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Song W, Su F, Li S, Wang S. The association between soyfoods or soybean products consumption and executive functioning among Chinese adolescents: A cross-sectional multicenter study. Acta Psychol (Amst) 2024; 246:104260. [PMID: 38626599 DOI: 10.1016/j.actpsy.2024.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND The association of soyfoods or soybean products with executive functions in the brain has been less well studied. In this study, we investigated the consumption of soyfoods or soybean products and its association with executive functions in Chinese adolescents. METHODS A three-stage stratified whole group sampling method was used to investigate the consumption of soyfoods or soybean products and executive functions among 1643 Chinese adolescents aged 13-15 years. One-way ANOVA and chi-square test were used to compare the basic conditions and executive functions of adolescents with different soyfoods or soybean products consumption. Linear regression analysis and logistic regression analysis were used to analyze the association between soyfoods or soybean products and executive functions. RESULTS The proportions of Chinese adolescents with soyfoods or soybean products consumption ≤0 time/week, 1-3 time/week, and ≥4 time/week were 41.14 %, 46.80 %, and 12.05 %, respectively. Logistic regression analysis showed that with adolescents with soyfoods or soybean products consumption ≥4 time/week as a reference, adolescents with ≤0 time/week were less likely to have executive dysfunction in inhibiting functional (OR = 17.523, 95 % CI: 7.501, 40.938), 2back (OR = 3.384, 95 % CI: 1.729, 6.623), and switching functional (OR = 7.846, 95 % CI: 3.300, 18.657), were at higher risk of executive dysfunction (P < 0.001). CONCLUSION Chinese adolescents' consumption of soyfoods or soybean products is inadequate and has a positive association with executive functions. The consumption of soyfoods or soybean products among Chinese adolescents should be increased in the future.
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Affiliation(s)
- Wei Song
- College of Education and Sports Sciences, Yangtze University, Hubei, Jingzhou 434023, PR China
| | - Fan Su
- College of Physical Education, China Three Gorges University, Hubei, Yichang 443002, PR China
| | - Shengpeng Li
- School of Preschool Education, Jingzhou Institute of Technology, Hubei, Jingzhou 434020, PR China
| | - Shoudu Wang
- School of Sports Science, Wenzhou Medical University, Zhejiang, Wenzhou 325000, PR China.
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Gamage MWK, Jagodage HMH, De Silva KK, Kariyawasam PN, Sundarapperuma TD. Quality of care as perceived by caregivers and residents in aged care homes in Sri Lanka: a qualitative study. BMC Geriatr 2024; 24:103. [PMID: 38281019 PMCID: PMC10821234 DOI: 10.1186/s12877-024-04721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/18/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE Quality of care determines the physical and psychological wellbeing of aged care residents. The study aims to explore barriers and facilitators of quality of care in aged care homes (ACHs) in Sri Lanka from the perspective of older adults and caregivers. METHODS This qualitative descriptive exploratory study was conducted in selected five ACHs in Galle District, Sri Lanka, from May 2021 to January 2022. We recruited a purposive sample of residents and caregivers and conducted ten in-depth interviews with ten caregivers and nine focus group discussions with forty-five residents. The data were analysed using the thematic analysis. RESULTS The majority of caregivers and residents were females. Caregivers and residents were aged 25-35 years and 70-80 years, respectively. Two major themes emerged: (a) barriers of quality of care and (b) facilitators of quality of care. Both residents and caregivers reported a lack of referring system facilities; a lack of financial support on the infrastructure; a lack of financial support in supplying medication and employing human resources; insufficient knowledge of gerontological care and geriatric syndromes for both caregivers and residents; and lack of interest in being a caregiver at the ACHs as barriers in providing quality care. Moreover, caregivers and older people reported donations by philanthropists; supportive leadership; and welfare benefits from the government authorities as facilitators of quality care. Additionally, caregivers reported a lack of in-service programmes for caregivers as a barrier and positive institutional values as a facilitator for providing quality care. CONCLUSION The available human and physical resources are insufficient to address the demanding needs of residents in ACHs, apart from the received donations. There is a simultaneous need for healthcare policymakers' and social welfare authorities' attention to implementing necessary measures to uplift the quality of care for residents in ACHs to enhance their quality of life.
