Health Of Survivors Research Articles

Addressing the psychological impact of infertility risk arising from breast cancer treatment: Education and self-compassion interventions

Breast cancer incidence is increasing globally, including populations of childbearing age. Infertility risk from cancer treatment can negatively impact mental health in breast cancer patients and survivors, in part due to a lack of understanding of the risk and mitigation options ahead of treatment. In this commentary, recent literature on understanding of breast cancer treatment risk to infertility is reviewed, and recommendations are made for improving knowledge for at-risk populations. In addition, we propose a novel integration of self-compassion interventions be applied within breast cancer clinical care, building on groundwork from both breast cancer and primary infertility research areas that indicate the psychological benefits of self-compassion. Considerations for the application of self-compassion interventions to address fertility concerns within breast cancer patient and survivor populations are discussed.

Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy: A Balance Between Side Effects and Costs

BackgroundDeep inspiration breath hold (DIBH) is an effective technique for reducing heart exposure during radiotherapy for left-sided breast cancer. Despite its benefits, cost considerations and its impact on workflow remain significant barriers to widespread adoption. ObjectivesThis study aimed to assess the cost-effectiveness of DIBH and compare its operational, financial, and clinical outcomes with free breathing (FB) in breast cancer treatment. MethodsTreatment plans for 100 patients with left-sided breast cancer were generated using both DIBH and FB techniques. Dosimetric data, including the average mean heart dose, were calculated for each technique and used to estimate the cardiotoxicity of radiotherapy. A state-transition microsimulation model based on SCORE2 (Systematic Coronary Risk Evaluation) algorithms projected the effects of DIBH on cardiovascular outcomes and quality-adjusted life-years (QALYs). Costs were calculated from a provider perspective using time-driven activity-based costing, applying a willingness-to-pay threshold of €40,000 for cost-effectiveness assessment. A discrete event simulation model assessed the impacts of DIBH vs FB on throughput and waiting times in the radiotherapy workflow. ResultsIn the base case scenario, DIBH was associated with an absolute risk reduction of 1.72% (95% CI: 1.67%-1.76%) in total cardiovascular events and 0.69% (95% CI: 0.67%-0.72%) in fatal cardiovascular events over 20 years. Additionally, DIBH was estimated to provide an incremental 0.04 QALYs (95% CI: 0.05-0.05) per left-sided breast cancer patient over the same time period. However, DIBH increased treatment times, reducing maximum achievable throughput by 12.48% (95% CI: 12.36%-12.75%) and increasing costs by €617 per left-sided breast cancer patient (95% CI: €615-€619). The incremental cost-effectiveness ratio was €14,023 per QALY. ConclusionsDespite time investments, DIBH is cost-effective in the Belgian population. The growing adoption of DIBH may benefit long-term cardiovascular health in breast cancer survivors.

Bone mineral density in childhood acute lymphoblastic leukaemia survivors and factors affecting it

BackgroundLiterature on bone health in childhood acute lymphoblastic leukemia survivors (cALLS) is conflicting with most studies suggesting an adverse effect on bone mineral density (BMD). MethodsThis cross-sectional study enrolled cALLS>7 years of age. BMD was measured using dual-energy x-ray absorptiometry (DEXA) scan [Lumbo-sacral (LS-BMD) and whole-body (WB-BMD)]. Low BMD was defined as an LS-BMD ≤2 z-score. Demographic, anthropometry-related, therapy/disease-related and endocrine factors affecting LS-BMD were noted in two groups: low verses normal BMD. ResultsFifty-nine cALLS were analyzed with a median age of 66 months (range: 6–212) at diagnosis and a median duration postcompletion of therapy for 14 months (range 1–113). Two-thirds were male, and 25/59 (42%) had Tanner staging>1. Low LS-BMD was seen in 15/59 (25%), and a low WB-BMD in 3/59 (5%). The mean therapeutic doses of steroids and methotrexate were comparable in two groups. In univariate analysis, age at diagnosis >10 years was associated with low BMD (p = 0.02), while high adiposity was seen commonly with normal BMD (p = 0.01). On multivariate analysis, high adiposity was the single-most factor associated with normal BMD, with an odds ratio of 5.2. The correlation between LS-BMD and WB-BMD was statistically significant (r = 0.55).The median values of hormonal and mineral assays affecting calcium and vitamin D homeostasis and BMD in the two groups were comparable. ConclusionWe report a high prevalence of low LS-BMD (25%) in our cohort. Out of the studied demographics, therapy-related, disease-related, and endocrine factors; high adiposity as defined by a high body fat percentage, was protective against low BMD. We also found a significant correlation between LS-BMD and WB-BMD.

Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions.

Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

Closing the research gaps in obstetric health for survivors of cancer

Closing the research gaps in obstetric health for survivors of cancer

The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse

BackgroundParental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA. ObjectiveWe aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD. Methods, participants, and settingsParticipants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity. ResultsNo significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group. ConclusionsThe results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.

Long term impact of Wenchuan earthquake on population mental and behavioral disorders in heavily-stricken areas: An ecological study based on big data

BackgroundThis study aimed to explore and evaluate the development trends and differential changes in the prevalence of mental and behavioral disorders among the earthquake survivors in exposure groups (highly hard-hit areas) and control groups (general disaster areas) from 2015 to 2019, as well as to investigate the potential influencing factors. MethodsData was obtained from the Sichuan Health Information System and the Sichuan Health Yearbook, the prevalence of the exposure group and the control group were calculated, the difference between the two groups was evaluated using the prevalence rate ratio, and a fixed effect model was developed to investigate the potential influencing factors of the prevalence. ResultsThe prevalence by gender and age in the exposure group was always greater than those in the control group (RR>1), although the disparity between the two proceeded to diminish with time. The urbanization rate (β = 0.0448, P < 0.05) and disaster area levels (β = 0.0104, P < 0.05) were risk factors for the prevalence of mental and behavioral disorders. LimitationsThe study only collected data at the group level following the Wenchuan earthquake. Consequently, the findings are only applicable at the group level. Furthermore, diagnostic criteria for various types of mental and behavioral disorders diseases were not provided. ConclusionsThe earthquake has a significant long-term impact on mental health. It is necessary to continuously monitor the mental health of Wenchuan earthquake survivors and take appropriate post-disaster intervention measures.

Addressing heart health in survivors of childhood cancers.

Addressing heart health in survivors of childhood cancers.

Premature thymic functional senescence is a hallmark of childhood acute lymphoblastic leukemia survivorship

Childhood acute lymphoblastic leukemia (cALL) survivors suffer early-onset chronic diseases classically associated with aging. Normal aging is accompanied by organ dysfunctions, including immunological ones. We hypothesize that thymic immunosenescence occurs in cALL survivors and that its severity may correlate with early-onset chronic diseases. The PETALE study is a cALL survivor cohort with an extensive cardiovascular and metabolic evaluation. The thymic immunosenescence biomarker, signal joint T-cell receptor excision circles (TREC), was evaluated and was highly correlated with age in healthy participants (n = 281) and cALL survivors (n = 248). We observed a systematic thymic immunoage accentuation in each cALL survivor compared to controls ranging from 5.9 to 88.3 years. The immunoage gain was independent of age at diagnosis and treatment modalities and was more severe for females. Thymic aging was associated with several pathophysiological parameters, was greater in survivors suffering from metabolic syndrome, but there was no significant association with global physical condition. The decrease in TREC was independent from blood cell counts, which were normal, suggesting a segmental aging of the thymic compartment. Indeed, increased plasmatic T cell regulatory cytokines IL-6, IL-7 and GM-CSF accompanied high immunoage gain. Our data reveal that cALL or its treatment trigger a rapid immunoage gain followed by further gradual thymic immunosenescence, similar to normal aging. This leads to an enduring shift in accentuated immunoage compared to chronological age. Thus, accentuated thymic immunosenescence is a hallmark of cALL survivorship and TREC levels could be useful immunosenescence biomarkers to help monitoring the health of cancer survivors.

Associations between initial heart rhythm and self-reported health among cardiac arrest survivors − A nationwide registry study

BackgroundNon-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete. AimTo examine the associations between initial rhythm and self-reported health in CA survivors. MethodsThis nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3–6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes. ResultsThe study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses. ConclusionsInitial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress.

Tackling Brain and Muscle Dysfunction in Acute Respiratory Distress Syndrome Survivors: NHLBI Workshop Report.

