenges faced in RACD implementation; (3) suggestions on how the effectiveness of RACD process can be improved. Results 411 titles were identified, 41 full text articles were screened and 29 were found eligible for inclusion in the review. Published literature on RACD, and case and foci investigations has mostly assessed the process of the activity. Most studies have documented that the yield of positives in RACD has been highest in the index case’s household and the immediate neighbourhood of the index case. Microscopy and RDTs are the common tests used in RACD. The guidelines for case and foci investigation, and RACD and PACD, are not universally adopted and are country-specific. Some of the limitations and challenges identified include lack of proper guidelines, logistic issues and problems with public compliance. Conclusions Although there is no documented evidence that RACD is useful in malaria elimination settings, most authors have opined that RACD is necessary for malaria elimination. Lack of knowledge in the target populations, a target radius and how to carry out the RACD process is a major challenge in the decision-making process.

Purpose The WHO-5 well-being index is a widely used, short rating scale that measures subjective well-being. We translated the WHO-5 index into Sinhala and tested its psychometric properties including measurement invariance among diverse groups in a community sample in Sri Lanka. Methods The sample of 267 persons aged between 16 and 75 years was recruited from a semi-urban area. 219 completed a paper-based questionnaire and 48 responded to an online survey. Construct validity was tested for factorial validity (Confirmatory Factor Analysis -CFA), convergent validity and known group validity. Composite reliability for congeneric measures and test-retest reliability were also tested. Multi-group CFA (MG-CFA) was used to test measurement invariance. Results The translated Sinhala version demonstrated good content and face validity. Internal consistency reliability of the five items had a Cronbach’s alpha of 0.85 and test-retest reliability over 2 weeks was satisfactory (Pearson r  = 0.72, p  < 0.001, ICC = 0.82). Confirmatory factor analysis supported factorial validity with a χ 5 2 =4.99 ( p  = 0.28), a RMSEA of 0.03 (90% C.I. =0.00–0.10), a SRMR of 0.02, a TLI of 0.99 and a CFI of 0.99; factor loadings were between 0.55 and 0.89. Measurement invariance was acceptable for configural, metric and scalar invariance for gender. WHO-5 scores were significantly negatively correlated with the Patient Health Questionnaire (PHQ-9) (Pearson’s r  = − 0.45, p  < 0.001) scores and the Kessler Psychological Distress Scale (K10) scores (Pearson’s r  = − 0.56, p  < 0.001). Conclusion The Sinhala translation of WHO-5 well-being index has shown acceptable psychometric properties and can be used for assessing mental well-being in the community in Sri Lanka. Further testing of the measure with larger and diverse (including different ethnic/cultural) groups are indicated to test measurement invariance of the measure.

Background The 55 million visits to government outpatient departments (OPD) in Sri Lanka in 2014, is estimated to increase to 100 million in 2027. The private OPD visits in 2014 was estimated at 50 million per annum. In primary care, there is a paucity of medical records, research on symptoms and healthcare seeking behaviour. We aimed to determine the symptom prevalence and healthcare seeking pattern of residents in Gampaha district, Sri Lanka. Methods A community-based prospective study using a participant-held symptom diary and interviews were conducted in two areas, Ragama (urban) and Mirigama (rural), in the Gampaha district of Sri Lanka during May–June 2018. For each area, three midwife areas were randomly chosen. Clusters of 15–20 households were selected from 5–6 random locations from each midwife area. Results 2046 individuals from 557 households participated. Majority were females ( n  = 1127, 55.1%). There were 1207 (59%) from Mirigama area. Among participants, 1919 (93.8%) reported symptoms. Phlegm ( n  = 4200, 7.0%), leg pain ( n  = 3943, 6.6%) and cough ( n  = 3153, 5.3%) were top symptoms among all symptoms reported; the musculoskeletal group ( n  = 18,081, 30.4%) predominated. 924 (45.1%) participants sought treatment, 763 out of 2046 participants (37.3%) sought allopathic treatment. Private sector visits were more ( n  = 515, 25.2%). The decision to seek private or public healthcare services was influenced by income. Persons with higher income preferred a private institution. Of the 46 (2.3%) hospital admissions, 42 (91.3%) were to public hospitals, of which, 19 (41.3%) were to teaching hospitals, and 4 (0.9%) to a private institution. Conclusions The population had a high prevalence of symptom reporting (93.8%) and a high healthcare seeking behaviour (45.2%). Among those who sought allopathic treatment, the majority preferred private ambulatory care. 90% of hospital admissions (42/47) were to public hospitals. Provision of ambulatory care services should be prioritized in further development of the health services.

