Background Mental illness contributes significantly to the global disease burden. There is great diversity in the manner in which mentally ill patients seek help as this is influenced by their beliefs and the opinion of the familysocial support unit. The stigma associated with mental illness is a barrier to effective therapy in Sri Lanka where systematic public awareness programmes are minimal.Objective To study the help-seeking behaviour and its impact on patients attending a psychiatry clinic of the National Hospital of Sri Lanka.Methods A cross sectional study was carried out among 120 attendees of the psychiatry clinic of the National Hospital of Sri Lanka. Sample was selected using systematic sampling. Data was collected using an interviewer administered questionnaire.Results More than half the participants sought psychiatric care as their first help-seeking behaviour and found it significantly more useful than non-psychiatric care alternatives. The average time to seek psychiatric care, irrespective of the pathway to care, was less than one month. The recommendation of the family and the social support unit and perceiving that the symptoms were due to a mental illness were the key factors in determining helpseeking behaviour. The average expense on alternative care was zero. There was no significant difference on the impact to employment among those that chose psychiatry care initially from those that did not.Conclusions Our findings suggest that mentally ill patients presenting to a tertiary care hospital in Colombo, are likely to seek psychiatric care early. This is probably due to better recognition and knowledge regarding available treatment.

Introduction: Hypertensive disorders in pregnancy are an important cause of maternal mortality in Sri Lanka. Gestational hypertension (GH)/Pre-eclampsia (PEC) and threatened miscarriage (TM) share common pathophysiological mechanisms. This study was conducted to determine the association between TM and development of GH/PEC. Methodology:A case control study was conducted at Castle Street Hospital for Women, Sri Lanka from May 2014 to May 2015. Cases consisted of patients with GH/PEC and compared with age and parity matched controls. A systematic random sampling method was used. Similar number of cases and controls were compared while each group consisted of 245 subjects. Data was obtained from medical records. Patients aged 20-35 years were included and medical disorders other than GH/PEC were excluded.Results: There were 245 subjects in each group of the study. Among the cases, 56% had GH and the rest had PEC. There were 25 patients had a history of TM in the study population. About 6.5% of cases had a history TM, while only 3.6% of controls had TM. There is also a significant risk of developing PEC in a patient who had a history of threatened miscarriage (OR 3.31,. Moreover the patients who had a history of TM tend to develop GH or PEC early, within 20-32 weeks of gestation (OR 11.49,). As we identified, 62% of patients who had TM developed GH/PEC early (from 20 to 32 weeks) but among the cases who had no history of TM, only 12% developed GH/PEC between 20 to 32 weeks of gestation (O.R. 20.7 (5.66 to 91.96). There is a significant risk of developing severe GH/PEC in the group of patients who had a history of TM (OR 8.59,. Eighty one percent (81%) of the cases, who had a history of TM, developed severe and moderate GH/PEC rather than mild. But the majority (63%) of the cases, who had no history of TM, developed mild GH/PEC (O.R. 7.6 (2.00 to 42.55).Conclusions: Shared pathophysiological mechanisms of GH/PEC and TM may explain the observed association between these obstetric complications. Early onset, severe GH/PEC in cases with TM suggests temporality and a biological gradient which favors causality.

PURPOSE This study sought to examine whether there was an association between language barriers and patient satisfaction with breast cancer care in Sri Lanka. METHODS A telephone-based survey was conducted in the three official languages (Sinhala, Tamil, or English) among adult women (older than 18 years) who had been treated for breast cancer within 6-12 months of diagnosis at the National Cancer Institute of Sri Lanka. The European Organisation for Research and Treatment of Cancer Satisfaction with Cancer Care core questionnaire was adapted to assess three main domains (physicians, allied health care professionals, and the organization). All scores were linearly transformed to a 0-100 scale, and subscores for domains were summarized using means and standard deviations. These were also calculated for the Sinhalese and Tamil groups and compared. RESULTS The study included 72 participants (32 ethnically Tamil and 40 Sinhalese, with 100% concordance with preferred language). The most commonly reported best aspect of care (n = 25) involved affective behaviors of the physicians and nurses. Ease of access to the hospital performed poorest overall, with a mean satisfaction score of 54 (30.5). Clinic-related concerns were highlighted as the worst aspect of the care (n = 10), including long waiting times during clinic visits. Sixty-three percent of Tamil patients reported receiving none of their care in Tamil and 18% reported experiencing language barriers during their care. Tamil patients were less satisfied overall and reported lower satisfaction with care coordination ( P = .005) and higher financial burden ( P = 0.014). CONCLUSION Ethnically Tamil patients were significantly less satisfied than their Sinhalese counterparts and experienced more language barriers, suggesting there is a need to improve access to language-concordant care in Sri Lanka.

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Introduction: Gestational hypertension (GH)/Pre-eclampsia (PEC) is an important cause of direct maternal deaths in Sri Lanka. GH/PEC and threatened miscarriage (TM) share common pathophysiological mechanisms. This study was conducted to determine the association between TM and development of GH/PEC. Methodology: A case control study was conducted at Castle Street Hospital for Women, Sri Lanka from April 2015 to October 2015. Cases consisted of patients with GH/PEC and compared with age and parity matched controls. A systematic random sampling method was used. Similar number of cases and controls were compared while each group consisted of 245 subjects. Data was obtained from medical records. It is also important to note that mothers aged 20-35 years were included and medical disorders other than GH/PEC was excluded. Results: There were 245 subjects in each group of the study. Among the cases, 56% had GH and the rest had PEC. There were 25 patients with TM in the study population and 64% of them subsequently developed GH or PEC. There is also a significant risk of developing PEC in a patient who had a history of threatened miscarriage (OR 3.31, 95% CI 1.35-8.11). Moreover the patients who had a history of TM tend to develop GH or PEC early, within 20-32 weeks of gestation (OR 11.49, 95% CI 3.88-33.99). As we identified, 62% of patients who had TM developed GH/PEC early (from 20 to 32 weeks) but among the cases who had no history of TM, only 12% developed GH/PEC between 20 to 32 weeks of gestation (O.R. 20.7 (5.66 to 91.96). There is a significant risk of developing severe GH/PEC in the group of patients who had a history of TM (OR 8.59, 95% CI 2.87- 25.66). Eighty one percent (81%) of the cases, who had a history of TM, developed severe and moderate GH/PEC rather than mild. But the majority (63%) of the cases, who had no history of TM, developed mild GH/PEC (O.R. 7.6 (2.00 to 42.55).