The Relationship between Body Esteem and Hope and Mental Health in Breast Cancer Patients after Mastectomy

Clinical outcomes of breast reconstruction using omental flaps: A systematic review

Background

Breast cancer is the most common cancer in women, and breast reconstruction improves the patient's quality of life. Autologous breast reconstruction provides benefits of natural appearance, feel, and long-term results without implant-associated problems. However, thin patients are not always suitable for standard autologous reconstructions. In these patients, an omental flap could be a useful alternative. The aim of this review was to provide an overview of the literature regarding the clinical outcomes of omental flaps in breast reconstruction.

Methods

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Medline and Embase databases up to November 1, 2023. Study outcomes were type of flap, tissue transfer, cosmetic outcomes, and short- and long-term complications.

Results

Eleven studies covering 985 reconstructions in 969 patients were included. The omentum was mostly laparoscopically harvested (88.6%) and a pedicled reconstruction was mostly performed (91.2%). The most commonly reported short-term complications were wound infections at the donor site (5.8%), partial flap necrosis, and fat necrosis. In the long term, epigastric, umbilical and tunnel hernias, and epigastric bulging were observed. Satisfactory cosmetic results were reported by the patients (88.7%) and professionals (80.0%).

Conclusion

Breast reconstruction using an omental flap can be performed in unilateral reconstructions with acceptable donor-site morbidity if laparoscopically harvested. In general, satisfactory cosmetic outcomes were reported and it appears to be a suitable alternative for selected patients who prefer autologous, unilateral breast reconstruction. Further research is necessary to determine the ideal candidates for this reconstruction and the long-term effects of an omentectomy in young patients.

Breast-Conserving Therapy Versus Postmastectomy Breast Reconstruction: Propensity Score-Matched Analysis

BACKGROUND

Although studies have compared patient-reported outcomes (PROs) after breast conserving-therapy (BCT) and postmastectomy breast reconstruction (PMBR), they often have been confounded by treatment or other factors that complicate a direct comparison. This study aimed to compare PROs after BCT and PMBR by using propensity score-matching analysis.

METHODS

Patients who underwent BCT or PMBR between 2010 and 2022 and completed the BREAST-Q were identified. Each BCT patient was matched to a PMBR patient using nearest-neighbor 1:1 matching with replacement for each BREAST-Q time point. Outcomes included all prospectively collected BREAST-Q domains preoperatively, at 6 months, and at 1, 2, and 3 years postoperatively. A 4-point difference was considered clinically meaningful.

RESULTS

For this study, 6215 patients (2501 BCT [40.2%] and 3714 PMBR [59.8%] patients) were eligible, and 2616 unique patients were matched. Preoperatively, 463 BCT and 463 PMBR patients were matched for analysis (6 months [443 matched pairs], 1 year [639 matched pairs], 2 years [421 matched pairs], 3 years [254 matched pairs]). At 6 months postoperatively, the BCT patients scored higher on all BREAST-Q domains than the PMBR patients (p < 0.05; differences > 4 points). At 1, 2, and 3 years, the patients who underwent BCT consistently had superior Satisfaction With Breasts, Psychosocial Well-Being, and Sexual Well-Being (p < 0.05), and the differences were clinically meaningful.

CONCLUSION

In this statistically powered study, the BCT patients reported higher quality of life than the PMBR patients in early assessment and also through 3 years of follow-up evaluation. Given the equivalency in survival and recurrence outcomes between BCT and PMBR, patients eligible for either surgery should be counseled regarding the superiority of BCT in terms of PROs.

Assessment of mental well-being and psychological distress in Moroccan breast cancer patients

The quality of life of breast cancer patients is strongly affected by physical pain, psychological distress, and uncertainty about vital prognosis.

Objective

To assess breast cancer patients' mental well-being and level of psychological distress at the Mohammed VI University Hospital in Marrakech.

Methods

Cross-sectional study carried out from April to December 2023 at the Mohammed VI University Hospital of Marrakech. The data were collected via a questionnaire comprising a sociodemographic section and a section reserved for the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Kessler Psychological Distress Scale (K10). Data analysis was performed using SPSS software, version 25.

Results

A total of 38.3% of patients experienced severe psychological distress. However, their mental well-being was high with a mean of 54.59 (±11.29). Older patients (>50 years) exhibited better mental well-being (56.46±10.39 vs. 52.99±11.81; p=0.020) and lower psychological distress (26.27±7.21 vs. 28.44±8.19; p=0.034) compared to their younger counterparts (≤50 years). As for the stage of cancer, patients with localized cancer presented a higher mental well-being score than patients with metastatic cancer (55.53±10.93 vs. 50.40±12.03; p=0.008). However, no statistically significant difference was recorded between mastectomy and lumpectomy patients regarding mental well-being or psychological distress.

Conclusion

Breast cancer has not only a physical but also a psychological and emotional impact on patients. Thus, early diagnosis and referral to appropriate psychosocial services can improve patients' mental well-being.

After an Earthquake: The Comparison of Psychological Status of Resident and Earthquake Survivor Cancer Patients

OBJECTIVE

Natural disasters such as earthquakes can have a significant impact on cancer treatment and care. The objective of the study was to evaluate the psychological effect of the earthquake on survivor cancer patients compared to regular cancer patients.

