Background and Objective: At present, ethical outrages and moral disputes are major concerns in healthcare organizations. In such situations, ethical behavior has emerged an important enabler to manage healthcare organizations. There are several beneficial outcomes that have been documented in the growing body of research on ethical leadership. Ethical behavior would cause a positive effect not only on followers’ attitudes and behaviors but also on work environment in healthcare organizations. The study intended to assess the impact of ethical leadership on work environment in public hospital in Hail, Saudi Arabia. Methodology: In this crosse sectional study, a total of 387 working health care professionals in public hospitals in Hail, Saudi Arabia filled the distributed questionnaire between March 9, 2025 to May 14, 2025. Study respondents were selected through a simple random sampling method. Version- 4 of Smart PLS was used to apply partial least squares-structural equation modeling (PLS-SEM) to validate conceptual model. Results: In this study 55.3% of the respondents were women, 44.7% were men, and the average years of experience was 8.7 years. Study results found the statistically significant direct effect of ethical leadership on work environment (β=0.850, t=39.168, P<0.001). Conclusion: The study revealed that ethical leadership have positive impact on work environment in public hospitals in Hail, Saudi Arabia.

Objective:To consider empirically how authentic leadership (AL) effects burnout experience (BE) and the employee turnover intention (TI) in healthcare settings. Methodology:This study followed a cross-sectional design. Furthermore, a close-ended, online survey was conducted between March to May, 2025. It concludes with the data collection from 318 healthcare professionals. The participants mainly include doctors, and nurses at leadings hospitals in Ha'il region of Kingdom of Saudi Arabia (KSA). Finally, the analysis of data includes descriptive statistics, reliability analysis, correlation matrices, regression analysis and diagnostic tests. All of these analyses were performed using SPSS 27 version. Results:The descriptive summary volunteer participants showed that majority of them are predominantly female (e.g., nurses). Most of these participants were aged between 31-40 years and holding bachelor's qualifications. Moreover, empirical results from regression analysis revealed some interesting relationships. For example, the results indicate that AL is positively linked with BE (β = 0.0374, p = 0.006). However, a negative impact was also found for TI (β = -0.2805, p < 0.001). The model was statistically fit and provide a reasonable explained variations for BE (R 2 = 0.0241, F = 7.81, p = 0.006). and TI (R 2 = 0.1035, F = 36.51, p < 0.001). Conclusion:The study concludes a strong positive impact of AL on BE while a strong negative impact of AL with TI. These results suggested a strong effort from the leadership is necessary to enhance the retention and wellbeing of employees in healthcare setting. Finally, studies can be made to further examine the cultural and organizational factors that may moderate these impacts.

BACKGROUND:Sri Lanka's health policies prioritize improving hypertension control. The care cascade framework, a valuable tool that has informed hypertension control strategy in many countries, has not been assessed previously in Sri Lanka. This study addresses this gap using data from a nationally representative, longitudinal cohort study, providing a baseline for future monitoring. METHODS:We analysed data from the 2018-2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS). The extended care cascade included: (i) prevalence, (ii) ever screened, (iii) diagnosis, (iv) awareness, (v) treatment, (vi) adherence, and (vii) control. We used multivariate logistic regression to assess factors associated with attainment of each step, conditional on prevalence and on treatment, and we assessed socioeconomic inequalities using concentration indices. We also compared performance against global estimates, and against regional and middle-income countries. RESULTS:We included 6,342 participants in the analysis. The weighted prevalence of hypertension was 27.6%. Of those with hypertension, 87% had their blood pressure (BP) ever measured; 53% were diagnosed; 50% were aware of their condition; 44% were taking treatment; and 20% had their blood pressure under control. Females and older adults had better cascade outcomes, but this was driven by higher rates of diagnosis. Diabetes and increased body mass index (BMI) were associated with higher diagnosis rates, but not treatment and control after diagnosis. Education and sector of residence were not associated with disparities, but treatment rates were higher in the most socioeconomic advantaged. Concentration indices confirmed pro-rich inequality across the care cascade from ever screened to treatment and adherence, but control was not unequal, with the data suggesting better control by public providers, whom the poor relied on more. CONCLUSIONS:Only one in five Sri Lankans with hypertension achieve BP control, with the biggest cascade losses occurring at diagnosis and control after treatment. Our findings point to a substantial influence of providers. Efforts to improve hypertension control in Sri Lanka should focus on increasing detection through opportunistic screening and improving interventions to improve physician control of BP. These findings provide actionable insights for further research and to strengthen hypertension control efforts in Sri Lanka.

