Sri Lankan Children Research Articles

An analysis on the impact of social media on the children's minds in modern Sri Lankan society

Today, the number of children spending their daily time on social media in Sri Lanka has grown exponentially. Therefore, this research was conducted with the aim of analytically studying the impact of social media on the minds of Sri Lankan children. The research problem focuses on what kind of impact social media has on the minds of Sri Lankan children. Data analysis used a mixed methodology of qualitative and quantitative methods with a sample of 180 children from the Colombo, Gampaha, and Kalutara districts in the Western Province. Questionnaires, observation, and semi-structured interview methods were used to collect quantitative and qualitative data. Based on the results of the data analysis, it was found that children use different social media platforms at different stages, and imitating the characters and activities of social media content creates a dependent personality in the child. It was clear that 46% of the respondents indicated that social media affected the child in a positive way, 27% indicated in a negative way, and 26% of the respondents did not have an idea about the kind of effect of social media on their children's minds. Accordingly, by verifying the research hypothesis and research problem that social media affects the mind of the Sri Lankan child, it was concluded that social media affects the mind of the Sri Lankan child. The research provides an in-depth study of the child's daily routine changes, the new social and human contexts that are formed due to the mental change in the child, and measures for the control and prevention of negative effects.

Do we need to re-think growth assessment in Sri Lankan children from birth to 2 years?

No abstract available

Future Directions for the Use of Fluorides in the Prevention of Dental Caries in Sri Lanka: Opinion Review

Dental caries is one of the most common oral diseases that affect children as well as adults globally. The prevalence of dental caries among 5-year-old Sri Lankan children remains high, creating the need of regular well-panned preventive programs. The use of fluorides is a one of the milestones in preventing dental caries. The aim of the present opinion review is to summarize the available literature on different fluoride modalities used to prevent dental caries globally and discuss the strengths and weaknesses of those regarding the Sri Lankan context. The authors searched for systematic reviews and meta-analysis on fluorides in the prevention of dental caries where the best evidence is synthesized and summarized in this article with the opinion of the authors.

Assessment of the nutritional status of school children in Galle Municipality area: A comparison between different body mass index classification systems

Introduction: Asian populations are at an increased risk of cardiometabolic disorders due to higher fat mass at a relatively lower body mass index (BMI). Several discrepancies have been reported in the BMI classification systems currently in practice to assess the nutritional status among children. Aim of this study was to compare the different international BMI based classification systems to identify the nutritional status in a cohort of Sri Lankan children.Methods: A cross sectional study was conducted on 833 (48.37% boys) school children aged 5-15 years in Galle Municipality area, Sri Lanka. The nutritional status of each child was defined according to five BMI classification systems: World Health Organization (WHO), Centers for Disease Control and Prevention(CDC), and International Obesity Task Force (IOTF), Indian and Sri Lankan systems. The agreement between them was tested using Cohen’s kappa coefficient.Results: Prevalence of under-weight, overweight and obesity of children, as determined by the WHO, CDC, IOTF, Indian and the Sri Lankan classification systems showed significant differences. The WHO classification system had the best agreement (k=0.649) with the Indian classification system. A wide difference between the Sri Lankan classification system (24.37%) and the Indian (9.60%) and WHO (5.04%) classification systems in defining obesity were observed.Conclusion & recommendations: A wide difference between different BMI classification systems when determining the nutritional status in children emphasise the importance of developing a country-specific classification system to identify the nutritional status among Sri Lankan children.

Clinical and demographic characteristics of organic acidaemias in children in a tertiary care hospital in Sri Lanka: A 4-year experience in a single centre