METHODS

Cancer patients who were evacuated from earthquake sites and referred for the continuation of their treatment, as well as regular resident patients were included in the study. The resident cancer patients were compared with the study population as a control group. DASS-21 forms were filled based on patients' declarations.

RESULTS

Forty-six patients were earthquake survivors and 55 were resident cancer patients. Stress scores were significantly higher in earthquake survivors (P = 0.021). In contrast, there was no difference in stratified groups due to DASS-21 categorization in stress scores while depression and anxiety subgroups had significant differences (P = 0.012; P < 0.001). Also, women significantly had a worse outcome in the depression and anxiety categories (P = 0.028; P = 0.021) while no difference was observed in men.

CONCLUSION

Recent earthquakes in Turkey had psychological negative effects on oncology patients. The increased stress, depression, and anxiety levels were observed in earthquake survivors who were evacuated from the disaster zone and compared to the control group.

The Persian version of the body esteem scale among Iranian adolescents: a translation, psychometrics, and network analysis

Introduction

The psychometric properties of the body esteem scale have not been assessed in Iran. Therefore, the aim of this study was to translate and determine the validity and reliability of the Persian version of the body esteem scale among Iranian adolescents.

Methods

The sample of this methodological study consisted of 504 adolescents [mean age: 16.55 (SD = 1.54) years] living in Tehran City, Iran. After translation of the scale, its content validity (quantitative and qualitative) and structural (exploratory and confirmatory factor analysis), convergent, and discriminant validity were evaluated. Exploratory graph analysis was performed to determine the number of factors. Cronbach's alpha, composite reliability, and maximal reliability were calculated.

Results

In the content validity evaluation step, all items had acceptable scores and were retained. The results of exploratory factor analysis with Promax rotation and exploratory graph analysis extracted three factors accounting for 49.49% of the variance, comprising 18 items. Furthermore, after necessary modifications during CFA, the final model was approved. Convergent and discriminant validity were confirmed. Cronbach's alpha, CR, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability.

Conclusion

According to the results, the Persian version of the body esteem scale has a valid structure and acceptable reliability. Health professionals, in many ways, can use this scale.

Perspectives on early insights: pediatric cancer caregiving amidst natural calamities - A call for future preparedness

Natural disasters cause immense damage and disruption to the environment, human lives, and property, posing a threat to safety and well-being. These disasters annually affect individuals and communities, severely impacting mental health. Research indicates a significant link between catastrophic events and an increased risk of mental disorders, including anxiety, depression, substance use, and post-traumatic stress disorder (PTSD). Individuals with chronic conditions, like cancer patients, are particularly vulnerable post-disaster due to disrupted healthcare services. The recent earthquake in Morocco highlighted the urgent need for continued care, especially for vulnerable populations living in poverty. Soleterre Foundation's interventions focus on supporting young cancer patients and their families, emphasizing psychological support following the earthquake. Effective disaster response needs coordinated efforts, clear roles, communication, and standardized healthcare procedures, especially for vulnerable groups like cancer patients. Education programs for patients and clinicians are vital for disaster preparedness. Communication challenges and lack of medical history further emphasize the need for well-defined disaster preparedness plans and continued care guidelines for cancer patients.

The mediating role of hope in relation with fear of COVID-19 and mental health: A study on tertiary level students of Rajshahi District

Background and Aims

The novel coronavirus disease (COVID-19) is influential in all parts of people's lives, specifically psychological states due to the fear related to the pandemic. Thus, this study aimed to investigate the mediating role of hope in the connection between the fear of COVID-19 and mental health among tertiary college students of Rajshahi district during the COVID-19 disease.

Method

A cross-sectional survey was conducted among tertiary college students a sample of 498 participants (53.4% females and 46.6% males) ranged between ages 19 and 31 (M = 22.03 ± 1.92) and participants filled out the fear of COVID-19 Scale, Trait Hope Scale, and General Health Questionnaire.

Result

In the case of correlation analysis, fear of COVID-19 is reversely correlated with mental health, while lower but positive correlations were found with hope. Findings from the process macro v3.5 by Hayes analysis for the study model indicated that hope mediated in the relationship between the fear of COVID-19 and mental health controlling for gender, and socioeconomic status, and the hypothesized model explained approximately 27% of the variance in mental health.

Conclusion

Overall, the findings suggest that a high level of mental health is impacted by a low level of fear of COVID-19. Additionally, a low level of fear of COVID-19 contributes to increasing levels of hope, which enhances mental health.

Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer

Objectives:

This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design.

Materials and Methods:

The HHI was translated into Greek (HHI-Gr) using the ‘forward-backward’ procedure. It was administered to 130 eligible cancer patients, while for the stability of patients’ responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach’s a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status.

Results:

The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001).

Conclusion:

These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.

Psychosocial impact of mastectomy on female breast cancer patients presenting at an academic radiotherapy oncology centre in Ghana

Introduction:

Mastectomy is a treatment option for patients diagnosed with breast cancer. There is very limited research into the psychosocial impact of mastectomy on female breast cancer patients, especially in the sub-Saharan African setting which has unique cultural norms. The study aimed at assessing the psychosocial impact of mastectomy on female breast cancer patients attending a radiotherapy/oncology centre in Ghana.

