Introduction
Symptoms of depression, anxiety and distress are common in the first years after a cancer diagnosis, but little is known about the prevalence of these symptoms at the long term. The aim ...of this review was to describe the prevalence of symptoms of depression, anxiety and distress in long‐term cancer survivors, five or more years after diagnosis, and to provide implications for primary care.
Methods
We performed a systematic literature search in the PubMed, PsycINFO and CINAHL databases. Studies were eligible when reporting on the prevalence of symptoms of depression, anxiety and/or distress in long‐term cancer survivors (≥5 years after diagnosis), treated with curative intent.
Results
A total of 20 studies were included. The reported prevalence of depressive symptoms (N = 18) varied from 5.4% to 49.0% (pooled prevalence: 21.0%). For anxiety (N = 7), the prevalence ranged from 3.4% to 43.0% (pooled prevalence: 21.0%). For distress (N = 4), the prevalence ranged from 4.3% to 11.6% (pooled prevalence: 7.0%).
Conclusion
Prevalences of symptoms of depression, anxiety and distress among long‐term survivors of cancer do not fundamentally differ from the general population. This is reassuring for primary care physicians, as they frequently act as the primary physician for long‐term survivors whose follow‐up schedules in the hospital have been completed.
Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs ...further investigation.
To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue.
A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner.
Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors.
Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 95%CI, 1.4-2.9), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 95%CI, 7.1-40.5) or anxiety (41.9% versus 10.1%; OR, 6.4 95%CI, 3.6-11.4).
One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.
Abstract Objectives Asymmetric dimethylarginine (ADMA) is a key regulator of nitric oxide production. Elevations of ADMA have previously been associated with endothelial dysfunction in pre-eclamptic ...women. ADMA is degraded mainly by dimethylarginine dimethylaminohydrolase (DDAH), which is also expressed in placental tissue. Therefore, we measured placental DDAH expression and activity in pre-eclampsia and normal pregnancies in order to determine whether impairment of this enzyme in the pre-eclamptic placenta could contribute to elevations of ADMA levels in these women. Study design ADMA plasma levels were measured by LC–MS/MS in 18 pre-eclamptic patients and 28 controls. Placental DDAH activity was determined by measuring the degradation of 2 H6 -labeled ADMA in tissue homogenates from placental biopsies in 15 women with pre-eclampsia and 16 controls. Placental mRNA expression of DDAH 1, DDAH 2, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and protein-arginine methyltransferase 1 (PRMT1) was determined in tissue biopsies by RT-PCR. Results Placental DDAH activity was almost undetectable in pre-eclampsia, and it was significantly higher in controls. ADMA plasma levels were higher in pre-eclampsia as compared to normal pregnancies (0.51 ± 0.15 μmol/l vs. 0.42 ± 0.07 μmol/l; p = 0.005), and the difference between maternal and fetal ADMA levels (feto-maternal ADMA gradient) was lower in pre-eclampsia (0.63 ± 0.20 μmol/l vs. 0.80 ± 0.18 μmol/l; p = 0.02). Furthermore, mRNA expression levels of DDAH 2 were significantly lower in pre-eclamptic women ( p = 0.04), while PRMT1 expression levels were the same. In pre-eclampsia, we found only weak correlations between maternal ADMA levels and DDAH 1 ( r = −0.41; p = 0.22) and DDAH 2 expressions ( r = −0.45; p = 0.17) but a slightly stronger correlation between DDAH 2 expression and feto-maternal ADMA gradient ( r = 0.60; p = 0.07). Conclusion Decreased DDAH activity in the pre-eclamptic placenta might contribute to elevated ADMA levels in these patients.
Owing to its unique host cell-dependent development cycle, Chlamydia pneumoniae occupies an intracellular niche that enables the bacterium to survive and to multiply, secluded from both the ...extracellular and the cytoplasmic environments. Within its separate chlamydial inclusion, it is able to genetically switch between a replicative and a persisting non-replicative state, linking the pathogen to acute as well as chronic diseases. Although its role in acute respiratory infection has been established, a potential link between chronic vascular infection with C. pneumoniae and the development of atherosclerosis remains enigmatic, in particular because chronic chlamydial infection cannot be eradicated by antibiotics. C. pneumoniae has developed numerous mechanisms to establish an adequate growth milieu involving the type III secretion-mediated release of chlamydial effector proteins that interact with cellular structures and reprogram host cell regulatory pathways. This brief overview of these pathomechanisms focuses on chronic vascular infection.
Highlights • The results suggest long-term increase in symptoms of depression after breast cancer. • We recommend discussing the long-term impact of breast cancer with patients. • Breast cancer ...survivors do not appear to have more long-term symptoms of anxiety.
•We identify ecosystem services (ES) enabling tourism activities at Costalegre.•Future scenarios help to visualize effects on the social–ecological system.•ES benefits are unequally distributed among ...stakeholders.•Main ES stewards are not acknowledged by ES beneficiaries.•Stakeholder dialogue and negotiation are needed to construct alternative futures.
