Background: Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries .The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. Objectives: The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. Materials and Methods: A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. Results: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was 47.8±12.4 years. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast.In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was 5.13±4.8 months, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. Conclusions: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding ,early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.
Amid the growing concerns of educational stakeholders about the academic achievements of students, educational literature, especially coming from the developed context, portrays instructional leadership as a desirable model with the potential to contribute to the improved capacity of teachers, ultimately leading to enhanced student achievements. However, research shows that school leadership is context-dependent, and different contexts and cultures differently influence the enactment of instructional leadership. Against this background, the current study explored the factors inhibiting instructional leadership practices in the developing world, taking Pakistan as a case. The research used a qualitative approach and case study method concentrating on the phenomenon of instructional leadership in a semi-government school in the context of Northern Sindh, Pakistan. Considering the area under investigation, the school manager and principal were purposefully selected as the research participants. Ten teachers were also consulted to enrich and triangulate data. The school leaders (manager and principal) were interviewed individually using semi-structured interviews, whereas the teachers were interviewed in groups. The emerging data were analyzed using thematic analysis. The results showed that the school leaders’ instructional leadership practices were mainly inhibited by their partial understanding of their responsibilities, limited exposure to capacity building opportunities, teachers’ attitudes, and a communication gap between the school and the upper management responsible for overseeing the academic activities of the school. The paper argues that unless these influential factors are considered by policy makers and educational leaders, it is very unlikely for the school leaders to exercise instructional leadership in this part of the world.
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