Background/Introduction: Breast cancer is recognized as the most prevalent malignancy worldwide and the leading cause of mortality among women, which influences individuals in lowand middle-income countries. Mammography, as the most effective method for early detection among asymptomatic women, significantly reduces mortality rates among women aged 40 and above. This study aimed to examine the predictive role of health literacy and the Extended Parallel Process Model (EPPM) constructs on intention to undergo mammography among women aged 40 years and older attending health care centers in Rey City in 2023. Methods: This cross-sectional study was conducted on 336 women using a two-stage sampling method. Data were collected through questionnaires developed based on the EPPM and health literacy constructs and analyzed using SPSS version 26 and SmartPLS version 3. Results: The mean age of women was 48.12 ± 5.67 years. Approximately 70.2% of the women were Iranian, while 29.8% were immigrants, and the majority (71.1%) were housekeepers. The constructs of perceived susceptibility, perceived self-efficacy, and perceived response efficacy significantly influenced the intention to undergo mammography. However, perceived severity and fear were not significantly associated with intention. No significant direct association was found between health literacy and mammography intention (β = 0.041, p = 0.312). However, health literacy exerted a significant total indirect effect on mammography intention (β = 0.411, 95% CI [0.292, 0.531], p < 0.001), fully mediated through perceived susceptibility, self-efficacy, and response efficacy, indicating full mediation. Discussion: The findings suggest that health literacy may contribute to mammography intention through its associations with key EPPM constructs, particularly perceived susceptibility, selfefficacy, and response efficacy. These results underscore the importance of addressing both cognitive and motivational factors when designing interventions to promote breast cancer screening. Conclusion: EPPM serves as an appropriate framework for predicting mammography intention. Among the EPPM constructs, perceived self-efficacy, response efficacy, and perceived susceptibility emerged as key determinants significantly influencing women's intention to undergo mammography. Health interventions should focus on enhancing these factors to promote preventive health behaviors.
Introduction: Breast cancer incidence has been rising worldwide in recent years, making it the leading cause of death among women globally. A breast cancer diagnosis is a major psychological stressor for women that can disrupt their lives and lead to Post-Traumatic Stress Disorder (PTSD). This study aimed to investigate the prevalence of PTSD in women with breast cancer through a systematic review and meta-analysis. Methods: This systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. A comprehensive search was performed using the keywords PTSD and cancer, along with their MeSH terms and synonyms, across international databases including PubMed, Web of Science, Scopus, Embase, and Google Scholar. Searches used database-specific strategies with the Boolean operators AND and OR, with no time restrictions, up to July 11, 2025. The study protocol is registered in PROSPERO under the code CRD420251090535. Two investigators independently conducted the searches, and study quality was assessed using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. Data analysis was carried out using STATA (version 18; StataCorp LLC, College Station, TX, USA), and publication bias was examined using the Egger test. Results: From 1,971 initial studies, 18 met inclusion criteria. Using random-effects models, the overall pooled prevalence of PTSD among women with breast cancer was 30.0% (95% CI: 18.0– 41.0%). Subgroup analysis by PTSD assessment tool revealed pooled prevalences of 36% (95% CI: -1% -72%) using the Impact of Event Scale-Revised (IES-R), 24% (95% CI: 7%-40%) with the DSM-IV criteria, and 18% (95% CI: 10%-26%) with the PTSD Checklist for Civilians (PCL-C). The prevalence of PTSD was 24% (95% CI: 10-38%) in Asia, 43% (95% CI: 10-76%) in Europe, and 24% (95% CI: 10-38%) in America. Discussion: The meta-analysis found an overall PTSD prevalence of 30% in women with breast cancer, with variation related to assessment methods. Despite this variability, the prevalence is significant and requires attention. Conclusion: Given the impact of PTSD on health outcomes, policymakers and healthcare providers should emphasize follow-up care, support services, and treatment for women with breast cancer. Routine PTSD screening in this population is also recommended.
Aim: This study aimed to investigate sex differences in the occurrence of Esophagogastric Variceal Re-Bleeding (EVR), Portal Vein Thrombosis (PVT), and Hepatocellular Carcinoma (HCC) among patients with cirrhosis. Methods: Between April 2012 and April 2022, 797 patients diagnosed with Cirrhotic Portal Hypertension (CPH) were enrolled at the Hepatobiliary and Pancreatic Center and followed retrospectively for up to 10 years. Quantitative analyses were conducted using logistic regression models, supplemented by subgroup interaction analyses, to elucidate the impact of sex differences on disease prognosis. Additionally, the restricted cubic spline technique was employed to further investigate the nonlinear relationship. Results: Laparoscopic splenectomy and azygoportal disconnection (LSD) demonstrated a more significant protective effect in females in reducing the risk of EVR. Conversely, an increased portal vein diameter significantly heightened the risk of PVT in both males and females, with a more pronounced effect observed in male patients (OR=1.21, P=0.015). In predicting the occurrence of HCC, an elevated lymphocyte ratio emerged as a significant risk factor specifically in male patients, while LSD exhibited a protective effect. In female patients, however, the protective effect of LSD was noted exclusively. Lymphocyte levels may have obscured the protective effect of LSD in male patients, particularly in the subgroup of males receiving LSD treatment. A significant non-linear relationship between lymphocyte levels and HCC was also identified (P=0.004). Discussion: Sex‑specific differences were evident across all endpoints. LSD protected against EVR in both sexes, with a more pronounced effect in females, while larger portal vein diameter conferred greater PVT risk in males. For HCC, LSD showed clear protection in females, but in males this benefit was masked by elevated lymphocyte levels, which exhibited a non‑linear relationship with HCC. These findings highlight the interplay between sex, immune status, and treatment response, supporting the need for sex‑tailored management in decompensated cirrhosis. Conclusion: The observation that males and females demonstrate significant sex differences in various prognostic outcomes of CPH underscores the importance of sex-specific characteristics in the prognosis of cirrhotic disease.
Background: Varicose veins (VV), characterized by swollen veins that disrupt blood flow, pose health and aesthetic concerns. The estimated regional prevalence is 45.6% in women. However, there is a lack of national references about the VV awareness levels among adult women in the UAE. Materials and Methods: This cross-sectional questionnaire-based study included 472 females aged between 18 and 50 years to assess awareness about the risk factors, complications, prevention, and treatment of VV in the UAE. The total awareness level was evaluated on a 31-point scale and was classified as high (>70%), intermediate (40-70%), and limited awareness (<40%). Results: The participants included students (38.8%), housewives (27.3%), employed (24.8%), and unemployed (9.1%). About 50% of women reported standing daily for more than 4 hours, while 33.7% reported no physical activity. The overall knowledge was intermediate in 74.2% of the participants. The results suggest significant knowledge gaps, with 56.7% having intermediate knowledge of “risk factors”, 47.6% demonstrating poor awareness of “complications”, and 57.7% achieving high knowledge of “prevention and treatment”. Medical/Health study fields, Sedentary lifestyle, previous diagnosis of VVs, and awareness of VVs are independent predictive factors associated with increased total knowledge about VVs. Age, education, field of occupation, or working hours were not associated with knowledge disparities. Although most participants demonstrated moderate awareness, considerable gaps still exist, particularly regarding the complications of VV. Discussion: We identified a moderate-to-poor level of awareness, which aligns with regional and international levels among women. Uniquely, our cohort showed higher awareness among women reporting low physical activity. Such a finding may be alarming, as these women might give less attention to VV. Conclusion: Our findings emphasize the unique context of VV awareness among women in the UAE. This calls for targeted public health campaigns to promote preventive strategies and improve overall regional health outcomes.
