Strengthening the reporting of observational studies in epidemiology using Mendelian randomization: the STROBE-MR statement

Science of The Total Environment

Plastic pollution in the marine realm is a severe environmental problem. Nevertheless, plastic may also serve as a potential carbon and energy source for microbes, yet the contribution of marine microbes, especially marine fungi to plastic degradation is not well constrained. We isolated the fungus Parengyodontium album from floating plastic debris in the North Pacific Subtropical Gyre and measured fungal-mediated mineralization rates (conversion to CO2) of polyethylene (PE) by applying stable isotope probing assays with 13C-PE over 9 days of incubation. When the PE was pretreated with UV light, the biodegradation rate of the initially added PE was 0.044 %/day. Furthermore, we traced the incorporation of PE-derived 13C‑carbon into P. album biomass using nanoSIMS and fatty acid analysis. Despite the high mineralization rate of the UV-treated 13C-PE, incorporation of PE-derived 13C into fungal cells was …

PLOS Global Public Health

The COVID-19 pandemic renewed interest in airborne transmission of respiratory infections, particularly in congregate indoor settings, such as schools. We modeled transmission risks of tuberculosis (caused by Mycobacterium tuberculosis, Mtb) and COVID-19 (caused by SARS-CoV-2) in South African, Swiss and Tanzanian secondary schools. We estimated the risks of infection with the Wells-Riley equation, expressed as the median with 2.5% and 97.5% quantiles (credible interval [CrI]), based on the ventilation rate and the duration of exposure to infectious doses (so-called quanta). We computed the air change rate (ventilation) using carbon dioxide (CO2) as a tracer gas and modeled the quanta generation rate based on reported estimates from the literature. The share of infectious students in the classroom is determined by country-specific estimates of pulmonary TB. For SARS-CoV-2, the number of infectious students was estimated based on excess mortality to mitigate the bias from country-specific reporting and testing. Average CO2 concentration (parts per million [ppm]) was 1,610 ppm in South Africa, 1,757 ppm in Switzerland, and 648 ppm in Tanzania. The annual risk of infection for Mtb was 22.1% (interquartile range [IQR] 2.7%-89.5%) in South Africa, 0.7% (IQR 0.1%-6.4%) in Switzerland, and 0.5% (IQR 0.0%-3.9%) in Tanzania. For SARS-CoV-2, the monthly risk of infection was 6.8% (IQR 0.8%-43.8%) in South Africa, 1.2% (IQR 0.1%-8.8%) in Switzerland, and 0.9% (IQR 0.1%-6.6%) in Tanzania. The differences in transmission risks primarily reflect a higher incidence of SARS-CoV-2 and particularly prevalence of TB in South Africa …

Rheumatology

DEAR EDITOR, PMR is a symmetrical, glucocorticoid-sensitive, inflammatory disorder of extracapsular structures [1]. PMR affects chronically mechanically stressed fibrocartilage-containing structures such as sternoclavicular joints, pubic symphysis, entheses and interspinous ligaments. IL-1 generated by activation of the NLRP3 inflammasome, from autoinflammatory stimuli such as calcium pyrophosphate crystals that are commonly found in fibrocartilage, might then be amplified locally by IL-6 and spread contralaterally [2]. Compared with glucocorticoids, the disadvantages of IL-6 inhibition as a therapeutic strategy for PMR include slow onset of benefit and long half-life for washout in the case of adverse effects. An alternative strategy for PMR relapse prevention might be to inhibit IL-1.The potential efficacy of pharmacologically targeting a protein can be investigated by leveraging naturally occurring genetic …

The effects of climate change and natural disasters on fungal pathogens and the risks for fungal diseases remain incompletely understood. In this literature review, we examined how fungi are adapting to an increase in the Earth's temperature and are becoming more thermotolerant, which is enhancing fungal fitness and virulence. Climate change is creating conditions conducive to the emergence of new fungal pathogens and is priming fungi to adapt to previously inhospitable environments, such as polluted habitats and urban areas, leading to the geographical spread of some fungi to traditionally non-endemic areas. Climate change is also contributing to increases in the frequency and severity of natural disasters, which can trigger outbreaks of fungal diseases and increase the spread of fungal pathogens. The populations mostly affected are the socially vulnerable. More awareness, research, funding, and policies …

BMC medicine

BackgroundCaffeine is one of the most utilized drugs in the world, yet its clinical effects are not fully understood. Circulating caffeine levels are influenced by the interplay between consumption behaviour and metabolism. This study aimed to investigate the effects of circulating caffeine levels by considering genetically predicted variation in caffeine metabolism.MethodsLeveraging genetic variants related to caffeine metabolism that affect its circulating levels, we investigated the clinical effects of plasma caffeine in a phenome-wide association study (PheWAS). We validated novel findings using a two-sample Mendelian randomization framework and explored the potential mechanisms underlying these effects in proteome-wide and metabolome-wide Mendelian randomization.ResultsHigher levels of genetically predicted circulating caffeine among caffeine consumers were associated with a lower risk of obesity (odds …