Acute respiratory distress syndrome (ARDS) is associated with long-term impairments in brain and muscle function that significantly impact the quality of life of those who survive the acute illness. The mechanisms underlying these impairments are not yet well understood, and evidence-based interventions to minimize the burden on patients remain unproved. The NHLBI of the NIH assembled a workshop in April 2023 to review the state of the science regarding ARDS-associated brain and muscle dysfunction, to identify gaps in current knowledge, and to determine priorities for future investigation. The workshop included presentations by scientific leaders across the translational science spectrum and was open to the public as well as the scientific community. This report describes the themes discussed at the workshop as well as recommendations to advance the field toward the goal of improving the health and well-being of ARDS survivors.

Sexual health and therapy adherence of hormone-sensitive breast cancer survivors on maintenance endocrine therapy: The SHE-CAN project in Toronto, Canada.

536 Background: Endocrine therapy (ET) is the standard of care for hormone sensitive (HR) breast cancer. While these drugs are highly efficacious and patients remain on them for extended periods of time, there are many side effects. It is estimated that 20-30% of women on ET stop early due to these side effects, most commonly due to gynecological symptoms of menopause (GSM). The purpose of this study is to better understand the vaginal health, sexual health, quality of life, sexual dysfunction, and adherence to therapy for HR breast cancer patients treated with anti-estrogen therapy. Methods: From August 2021 to January 2024, women from Mount Sinai Hospital’s outpatient oncology clinic and Women’s College Hospital After Cancer Treatment Transition (ACTT) clinic, who presented with HR breast cancer and who were being treated with anti-estrogen agents for a minimum of three months, were invited to participate in the study. Participants were asked to complete a survey examining their treatment experience and adherence, occurrence and frequency of GSM, patient-provider communication, along with two validated measurement tools (Female Sexual Function Index [FSFI} and Menopause-Specific Quality of Life questionnaire [MENQOL]). Medical history was also reviewed from the participant’s medical chart. Analysis was conducted using Excel. Results: A total of 417 participants completed the questionnaire. The median age was 60 years [IQR:52-69] with 401 participants (96.2%) being treated in the adjuvant setting versus 16 patients (3.8%) in the metastatic setting. At the time of diagnosis, 156 participants (37.4%) were pre-menopausal, 52 participants (12.5%) were peri-menopausal, and 185 participants (44.4%) were post-menopausal. When surveyed, 134 participants (32.1%) were on tamoxifen and 272 participants (65.2%) were on an aromatase inhibitor. Within six months prior to survey completion, 214 participants (51.3%) stopped taking their medication for a period of time. Within the past year, participants reported experiencing the following symptoms “all of the time”: vaginal dryness (24.9%), hot flashes (24.7%), and decreased sex drive (34.5%). Only 144 participants (34.5%) reported that a healthcare provider had asked them about experiencing GSM. The mean FSFI score was 21.9 ± 7.7 among 168 sexually active participants. Of these 168 participants, 116 (69.0%) had a final score of 26.5 or less, the cut-point used to demonstrate female sexual dysfunction. Symptoms captured in the MENQOL’s sexual domain (3.7 ± 2.3) and physical domain (3.7 ± 1.4) were found to be most bothersome. Conclusions: In our study, patients with breast cancer on ET report significant sexual dysfunction. Management of GSM and improved communication between patients and healthcare providers is required and should be prioritized to improve sexual dysfunction and treatment adherence.

Characterizing vaginal stenosis in female cancer survivors.