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Affiliation(s)
| | | | - Kkpm Kumari De Silva
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
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Poudel P, Paudel G, Acharya R, George A, Borgnakke WS, Rawal LB. Oral health and healthy ageing: a scoping review. BMC Geriatr 2024; 24:33. [PMID: 38191307 PMCID: PMC10773108 DOI: 10.1186/s12877-023-04613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people. METHODS A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework. RESULTS The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. CONCLUSION There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.
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Affiliation(s)
- Prakash Poudel
- Office of Research and Education, Canberra Health Services, Australian Capital Territory (ACT) Government, Garran, ACT, 2606, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
| | - Reecha Acharya
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Australia.
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, 2751, Australia
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Olegário RL, Fernandes SR, de Moraes R. Efficacy of cognitive training on executive functions in healthy older adults: a systematic review with meta-analysis of randomized controlled trials. Psychol Health 2023:1-28. [PMID: 37822255 DOI: 10.1080/08870446.2023.2267610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Systematically review randomized controlled trials on the efficacy of cognitive training on executive functions in healthy older people. MEASURES The outcome measures were related to inhibitory control, working memory, and cognitive flexibility. RESULTS Thirty-one trials were included in the systematic review and thirteen trials in the meta-analysis. In the overall analysis, the cognitive training enhanced inhibitory control when measured by the Stroop task (p < .001, d = 1.64) and working memory when measured by the Corsi Block task (p = .002, d = .16). A marginal significance was found for working memory in the Digit Span task - Forward (p = .06, d = .92). However, cognitive training did not enhance inhibitory control when measured by the Go/No-Go task (p = .76, d = .59), working memory when measured by the Digit Span - Backward (p = .72, d = .95) and N-Back (p = .10, d = .26) tasks, and cognitive flexibility when measured by Trail Making - Part B (p = .08, d = .27) and Semantic Fluency (p = .49, d = .06) tasks. CONCLUSION Mixed evidence was found for inhibitory control and working memory; cognitive flexibility showed no evidence of improvement.
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Affiliation(s)
- Raphael Lopes Olegário
- Institute of Psychology, University of Brasília, Brasília, DF, Brazil
- Postgraduate Program in Behavioural Sciences, University of Brasília, Brasília, DF, Brazil
| | | | - Rui de Moraes
- Institute of Psychology, University of Brasília, Brasília, DF, Brazil
- Postgraduate Program in Behavioural Sciences, University of Brasília, Brasília, DF, Brazil
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Wickramasinghe A, Gamage M, Torabi MR, Perera B. Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka. DIALOGUES IN HEALTH 2022; 1:100079. [PMID: 38515873 PMCID: PMC10953875 DOI: 10.1016/j.dialog.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 03/23/2024]
Abstract
Background and aim Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka. Methods A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis. Results The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults. Conclusions Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.
