Are Sodium-Glucose Cotransporter-2 Inhibitors the Cherry on Top of Cardio-Oncology Care?

The increasing aging of the population combined with improvements in cancer detection and care has significantly improved the survival and quality of life of cancer patients. These benefits are hampered by the increase of cardiovascular diseases being heart failure the most frequent manifestation of cardiotoxicity and becoming the major cause of morbidity and mortality among cancer survivor. Current strategies to prevent cardiotoxicity involves different approaches such as optimal management of CV risk factors, use of statins and/or neurohormonal medications, and, in some cases, even the use of chelating agents. As a class, SGLT2-i have revolutionized the therapeutic horizon of HF patients independently of their ejection fraction or glycemic status. There is an abundance of data from translational and observational clinical studies supporting a potential beneficial role of SGLT2-i in mitigating the cardiotoxic effects of cancer patients receiving anthracyclines. These findings underscore the need for more robust clinical trials to investigate the effect on cardiovascular outcomes of the prophylactic SGLT2-i treatment in patients undergoing cancer treatment.

Le rôle des pairs chercheurs dans la recherche sur la consommation sexualisée de substances : avantages et défis.

CONTEXT: Sexual and gender diverse individuals (SGDI) report higher usage of methamphetamine in sexual contexts. They face difficulties making sense of their experiences and being heard in services. Peer researchers (individuals with lived experience) were involved in a participatory study on methamphetamine consumption. OBJECTIVES: 1) To describe the opportunities and challenges of involving peer researchers in all stages of the research process; 2) To discuss how this involvement could address the epistemic injustice experienced by SGDI who practice chemsex. METHODOLOGY: The peer-researcher participatory process was documented through a journal and meeting notes, which were analyzed through the framework of epistemic injustice. This notion refers to the mechanisms that prevent the knowledge of a person or group from being heard and considered legitimate. RESULTS: The contribution of peer researchers was highly valued and raised questions. Their in-depth knowledge facilitated data analysis and guided knowledge dissemination, promoting the transformation of current services. Their presence also helped to establish relationships of trust with the study population. DISCUSSION: This connection with the study population can create expectations for services that may require a significant level of involvement from researchers. The team’s commitment to improving services can generate a mistaken perception of a lack of objectivity.

Dissecting succulence: Crassulacean acid metabolism and hydraulic capacitance are independent adaptations in Clusia leaves.

Succulence is found across the world as an adaptation to water-limited niches. The fleshy organs of succulent plants develop via enlarged photosynthetic chlorenchyma and/or achlorophyllous water storage hydrenchyma cells. The precise mechanism by which anatomical traits contribute to drought tolerance is unclear, as the effect of succulence is multifaceted. Large cells are believed to provide space for nocturnal storage of malic acid fixed by crassulacean acid metabolism (CAM), whilst also buffering water potentials by elevating hydraulic capacitance (CFT ). The effect of CAM and elevated CFT on growth and water conservation have not been compared, despite the assumption that these adaptations often occur together. We assessed the relationship between succulent anatomical adaptations, CAM, and CFT , across the genus Clusia. We also simulated the effects of CAM and CFT on growth and water conservation during drought using the Photo3 model. Within Clusia leaves, CAM and CFT are independent traits: CAM requires large palisade chlorenchyma cells, whereas hydrenchyma tissue governs interspecific differences in CFT . In addition, our model suggests that CAM supersedes CFT as a means to maximise CO2 assimilation and minimise transpiration during drought. Our study challenges the assumption that CAM and CFT are mutually dependent traits within succulent leaves.

Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal.

BACKGROUND: People experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada. METHODS: The qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed. RESULTS: Participants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices. CONCLUSION: Associating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.

Espacios cardioprotegidos en México: acciones para prevenir la muerte súbita cardiaca. Una postura de profesionales de la salud.

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La  mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Imbalanced data preprocessing techniques for machine learning: a systematic mapping study.