e13800 Background: Vaginal stenosis is an underreported and undertreated sequelae of cancer treatment that leads to pain with sexual activity and inability to tolerate pelvic exams. We sought to describe a population of female cancer survivors presenting with sexual health concerns and identify factors associated with presence of vaginal stenosis on genitourinary exam (GU). Methods: A retrospective analysis included 134 female cancer survivors presenting to a sexual health after cancer program in South Florida (2020-2023). Sexual function and GU anatomy disruptions were evaluated using the Female Sexual Function Index (FSFI) and Adapted Vulvovaginal Exam Score (AVES), respectively. Vaginal stenosis was defined as presence of vaginal agglutination, shortening, or scarring/adhesions on GU exam. Patients who did and did not present with vaginal stenosis were compared using Chi-squared analysis, while independent t-test analyzed FSFI and AVES scores. Results: Of 134 patients, 116 met criteria for inclusion and underwent a GU examination. Median age was 45 (23-75). Race, ethnicity, menopausal status, cancer type, and treatment type were similar between groups. The rate of vaginal stenosis in patients with breast cancer was 13.4%, gynecologic cancer was 27.2%, and 28.6% with other cancer types (including gastrointestinal, hematologic, sarcoma). Higher median AVES scores, which denote more severe GU exam disruptions, were found in patients with vaginal stenosis compared to those without (13 vs 5; p&lt;.001). While overall FSFI scores were similar between groups, median FSFI pain domain scores were lower in those with vaginal stenosis compared to those without stenosis (7.8 vs 11; p=0.037). Conclusions: Factors associated with the development of vaginal stenosis in female cancer survivors are not well-described. Our analysis reveals that vaginal stenosis develops in women treated for a variety of cancer types across the age continuum. Identifying and treating this severe sequela of treatment is a critical step in improving the sexual health of female cancer survivors. Ongoing work seeks to evaluate the safety and efficacy of treatments to reverse GU exam disruptions after cancer treatment. [Table: see text]

Neighborhood Archetypes and Cardiovascular Health in Black Breast Cancer Survivors

BackgroundMaintaining cardiovascular health (CVH) is critical for breast cancer (BC) survivors, particularly given the potential cardiotoxic effects of cancer treatments. Poor CVH among Black BC survivors may be influenced by various area-level social determinants of health, yet the impact of neighborhood archetypes in CVH among this population remains understudied. ObjectivesThis study aimed to characterize the neighborhood archetypes where Black BC survivors resided at diagnosis and evaluate their associations with CVH. MethodsWe assessed CVH 24 months post-diagnosis in 713 participants diagnosed between 2012 and 2017 in the Women’s Circle of Health Follow-Up Study, a population-based study of Black BC survivors in New Jersey. Neighborhood archetypes, identified via latent class analysis based on 16 social and built environment features, were categorized into tertiles. Associations between neighborhood archetypes and CVH scores were estimated using polytomous logistic regression. ResultsCVH scores were assessed categorically (low, moderate, and optimal) and as continuous variables. On average, Black BC survivors achieved only half of the recommended score for optimal CVH. Among the 4 identified archetypes, women in the Mostly Culturally Black and Hispanic/Mixed Land Use archetype showed the lowest CVH scores. Compared to this archetype, Black BC survivors in the Culturally Diverse/Mixed Land Use archetype were nearly 3 times as likely to have optimal CVH (relative risk ratio: 2.92; 95% CI: 1.58-5.40), with a stronger association observed in younger or premenopausal women. No significant CVH differences were noted for the other 2 archetypes with fewer built environment features. ConclusionsNeighborhood archetypes, integrating social and built environment factors, may represent crucial targets for promoting CVH among BC survivors.

Prevalence and risk factors associated with chronic pain among survivors of head and neck cancer.

e18016 Background: There are over 500,000 survivors of head and neck cancer (HNC) in the United States. Pain is one of the most common symptoms of HNC due to disease anatomy, treatment and post-treatment toxicities. While opioid treatment is a mainstay in HNC care, factors associated with chronic pain are not properly understood. Methods: We built a retrospective cohort of adult patients with a history of HNC using the National Health Interview Survey (NHIS) from 2010 to 2021 that collected through personal household interviews ( n = 353). Chronic pain was defined using the question: In the past three months, how often did you have pain? Would you say never, some days, most days, or every day? Chronic pain was coded as “yes” if the response was most or every day, and “no” if it was never or some days. Using weighted logistic regression analysis adjusting for age and sex, we examined the association between chronic pain and sociodemographic (race, insurance, education, income, employment and smoking history) and clinical (depression, and self-rated health status) factors. Results: Among individuals with a history of HNC, 149 (adjusted Prevalence Rate = 43.2%; 95% CI: 36.6%, 49.8%) had experienced chronic pain in the past three months. There were significant associations with clinical factors, as individuals with poor self-rated health (aOR = 6.42; 95% CI: 3.25, 12.70) and those with depression (aOR = 3.25; 95% CI: 1.73, 6.11) had increased odds of reporting chronic pain. Among sociodemographic factors White race (aOR = 2.52, 95% CI: 1.04, 6.10) and Medicaid insurance (aOR = 3.76, 95% CI: 1.40, 10.10) were associated with and increased odds of reporting chronic pain. There was no significant association of education, income, employment or smoking history with chronic pain among the study HNC survivors. Conclusions: Over 40% of individuals with a history of HNC may be living with chronic pain, unequally distributed based on race, payor status and comorbid depression. Given the current opioid crisis in the United States, and the poor outcomes associated mental health in cancer survivors, our findings highlight clinical and social determinants of health factors that should be taken into the consideration for management of chronic pain among survivors of HNC patients.

