The Effect of Female Genital Cosmetic and Reconstructive Procedures on Body and Genital Self-Image: A Systematic Review and Meta-Analysis.

Performance of female genital cosmetic and reconstructive procedures (FGCRP) has been increasing over past decades. Appearance and functional concerns are the most common reasons for seeking FGCRP. Poor body and genital self-image may contribute to the increase in demand for surgery. The aim of this systematic review is to explore outcomes of FGCRP in the domains of body and genital self-image. A systematic literature review of PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library was conducted to identify articles that measured body and genital self-image in females after FGCRP. The authors identified 5 articles for a systematic review of body image and 8 studies for a systematic review of genital self-image. The most common procedure performed was labia minora labiaplasty. Instruments for body image evaluation were the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and the Body Image Quality of Life Inventory. Genital image was assessed with the Female Genital Self-Image Scale and Genital Appearance Satisfaction (GAS) scale. Most of the studies indicated that FGCRP can improve both body image and genital self-image; meta-analysis revealed that FGCRP improved GAS scores by 17.96 (range: 0-33; P < .001). It appears that FGCRP leads to improvements in females' body and genital self-image. Inconsistencies in study design and measures, however, limit this conclusion. Future research should involve more rigorous study designs (for example randomized clinical trials with large sample sizes) for a more accurate assessment of FGCRP's consequences.

The trend analysis of neurological disorders as major causes of death and disability according to human development, 1990-2019.

This study aims to assess the trends in the incidence rate of neurological disorders in developed and developing countries worldwide during 1990-2019. The age-standardized incidence rate (per 100000 persons) of neurological disorders was the primary outcome, extracted from the Global Burden of Disease database for 189 countries and territories from 1990 to 2019. Using the Human Development Index (HDI), countries were classified into developed (HDI ≥ 0.7) and developing (HDI < 0.7) groups. Longitudinal analysis was performed using the Latent Growth Model (LGM) to assess the change in the incidence rate of neurological disorders over time in these groups. In developed countries, the most increasing rate is related to depressive disorders, with a rising rate of 40.15 in 100000 every five years (p = 0.001). Alzheimer's and dementia, Parkinson and multiple sclerosis are in the next rank, with increasing rates of 8.77, 1.24, and .02, respectively (all p < 0.001). Over time, the significant decreasing trend has been determined related to conducting disorder, attention-deficit and hyperactivity, meningitis, anxiety, and eating disorders, with the rates of - 13.92, - 4.96, - 2.7, - 1.6, and - 1.44, respectively (all p < 0.05). In developing countries, meningitis, conduct disorder, attention-deficit and hyperactivity, stroke, and autism spectrum showed a significant decreasing trend over time, with rates of - 15.45, - 5.84, - 2.56, - 1.86, and - 1.07, respectively (all p < 0.05). Headache disorder has the most increasing rate of 79.5, following depressive (rate 35.32), substance use (rate 14.99), anxiety (rate 7.18), and eating (rate 3.4) disorders. Also, Alzheimer's and dementia, bipolar disorder, schizophrenia, Parkinson's, brain and central nervous system cancer, and multiple sclerosis are in the next rank and had significant increasing trends (all p < 0.05). Given the high economic and social burden of neurological disorders, the rate of these diseases in most countries does not seem to have dropped remarkably. The heterogeneous incidence rate in some world countries seems to be due to underestimating and gaps in epidemiological information. It is necessary to provide exact registry systems for health policies, especially in developing countries.

Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. This study aimed to compare the effects of lifestyle interventions on anthropometric, clinical, and biochemical parameters in adolescent girls with PCOS. METHODS: PubMed, Scopus, and Web of Science was systematically searched to retrieve studies investigating the effects of lifestyle modifications in adolescent girls with PCOS, which were published up to December 2019. The primary outcome was Body Mass Index (BMI) and secondary outcomes were all manifestations of PCOS, including clinical, metabolic, and hormonal parameters. Random effect meta-analysis was applied for significant results. Publication bias was assessed using the Egger test. RESULTS: This study showed significant improvements in luteinizing hormone (LH) (Pooled SMD = - 0.1.23; 95% CI, - 2.44 to - 0.03), and Free Androgen Index (FAI) levels (Pooled SMD = - 0.78 95% CI, - 0.1.42 to - 0.13) in adolescent girls receiving lifestyle intervention compared to baseline. This study also revealed that diet modifications alone were associated with a significant decrease in Body Mass Index (BMI) (Pooled SMD = - 0.45; 95% CI, - 0.76 to - 0.13), and FG score (Pooled SMD = - 0.81; 95% CI, - 1.33 to - 0.28). Exercise interventions were associated with significant changes in the menstrual cycles (Pooled SMD = 1.16; 95% CI, 0.72 to 1.61), Ferriman-Gallwey (FG) score (Pooled SMD = - 0.57; 95% CI, - 0.99 to - 0.15), LH (Pooled SMD = - 056; 95% CI, - 0.98 to - 0.14), Anti-Müllerian Hormone (AMH) (Pooled SMD = - 0.81; 95% CI, - 0.1.24 to - 0.38), and Triglyceride (TG) levels (Pooled SMD = - 0.32; 95% CI, - 0.62 to - 0.02). CONCLUSION: This meta-analysis concluded lifestyle interventions, such as diet and exercise, can improve some clinical, metabolic, and hormonal parameters in adolescent girls with PCOS.

Lived Experiences of "Illness Uncertainty" of Iranian Cancer Patients: A Phenomenological Hermeneutic Study.

BACKGROUND: For cancer patients, uncertainty is a pervasive experience and a major psychological stressor that affects many aspects of their lives. Uncertainty is a multifaceted concept, and its understanding for patients depends on many factors, including factors associated with various sociocultural contexts. Unfortunately, little is known about the concept of uncertainty in Iranian society and culture. OBJECTIVES: This study aimed to clarify the concept and explain lived experiences of illness uncertainty in Iranian cancer patients. METHODS: In this hermeneutic phenomenological study, 8 cancer patients participated in semistructured in-depth interviews about their experiences of uncertainty in illness. Interviews continued until data saturation was reached. All interviews were recorded, transcribed, analyzed, and interpreted using 6 stages of the van Manen phenomenological approach. RESULTS: Seven main themes emerged from patients' experiences of illness uncertainty of cancer. Four themes contributed to uncertainty including "Complexity of Cancer," "Confusion About Cancer," "Contradictory Information," and "Unknown Future." Two themes facilitated coping with uncertainty including "Seeking Knowledge" and "Need for Spiritual Peace." One theme, "Knowledge Ambivalence," revealed the struggle between wanting to know and not wanting to know, especially if bad news was delivered. CONCLUSION: Uncertainty experience for cancer patients in different societies is largely similar. However, some experiences (eg, ambiguity in access to medical resources) seemed unique to Iranian patients. IMPLICATIONS FOR PRACTICE: This study provided an outlook of cancer patients' experiences of illness uncertainty in Iran. Cancer patients' coping ability to deal with uncertainty can be improved.

Improved viability of random pattern skin flaps with the use of bone marrow mesenchymal-derived stem cells and chicken embryo extract.

OBJECTIVES: Covering tissue defects using skin flaps is a basic surgical strategy for plastic and reconstructive surgery. The aim of this study was to evaluate the effects of chicken embryo extract (CEE) and bone marrow derived mesenchymal stem cells (BM-MSCs) on random skin flap survival (RSF) in rats. Using chicken embryo extract can be an ideal environment for the growth and proliferation of transplanted cells. MATERIALS AND METHODS: Forty albino male Wistar rats were divided into 4 groups; each group consisted of 10 rats. BM-MSCs and CEE were transplanted into subcutaneous tissue in the area, where the flap would be examined. On the 7(th) postoperative day, the survival areas of the flaps were measured by using digital imaging with software assistance, and tissue was collected for evaluation. RESULTS: Survival area was 19.54±2 in the CEE group and 17.90±2 in the CEE/BM-MSC group when compared to the rates of the total skin flaps, which were significantly higher than the control group (13.47±2) (P<0.05). The biomechanical assessment showed a slight difference, although there was no statistically significant difference between the experimental groups and the control group (P>0.05). CONCLUSION: The findings from this study demonstrated that in operative treatment with BM-MSCs and CEE transplantation could promote flap survival, but the biomechanical parameters were not contrasted with a saline injection.

Application of a Non-Mixture Cure Rate Model for Analyzing Survival of Patients with Breast Cancer.