Background: Organic acidaemias (OAs) are a biochemically heterogeneous group of inborn errors of metabolism. They are rare and infrequently reported worldwide. Most OAs are clinically apparent in the neonatal period or early infancy while some can present as a chronic progressive form or even an asymptomatic form. Objectives: To describe the clinical presentation, demographic characteristics and the incidence of OAs in Sri Lankan children. Method: A retrospective descriptive cross-sectional study was conducted over a 4-year period by reviewing records of children suspected of having OAs referred to the Department of Chemical Pathology, Lady Ridgeway Hospital. Demographic information, clinical manifestations, biochemical investigations and mutational results were recorded and analysed using descriptive statistics. Definitive diagnosis was established by gas chromatography and mass spectroscopy (GC-MS) of urine for organic acids. Results: Among the 458 patients suspected, 20 (4.3%) were confirmed to have an OA resulting in an incidence of 13/319,000 live births per year. The mean ages at onset of symptoms and diagnosis were 11.8 months (range; day 1 to 5 years) and 27.1 months (range; day 10 to 12 years) respectively. Among the 20 patients were 5 (25%) with propionic acidaemia and 4 (20%) with beta-ketothiolase deficiency. Nineteen (95%) presented acutely. Common manifestations were respiratory distress in 12 (60%) and persistent or recurrent vomiting in 10 (50%). Learning difficulty, dyskinesia and macrocephaly were some chronic manifestations. Biochemically, 15 (75%) had acidosis and 9 (45%) had ketosis. There were 13 (65%) deaths of which 6 were neonates with acute presentation. Conclusions: Propionic acidaemia and beta-ketothiolase deficiency were the common OAs identified. Common clinical presentations were respiratory distress and persistent or recurrent vomiting. Acidosis was a common biochemical finding.

Serum Triglyceride to High-Density Lipoprotein Ratio as a Marker of Insulin Resistance Among 5-15-Year-Old Sri Lankan Children in an Urban Setting.

Objective: Prevalence of insulin resistance (IR) among South Asian populations is relatively high. It increases with the obesity epidemic. Since determining IR is costly, triglyceride to high-density lipoprotein (TG/HDL) ratio has shown to be a good proxy marker for IR in adults. However, it is not yet well established in children. This study aimed to assess TG/HDL ratio as a marker of IR in 5-15-year-old children in Colombo District of Sri Lanka. Methods: A cross-sectional descriptive study was conducted among 309 school children 5-15 years of age, selected using two-stage probability-proportionate-to-size cluster sampling technique. Sociodemographic data, and anthropometric and biochemical parameters were obtained. After a 12-hr overnight fast, blood was taken for biochemical investigations. Results: Three hundred nine children (173 girls) were recruited. Mean age of girls was 9.9 years and boys 10.3 years. Based on body mass index (BMI) z-score, 15.3% were overweight and 6.1% were obese. Metabolic syndrome was present in 2.3% of children and IR based on Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) ≥2.5 in 7.5%. Mean TG/HDL ratio, waist circumference (WC), hip circumference (HC), BMI, waist-to-height-ratio (WHtR), and body fat percentage were significantly higher (P < 0.01) among children with IR compared with non-IR children. TG/HDL ratio significantly correlated with BMI, % fat mass, WC, HC, WHtR, and HOMA-IR. TG/HDL ratio is an independent risk factor in determining IR. The cutoff value of TG/HDL ratio ≥3 had higher specificity (89.8%) but lower sensitivity (47.8%) for detection of IR. TG/HDL ratio >1.5 had a higher sensitivity (82.6%) but lower specificity (47.7%). Conclusions: TG/HDL ratio is a good proxy marker of IR among 5-15-year-old children. A cutoff value of ≥1.5 had satisfactory sensitivity and specificity.

Consensus on an assessment protocol for children with speech sound disorders in Sri Lanka.