Machine Learning (ML) algorithms have been increasingly replacing people in several application domains-in which the majority suffer from data imbalance. In order to solve this problem, published studies implement data preprocessing techniques, cost-sensitive and ensemble learning. These solutions reduce the naturally occurring bias towards the majority sample through ML. This study uses a systematic mapping methodology to assess 9927 papers related to sampling techniques for ML in imbalanced data applications from 7 digital libraries. A filtering process selected 35 representative papers from various domains, such as health, finance, and engineering. As a result of a thorough quantitative analysis of these papers, this study proposes two taxonomies-illustrating sampling techniques and ML models. The results indicate that oversampling and classical ML are the most common preprocessing techniques and models, respectively. However, solutions with neural networks and ensemble ML models have the best performance-with potentially better results through hybrid sampling techniques. Finally, none of the 35 works apply simulation-based synthetic oversampling, indicating a path for future preprocessing solutions.

"A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada.

BACKGROUND: The harmful use of alcohol is one of the leading health risk factors for people's health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada. METHODS: Community based participatory research approach and qualitative methods-including semi-structured interviews and focus groups-were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. RESULTS: Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants' alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal's wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. CONCLUSIONS: Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users' engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.

How do Past, Present and Future Weigh into Trajectories of Precarity? The Time Perspectives of Young Psychoactive Substance Users Living in Situations of Social Precarity in Montreal.

Young psychoactive substance users in social precarity are vulnerable to a range of health and social issues. Time perspective is one aspect to consider in supporting change. This study draws on the views expressed by young adults to portray their subjective experience of time, how this perception evolves and its implications for their substance use and socio-occupational integration trajectories. The sample includes 23 young psychoactive substance users (M = 24.65 years old; 83% male) in social precarity frequenting a community-based harm reduction centre. Thematic analysis of the interviews reveals the past to be synonymous with disappointment and disillusionment, but also a constructive force. Participants expressed their present-day material and human needs as well as their need for recognition and a sense of control over their own destiny. Their limited ability to project into the future was also discussed. Avenues on how support to this population might be adapted are suggested.

Leaf heat tolerance of 147 tropical forest species varies with elevation and leaf functional traits, but not with phylogeny.

Exceeding thermal thresholds causes irreversible damage and ultimately loss of leaves. The lowland tropics are among the warmest forested biomes, but little is known about heat tolerance of tropical forest plants. We surveyed leaf heat tolerance of sun-exposed leaves from 147 tropical lowland and pre-montane forest species by determining the temperatures at which potential photosystem II efficiency based on chlorophyll a fluorescence started to decrease (TCrit ) and had decreased by 50% (T50 ). TCrit averaged 46.7°C (5th-95th percentile: 43.5°C-49.7°C) and T50 averaged 49.9°C (47.8°C-52.5°C). Heat tolerance partially adjusted to site temperature; TCrit and T50 decreased with elevation by 0.40°C and 0.26°C per 100 m, respectively, while mean annual temperature decreased by 0.63°C per 100 m. The phylogenetic signal in heat tolerance was weak, suggesting that heat tolerance is more strongly controlled by environment than by evolutionary legacies. TCrit increased with the estimated thermal time constant of the leaves, indicating that species with thermally buffered leaves maintain higher heat tolerance. Among lowland species, T50 increased with leaf mass per area, suggesting that in species with structurally more costly leaves the risk of leaf loss during hot spells is reduced. These results provide insight in variation in heat tolerance at local and regional scales.

Efficacy of venetoclax in high risk relapsed mantle cell lymphoma (MCL) - outcomes and mutation profile from venetoclax resistant MCL patients.

