Associations between modifiable lifestyle factors and health-related quality of life among endometrial carcinoma survivors - A cross-sectional study.

OBJECTIVE: To explore possible associations between modifiable lifestyle factors and health-related quality of life (HRQoL) in endometrial carcinoma survivors by assessing differences in HRQoL between survivors meeting and not meeting the World Health Organization's (WHO) recommendations regarding physical activity, BMI, and smoking. METHODS: This was a cross-sectional population-based study in women having undergone surgery for assumed early-stage endometrial carcinoma. Thresholds for clinical importance based on the EORTC QoL working group were used to interpret scores. Effect size (ES) was interpreted as small (d = 0.2-0.49), medium (d = 0.5-0.8), and large (d > 0.8). RESULTS: In total, 1200 evaluable women were included. Meeting physical activity recommendations and BMI <25 kg/m2 was associated with significantly better global health status, (ES) = 0.18 and ES = -0.11, respectively. On multivariate analysis, women meeting physical activity recommendations had significantly higher scores on physical- (ES = 0.31), role- (ES = 0.15), and social functioning (ES = 0.15), and lower levels of fatigue (ES = -0.16), pain (ES = -0.10), and appetite loss (ES = -0.15) (all p < 0.05) compared to non-meeting survivors. Participants with BMI ≥25 kg/m2 had lower scores for social functioning (ES = -0.10), and higher levels of pain (ES = 0.13) and dyspnea (ES = 0.12) (all p < 0.05) compared to those with BMI <25 kg/m2. Smokers had lower scores for emotional functioning (ES = -0.09) and higher levels of diarrhea (ES = 0.10) (all p < 0.05) compared to non-smokers. CONCLUSION: Meeting WHO recommendations for modifiable life-style factors is associated with better HRQoL among endometrial carcinoma survivors: Being sufficiently physical active and having a BMI <25 kg/m2 are significantly associated with better self-reported global health status. All modifiable factors are associated with better functioning, and reduced symptom-burden.

Self-reported lower extremity lymphedema and quality of life after surgical staging of endometrial carcinoma: A population based cross-sectional study.

OBJECTIVES: Sentinel lymph node biopsy (SLN) has replaced lymphadenectomy in staging of endometrial carcinoma. The aims of the study were to explore the prevalence of self-reported lymphedema (LEL), identify factors associated with LEL, compare quality of life (QoL) scores using thresholds of clinical importance, and assess correlation between different questionnaires. METHODS: Women who underwent staging for endometrial carcinoma from 2006 to 2021 were invited to complete the Lower Extremity Lymphedema Screening Questionnaire (LELSQ), EORTC QLQ-C30, QLQ-EN24 and EQ-5D-5L. RESULTS: Of 2156 invited survivors, 61% participated in the study, whereof 1127 were evaluable by LELSQ. The LEL prevalence was 51%, 36% and 40% after lymphadenectomy, SLN and hysterectomy, respectively (p < 0.001). Higher BMI, undergoing lymphadenectomy and receiving adjuvant chemotherapy were associated with LEL; odds ratios 1.07 (95% CI 1.05-1.09), 1.42 (95% CI 1.03-1.97) and 1.43 (95% CI 1.08-1.89) respectively. QoL was lower for women with LEL compared to those without. In women with musculoskeletal complaints the prevalence of LEL was 59%, 50% and 53% after lymphadenectomy, SLN and hysterectomy (p = 0.115), respectively, compared to 39%, 17% and 18% (p < 0.001) in women without musculoskeletal complaints. Spearman's correlation was moderate to strong between the questionnaires. CONCLUSION: SLN implementation is not associated with increased LEL prevalence compared to hysterectomy alone, but is associated with a significantly lower prevalence compared to lymphadenectomy. LEL is associated with lower QoL. Our study demonstrates moderate to strong correlation between self-reported LEL and QoL scores. Available questionnaires may not distinguish between symptoms caused by LEL and musculoskeletal disease.

Mitochondria as the powerhouses of sexual selection: Testing mechanistic links between development, cellular respiration, and bird song.