Tourism, as all human activities, is dependent on the natural environment and its respective ecosystem services (ES). Different user groups manage and consume these touristic ES differently, resulting in discrepancies and potential conflicts. Despite the urgency to find inclusive local approaches for sustainable development, tourism studies still analyze socio-economic and ecological impacts separately and lack integrated social–ecological approaches to improve foresight in tourism planning. Based on a growing concern regarding the future of Costalegre on the Jalisco coast of Western Mexico, we analyze through interviews, surveys, and participant observation the dependence of tourism on specific ecosystem services and conduct a scenario analysis which shows present and future implications for the social–ecological system. Furthermore, this analysis shows in detail how different scenarios change ES provision and people's livelihoods. Key findings include identifying freshwater provision and cultural ES as the most important touristic ES. At a regional scale, peasants in ejidos are the main ES stewards, whereas high-class tourism facilities constitute important local stewards. Benefits, mainly access to freshwater and the beach, are unequally distributed, provoking conflicts among different ES user groups that may escalate in the near future. Improved communication between all user groups and strengthening of key political actors seem to be the most immediate recommendations to ensure the long term sustainability of this particular region. This work may contribute to improved planning and decision-making as our ES based scenarios are a first step to integrate social–ecological knowledge into improved decision-making. At a local scale, the study reveals the most likely future development options and their social and ecological consequences. It could also serve as a baseline for informed policy making.
Background
Achieving an aesthetic outcome following postmastectomy breast reconstruction is both an important goal for the patient and plastic surgeon. However, there is currently an absence of a ...widely accepted, standardized, and validated professional aesthetic assessment scale following postmastectomy breast reconstruction.
Methods
A systematic review was performed to identify all articles that provided professional assessment of the aesthetic outcome following postmastectomy, implant- or autologous tissue-based breast reconstruction. A modified version of the Scientific Advisory Committee’s Medical Outcomes Trust (MOT) criteria was used to evaluate all professional aesthetic assessment scales identified by our systematic review. The criteria included conceptual framework formation, reliability, validity, responsiveness, interpretability, burden, and correlation with patient-reported outcomes.
Results
A total of 120 articles were identified: 52 described autologous breast reconstruction, 37 implant-based reconstruction, and 29 both. Of the 12 different professional aesthetic assessment scales that exist in the literature, the most commonly used scale was the four-point professional aesthetic assessment scale. The highest score on the modified MOT criteria was assigned to the ten-point professional aesthetic assessment scale. However, this scale has limited clinical usefulness due to its poor responsiveness to change, lack of interpretability, and wide range of intra- and inter-rater agreements (Veiga et al. in Ann Plast Surg 48(5):515–520,
2002
).
Conclusions
A “gold standard” professional aesthetic assessment scale needs to be developed to enhance the comparability of breast reconstruction results across techniques, surgeons, and studies to aid with the selection of procedures that produce the best aesthetic results from both the perspectives of the surgeon and patients.
Andisols are very important land resources supporting high human population density. Maize (
Zea mays L.) production on Andisols located in the Purhepecha Region of central Mexico is representative ...of the highlands conditions of Mexico and Latin America. Farmers struggle with low crop yield and low soil nutrient availability. A 2-year field study was conducted to evaluate the effects of green manures either tilled into the soil (CT) or cut and left on the surface as a mulch (ZT), on maize yield and soil quality. Green manure treatments were: vetch (
Vicia sativa L.), oat (
Avena sativa L.) and none. No extra N was added to maize. Green manure and tillage had a significant effect on maize grain yield, N uptake and P uptake with CT vetch performing better than ZT oat. Soil organic C and total N were significantly higher under ZT than under CT management. Soils with vetch had higher P concentration. Soil under ZT oat had the highest infiltration rate and penetration resistance compared with other treatments. There appears to be a trade off between soil productivity and intrinsic soil physical properties among soil treatments.
Previous studies comparing muscle-sparing transverse rectus abdominis myocutaneous (TRAM) versus deep inferior epigastric artery perforator (DIEP) free flaps have not considered procedure selection ...bias. Propensity score analysis provides a statistical approach to consider preoperative factors in flap selection, and was used to compare major complications (breast and abdominal) between these microsurgical breast reconstruction (free muscle-sparing TRAM versus DIEP).
This study evaluated major breast and abdominal complications in 292 consecutive patients (428 free abdominal flaps). Propensity scores were calculated for patient differences affecting flap selection (DIEP versus free muscle-sparing TRAM). Multivariate logistic models using selected covariates separately analyzed breast and abdominal complications between flap methods.
There were 83 major complications (28 percent): breast, 20 percent; abdomen, 8 percent. Using propensity scores, the adjusted odds of abdominal complications were significantly higher in free muscle-sparing TRAM than in DIEP flaps (OR, 2.73; 95 percent CI, 1.01 to 7.07). With prior chemotherapy, body mass index significantly increased abdominal complications (OR, 1.16; 95 percent CI, 1.01 to 1.34). Using propensity scores, there was no significant association between reconstruction method and breast complications; diabetics had significantly increased breast complications (OR, 4.19; 95 percent CI, 1.14 to 15.98). Previous abdominal operations (OR, 1.77; 95 percent CI, 0.96 to 3.30) and immediate reconstruction (OR, 1.86; 95 percent CI, 0.94 to 3.71) approached significance.
Propensity score analysis indicated significantly higher abdominal complications in free muscle-sparing TRAM compared with DIEP flaps. This study highlights the importance of separately evaluating recipient breast and donor abdominal complications and use of propensity scores to minimize procedure selection bias.
Therapeutic, III.
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