Background Pulmonary rehabilitation is recommended for most patients with chronic obstructive pulmonary disease (COPD). Accordingly, the aim of this study was to explore the feasibility of devising a pulmonary rehabilitation program for patients with COPD in a low resource setting (Jaffna, Sri Lanka) and to observe its effects. Methods Non-randomized controlled feasibility trial of ambulatory patients with COPD attending the pulmonary outpatient clinic of the Jaffna Teaching Hospital, Northern Province, Sri Lanka. Age-matched patients were allocated alternatively to an intervention group or to a control group. Twice weekly, for six weeks, patients in the intervention group attended pulmonary rehabilitation sessions consisting of supervised stretching, aerobic and strengthening exercises, and patient-education. Before and at the conclusion of the study, all patients performed incremental shuttle walking test (ISWT), 6-min walk test (6MWT) and completed the Medical Research Council (MRC) dyspnea scale, COPD assessment test (CAT), chronic COPD questionnaire (CCQ), and hospital anxiety depression scale (HADS). Results 204 patients with COPD (94% males) were identified at screening; 136 (66.7%) were eligible for pulmonary rehabilitation and 96 patients (47%) consented to participate. Of these, 54 patients (53 males) eventually participated in the study (42 patients were discouraged to participate by family members or friends); 40 patients (20 in the rehabilitation group and 20 patients in the control group) completed the study. Baseline characteristics of the intervention group and the control group were similar. 95% of patients in the intervention group adhered to regular home training exercises (self-reported diary). At post assessment, only the intervention group experienced clinically-meaningful improvements in symptoms and exercise capacity. Conclusion A simple and clinically beneficial pulmonary rehabilitation program for patients with COPD can be effectively implemented in a low resource setting. However, there is a need for educating patients and the local community on the benefits of pulmonary rehabilitation to enhance uptake. Retrospective Trial Registration date and number: 16/04/2021, ISRCTN10069208.

Spirometry and Peak Expiratory Flow Rate (PEFR) are important measurements in diagnosing and monitoring of COPD and asthma. Ethnic specific reference equations are necessary in interpretation of these parameters. However, equations for Sri Lankan Tamil adults are not available. This study aims to establish reference equations for lung function parameters of Sri Lankan Tamils. A descriptive cross sectional study was carried out in all 5 districts of Northern Sri Lanka. Participants were selected by cluster sampling. Base line data were obtained by a questionnaire. Height, sitting height, weight, arm span, mid arm circumference, and chest expansion were measured. Respiratory functions were assessed by a calibrated spirometer (Cosmed Micro Quark, Italy) and Wright compatible peak expiratory flow meter. Means, and standard deviations for Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1%, Peak Expiratory Flow Rate (PEFR) and for other forced expiratory parameters of 775 males and 687 females were determined. Lung function parameters have significant p<0.05 positive correlations with most of the anthropometric measures. Age had a significant p<0.05 negative correlation with lung function parameters in adults >20 years and positive correlation p<0.05 in 14–20 years group. Step wise multiple regression analysis was used to determine the prediction equations. Also equations based on age, height and age, arm span were derived. Age, height based equations were retested in the same population. Predicted values by the developed equations had better agreement than that of GLI 2012 equations. This can be useful in assessing the respiratory function in Sri Lankan Tamil population as there are no already existing equations.

