{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T02:24:25Z","timestamp":1778034265696,"version":"3.51.4"},"reference-count":54,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T00:00:00Z","timestamp":1723507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","award":["UIDB\/05704\/2020"],"award-info":[{"award-number":["UIDB\/05704\/2020"]}]},{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","award":["UIDP\/05704\/2020"],"award-info":[{"award-number":["UIDP\/05704\/2020"]}]},{"name":"Scientific Employment Stimulus\u2014Institutional Call","award":["UIDB\/05704\/2020"],"award-info":[{"award-number":["UIDB\/05704\/2020"]}]},{"name":"Scientific Employment Stimulus\u2014Institutional Call","award":["UIDP\/05704\/2020"],"award-info":[{"award-number":["UIDP\/05704\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Breast Cancer Associated Susceptibility Proteins Type 1\/2 (BRCA1\/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1\/2 insufficiency increases the risk for breast\/ovarian\/uterine cancers. Risk-reducing salpingo-oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which is frequently conducted by the age of 40 to lower the occurrence of cancer in women with BRCA1\/2 mutations. However, abrupt estrogen decline following RRSO causes ovarian failure, which implicates various cellular physiological processes, resulting in the increased release of free radicals and subsequent severe onset of menopausal symptoms. Comfort measures (e.g., hormonal replacement therapy (HRT) and mindfulness-based stress reduction (MBSR)) may improve chronological menopause-related quality of life, but their specific effects are not clear in women with gene mutations. Aiming to fill the gap, this study used path analysis to examine the effects of HRT and MBSR on menopausal symptoms among RRSO patients (N = 199, mean age = 50.5 \u00b1 6.7 years). HRT directly alleviated the levels of urogenital symptoms (\u03b2 = \u22120.195, p = 0.005), which mediated its indirect significant effects on the somatic\u2013vegetative and psychological symptoms of menopause (\u03b2 = \u22120.046, \u22120.067; both p values = 0.004, respectively), especially in BRCA2 carriers and in women who were currently physically active, premenopausal at the time of RRSO, had a high BMI, and had no history of breast cancer. It increased the severity of urogenital symptoms in women with a history of cancer. MBSR, on the other hand, was associated with indirect increases in the intensity of the somatic\u2013vegetative and psychological symptoms of menopause (\u03b2 = 0.108, 0.029; p = 0.003, 0.033, respectively). It exerted positive direct effects on different menopausal symptoms in multigroup analysis. The results suggest that young women undergoing recent RRSO may benefit from HRT at an individual level, while their need for extensive measures to optimize their psychological wellbeing is ongoing. The adverse effects of MBSR, which are captured in the present study, imply that MBSR may interfere with redox sensitivity associated with estradiol fluctuations in BRCA1\/2 carriers. Investigations are needed to test this hypothesis and elaborate on the underlying mechanisms in these women.<\/jats:p>","DOI":"10.3390\/healthcare12161612","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T06:02:37Z","timestamp":1723528957000},"page":"1612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effects of Hormonal Replacement Therapy and Mindfulness-Based Stress Reduction on Climacteric Symptoms Following Risk-Reducing Salpingo-Oophorectomy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-8282","authenticated-orcid":false,"given":"Amira Mohammed","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria 21527, Egypt"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2392-595X","authenticated-orcid":false,"given":"Saeed A.","family":"Al-Dossary","sequence":"additional","affiliation":[{"name":"Department of Psychology, College of Education, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1080-9535","authenticated-orcid":false,"given":"Carlos","family":"Laranjeira","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal"},{"name":"Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua das Olhalvas, 2414-016 Leiria, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), University of \u00c9vora, 7000-801 \u00c9vora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5214-3797","authenticated-orcid":false,"given":"Faten","family":"Amer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Faculty of Medicine and Health Science, An-Najah National University, Nablus 00970, Palestine"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-5689","authenticated-orcid":false,"given":"Souheil","family":"Hallit","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon"},{"name":"Psychology Department, College of Humanities, Effat University, Jeddah 21478, Saudi Arabia"},{"name":"Applied Science Research Center, Applied Science Private University, Amman 11937, Jordan"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2808-2370","authenticated-orcid":false,"given":"Abdulmajeed A.","family":"Alkhamees","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, Qassim University, Buraidah 52571, Al Qassim, Saudi Arabia"}]},{"given":"Aljawharah Fahad","family":"Aljubilah","sequence":"additional","affiliation":[{"name":"College of Education and Human Development, Princess Nourah