Methods:

A cross-sectional design was used to undertake this study. A total of 80 female mastectomy breast cancer patients participated in this study. A semi-structured questionnaire was used for data collection over a 5-month period, January to May 2018. The data collected were analysed with Statistical Package for Social Science (SPSS) version 22.

Results:

Most of the participants were adversely affected psychologically and emotionally by mastectomy. In particular, many (56·7%) agreed that they felt less feminine, and 71% reported they experienced psychological distress as a result of their mastectomy, while 63% of them reported loss of self-confidence. A large proportion of them (51, 63·8%) agreed that their lifestyles had changed following mastectomy, while 58% of them admitted that they felt treated as outcasts by society, and 75% resorted to the use of breast prostheses to reduce attention.

Conclusion:

The study revealed that mastectomy for breast cancer patients had a negative impact on their psychological, emotional and social well-being. The availability of affordable breast prostheses, involvement of clinical psychologists in the care of post-mastectomy women, provision of emotional, psychological and even financial support could alleviate the psychosocial impact of affected women.

Hope, death anxiety and simplified coping style scores of nursing students during the outbreak of COVID-19: A cross-sectional study

ABSTRACT

Nursing students are the main force of future nursing development, and their hope and death anxiety are important aspects of their coping styles and clinical practice.The present study examined the relationships between hope, death anxiety and simplified coping style scores of nursing students during the outbreak of COVID-19.Between February and April 2020, a cross-sectional descriptive study was performed using a Sojump online survey, and 870 nursing students completed the herth hope (HH), death anxiety scale (DAS) and simplified coping style questionnaire. The data were analyzed using t-tests, one-way analysis of variance (ANOVA), and multiple linear regression in SPSS 23.0 (IBM Corp, Armonk, NY).The average HH, DAS and active and passive coping scores of the 870 nursing students were 3.07 ± 0.32, 3.01 ± 0.37, 2.84 ± 0.48, and 2.25 ± 0.50, respectively. Participants with contact experience with individuals with suspected or confirmed COVID-19 were more likely to adopt passive coping styles than students without contact experience (t = 5.019, P = .025). Being older and having higher inner positive readiness and expectancy, a lower inner sense of temporality and future, and lower time awareness were predictors of passive coping styles (P < .05). Living in cities (vs towns) and having a higher inner positive readiness and expectancy, a higher inner sense of temporality and future and lower cognition of death were predictors of active coping styles (P < .05).The findings of this study suggest that hope and death anxiety are important aspects of the coping styles of nursing students. Nursing educators should emphasize the role of hope, further deepen the death education mode, and perform scientific and reasonable death education programmes to reduce the death anxiety level of nursing students to promote their coping styles in crisis.

Risk factors for attempting suicide during the COVID-19 lockdown: Identification of the high-risk groups

Objectives

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed a rise in the instances of mental health problems and the suicide-related mortality rates. This study aims to identify the suicide-related risk factors and stressors to determine the groups at a greater risk of attempting suicide during the COVID-19 lockdown.

Methods

This retrospective study examined 29 cases of attempted suicide during the 3-month COVID-19 lockdown in KSA. The suicide risk factors were evaluated using specific instrument the modified (SAD PERSONS) scale. It is an acronym for sex, age, depression, previous attempt, excess alcohol, rational thinking loss, social status, organized plan, no social supports and stated future intent.

Results

The lockdown stressors that may have triggered suicidal behaviours were identified as follows: psychological distress, relationship problems, financial difficulties, and extreme fear of the COVID-19 infection. While all age groups carried the risk of attempting suicide during the lockdown, patients with psychiatric disorders and women accounted for 69% and 65.5% of the cohort, respectively. Factors like hopelessness and depression were highly related to suicide attempts, as well as the statement of future intent to repeat the attempt, at 72.4% and 65.5% respectively. Almost two-thirds of the attempts made were serious, and many women felt unsafe in their own homes during the lockdown.

Conclusion

Patients with pre-existing psychiatric disorders and women carry high risk of attempting suicide during the COVID-19 lockdown. This study offers insights on the greater outreach efforts that can be carried out for these patients by calling for the prioritization of mental health care, improvement of domestic violence services, and strengthening of suicide prevention strategies.

Hope Levels and Resilience in Patients with Severe Novel Coronavirus Pneumonia: The Current Situation and a Correlation Analysis

Objective

The study aims to analyze the correlation between hope levels and resilience in patients with severe novel coronavirus pneumonia (COVID-19).

Methods

Fifty-six patients with severe COVID-19 were investigated, with the use of a general information questionnaire, the Herth Hope Index, and the Connor–Davidson resilience scale.

Results

There was a significant difference in patients’ hope levels with respect to marital status and educational background (P < 0.05), and there was a significant difference in resilience scores depending on gender and family economic situation (P < 0.05). In the present study, the hope levels and resilience in the patients were moderate, with an average score of (34.93 ± 5.45) and (69.36 ± 15.52), respectively. There was a significant positive correlation between the hope level and the resilience score in these patients (P < 0.05).

Conclusion

In patients with severe COVID-19, the higher the hope level, the higher the resilience score.