Venetoclax is effective in relapsed patients with mantle cell lymphoma (MCL). Mechanisms of resistance to venetoclax in MCL are poorly understood. We describe the clinical outcomes and genomic characteristics of 24 multiply relapsed patients (median of five prior lines of therapy) who received venetoclax-based therapies; 67% had progressed on BTK inhibitors (BTKi) and 54% had blastoid or pleomorphic histology. Median follow up after venetoclax treatment was 17 months. The overall response rate was 50% and complete response (CR) rate was 21%, 16 patients had progressed and 15 died. The median progression free, overall and post venetoclax survival were 8, 13.5 and 7.3 months respectively. Whole-exome sequencing (WES) was performed on samples collected from seven patients (including five pairs; before starting venetoclax and after progression on venetoclax). The SMARCA4 and BCL2 alterations were noted only after progression, while TP53, CDKN2A, KMT2D, CELSR3, CCND1, NOTCH2 and ATM were altered 2-4-fold more frequently after progression. In two patients with serial samples, we demonstrated clonal evolution of novel SMARCA4 and KMT2C/D mutations at progression. Mutation dynamics in venetoclax resistant MCL is demonstrated. Our data indicates that venetoclax resistance in MCL is predominantly associated with non-BCL2 gene mutations. Further studies are ongoing in MCL patients to evaluate the efficacy of venetoclax in combination with other agents and understand the biology of venetoclax resistance in MCL.

Mind-body practices for people living with HIV: a systematic scoping review.

BACKGROUND: Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV. METHODS: The Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983-2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice. RESULTS: One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants. CONCLUSION: The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.

Impact of Surgery in Ebstein's Anomaly Using Current Surgical Criteria.

BACKGROUND: In Ebstein's anomaly (EA) current surgical criteria may not translate into better long-term survival. The aim of this study was therefore to determine if surgical treatment for EA increases survival, and to analyze factors associated with mortality.Methods and Results:A retrospective study was carried out involving 103 patients with surgical indication using current criteria, comparing operated (n=49; 47.5%) and non-operated patients (n=54; 52.4%); the severity of disease was similar in all cases. Overall follow-up was 12 years (range, 1-49 years). There were no differences in mortality: in the surgical and non-surgical groups, survival at 10 years was 92.8% vs. 90.7%; 20 years, 85.7% vs. 81.0%; and 30 years, 78.5% vs. 72.2%, respectively. On multivariate analysis right ventricular fractional shortening (RVFS) was associated with mortality in both groups. Decreasing RVFS was associated with worse survival according to severity: when RVFS was <20%, survival at 20, 40 and 60 years was 58%, 39%, and 12.5%, respectively (P<0.0013). Left ventricular ejection fraction also correlated with survival (P<0.0013). CONCLUSIONS: Surgery did not translate into benefit in terms of survival, and this was clearly associated with RV function; therefore this should be a key factor in the surgical decision making.

Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences.

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

The effects of CO2 and nutrient fertilisation on the growth and temperature response of the mangrove Avicennia germinans.

In order to understand plant responses to both the widespread phenomenon of increased nutrient inputs to coastal zones and the concurrent rise in atmospheric CO2 concentrations, CO2-nutrient interactions need to be considered. In addition to its potential stimulating effect on photosynthesis and growth, elevated CO2 affects the temperature response of photosynthesis. The scarcity of experiments testing how elevated CO2 affects the temperature response of tropical trees hinders our ability to model future primary productivity. In a glasshouse study, we examined the effects of elevated CO2 (800 ppm) and nutrient availability on seedlings of the widespread mangrove Avicennia germinans. We assessed photosynthetic performance, the temperature response of photosynthesis, seedling growth and biomass allocation. We found large synergistic gains in both growth (42 %) and photosynthesis (115 %) when seedlings grown under elevated CO2 were supplied with elevated nutrient concentrations relative to their ambient growing conditions. Growth was significantly enhanced under elevated CO2 only under high-nutrient conditions, mainly in above-ground tissues. Under low-nutrient conditions and elevated CO2, root volume was more than double that of seedlings grown under ambient CO2 levels. Elevated CO2 significantly increased the temperature optimum for photosynthesis by ca. 4 °C. Rising CO2 concentrations are likely to have a significant positive effect on the growth rate of A. germinans over the next century, especially in areas where nutrient availability is high.

Two tropical conifers show strong growth and water-use efficiency responses to altered CO2 concentration.