Background Medicinal plants and herbal preparations have been used in Ayurveda medicine to treat diabetes for centuries. Link Gluconorm (LG) is a standardized solid formulation comprising seven medicinal herbs that have been used as herbal ingredients in Ayurveda for treating type 2 diabetes mellitus (T2DM). This study evaluated the efficacy and safety of the solid form of LG, and its effect on the quality of life (QoL) in T2DM patients. Materials and methods An observational study was conducted on 37 newly diagnosed uncomplicated T2DM patients aged between 35 and 65 years, whose fasting blood glucose levels ranged between 110 and 160 mg/dL. They were being treated for diabetes using the LG herbal formulation as the sole treatment. Laboratory tests for assessing glycemic control and safety were done at baseline and repeated at 4-weekly intervals for 24-weeks. A validated diabetes-specific QoL inventory was administered every 2 weeks. Results The mean age was 48 ± 9y, and the mean body mass index was 25.0 ± 4.4 kg/m 2 and 25.2 ± 4.2 kg/m 2 for females and males, respectively. Statistically significant reductions in mean fasting blood glucose (153.85 mg/dL ± 15.62 to 129.01 mg/dL ± 12.88, p = 0.006), postprandial blood glucose (191.27 mg/dL ± 21.40 to 140.72 mg/dL ± 8.92, p < 0.001), glycosylated hemoglobin (8.51%±0.44 to 7.43%±0.40, p < 0.001) and improved QoL scores (1.93 ± 0.22 to 1.55 ± 0.08, p < 0.01) were observed at 24 weeks. There were no adverse changes in the hematological, liver and renal function safety parameters assessed using laboratory investigations. No adverse events or hypoglycemia were reported. Conclusions The polyherbal formulation LG significantly improved the QoL and glycaemic parameters and appeared safe after 24 weeks of treatment. Due to the small sample size, unblinded nature of this preliminary study, and the lack of a control arm, a randomized double-blinded controlled clinical trial on a larger group of patients is recommended.

The role of institutional partnerships is increasingly recognized as a means of advancing our collective efficacy in improving public health. Shared challenges related to infectious and chronic diseases, as well as social determinants of health including environmental stressors, have led to a growth in academic global health collaborations. Triggered by the 2004 tsunami, the University of Ruhuna, Sri Lanka, and Duke University, USA, established an educational and research collaboration that has been sustained and broadened over two decades. The initiation and development of the collaboration, as well as its educational and research components, are described in this manuscript. We discuss lessons learned that may be of interest to other emerging partnerships: the keys to the collaboration’s success, challenges and barriers faced, as well as plans to sustain and further grow an equitable, academically rigorous, and impactful global health partnership.

Background/Objectives: Ethical leadership (EL) propels and enhances employee performance (EP), especially in healthcare, where ethics are paramount. However, existing research lacks a focus on how EL functions within Saudi Arabia (SA)'s public healthcare context. Primarily, this research investigates how EL directly affects EP. The research also investigates how organizational support (OS) influences EP and moderates the EL-to-EP relationship. Methods: This cross-sectional study consisted of 312 responses from doctors, nurses, and other administrators within Saudi public healthcare units. To analyze the collected data statistically, structural equation modeling (SEM) was opted for with the help of Smart-PLS 4. It helped to assess the direct effects of EL and OS on EP and further examine OS's moderating role. A multigroup analysis (MGA) was also conducted in comparative form. It examined subgroup variations across gender, age, marital status, experience, and departmental affiliation. Results: The findings confirmed a positive impact of EL on EP. Moreover, a positive effect of OS on EP was also confirmed. Similarly, OS strengthened the positive effect of EL on EP. The MGA revealed variations across employee groups. It offered practical insights into how EL and OS function in diverse organizational contexts. These differences across groups reflect cultural and structural features of Saudi public healthcare. Conclusions: The extended research contributes to the literature on ethical leadership (EL) theory by applying contextual and demographic contingencies within the Saudi public healthcare sector. It also introduces OS as a significant moderator and provides actionable implications for improving performance through context-sensitive leadership and support strategies.