Speech sound disorders (SSDs) are the most common form of communication disorders in children. SSD have an impact on children's abilities to make themselves understood to their listeners and can influence a child's social and emotional well-being as well as their academic achievements. Therefore, it is important to identify children with an SSD early, in order to provide appropriate intervention. A wealth of information on best practice in the assessment of children with SSD is available in countries where the speech and language therapy profession is well established. In Sri Lanka, there is a paucity of research evidence supporting assessment practices that are culturally and linguistically appropriate in SSDs. Therefore, clinicians rely on informal assessment methods. There is a need to understand more about how clinicians in Sri Lanka assess this caseload in order to get general agreement regarding comprehensive and consistent procedures for assessment of paediatric SSD in Sri Lanka. This would support speech and language therapists' (SLTs') clinical decision-making in relation to choice of appropriate goals and intervention for this caseload. To develop and gain consensus on an assessment protocol for Sri Lankan children with SSD that is culturally appropriate and based on existing research. A modified Delphi method was utilised to gather data from clinicians currently working in Sri Lanka. The research involved three rounds of data collection, exploring current assessment practices in Sri Lanka, ranking these in order of priority and establishing consensus on a proposed assessment protocol. The proposed assessment protocol was based on the results of the first and second rounds as well as previously published best practice guidelines. The proposed assessment protocol achieved consensus in relation to content, format and cultural appropriateness. SLTs affirmed the usefulness of the protocol within the Sri Lankan context. Further research is required to assess the feasibility and effectiveness of this protocol in practice. The assessment protocol supports practicing SLTs with a general guide to assessing children with suspected SSDs in Sri Lanka. The application of this protocol built upon consensus enables clinicians to improve their individual practice patterns based on best practice recommendations in the literature and the evidence on culturally and linguistically appropriate practices. This study has identified the need for further research in this area, including the development of culturally and linguistically specific assessment tools that would complement the use of this protocol. What is already known on the subject The assessment of children with speech sound disorders (SSDs) requires a comprehensive and holistic approach due to their heterogeneous nature. Although there is evidence to support the assessment of paediatric SSDs in many countries where the profession of speech and language therapy is established, there is limited evidence to support the assessment of children with SSDs in Sri Lanka. What this study adds This study provides information about current assessment practices in Sri Lanka and consensus on a proposed culturally appropriate protocol for the assessment of children with SSDs in this country. What are the clinical implications of this work? The proposed assessment protocol provides speech and language therapists in Sri Lanka with a guide for assessment of paediatric SSDs to support more consistent practice in this area. Future evaluation of this preliminary protocol is required; however, the methodology used in this research could be applied to the development of assessment protocols for other range of practice areas in this country.

Predictors of Attention Deficit Hyperactivity Disorder in Sri Lankan Children: A School Based Community Study

Objective: To evaluate potential risk-factors of ADHD among primary school-children (PSC) in state schools in Colombo district of Sri Lanka. Method: A case-control study was conducted with 73 cases and 264 controls selected randomly among 6 to 10-year-old PSC from Sinhala medium state schools in Colombo district. Primary care givers completed the SNAP-IV P/T-S scale to screen for ADHD and an interviewer-administered questionnaire on risk-factors. Children’s diagnostic status was confirmed by a Consultant Child and Adolescent Psychiatrist based on DSM-5 criteria. Results: A binomial regression model identified male sex (aOR = 3.45; 95% CI [1.65, 7.18]), lower educational level of the mother (aOR = 2.99; 95% CI [1.31, 6.48]), birth weight <2,500 g (aOR = 2.83; 95% CI [1.17, 6.81]),a neonatal complications (aOR = 3.82; 95% CI [191, 7.65]) and child having witnessed verbal/emotional aggression between parents (aOR = 2.08; 95% CI [1.01, 4.27])as significant predictors of ADHD. Conclusion: Primary prevention should focus on strengthening neonatal, maternal and child health services within the country.

Effect of body composition in the assessment of growth of Sri Lankan children and need for local references

Measuring growth provides the opportunity to assess an individual’s health and nutritional status as well as reflect the quality of life and social wellbeing. Global standards and references for child and adolescent growth have been adopted by many countries including Sri Lanka, but it is questionable whether these charts are appropriate. They are known to over-diagnose undernutrition and under-diagnose over-nutrition in many low-and-middle-income countries.&#x0D; This article reviews the effect of body composition and ethnicity on the assessment of growth of Sri Lankan children.&#x0D; Growth has been documented since early civilization. Standards and references for assessing intrauterine, infant, child and adolescent growth have evolved for regional, national, and international use. Attention has been focused on socio-economic, political, and emotional (SEPE) factors as primary determinants of growth as well as ethnicity.&#x0D; Growth charts are based on the distribution of growth parameters in the population. Cut-off values are defined by statistical distributions rather than by the biological meaning of growth measurements. As most of the adverse health outcomes are related to an individual’s body composition, anthropometry should correctly reflect body composition and critical cut-off values should help assessing health risks. Yet, the distributions of height, weight, and BMI of healthy children of many low-and-middle-income countries differs from the global growth standards recommended for use by the WHO, and Sri Lankan children differ and show a shift to the left. In 5- to 15-year-old healthy children height, weight, and BMI range between -3SD and +1SD. Thus, applying global standards will often lead to false estimates when defining stunting, thinness, and obesity in these children. This highlights the importance of local rather than universal growth standards. Many countries have meanwhile taken the initiative to develop national growth charts. Further, Sri Lanka needs local growth charts and relevant cut-off values for the correct assessment of height, weight and BMI.

