The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 8: Knowledge Gaps and Status of Existing Research Programs in Canada.

Despite significant progress in medical research and public health efforts, gaps in knowledge of women's heart health remain across epidemiology, presentation, management, outcomes, education, research, and publications. Historically, heart disease was viewed primarily as a condition in men and male individuals, leading to limited understanding of the unique risks and symptoms that women experience. These knowledge gaps are particularly problematic because globally heart disease is the leading cause of death for women. Until recently, sex and gender have not been addressed in cardiovascular research, including in preclinical and clinical research. Recruitment was often limited to male participants and individuals identifying as men, and data analysis according to sex or gender was not conducted, leading to a lack of data on how treatments and interventions might affect female patients and individuals who identify as women differently. This lack of data has led to suboptimal treatment and limitations in our understanding of the underlying mechanisms of heart disease in women, and is directly related to limited awareness and knowledge gaps in professional training and public education. Women are often unaware of their risk factors for heart disease or symptoms they might experience, leading to delays in diagnosis and treatments. Additionally, health care providers might not receive adequate training to diagnose and treat heart disease in women, leading to misdiagnosis or undertreatment. Addressing these knowledge gaps requires a multipronged approach, including education and policy change, built on evidence-based research. In this chapter we review the current state of existing cardiovascular research in Canada with a specific focus on women.

En dépit des avancées importantes de la recherche médicale et des efforts en santé publique, il reste des lacunes dans les connaissances sur la santé cardiaque des femmes sur les plans de l'épidémiologie, du tableau clinique, de la prise en charge, des résultats, de l'éducation, de la recherche et des publications. Du point de vue historique, la cardiopathie a d'abord été perçue comme une maladie qui touchait les hommes et les individus de sexe masculin. De ce fait, la compréhension des risques particuliers et des symptômes qu'éprouvent les femmes est limitée. Ces lacunes dans les connaissances posent particulièrement problème puisqu'à l'échelle mondiale la cardiopathie est la cause principale de décès chez les femmes. Jusqu'à récemment, la recherche en cardiologie, notamment la recherche préclinique et clinique, ne portait pas sur le sexe et le genre. Le recrutement souvent limité aux participants masculins et aux individus dont l'identité de genre correspond au sexe masculin et l'absence d'analyses de données en fonction du sexe ou du genre ont eu pour conséquence un manque de données sur la façon dont les traitements et les interventions nuisent aux patientes féminines et aux individus dont l'identité de genre correspond au sexe féminin, et ce, de façon différente. Cette absence de données a mené à un traitement sous-optimal et à des limites de notre compréhension des mécanismes sous-jacents de la cardiopathie chez les femmes, et est directement reliée à nos connaissances limitées, et à nos lacunes en formation professionnelle et en éducation du public. Le fait que les femmes ne connaissent souvent pas leurs facteurs de risque de maladies du cœur ou les symptômes qu'elles peuvent éprouver entraîne des retards de diagnostic et de traitements. De plus, le fait que les prestataires de soins de santé ne reçoivent pas la formation adéquate pour poser le diagnostic et traiter la cardiopathie chez les femmes les mène à poser un mauvais diagnostic ou à ne pas traiter suffisamment. Pour pallier ces lacunes de connaissances, il faut une approche à plusieurs volets, qui porte notamment sur l'éducation et les changements dans les politiques, et qui repose sur la recherche fondée sur des données probantes. Dans ce chapitre, nous passons en revue l'état actuel de la recherche existante sur les maladies cardiovasculaires au Canada, plus particulièrement chez les femmes.

Preventing child welfare reinvolvement: The efficacy of the Reminiscing and Emotion Training intervention.

Child maltreatment is a pathogenic relational experience that creates risk for physical and psychological health difficulties throughout the lifespan. The Reminiscing and Emotion Training intervention (RET) was developed to support maltreated children's healthy development by improving parenting behavior among maltreating mothers. Here, we evaluated whether RET was associated with reductions in child welfare reinvolvement over the course of two years. The sample included 165 maltreating and 83 nonmaltreating mothers and their 3- to 6-year-old children who were enrolled in a longitudinal randomized controlled trial of RET. Maltreating mother-child dyads were randomly assigned to receive RET or an active control condition (community standard [CS]). Nonmaltreating dyads were a separate control group (nonmaltreating control). Comparing CS and RET dyads, there was a significant effect of RET on frequency of child welfare reinvolvement (substantiations and unsubstantiated assessments) during the two years following dyads' enrollment in the intervention, t(163) = 2.02, p < .05, Cohen's d = 0.32. There was a significant indirect effect of RET on child welfare reinvolvement through maternal sensitive guidance during reminiscing [95% CI -0.093, -0.007]. Results provide support for the efficacy of RET in preventing child welfare reinvolvement.

