Background: Neoplasms are the second leading cause of deaths in Sri Lanka. Present study analysed the trends in incidence and mortality of all cancers, breast cancer, cervical, ovarian and uterine cancers among Sri Lankan females over 1995-2010. Methods: Cancer incidence was obtained from national hospital-based cancer registries. Cancer mortality was abstracted from World Health Organization database and Department of Census and Statistics Sri Lanka. Number of new cases and deaths were obtained by five-year age group for all cancers by sex and breast, cervical, ovarian and uterine cancers for females. Particular cancer specific incidence and mortality rates were directly age-standardised to the Segi-Doll world standard population. Age-standardised incidence and mortality for young adults (20-34 years), adults (35-64 years) and older adults (over 64 years) by the type of the female cancer over 1995-2010 were calculated. Results: Age-standardised rates for incidence for all cancers among females rose from 63.3 to 87.5 per 100 000 population during 1995-2010 and its morality increased from 44.5 to 53.5 per 100 000 population. In spite of having similar trends in both sexes, cancer incidence among females remained higher while mortality persisted lower than males. Breast cancer was the commonest cancer among females with its incidence and mortality increasing through-out. Cervical cancer incidence increased during 1995-2000, declined slightly in 2005 and remained stable over 2006-2010.Cervical cancer mortality remained stable over 1995-1999, declined in 1999-2003, increased slightly throughout 2003-2006 and remained stable during 2007-2010. Ovarian cancer incidence remained stable over 1995-2010. Its mortality remained stable over 1995-2000, declined slightly during 2000-2003 and increased in 2003-2010. Uterine cancer incidence and mortality increased steadily throughout 1995-2010. For all these cancers, incidence and mortalityin 0-34 years remained low.Conclusions: Increasing trend of cancer incidence and mortality among females over 1995-2010, directs the need of revisiting female cancer control programmes.
Background Spatial repellents (SRs) have been widely used for prevention of mosquito bites, but their efficacy in reducing Aedes-borne viruses (ABV) has not been tested rigorously at large scale in Asia. To address this knowledge gap, a trial to evaluate the efficacy of Mosquito Shield™, a transfluthrin SR, was developed in Gampaha District of Sri Lanka across three Medical Officer of Health areas; i.e., Negombo, Wattala, and Kelaniya. Methods This trial is a cluster-randomized, placebo-controlled, double-blinded clinical trial. A total of ~14,430 subjects aged ≥ 6 months in 30 clusters (15 intervention, 15 placebo) from ~3900 households (HH) will be randomly selected for enrolment into a “febrile surveillance cohort.” A subset of the surveillance cohort, ~3570 subjects aged ≥4–16 years that test seronegative (naïve) or are serologically positive for a previous single dengue virus (DENV) infection (monotypic) at baseline sampling, will be enrolled into a “longitudinal cohort” for measuring DENV infection based on laboratory-confirmed seroconversion during the trial. Persons identified positive for antibodies against multiple DENV serotypes (multitypic) at baseline will be monitored for secondary analyses. Active ABV disease will be assessed using an enhanced passive surveillance system with case ascertainment performed in designated healthcare facilities. Serum samples will be taken from longitudinal cohort subjects within 1–2 weeks of when intervention is first deployed (T0) with additional samples taken ~12 (T1) and ~24 months (T2) from baseline sampling. DENV seroconversion and ABV active disease rates from baseline (pre-intervention) and follow-up (post-intervention) samples will be compared between intervention and placebo clusters. Participating houses will be monitored entomologically (indoor adult Aedes aegypti population densities and adult female blood fed status) within 3 months before intervention deployment and monthly during the intervention phase. Entomological surveys will monitor indoor adult Ae. aegypti population densities and blood fed status. Dengue incidence in each cohort will be estimated and compared to determine the public health benefit of using an SR. Entomological parameters will be measured to determine if there are entomological correlates of SR efficacy that may be useful for the evaluation of new SR products. Discussion The trial will serve as an efficacy assessment of SR products in South Asia. Results will be submitted to the World Health Organization Vector Control Advisory Group for assessment of public health value towards an endorsement to recommend inclusion of SRs in ABV control programs. Trial registration Sri Lanka Clinical Trial Registry SLCTR/2022/018. Registered on July 1, 2022. ClinicalTrials.govNCT05452447. Registered on July 11, 2022. The Universal Trial Number is U1111-1275-3055.