Autosomal Recessive Renal Hypouricemia Type 2 Presenting with Childhood Stroke in a Sri LankanChild.

A previously healthy 14-year-old girl who was the youngest of 4 siblings with no parental consanguinity presented with sudden onset right-sided upper limb and lower limb weakness, unsteady gait, and slurred speech. On examination, there was right-sided upper motor facial nerve palsy. A brain MRI revealed a left-sided parietal lobe infarction. In the complete blood count and peripheral blood smear there was a neutrophil leukocytosis with mild left shift maturation. More than 5% of neutrophils displayed hypersegmentation. Platelets and red blood cells were normal, both quantitatively and morphologically, except for a few teardrop-shaped cells. The overall picture indicated vitamin B12 deficiency. There were no features suggestive of iron deficiency. Renal function and electrolytes were within age-matched intervals. Plasma glucose level was 4.8 mmol/L. The infection markers, including cerebrospinal fluid analysis, were normal. The coagulation screen performed as international normalized ratio/prothrombin time, activated partial thromboplastin time, and fibrinogen were unremarkable (TABLES 1 and 2).

Prediction Equation for Physical Activity Energy Expenditure in 11-13-Year-Old Sri Lankan Children.

This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.

The prevalence of diabetes and thyroid related autoantibodies in Sri Lankan children with type 1 diabetes and their unaffected siblings - The utility of a new screening assay.

There is limited information about diabetes and thyroid related autoantibodies in children with type 1 diabetes (T1D) or their siblings in Sri Lanka. To assess in T1D children and their unaffected siblings the prevalence of autoantibodies to (1) glutamic acid decarboxylase (GADA), insulinoma associated antigen-2 (IA-2A) and zinc transporter 8 (ZnT8A) using 3 Screen ICA™ (3-Screen) and individual ELISA assays; (2) insulin (IAA); and (3) thyroid peroxidase (TPOA), thyroglobulin (TgA) and the TSH receptor (TSHRA). We selected - (a) consecutive T1D children, and (b) their unaffected siblings of both sexes, from the T1D Registry at Lady Ridgeway Hospital, Colombo. The median age (IQR) of 235 T1D children and 252 unaffected siblings was 11 (8.4, 13.2) and 9 (5.4, 14.9) years respectively, and the duration of T1D was 23 (7, 54) months. (1) T1D children (a) 79.1% were 3-Screen positive; (b) all 3-Screen positives were individual antibody positive (GADA in 74%; IA-2A 31.1%; ZnT8A 38.7%); (c) and were younger (p=0.01 vs 3-Screen negatives); (d) multiple autoantibodies were present in 45.1%; (e) IA-2A (p=0.002) and ZnT8A (p=0.006) prevalence decreased with T1D duration. (f) TPOA and TgA prevalence was higher in T1D children compared to unaffected siblings (28%, p=0.001 and 31%, p=0.004, respectively). (2) Unaffected siblings (a) 6.3% were 3-Screen positive (p=0.001 vs T1D), and 2.4% were positive for IAA; (b) four subjects had two diabetes related autoantibodies, one of whom developed dysglycaemia during follow-up. The 3-Screen assay, used for the first time in Sri Lankan T1D children and their siblings as a screening tool, shows a high prevalence of T1D related Abs with a high correlation with individual assays, and is also a helpful tool in screening unaffected siblings for future T1D risk. The higher prevalence of thyroid autoantibodies in T1D children is consistent with polyglandular autoimmunity.

The effect of foetal and early childhood growth on metabolic derangements of Sri Lankan children