Sexual health and testosterone concentration in male lymphoma survivors: A systematic review

Advancements in lymphoma treatment have increased the number of long-term survivors who may experience late effects such as impaired sexual function and testosterone deficiency. The aim of this review was to determine the prevalence of testosterone deficiency and sexual dysfunction among male lymphoma survivors; and associations between the two. A systematic search identified 20 articles for inclusion. The prevalence of low total testosterone was 0%–50 %, with mean values within reference levels, and for luteinizing hormone above reference levels in 0%–80 %. Four studies included SHBG and free testosterone, with mixed results. Compromised sexual health was found in 23%–61 %. Overall, total testosterone and sexual health were associated. The risk of bias (ROBINS-E and RoB 2) was high/very high, leading to low/very low overall confidence in the bulk of evidence (GRADE). Longitudinal studies evaluating biologically active testosterone and sexual health are needed, to develop evidence based standard procedures for follow-up of sexual health.

Effect and acceptability of jasmine compound essential oil for premenopausal breast cancer survivors suffering from genitourinary syndrome of menopause: A prospective interventional study.

1063 Background: Genitourinary syndrome of menopause (GSM) includes dyspareunia, vaginal dryness, vaginal burning, urinary urgency, and recurrent urinary tract infections. Breast cancer survivors (BCSs) exhibit more severe symptoms of GSM than healthy aging women, especially premenopausal BCSs in sexually active lifetime. GSM detrimentally impacts their quality of life and contributes to the premature cessation of endocrine therapy for breast disease. This study aims to explore the efficacy and safety of Jasmine compound essential oil in the treatment of GSM in premenopausal breast cancer women. Methods: Premenopausal sextually-active women with hormone receptor (HR) positive stage I to III BC taking ovarian function suppression (OFS) treatment and endocrine therapy with self-reported vaginal dryness, dyspareunia, or decreased libido were enrolled to the 12 weeks topically applied Jasmine compound essential oil trial. E2 and FSH was measured at baseline and weeks 12. A series of validated sexual quality-of-life questionnaires were completed at baseline, and subsequently at weeks 4, 8, and 12. The primary endpoint is the improvement in sexual pain evaluated based on the Female Sexual Function Index scale (FSFI). Acceptability was measured by patient preference and reported intention to continue using the products. Gynecologic examinations and metagenomic profiling of the vaginal microbiota were conducted at baseline and post-treatment for patients in an exploratory cohort. Results: Overall, 96 BCSs signed consent (mean [range] age, 45 [32-55] years) and 89 completed 12 weeks of treatment. E2 and FSH were maintained within the postmenopausal range without significant fluctuations during the treatment. Topically applied Jasmine compound essential oil resulted in significant improvements in dyspareunia, vaginal dryness, irritation and quality of life over time (all P&lt; 0.001). Both BCSs and their sexual partners reported being satisfied with the essential oil treatment and the adherence rate reached 95% (SD 10). In the 20-patient exploratory cohort, there were improvements in vaginal pH (baseline mean 6.07 compared with 12-week mean 4.68[ P&lt;.001]), and vaginal maturation index (45.3 compared with 52.1[ P&lt;.001]). We also observed a positive influence on the vaginal microbiota after intervention. In patients with elevated baseline abundance of Lactobacillus in the vaginal microbiome, there was a more pronounced improvement in scale scores following essential oil access. Conversely, a high baseline abundance of Escherichia coli may be considered a detrimental factor associated with less benefit from essential oil. Conclusions: Jasmine compound essential oil could relieve vaginal symptoms and improve vaginal health in breast cancer survivors who have experienced menopause after cancer treatment.