BACKGROUND AND AIMS: Conifers dominated wet lowland tropical forests 100 million years ago (MYA). With a few exceptions in the Podocarpaceae and Araucariaceae, conifers are now absent from this biome. This shift to angiosperm dominance also coincided with a large decline in atmospheric CO2 concentration (ca). We compared growth and physiological performance of two lowland tropical angiosperms and conifers at ca levels representing pre-industrial (280 ppm), ambient (400 ppm) and Eocene (800 ppm) conditions to explore how differences in ca affect the growth and water-use efficiency (WUE) of seedlings from these groups. METHODS: Two conifers (Araucaria heterophylla and Podocarpus guatemalensis) and two angiosperm trees (Tabebuia rosea and Chrysophyllum cainito) were grown in climate-controlled glasshouses in Panama. Growth, photosynthetic rates, nutrient uptake, and nutrient use and water-use efficiencies were measured. KEY RESULTS: Podocarpus seedlings showed a stronger (66 %) increase in relative growth rate with increasing ca relative to Araucaria (19 %) and the angiosperms (no growth enhancement). The response of Podocarpus is consistent with expectations for species with conservative growth traits and low mesophyll diffusion conductance. While previous work has shown limited stomatal response of conifers to ca, we found that the two conifers had significantly greater increases in leaf and whole-plant WUE than the angiosperms, reflecting increased photosynthetic rate and reduced stomatal conductance. Foliar nitrogen isotope ratios (δ15N) and soil nitrate concentrations indicated a preference in Podocarpus for ammonium over nitrate, which may impact nitrogen uptake relative to nitrate assimilators under high ca SIGNIFICANCE: Podocarps colonized tropical forests after angiosperms achieved dominance and are now restricted to infertile soils. Although limited to a single species, our data suggest that higher ca may have been favourable for podocarp colonization of tropical South America 60 MYA, while plasticity in photosynthetic capacity and WUE may help account for their continued persistence under large changes in ca since the Eocene.

Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect.

OBJECTIVE: To identify echocardiographic factors that correlate with pulmonary hypertension (PH) in adults with ostium secundum atrial septal defect (ASD). METHODS: Between November 2009 and November 2013, 92 adults with ASD were studied. All had clinical history and transthoracic echocardiogram. RESULTS: Thirty-nine percent of patients had severe PH defined as systolic pulmonary artery pressure (sPAP) of 70 mm Hg or more. The size of ASD (31.84±8.21 mm) and a right-sided tricuspid inflow E-wave to tissue Doppler e'-wave ratio >6.2 correlated with severe PH with AUC of 0.704 (CI 95%=0.59 to 0.818, P<.001) and 0.65 (CI 95%=0.531 to 0.773, P<.014), respectively. Multivariate logistic regression showed that sPAP >70 mm Hg was the variable that most precisely correlated with right ventricular (RV) dysfunction as evidenced by TAPSE <17 mm and RV fractional shortening area (RVFSA) <35%. Left ventricular (LV) diastolic function was also significantly reduced in the group with severe PH with mitral inflow E/A ratio of 0.73±0.23 vs 1.13±0.42 in the group without severe PH (sPAP <70 mm Hg, (P=.001). The pulmonary (Qp) to systemic (Qs) cardiac output ratio (3.09±1.12) and right-sided tissue Doppler S <9.5 cm/s most accurately predicted a Tei index >0.55. CONCLUSIONS: Larger size of ASD using the QP/QS ratio and increased right-sided tricuspid E/e' ratio correlated with severe PH with a sPAP of 70 mm Hg or more. Patients with severe PH had more severe RV dysfunction as evaluated by TAPSE and RVFSA in comparison to those with PH <70 mm Hg. LV diastolic function was also reduced in the severe PH group.

Pericytes prevent regression of endothelial cell tubes by accelerating metabolism of lysophosphatidic acid.