Background: Sri Lanka is facing epidemiologic transition from communicable diseases to noncommunicable diseases in recent decades. Aim: This study analyses the trends in incidence and mortality of all cancers, breast cancer, cervical, ovarian and uterine cancers among Sri Lankan females over 1995-2010. Methods: Cancer incidence was obtained from the published national hospital based cancer registries, Sri Lanka for 1995-2010. Cancer mortality was abstracted from World Health Organization (WHO) database for 1996-2003 and 2006 and Department of Census and Statistics Sri Lanka for 1995 and 2004-2010 where WHO data were not available. Number of new cases and deaths were obtained by five-year age group for all cancers by sex and breast, cervical, ovarian and uterine cancers for females. Particular cancer specific incidence and mortality rates were directly age-standardized to the world population and age standardized rates were calculated for all ages, 20-34, 35-64 and over 64 years. Results: Female, age-standardized rates (ASR) for incidence for all cancers rose from 63.3 to 87.5 per 100 000 population during 1995-2010 and morality increased from 44.5 to 53.5 per 100 000 population over 1995-2010. In spite of having basically similar trends in both sexes, female incidence remained higher and mortality lower than males. Breast cancer was the commonest cancer among females with its incidence and mortality increasing through-out. Cervical cancer incidence increased during 1995- 2000, declined slightly in 2005 and remained stable over 2006-2010. Cervical cancer mortality remained stable over 1995-1999, declined in 1999-2003, increased in a lesser extend throughout 2003-2006 and remained stable during 2007-2010. Ovarian cancer incidence remained stable over 1995-2010 with 35-64 years being highest. Its mortality remained stable over 1995-2000 and declined slightly during 2000-2003 and increased in 2003-2010 with over 64 years being highest. Uterine cancer incidence and mortality increased steadily throughout 1995-2010. For all above mentioned cancers, incidence and mortality in 0-34 years remained low. Conclusion: Increasing trend of cancer incidence and mortality among females over 1995-2010, directs the need of revisiting breast cancer and cervical cancer control program in the country and strengthening awareness and early diagnosis and timely treatment of the other gynecologic cancers.
Background: Spatial repellents (SRs) have been widely used for prevention of mosquito bites, but their efficacy in reducing Aedes-borne viruses (ABV) has not been tested rigorously at large-scale in Asia. To address this knowledge gap, a trial to evaluate the efficacy of Mosquito Shield™, a transfluthrin SR, was developed in Gampaha District of Sri Lanka across three Medical Officer of Health areas; i.e., Negombo, Wattala, Kelaniya. Methods: This trial is a cluster-randomized, placebo-controlled, double-blinded clinical trial. A total of ~14,430 subjects aged ≥ 6 months in 30 clusters (15 intervention, 15 placebo) from ~3,900 households (HH) will be randomly selected for enrolment into a ‘febrile surveillance cohort.’ A subset of the surveillance cohort, ~3,570 subjects aged ≥4-16 years that test seronegative (naïve) or are serologically positive for a previous single dengue virus (DENV) infection (monotypic) at baseline sampling, will be enrolled into a ‘longitudinal cohort’ for measuring DENV infection based on laboratory-confirmed seroconversion during the trial. Persons identified positive for antibodies against multiple DENV serotypes (multi-typic) at baseline, will be monitored for secondary analyses. Active ABV disease will be assessed using an enhanced passive-surveillance system with case ascertainment performed in designated healthcare facilities. Serum samples will be taken from longitudinal cohort subjects within 1-2 weeks of when intervention is first deployed (T0) with additional samples taken ~12 (T1) and ~24 months (T2) from baseline sampling. DENV seroconversion and ABV active disease rates from baseline (pre-intervention) and follow-up (post-intervention) samples will be compared between intervention and placebo clusters. Participating houses will be monitored entomologically (indoor adult Ae. aegypti population densities and adult female blood-fed status) within 3 months before intervention deployment and monthly during the intervention phase. Entomological surveys will monitor indoor adult Ae. aegypti population densities and blood-fed status. Dengue incidence in each cohort will be estimated and compared to determine the public health benefit of using an SR. Entomological parameters will be measured to determine if there are entomological correlates of SR efficacy that may be useful for the evaluation of new SR products. Discussion: The trial will serve as an efficacy assessment of SR products in South Asia. Results will be submitted to the World Health Organization Vector Control Advisory Group for assessment of public health value towards an endorsement to recommend inclusion of SRs in ABV control programs. Trial registration: Sri Lanka Clinical Trial Registry SLCTR/2022/018. Registered July 1, 2022. https://slctr.lk/trials/slctr-2022-018 ClinicalTrials.gov NCT05452447. Registered July 11, 2022. https://clinicaltrials.gov/ct2/show/record/NCT05452447?cond=dengue&cntry=LK&draw=2&rank=4 The Universal Trial Number is U1111-1275-3055.