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Affiliation(s)
- Anuradha Wickramasinghe
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Madushika Gamage
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Mohammad R. Torabi
- School of Public Health – Bloomington, Indiana University, IN 47405, USA
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Cantisano N, Menei P, Roualdes V, Seizeur R, Allain P, Le Gall D, Roy A, Dinomais M, Laurent A, Besnard J. Relationships between executive functioning and health-related quality of life in adult survivors of brain tumor and matched healthy controls. J Clin Exp Neuropsychol 2022; 43:980-990. [PMID: 35230209 DOI: 10.1080/13803395.2022.2040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Few studies have considered health-related quality of life (HRQOL) as a primary outcome measure in adult survivors of primary brain tumor (PBT), and fewer still have studied the cognitive factors that may influence it. Research suggests that executive functions (EFs) are associated with HRQOL, but there is scant evidence to support this. The present study was conducted to (1) extend prior findings about HRQOL limitations in a sample of stable, long-term adult survivors of PBT, (2) investigate the associations between objective/reported EFs and HRQOL, and (3) identify the EFs that contribute most to HRQOL. METHOD We recruited 40 survivors of PBT (> 2 years post-treatment) and 40 matched healthy controls. Participants completed an objective EF assessment (inhibition, working memory, shifting, and rule detection) and two self-report questionnaires probing EFs (Behavior Rating Inventory of Executive Function-Adult) and HRQOL (Medical Outcomes Study Short-Form 36). Participants' relatives completed observer-rated versions of these questionnaires. RESULTS Patients' objective EF performances were relatively intact. However, patients and caregivers reported significantly more problems than healthy controls and their relatives, for both EFs and HRQOL. There were only negligible links between objective EFs and HRQOL, whereas numerous associations were found between reported EFs and HRQOL components. ANCOVA models revealed that specific reported EF processes contributed to both the physical and mental components of HRQOL, regardless of group. CONCLUSIONS From a clinical point of view, this study demonstrates that even several years after end of treatment, adult PBT survivors experience substantial problems across different HRQOL domains. HRQOL assessment should therefore be part of the long-term follow-up of PBT survivors, and clinicians should consider EF limitations when designing appropriate survivorship care plans. These findings indicate that cognitive interventions targeting EFs could improve HRQOL.
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Affiliation(s)
- Nicole Cantisano
- Centre d'Etudes En Psychopathologie Et Psychologie de la Santé (Ea 7411), University of Toulouse Jean Jaurès, Toulouse, France
| | - Philippe Menei
- Department of Neurosurgery, Angers University Hospital, Angers, France
| | - Vincent Roualdes
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Romuald Seizeur
- Department of Neurosurgery, Brest Regional University Hospital, Brest, France
| | - Philippe Allain
- Department of Neurology, Angers University Hospital, Angers, France.,Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
| | - Didier Le Gall
- Department of Neurology, Angers University Hospital, Angers, France.,Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
| | - Arnaud Roy
- Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France.,Centre Référent Des Troubles d'Apprentissage Et Centre de Compétence Nantais de Neurofibromatose, Nantes University Hospital, Nantes, France
| | - Mickaël Dinomais
- Department of Paediatric Physical Medicine and Rehabilitation, Angers University Hospital, Angers, France
| | | | - Jérémy Besnard
- Univ Angers, Department of Psychology, Nantes Université, Laboratoire de psychologie des Pays de la Loire (LPPL, UR 4638), SFR CONFLUENCES, F-49000, Angers, France
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Engel-Yeger B, Rosenblum S. Executive dysfunctions mediate between altered sensory processing and daily activity performance in older adults. BMC Geriatr 2021; 21:132. [PMID: 33618664 PMCID: PMC7898742 DOI: 10.1186/s12877-021-02032-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sensory processing is essential for the interaction with the environment and for adequate daily function. Sensory processing may deteriorate with aging and restrict daily activity performance. Aging may also affect Executive functions (EFs) which are critical for daily activity performance. Yet, most studies refer separately to the impacts of sensory processing or EFs and use clinical evaluations that do not necessarily reflect functional restrictions in real life. This study aims to describe the prevalence of altered sensory processing in the elderly as expressed in daily life scenarios and explore whether EFs mediate between altered sensory processing and daily activity performance in older adults. METHODS This cross-sectional study included 167 healthy independently functioning people aged 65 and above who were living in the community, had sufficient cognitive status and no symptoms of depression (based on the GDS and the MMSE). All participants completed a socio-demographic-health questionnaire, the Adolescent/Adult Sensory Profile, the Behavior Rating Inventory of Executive Function-Adult Version and the Daily Living Questionnaire. RESULTS Altered sensory processing, and mainly by the reduced ability to register and modulate sensory input from daily environment, were prevalent in older adults. Their impacts on daily activity performance were mediated by executive dysfunctions. CONCLUSIONS Executive dysfunctions may worsen the negative effects of altered sensory processing on daily activity performance in older adults. The interaction between EFs and sensory processing should receive growing attention in intervention and prevention programs for older adults, with the emphasis on their expressions and implications on peoples' function in real life context.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Aba Hushi, 199, Mount Carmel, 3498838, Haifa, Israel.