bint Abdulrahman University, Riyadh 13415, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6533-7868","authenticated-orcid":false,"given":"Musheer A.","family":"Aljaberi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Center (Erasmus MC), 3015 GD Rotterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4849-1921","authenticated-orcid":false,"given":"Ebtesam Abdullah","family":"Alzeiby","sequence":"additional","affiliation":[{"name":"College of Education and Human Development, Princess Nourah bint Abdulrahman University, Riyadh 13415, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5065-9626","authenticated-orcid":false,"given":"Hammad Ali","family":"Fadlalmola","sequence":"additional","affiliation":[{"name":"Department of Community and Public Health, Nursing College, Taibah University, Madinah 42377, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2849-1310","authenticated-orcid":false,"given":"Annamaria","family":"Pakai","sequence":"additional","affiliation":[{"name":"Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2019-6621","authenticated-orcid":false,"given":"Haitham","family":"Khatatbeh","sequence":"additional","affiliation":[{"name":"Department of Nursing, Faculty of Nursing, Jerash University, Jerash 26173, Jordan"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Noman, S., Shahar, H.K., Abdul Rahman, H., Ismail, S., Abdulwahid Al-Jaberi, M., and Azzani, M. (2021). The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010263"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.canlet.2012.02.033","article-title":"Crosstalk between NFkB and glucocorticoid signaling: A potential target of breast cancer therapy","volume":"322","author":"Ling","year":"2012","journal-title":"Cancer Lett."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e788","DOI":"10.1016\/j.clbc.2022.07.001","article-title":"Characterizing Clinicopathologic Features of Estrogen Receptor-Positive\/Progesterone Receptor-Negative Breast Cancers","volume":"22","author":"Fei","year":"2022","journal-title":"Clin. Breast Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/jcp.10257","article-title":"BRCA1 gene in breast cancer","volume":"196","author":"Rosen","year":"2003","journal-title":"J. Cell. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e31705","DOI":"10.1097\/MD.0000000000031705","article-title":"BRCA2 gene mutation in cancer","volume":"101","author":"Xie","year":"2022","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.redox.2018.06.012","article-title":"Breast cancer susceptibility protein 1 (BRCA1) rescues neurons from cerebral ischemia\/reperfusion injury through NRF2-mediated antioxidant pathway","volume":"18","author":"Xu","year":"2018","journal-title":"Redox Biol."},{"key":"ref_7","unstructured":"Djedovic, V. (2016). BRCA1 Modulation of Glucocorticoid Receptor Signaling in High-Grade Serous Ovarian Cancer Cells. [Master\u2019s Thesis, University of Toronto]."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.maturitas.2018.01.012","article-title":"Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy","volume":"111","author":"Stuursma","year":"2018","journal-title":"Maturitas"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4334","DOI":"10.1158\/1078-0432.CCR-12-0199","article-title":"Prolonged postovulatory proinflammatory signaling in the fallopian tube epithelium may be mediated through a BRCA1\/DAB2 axis","volume":"18","author":"Tone","year":"2012","journal-title":"Clin. Cancer Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/1471-0528.15471","article-title":"Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): A randomised controlled trial","volume":"126","author":"Schroevers","year":"2019","journal-title":"BJOG"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ali, A.M., and Kunugi, H. (2020). Royal jelly as an intelligent anti-aging\u2014A focus on cognitive aging and Alzheimer\u2019s disease: A review. Antioxidants, 9.","DOI":"10.3390\/antiox9100937"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.mad.2017.04.002","article-title":"Differential menopause- versus aging-induced changes in oxidative stress and circadian rhythm gene markers","volume":"164","author":"Haro","year":"2017","journal-title":"Mech. Ageing Dev."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Rodr\u00edguez, M.A., Zacar\u00edas-Flores, M., Arronte-Rosales, A., and Mendoza-N\u00fa\u00f1ez, V.M. (2019). Association between hot flashes severity and oxidative stress among Mexican postmenopausal women: A cross-sectional study. PLoS ONE, 14.","DOI":"10.1101\/575621"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/GME.0000000000001540","article-title":"Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data","volume":"27","author":"Shea","year":"2020","journal-title":"Menopause"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ali, A.M., Ahmed, A.H., and Smail, L. (2020). Psychological Climacteric Symptoms and Attitudes toward Menopause among Emirati Women. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17145028"},{"key":"ref_16","first-page":"804","article-title":"Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes","volume":"95","author":"Leal","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8364297","DOI":"10.1155\/2021\/8364297","article-title":"Hormone Replacement Therapy and Aging: A Potential Therapeutic Approach for Age-Related Oxidative Stress and Cardiac Remodeling","volume":"2021","author":"Hoffmann","year":"2021","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1089\/ars.2012.5112","article-title":"Early, but not late onset estrogen replacement therapy prevents oxidative stress and metabolic alterations caused by ovariectomy","volume":"20","author":"Gambini","year":"2014","journal-title":"Antioxid. Redox Signal"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1001\/jamaoncol.2018.0211","article-title":"Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers","volume":"4","author":"Kotsopoulos","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.critrevonc.2018.09.018","article-title":"Hormone replacement therapy after prophylactic risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers: A meta-analysis","volume":"132","author":"Marchetti","year":"2018","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ygyno.2018.12.014","article-title":"Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations; a systematic review of risks and benefits","volume":"153","author":"Gordhandas","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1007\/s00432-021-03629-z","article-title":"Hormone replacement therapy in BRCA mutation carriers and risk of ovarian, endometrial, and breast cancer: A systematic review","volume":"147","author":"Huber","year":"2021","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7804","DOI":"10.1200\/JCO.2004.00.8151","article-title":"Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group","volume":"23","author":"Rebbeck","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.maturitas.2018.10.015","article-title":"Improvement of menopausal symptoms and the impact on work ability: A retrospective cohort pilot study","volume":"120","author":"Geukes","year":"2019","journal-title":"Maturitas"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Converso, D., Viotti, S., Sottimano, I., Loera, B., Molinengo, G., and Guidetti, G. (2019). The relationship between menopausal symptoms and burnout. A cross-sectional study among nurses. BMC Women\u2019s Health, 19.","DOI":"10.1186\/s12905-019-0847-6"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Viotti, S., Guidetti, G., Sottimano, I., Travierso, L., Martini, M., and Converso, D. (2021). Do Menopausal Symptoms Affect the Relationship between Job Demands, Work Ability, and Exhaustion? Testing a Moderated Mediation Model in a Sample of Italian Administrative Employees. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910029"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105277","DOI":"10.1016\/j.psyneuen.2021.105277","article-title":"Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial","volume":"130","author":"Gordon","year":"2021","journal-title":"Psychoneuroendocrinology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101398","DOI":"10.1016\/j.ctcp.2021.101398","article-title":"A study of mindfulness-based stress-reduction training effects on menopause-specific quality of life in postmenopausal women: A randomized controlled trial","volume":"44","author":"Javadnoori","year":"2021","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Stuursma, A., Wessels, N., Bock, G.H.d., Mourits, M., and Driel, C.V. (2018). Data for: Severity and duration of menopausal symptoms after risk-reducing salpingo-oophorectomy. Mendeley Data.","DOI":"10.1016\/j.maturitas.2018.01.012"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ali, A.M., Hendawy, A.O., Al-Amer, R., Shahrour, G., Ali, E.M., Alkhamees, A.A., Ibrahim, N., Lamadah, S.M.T., and Ahmed, A.H. (2022). Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-15005-z"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ali, A.M., Alameri, R.A., Hendawy, A.O., Al-Amer, R., Shahrour, G., Ali, E.M., Alkhamees, A.A., Ibrahim, N., and Hassan, B.H. (2022). Psychometric evaluation of the depression anxiety stress scale 8-items (DASS-8)\/DASS-12\/DASS-21 among family caregivers of patients with dementia. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.1012311"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/1471-0528.17008","article-title":"The effect of hormone replacement therapy on the survival of UK women: A retrospective cohort study 1984\u22122017","volume":"129","author":"Akter","year":"2022","journal-title":"BJOG"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Park, S., Sim, K.-S., Heo, W., and Kim, J.-H. (2023). Protective Effects of Coumestrol on Metabolic Dysfunction and Its Estrogen Receptor-Mediated Action in Ovariectomized Mice. Nutrients, 15.","DOI":"10.3390\/nu15040954"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/s00204-020-02752-z","article-title":"Adverse outcome pathways for ionizing radiation and breast cancer involve direct and indirect DNA damage, oxidative stress, inflammation, genomic instability, and interaction with hormonal regulation of the breast","volume":"94","author":"Helm","year":"2020","journal-title":"Arch. Toxicol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10549-021-06436-9","article-title":"Safety of systemic hormone replacement therapy in breast cancer survivors: A systematic review and meta-analysis","volume":"191","author":"Poggio","year":"2022","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1002\/jgc4.1436","article-title":"A systematic review of psycho-social interventions for individuals with a BRCA1\/2 pathogenic variant","volume":"30","author":"Warner","year":"2021","journal-title":"J. Genet. Couns."