Breast Awareness, Self-Reported Abnormalities, and Breast Cancer in Rural Ethiopia: A Survey of 7,573 Women and Predictions of the National Burden

Background

Breast cancer (BC) is the most frequently diagnosed cancer and leading cause of cancer deaths among women in low‐income countries. Ethiopia does not have a national BC screening program, and over 80% of patients are diagnosed with advanced stage disease. The aim of this study was to assess how many women self‐report a breast abnormality and to determine their diagnoses in rural Ethiopia.

Methods

A community‐based cross‐sectional study was conducted among 7,573 adult women. Women were interviewed and educated about breast awareness, and those who reported breast abnormalities underwent clinical examination by experienced surgeons. Ultrasound‐guided fine needle aspiration cytology (FNAC) was obtained, and cytological analysis was performed. The findings were projected to the female population of Ethiopia to estimate current and future burden of diseases.

Findings

Of the 7,573 women surveyed, 258 (3.4%) reported a breast abnormality, 246 (3.2%) received a physical examination, and 49 (0.6%) were found to be eligible for ultrasound‐guided FNAC or nipple discharge evaluation. Of all the cases, five (10.2%) breast malignancies were diagnosed. We projected for Ethiopia that, approximately, 1 million women could self‐report a breast abnormality, 200,000 women could have a palpable breast mass, and 28,000 women could have BC in the country.

Conclusion

The health care system needs to build capacity to assess and diagnose breast diseases in rural areas of Ethiopia. These data can be used for resource allocation to meet immediate health care needs and to promote detecting and treating BC at earlier stages of disease.

Implications for Practice

Routine mammography screening in a resource‐limited country with a young population is neither sensitive nor affordable. Clinical breast examination with consecutive ultrasound‐guided fine needle aspiration cytology may ensure early diagnosis, downstage disease, and reduce breast cancer mortality. This study had the unique opportunity to educate over 7,573 rural women about breast abnormalities and offer clinical and cytological diagnosis for reported breast abnormalities. The findings were extrapolated to show the nationwide burden of breast abnormalities and unmet diagnostic needs. These data will serve as policy guide to improve adequate referral mechanisms and breast diagnostic and treatment facilities.

Developing tailored interventions for the prevention of breast cancer in Ethiopia is a major challenge in this resource‐limited country. This article reports on the proportion of adult women with self‐reported breast abnormalities in a rural region of Ethiopia, assessing the diagnosis of these abnormalities and extrapolating the disease burden for the entire Ethiopian female population.

Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal

Background

Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal.

Methods

A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model.

Results

Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer.

Conclusion

Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.

Non-communicable diseases in disasters: a protocol for a systematic review

Background:

NCDs require an ongoing management for optimal outcomes, which is challenging in emergency settings, because natural disasters increase the risk of acute NCD exacerbations and lead to health systems’ inability to respond. This study aims to develop a protocol for a systematic review on non-communicable diseases in natural disaster settings.

Methods:

This systematic review protocol is submitted to the International Prospective Register of Systematic Reviews (Registration No. CRD42020164032). The electronic databases to be used in this study include: Medline, Scopus, Web of Science, Clinical Key, CINAHL, EBSCO, Ovid, EMBASE, ProQuest, Google Scholar, Cochrane Library (Cochrane database of systematic reviews; Cochrane central Register of controlled Trials). Records from 1997 to 2019 are subject to this investigation. Three independent researchers will review the titles, abstracts, and full texts of articles eligible for inclusion, and if not matched, they will be reviewed by a final fourth reviewer. The proposed systematic review will be reported in accordance with the reporting guideline provided in the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. We select studies based on: PICOs (Participants, Interventions, Comparators, and Outcomes).

Results:

This systematic review identifies any impacts of natural disasters on patients with NCDs in three stages i.e. before, during and in the aftermath of natural disasters.

Conclusions:

A comprehensive response to NCD management in natural disasters is an important but neglected aspect of non-communicable disease control and humanitarian response, which can significantly reduce the potential risk of morbidity and mortality associated with natural disasters.

Study of quality of life and effectiveness of physical therapy of women after mastectomy in the COVID-19 pandemic conditions