Nature Communications

Circulating proteins can reveal key pathways to cancer and identify therapeutic targets for cancer prevention. We investigate 2,074 circulating proteins and risk of nine common cancers (bladder, breast, endometrium, head and neck, lung, ovary, pancreas, kidney, and malignant non-melanoma) using cis protein Mendelian randomisation and colocalization. We conduct additional analyses to identify adverse side-effects of altering risk proteins and map cancer risk proteins to drug targets. Here we find 40 proteins associated with common cancers, such as PLAUR and risk of breast cancer [odds ratio per standard deviation increment: 2.27, 1.88-2.74], and with high-mortality cancers, such as CTRB1 and pancreatic cancer [0.79, 0.73-0.85]. We also identify potential adverse effects of protein-altering interventions to reduce cancer risk, such as hypertension. Additionally, we report 18 proteins associated with cancer risk …

We conducted a genome-wide association study (GWAS) on income among individuals of European descent and leveraged the results to investigate the socio-economic health gradient (N= 668,288). We found 162 genomic loci associated with a common genetic factor underlying various income measures, all with small effect sizes. Our GWAS-derived polygenic index captures 1-4% of income variance, with only one-fourth attributed to direct genetic effects. A phenome-wide association study using this polygenic index showed reduced risks for a broad spectrum of diseases, including hypertension, obesity, type 2 diabetes, coronary atherosclerosis, depression, asthma, and back pain. The income factor showed a substantial genetic correlation (0.92, se=. 006) with educational attainment (EA). Accounting for EA's genetic overlap with income revealed that the remaining genetic signal for higher income related to better mental health but reduced physical health benefits and increased participation in risky behaviours such as drinking and smoking.

The Journal of Clinical Endocrinology & Metabolism

Numerous observational studies have identified nonlinear relationships between sleep duration and cardiometabolic risk, many of which highlight a U-shaped relationship with elevated risk among both short (< 7 hours) and long (> 8 hours) sleepers (1). Nonetheless, previous studies have typically relied on self-reported sleep duration and residual confounding remains problematic. In an attempt to overcome these issues and re-evaluate the relationship between sleep duration and visceral adiposity tissue, Yu et al. performed linear and nonlinear Mendelian randomization (MR) in the UK Biobank (n= 396 858), using 77 single nucleotide polymorphisms (SNPs) associated with sleep duration (2) as instrumental variables.The authors found evidence for nonlinearity between genetically predicted sleep duration and visceral adipose tissue (VAT), whereby short sleep duration (≤ 6 hours) increased VAT but with little …

medRxiv

DNA methylation (DNAm) is a developmentally dynamic epigenetic process, yet we still know little about how epigenetic effects on health outcomes vary over time; whether DNAm alterations during certain periods of development are more informative than others; and whether epigenetic timing effects differ by outcome. To address these questions, we applied longitudinal meta-regression to published meta-analyses from the PACE consortium that examine DNAm at multiple time points (prospectively at birth and cross-sectionally in childhood) in relation to the same child outcome (ADHD, general psychopathology, sleep, BMI, asthma). Our findings reveal three new insights: (i) across outcomes, effects sizes are larger when DNAm is measured in childhood compared to at birth; (ii) higher effect sizes do not necessarily translate into more significant findings, as associations also become noisier in childhood for most outcomes (i.e. showing larger standard errors); and (iii) DNAm signals are highly time-specific while showing pleiotropy across health outcomes

Communications Biology

Risk behaviours are common in adolescent and persist into adulthood, people who engage in more risk behaviours are more likely to have lower educational attainment. We applied genetic causal inference methods to explore the causal relationship between adolescent risk behaviours and educational achievement. Risk behaviours were phenotypically associated with educational achievement at age 16 after adjusting for confounders (−0.11, 95%CI: −0.11, −0.09). Genomic-based restricted maximum likelihood (GREML) results indicated that both traits were heritable and have a shared genetic architecture (Risk \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{{{{{\boldsymbol{h …

medRxiv

Background Recent systematic reviews and meta-analyses on the effects of interventions to prevent obesity in children aged 5 to 18 years identified over 200 randomized trials. Interventions targeting diet, activity (including physical activity and sedentary behaviours) and both diet and activity appear to have small but beneficial effects, on average. However, these effects varied between studies and might be explained by variation in characteristics of the interventions, for example by the extent to which the children enjoyed the intervention or whether they aim to modify behaviour through education or physical changes to the environment. Here we develop a novel analytic framework to identify key intervention characteristics considered likely to explain differential effects. Objectives To describe the development of the analytic framework, including the involvement of school-aged children, parents, teachers and other stakeholders, and to present the content of the finalized analytic framework and the results of the coding of the interventions. Design and methods We first conducted a literature review to find out from the existing literature what different types of characteristics of interventions we should be thinking about, and why. This information helped us to develop a comprehensive map (called a logic model) of these characteristics. We then used this logic model to develop a list of possible intervention characteristics. We held a series of workshops with children, parents, teachers and public health professionals to refine the list into a coding scheme. We then used this to code the characteristics of each intervention in all the trials which aimed to …

BackgroundAcute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid over-prescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance.