BackgroundPrevious studies have shown that delayed prenatal growth followed by accelerated postnatal growth plays a significant role on the onset of adult metabolic diseases. The present study aimed to identify the effects of intrauterine and later growth on metabolic derangements among children in Colombo, Sri Lanka.MethodsA school-based cross-sectional study was conducted among 5–15-year-old children selected using a two-stage probability-proportionate-to-size cluster sampling technique. Birth-weight (BW) was extracted from records (denotes prenatal growth) and body mass index(BMI)-Z score and fat mass(FM) measured to denote the current growth of children. Fasting and random blood glucose, lipid profile and blood pressure(BP) were measured. The sample was stratified by age (5—< 10 and 10—15 years); was further categorized into tertiles of BW and BMI-Z scores. Based on these two parameters, metabolic parameters were evaluated within each age category.ResultsThe sample comprised 833(494 boys) healthy school children. Metabolic parameters did not significantly differ by sex or across BW tertiles of each BMI-Z score tertile. However, significant changes in some metabolic parameters were noted across the BMI-Z score tertiles of each BW tertile. Children belonging to the lowest BW and highest BMI-Z score tertiles had worst metabolic profiles, while those in the lowest BW as well as BMI-Z score tertile were protected. Excessive fat deposition seemed to move children to higher BMI-Z score tertiles.ConclusionPoor prenatal growth is not the sole risk factor for abnormal metabolic profile found in childhood. Those who gain fat, denoted by weight, during early childhood are at a higher risk of developing metabolic abnormalities than those who do not. This favours the accelerated postnatal growth hypothesis.

Identifying high-risk children for dental caries in school settings: A simple predictive model.

Untreated caries in permanent teeth is the most prevalent condition worldwide. Use of a simple, validated caries risk prediction tool will offer a low-cost mechanism to identify high-risk children for targeted preventive programmes. To develop and validate a caries risk prediction model for 5-6-year-old Sri Lankan children. Methods Two case-control studies were done for model development and validation. Cases and controls were defined as 8-9-year-olds with and without permanent tooth caries respectively. Based on dental records and confirmation by clinical examination, 120 cases and 360 controls for model development, and 100 cases and 100 controls for model validation were selected. Data was collected using dental records and a pretested parental self-administered questionnaire. Risk predictors were identified by logistic regression analysis. Cut-off point was determined by plotting a ROC curve. Four risk predictors were identified: 'having 5 or more posterior decayed teeth' (OR= 2.1, 95% CI: 1.0 - 4.4), 'brushing frequency of once or less' (OR= 3.5, 95% CI: 2.1 - 6.0), 'not using fluoridated toothpaste' (OR= 3.2, 95% CI: 1.8 - 5.6) and 'consuming more than two snacks containing fermentable carbohydrates in between meals' (OR= 1.6, 95% CI: 0.9 - 2.9). A 10-point score was developed. Following external validation, a sensitivity of 31% (95% CI: 22.1% - 41.0 %) and a specificity of 87% (95% CI: 78.8% - 92.9 %) was obtained for a cut-off value of 2.5. The model could be used to identify high-risk children, especially in areas with higher disease burdens.

Status epilepticus due to Posterior Reversible Encephalopathy Syndrome in a Sri Lankan child with Nephrotic Syndrome.

The AMJ is a peer-reviewed, triannual health journal published by Anuradhapura Clinical Society (ACS).The Journal strives to be a forum for all health professionals to publish original research and review articles in their area of expertise. The AMJ publishes articles in clinical medicine, public health and health promotion. Our priority is given to manuscripts on health related issues which affects the communities living in rural tropical communities. Established as a journal in 2006 as a publication parallel to ACS annual scientific sessions, the journal was relaunched as a proper journal in 2013. Anuradhapura Medical Journal is a member of COPE and is included on DOAJ.

Association of selected genetic variants in CBS and MTHFR genes in a cohort of children with homocystinuria in Sri Lanka

BackgroundHomocystinuria is an inherited, inborn error of homocysteine metabolism, which leads to the abnormal accumulation of homocysteine and its metabolites in blood and urine, resulting in various complications. Variants in the cystathionine β-synthase (CBS) and methylenetetrahydrofolate reductase (MTHFR) genes interrupt the formation of the corresponding enzymes and prevent homocysteine from being metabolised; hence, the homocysteine levels in plasma increase than the optimum levels. Materials and methodsIn the current study, eight clinically confirmed children with homocystinuria were detected to study the chosen variants in the CBS gene (c.833 T>C and c.19del) and in the MTHFR gene (c.665 C>T, c.1286 A>C) using SNaPshot mini-sequencing and direct sequencing. ResultsAfter screening eight patients, none had the c.833T>C, but four patients were in the homozygous state for the c.19del variant in the CBS gene. Furthermore, seven were heterozygous for c.1286A>C, while one patient was heterozygous for c.665C>T in the MTHFR gene. ConclusionAccording to the results, c.19del is common in the studied cohort of Sri Lankan children, while c.833T>C is absent, whereas c.1286A>C was more frequent than c.665C>T. To our knowledge, the current study was the first report to discuss the genetic impact of homocystinuria in Sri Lanka; further comprehensive studies are necessary with a larger sample size to establish the association of these variants with the disease in Sri Lanka, which can be beneficial in enhanced patient care and for prospective studies.

