Community- and Patient-Partner Engagement in Women's Cardiovascular Disease Research: A Rapid Review of the Evidence.

The primary objective of this rapid review is to describe community-partner and patient-partner engagement in women's cardiovascular disease (CVD) research. Secondary objectives are to: (i) describe the phase of the research in which community and patient partners were engaged; (ii) define the level of engagement at each research phase; and (iii) make recommendations for future engagement of community and/or patient partners in women's CVD research. Rapid review guidelines recommended by the Cochrane Rapid Reviews Methods Group and Tricco et al. were used to search 5 databases using medical subject headings (MeSH) and/or keywords. Participants included women (cis and trans) aged > 18 years who had ischemic heart disease, heart failure, or stroke. A risk of bias assessment was not undertaken. Findings are summarized and/or clustered as community-based participatory research, or patient-oriented and/or patient-partner research. Our search yielded 39,998 titles and abstracts. Of these, 35 were included in a final narrative synthesis, comprising data from 474 community and/or patient partners, including 417 (88%) women. Over 85% of community partners collaborated in the design and/or planning and implementation of women's CVD research; most originated in the US; only one originated in Canada. Most patient-oriented and patient-partner research originated in Canada. However, less than 50% of patient partners collaborated in any phase of research. Sex, gender, race, and ethnicity were rarely reported. Results suggest negligible community and inadequate patient-oriented and/or patient-partner engagement in women's CVD research in Canada. Improved CVD outcomes for women may be achieved with better community- and patient-partner collaboration across all phases of research, genders, race, and ethnicities.

L'objectif principal de cette brève revue de littérature est de décrire l'engagement des partenaires communautaires et des patients partenaires dans la recherche sur les maladies cardiovasculaires (MCV) chez les femmes. Les objectifs secondaires sont les suivants (i) décrire la phase de la recherche dans laquelle la communauté et les patients partenaires ont été impliqués; (ii) définir le niveau d'engagement à chaque phase de la recherche; et (iii) formuler des recommandations pour l'engagement futur des partenaires communautaires et/ou des patients partenaires dans la recherche sur les MCV chez les femmes. Les lignes directrices pour effectuer des revues de littérature rapides recommandées par le Cochrane Rapid Reviews Methods Group et Tricco et coll. ont été utilisées pour effectuer des recherches dans 5 bases de données à l'aide de rubriques médicales sous-jacentes (MeSH) et/ou de mots-clés. Les participants étaient des femmes (cis et trans) âgées de plus de 18 ans et ayant eu une cardiopathie ischémique, une insuffisance cardiaque ou un accident vasculaire cérébral. Aucune évaluation du risque de biais n'a été entreprise. Les résultats sont résumés et/ou regroupés en tant que recherche communautaire participative, ou recherche orientée vers le patient et/ou recherche avec partenariat patient. Notre recherche a collecté 39 998 titres et résumés. Parmi ceux-ci, 35 ont été inclus dans une synthèse narrative finale, comprenant des données provenant de 474 partenaires communautaires et/ou patients, dont 417 (88%) femmes. Plus de 85% des partenaires communautaires ont collaboré à la conception et/ou à la planification et à la mise en œuvre de la recherche sur les MCV chez les femmes; la plupart étaient originaires des États-Unis; une étude seulement était originaire du Canada. La plupart des recherches axées sur le patient et sur les patients partenaires ont été menées au Canada. Cependant, moins de 50 % des patients partenaires ont collaboré à l'une ou l'autre phase de la recherche. Le sexe, le genre, la race et l'origine ethnique étaient rarement rapportés. Les résultats suggèrent un engagement négligeable des communautés et un engagement insuffisant des patients et/ou des patients partenaires dans la recherche sur les MCV chez les femmes au Canada. Une meilleure collaboration entre la communauté et les patients partenaires à toutes les étapes de la recherche, quel que soit le sexe, la race ou l'origine ethnique, permettrait d'améliorer les résultats de la recherche sur les MCV chez les femmes.

Mental health and well-being of unpaid caregivers: a cross-sectional survey protocol.