Nature Communications

To date only a fraction of the genetic footprint of thyroid function has been clarified. We report a genome-wide association study meta-analysis of thyroid function in up to 271,040 individuals of European ancestry, including reference range thyrotropin (TSH), free thyroxine (FT4), free and total triiodothyronine (T3), proxies for metabolism (T3/FT4 ratio) as well as dichotomized high and low TSH levels. We revealed 259 independent significant associations for TSH (61% novel), 85 for FT4 (67% novel), and 62 novel signals for the T3 related traits. The loci explained 14.1%, 6.0%, 9.5% and 1.1% of the total variation in TSH, FT4, total T3 and free T3 concentrations, respectively. Genetic correlations indicate that TSH associated loci reflect the thyroid function determined by free T3, whereas the FT4 associations represent the thyroid hormone metabolism. Polygenic risk score and Mendelian randomization analyses …

International journal of cancer

Breast and gynaecologic cancers account for approximately half of all cancers diagnosed amongst women in South Africa, many of whom also live with HIV. We aimed to determine the incidence of and risk factors for developing breast and gynaecologic cancers in women living with HIV (WLHIV) in South Africa. This is a longitudinal analysis of the South African HIV Cancer Match study including women aged ≥15 years with two or more HIV‐related laboratory tests. We used Cox proportional hazard models to determine the association of Human Papilloma Virus (HPV)‐related and hormone‐related gynaecologic cancer with patient‐ and municipal‐level characteristics. From 3 447 908 women and 10.5 million years of follow‐up, we identified 11 384 incident and 7612 prevalent gynaecologic and breast cancers. The overall crude incidence rate was 108/1 00 000 person‐years (pyears) (95% confidence …

Fungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into “sequestered” sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the …

EBioMedicine

BackgroundTumour-promoting inflammation is a "hallmark" of cancer and conventional epidemiological studies have reported links between various inflammatory markers and cancer risk. The causal nature of these relationships and, thus, the suitability of these markers as intervention targets for cancer prevention is unclear.MethodsWe meta-analysed 6 genome-wide association studies of circulating inflammatory markers comprising 59,969 participants of European ancestry. We then used combined cis-Mendelian randomization and colocalisation analysis to evaluate the causal role of 66 circulating inflammatory markers in risk of 30 adult cancers in 338,294 cancer cases and up to 1,238,345 controls. Genetic instruments for inflammatory markers were constructed using genome-wide significant (P < 5.0 × 10−8) cis-acting SNPs (i.e., in or ±250 kb from the gene encoding the relevant protein) in weak linkage …

Clinical Microbiology and Infection

ObjectivesTo compare the prevalence of SARS-CoV-2 and other respiratory viruses in saliva and bioaerosols between two winters and to model the probability of virus detection in classroom air for different viruses.MethodsWe analysed saliva, air, and air cleaner filter samples from studies conducted in two Swiss secondary schools (students aged 14–17 years) over 7 weeks during the winters of 2021/22 and 2022/23. Two bioaerosol sampling devices and high efficiency particulate air (HEPA) filters from air cleaners were used to collect airborne virus particles in four classrooms. Daily bioaerosol samples were pooled for each sampling device before PCR analysis of a panel of 19 respiratory viruses and viral subtypes. The probability of detection of airborne viruses was modelled using an adjusted Bayesian logistic regression model.ResultsThree classes (58 students) participated in 2021/22, and two classes (38 …

BMC Research Notes

Two-sample MR is an increasingly popular method for strengthening causal inference in epidemiological studies. For the effect estimates to be meaningful, variant-exposure and variant-outcome associations must come from comparable populations. A recent systematic review of two-sample MR studies found that, if assessed at all, MR studies evaluated this assumption by checking that the genetic association studies had similar demographics. However, it is unclear if this is sufficient because less easily accessible factors may also be important. Here we propose an easy-to-implement falsification test. Since recent theoretical developments in causal inference suggest that a causal effect estimate can generalise from one study to another if there is exchangeability of effect modifiers, we suggest testing the homogeneity of variant-phenotype associations for a phenotype which has been measured in both genetic …

BMC medicine

BackgroundThe timing of puberty may have an important impact on adolescent mental health. In particular, earlier age at menarche has been associated with elevated rates of depression in adolescents. Previous research suggests that this relationship may be causal, but replication and an investigation of whether this effect extends to other mental health domains is warranted.MethodsIn this Registered Report, we triangulated evidence from different causal inference methods using a new wave of data (N= 13,398) from the Norwegian Mother, Father, and Child Cohort Study. We combined multiple regression, one-and two-sample Mendelian randomisation (MR), and negative control analyses (using pre-pubertal symptoms as outcomes) to assess the causal links between age at menarche and different domains of adolescent mental health.ResultsOur results supported the hypothesis that earlier age at menarche is …

We carried out a genome-wide association and Mendelian randomization analysis to probe genetic and environmental risk factors for sarcoidosis. We performed a genome-wide meta-analysis in 5,194 sarcoidosis cases and 777,559 non-cases from the FinnGen and UK Biobank studies. We estimated the heritability, pinpointed genomic risk loci, predicted deleteriousness, mapped corresponding genes, and enriched gene expression to tissues using FUMA (Functional Mapping and Annotation) and MAGMA (Multi-marker Analysis of GenoMic Annotation) softwares. We performed Mendelian randomization analyses to investigate the links between 6 modifiable factors and 66 inflammatory markers in relation to sarcoidosis. Genetic variants associated with these exposures at the genome-wide significance level and in low linkage disequilibrium were used as instrumental variables. The heritability of sarcoidosis explained by common genetic variants was around 12%. We annotated 14 genomic loci that surpassed the genome-wide significance threshold of which 6 loci were previously unreported. The locus proximal to TYK2 had a high potential deleterious impact on protein function. MAGMA revealed notable gene expression patterns in whole blood, spleen, and lung. Genetically predicted lower levels of physical activity and higher levels of body mass index, interleukin-23 receptor, and interleukin 1 receptor-like 2 were associated with a heighted risk of sarcoidosis.