Background:Reliable epidemiological evidence of alcohol use in Sri Lanka is limited. This study addressed this gap using nationally representative data. Methods:Data from a 2018/2019 national study of non-institutionalized adults in Sri Lanka were used. Weighted data were analysed using descriptive and logistic regression techniques. Results:Among 6473 adults (mean age 43.9 (SD = 16.7); 52.5 % women) surveyed, 53.1 % (95 %CI; 51.9 %, 54.3 %) of men and 2.0 % (95 % CI; 1.9 %, 2.1 %) of women were current (yearly) alcohol users. Per capita consumption of alcohol was 3.12 l for men and 0.028 l for women. Predictors of alcohol use in men included being aged 30-39 years, Sinhalese ethnicity, secondary education, currently married, and being in the middle wealth quintile and in women, being aged 30-39 years, Indian Tamil ethnicity, tertiary education, being a widow or separated, and being in the highest wealth quintile were the significant predictors of current alcohol use. Hazardous drinking (≥21 units per week) was observed only in men: 14.1 %. In men, smoking, elevated blood pressure and low self-rated health were related to higher likelihood of alcohol use. Alcohol use showed protective effects on type 2 diabetes and depression in men. Conclusions:Prevalence, distribution and associated factors of alcohol use vary by demographic and health characteristics of Sri Lankan adults. Preventive strategies should be based on population risk stratification of alcohol use.

Objective:The study aimed to examine the factor structure and psychometric properties of ethical leadership questionnaire (ELQ) by using a healthcare professional sample in Saudi Arabia. Methods:A cross-sectional study was conducted, and a total of 387 healthcare professionals completed the 15-items ELQ questionnaire between 18 October, 2023 and 17 January, 2024. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a reliability test were performed on the obtained data. Results:It was found that the ELQ involved four factors including honesty (four items), integrity (four items), sets example (three items), and concern for values (four items). The study was able to explain 74.14% of the total variance. The model comparative fit index (CFI) was 0.952, the goodness-of-fit index (GFI) was 0.915, the standardized root mean squared residual (SRMR) was 0.0536, and the root mean square error of approximation (RMSEA) was 0.076. The reliability value was obtained by using Cronbach's alpha, and the results of each subscale were higher than 0.80, which means they were deemed adequate and reliable. The results from these fit indices indicated that the four-factor model with EC offered the utmost fit. Conclusion:The ELQ is a reliable and valid instrument that can be used on this population to determine employees' perceptions of their leaders' ethical behavior.

Introduction: Lymphoedema (LE) due to lymphatic filariasis (LF) is considered a neglected, lifelong disease. This study aims to deliver and evaluate psychological support provided to a sample of patients using a newly developed, culturally appropriate questionnaire.Methods: Two groups of patients with lymphoedema due to lymphatic filariasis in Southern Sri Lanka were enrolled in a case-control study to assess the effect of psychosocial support on their Psychosocial Burden (PSB) using a disease-specific questionnaire (PSB-CL15). Results: The scale scores indicated a significant improvement in the total score as well as in all four dimensions (social, physical, fear, and humiliation) following the psychosocial support intervention. However, the humiliation dimension appeared more resistant to improvement according to the individual item analysis.Conclusions: The psychosocial burden of LF patients with LE can be successfully alleviated through psychological support, and the dimensions of PSB can be effectively identified using the PSB-CL15 questionnaire.