},{"key":"ref_37","first-page":"CD012894","article-title":"Interventions to improve psychosocial well-being in female BRCA-mutation carriers following risk-reducing surgery","volume":"10","author":"Jeffers","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Bishop, J.R., Lee, A.M., Mills, L.J., Thuras, P.D., Eum, S., Clancy, D., Erbes, C.R., Polusny, M.A., Lamberty, G.J., and Lim, K.O. (2018). Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder. Front. Psychiatry, 9.","DOI":"10.3389\/fpsyt.2018.00418"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/1534735412473640","article-title":"A Randomized Controlled Trial of Mindfulness-Based Stress Reduction for Women With Early-Stage Breast Cancer Receiving Radiotherapy","volume":"12","author":"Henderson","year":"2013","journal-title":"Integr. Cancer Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1093\/tbm\/iby061","article-title":"Translational genomic research: The role of genetic polymorphisms in MBSR program among breast cancer survivors (MBSR[BC])","volume":"9","author":"Park","year":"2018","journal-title":"Transl. Behav. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Giudice, A., Aliberti, S.M., Barbieri, A., Pentangelo, P., Bisogno, I., D\u2019Arena, G., Cianciola, E., Caraglia, M., and Capunzo, M. (2022). Potential Mechanisms by which Glucocorticoids Induce Breast Carcinogenesis through Nrf2 Inhibition. Front. Biosci., 27.","DOI":"10.31083\/j.fbl2707223"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.mce.2017.07.004","article-title":"Possible roles for glucocorticoid signalling in breast cancer","volume":"466","author":"McNamara","year":"2018","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/pon.1291","article-title":"Psychological distress and quality of life associated with genetic testing for breast cancer risk","volume":"17","author":"Smith","year":"2008","journal-title":"Psychooncology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1023\/B:JOBM.0000042411.56032.42","article-title":"Predictors of Cognitive Appraisals Following Genetic Testing for BRCA1 and BRCA2 Mutations","volume":"27","author":"Halbert","year":"2004","journal-title":"J. Behav. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Stanisz, M., Panczyk, M., Kurzawa, R., and Grochans, E. (2019). The Effect of Prophylactic Adnexectomy on the Quality of Life and Psychosocial Functioning of Women with the BRCA1\/BRCA2 Mutations. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16244995"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1097\/GME.0000000000001535","article-title":"Executive function after risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: Does current mood and early life adversity matter?","volume":"27","author":"Shanmugan","year":"2020","journal-title":"Menopause"},{"key":"ref_47","first-page":"e1","article-title":"Psychosocial Stress, Glucocorticoid Signaling, and Prostate Cancer Health Disparities in African American Men","volume":"4","author":"Stiel","year":"2020","journal-title":"Cancer Health Disparities"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1037\/hea0000882","article-title":"An observational study and randomized trial of stress reactivity in cancer disparities","volume":"39","author":"Halbert","year":"2020","journal-title":"Health Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.smhs.2021.06.002","article-title":"Bee honey and exercise for improving physical performance, reducing fatigue, and promoting an active lifestyle during COVID-19","volume":"3","author":"Ali","year":"2021","journal-title":"Sports Med. Health Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3390\/biomed1010002","article-title":"Physical frailty\/sarcopenia as a key predisposing factor to coronavirus disease 2019 (COVID-19) and its complications in older adults","volume":"1","author":"Ali","year":"2021","journal-title":"BioMed"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ali, A.M., and Kunugi, H. (2020). Apitherapy for age-related skeletal muscle dysfunction (sarcopenia): A review on the effects of royal jelly, propolis, and bee pollen. Foods, 9.","DOI":"10.3390\/foods9101362"},{"key":"ref_52","first-page":"361","article-title":"Advances in the treatment of menopausal symptoms","volume":"5","author":"Pinkerton","year":"2009","journal-title":"Women\u2019s Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"13075","DOI":"10.1038\/s41598-024-60127-1","article-title":"The Depression Anxiety Stress Scale 8: Investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers","volume":"14","author":"Ali","year":"2024","journal-title":"Sci Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"104397","DOI":"10.1016\/j.actpsy.2024.104397","article-title":"Psychometric properties of the Benign and Malicious Envy Scale: A cross-cultural study in the Arab Maghreb countries","volume":"248","author":"Sabah","year":"2024","journal-title":"Acta Psychol."}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/16\/1612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:35:45Z","timestamp":1760110545000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/16\/1612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,13]]},"references-count":54,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["healthcare12161612"],"URL":"https:\/\/doi.org\/10.3390\/healthcare12161612","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,13]]}}}