Journal of the College of Community Physicians of Sri Lanka

Introduction: Occupational stress among bus drivers is on the rise in the world. It is of prime importance to detect the prevalence and to identify the associated factors of job stress for managing it among bus drivers in Sri Lanka.Objectives: To determine the prevalence of occupational stress and its associated factors among bus drivers of Sri Lanka Transport Board in Colombo DistrictMethods: A descriptive cross-sectional study with an analytical component was carried out in Sri Lanka Transport Board depots in the district of Colombo among 631 bus drivers. The study population was selected by simple random sampling method and used the Effort Reward Imbalance-Sinhala questionnaire and other self-administered questionnaires as instruments. Associated factors with occupational stress were determined by multivariate analysis using adjusted odds ratio (aOR).Results: The prevalence of occupational stress was 52.1%(95% CI= 50.66, 53.62). The factors associated with occupational stress in multivariate analysis were current use of tobacco (aOR= 9.3; 95% CI= 5.71, 11.2), good alertness at the end of the day (aOR= 13.2; 95% CI= 9.48, 15.11), work experience ten years or less (aOR= 9.8; 95% CI= 8.65, 11.2), working days per week six days or more (aOR= 9.72; 95% CI= 5.65, 12.16) and working hours per day more than 10 hours (aOR= 3.1; 95% CI= 2.67, 5.1).Conclusions & Recommendations: The prevalence of occupational stress was high among bus drivers. There were modifiable and non-modifiable associated factors for job stress. Mental health promotion programs need to be conducted at the recruitment of bus drivers.

Journal of the College of Community Physicians of Sri Lanka

Introduction: Occupational stress among bus drivers is on the rise in the world. It is of prime importance to detect the prevalence and to identify the associated factors of job stress for managing it among bus drivers in Sri Lanka.Objectives: To determine the prevalence of occupational stress and its associated factors among bus drivers of Sri Lanka Transport Board in Colombo DistrictMethods: A descriptive cross-sectional study with an analytical component was carried out in Sri Lanka Transport Board depots in the district of Colombo among 631 bus drivers. The study population was selected by simple random sampling method and used the Effort Reward Imbalance-Sinhala questionnaire and other self-administered questionnaires as instruments. Associated factors with occupational stress were determined by multivariate analysis using adjusted odds ratio (aOR).Results: The prevalence of occupational stress was 52.1%(95% CI= 50.66, 53.62). The factors associated with occupational stress in multivariate analysis were current use of tobacco (aOR= 9.3; 95% CI= 5.71, 11.2), good alertness at the end of the day (aOR= 13.2; 95% CI= 9.48, 15.11), work experience ten years or less (aOR= 9.8; 95% CI= 8.65, 11.2), working days per week six days or more (aOR= 9.72; 95% CI= 5.65, 12.16) and working hours per day more than 10 hours (aOR= 3.1; 95% CI= 2.67, 5.1).Conclusions & Recommendations: The prevalence of occupational stress was high among bus drivers. There were modifiable and non-modifiable associated factors for job stress. Mental health promotion programs need to be conducted at the recruitment of bus drivers.

Journal of the College of Community Physicians of Sri Lanka

Introduction: Occupational stress among bus drivers is on the rise in the world. It is of prime importance to detect the prevalence and to identify the associated factors of job stress for managing it among bus drivers in Sri Lanka.Objectives: To determine the prevalence of occupational stress and its associated factors among bus drivers of Sri Lanka Transport Board in Colombo DistrictMethods: A descriptive cross-sectional study with an analytical component was carried out in Sri Lanka Transport Board depots in the district of Colombo among 631 bus drivers. The study population was selected by simple random sampling method and used the Effort Reward Imbalance-Sinhala questionnaire and other self-administered questionnaires as instruments. Associated factors with occupational stress were determined by multivariate analysis using adjusted odds ratio (aOR).Results: The prevalence of occupational stress was 52.1%(95% CI= 50.66, 53.62). The factors associated with occupational stress in multivariate analysis were current use of tobacco (aOR= 9.3; 95% CI= 5.71, 11.2), good alertness at the end of the day (aOR= 13.2; 95% CI= 9.48, 15.11), work experience ten years or less (aOR= 9.8; 95% CI= 8.65, 11.2), working days per week six days or more (aOR= 9.72; 95% CI= 5.65, 12.16) and working hours per day more than 10 hours (aOR= 3.1; 95% CI= 2.67, 5.1).Conclusions & Recommendations: The prevalence of occupational stress was high among bus drivers. There were modifiable and non-modifiable associated factors for job stress. Mental health promotion programs need to be conducted at the recruitment of bus drivers.

