The COVID-19 pandemic has resulted in a predominantly global quarantine response that has been associated with social isolation, loneliness, and anxiety. The foregoing experiences have been amply documented to have profound impacts on health, morbidity, and mortality. This narrative review uses the extant neurobiological and theoretical literature to explore the association between social isolation, loneliness, and anxiety in the context of quarantine during the COVID-19 pandemic. Emerging evidence suggests that distinct health issues (e.g., a sedentary lifestyle, a diminished overall sense of well-being) are associated with social isolation and loneliness. The health implications of social isolation and loneliness during quarantine have a heterogenous and comorbid nature and, as a result, form a link to anxiety. The limbic system plays a role in fear and anxiety response; the bed nucleus of the stria terminalis, amygdala, HPA axis, hippocampus, prefrontal cortex, insula, and locus coeruleus have an impact in a prolonged anxious state. In the conclusion, possible solutions are considered and remarks are made on future areas of exploration.

Background: Past studies suggest mixed associations between selective serotonin reuptake inhibitor (SSRI) prescription and carcinogenic risk. There is no epidemiological study reporting on the association between SSRI use and the incidence of bladder cancer. The aim of this study is to determine whether SSRI use influences the risk of bladder cancer. Methods: We conducted a nationwide retrospective cohort study by Taiwan’s National Health Insurance Research Database from January 1, 1997 to December 31, 2013. 192,392 SSRI prescribed individuals were randomly matched 1 to 1 with 191,786 individuals who had never received any SSRIs by propensity scores match. The Cox Proportional Hazard models were conducted to examine the risk of bladder cancer between individuals prescribed SSRIs and individuals not prescribed SSRIs. Results: SSRIs were associated with significant reduced risk of bladder cancer with 0.5, 1, and 2 year induction periods (adjusted hazard ratio (aHR) = 0.86, 95% CI (confidence interval) = 0.76–0.98, aHR = 0.85, 95% CI = 0.75–0.97, and aHR = 0.77, 95% CI = 0.66–0.89). When examining the effect of specific SSRI, there was significantly lower risk of bladder cancer in individuals prescribed fluoxetine (6 month induction period: aHR = 0.78, 95% CI = 0.65–0.93; 1 year induction period: aHR = 0.78, 95% CI = 0.65–0.94; 2 year induction period: aHR = 0.73, 95% CI = 0.60–0.89), paroxetine (6 month induction period: aHR = 0.78, 95% CI = 0.61–0.99; 1 year induction period: aHR = 0.79, 95% CI = 0.61–1.01; 2 year induction period: aHR = 0.72, 95% CI = 0.54–0.95), and citalopram (6 month induction period: aHR = 0.74, 95% CI = 0.53–1.03; 1 year induction period: aHR = 0.70, 95% CI = 0.50–0.99; 2 year induction period: aHR = 0.60, 95% CI = 0.41–0.88). Conclusions: Individuals prescribed fluoxetine, paroxetine, or citalopram had a reduced risk of bladder cancer in this large, cross-national database.

: The incidence of female genital cosmetic surgery (FGCS), and specifically labiaplasty, is on the rise. Common motivators for labiaplasty include hygiene concerns, functional impairment, difficulties with physical or sexual activity, and dissatisfaction with genital appearance, among others. However, there have been few reports on long-term functional and aesthetic outcomes and complications of labiaplasty. The aim of this literature review was to report on long-term outcomes of labiaplasty, defined as ≥1 year postoperatively, to inform safety and efficacy recommendations for the procedure. A comprehensive literature review was conducted on PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) from inception to December 1, 2023, following PRISMA guidelines. Articles were selected according to predetermined eligibility criteria. A manual search was performed to identify additional relevant studies. Nine studies reported on the long-term postoperative complications associated with labiaplasty, with a cumulative total of 748 patients. The most commonly reported complications included postoperative asymmetry (n = 45, 6.02%), scarring (n = 14, 1.87%), and the need for revisional surgery (n = 42, 5.61%). Of note, the majority of patients (n = 621 of 748) were reported to not have any postoperative complications. In the 7 studies that reported on psychological outcomes associated with labiaplasty, all reported sustained improvement in genital appearance scores as well as aesthetic and sexual satisfaction over the long term. Level of Evidence: 3 (Therapeutic):

Importance: Loneliness has been associated with adverse health outcomes. However, few studies have evaluated its comparative effects on distinct health outcomes. Objective: The primary objective was to evaluate the comparative effects of loneliness on multiple health outcomes. The literature was qualitatively reviewed to identify risk factors associated with loneliness, explore mechanisms, and discuss potential evidence-based interventions for targeting loneliness. Data Sources: A systematic review and meta-analysis of studies were conducted to examine the association between loneliness and health outcomes. We searched the databases Ovid MEDLINE/PubMed, Embase, and PsycINFO from inception to April/01/2019 for relevant peer-reviewed publications. Study Selection: We selected studies that measured the association between subjective ratings of loneliness (i.e., UCLA Loneliness Scale or de Jong Gierveld Loneliness Scale) and one or more health outcome(s). Only validated measurement scales for health outcomes were used. Data Extraction and Synthesis: Data was extracted by four independent reviewers using a standardized data extraction form. A total of 114 identified studies were systematically evaluated to extract study characteristics, risk of bias, and loneliness-health associations required for the calculation of pooled effects (i.e., correlations). Main Outcome(s) and Measures: Loneliness and health outcomes were measured. Health outcomes were broadly defined to include measures of mental health (i.e., depression, anxiety, suicidality, general mental health), general health (i.e., overall self-rated health), well-being (i.e., quality of life, life satisfaction), physical health (i.e., functional disability), sleep, and cognition. Results: Loneliness had medium to large effects on all health outcomes, with the largest effects on mental health and overall well-being. No significant effects of age, health condition, or stigma were observed. However, we observed a significant effect of gender on the association between loneliness and cognition (i.e., more pronounced in studies with a greater proportion of males). We also observed a significant effect of geographical distribution on the associations between loneliness and overall well-being, sleep, and cognition (i.e., lower among European nations and higher among Asian nations). Conclusions and Relevance: Loneliness is associated with adverse effects on health, particularly mental health outcomes. Future research should explore the potential moderating effects of gender and geographical distribution. From a public health perspective, the adequate training of health care providers (HCPs) to perceive, detect, and respond to loneliness among patients should be prioritized. Funding Statement: The authors stated: "This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors." Declaration of Interests: Roger S. McIntyre is a consultant to speak on behalf of, and/or has received research support from Lundbeck, Janssen, Shire, Purdue, Pfizer, Otsuka, Allergan, Takeda, Neurocrine, Sunovion, Stanley Medical Research Institute, and CIHR/GACD/Chinese National Natural Research Foundation. All other authors have no conflicts of interest to disclose. Ethics Approval Statement: The current systematic review and meta-analysis adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for transparent and comprehensive reporting of study methods and results.