Snakebite is a major problem affecting the rural poor in many of the poorest countries in the tropics. However, the scale of the socio-economic burden has rarely been studied. We undertook a comprehensive assessment of the burden in Sri Lanka. Data from a representative nation-wide community based household survey were used to estimate the number of bites and deaths nationally, and household and out of pocket costs were derived from household questionnaires. Health system costs were obtained from hospital cost accounting systems and estimates of antivenom usage. DALYs lost to snakebite were estimated using standard approaches using disability weights for poisoning. 79% of victims suffered economic loss following a snakebite with a median out of pocket expenditure of $11.82 (IQR 2-28.57) and a median estimated loss of income of $28.57 and $33.21 for those in employment or self-employment, respectively. Family members also lost income to help care for patients. Estimated health system costs for Sri Lanka were $ 10,260,652 annually. The annual estimated total number of DALYS was 11,101 to 15,076 per year for envenoming following snakebite. Snakebite places a considerable economic burden on the households of victims in Sri Lanka, despite a health system which is accessible and free at the point of care. The disability burden is also considerable, similar to that of meningitis or dengue, although the relatively low case fatality rate and limited physical sequelae following bites by Sri Lankan snakes means that this burden may be less than in countries on the African continent.

Objective: To determine if children born prematurely exhibit atypical responses to normally occurring sensory stimuli, as measured by the Sensory Profile. Study design: This is a cross-sectional study of children born at ⩽32 weeks gestation, followed at 1 to 8 years of age. The Sensory Profile questionnaire was completed by each child′s primary caregiver. The overall Sensory Profile was considered atypical if any quadrant or section score was >2 s.d. from the mean of the Sensory Profile validation group. Bivariate analyses were performed to determine associations between risk factors for adverse neurodevelopment and overall atypical Sensory Profiles. A section or quadrant was considered atypical if its score was >2 s.d. from the mean. A test of proportions was used to compute observed versus expected scores for each section and quadrant (Sensory Profile scores were based on a normal distribution so one would expect approximately 95% of participants to score within 2 s.d. of the mean). Result: Of our 107 participants, 39% had an atypical score in at least one section or quadrant. No specific perinatal or neonatal risk factors were associated with atypical overall Sensory Profiles ( P ⩾0.05 for all). Children born prematurely were at risk of having atypical scores in the auditory, tactile and vestibular processing sections, and in the four Sensory Profile quadrants ( P <0.05). Conclusion: Children born prematurely exhibit atypical sensory behaviors on the Sensory Profile. Further investigation to understand the underlying neural mechanisms and to develop effective interventions are critical to support neurodevelopment for these children.

Background Well-being is an important aspect of people’s lives and can be considered as an index of social progress. The Warwick Edinburgh Mental Well-being scale (WEMWBS) was developed to capture subjective mental well-being. It is a widely tested measure of mental well-being at the population level and has 14 items and a short-form with 7 items. This study was carried out to culturally validate and adapt the WEMWBS among a Sinhala speaking population in Sri Lanka. Methods A forward and backward translation of the scale into Sinhala was done followed by a cognitive interview. The translated and culturally adapted scale and other mental health scales were administered to a sample of 294 persons between the ages of 17–73 using a paper-based version ( n  = 210) and an online survey ( n  = 84). Internal consistency reliability and test–retest reliability were tested. Construct validity, and convergent and discriminant validity were assessed using the total sample. Results The translated questionnaire had good face and content validity. Internal consistency reliability was 0.91 and 0.84 for the 14-item and 7-item scales, respectively. Test–retest reliability over two weeks was satisfactory (Spearman r  = 0.72 p  < 0.001). Confirmatory factor analysis supported a one factor model. Convergent validity was assessed using WHO-5 well-being index (Spearman r  = 0.67, p  < 0.001), Patient Health Questionnaire (PHQ-9) (Spearman r  = (-0.45), p  < 0.001) and Kessler psychological distress scale (K10) (Spearman r  = (-0.55), p  < 0.001). Conclusions The translated and culturally adapted Sinhala version of the WEMWBS has acceptable psychometric properties to assess mental well-being at the population level among the Sinhala speaking population in Sri Lanka.