Journal of the College of Community Physicians of Sri Lanka

ImportanceMendelian randomization (MR) studies use genetic variation associated with modifiable exposures to assess their possible causal relationship with outcomes and aim to reduce potential bias from confounding and reverse causation.ObjectiveTo develop the STROBE-MR Statement as a stand-alone extension to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline for the reporting of MR studies.Design, Setting, and ParticipantsThe development of the STROBE-MR Statement followed the Enhancing the Quality and Transparency of Health Research (EQUATOR) framework guidance and used the STROBE Statement as a starting point to draft a checklist tailored to MR studies. The project was initiated in 2018 by reviewing the literature on the reporting of instrumental variable and MR studies. A group of 17 experts, including MR methodologists, MR study design …

Journal of the College of Community Physicians of Sri Lanka

ImportanceMendelian randomization (MR) studies use genetic variation associated with modifiable exposures to assess their possible causal relationship with outcomes and aim to reduce potential bias from confounding and reverse causation.ObjectiveTo develop the STROBE-MR Statement as a stand-alone extension to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline for the reporting of MR studies.Design, Setting, and ParticipantsThe development of the STROBE-MR Statement followed the Enhancing the Quality and Transparency of Health Research (EQUATOR) framework guidance and used the STROBE Statement as a starting point to draft a checklist tailored to MR studies. The project was initiated in 2018 by reviewing the literature on the reporting of instrumental variable and MR studies. A group of 17 experts, including MR methodologists, MR study design …

Journal of the College of Community Physicians of Sri Lanka

Introduction: Recently, the United Nations declared November 18 as the World Day for the Prevention of and Healing from Child Sexual Exploitation, Abuse, and Violence. Despite sexual offences against children being frequently reported in Indian media, scientific studies analysing the annual trends and regional patterns of these crimes are scarce in India.Objectives: To describe annual trends and regional patterns of sexual crimes against children (CAC) in IndiaMethods: National Crimes Record Bureau (NCRB) data on sexual crimes for years 2014-2021 were analysed to describe annual trends and regional patterns of sexual offences against children in India.Results: An incremental trend in sexual offences was reported during the 2014-2021 period. Sexual offences had the highest crime rate in 2021 (12.1%). There was a continuous increase in sexual offences in each succeeding year during the 2014-2021 period. The highest year-over-year increase was reported in 2017 (142%). The proportion of sexual offences in all CAC increased from 10% in 2014 to 36% in 2021. A higher number of cases were reported among girls (mean= 25112; SD= 5371) than boys (mean= 241; SD= 47). In 2021, Delhi had the highest crime rate for all CAC, while Andaman and Nicobar Islands had the highest crime rate for sexual offences.Conclusions & Recommendations: Despite the legal framework available to protect children, there is still an increase in sexual offences against children in India. Regional patterns suggest a diverse distribution of sexual offences across India. A higher concentration of sexual offences was reported on remote, geographically …

Journal of the College of Community Physicians of Sri Lanka

Introduction: Pregnancy and motherhood are highly esteemed in Asian cultures. Consequently, subfertility is considered a major life issue for both men and women, which in turn could affect their quality of life (QOL).Objectives: To assess the QOL and its associated factors among the partners of sub fertile couplesMethods: To identify the primary and secondary sub fertile couples, this community-based study used a stratified cluster sampling method to recruit 3366 married couples whose 15-49 aged female partners were residing in the Colombo district. Out of the 423 sub fertile couples identified, 384 were successfully interviewed. The Fertility Quality of Life (FertiQoL) tool, developed at Cardiff University was translated and culturally adapted to Sri Lanka to assess their QOL, based on the total score out of 100. An interviewer-administered questionnaire was used to collect data to assess the associated factors.Results: In this study, median of the total FertiQoL score was 68.3 (IQR: 60.2-77.2) for male partners and 65.2 (IQR: 58.0-73.5) for female partners. Male partners had significantly higher scores than their female partners. Advanced age, longer duration of the marriage, higher level of education, and having at least one living child were found to be significantly associated (p< 0.01) with the QOL of sub fertile couples.Conclusions & Recommendations: The QOL was higher among male partners of the sub-fertile couples and male and female partners who had at least one living child. Negatively associated factors such as the age of the couple, duration of the marriage, and not having at least one living child should be prioritized when providing …

Journal of the College of Community Physicians of Sri Lanka

Introduction: A risk prediction model was developed to predict the risk of developing endometrial carcinoma among postmenopausal women. It is strongly recommended to evaluate the performance of the risk prediction model by external validation before using it in the community.Objectives: To validate a risk prediction model for endometrial carcinoma among postmenopausal women in Western ProvinceMethods: An unmatched case control study was conducted to validate a developed model, including 35 cases and 50 controls of postmenopausal women from five tertiary hospitals in Western Province. The cases and controls were defined as postmenopausal women who had and had not been diagnosed as endometrial carcinoma based on histological confirmation, respectively. A model was developed considering the objectivity and feasibility of the measurements in addition to statistical criteria. The developed …

