University of Ruhuna

Abstract Objective Menopause, a universal yet diverse life stage, profoundly influences women's physical, emotional, and social well‐being. In Malaysia's multi‐ethnic context, experiences are shaped by cultural meanings, religious beliefs, healthcare structures, and socioeconomic factors. Despite this, policies and services remain limited, with low uptake of hormone replacement therapy (HRT), poor workplace recognition, and uneven access to care. This study is designed to identify the different experiences of menopause in Malaysian population. Design Qualitative study using semi‐structured interviews. Setting and Population Women in perimenopause, menopause, and post‐menopause stages from the general population. Methods Part of the Malaysian chapter of the MARIE WP2a project, this study explored lived experiences among women aged over 18, purposively recruited across ethnic, religious, and socioeconomic groups. Interviews conducted in English, Malay, or Mandarin were analysed thematically using the Delanerolle and Phiri equity‐oriented framework to identify determinants at individual, community, health system, and policy levels. Results Eleven women described a range of symptoms, from mild discomfort to severe vasomotor, psychological, and musculoskeletal issues. Surgical menopause caused abrupt, compounded symptoms. Coping strategies included exercise, herbal remedies, religious practices, and selective biomedical use. HRT uptake remained low due to cancer fears, cultural perceptions, and limited clinician engagement. Workplace support was minimal, with most relying on informal networks. Healthcare engagement was reactive, and anticipatory guidance was scarce. Equity gaps emerged around affordability, rural–urban divides, religious norms, workplace stigma, and lack of culturally appropriate information. Conclusion Menopause in Malaysia is shaped by biological, sociocultural, and systemic factors. Culturally sensitive clinical pathways, workplace reforms, and equity‐focused primary care policies are urgently needed.

The purpose of this study is to explore the role of gamification in enhancing motivation and academic success among Croatian university students. Currently, universities face the challenge of minimising high dropout rates, especially during the first two years. This study investigates how the integration of gamification can impact students’ engagement and academic performance. The study employed a quantitative approach, collecting data from 248 undergraduate students at the Faculty of Tourism and Rural Development, University of Osijek. The findings confirm a strong positive correlation between gamification and academic achievement, with gamification significantly boosting both intrinsic and extrinsic motivation. However, the results show that gamification directly affects academic performance, but its indirect effect through intrinsic motivation is not significant. In contrast, extrinsic motivation serves as a significant mediator. The study highlights the critical role of gamification in promoting extrinsic motivation and suggests that educational institutions should carefully blend gamification with high-quality content to maximise expected outcomes and motivation. These insights are vital for policymakers and educators aiming to enhance student engagement and reduce dropout rates in Croatian higher education.

The management of perforated diverticulitis (PD) has shifted over the last decade, moving from aggressive surgery toward non-operative strategies for hemodynamically stable patients. However, the safety of non-operative treatment in cases with extraluminal air, particularly Hinchey Ia-II disease, remains debated. This systematic review evaluates the efficacy, safety, and long-term outcomes of non-operative management for PD and identifies radiologic predictors of treatment failure. A systematic review was conducted per PRISMA 2020 guidelines. PubMed/MEDLINE, Europe PMC, Science Direct, EBSCO Open Dissertations, ClinicalTrials.Gov, and Cochrane Library were searched for cohort studies published between 2015 and 2025. Inclusion criteria were adults with CT-confirmed PD (Hinchey I-II) treated non-operatively. The primary outcome was treatment success (survival without emergency surgery); secondary outcomes included recurrence, readmission, and mortality. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Twelve cohort studies comprising 25 064 patients were included. Success rates ranged from 76% to 96% for contained perforations. Distant extraluminal air (DA) was a key predictor of failure, with success falling to 10%-37% compared to > 85% for isolated pericolic air. Other risk factors included abscess diameter > 4 cm, free fluid, and age > 75 years. Mortality declined over time (from 18.6% to < 5%), coinciding with increased colorectal subspecialist involvement. Recurrence rates remained notable (16.5%-37.5%), with most occurring after one year. Non-operative management is a safe, effective first-line option for stable patients with PD, especially those with isolated pericolic air. Patients with DA or large abscesses are at higher risk of failure and require close monitoring or early intervention.

This study aims to determine the extent to which water, sanitation and hygiene (WASH) coverage is established in rural schools, and the barriers to accessing WASH services in the Dehiovita educational zone of the Kegalle District in Sri Lanka. Random sampling was used to collect data from 500 students in grades 7–13 from 15 schools using a semi-structured questionnaire. The analysis shows that 43% of children use unsafe plastic bottles, 62% reported broken taps as a major barrier to safe access to water, and 54% reported receiving inadequately treated water. The majority of respondents (88%) mentioned that they do not use soap after using the toilet. In terms of menstrual hygiene management, 26% of female students do not use the sanitation facilities due to issues such as poor quality or safety concerns in the sanitary services provided, and this may prevent the achievement of gender justice in WASH coverage. These findings highlight the urgent need to raise awareness in schools about safe water consumption, sanitation, hygiene practices and spread of water-borne diseases.

<title>Abstract</title> <bold>Introduction:</bold> Rabies is a zoonotic disease of the central nervous system, caused by the neurotropic virus of the genus Lyssavirus of the family Rhabdoviridae. It is considered as one of the dreaded infectious diseases among warm-blooded animals, which progressed into invariably fatal encephalomyelitis. <bold>Method</bold> : Data was retrieved from the available records from January 2021 to December 2023 at the rabies diagnostic unit for the assessment of rabies prevalence. A descriptive cross-sectional study was carried out using 113 bite victims attending the rabies diagnostic unit at National Hospital Galle, Sri Lanka from January 2023 to December 2023 using a modified pre-tested interviewer administered questionnaire for the assessment of knowledge, attitudes and practices towards rabies. <bold>Results</bold> : From the total samples received, 48%, 38% and 41% were confirmed positive for rabies by Sellers’ staining and/or direct fluorescent antibody test in year 2021, 2022 and 2023, respectively. The reduction in rabies prevalence from 2021 to 2023 was statistically significant (p&lt;0.05). Majority of the positive cases were of canine in origin and were domesticated animals. More than 90% of the positive cases were from the animals which were non-vaccinated or without a vaccination history. Around 2% of the positive cases were reported from the vaccinated animals. Of the total respondents, 40% were aware that rabies is an infectious disease and 61% knew that it is preventable. All the respondents knew that dogs and cats transmit the disease via bites, scratches and aerosols, however 69% believed the possibility of transmitting the disease by rats. Almost all the participants believed vaccination of dogs/cats as a preventive measure to control rabies and 70% knew that vaccination need to be done annually. The scores of knowledge level, attitudes and practices of respondents were in satisfactory levels and none of the socio-demographic characteristics of respondents’ contributed for the scores significantly. <bold>Conclusion</bold> : This study highlights the prevalence of rabies in non-vaccinated domestic animals with a significant percentage in dogs, although it shows a reduction in total number of positive cases with time. Further, the results revealed satisfactory level of knowledge, attitudes and practices on rabies among the bite victims to the rabies unit.