Objective: To examine junior managers experiences of ethical leadership behaviors exhibited by their senior managers. Methods: In this cross-sectional study, 263 junior health care managers working in public hospitals in Hail, Saudi Arabia were surveyed using a self-administered questionnaire between 20 November, 2022 and 15 February, 2023. Descriptive statistics and regression analysis were employed in the analysis. Statistical Package for Social Sciences (SPSS) version 25 (IBM, Armonk, NY, USA) was used to conduct statistical analyses. Results: The sample consisted of 118 men (44.9%) and the majority (66.6%) of the respondents were below the age of 36 years. In case of working environment, nearly 84% of the participants were satisfied with the relationships that they have had with their supervisors. Regression analysis indicate that women were more likely than men to experience healthy ethical leadership behaviors of their seniors (β = -0.163, p < 0.05). Ethical leadership behaviors of senior health care managers would not influence by the age or work experience of their juniors. Conclusion: Ethical leadership behavior of senior health care managers was satisfactory. Longitudinal research is needed to investigate how cultural and environmental factors affect the ethical leadership behavior of healthcare managers in Saudi Arabia. doi: https://doi.org/10.12669/pjms.40.5.8996 How to cite this: Aldhmadi BK, Kumar R, Perera B, Algarni MA, Raguindin SM, Attar AA, et al. Ethical leadership behaviors of senior managers perceived by the junior managers working in public hospitals in Hail, Saudi Arabia. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8996 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background:It has been postulated that the lipid effects of coconut could be mediated by its fatty acids, fiber and lysine/arginine ratio. Hence, the lipid effects of coconut oil could be different from the effects of the kernel flakes or milk extract because the constituents could be different in each coconut preparation. The present research investigated the lipid effects of different modes of coconut used in food preparation. Methods:This study involved a total of 190 participants, randomized into four groups, which received coconut oil supplement (30 ml) (n = 53), kernel flakes (30 g) (n = 52) or coconut milk powder (30 g) (n = 44) for a period of 8 weeks. The control group (n = 41) received no supplement. Lipid assays were performed at baseline and at the end of the 4th and 8th weeks. The generalized estimating equations (GEE), ANOVA, and paired and independent t-tests were used in the analysis. Result:The age range of the participants was 25-60 years, and 52.6% of them (n = 100) were men. Coconut milk supplementation induced beneficial changes in the lipid profile in that the LDL and non-HDL levels decreased while the HDL levels increased. The subgroup whose baseline LDL level was elevated appeared to benefit most from coconut milk supplementation. Coconut oil and kernel flakes failed to induce favorable lipid changes comparable to coconut milk supplementation. Conclusion:Differing concentrations of protein, fat and fiber in coconut preparations could possibly explain the dissimilar effects on the lipid profile caused by the different coconut preparations. The benefits of coconut milk seen in the high basal LDL subgroup warrant a detailed study.

Journal Article Cohort Profile: The Sri Lanka Health and Ageing Study (SLHAS) Get access Ravindra P Rannan-Eliya, Ravindra P Rannan-Eliya Institute for Health Policy (IHP), Colombo, Sri Lanka Corresponding author. Institute for Health Policy, 72 Park Street, Colombo 00200, Sri Lanka. E-mail: ravi@ihp.lk https://orcid.org/0000-0002-5013-2816 Search for other works by this author on: Oxford Academic PubMed Google Scholar Vajira H Dissanayake, Vajira H Dissanayake Department of Anatomy, Genetics and Biomedical Informatics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka https://orcid.org/0000-0002-3264-6856 Search for other works by this author on: Oxford Academic PubMed Google Scholar Prasadini Perera, Prasadini Perera Department of Pharmacy, University of Peradeniya, Peradeniya, Sri Lanka https://orcid.org/0000-0001-7887-7564 Search for other works by this author on: Oxford Academic PubMed Google Scholar Bilesha Perera, Bilesha Perera Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka https://orcid.org/0000-0001-5398-710X Search for other works by this author on: Oxford Academic PubMed Google Scholar H M Meththananda Herath, H M Meththananda Herath Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka https://orcid.org/0000-0001-5853-8880 Search for other works by this author on: Oxford Academic PubMed Google Scholar Nilmini Wijemunige, Nilmini Wijemunige Institute for Health Policy (IHP), Colombo, Sri Lanka https://orcid.org/0000-0002-2241-3194 Search for other works by this author on: Oxford Academic PubMed Google Scholar Shanti Dalpatadu, Shanti Dalpatadu Institute for Health Policy (IHP), Colombo, Sri Lanka Search for other works by this author on: Oxford Academic PubMed Google Scholar Sarath Samarage, Sarath Samarage Institute for Health Policy (IHP), Colombo, Sri Lanka https://orcid.org/0000-0002-8137-3786 Search for other works by this author on: Oxford Academic PubMed Google Scholar Anuji Gamage, Anuji Gamage Department of Public Health and Family Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka https://orcid.org/0000-0002-4713-9283 Search for other works by this author on: Oxford Academic PubMed Google Scholar Renuka Jayatissa, Renuka Jayatissa Nutrition Department, Medical Research Institute (Ministry of Health), Colombo, Sri Lanka https://orcid.org/0000-0002-3961-8735 Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Eustace Y Fernando Eustace Y Fernando Faculty of Applied Sciences, Rajarata University, Mihintale, Sri Lanka https://orcid.org/0000-0003-4877-0306 Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 53, Issue 2, April 2024, dyae044, https://doi.org/10.1093/ije/dyae044 Published: 21 March 2024 Article history Received: 10 August 2023 Editorial decision: 13 February 2024 Accepted: 07 March 2024 Published: 21 March 2024