In case of oncological disease there is a deterioration of patients’ quality of life as such of its characteristics as physiological, psychological, emotional and social decrease. These problems are especially worsened by additional threats of social life. Today, such a challenge to the health of all mankind, and especially cancer patients, is the global pandemic caused by the spread of coronavirus disease COVID-19. Fear of death and loss of loved ones, isolation, economic shock and uncertainty about the future – all this certainly affects the quality of life, especially for patients after mastectomy, because they were already in emotional and physiological stress. The problem of determining the patients’ quality of life after mastectomy and correcting the nature of the personal reaction to the disease in the coronavirus pandemic is an integral part of the physical rehabilitation programme. The objective of the study: to assess the quality of life and effectiveness of physical rehabilitation programmes of women after mastectomy in the conditions of pandemic COVID-19. Research methods. The study involved 36 women aged from 42-69, who underwent radical mastectomy and were receiving adjuvant treatment at the Kherson Regional Oncological Center. To restore their health, the patients passed an author's programme of physical therapy for people after radical mastectomy. The methodology of building the author's programme was based on continuity, phasing and its implementation both in the mammology department and at home. The quality of life parameters and the volume indicators of mobility of the joints of the upper extremity were evaluated by the operated part before the application of physical therapy methods (early hospital period), after physical therapy (late hospital period) and after discharge from a hospital, but women continued to perform rehabilitation measures independently and were at home during the COVID-19 pandemic (post-hospital period + quarantine). To assess the quality of life, we used the questionnaire "MOS SF-36", which was used at each stage of rehabilitation. Research results. Based on the conducted goniometry of women after radical mastectomy, it can be concluded that the amplitude of movements in the shoulder joint differs significantly at all periods of physical therapy (early hospital period, late hospital period and post-hospital period + quarantine) from the standard indicators. Extension of the shoulder among most women after the application of an individual rehabilitation programme has fully recovered, forced quarantine and lack of general physical activity did not affect this indicator. Independent performance of therapeutic gymnastics (in the post-hospital period + quarantine) did not significantly improve this indicator and did not lead to complete recovery of movement. The analysis of the obtained results showed that among women, who underwent mastectomy under the influence of physical exercises, already in the late hospital period of rehabilitation, there was not only an improvement in joint mobility, but there was an improvement in quality of life. At the same time, women in the post-hospital period of physical rehabilitation, which coincided with the quarantine period, there was a slight decrease in quality of life. Namely: there was a decrease in physical activity (PF) by 4.5%, which indicated a decrease in daily physical activity; it was found that the role of physical problems in the limitation of vital functions (RF) decreased by 2.7% (this indicator reflected the impact of physical condition on daily role activities). Low RF values indicate that daily activities are significantly limited by the patient's physical condition; women noted an increase in pain indicator (BP) by 9.6% and its effect on the ability to engage in daily activities, which led to limited activity of patients; deterioration of mental health (MH) – by 3.8%, which was characterized by low mood, depression, anxiety and a decrease in the overall rate of positive emotions. Low scores indicated the presence of depressive, anxious experience and mental distress; decrease of the indicator of role functioning, which is due to emotional state (RE), during forced quarantine by 13.6%, interpreted as a restriction in the performance of daily work, which is due to the deterioration of emotional state; vital activity parameters (VT) decreased during quarantine by 11.7%. The obtained indicators testified to higher fatigue of patients, decrease of their vital activity and decrease of their vivacity. Conclusions. Quarantine conditions and self-isolation, which appeared during the spread of coronavirus disease, are an additional source of concern for patients after mastectomy and have identified a decline in their quality of life and the effectiveness of physical therapy in general. Although before the quarantine measures, the indicators of quality of life and mobility of the shoulder joints on the operated side were significantly increased under the influence of the physical therapy programme for this category of patients.т Assessment of the quality of life of patients after mastectomy is an integral characteristic of physical, mental, social and spiritual condition, which allows determining the effectiveness of physical rehabilitation measures. Therefore, the assessment of the life quality of women after mastectomy, which is made by the patients themselves, is a secure and reliable indicator of their general condition under normal conditions and during the pandemic period of coronavirus disease. The obtained data on the quality of life allow for constant monitoring of the patients’ general condition after undergoing surgery on the mammary, as well as timely, if necessary, to adjust the physical therapy programme.

The Assessment and Relationship Between Quality of Life and Physical Activity Levels in Greek Breast Cancer Female Patients under Chemotherapy

A growing body of evidence suggests that physical activity (PA) can be a complementary intervention during breast cancer (BCa) treatment, contributing to the alleviation of the chemotherapy-related side-effects. The purpose of this study was to assess physical activity (PA) levels and quality of life (QoL) parameters of BCa patients undergoing chemotherapy and compare them with healthy controls. A total of 94 BCa female patients and 65 healthy women were recruited and self-reported QoL and PA levels. The results reveal that women suffering from BCa spent only 134 ± 469 metabolic equivalents (MET)/week in vigorous PAs compared with the healthy females who spent 985±1508 MET/week. Also, BCa patients were spending 4.62±2.58 h/day sitting, contrary to the 2.34±1.05 h/day of the controls. QoL was scored as 63.43±20.63 and 70.14±19.49 while physical functioning (PF) as 71.48±23.35 and 84.46±15.48 by BCa patients and healthy participants, respectively. Negative correlations were found between QoL and fatigue, PF and pain, and fatigue and dyspnea, while a positive correlation was found between QoL and PF. This study indicated that the BCa group accumulated many hours seated and refrained from vigorous Pas, preferring PAs of moderate intensity. Additionally, BCa patients' levels of functioning and QoL were moderate to high; however, they were compromised by pain, dyspnea and fatigue.

Tools Used to Measure the Physical State of Women with Celiac Disease: A Review with a Systematic Approach

Celiac disease (CD) is an immunological disorder that mainly affects the small intestine, generating an inflammatory process in response to the presence of gluten (a protein). Autoimmune diseases are part of a group of diseases that are difficult to diagnose without a specific protocol or consensus to detect them due to the number of symptoms and diseases with which it has a relationship. Therefore, the aim of this review was to analyze the diagnostic tools of CD used in middle-aged women, to compare the use and effectiveness of the different tools, and to propose a strategy for the use of the tools based on the results found in the literature. The present research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search was conducted in the following databases: Scielo, PubMed, Web of Science, and Worldwide Science org. In the initial literature search, 2004 titles and relevant abstracts were found. Among them, 687 were duplicates, leaving 1130 articles. Based on the inclusion criteria, only 41 articles passed the selection process; 4 main types of analyses appear in the studies: blood tests, questionnaires, clinical history, and biopsy. It can be said that none of the analyses have a 100% reliability since most of them can present false negatives; therefore, the best way to diagnose celiac disease up to now is through a combination of different tests (Immunoglobulin A and small intestinal biopsy).