BACKGROUND: As a result of significant progress made in treatment of many types of cancers during the last few decades, there have been an increased number of patients who do not experience mortality. We refer to these observations as cure or immune and models for survival data which include cure fraction are known as cure rate models or long-term survival models. MATERIALS AND METHODS: In this study we used the data collected from 438 female patients with breast cancer registered in the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients had been diagnosed from 1992 to 2012 and were followed up until October 2014. We had to exclude some because of incomplete information. Phone calls were made to confirm whether the patients were still alive or not. Deaths due to breast cancer were regarded as failure. To identify clinical, pathological, and biological characteristics of patients that might have had an effect on survival of the patients we used a non-mixture cure rate model; in addition, a Weibull distribution was proposed for the survival time. Analyses were performed using STATA version 14. The significance level was set at P ≤ 0.05. RESULTS: A total of 75 patients (17.1%) died due to breast cancer during the study, up to the last follow-up. Numbers of metastatic lymph nodes and histologic grade were significant factors. The cure fraction was estimated to be 58%. CONCLUSIONS: When a cure fraction is not available, the analysis will be changed to standard approaches of survival analysis; however when the data indicate that the cure fraction is available, we suggest analysis of survival data via cure models.

Spiritual needs of cancer patients: a qualitative study.

INTRODUCTION: Diagnosis of cancer can cause huge spiritual crisis in a person and affect different aspects of life. At this stage, patients have certain spiritual needs. AIM: This study was conducted to explain spiritual needs of cancer patients in Iran. MATERIALS AND METHODS: In this qualitative study, 18 cancer patients, referred to the Cancer Institute of Imam Khomeini Hospital in Tehran were selected using purposive sampling method, and their spiritual needs emerged out of conventional content analysis of interviews conducted with them. RESULTS: From 1850 initial codes, 4 themes (connection, peace, meaning and purpose, and transcendence) were identified that contained categories of social support, normal behavior, inner peace, seeking forgiveness, hope, acceptance of reality, seeking meaning, ending well, change of life meaning, strengthening spiritual belief, communication with God, and prayer. CONCLUSIONS: Spiritual needs of cancer patients should be recognized, realized, and considered in care of patients by the medical team. An all-out support of health system policy makers to meet patients' spiritual needs is particularly important.

Survival Analysis of Patients with Breast Cancer using Weibull Parametric Model.

BACKGROUND: The Cox model is known as one of the most frequently-used methods for analyzing survival data. However, in some situations parametric methods may provide better estimates. In this study, a Weibull parametric model was employed to assess possible prognostic factors that may affect the survival of patients with breast cancer. MATERIALS AND METHODS: We studied 438 patients with breast cancer who visited and were treated at the Cancer Research Center in Shahid Beheshti University of Medical Sciences during 1992 to 2012; the patients were followed up until October 2014. Patients or family members were contacted via telephone calls to confirm whether they were still alive. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. The log-rank test and the Weibull parametric model with a forward approach, respectively, were used for univariate and multivariate analyses. All analyses were performed using STATA version 11. A P-value lower than 0.05 was defined as significant. RESULTS: On univariate analysis, age at diagnosis, level of education, type of surgery, lymph node status, tumor size, stage, histologic grade, estrogen receptor, progesterone receptor, and lymphovascular invasion had a statistically significant effect on survival time. On multivariate analysis, lymph node status, stage, histologic grade, and lymphovascular invasion were statistically significant. The one-year overall survival rate was 98%. CONCLUSIONS: Based on these data and using Weibull parametric model with a forward approach, we found out that patients with lymphovascular invasion were at 2.13 times greater risk of death due to breast cancer.

Poor reproductive health among a group of socially damaged Middle Eastern women: a cross-sectional study.

BACKGROUND: Despite the scope of violence against women and its importance for reproductive health, few data are available on the reproductive health issues among women having experienced violence. METHODS: This study described the reproductive disorders complicating social harm among 98 socially damaged women seeking care from drop-in centers who were of Persian ancestry, able to communicate and comprehend the contents of the questionnaire, and had history of domestic violence. The questionnaire had five dimensions: demographics, reproductive health, sexual performance, sexual behavior, and violence. Reproductive health included data on gestation, unplanned pregnancy, abortion, contraception, and cervical cancer screening. Data on sexual performance was acquired via the Persian version of sexual function scale, which has been demonstrated to have acceptable external validity in Iranian population. For sexual function, data was gathered on age at first intercourse and whether a participant had ever engaged in an oral or anal sexual activity. RESULTS: Mean age of participants was 33.4 years. Forty-seven percent of participants were married, 34.8% were divorced, 9.8% were widowed, and 8.7% were single. Mean age at first marriage was 16.4 (4.3) years and mean age at first sexual relationship was 16 (3.9) years. Illiteracy was observed among 18.5% of participants. Elementary education was reported by 22.8%, while only 3.3% of participants reported academic studies. Fifty-five percent were unemployed and 44.6% reported to be working at the time of the study. It was observed that 72.8% of participants were inflicted physically, as well as emotionally and sexually. The violence was reported to be exerted by husband (42.6%), parents (38.4%), or both (19.0%). Among 39 participants who ran away from home, 38 participants reported to be inflicted by violence. Unwanted pregnancy was reported by 64.6% of the participants. Abortion was reported in 50.0% of participants. Contraception was completely ignored in 44.6% of participants. Among eligible women, 53.3% never participated in cervical cancer screening examination. Mean sexual performance scale score was 21.9 (5.5) and 75 (83.3%) participants scored less than 28. CONCLUSION: A high prevalence of poor reproductive health was documented among a group of Middle Eastern socially damaged women.