Elderly are considered a high-risk group for COVID-19 due to the occurrence of severe disease with higher mortality. High prevalence of comorbidities and deprived access of routine health care can make them particularly susceptible for complications of COVID-19. Moreover, the elderly share certain misconceptions on disease prevention/immunization resulting in poor vaccine acceptance. Data on non-communicable disease (NCD) status and their control during COVID-19 pandemic among community-dwelling elderly would be important in designing disease control strategies in future pandemics. This study evaluated self-reported NCD status and acceptance of vaccination against COVID-19 among elders in an urban locality of Southern Sri Lanka.

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (β = .52, p < .01) and reduces the time required to complete physical functions (β = −.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Introduction: Religious and spiritual support reduces distress in patients with cancer. Accurate and reliable data on religious and spiritual support received and perceived by patients with cancer would assist health authorities in planning health promotion strategies targeted at patients with cancer. In this study, a new measurement tool of religious and spiritual support for patients with cancer in Sri Lanka was developed and validated. Methods: A new tool, the Religious and Spiritual Support Scale (RSSS) was developed based on the previous questionnaire and evaluated using 40 patients with cancer. Cross-cultural adaptation was made using WHO guidelines. Reliability was checked using Cronbach’s alpha. Intra-class correlation coefficient (ICC) was used to examine the test-retest reliability of the tool. Convergent and divergent validity of the tool was examined using the World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and the Centre for Epidemiological Studies–Depression scale (CES-D). Exploratory factor analysis (EFA) was performed to test the construct validity of the RSSS. Results: The RSSS showed a high internal consistency (Cronbach’s alpha-0.874). The test-retest reliability of the scale was good (ICC = 0.981). As expected, the overall RSSS score correlated negatively with CES-D (r= - 0.338, p<0.05) and positively with overall QoL scores of the WHOQOL-BREF; (r=0.421, p<0.001), confirming satisfactory divergent and convergent validity of the RSSS. EFA revealed a structure comprised of two factors: Religious practice and religious support. Conclusions: The RSSS is a reliable and valid scale to assess religious and spiritual support received and perceived by patients with cancer in Sri Lanka.