Journal of the College of Community Physicians of Sri Lanka

Introduction: The degree of health risk behaviour (HRB) among undergraduates has not been researched extensively in Sri Lanka and there is no tool available to assess common HRBs in a university setting.Objectives: To develop, translate and validate a tool to measure common HRBs in Sinhalese second-year undergraduates in Sri LankaMethods: The UniHRB-Inventory (Sinhala) was developed using a seven-step design process for tool development. An extensive literature review, nine key informant interviews (KII), and five focus group discussions (FGD) were carried out. A combination of deductive and inductive methods was used to define the domain and identify the questions to assess. Content and consensual validity was assessed using the modified Delphi process. A validation study was conducted among 666 second-year undergraduates at the University of Kelaniya selected using stratifiedcluster sampling. Construct-validity of UniHRB-Inventory-Sinhala was assessed using Principal Component Analysis (PCA)(n= 333), Confirmatory Factor Analysis (CFA)(n= 333), multi-trait scaling analysis and convergent validity assessment (n= 80). Internal consistency and test-retest reliability was assessed in a sub-sample (n= 25).Results: There has been a deficit of choices for adapting an HRB tool for undergraduates in Sri Lanka. Violence and injuries, sexual risk behaviours, addictions to mobile phones and the internet are common among undergraduates. Students’ dismissive attitude towards violence and neglecting health behaviours, such as sleep deprivation and poor hygienic practice, were highlighted as important aspects of HRBs …

Journal of the College of Community Physicians of Sri Lanka

June 26th, the International Day Against Drug Abuse and Illicit Trafficking focuses on strengthening collective efforts with a goal of zero illicit substance usage. Though people claim various reasons for using licit and illicit drugs, escaping from reality had been the main reason highlighted in many publications (1). The drugs used under this claimant include licit drugs like opioids and benzodiazepines which are medicinally highly valued and illicit drugs like heroin, cocaine and marijuana throughout years. However, the prevalence of illicit drug use remains low in Sri Lanka compared to the prevalence of licit drugs, alcohol and tobacco use. Of the illicit drugs, the highest prevalence of use is for cannabis, which has shown an increase in use during the past five years.Sri Lanka, due to its unique geographical location in the middle of the Indian Ocean with easy access to many of the international logistics, transportation modalities and routes, this island nation had been used by drug dealers for trafficking in the past and in the present (2-3). Each year, defence forces retrieve hundreds of kilos of these products during different raids concentrated mainly around the sea and airports (3). These raids sometimes discover cigarettes and alcohol as well, mainly contrabands, products that have been bought or transported from a low-tax country, to be illegally re-sold here. Globally, these industries are known for trafficking their own

Journal of the College of Community Physicians of Sri Lanka

Introduction: Anxiety disorders is one of the most prevalent psycho-pathological condition among children and adolescents. Screen for Anxiety Related Disorders (SCARED)-Child version is a cross-culturally validated selfadministered questionnaire to detect children with anxiety disorders.Objectives: To assess the validity and reliability of SCARED-Child to identify anxiety among adolescents aged 13-15 years attending government schools (Sinhala medium) in the district of Colombo, Sri LankaMethods: The SCARED-Child was culturally adapted, translated to Sinhala and its judgmental validity was ensured. The instrument was validated among 423 adolescents aged 13-15 years in Colombo District by assessing criterion validity using the diagnosis made by a consultant psychiatrist as the gold standard, developing clinically validated cut-off values using ROC curve. The internal consistency and test-retest assessment were used to assess the reliability.Results: The culturally adapted and translated SCARED-Child (Sinhala version) showed sensitivity of 85.7%(95% CI= 74.61, 93.25) and specificity of 91.3%(95% CI= 88.0, 94.07) at a cut-off of 36.5, with a high reliability of Cronbach's alpha (0.87) and test-retest correlation coefficient (0.74).Conclusions & Recommendations: This study revealed that SCARED-Child has a high validity and excellent reliability to identify a child with an anxiety disorder at community setting.

Journal of the College of Community Physicians of Sri Lanka

Introduction: High fertility, low contraceptive prevalence and poor maternal indices characterize the reproductive history of women in sub-Sahara Africa. In such populations, unmet need for contraception tend to be high; there is a dearth of evidence about the unmet need for family planning in these settings.Objectives: To determine and to compare the unmet need, demand and potential demand met for family planning services (FPS) amongst urban and rural women of Bayelsa State in Southern NigeriaMethods: A community-based cross-sectional study design was used to survey 200 urban and 200 rural currently married or in-union women in April-July 2018. Data were collected using a pretested, structured intervieweradministered questionnaire on unmet need, after written consent was obtained from respondents. Collected data were edited, coded, and entered to IBM Statistical Package for Social Sciences (SPSS) version 23.0.Results: The proportion of unmet need was 46.5%(n= 93) for urban women compared to 57.5%(n= 115) for the rural 2 (χ= 4.85; p= 0.03). The potential demand for contraception was at 62.5% in the urban and 71.5% for the rural women. The proportion of demand satisfied in the urban areas was 26.4% and 19.6% for the rural women.Conclusions & Recommendations: This study found differences in the level of demand and potential demand met for FPs leading to high unmet need for family planning, between women in urban and rural areas in Bayelsa State. Thus, efforts still need to be intensified in promoting FP programmes as we see that the improvement in uptake with high unmet need, reflects the needs to be met …

Journal of the College of Community Physicians of Sri Lanka

Objectives: To develop and validate a simple low-cost risk prediction tool to identify high-risk individuals for OC early, based on population-specific riskMethods: A risk prediction tool including cut-off value to identify high-risk individuals, was developed based on weighted scores derived from the risk factor profile specific for Sri Lankans. Its criterion validity was assessed against histological diagnosis of OC in an unmatched case-control study conducted among 83 cases recruited from the National Cancer Institute, Maharagama (NCIM) using a non-probability sampling method, and ambulatory hospital controls (n= 166) excluded of OC recruited from the Endoscopy Unit at National Hospital of Sri Lanka (NHSL). Data were collected through an interviewer-administered-questionnaire.Results: Risk predictors in the tool included age> 65 years, family history of cancer, sub-optimal consumption offibre, antioxidants and deep-fried food, low total lifetime sports and exercise activities, high risk alcohol consumption, ever betel quid chewing, ever exposure to agrochemicals, consumption of pipe-borne water, ever exposure to radiation and ever tobacco smoking. The tool demonstrated valid predictions (92.8% sensitivity; 88.6% specificity; 80.2% positive predictive value (PPV); 96.1% negative predictive value (NPV); 8.1 positive likelihood ratio (LR); and 0.1 negative LR) to identify high-risk individuals for OC at 17. 83 cut-off value.Conclusions & Recommendations: To minimize delayed diagnosis and improve survival, this simple and low-cost risk prediction tool is recommended for identifying and prioritizing high-risk individuals for endoscopy screening for oc.

Journal of the College of Community Physicians of Sri Lanka

Introduction: Occupational eye injuries (OEIs) cause substantial morbidity, disability and economic loss globally. Local studies on OEIs and their prevention are scarce.Objectives: To describe socio-demographic, occupational, clinical characteristics and associated factors among patients presenting with OEIs to National Eye Hospital, Colombo and their practices on prevention and first aid on OEIMethods: A descriptive cross-sectional study was conducted in 218 consecutive patients presenting with OEIs to National Eye Hospital, Colombo. Data were collected using an interviewer-administered questionnaire and clinicalrecords. Practices on prevention and first aid were assessed and separate total scores were calculated.Results: Of the 218 participants, majority were males (n= 213; 97.7%) with mean age of 34 years (SD= 11.5). Most of them were married (65.6%) as well as the sole bread winners (58.3%). Most affected were welders (29.8%) and construction workers (19.7%). Flying-particles (41.7%), grinding-particles (36.7%) and chemicals (11%) were main causes, resulting in 57.3% foreign bodies, 10.1% abrasions and 5.9% chemical-burns. Thirteen (6%) injuries were bilateral, 18 (8.7%) had partial/complete vision loss and 121 (55.5%) were recurrent. Majority had goggles (90.7%), spectacles (60.8%), hand-shields (64.1%) but not face-masks (9.4%) or welding-helmets (32.4%. Personnel protective equipment (PPE) usage was compulsory in 63.3% workplaces but only 16.5% used PPE during injury, reasons being unavailability (22.5%) and low priority (20.6%). The PPE use was significantly (p= 0.004) higher in settings where it was …

Journal of the College of Community Physicians of Sri Lanka

Objectives: To develop and validate a simple low-cost risk prediction tool to identify high-risk individuals for OC early, based on population-specific riskMethods: A risk prediction tool including cut-off value to identify high-risk individuals, was developed based on weighted scores derived from the risk factor profile specific for Sri Lankans. Its criterion validity was assessed against histological diagnosis of OC in an unmatched case-control study conducted among 83 cases recruited from the National Cancer Institute, Maharagama (NCIM) using a non-probability sampling method, and ambulatory hospital controls (n= 166) excluded of OC recruited from the Endoscopy Unit at National Hospital of Sri Lanka (NHSL). Data were collected through an interviewer-administered-questionnaire.Results: Risk predictors in the tool included age> 65 years, family history of cancer, sub-optimal consumption offibre, antioxidants and deep-fried food, low total lifetime sports and exercise activities, high risk alcohol consumption, ever betel quid chewing, ever exposure to agrochemicals, consumption of pipe-borne water, ever exposure to radiation and ever tobacco smoking. The tool demonstrated valid predictions (92.8% sensitivity; 88.6% specificity; 80.2% positive predictive value (PPV); 96.1% negative predictive value (NPV); 8.1 positive likelihood ratio (LR); and 0.1 negative LR) to identify high-risk individuals for OC at 17. 83 cut-off value.Conclusions & Recommendations: To minimize delayed diagnosis and improve survival, this simple and low-cost risk prediction tool is recommended for identifying and prioritizing high-risk individuals for endoscopy screening for oc.