Comparing Quality of Life in Breast Cancer Patients Who Underwent Mastectomy Versus Breast-Conserving Surgery: A Meta-Analysis

: The purpose of our study was to carry out a meta-analysis of current literature to determine whether total mastectomy and breast-conserving surgery induce different outcomes in quality of life, based on the breast-cancer-specific module of the European Organizaation for Research and Treatment of Cancer core questionnaire (EORTC QLQ-BR23) used postoperatively. A systematic literature search of PubMed and EMBASE was conducted. Observational clinical studies that compared the quality of life in different surgery groups and presented empirical findings were selected. Six studies met the inclusion criteria. Breast-conserving surgery has statistically significant better outcomes than mastectomy in three of the eight outcomes measured in the EORTC QLQ-BR23, namely body image (standard mean difference, SMD = 1.742, 95% CI 0.579-2.905, p = 0.003), future perspective (SMD = 0.606, 95% CI 0.075-1.138, p = 0.025) and systemic therapy side effects (SMD = -0.641, 95% CI 0.101-1.181, p = 0.020). Our study highlighted that breast-conserving surgery was preferred over mastectomy because breast-conserving surgery leads to better outcomes in body image, future perspectives and less systemic side effects.

The Assessment Effect of Spiritual Care on Hopelessness and Depression in Suicide Attempts

The purpose of this study was to assess the effect of spiritual care on hopelessness and depression among suicide attempts. This semi-experimental study that 60 suicide attempts and these samples were divided in to two cases and control groups. For case group, service package of spiritual care was designed and conducted during their visits to psychiatrists' offices. Findings showed that there was a significant difference after performing spiritual care in depression in both groups (X² = 22, P = 0.002) and their hopelessness (X² = 20, P = 0.001). The use of spiritual intervention is suggested in order to implement holistic nursing care during treatment should be considered as a matter of principle.

Sexual Function and Factors Affecting Menopause: A Systematic Review

The purpose of this review study is to evaluate sexual function and its effective factors in menopause. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of “menopause,” “postmenopause,” “postmenopausal,” “premenopause,” “pre-menopausal period,” “sexual function,” “sexual health,” “sexuality,” “sexual and gender disorders,” “sexual development,” “sexual dysfunction,” “sexual disorders,” “sexual behavior and “sexual activity” were used in combination with the Boolean operators OR and AND. After reviewing the selected articles, 27 papers were selected based on the criteria for entering the study and the goals set. The results of the reviewed articles showed that, in the physical domain, the factors affecting sexual function can be mentioned, age, hormonal changes, medical problems and reproductive history. Sexual disorders in menopause can be affected by some of the individual and social characteristics and psychological problems. Considering the fact that many psychological and social injuries occur in this period following sexual disorders; therefore, policies and programs for improving the quality of life of women in menopause should be aimed at eliminating sexual dysfunction, correcting attitudes and negative emotions and help to women for more comfortable in menopause.

Cancer Patients During and after Natural and Man-Made Disasters: A Systematic Review

Background: Disasters affect all social functions. In particular, hospitals must mobilize their resources for response to mass injuries. This process can affected treatment of cancer patients and may resulted in delayed care. Considering the importance of continuity of care for cancer patients, the aim of this systematic review was to identify challenges and preparedness measures for cancer patients during and after disasters. Materials and Methods: This systematic review that was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines between January 2000 to December 2017. The keywords searched included: “disaster,” “emergency,” “crisis,” “disruptive event,” “technological disaster,” “natural disaster,” “cancer,” “cancer patient,” “chronic disease,” “continuity of care,” and “patient with chronic disease. “The Google Scholar, ISI Web of Science, Science Direct, PubMed and Scopus databases were searched. Results: After screening and review of article eligibility, seven were included in the study. The selected articles were compared from several aspects. The results showed that most publications concerned all of the chronic diseases or all types of cancers. In addition breast cancer appeared a field of interest in disaster studies. Cancer studies in disaster management usually concentrated less on technological disasters. Conclusion: In aftermath of disasters, the concentration on measures to provide services for injuries and food, water and shelter, results in many challenges for cancer patients. Thus the health system must prepare cancer patients and caregivers for better responses to disasters. In addition, surge capacity must be considered in hospitals and other medical facilities to guarantee continuity of care.

The childhood maltreatment influences on breast cancer patients: A second wave hit model hypothesis for distinct biological and behavioral response

Stress and cancer are two complex situations involving different biological and psychological mechanisms. Their relationship have long been studied, and there is evidence of the impact stress has on both, development and disease progression. Furthermore, early stress has been studied as an important factor associated to this relationship, since its impacts on the immune, endocrine and cognitive development throughout life is already known. Therefore, understanding early stress as a first wave of stress in life is necessary in order to explore a possible second wave hit model. From this perspective, we believe that breast cancer can be understood as a second wave of stress during development and that, in addition to the first wave, can cause important impacts on the response to cancer treatment, such as increased chances of disease progression and distinct behavioral responses. In this article we propose a second wave hit hypothesis applied to breast cancer and its implications on the immune, endocrine and cognitive systems, through mechanisms that involve the HPA axis and subsequent activations of stress responses.