Potential Benefits of Aerobic Walking Exercise on Cardiovascular, Pulmonary, and Bone Health in Non-Ambulatory Stroke Survivors: A Narrative Review

Stroke is the leading cause of long-term disability worldwide. After stroke, people commonly experience additional cardiovascular disease, cognitive declination, sensorimotor disability, pulmonary dysfunction, psychological problems, and bone health declinations. In stroke rehabilitation research, most of previous studies focused on recovery of sensorimotor function, with few studies examined outcomes in cardiovascular, cardiopulmonary, and bone health, particularly in non-ambulatory individuals who are at even higher risk of secondary complications. In this narrative review, we reviewed the health benefits of aerobic walking exercise on cardiovascular, pulmonary, and bone health in non-ambulatory stroke survivors. We started with a review of health issues in cardiopulmonary system and bones in non-ambulatory stroke survivors. We then reviewed the current state of clinical research findings of aerobic walking exercise in non-ambulatory stroke survivors. We reviewed the aerobic exercise guidelines for non-ambulatory stroke survivors and whether walking exercise was recommended for them. Then, we investigated the exercise position (standing vs. sitting) to see which exercise position would be recommended to improve or at least maintain the health of cardiopulmonary and bone in non-ambulatory stroke survivors. We finally reviewed the walking assistive devices that makes walking exercise feasible for non-ambulatory stroke survivors.

Sexual health in adult survivors of childhood cancer: A Project REACH study.

Sexual dysfunction is a significant complication of treatment for many adult-onset cancers. However, comparatively less is known about sexual dysfunction in adult childhood cancer survivors (CCSs). Research has been limited by the exclusion of specific cancers (e.g., central nervous system [CNS] tumors) and the lack of validated measures, which makes it difficult to understand the nature and prevalence of sexual dysfunction in CCSs. A total of 249 adult CCSs (aged 18-65 years) enrolled in Project REACH, a prospective cohort study, and completed measures of physical and mental health, including sexual dysfunction. Participants scoring ≤19 on the Female Sexual Function Index 6 or ≤21 on the International Index of Erectile Function 5 were classified as experiencing sexual dysfunction. Analyses examined the relationships between sexual dysfunction and demographic, disease, treatment, and health variables. A total of 78 participants (32%) experienced clinically significant sexual dysfunction. In univariate analysis, sexual dysfunction was significantly associated with CNS tumor diagnosis (odds ratio [OR],2.56) and surgery (OR,1.96) as well as with health variables such as fatigue (OR,3.00), poor sleep (OR,2.84), pain (OR,2.04), depression (OR,2.64), poor physical health (OR,2.45), and poor mental health (OR,2.21). Adjusted analyses found that CNS tumor diagnosis (p=.001) and health variables (p=.025) contribute significantly to sexual dysfunction in CCSs. Approximately one third of adult CCSs report clinically significant sexual dysfunction, which underscores a significant screening and treatment need. However, because available measures were developed for survivors of adult cancers, research to create a sexual health measure specifically for adult CCSs is necessary to better identify the sexual health concerns of this vulnerable population.

The Association Between Food Insecurity and Intimate Partner Violence Among U.S. Army Soldiers.

Food insecurity in the military ranges between 25% and 33%, significantly higher than the 10.5% for civilians reported by the U.S. Department of Agriculture. The primary objective of this study is to analyze the association between food insecurity and intimate partner violence (IPV) victimization among U.S. Army Soldiers. The secondary objective is to determine if there are any moderating effects in the relationship between food insecurity and IPV victimization by demographic, financial, and mental health covariates. A cross-sectional, online survey was administered by the U.S. Army Public Health Center at an Army installation in 2019; 56% of respondents reported that they were married or in a relationship (n = 2,740). The main predictor was the two-item food insecurity screener (Hunger Vital Signs), which measures marginal food insecurity (encompassing marginal, low, and very low food security). The main outcome was IPV victimization as measured by the Hurt, Insult, Threaten, Scream scale. Multiple logistic regression was used to assess the association between marginal food insecurity and IPV victimization, controlling for demographic, financial, and mental health covariates. In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval [1.40, 3.00]). The only interaction that was statistically significant was between anxiety and food insecurity on IPV victimization (p = .0034). Interactions by soldier's military rank, birth sex, and race and ethnicity were not statistically significant. IPV has implications for the emotional and physical health of survivors. In addition, service members who are food insecure may experience similar decrements in emotional and physical health due to suboptimal nutrient intake. By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their dependents.