Background Patient reported outcomes are increasingly being assessed in many studies due to the demand for reliable and valid measures that enable assessment of such outcomes and comparison of scores between different populations. The Warwick Edinburgh Mental Well-being Scale (WEMWBS) and its shorter version (SWEMWBS) are widely used questionnaires that assess subjective mental well-being at the population level. The scales have been translated into many languages and are being used in a variety of settings to assess well-being. This systematic review aimed to evaluate the psychometric properties of the available versions of the scale. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42020149849) reports the psychometric properties reported by validation studies published until 31 December 2023. A search for ‘WEMWBS’ and/or ‘Warwick Edinburgh Mental Well-being Scale’, used in combination with ‘validation’, was used to search PubMed, Semantic Scholar, OpenGrey, and the first 10 pages of Google Scholar. One author screened all titles after duplicates and unrelated items were removed. The abstracts of the remaining studies ( n  = 142) were screened and suitable articles were selected for data extraction. Methodological quality was independently assessed by two investigators against the CONSensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) risk of bias assessment checklist. The articles were evaluated and compared based on the reported translation process, internal consistency reliability and test–retest reliability, construct validity, responsiveness to change, and discriminatory power. Results Fifty-six full-text articles were included in the study and were assessed for adherence to the accepted translation protocol and reporting of reliability and validity criteria. Many studies that have translated the instrument have focused on forward and backward translation without paying much attention to the appraisal of the translation. Most reports of internal consistency were within acceptable limits. However, test–retest reliability was not often assessed. The instrument has been administered online and in person. The instrument was well received by many populations; the instrument was able to capture changes in well-being scores between subgroups and post intervention. Conclusion The WEMWBS can be used to assess mental well-being in populations; it provides reliable assessments and is responsive to change. Cognitive assessments and pretesting of the scale prior to data collection are strongly advised. Systematic review registration: PROSPERO CRD42020149849.

Background Knee pain is common in the general population, increasingly so with age. It causes substantial disability which can lead to premature exit from the workforce. Current epidemiological data on knee pain prevalence in working-age populations are limited, particularly concerning the interplay of occupational, psychosocial, and cultural factors. To address this, in a large group of workers, we examined the prevalence of knee pain longitudinally, its relationship with pain at other sites and personal and occupational risk factors for pain at follow-up. Methods Data came from the CUPID study, a cohort study including people aged 20–59 years at work from 18 countries in broadly three types of occupations: office work, nurses and manual workers. Baseline data were collected on knee pain, pain at other anatomical sites, occupational characteristics and psychosocial aspects of work. Follow-up information about knee pain was obtained approximately a year later. Descriptive statistics were used to describe knee pain prevalence and characteristics as well as persistence. Poisson regression was used to explore baseline factors in relation to knee pain, and disabling knee pain, at follow-up. Results In total 9,161 workers provided baseline and follow-up data, amongst whom 28% reported knee pain in the past year and 21% knee pain in the past month at baseline. 79% of workers with knee pain reported disability. The prevalence increased with age and was higher among women. Only 8% of workers with knee pain had single-site pain. There was wide variation in the prevalence rates reported amongst workers even doing broadly similar work. Psychosocial and occupational work demands predicted knee pain at follow-up, as did poorer mental health and somatisation but the highest effect size was found amongst people reporting a high number of painful sites at baseline (PRR: 2.06,95%CI: 1.78–2.39). Conclusions Knee pain is prevalent in the workforce, even at younger ages. It is commonly persistent and disabling. Given its link with work disability, the emphasis needs to be on prevention and both mechanical and psychosocial exposures at work are implicated. However, like low back pain, other factors appear to be important, particularly pain at other sites. Trial registration Clinical trial number: not applicable.