Introduction: The Multidimensional Scale of Perceived Social Support (MSPSS) is a tool widely used in health surveys to assess social support (SS) perceived by individuals. The lack of an appropriate tool to measure SS perceived by patients with cancer has hindered our understanding of how SS is associated with the management and recovery process of Sri Lankan patients with cancer. The study aimed to examine the reliability and validity of the Sinhalese version of the MSPSS.Methods: Cross-cultural adaptation of the MSPSS was done following the standard guidelines of the process of translation and adaptation set by the World Health Organization. The study sample consisted of 40 patients with cancer at the Teaching Hospital Karapitiya, Galle, Sri Lanka. Data analysis was done using SPSS 25.0. Internal consistency of the overall MSPSS was calculated using Cronbach’s alpha. Test-retest reliability of the tool was also assessed using the intra-class correlation coefficient (ICC). The convergent and divergent validity of the tool was assessed using the Centre for Epidemiological Studies-Depression (CES-D) and the World Health Organization-Quality of Life-Brief Scale (WHOQoL-BREF). Construct validity was assessed using Exploratory Factor Analysis (EFA).Results: The Sinhalese version of MSPSS showed high reliability (Cronbach’s alpha-0.911). The tool showed favourable test-retest reliability (ICC=0.91). The overall MSPSS score was correlated negatively with depressive symptoms (r= -0.459, p<0.001) and positively with dimensions of quality-of-life scores; overall (r=0.674, p<0.001), physical (r=0.426, p<0.001), psychological (r=0.540, p<0.001), social (r=0.674, p<0.001) and environmental quality of life (r=0.767, p<0.001) ensuring strong discriminant/divergent and convergent validity of the Sinhalese version of the MSPSS. Factor analysis extracted three factors (e.g., family, friends, and significant others) explaining 96.65% of the variance.Conclusion: The Sinhalese version of MSPSS is a reliable and valid tool to assess the perceived SS from family, friends, or significant others among patients with cancer.

Introduction This study’s objective was to produce robust, comparable estimates of the prevalence of diabetes and pre-diabetes in the Sri Lankan adult population, where previous studies suggest the highest prevalence in South Asia. Research design and methods We used data on 6661 adults from the nationally representative 2018/2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS). We classified glycemic status based on previous diabetes diagnosis, and either fasting plasma glucose (FPG), or FPG and 2-hour plasma glucose (2-h PG). We estimated crude and age-standardized prevalence of pre-diabetes and diabetes and by major individual characteristics weighting the data to account for study design and subject participation. Results Crude prevalence of diabetes in adults was 23.0% (95% CI 21.2% to 24.7%) using both 2-h PG and FPG, and age-standardized prevalence was 21.8% (95% CI 20.1% to 23.5%). Using only FPG, prevalence was 18.5% (95% CI 7.1% to 19.8%). Previously diagnosed prevalence was 14.3% (95% CI 13.1% to 15.5%) of all adults. The prevalence of pre-diabetes was 30.5% (95% CI 28.2% to 32.7%). Diabetes prevalence increased with age until ages ≥70 years and was more prevalent in female, urban, more affluent, and Muslim adults. Diabetes and pre-diabetes prevalence increased with body mass index (BMI) but was as high as 21% and 29%, respectively, in those of normal weight. Conclusions Study limitations included using only a single visit to assess diabetes, relying on self-reported fasting times, and unavailability of glycated hemoglobin for most participants. Our results indicate that Sri Lanka has a very high diabetes prevalence, significantly higher than previous estimates of 8%–15% and higher than current global estimates for any other Asian country. Our results have implications for other populations of South Asian origin, and the high prevalence of diabetes and dysglycemia at normal body weight indicates the need for further research to understand the underlying drivers.

Background: A correct understanding of pregnancy and related issues would facilitate pregnant women to manage their pregnancies well. The objective of this study was to assess the pregnancy-related information needed by pregnant women in Sri Lanka and the obstacles that they face when acquiring such information. Materials and Methods: A descriptive cross-sectional study was conducted among 420 pregnant women admitted to a teaching hospital in Southern Sri Lanka. Data related to demography, information needed, sources of information seeking, and barriers that they face in acquiring such information were collected using an interviewer-administered questionnaire. Mean scores of the information needed (ranges 0–4) in different areas and a total score of the information needed were calculated. Regression analysis was used to identify possible predictors of information needed by the target group. Results: Family members, visiting obstetrician and gynecologist, antenatal clinical staff, and midwives were the common sources of information for nearly 80% of the participants. Psychological and physical complications after delivery (2.61 ± 1.21), special tests during pregnancy (2.44 ± 1.26), development and growth of the fetus (2.40 ± 1.26), and nutrition during pregnancy (2.36 ± 1.26) were the main areas where accurate and more information was sought by the participants. Failures in making a distinction between correct and incorrect information received ( n = 113 [26.9%]) and poor interactions between healthcare providers and pregnant women ( n = 103 [24.5%]) were the main barriers identified in acquiring trustworthy information. About one-fourth of the participants had used pregnancy-related apps. Information needs were high among pregnant women with less number of children ( β = −0.14, p < .01). Age, income, and area of living (rural or urban) did not significantly predict information needs in this target population. Conclusion: The free maternal and child healthcare system prevailing in the country seems to be the main source of information gathering for pregnant mothers. Physical, psychological, and nutritional facts related to pregnancy and its management should be increased among pregnant mothers, and it is imperative to empower them in the identification of correct information from authenticated sources. Primigravida women need more educational support. Electronic platforms should be effectively used in the future to disseminate information required by pregnant women in the country.