The developmental environment can affect the expression of sexually selected traits in adulthood. The physiological mechanisms that modulate such effects remain a matter of intense debate. Here, we test the role of the developmental environment in shaping adult mitochondrial function and link mitochondrial function to expression of a sexually selected trait in males (bird song). We exposed male zebra finches (Taeniopygia guttata) to corticosterone (CORT) treatment during development. After males reached adulthood, we quantified mitochondrial function from whole red blood cells and measured baseline CORT and testosterone levels, body condition/composition, and song structure. CORT-treated males had mitochondria that were less efficient (FCRL/R) and used a lower proportion of maximum capacity (FCRR/ETS) than control males. Additionally, CORT-treated males had higher baseline levels of CORT as adults compared to control males. Using structural equation modelling, we found that the effects of CORT treatment during development on adult mitochondrial function were indirect and modulated by baseline CORT levels, which are programmed by CORT treatment during development. Developmental treatment also had an indirect effect on song peak frequency. Males treated with CORT during development sang songs with higher peak frequency than control males, but this effect was modulated through increased CORT levels and by a decrease in FCRR/ETS. CORT-treated males had smaller tarsi compared to control males; however, there were no associations between body size and measures of song frequency. Here, we provide the first evidence supporting links between the developmental environment, mitochondrial function, and the expression of a sexually selected trait (bird song).

Beyond multimorbidity: What can we learn from complexity science?

Multimorbidity - the occurrence of two or more long-term conditions in an individual - is a major global concern, placing a huge burden on healthcare systems, physicians, and patients. It challenges the current biomedical paradigm, in particular conventional evidence-based medicine's dominant focus on single-conditions. Patients' heterogeneous range of clinical presentations tend to escape characterization by traditional means of classification, and optimal management cannot be deduced from clinical practice guidelines. In this article, we argue that person-focused care based in complexity science may be a transformational lens through which to view multimorbidity, to complement the specialism focus on each particular disease. The approach offers an integrated and coherent perspective on the person's living environment, relationships, somatic, emotional and cognitive experiences and physiological function. The underlying principles include non-linearity, tipping points, emergence, importance of initial conditions, contextual factors and co-evolution, and the presence of patterned outcomes. From a clinical perspective, complexity science has important implications at the theoretical, practice and policy levels. Three essential questions emerge: (1) What matters to patients? (2) How can we integrate, personalize and prioritize care for whole people, given the constraints of their socio-ecological circumstances? (3) What needs to change at the practice and policy levels to deliver what matters to patients? These questions have no simple answers, but complexity science principles suggest a way to integrate understanding of biological, biographical and contextual factors, to guide an integrated approach to the care of people with multimorbidity.

Developmental stress reduces body condition across avian life-history stages: A comparison of quantitative magnetic resonance data and condition indices.

Animals exposed to stressful developmental conditions can experience sustained physiological, behavioral, and fitness effects. While extensive research shows how developmental stress affects development, few studies have examined the effects on body composition. To test the effects of developmental stress on nestling and adult body composition, we dosed nestling zebra finches (Taeniopygia guttata) with either a corticosterone (CORT) or control treatment. We calculated condition indices (scaled mass, residual mass, and ratio indices) from morphometric measurements and used quantitative magnetic resonance (QMR) to assess body composition during early development and adulthood. We compared these three traditionally-used condition indices to QMR-derived body composition measurements, to test how well they predict relative fat mass. Our results show that developmental stress decreases body mass, and has a dose-dependent effect on tarsus length in nestling birds. Furthermore, stress treatment during the nestling period had long-lasting effects on adult body mass, lean mass and tarsus length. None of the three condition indices were good indicators of relative fat mass in nestlings, but all indices were closely associated with relative fat mass in adults. The scaled mass index was more closely associated with relative fat mass than the other condition indices, when calculated from wing chord length in nestlings. In adults however, the residual mass index and the ratio index were better indicators of relative body fat than the scaled mass index, when calculated from tarsus length. Our data demonstrate the short and long-term impact of developmental stress on birds, and highlight important age-related factors to consider when using condition indices.