Introduction Chronic respiratory diseases are the most common causes of morbidity and mortality globally. Pulmonary rehabilitation (PR) is a low-cost, high-impact intervention with patient education and exercise at its core. Although supported by a well-established evidence base, demand greatly exceeds capacity in low- and middle-income countries (LMIC), including limited workforce training opportunities to support PR development and implementation. The International Primary Care Respiratory Group’s (IPCRG) Teach the Teacher (TtT) is an established education programme designed to build sustainable local clinical teaching and delivery capacity. Methods A collaboration between the National Institute for Health and Care Research (NIHR) funded Global RECHARGE Group for PR and IPCRG to deliver a ‘Teach the Teacher’ (TtT) programme for PR capacity building. Our Tier 1 TtT programme combined educational and PR service development concepts with core clinical content adapted for RECHARGE partners in India (Pune and Delhi), Sri Lanka, Kyrgyzstan and Uganda. Due to the severe acute respiratory syndrome coronavirus-2 (SARS‑CoV‑2) pandemic, the programme was adapted to a digital environment using online platforms such as Zoom video conferencing and Google Classroom. We used an adapted framework to evaluate professional learning and its impact. Findings Fifteen Tier 1/local leader participants attended a sixteen-hour online programme in September-October 2021. Participants included nurses, physiotherapists, doctors and early career health professionals/researchers. As local leaders in PR, participants created a tiered teaching programme for developing a critical mass of PR expert teachers, contextualised to their local healthcare systems and cultures. Participants also explored how to engage and influence multiple professional groups and stakeholders to support the widespread sustainable implementation of PR. Conclusions The RECHARGE-IPCRG TtT programme provided a clear education and service development framework to support PR capacity development in LMIC. We address a lack of empirical evidence concerning capacity-building initiatives by being explicit about the programme’s learning design, management and evaluation. A whole system perspective to PR allowed consideration of health systems, culture, referral pathways and scalability. Sustainable national PR education programmes will require additional resources and a long-term strategy, potentially aligning with the TtT three-tier cascade model.

Introduction: Increasing trend of childhood obesity leads to high blood Pressure (BP) in children and adolescents. Ethnic differences in BP have been reported. Normal BP values of Sri Lankan Tamil children are not available. Objective: To measure BP of healthy Sri Lankan Tamil children in the Jaffna district to get normal BP values and to correlate them with anthropometric measurements. Method: A population based descriptive cross sectional study was carried out among children and adolescents (950 boys, 972 girls) aged 6 to 18 years in schools in Jaffna district. Cluster sampling was applied to classrooms in the schools. The classes were selected by systematic random sampling. Age, height, weight, waist circumference and hip circumference were taken. Body mass index, waist hip ratio and waist height ratio were calculated. BP was measured with a mercury sphygmomanometer. Pubertal stage was assessed with a self-administered Tanner staging scale. Results: Mean of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) of boys and girls increased from 98/70 mm Hg and 99/70 mm Hg to 107/73 mm Hg and 107/73 mm Hg until 10 years, decreased slightly up to 13 years (101/64 mm Hg and 102/63 mm Hg) and increased until 18 years to 119/76 mm Hg and 111/70 mm Hg. From the age of 15 years, boys had higher SBP and DBP than girls (p<0.05). SBP had significant (p<0.001) positive correlations with pubertal staging and all measured anthropometric parameters. Highest correlation was observed with weight (0.522). A normogram for BP was constructed with age and height.

Reaction time (RT) is important in learning. Relationship of RT to Intelligent Quotient (IQ) and Working Memory (WM) has not been studied in Sri Lankans. To measure the visual RT(VRT), discrimination RT (DRT) and choice RT (CRT) of young adults and to correlate these reaction times (RTs) to IQ and WM. A cross sectional study was conducted among 200 volunteers (18-28 years). RTs were measured using the "reaction timer software" developed locally. WM was assessed using "digit span backward test (DSBT)". IQ was assessed using Raven's standard progressive matrices (RSPM). Mean, SD of VRT, CRT and DRT in males were 292.85±32.88ms, 395.75±75.62ms and 407.45±82.11ms respectively. The respective values in females were 317.85±43.15ms, 452.68±96.47ms and 454.26±93.5ms. RTs were faster (p<0.05) in males. VRT was faster (p<0.05) than CRT and DRT in both sexes. CRT and DRT did not differ significantly in both sexes (p>0.05). Mean IQ scores of males and females were 52.17± 6.2 and 51.74±6.2. Respective DSBT scores were 7.55±1.62 and 7.64±1.33. IQ and DSBT scores were not differed (p>0.05) between sexes. RTs had negative correlations with IQ and DSBT score. Only the correlations of IQ with VRT of males (-0.203) and DRT (-0.225) and CRT (-0.235) of females were significant (p<0.05). Significant negative correlation (-0.293) of DSBT score was observed with DRT of females only. RTs were shorter in males. IQ and WM capacity showed negative correlations with RTs. Further studies are necessary to assess the contribution of the processing speed on the IQ and WMC.