Efforts to eradicate pathological vessels in neovascular diseases and induce growth of mature, functional vasculature in ischemic diseases are limited by our incomplete understanding of molecular mechanisms of vessel stabilization. While it is well known that pericytes stabilize blood vessels, the underlying mechanisms have not been fully elucidated. The goal of this study was to further investigate the mechanisms by which pericytes stabilize vessels. In an in vitro model of blood vessels, in which regression is driven by lysophosphatidic acid (LPA), pericyte-mediated stabilization was associated with a decrease in the concentration of LPA. The decline in the concentration of LPA was not caused by a reduction in activity or expression of autotaxin, the main enzyme implicated in LPA production. Rather, pericytes accelerated LPA metabolism. Stabilization of tubes by pericytes correlated with accelerated LPA dephosphorylation and increased expression of lipid phosphate phosphatases (LPPs). Finally, pericytes failed to stabilize tubes exposed to an LPA analogue, which was resistant to degradation. Our results suggest that pericytes stabilize endothelial cell tubes by accelerating the metabolism of LPA.

Sexualized substance use among gbMSM: Their perspectives on their intervention needs and counsellor competencies.

INTRODUCTION: Treatments for problematic substance use by gay, bisexual and other men who have sex with men (gbMSM) in sexualized contexts must be adapted to take sociocultural aspects of these sexual practices into account. When treatment programs factor in sexuality, they most commonly address it from a biological perspective (STTBIs, HIV). This article sets out to identify intervention needs related to sexualized substance use (SSU) from the perspective of gbMSM, taking into consideration different dimensions of sexuality to offer more effective support. METHODS: Twenty adult gbMSM, each of whom had previously participated in addiction-related treatment programs, took part in this study. We recruited through medical clinics, community organizations, social media advertising and word of mouth. Through one-on-one semi-structured interviews, participants shared their perspectives on the treatment they had received, how their sexuality had been addressed during treatment, and their perceptions of their treatment-related needs and requirements. The study analyzed and interpreted the data gathered during these interviews using a conceptual framework of sexual health combined with The Competencies, a model for addiction counselling training. RESULTS: When the study asked participants what they would consider beneficial in terms of SSU-related treatment, they identified certain key competencies. These can be broken down into three categories - knowledge, skills and attitudes - that, together, participants perceived as critical to the development of adequate programs and services. While participants reported addiction-related knowledge was important, so too was an understanding of sexuality (e.g., sexual practices, gbMSM communities, sociocultural norms). With regard to attitudes, the study identified respect, non-judgment, acceptance and empathy as themes for most participants. Lastly, the desired skills were those permitting counsellors and other treatment providers to better align programs and services with each individual's singular reality within the context of their substance use. CONCLUSIONS: The results of this study suggest that, to provide treatment programs adapted to the needs of gbMSM in a context of SSU, knowledge must be consolidated and new skills developed. Furthermore, both knowledge and skills need to be placed within an overarching perspective of cultural humility. Overall, improving these various competencies should improve the continuum of care in addiction treatment.

Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Evidence about art-based interventions for Indigenous people: a scoping review protocol.

INTRODUCTION: Indigenous people experience a unique set of health inequalities and social determinants that can negatively affect their physical health, mental health and wellness. This critical state of affairs is compounded by the limited availability of culturally appropriate care services and treatments for the different groups. In response, increasing numbers of studies are turning their focus to art-based interventions and how these might benefit Indigenous lives. The proposed scoping review aims to map this growing field of research. METHODS AND ANALYSIS: This scoping review is based on the Arksey and O'Malley methodological framework and the subsequent enhancements proposed by Levac et al. Academic databases and grey literature sources will be searched to identify appropriate studies for inclusion. The search strategies of all databases were tested on 25 April 2024. This will be followed by a two-step screening process to be conducted by two researchers and consisting of (1) a title and abstract review and (2) a full-text review. Data from the selected studies will be extracted, collated and charted to summarise all relevant interventions, their outcomes and key findings. An Indigenous research partner will be hired as a consultant, and the research will be further informed by other stakeholders. ETHICS AND DISSEMINATION: This study is the first step in a research programme involving working with Indigenous artists to codesign a pilot art-based intervention aimed at improving mental health and wellness among Indigenous people. The scoping review will identify the specific components in documented art-based interventions that have proven beneficial to this group. Since it will draw exclusively on data from published and public sources, no ethics approval is required. The results will be disseminated through knowledge translation activities with Indigenous organisations and art therapy groups; a summary of the results will also be distributed through Indigenous networks.