A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report

BackgroundLymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath.Case presentationA 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung.ConclusionWe report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.

Wilson disease presenting as acute haemolytic anaemia in a Sri Lankan child

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Radiographical Assessment of Mandibular Molars of children and young Adults to determine the probability at 16-year threshold: Sri Lankan study

• 16-year threshold was established successfully using mandibular 2 nd and 3rd Molars. • The probability for an individual to be identified correctly as above or below 16 year threshold was 93% and identified incorrectly with 7% probability. • According to the present study, the investigators can continue to use Tables of ABFO study of Mincer et al. in children and young adults. But Tables 4 and 5 are more appropriate for local applications. • Estimation of dental age can be done satisfactorily using mandibular molars recorded on Intra Oral Peri-Apical radiographs. Main objective was to determine the probability at 16-year age threshold by using unilateral second and third developing mandibular molars in a group of Sri Lankan children. The above threshold is one of the specific ages for children in Sri Lanka legislature. This retrospective cross sectional study used 783 Orthopantomographs (385 males and 398 females) of Sri Lankan children and young adults ranging in age from 8.00 to 24.99 years both males and females and analysed based on Demirjian maturity stages A to H. The Mean (SD) age of assessments to the different Demirjian stages for two molars were calculated using SPSS. The probability assessment for a child being reached the 16-year threshold was calculated using NORMDIST function in Excel. The validity was tested on a validation sample of 50 males and 50 females. Third molar comparison of mean ages of assessments to Demirjian stages was done with other population studies. The Mean and (SD) in the reference sample was 15.02(3.77) years for males 15.51(4.98) years for females. The probability estimates correctly identified individuals above or below the reference age was 93% and only 7% was identified incorrectly. This study has confirmed that the second and third molars in the mandible can reliably be used to determine the probability at 16-year threshold. The Mean (SD) ages of assessment to corresponding Demirjian stages from D to H of third mandibular molar in the present study are fairly compatible with that of ABFO study of Mincer et al. which is widely used as a reference data for Forensic age estimation procedure in Sri Lanka.

Thinness negatively affects lung function among Sri Lankan children.

BackgroundThere have been conflicting findings on the effect of body mass index (BMI) on lung functions in children. Therefore, we studied the relationship between spirometry parameters and BMI among healthy Sri Lankan school children aged 5–7 years.MethodsA cross-sectional study was conducted among 296 school children (5–7-year-old) without apparent lung disease. Recruitment was done with stratified random sampling. Spirometry parameters, FEV1, FVC, PEFR, and FEV1/FVC ratio were determined. The acceptable and reproducible spirometry recordings were included in the analysis. Simple and multivariate linear regression analysis examined possible associations of lung function parameters with BMI, socio‐demographic variables and indoor risk factors. Also, the mediator effect of gender on lung function through BMI was explored.ResultsThe participants’ mean age (SD) was 6.4 (0.65) years. One-third were thin/severely thin (37%). A statistically significant difference in FVC (p = 0.001) and FEV1 (p = 0.001) was observed between BMI groups (obesity/overweight, normal, and thinness). Yet, PEFR or FEV1/FVC did not significantly differ among BMI groups (p = 0.23 and p = 0.84). Multivariate regression analysis showed that FEV1 and FVC were significantly associated with BMI, child’s age, gender, family income, father’s education, having a pet, and exposure to mosquito coil smoke. Interaction between gender and BMI for lung functions was not significant. The thin children had significantly lower FVC (OR: -0.04, 95%CI: -0.077, -0.012, p = 0.008) and FEV1 (OR: -0.04, 95%CI: -0.075, -0.014, p = 0.004) than normal/overweight/obese children. Family income demonstrated the greatest effect on lung functions; FVC and FEV1 were 0.25L and 0.23L smaller in low-income than the high-income families.ConclusionLower lung function parameters (FVC and FEV1) are associated with thinness than normal/overweight/obese dimensions among children without apparent lung disease. It informs that appropriate nutritional intervention may play a role in improving respiratory health.