Effects of walking on quality of life of mastectomy patients at selected hospitals of Tehran.

BACKGROUND: Breast cancer is the first-rank malignancy in women. Although surgery is the most common method of treatment, patients experience many threats both from the cancer and from the surgery itself. Exercises such as walking can improve body mass index, attitudes and life quality of patients. The aim of the present study was to determine the effect of walking on physical aspect of quality of life (QOL) in mastectomy patients in 2007. METHODS: Thirty four mastectomy patients took part in the study. Walking was performed in a flat surface 3 times a week, each lasting 30 minutes over 6 weeks. Data were collected by a questionnaire before and after the intervention and a self-report form. After identifying content and face validity of the questionnaire, its reliability was measured by Cronbach's alpha (α = 0.89) and test-retest (r = 0.91) methods. RESULTS: Mean scores (standard deviations) of physical, psychological, social, economic and religious aspects of QOL before the intervention were 64.55(8.10), 78.89 (5.81), 52.89 (10.74), 64.92 (8.64) and 64.76 (9.59), respectively. These aspects were 79.06 (25.62), 68.63 (16.29), 73.28 (15.32), 79.96 (12.57) and 82.54 (11.18) after the intervention, respectively. Total mean scores of QOL before the intervention was 66.16 (6.30) and increased to 75.74 (6.59) after the intervention with a significant difference in all aspects except the religious aspect. Therefore, this study showed the positive effects of walking on QOL of mastectomy patients. CONCLUSIONS: Patients with breast cancer experience physical as well as psychological malfunctions and fatigue during the condition and its treatment. Walking can solve many of their problems and, ultimately, improve their QOL.

A survey of the body image of mastectomies women referring to imam khomeini and imam hussein hospitals in tehran, iran.

BACKGROUND: Breast cancer treatment may have severe effects on women body image. As a routine care, mastectomy may enhance the risks for anxiety, depression, low self-esteem, and fear of social relationships among women. An awareness of body image changes following mastectomy may promote adaptation among women. AIM: The present study has sought to determine body image levels following mastectomy among females referring to clinics at Imam Khomeini and Imam Hussein Hospitals in Tehran, Iran. MATERIALS AND METHODS: In this descriptive study, 90 women, aged 30-50, who had undergone mastectomy in least 3 weeks before the study started participated. They had no history of any previous surgery, chronic or psychological diseases. The subjects only referred to the clinics for follow-up treatment procedures such as chemotherapy and radiotherapy. The study benefited from a questionnaire which was validated for content. The questionnaire reliability was qualified by Cronbach Procedure (α=0.8). The questionnaire included demographic information as well as information on surgery and body image. The data collected were analyzed by the SPSS software. RESULTS: The study show that body image among most subjects (44.4%) 1-3 months after mastectomy was at the "medium" level showing that 43.3% of the subjects were in favorable conditions. The study also showed that body image for most subjects (40%) was at the "medium" level, the image of most subjects (51.1%) of their breasts was at: very favorable" level, the image of most subjects (31.1%) of sexual relation was at "unfavorable" level, the image of most subjects (34.4%) upon the feeling of what others thought of them was at "favorable" level, and the image of most subjects (40%) of their familial relationships was at "medium" level. DISCUSSION AND CONCLUSION: Generally speaking, body image among most subjects under study was at medium-favorable levels. Since the study was conducted 1-3 months following mastectomy, and as the patients were at the recovery stages, the feelings of conquest over cancer may have caused them not to worry much about the body images.