Influence of Training about Carcinogenic Effects of Hookah Smoking on the Awareness, Attitude, and Performance of Women

Background:

Wrong attitudes and beliefs about the less carcinogenic effects of hookah smoking comparing to cigarette, easy availability, low cost, and other factors have caused that the usage of hookah smoking increase a lot in our country. Objective: This study has been done with the purpose of examining the influence of education about carcinogenic effects of hookah smoking on the awareness, attitude, and performance of women who refer to the healthcare and medical treatment centers.

Materials and Methods:

At this semi experimental study, 60 women who refer to the medical and hygienic centers of Bushehr were placed in 3 educational groups based on simple accidental sampling. The tool for data collection was a questionnaire including demographic features, awareness, attitude, and performance measurement.

Results:

According to the results, the amount of awareness in the majority (48%) of participants about carcinogenic effects of hookah smoking was in an average level. 100% of the participants had the awareness of over 33.1% and their attitude toward hookah smoking was 100% positive that after the intervention it was reported 5%. The participants’ performance in hookah smoking before the intervention was only 25% desirable that after the intervention it was reported 73.3%. The results of Kolmogorov–Smirnov test also showed that the distribution of awareness, attitude, and performance was quite normal.

Conclusion:

According to the results, it’s the society’s basic need to warn people about carcinogenic effects of hookah smoking by increasing people’s awareness through media, holding training courses, showing movies, and training booklets.

Predictors of hope among women with breast cancer during chemotherapy

OBJECTIVE

Identifying the predictors of hope in patients with breast cancer during chemotherapy treatment.

METHOD

A prospective longitudinal study. The sample was composed of 122 women who responded to the instruments of hope, anxiety and depression, coping, fatigue, religiosity and self-esteem in the first and last cycle of chemotherapy. These variables were used in adjusting the logistic regression model that characterized multivariate statistics, allowing identification of predictor variables.

RESULT

The increase of hope at the end of chemotherapy treatment was statistically significant (p = 0.012). The delay in undergoing treatment from the onset of breast cancer symptoms, Karnofsky Performance Status, depression, self-esteem and pain were characterized as factors being associated to hope by univariate analysis. Among the variables analyzed, pain was the only predicting factor of hope.

CONCLUSION

Pain was the predicting factor in this sample. Hope increased during treatment and revealed the following associated factors: Karnofsky Performance Status, delay in starting the treatment, depression, self-esteem and pain. This study brought forth a multidisciplinary contribution, allowing for understanding the factors that can influence hope and presenting support to nursing care. The data evidenced conditions of improvement or worsening of hope, which requires interdisciplinary attention in Oncology.

OBJETIVO

Identificar os fatores preditores da esperança nas pacientes com câncer de mama em tratamento quimioterápico.

MÉTODO

Estudo prospectivo longitudinal. A amostra foi de 122 mulheres que responderam aos instrumentos de esperança, ansiedade e depressão, coping, fadiga, religiosidade e autoestima no primeiro e no último ciclo de quimioterapia. Essas variáveis foram utilizadas no ajuste do modelo de regressão logística que caracterizou a estatística multivariada permitindo a identificação das variáveis preditoras.

RESULTADO

O aumento da esperança ao final do tratamento quimioterápico foi estatisticamente significante (p = 0,012). A demora na realização do tratamento desde o início dos sintomas do câncer de mama, o Karnofsky Performance Status, a depressão, a autoestima e a dor foram caracterizadas como fatores associados à esperança pela análise univariada. Dentre as variáveis analisadas, a dor apresentou-se como o único fator preditor da esperança.

CONCLUSÃO

A dor foi o fator preditor nesta amostra. A esperança aumentou durante o tratamento e revelou os fatores associados: Karnofsky Performance Status, demora no início do tratamento, depressão, autoestima e dor. Este estudo trouxe uma contribuição multidisciplinar, permitiu compreender os fatores que podem influenciar a esperança e apresentou subsídios à assistência de enfermagem. Os dados evidenciaram condições de melhora ou agravamento da esperança, o que requer atenção interdisciplinar em Oncologia.

Sexual Self-concept and Its Relationship to Depression, Stress and Anxiety in Postmenopausal Women

Objectives

Women in menopause have the more mood swings than before menopause. At the same time seem to sexual self-concept and sexual aspects of self-knowledge has a great impact on their mental health. This study aimed to investigate the sexual self-concept and its relationship to depression, stress and anxiety in postmenopausal women's.

Methods

In this descriptive correlation research, 300 of postmenopausal women referred to healthcare and medical treatment centers in Abadeh city were selected by convenience sampling method. The information in this study was collected by using questionnaires of multidimensional sexual self-concept and depression anxiety stress scale 21 (DASS-21). For data analysis, SPSS/17 software was used.