Background: Depression, anxiety, neuroticism and phobia are all risk factors for cardiac morbidity and mortality following Acute Coronary Syndrome (ACS). Yet to date, there is no evidence that treating clinically meaningful mental health symptoms after ACS ameliorates these risks. Understanding the key patho-physiologic drivers of poor mental health post-ACS could provide critical insights that guide treatment options. Autonomic nervous system dysfunction is a leading candidate mechanism thought to account for a substantial part of the risk associated with depression in patients with stable coronary disease. Low heart rate variability (HRV) reflects excessive sympathetic or inadequate parasympathetic modulation of heart rate, thus elevating mortality risk after ACS. As depression commonly coexists with other mental health symptoms like anxiety, neuroticism and phobia, it is plausible that specific combinations of symptoms are accompanied by unique pathophysiology that leads to increased morbidity and mortality risk after ACS. Purpose: To assess whether mental health clusters yield distinct autonomic dysfunction profiles after ACS. Methods: The ADVENT study followed 416 ACS patients admitted to one of the largest cardiology hospitals in Australia. Over 12 months mental health and autonomic functioning data were collected at 2 timepoints. Mental health clusters were derived from 4 inventories (Beck Depression Inventory, State-Trait Anxiety Inventory-Trait Version, Crown Crisp Index of Phobic Anxiety, Penn State Worry Questionnaire) and analysed using latent class analysis (LCA). HRV was collected via a 20 minute Electrocardiograph with AD Instruments software for continuous beat-to-beat heart rate recording with detection of R waves at frequency of 1000Hz. Data were converted to R-R intervals for time domain measurement and power spectrum analysis. Results: The predominantly male (79.0%) sample comprised participants with a mean (SD) age 58.4 (10.7) years. The 4 mental health clusters recovered in LCA were characterized by distinct R-R intervals: 1) Asymptomatic: 1017.5 ms (95% CIs: 983.5,1051.5) (47%); 2) Elevated worry and trait anxiety only: 1025.5 ms (95% CIs: 976.1, 1074.7) (29%); 3) Moderate depression and anxiety only: 1036.7 ms (95% CIs: 1006.2, 1067.1) (13%); 4) High on most/all dimensions: 855.28 ms (95% CIs: 800.2, 910.3) (5%). Between group differences in Low Frequency Power (normalized units; nu) were also observed: 47.4 nu (95% CIs: 43.3, 51.6), 48.5 nu (95% CIs: 41.9, 55.2), 47.9 nu (95% CIs: 44.6, 51.3), and 62.9 nu (95% CIs: 55.1,70.7), respectively. Multivariate analysis of variance revealed these to be statistically significant at 1 month [average R-R intervals F(3,346)=6.33) (p<0.00); LF Power F(3,346)=2.96) (p=0.03)] but not 12 months. Conclusion: High levels of depressive, anxious, neurotic and phobic symptoms that are characterized by reduced vagal activity and high sympathetic function cluster in the weeks following ACS.
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