| | - Sara Rosenblum
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Aba Hushi, 199, Mount Carmel, 3498838, Haifa, Israel
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Shokouhi E, Mohamadian H, Babadi F, Cheraghian B, Araban M. Improvement in oral health related quality of life among the elderly: a randomized controlled trial. Biopsychosoc Med 2019; 13:31. [PMID: 31827601 PMCID: PMC6902433 DOI: 10.1186/s13030-019-0170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background The present study was conducted to determine the impact of educational intervention based on adult learning theory on oral health related quality of life of the elderly. Materials and methods This study (IRCT20120910010804N13) was performed with 92 elderly patients referred to the dental clinic of Ahvaz Jundishapur University of medical sciences. Participants were randomly divided into experimental and control groups. The data were gathered by a questionnaire with demographic variables, variables of oral health related quality of the elderly, and variables for assessing the effectiveness of adult learning theory. Following pre-test, educational programs were conducted for the interventional group. After 1 month, the questionnaire was again administered to both groups. Next, the results of pre-test and post-test were analyzed using SPSS-23 at a significance level of 0.05. Results Educational intervention was significant in terms of overall oral health related quality of life and the overall effectiveness score of adult learning theory (P < 0.001). There was a significant difference between the two groups in terms of the mean change score of three physical, psychosocial, and pain dimensions following the educational intervention (P < 0.001). Conclusion Education based on adult learning theory is recommended for improving oral health related quality of life among the elderly. Trial registration Iranian Registry of Clinical Trials, IRCT20120910010804N13. Registered on 2018-12-16. https://www.irct.ir/trial/35239
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Affiliation(s)
- Elham Shokouhi
- 1Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hashem Mohamadian
- 2Department of Health Education and Promotion , Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Babadi
- 3Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- 4Department of Biostatistics and Epidemiology, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Araban
- 5Department of Health Education and Promotion, Social Determinants of Health Research center, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Gamage MWK, Hewage C, Pathirana KD. Associated factors for cognition of physically independent elderly people living in residential care facilities for the aged in Sri Lanka. BMC Psychiatry 2019; 19:10. [PMID: 30621644 PMCID: PMC6325741 DOI: 10.1186/s12888-018-2003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND As the elderly population and prevalence of dementia is increasing, it is necessary to have a better comprehension of the influence of specific factors on cognitive function. Dementia is not an inevitable consequence of ageing. Lifestyle factors might either increase or decrease the risk. Even though different studies have focused on individual factors, only a few studies are available which assess all these factors as a whole. Available evidence on these factors is mainly from high income countries and much less evidence is available from low and middle income countries. As cognition is critical for elderly people to engage in a physically independent life, we aimed to identify the associated factors of cognition. METHODS This was a descriptive cross sectional study performed with 421 elderly people dwelling in residential care facilities for the aged in two selected districts in the Southern Province of Sri Lanka. Cognition was assessed using the Mini Mental State Examination (MMSE). Independent sample t test, ANOVA and regression analyses were used to explore associated factors for cognition. The statistical significance was kept at bonferroni adjusted p < 0.004. RESULTS The study included elderly people with a mean age of 71.9 ± 6.7 years and of them 65.8% were females. Factors affecting higher level of cognition were, having upper secondary, advanced and higher education; being married; arriving at the facility on one's own accord; being visited by family members; higher physical activity levels and engaging in social and leisure activities (p < 0.004). The factors, namely physical activity level, educational status, visits by family members and engaging in leisure activities were the predictors of cognition in the regression model. CONCLUSION Though there were several factors that associated with the level of cognition such as educational status, marital status, reason for attending the facility, visits by family members, physical activity levels and participation in social and leisure activities, only the factors, such as physical activity levels, visits by family members, educational status and engaging in leisure activities were the predictors of cognition.
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Affiliation(s)
| | - Chandana Hewage
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
| | - Kithsiri Dedduwa Pathirana
- 0000 0001 0103 6011grid.412759.cDepartment of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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