INTRODUCTION: Unpaid caregiving, care provided by family/friends, is a public health issue of increasing importance. COVID-19 worsened the mental health conditions of unpaid caregivers, increasing substance/drug use and early development of chronic disease. The impact of the intersections of race and ethnicity, sex, age and gender along with unpaid care work and caregivers' health and well-being is unknown. The aim of this study is to describe the inequities of caregiver well-being across the intersections of race and ethnicity, sex, age and gender using a cross-sectional survey design. METHODS AND ANALYSIS: We are collaborating with unpaid caregivers and community organisations to recruit a non-probability sample of unpaid caregivers over 18 years of age (n=525). Recruitment will focus on a target sample of 305 South Asian, Chinese and Black people living in Canada, who represent 60% of the Canadian racial and ethnic populations. The following surveys will be combined into one survey: Participant Demographic Form, Caregiver Well-Being Index, interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using descriptive statistics. The scores from the Caregiver Well-Being Index will be dichotomised into fair/poor and good/excellent. A two-stage analytical strategy will be undertaken using logistic regression to model fair/poor well-being and good/excellent well-being according to the following axes of difference set a priori: sex, race and ethnicity, gender identity, age, gender relations, gender roles and institutionalised gender. The first stage of analysis will model the main effects of each factor and in the second stage of analysis, interaction terms will be added to each model. ETHICS AND DISSEMINATION: The University of Toronto's Health Sciences Research Ethics Board granted approval on 9 August 2022 (protocol number: 42609). Knowledge will be disseminated in pamphlets/infographics/email listservs/newsletters and journal articles, conference presentation and public forums, social media and through the study website. TRIAL REGISTRATION NUMBER: This is registered in the Open Sciences Framework with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.

Peer-support interventions for women with cardiovascular disease: protocol for synthesising the literature using an evidence map.

INTRODUCTION: The leading cause of death for women is cardiovascular disease (CVD), including ischaemic heart disease, stroke and heart failure. Previous literature suggests peer support interventions improve self-reported recovery, hope and empowerment in other patient populations, but the evidence for peer support interventions in women with CVD is unknown. The aim of this study is to describe peer support interventions for women with CVD using an evidence map. Specific objectives are to: (1) provide an overview of peer support interventions used in women with ischaemic heart disease, stroke and heart failure, (2) identify gaps in primary studies where new or better studies are needed and (3) describe knowledge gaps where complete systematic reviews are required. METHODS AND ANALYSIS: We are building on previous experience and expertise in knowledge synthesis using methods described by the Evidence for Policy and Practice Information (EPPI) and the Coordinating Centre at the Institute of Education. Seven databases will be searched from inception: CINAHL, Embase, MEDLINE, APA PsycINFO, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, and Scopus. We will also conduct grey literature searches for registered clinical trials, dissertations and theses, and conference abstracts. Inclusion and exclusion criteria will be kept broad, and studies will be included if they discuss a peer support intervention and include women, independent of the research design. No date or language limits will be applied to the searches. Qualitative findings will be summarised narratively, and quantitative analyses will be performed using R. ETHICS AND DISSEMINATION: The University of Toronto's Research Ethics Board granted approval on 28 April 2022 (Protocol #42608). Bubble plots (ie, weighted scatter plots), geographical heat/choropleth maps and infographics will be used to illustrate peer support intervention elements by category of CVD. Knowledge dissemination will include publication, presentation/public forums and social media.

"Her Heart Matters"-Making Visible the Cardiac Pain Experiences of Women with Physical Disabilities and Heart Disease: A Qualitative Study.

BACKGROUND: Women with physical disabilities are faced with challenges in many aspects of life-education, work, income, relationships, as well as their general health. These women are at a greater risk of developing heart disease. This study aimed to explore the cardiac pain experiences of women with physical disabilities and heart disease within a Canadian healthcare context. METHODS: In this qualitative study, 8 women with physical disabilities and heart disease from across Canada were interviewed. They were asked about their pre-, peri-, and post-diagnostic experiences in the Canadian healthcare system. Transcripts of the interviews were analyzed using a hermeneutic phenomenological approach inspired by Ricoeur. RESULTS: Two main themes were uncovered in the analysis of the transcripts, as follows: (i) the diagnostic journey; and (ii) life with cardiac symptoms and a disability. The women indicated that they had experienced difficulties in utilizing the Canadian healthcare system prior to receiving a cardiac diagnosis, including long waitlists, expensive and unreliable transport, issues with accessibility, and dealing with providers' attitudinal barriers regarding disability. Receiving a diagnosis was challenging due to poor relationships with healthcare providers; however, having a same-sex provider seemed essential to receiving adequate care. Self-managing a disability and heart disease had significant physical and psychological impact, which was lightened by financial and social supports, modified lifestyle choices, and self-advocacy. CONCLUSIONS: Women with physical disabilities are often forgotten in discussions encompassing equity and inclusion. The participants' experiences offer insight into what changes are needed within the Canadian healthcare system in order to improve outcomes for these women.

CONTEXTE: Les femmes qui présentent une incapacité physique doivent composer avec des défis dans de nombreux aspects de leur vie, notamment en ce qui touche l'éducation, le travail, le revenu, les relations et la santé en général. Le risque de cardiopathie est plus important dans leur cas. Cette étude visait à examiner comment la douleur cardiaque est vécue par les femmes présentant une incapacité physique et une cardiopathie dans le contexte des soins de santé au Canada. MÉTHODOLOGIE: Dans le cadre de cette étude qualitative, huit femmes présentant une incapacité physique et une cardiopathie ont participé à des entrevues menées à l'échelle du Canada. Elles ont été interrogées sur leurs expériences au sein du système de santé canadien au cours des périodes précédant, entourant et suivant le diagnostic. Les transcriptions des entrevues ont été analysées en fonction d'une approche phénoménologique herméneutique inspirée par Ricœur. RÉSULTATS: Deux grands thèmes ressortent de l'analyse des transcriptions, à savoir : (i) le parcours diagnostique; (ii) la vie avec des symptômes cardiaques et une incapacité physique. Les femmes interrogées ont indiqué qu'elles avaient éprouvé des difficultés dans leur parcours au sein du système de santé canadien avant de recevoir un diagnostic en cardiologie, évoquant à cet égard les longues listes d'attente, les services de transport coûteux et peu fiables, les problèmes d'accessibilité et les obstacles liés à l'attitude des fournisseurs de soins vis-à-vis de l'incapacité physique. Le fait de recevoir un diagnostic a été éprouvant en raison de rapports difficiles avec les fournisseurs de soins de santé; cependant, le fait d'avoir un fournisseur de soins de sexe féminin semblait être une condition essentielle à une prestation de soins adéquate. L'autoprise en charge d'une incapacité physique et d'une cardiopathie a eu des répercussions physiques et psychologiques importantes qui ont pu être allégées par le soutien financier et social, des modifications des habitudes de vie et l'autonomie sociale. CONCLUSIONS: Les femmes qui présentent une incapacité physique sont souvent laissées pour compte dans les discussions portant sur l'équité et l'inclusion. Le vécu des participantes donne un aperçu des changements qui doivent être apportés au sein du système de santé canadien afin d'améliorer les résultats chez ces femmes.

A cluster-randomized controlled trial of the effectiveness of the JUMP Math program of math instruction for improving elementary math achievement.

Students in many western countries struggle to achieve acceptable standards in numeracy despite its recognition as an important 21st century skill. As commercial math programs remain a staple of classroom instruction, investigations of their effectiveness are essential to inform decision-making regarding how to invest limited resources while maximizing student gains. We conducted a cluster randomized-controlled trial of the effectiveness of JUMP Math, a distinctive math program whose central tenets are empirically supported, for improving elementary math achievement (clinical trial.gov no. NCT02456181). The study involved 554 grade 2 (primary) and 592 grade 5 (junior) students and 193 teachers in 41 schools, in an urban-rural Canadian school board. Schools were randomly assigned to use either JUMP Math or their business-as-usual, problem-based approach to math instruction. We tracked student progress in math achievement on standardized and curriculum-based measures of computation and problem solving, for 2 consecutive school years. Junior students taught with JUMP Math made significantly greater progress in computation than their non-JUMP peers but the groups did not differ significantly in problem solving. Effects took hold relatively quickly, replicating the results from an earlier pilot study. Primary students in the non-JUMP group made significantly greater gains in problem solving and computation in year 1. But those taught with JUMP Math made significantly greater gains in problem solving and the groups did not differ in computation, in year 2. The positive effects of JUMP Math are noteworthy given that the JUMP Math teachers were likely still adjusting to the new program. That these positive findings were obtained in an effectiveness study (i.e. in real-world conditions), suggests that JUMP Math may be a valuable evidence-based addition to the teacher's toolbox. Given the importance of numeracy for 21st century functioning, identifying and implementing effective math instruction programs could have far-reaching, positive implications.

A Cluster Randomized-Controlled Trial of the Impact of the Tools of the Mind Curriculum on Self-Regulation in Canadian Preschoolers.

Early self-regulation predicts school readiness, academic success, and quality of life in adulthood. Its development in the preschool years is rapid and also malleable. Thus, preschool curricula that promote the development of self-regulation may help set children on a more positive developmental trajectory. We conducted a cluster-randomized controlled trial of the Tools of the Mind preschool curriculum, a program that targets self-regulation through imaginative play and self-regulatory language (Tools; clinical trials identifier NCT02462733). Previous research with Tools is limited, with mixed evidence of its effectiveness. Moreover, it is unclear whether it would benefit all preschoolers or primarily those with poorly developed cognitive capacities (e.g., language, executive function, attention). The study goals were to ascertain whether the Tools program leads to greater gains in self-regulation compared to Playing to Learn (YMCA PTL), another play based program that does not target self-regulation specifically, and whether the effects were moderated by children's initial language and hyperactivity/inattention. Two hundred and sixty 3- to 4-year-olds attending 20 largely urban daycares were randomly assigned, at the site level, to receive either Tools or YMCA PTL (the business-as-usual curriculum) for 15 months. We assessed self-regulation at pre-, mid and post intervention, using two executive function tasks, and two questionnaires regarding behavior at home and at school, to capture development in cognitive as well as socio-emotional aspects of self-regulation. Fidelity data showed that only the teachers at the Tools sites implemented Tools, and did so with reasonable success. We found that children who received Tools made greater gains on a behavioral measure of executive function than their YMCA PTL peers, but the difference was significant only for those children whose parents rated them high in hyperactivity/inattention initially. The effect of Tools did not vary with children's initial language skills. We suggest that, as both programs promote quality play and that the two groups fared similarly well overall, Tools and YMCA PTL may be effective curricula choices for a diverse preschool classroom. However, Tools may be advantageous in classrooms with children experiencing greater challenges with self-regulation, at no apparent cost to those less challenged in this regard.

Maternal and Peer Regulation of Adolescent Emotion: Associations with Depressive Symptoms.

Emotion socialization by close relationship partners plays a role in adolescent depression. In the current study, a microsocial approach was used to examine how adolescents' emotions are socialized by their mothers and close friends in real time, and how these interpersonal emotion dynamics are related to adolescent depressive symptoms. Participants were 83 adolescents aged 16 to 17 years who participated in conflict discussions with their mothers and self-nominated close friends. Adolescents' positive and negative emotions, and mothers' and peers' supportive regulation of adolescent emotions, were coded in real time. Two multilevel survival analyses in a 2-level Cox hazard regression framework predicted the hazard rate of (1) mothers' supportive regulation of adolescents' emotions, and (2) peers' supportive regulation of adolescents' emotions. The likelihood of maternal supportiveness, regardless of adolescent emotions, was lower for adolescents with higher depressive symptoms. In addition, peers were less likely to up-regulate adolescent positive emotions at higher levels of adolescent depressive symptoms. The results of the current study support interpersonal models of depression and demonstrate the importance of real-time interpersonal emotion processes in adolescent depressive symptoms.

A dynamic systems analysis of parent-child changes associated with successful "real-world" interventions for aggressive children.

Studies have shown that improved parenting mediates treatment outcomes for aggressive children, but we lack fine-grained descriptions of how parent-child interactions change with treatment. The current study addresses this gap by applying new dynamic systems methods to study parent-child emotional behavior patterns. These methods tap moment-to-moment changes in interaction processes within and across sessions and quantify previously unmeasured processes of change related to treatment success. Aggressive children and their parents were recruited from combined Parent Management Training and Cognitive-behavioral programs in "real world" clinical settings. Behavioral outcomes were assessed by reports from parents and clinicians. At pre- and post-treatment, home visits were videotaped while parents and children discussed consecutively: a positive topic, a mutually unresolved problem, and another positive topic. Results showed that significant improvements in children's externalizing behavior were associated with increases in parent-child emotional flexibility during the problem-solving discussion. Also, dyads who improved still expressed negative emotions, but they acquired the skills to repair conflicts, shifting out of their negative interactions to mutually positive patterns.