Parenting, emotion regulation, and externalizing symptomatology as adolescent antecedents to young adult health risk behaviors.

This study used longitudinal data to elucidate how trajectories of negative parenting across adolescence are associated with young adult health risk behaviors (HRBs) by testing difficulties with emotion regulation and externalizing symptomatology as sequential underlying mediators. The sample included 167 adolescents (53% males, Mage  = 14 at Time 1 and Mage  = 18 at Time 5) who were assessed five times. Adolescents self-reported on negative parenting, emotion regulation, externalizing symptomatology, and engagement in HRBs. Results suggest that increasingly negative parenting across adolescence has adverse consequences for emotion regulation development and in turn, externalizing symptomatology, which confers risk for young adult HRBs. Results offer insights towards mechanisms for prevention and intervention and public health policy aimed at reducing the prevalence and consequences of engagement in HRBs.

An Analogue Study Investigating Differential Parenting of Gender Conforming and Nonconforming Boys.

Gender nonconforming children are at heightened risk for negative parenting interactions. This study investigated possible explanations for differences in parenting behaviors with gender conforming and nonconforming boys. A sample of 201 adults (43% women/57% men; 81% White, 10% Black/African American, 6% Multiracial, 3% Asian, and 1% American Indian or Alaska Native; and 7% Hispanic/Latinx) ranging in age from 20 to 74 years (M = 35.44, SD = 9.76) were presented two vignettes describing a gender conforming and nonconforming boy. Following each vignette, participants provided endorsements of parenting behaviors and reported their concern for that child's future. In addition, participants completed measures assessing their attitudes toward homosexuality and need for closure. Contrary to expectations, there were no significant differences in endorsements of physical discipline or positive parenting for the two boys. Participants did, however, report higher concern for the gender nonconforming boy's future. Individual differences in homonegativity were associated with greater endorsements of physical discipline toward the gender nonconforming boy, after accounting for endorsements of physical discipline toward the gender conforming boy. Further, higher concern for the gender nonconforming boy's future was associated with greater endorsements of physical discipline and lower endorsements of positive parenting, after accounting for endorsements of each behavior for the gender conforming boy as well as concern for their future. Intervention efforts to support the parent-child relationship for gender nonconforming boys may benefit from identifying and responding to both negative attitudes toward homosexuality and addressing motivations to change behavior resulting from concern for their child's future.

The Influence of Social Conditions Across the Life Course on the Human Gut Microbiota: A Pilot Project With the Wisconsin Longitudinal Study.

Objective: To test the feasibility of collecting and integrating data on the gut microbiome into one of the most comprehensive longitudinal studies of aging and health, the Wisconsin Longitudinal Study (WLS). The long-term goal of this integration is to clarify the contribution of social conditions in shaping the composition of the gut microbiota late in life. Research on the microbiome, which is considered to be of parallel importance to human health as the human genome, has been hindered by human studies with nonrandomly selected samples and with limited data on social conditions over the life course. Methods: No existing population-based longitudinal study had collected fecal specimens. Consequently, we created an in-person protocol to collect stool specimens from a subgroup of WLS participants. Results: We collected 429 stool specimens, yielding a 74% response rate and one of the largest human samples to date. Discussion: The addition of data on the gut microbiome to the WLS-and to other population based longitudinal studies of aging-is feasible, under the right conditions, and can generate innovative research on the relationship between social conditions and the gut microbiome.

Myths and realities of female-perpetrated terrorism.

The authors examined the backgrounds and social experiences of female terrorists to test conflicting accounts of the etiology of this offending group. Data on 222 female terrorists and 269 male terrorists were examined across 8 variables: age at first involvement, educational achievement, employment status, immigration status, marital status, religious conversion, criminal activity, and activist connections. The majority of female terrorists were found to be single, young (<35 years old), native, employed, educated to at least secondary level, and rarely involved in criminality. Compared with their male counterparts, female terrorists were equivalent in age, immigration profile, and role played in terrorism, but they were more likely to have a higher education attainment, less likely to be employed, and less likely to have prior activist connections. The results clarify the myths and realities of female-perpetrated terrorism and suggest that the risk factors associated with female involvement are distinct from those associated with male involvement.

Dopamine and serotonin transporter availability in chronic heroin users: a [¹²³I]ß-CIT SPECT imaging study.

Dopamine (DA) and serotonin (5-HT) transporter availability in heroin users and healthy controls was measured using [¹²³I]ß-CIT and SPECT imaging. Heroin users had statistically similar striatal DA and brainstem and diencephalon 5-HT transporter availability compared with controls. No associations between transporter availability and heroin use characteristics were found.