Background: Religious and spiritual support (RSS) is considered a vital method of coping among patients with cancer and cancer survivors. Measuring religion and spiritual support received by cancer patients has very little evidence in Sri Lanka compared to the western countries. It would be affected on cancer care management and speedy recovery process of cancer patients; could be benefited to reduce long-term suffering of patients with cancer. This study aimed to develop and validate a tool to measure religion and spiritual support in patients with cancer. Methods : WHO guidelines were incorporated into the cross-cultural adaptation of the newly developed religious and spiritual support scale (RSSS). Internal consistency for the overall RSSS was investigated using Cronbach’s alpha. Intra-class correlation coefficient (ICC) was used to examine the test-retest reliability of the RSSS for the same sample. Validity was checked using convergent and divergent validity. Principal component analysis (PCA) was performed to test factorial/construct validity. Results : The Sinhalese version of RSSS showed a high internal consistency (Cronbach’s alpha-0.883). The scale revealed favourable test-retest reliability (ICC = 0.981). The overall RSSS score correlated negatively and positively with depressive symptoms (r= - 0.338, p<0.05) and quality of life scores; overall (r=0.421, p<0.001), physical (r=0.340, p<0.05), psychological (r=0.279, p=0.08), social (r=0.373, p<0.05) and environmental quality of life (r=0.429, p<0.001) confirming satisfactory divergent and convergent validity of the Sinhalese version of the RSSS. Factor analysis with PCA extracted two factors explaining 74.47% of the variance. Conclusions : The Sinhalese version of RSSS is a reliable and valid scale to assess the religious and spiritual support of patients with cancer in Sri Lanka.

Background: Sri Lanka lacks robust estimates of hypertension (HTN) prevalence owing to few national studies, hindering optimization of control strategies. Evidence on how the revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) HTN definition affects prevalence in low- and middle-income countries (LMICs) is also limited. Objectives: To make robust estimates of HTN prevalence in the Sri Lankan adult population, and to assess impact of the ACC/AHA 2017 definitions. Methods: Data were sourced from the 2018–2019 first wave of the Sri Lanka Health and Ageing Study (SLHAS), a nationally representative longitudinal study of the noninstitutionalized adult population. After excluding those with missing data and aged <18 years, 6,342 participants (95.1%) were included in the analysis. HTN was defined using either the traditional threshold of systolic BP (SBP) ≥140 mmHg or a diastolic BP (DBP) ≥90 mmHg, or the ACC/AHA 2017 threshold of SBP ≥130 mmHg or DBP ≥80 mmHg, or if taking antihypertensive medication. Results: Estimated prevalence of HTN in all Sri Lankan adults was 28.2% using the traditional definition, and it doubled to 51.3% when applying the ACC/AHA 2017 definition. Of those classified as hypertensive according to the older and ACC/AHA 2017 definitions, 53.4% and 31.2%, respectively, were previously diagnosed. Of the 23.2% of adults reclassified as hypertensive by the ACC/AHA 2017 definition, 16.6% had a history of CVD or diabetes. Increased prevalence was associated with urban residence, socioeconomic status, obesity, and Muslim ethnicity. Prevalence increased with age, but the increase was steeper in women from their 30s. Conclusions: Nearly one in three adult Sri Lankans are hypertensive, requiring antihypertensive treatment. Applying the ACC/AHA 2017 definitions almost doubles numbers, but many of those reclassified would require treatment under recent WHO guidelines. Study findings also suggest that design effects in HTN surveys may be higher than usually assumed.