Results

The results showed the mean score positive sexual self-concept was 41.03 ± 8.66 and the average score of negative sexual self in women's was 110.32 ± 43.05. As well as scores of depression, stress, and anxiety, 35.67%, 32.33% and 37.67% respectively were in severe level. Positive and negative sexual self-concept scores with scores of stress, anxiety, and depression, of post-menopausal women in the confidence of 0.01, is significantly correlated (P < 0.05).

Conclusions

Being stress, anxiety, and depression in severe level and also a significant correlation between increased stress, anxiety and depression with negative and weak self-concept of women's, it is necessary to devote more careful attention to mental health issues of women's and have appropriate interventions.

Comparison of Direct and Indirect Methods of Teaching Breast Self-Examination – Influence on Knowledge and Attitudes of Iranian Nursing and Midwifery Personnel

Background:

Breast cancer is the most common cancer in women. Monthly breast self-examination (BSE) has been presented as one of the best screening methods available. The aim of this study was to compare effects of both direct and indirect methods of teaching of BSE on knowledge and attitudes of nursing and midwifery personnel.

Materials and Methods:

The present study was performed on 89 nursing and midwifery personnel in Valiasr hospital of Borujen city. Participants were randomly divided into a direct and an indirect training group. Researcher-designed BSE knowledge and attitude and demographic information questionnaires were used for data collection.

Results:

Before the education intervention, the mean levels of knowledge and attitude were 9.82±2.79 and 56.5±6.21 in the direct training group and 9.59±2.71 and 54.5±4.51 in the indirect training group; after the intervention, they reached 19.2±0.96 and 62.9±4.21, and 11.0±2.58 and 59.0±3.44, respectively. The difference in the mean levels of knowledge and attitude were significantly higher in the direct training group post intervention (P<0.05).

Conclusion:

It appears that educational planners and hospital personnel education officials should seek to teach aspects of crucial health behavior to female personnel using cooperative and direct training methods.

Associations of perceived social support and positive psychological resources with fatigue symptom in patients with rheumatoid arthritis

Objective

This study aimed to assess the association between perceived social support (PSS) and fatigue and the roles of hope, optimism, general self-efficacy and resilience as mediators or moderators on PSS-fatigue association among Rheumatoid Arthritis (RA) patients in China.

Methods

A multi-center, cross-sectional study was conducted withinpatients diagnosed with RA in northeast China, in which 305 eligible inpatients were enrolled. The Multidimensional Fatigue Inventory, Multidimensional Scale of Perceived Social Support, Herth Hope Index, Life Orientation Test Revised, General Self-Efficacy Scale and Ego-Resiliency Scale were completed. The associations of PSS, hope, optimism, general self-efficacy and resilience with fatigue and the moderating roles of these positive psychological constructs were tested by hierarchical linear regression. Asymptotic and resampling strategies were utilized to assess the mediating roles of hope, optimism, general self-efficacy and resilience.

Results

The mean score of the MFI was 57.88 (SD = 9.50). PSS, hope, optimism and resilience were negatively associated with RA-related fatigue, whereas DAS28-CRP was positively associated. Only resilience positively moderated the PSS-fatigue association (B = 0.03, β = 0.13, P<0.01). Hope, optimism and resilience may act as partial mediators in the association between PSS and fatigue symptoms (hope: a*b = -0.16, BCa 95%CI: -0.27, -0.03; optimism: a*b = -0.20, BCa 95%CI: -0.30, -0.10; resilience: a*b = -0.12, BCa 95%CI: -0.21–0.04).

Conclusions

Fatigue is a severe symptom among RA patients. Resilience may positively moderate the PSS-fatigue association. Hope, optimism and resilience may act as partial mediators in the association. PSS, hope, optimism and resilience may contribute as effective recourses to alleviate fatigue, upon which PSS probably has the greatest effect.

Relationship of Lifestyle with Academic Achievement in Nursing Students

INTRODUCTION

A healthy lifestyle is one of the main factor in maintaining the health of people in society. With regard to the role of youth and students in public health, they must complete and follow a training program on lifestyle related factors. One of the main aim of the training centres is to improve the academic achievement of students.

AIM

This study was designed to determine the correlation of lifestyle with academic achievement in nursing students.

MATERIALS AND METHODS

This was a cross-sectional study, wherein all nursing students of School of Borujen Nursing were selected by census sampling. Data gathering tool was Walker's lifestyle questionnaire which was modified for the purpose of the study. To evaluate the educational status of students, final grade point average was considered as an indicator of academic achievement. To analyze the data, SPSS version 16.0, and descriptive and analytical tests were used.

RESULTS

The results indicated that most subjects (61.01%) displayed moderate levels of lifestyle. Pearson's correlation coefficient showed the significant positive relationship between lifestyle and academic achievement (p=0.03 and r=0.628).

CONCLUSION

To improve the academic achievement of students, in addition to the cognitive abilities-perception, their lifestyle should also be considered. Therefore, it is suggested to incorporate lifestyle education in the curriculum of nursing students so as to improve their lifestyle.

Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran

Background: Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care. Objective: This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences. Materials and Methods: This descriptive-analytical crosssectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software. Results: The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05). Conclusion: Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication.

Woman experiencing gynecologic surgery: coping with the changes imposed by surgery

Objectives:

to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery.

Method:

a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory.

Results:

from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery.

Conclusions:

the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived.