scholarly journals Insights into preventing female genital mutilation/cutting in Sri Lanka: a qualitative interpretative study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Angela Dawson ◽  
Kumudu Wijewardene
Keyword(s):  
Sri Lanka ◽  
Complete Removal ◽  
Cultural Practice ◽  
Adverse Outcomes ◽  
Detailed Knowledge ◽  
The Sustainable Development ◽  
Genital Mutilation ◽  
Adverse Health Outcomes ◽  
Template Analysis ◽  
Role Of Religion

Abstract Background FGM/C is a cultural practice associated with adverse health outcomes that involves the partial or complete removal of the external female genitalia or injury to the genitalia. FGM/C is a form of violence against women and girls. There are no laws that specifically outlaw FGM/C in Sri Lanka and no national prevalence data. There is a lack of evidence about this practice to inform prevention efforts required to achieve the Sustainable Development Goal (SDG) target 5.3.2, which focuses on the elimination of all harmful practices, including FGM/C. Methods We undertook a qualitative interpretative study to explore the knowledge and perceptions of community members, religious leaders and professionals from the health, legal and community work sectors in five districts across Sri Lanka. We aimed to identify strategies to end this practice. Results Two-hundred-and twenty-one people participated in focus group discussions and key informant interviews. A template analysis identified five top-level themes: Providers, procedures and associated rituals; demand and decision-making; the role of religion; perceived benefits and adverse outcomes; ways forward for prevention. Conclusions This study delivered detailed knowledge of FGM/C related beliefs, perceptions and practitioners and provided opportunities to develop an integrated programming strategy that incorporates interventions across three levels of prevention.

scholarly journals Insights into Preventing Female Genital Mutilation/cutting in Sri Lanka: A Qualitative Interpretative Study.

2020 ◽  
Author(s):  
Angela Dawson ◽  
Kumudu Wijewardene
Keyword(s):  
Sri Lanka ◽  
Complete Removal ◽  
Cultural Practice ◽  
Adverse Outcomes ◽  
Detailed Knowledge ◽  
The Sustainable Development ◽  
Genital Mutilation ◽  
Adverse Health Outcomes ◽  
Template Analysis ◽  
Role Of Religion

Abstract Background: FGM/C is a cultural practice associated with adverse health outcomes that involves the partial or complete removal of the external female genitalia or injury to the genitalia. FGM/C is a form of violence against women and girls. There are no laws that specifically outlaw FGM/C in Sri Lanka and no national prevalence data. There is a lack of evidence about this practice to inform prevention efforts required to achieve the Sustainable Development Goal (SDG) target 5.3.2, that focuses on the elimination of all harmful practices including FGM/C. Methods: We undertook a qualitative interpretative study to explore the knowledge and perceptions of community members, religious leaders and professionals from the health, legal and community work sectors in five districts across Sri Lanka. We aimed to identify strategies to end this practice. Results: Two-hundred-and twenty one people participated in focus group discussions and key informant interviews. A template analysis identified five top-level themes: Providers, procedures and associated rituals; demand and decision-making; the role of religion; perceived benefits and adverse outcomes; ways forward for prevention. Conclusions: This study delivered detailed knowledge of FGM/C related beliefs, perceptions and practitioners and provided opportunities for the development of an integrated programming strategy that incorporates interventions across three levels of prevention.

Legal Impact of Female Genital Mutilation: Special Reference to Penal Laws and Human Rights Perspective in the Criminal Justice System of Sri Lanka

2019 ◽  
Vol 4 (2) ◽  
pp. 222-237
Author(s):  
Aruni Wijayath
Keyword(s):  
Human Rights ◽  
Sri Lanka ◽  
Female Genital Mutilation ◽  
Cultural Practice ◽  
World Health ◽  
African Region ◽  
Genital Mutilation ◽  
Female Community ◽  
Health Organization ◽  
Female Genital

Female genital mutilation (FGM) is a ritual and religious and cultural practice among the Moor, Malay and Dawoodi Bohra ethnic communities in Sri Lanka. The process of FGM is ensconced from the general public in Sri Lanka; therefore, few pieces of research pertaining to the practice of FGM are available. A considerable number of international organizations profess that the percentage of FGM/cutting is zero in Sri Lanka through their reports, although newspaper articles and country reports disclose that FGM actually exists among the Muslim community in Sri Lanka. The knowledge regarding the process of FGM is in the backwater in Sri Lanka, even though a considerable number of feminism activists have created a platform to discuss the bad consequences emerging from this harmful practice. According to the World Health Organization (WHO), 30 countries of African Region, selected countries in the Middle East, and countries of Asian Region practice this custom among the female community in some ethnic and religious groups. Through this practice, the female community has not gained any advantage or benefit. The purpose of this research is to explore the municipal laws and human rights regarding FGM in the Sri Lankan context. Furthermore, international conventions which are ratified by Sri Lanka will be analysed in this manner. This research is mainly based on the normative method and retrieved Internet documentary analysis in a qualitative manner.

scholarly journals Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)—A Condition Associated with Heightened Sympathetic Activation

2021 ◽  
Vol 22 (8) ◽  
pp. 4241
Author(s):  
Revathy Carnagarin ◽  
Kearney Tan ◽  
Leon Adams ◽  
Vance B. Matthews ◽  
Marcio G. Kiuchi ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Metabolic Diseases ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Metabolic Dysfunction ◽  
Sympathetic Activation ◽  
Beneficial Effects ◽  
Adverse Health Outcomes

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver disease affecting a quarter of the global population and is often associated with adverse health outcomes. The increasing prevalence of MAFLD occurs in parallel to that of metabolic syndrome (MetS), which in fact plays a major role in driving the perturbations of cardiometabolic homeostasis. However, the mechanisms underpinning the pathogenesis of MAFLD are incompletely understood. Compelling evidence from animal and human studies suggest that heightened activation of the sympathetic nervous system is a key contributor to the development of MAFLD. Indeed, common treatment strategies for metabolic diseases such as diet and exercise to induce weight loss have been shown to exert their beneficial effects at least in part through the associated sympathetic inhibition. Furthermore, pharmacological and device-based approaches to reduce sympathetic activation have been demonstrated to improve the metabolic alterations frequently present in patients with obesity, MetSand diabetes. Currently available evidence, while still limited, suggests that sympathetic activation is of specific relevance in the pathogenesis of MAFLD and consequentially may offer an attractive therapeutic target to attenuate the adverse outcomes associated with MAFLD.

Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Jing Jiao ◽  
Na Guo ◽  
Lingli Xie ◽  
Qiaoyan Ying ◽  
Chen Zhu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Outcomes ◽  
Hospital Ward ◽  
Adverse Health Outcomes ◽  
Multicentre Cohort Study ◽  
Older Inpatients ◽  
Ward Clustering ◽  
Clustering Effect ◽  
The Relationship ◽  
Multicentre Cohort

<b><i>Introduction:</i></b> Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. <b><i>Methods:</i></b> We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. <b><i>Results:</i></b> We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59–6.38), readmission (OR 1.45; 95% CI 1.25–1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10–5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09–4.01), readmission (OR 1.38; 95% CI 1.21–1.57), and mortality (OR 6.50; 95% CI 4.00–7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. <b><i>Conclusions:</i></b> Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

Challenges to Meeting the UN Sustainable Development Goals in Sri Lanka

Asian Survey ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 726-746
Author(s):  
Gamini Herath
Keyword(s):  
Sustainable Development ◽  
Sri Lanka ◽  
Sustainable Development Goals ◽  
Good Governance ◽  
Institutional Capacity ◽  
Political Will ◽  
The Sustainable Development ◽  
Development Goals

In 2015, the UN proposed the Sustainable Development Goals; they were accepted by 193 countries. Sri Lanka faces many challenges in implementing the SDGs. The lack of reliable and recent data is a serious issue. Another issue is the weak institutional capacity of Sri Lanka, which has led to poor governance and policy incoherence. There is no strong political will, and interministerial conflicts are rampant. Unless these issues are properly addressed, the yahapalanaya (good governance) government of President Sirisena may not contribute well to achieve the SDGs by 2030.

scholarly journals Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against

2017 ◽  
Vol 44 (2) ◽  
pp. 86-90 ◽  
Author(s):  
Keymanthri Moodley ◽  
Stuart Rennie
Keyword(s):  
Public Health ◽  
South Africa ◽  
Male Circumcision ◽  
Resource Constraints ◽  
Cultural Practice ◽  
Public Health Response ◽  
Genital Mutilation ◽  
Ethical Implications ◽  
Healthcare Needs ◽  
Health Response

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.

Abstract P179: Comparison of Earlier versus Later Orthostatic Hypotension Assessment Times in Middle-Age Adults of the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Stephen P Juraschek ◽  
Natalie Daya ◽  
Andreea M Rawlings ◽  
Lawrence J Appel ◽  
Edgar R Miller ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Standing Position ◽  
Adverse Outcomes ◽  
Cox Models ◽  
Atherosclerosis Risk In Communities ◽  
Adverse Health Outcomes ◽  
History Of ◽  
Risk Of Fall

Background: Guidelines recommend assessing orthostatic hypotension (OH) 3 minutes after rising from supine to standing positions. Hypothesis: Measurements performed immediately after standing will be as informative as measurements performed closer to 3 minutes after standing with regards to symptoms of dizziness or risk of adverse outcomes. Methods: OH, defined as a drop in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, was measured up to five times at 25 seconds intervals in middle-aged (range 44 to 66 years) ARIC participants (1987-1989). Associations between each measurement and history of dizziness upon standing were examined via logistic regression. We used Cox models to examine the association between each of five measurements with risk of fall, fracture, syncope, and all-cause mortality over a median follow-up of 23 years. Results: In 11,449 participants (mean age 54 years, 54% women, 26% black) 10% reported a history of dizziness upon standing. OH assessed at measurement 1 (performed at a mean of 28 seconds after standing) was associated with risk of fall ( P = 0.03), fracture ( P = 0.05), syncope ( P <0.001), and mortality ( P < 0.001) ( Table ). Furthermore, measurement 1 was the only measurement associated with higher odds of dizziness upon standing (OR: 1.5; P = 0.001). Measurement 2 (performed on average 53 seconds after standing) was associated with all long-term outcomes. Measurements 4 and 5 (mean 100 and 116 seconds after standing) were generally less informative with regards to prospective outcomes than earlier measurements and were not statistically associated with history of dizziness. Conclusions: OH measurements obtained, on average, within the first 30 seconds of standing were predictive of long-term adverse health outcomes and were the most strongly related to symptoms of dizziness compared to later measurements. These findings suggest that BP measurements for determining orthostatic hypotension should be performed immediately after standing.

scholarly journals Structure-Dependent Effects of Phthalates on Intercellular and Intracellular Communication in Liver Oval Cells

2020 ◽  
Vol 21 (17) ◽  
pp. 6069
Author(s):  
Lucie Čtveráčková ◽  
Daniel Jančula ◽  
Jan Raška ◽  
Pavel Babica ◽  
Iva Sovadinová
Keyword(s):  
Liver Toxicity ◽  
Daily Basis ◽  
Adverse Outcomes ◽  
Chronic Liver ◽  
Oval Cells ◽  
Gap Junctional Intercellular Communication ◽  
Cellular Effects ◽  
Adverse Health Outcomes ◽  
Gap Junctional ◽  
Homeostatic Mechanisms

Humans are exposed to phthalates released from plastics, cosmetics, or food on a daily basis. Phthalates have low acute liver toxicity, but their chronic exposures could induce molecular and cellular effects linked to adverse health outcomes, such as liver tumor promotion or chronic liver diseases. The alternation of gap junctional intercellular communication (GJIC) and MAPK-Erk1/2 pathways in liver progenitor or oval cells can disrupt liver tissue homeostatic mechanisms and affect the development and severity of these adverse outcomes. Our study with 20 different phthalates revealed their structurally dependent effects on liver GJIC and MAPK-Erk1/2 signaling in rat liver WB-F344 cell line with characteristics of liver oval cells. The phthalates with a medium-length side chain (3–6 C) were the most potent dysregulators of GJIC and activators of MAPK-Erk1/2. The effects occurred rapidly, suggesting the activation of non-genomic (non-transcriptional) mechanisms directly by the parental compounds. Short-chain phthalates (1–2 C) did not dysregulate GJIC even after longer exposures and did not activate MAPK-Erk1/2. Longer chain (≥7 C) phthalates, such as DEHP or DINP, moderately activated MAPK-Erk1/2, but inhibited GJIC only after prolonged exposures (>12 h), suggesting that GJIC dysregulation occurs via genomic mechanisms, or (bio)transformation. Overall, medium-chain phthalates rapidly affected the key tissue homeostatic mechanisms in the liver oval cell population via non-genomic pathways, which might contribute to the development of chronic liver toxicity and diseases.

scholarly journals A Comprehensive Analysis on Abundance, Distribution, and Bionomics of Potential Malaria Vectors in Mannar District of Sri Lanka

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Nayana Gunathilaka ◽  
Menaka Hapugoda ◽  
Rajitha Wickremasinghe ◽  
Wimaladharma Abeyewickreme
Keyword(s):  
Waste Water ◽  
Sri Lanka ◽  
Current Knowledge ◽  
Breeding Habitat ◽  
Control Measures ◽  
Malaria Vectors ◽  
Detailed Knowledge ◽  
Lagoon Water ◽  
Breeding Habitats ◽  
The Mean

Background. A detailed knowledge of the distribution of the malaria vectors in Mannar district of Sri Lanka has not been studied after 1927. Past records indicated the presence of only seven species of anophelines, namely, An. culicifacies, An. subpictus, An. barbirostris, An. peditaeniatus, An. nigerrimus, An. Jamesii, and An. maculatus. There have been many changes in terms of distribution of Anopheles in the district over time. Methods. Entomological surveillance was conducted on a monthly basis, comprising indoor hand collection, window trap collection, cattle-baited net collection, cattle-baited hut collection, and larval survey from June 2010 to June 2012 in 12 study areas under three entomological sentinel sites. The relationship between seven abiotic variables of the breeding habitats was measured. Pearson’s correlation coefficients were used to determine the associations between climatic variables and anopheline densities. Results. A total of 74,181 mosquitoes belonging to 14 Anopheles species were recorded. An. subpictus was the most predominant species from all techniques representing 92% (n=68,268) of the total anopheline collection. However, Anopheles culicifacies was not recorded from any site during the study period. Larval surveys identified 12 breeding habitat categories including waste water collections, lagoon water collections, and drains which were not recorded as breeding habitats by previous studies. The mean dissolved oxygen level of waste water collections was 3.45±0.15 mg/l. The mean salinity and conductivity of lagoon water collections were 21105±1344 mg/l and 34734±1974 μs/cm, respectively. Conclusion. The present study provides the updated knowledge on anopheline distribution and vector bionomics. Therefore, documentation of the current knowledge would be useful for learners and health authorities to design appropriate vector control measures in the prevention of reintroduction of malaria.

scholarly journals Medicare Competitive Bidding Program

2016 ◽  
Vol 11 (2) ◽  
pp. 324-326
Author(s):  
Christopher G. Parkin
Keyword(s):  
Program Implementation ◽  
Economic Modeling ◽  
Unintended Consequences ◽  
Adverse Outcomes ◽  
Competitive Bidding ◽  
National Minority ◽  
Medicare Beneficiaries ◽  
Medical Products ◽  
Adverse Health Outcomes ◽  
Monitoring Protocols

A recent study by the National Minority Quality Forum (NMQF) reported the failures and adverse health outcomes of the Medicare competitive bidding program as implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. CMS has repeatedly reported that the program caused no disruption of beneficiary access to needed medical products (including diabetes testing supplies) and that no adverse outcomes occurred. Although signals of disruption were seen early in the program implementation, economic modeling by McGeary and Katzman in 2004 demonstrated that the program design was significantly flawed. This article discusses the unintended consequences of competitive bidding program and provides a rationale for suspending the program until CMS can implement effective monitoring protocols to protect the safety of Medicare beneficiaries.

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