Journal of the College of Community Physicians of Sri Lanka

Noncommunicable diseases (NCDs) kill 41 million people each year, contributing to 74% of all deaths globally. Out of this, 17 million people die before age 70 years. Further, 86% of these premature deaths occur in low-and middle-income countries (1). Physical inactivity being the 4th leading risk factor for NCDs, accounts for an estimated 3.2 million deaths per year. Evidence suggest that physical inactivity increases the risk of cardiovascular diseases, diabetes and stroke, reduces HDL cholesterol, increase blood pressure, reduces psychological well‐being, and increases osteoporosis, colon cancer and breast cancer (2).The World Health Organization (WHO) estimates that currently 60% of the world’s population is not achieving at least 30 minutes daily moderate intensity activity (3). Physical activity is defined as “any bodily movement produced by skeletal muscles that increases energy expenditure above the basal level”, including activities undertaken while travelling, work related activities, carrying out household chores, playing and engaging in recreational pursuits, whereas exercise is planned, structured, repetitive, and aims to improve or maintain one or more components of physical fitness (4). As all forms of physical activity is beneficial, the aim should be to enjoy healthenhancing physical activity which is “any form of physical activity, that benefits health and functional

Journal of the College of Community Physicians of Sri Lanka

Introduction: Anxiety disorders is one of the most prevalent psycho-pathological condition among children and adolescents. Screen for Anxiety Related Disorders (SCARED)-Child version is a cross-culturally validated selfadministered questionnaire to detect children with anxiety disorders.Objectives: To assess the validity and reliability of SCARED-Child to identify anxiety among adolescents aged 13-15 years attending government schools (Sinhala medium) in the district of Colombo, Sri LankaMethods: The SCARED-Child was culturally adapted, translated to Sinhala and its judgmental validity was ensured. The instrument was validated among 423 adolescents aged 13-15 years in Colombo District by assessing criterion validity using the diagnosis made by a consultant psychiatrist as the gold standard, developing clinically validated cut-off values using ROC curve. The internal consistency and test-retest assessment were used to assess the reliability.Results: The culturally adapted and translated SCARED-Child (Sinhala version) showed sensitivity of 85.7%(95% CI= 74.61, 93.25) and specificity of 91.3%(95% CI= 88.0, 94.07) at a cut-off of 36.5, with a high reliability of Cronbach's alpha (0.87) and test-retest correlation coefficient (0.74).Conclusions & Recommendations: This study revealed that SCARED-Child has a high validity and excellent reliability to identify a child with an anxiety disorder at community setting.

Journal of the College of Community Physicians of Sri Lanka

Introduction: The global first national level social marketing programme (SMP) implemented by a nongovernmental organization was started in Sri Lanka on 1973 by The Family Planning Association of Sri Lanka. After four decades, this operation has grown to be the market leader of contraceptives, distributing over 15 products through 4867 pharmacies island wide. In 2020, despite the COVID-19 pandemic and other related challenges, it generated 367 442 couple years of protection (CYP).Objectives: To assess the impact and contribution of SMP to the National Family Planning Programme (NFPP) during the past two decades with a special focus on the effect of the COVID-19 pandemic in 2020.Methods: The product-wise annual sales figures of the SMP during past two decades (2001-2020) were analyzed using Marries Stop International Impact2 Calculation Tool (MSI-Impact2) to estimate the impact and …

Journal of the College of Community Physicians of Sri Lanka

Introduction: Occupational stress among bus drivers is on the rise in the world. It is of prime importance to detect the prevalence and to identify the associated factors of job stress for managing it among bus drivers in Sri Lanka.Objectives: To determine the prevalence of occupational stress and its associated factors among bus drivers of Sri Lanka Transport Board in Colombo DistrictMethods: A descriptive cross-sectional study with an analytical component was carried out in Sri Lanka Transport Board depots in the district of Colombo among 631 bus drivers. The study population was selected by simple random sampling method and used the Effort Reward Imbalance-Sinhala questionnaire and other self-administered questionnaires as instruments. Associated factors with occupational stress were determined by multivariate analysis using adjusted odds ratio (aOR).Results: The prevalence of occupational stress was 52.1%(95% CI= 50.66, 53.62). The factors associated with occupational stress in multivariate analysis were current use of tobacco (aOR= 9.3; 95% CI= 5.71, 11.2), good alertness at the end of the day (aOR= 13.2; 95% CI= 9.48, 15.11), work experience ten years or less (aOR= 9.8; 95% CI= 8.65, 11.2), working days per week six days or more (aOR= 9.72; 95% CI= 5.65, 12.16) and working hours per day more than 10 hours (aOR= 3.1; 95% CI= 2.67, 5.1).Conclusions & Recommendations: The prevalence of occupational stress was high among bus drivers. There were modifiable and non-modifiable associated factors for job stress. Mental health promotion programs need to be conducted at the recruitment of bus drivers.

Journal of the College of Community Physicians of Sri Lanka

ImportanceMendelian randomization (MR) studies use genetic variation associated with modifiable exposures to assess their possible causal relationship with outcomes and aim to reduce potential bias from confounding and reverse causation.ObjectiveTo develop the STROBE-MR Statement as a stand-alone extension to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline for the reporting of MR studies.Design, Setting, and ParticipantsThe development of the STROBE-MR Statement followed the Enhancing the Quality and Transparency of Health Research (EQUATOR) framework guidance and used the STROBE Statement as a starting point to draft a checklist tailored to MR studies. The project was initiated in 2018 by reviewing the literature on the reporting of instrumental variable and MR studies. A group of 17 experts, including MR methodologists, MR study design …