Clinico-pathological factors influencing the recurrence free interval of patients with recurrent breast cancer

Objectives: Clinico-pathological factors affect the prognosis of breast cancer (BC) reflecting the heterogeneity of the disease. Following initial treatment, there is an ongoing risk of recurrence. The influence of these prognostic factors on the time taken to develop recurrence is not well established. This study was designed to determine the effect of clinic-pathological factors on the recurrence free interval (RFI) of BC patients with recurrent disease.Methods: This retrospective study included BC patients who had sought the immunohistochemistry laboratory services of our unit from May 2006 to December 2012. Mean follow up time was 45±23 months. All BC patients who had recurrences (loco-regional and distant metastasis) during the follow up period were enrolled. RFI was measured from the date of first therapeutic intervention to the date of confirmation of recurrence. Chi-square test was used for analysis.Results: Out of 944 BC patients, 188(mean age 50±11 years), had recurrences (loco-regional =35, distant metastasis =153). More than 50% of them had recurrence within 24 months of initial treatment (local=18/35 and distant=81/153). Mean RFI was 33±21 months for oestrogen receptor (ER)/progesterone receptor (PR) positive BC and 22±16 months for ER/PR negative BC. ER/PR positive BCs had a significant upward trend in developing recurrences over time (χ2 trend<0.001) while the rest had a downward trend. Other clinico-pathological factors were not associated with RFI. Majority (49/53) of the ER/PR positive BC patients had received hormone therapy and 179/188 BC patients had received chemotherapy.Conclusions: ER/PR positive BC patients develop late recurrences while hormone receptor negative patients develop early recurrences depicting late and early treatment failure in respective groups

Suicide in Sri Lanka 1975-2012:age, period and cohort analysis of police and hospital data

BACKGROUND: Sri Lanka has experienced major changes in its suicide rates since the 1970s, and in 1995 it had one of the highest rates in the world. Subsequent reductions in Sri Lanka’s suicide rates have been attributed to the introduction of restrictions on the availability of highly toxic pesticides. We investigate these changes in suicide rates in relation to age, gender, method specific trends and birth-cohort and period effects, with the aim of informing preventative strategies. METHODS: Secular trends of suicide in relation to age, sex, method, birth-cohort and period effects were investigated graphically using police data (1975–2012). Poisoning case-fatality was investigated using national hospital admission data (2004–2010). RESULTS: There were marked changes to the age-, gender- and method-specific incidence of suicide over the study period. Year on year declines in rates began in 17–25 year olds in the early 1980s. Reduction in older age groups followed and falls in all age groups occurred after all class I (the most toxic) pesticides were banned. Distinct changes in the age/gender pattern of suicide are observed: in the 1980s suicide rates were highest in 21–35 year old men; by the 2000s, this pattern had reversed with a stepwise increase in male rates with increasing age. Throughout the study period female rates were highest in 17–25 year olds. There has been a rise in suicide by hanging, though this rise is relatively small in relation to the marked decline in self-poisoning deaths. The patterns of suicides are more consistent with a period rather than birth-cohort effect. CONCLUSIONS: The epidemiology of suicide in Sri Lanka has changed noticeably in the last 30 years. The introduction of pesticide regulations in Sri Lanka coincides with a reduction in suicide rates, with evidence of limited method substitution. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2458-14-839) contains supplementary material, which is available to authorized users

Changes in mental disorder prevalence among conflict-affected populations: a prospective study in Sri Lanka (COMRAID-R).

BACKGROUND: Longitudinal data are lacking on mental health trajectories following conflict resolution and return migration. COMRAID-R is a follow-up study of Muslims displaced by conflict from Northern Sri Lanka 20 years ago who are now beginning to return. METHODS: Of 450 participants in displacement interviewed in 2011, 338 (75.1%) were re-interviewed a year later, and a supplementary random sample (n = 228) was drawn from return migrants with a comparable displacement history. Common mental disorder (CMD; Patient Health Questionnaire) and post-traumatic stress disorder (CIDI-subscale) were measured. RESULTS: A CMD prevalence of 18.8% (95%CI 15.2-22.5) at baseline had reduced to 8.6% (5.6-11.7) at follow-up in those remaining in displacement, and was 10.3% (6.5-14.1) in return migrants. PTSD prevalences were 2.4%, 0.3% and 1.6% respectively. CONCLUSIONS: We observed a substantial decrease in CMD prevalence in this population over a short period, which may reflect the prospect of return migration and associated optimism following conflict resolution