Although it is commonly believed that recovery from subtotal abdominal hysterectomy (SH) is associated with fewer complications and less pelvic organ dysfunction than total abdominal hysterectomy (TH), there is little data supporting this belief in the literature. Previous studies have found no difference in the postoperative recovery time between these procedures. Overall recovery after hysterectomy depends on treatment of postoperative physical symptoms and complications. Some studies have shown that recovery also depends on preoperative psychological well being and postoperative overall well being. The impact of these factors on the postoperative day-by-day recovery has not been investigated.This prospective randomized, controlled, open, multicenter study assessed possible differences between SH and TH in the day-by-day postoperative recovery, and also analyzed factors associated with postoperative recovery and sick leave. The study was conducted at 7 hospitals and 1 private gynecological clinic in Sweden between 1998 and 2004. The study subjects were 200 women who were scheduled for hysterectomy because of benign gynecological conditions. Of the 178 patients who completed the study, 94 were randomized to a SH group and 84 to a TH group. Assessment of day-by-day recovery of general well being was made using a patient diary with daily entries initiated at 1 week before surgery and continuing until the 35th postoperative day; the results were calculated on a visual analogue scale. Psychometric measurements included depression and anxiety; general psychological well being was also assessed. The primary study outcome measures were the associations between day-by-day recovery of general well being and duration of sick leave with mode of hysterectomy.The data showed no significant difference in the SH and TH groups for the day-by-day recovery of general well being in the preoperative and postoperative periods. A strong association was found between both postoperative day-by-day recovery of general well being and the duration of sick leave, with the occurrence of minor complications, but there was no significant association for major complications. The postoperative day-by-day recovery of general well being and duration of sick leave were strongly associated with the level of preoperative psychological well being.These findings show no difference in the speed of day-by-day recovery of general well being between the 2 procedures, but demonstrate an association between postoperative recovery of general well being and the duration of sick leave with preoperative psychological well being. Strong determinants for a prolonged sick leave include minor postoperative complications and a low preoperative level of psychological well being. GYNECOLOGY Volume 65, Number 6 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTPrevious studies have shown that the new minimally invasive mid-urethral tape procedures are as effective or even more effective in curing female stress urinary incontinence (SUI) than the traditional methods. An esse...

ObjectivesTo summarise the evidence about the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states.DesignA systematic review of all meta-analyses and randomised controlled trials (RCTs) that compared the Mediterranean diet with a control diet on the treatment of type 2 diabetes and prediabetic states was conducted. Electronic searches were carried out up to January 2015. Trials were included for meta-analyses if they had a control group treated with another diet, if they were of sufficient duration (at least 6 months), and if they had at least 30 participants in each arm. A random-effect model was used to pool data.ParticipantsAdults with or at risk for type 2 diabetes.InterventionsDietary patterns that described themselves as using a ‘Mediterranean’ dietary pattern.Outcome measuresThe outcomes were glycaemic control, cardiovascular risk factors and remission from the metabolic syndrome.ResultsFrom 2824 studies, 8 meta-analyses and 5 RCTs were eligible. A ‘de novo’ meta-analysis of 3 long-term (>6 months) RCTs of the Mediterranean diet and glycaemic control of diabetes favoured the Mediterranean diet as compared with lower fat diets. Another ‘de novo’ meta-analysis of two long-term RCTs showed a 49% increased probability of remission from the metabolic syndrome. 5 meta-analyses showed a favourable effect of the Mediterranean diet, as compared with other diets, on body weight, total cholesterol and high-density lipoprotein cholesterol. 2 meta-analyses demonstrated that higher adherence to the Mediterranean diet reduced the risk of future diabetes by 19–23%.ConclusionsThe Mediterranean diet was associated with better glycaemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes.

The importance of metabolic syndrome (MetS) lies in its associated risk of cardiovascular disease and type 2 diabetes, as well as other harmful conditions such as nonalcoholic fatty liver disease. In this report, the available scientific evidence on the associations between lifestyle changes and MetS and its components is reviewed to derive recommendations for MetS prevention and management. Weight loss through an energy-restricted diet together with increased energy expenditure through physical activity contribute to the prevention and treatment of MetS. A Mediterranean-type diet, with or without energy restriction, is an effective treatment component. This dietary pattern should be built upon an increased intake of unsaturated fat, primarily from olive oil, and emphasize the consumption of legumes, cereals (whole grains), fruits, vegetables, nuts, fish, and low-fat dairy products, as well as moderate consumption of alcohol. Other dietary patterns (Dietary Approaches to Stop Hypertension, new Nordic, and vegetarian diets) have also been proposed as alternatives for preventing MetS. Quitting smoking and reducing intake of sugar-sweetened beverages and meat and meat products are mandatory. Nevertheless, there are inconsistencies and gaps in the evidence, and additional research is needed to define the most appropriate therapies for MetS. In conclusion, a healthy lifestyle is critical to prevent or delay the onset of MetS in susceptible individuals and to prevent cardiovascular disease and type 2 diabetes in those with existing MetS. The recommendations provided in this article should help patients and clinicians understand and implement the most effective approaches for lifestyle change to prevent MetS and improve cardiometabolic health.

We performed a systematic review and meta-analysis of the empirical evidence on the association of metabolic syndrome and its components with colorectal cancer incidence and mortality. A systematic literature search of multiple electronic databases was conducted and complemented by cross-referencing to identify studies published before 31 October 2012. Every included study was to report risk estimates with 95 % confidence intervals for the association between metabolic syndrome and colorectal cancer (incidence or mortality). Core items of identified studies were independently extracted by two reviewers, and results were summarized by standard methods of meta-analysis. We identified 17 studies, which reported on 49 data sets with 11,462 cancer cases. Metabolic syndrome was associated with an increased risk of colorectal cancer incidence and mortality in both men (RR: 1.33, 95 % CI 1.18-1.50, and 1.36, 1.25-1.48, respectively) and women (RR: 1.41, 1.18-1.70, and 1.16, 1.03-1.30, respectively). The risk estimates changed little depending on type of study (cohort vs non cohort), populations (US, Europe, Asia), cancer site (colon and rectum), or definition of the syndrome. The risk estimates for any single factor of the syndrome were significant for higher values of BMI/waist (RR: 1.19, 95 % CI 1.10-1.28), dysglycemia (RR: 1.29, 1.11-1.49), and higher blood pressure (RR: 1.09, 1.01-1.18). Dysglycemia and/or higher BMI/waist explained most of the risk associated with metabolic syndrome. Metabolic syndrome is associated with an increased risk of colorectal cancer incidence and mortality in both sexes. The risk conveyed by the full syndrome is not superior to the sum of its parts.