Explore the vast range of titles available.

Hypertension (HTN) is a critical primary modifiable risk factor for the development of cardiovascular diseases, with recognized sex-based differences. While sex refers to one’s biological genetic makeup and attributes, gender encompasses the individual’s psycho-socio-cultural characteristics, including their environment and living conditions. The impact of each gendered variable may differ amongst men and women with respect to HTN. Applying a sex and gender-based lenses to inform our understanding of HTN has the potential to unveil important contributors of HTN-related cardiovascular outcomes. For instance, increased life stressors, work related anxiety and depression, typically have more pronounced effect on women than men with HTN. The impact of social surrounding including marital status and social support on HTN also differs amongst men and women. While married men are less likely to have higher blood pressure, single women, and those who never married are less likely to have HTN. Additionally, the beneficial role of social support is more pronounced in more historically marginalized cultural groups compared to majority. Finally, socioeconomic status, including education level and income have a linear and inverse relationship in blood pressure control in more resource-rich countries. The aim of this review is to summarize how sex and gender interact in shaping the clinical course of HTN demonstrating the importance of both sex and gender in HTN risk and its treatment. Hence, when investigating the role of gendered factors in HTN it is imperative to consider cultural, and social settings. In this narrative we found that employment and education play a significant role in manifestation and control of HTN particularly in women.

The objective of this review is to evaluate the effectiveness of psychosocial interventions on mental health outcomes in adult patients with Cardiovascular Diseases (CVDs) living in low- and middle-income countries (LMICs). Mental health issues are highly prevalent among patients with CVDs leading to poor disease prognosis, self-care/ management, and Quality of Life (QOL). In the context of LMICs, where the disease burden and treatment gap are high and resources are inadequate for accessing essential care, effective psychosocial interventions can make significant contributions for improving mental health and reducing mental health problems among patients who live with cardiovascular diseases. This review will include studies published between 2010 and 2021 that evaluated the effect of psychosocial interventions on mental health outcomes (resilience, self-efficacy, QOL, depression and anxiety) on adult patients (aged ≥18 years) with any cardiovascular diseases using experimental and quasi experimental designs. The search will be conducted from the following databases: MEDLINE via OVID (1946-Present), EMBASE via OVID (1974 -Present), Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost (1936-Present), PsycINFO via OVID (1806-Present), Scopus via Elsevier (1976-Present), and Cochrane Library via Wiley (1992-Present). Data will be critically appraised using standard tools and extracted by two reviewers and disagreement will be solved by the third reviewer. Meta-analysis will be performed, if possible, otherwise, data will be synthesized in narrative and tabular forms. The findings of this review will provide a key insight into contextually relevant psychosocial interventions for promoting mental health of patients with CVDs living in LMICs. The review findings will be potentially useful for health care providers and researchers to implement such interventions not only for reducing the burden of mental health issues but also for improving the overall well-being among patients with chronic illnesses. Prospero-CRD42020200773.

In patients with chronic heart failure (CHF), previous studies have reported reduced mortality rates in patients with increased body mass index (BMI). The potentially protective effect of increased BMI in CHF has been termed the obesity paradox or reverse epidemiology. This meta-analysis was conducted to examine the relationship between increased BMI and mortality in patients with CHF. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, and Web of Science to identify studies with contemporaneous control groups (cohort, case-control, or randomized controlled trials) that examined the effect of obesity on all-cause and cardiovascular mortality. Two reviewers independently assessed studies for inclusion and performed data extraction. Nine observational studies met final inclusion criteria (total n = 28,209). Mean length of follow-up was 2.7 years. Compared to individuals without elevated BMI levels, both overweight (BMI ∼25.0-29.9 kg/m 2, RR 0.84, 95% CI 0.79-0.90) and obesity (BMI ∼≥30 kg/m 2, RR 0.67, 95% CI 0.62-0.73) were associated with lower all-cause mortality. Overweight (RR 0.81, 95% CI 0.72-0.92) and obesity (RR 0.60, 95% CI 0.53-0.69) were also associated with lower cardiovascular mortality. In a risk-adjusted sensitivity analysis, both obesity (adjusted HR 0.88, 95% CI 0.83-0.93) and overweight (adjusted HR 0.93, 95% CI 0.89-0.97) remained protective against mortality. Overweight and obesity were associated with lower all-cause and cardiovascular mortality rates in patients with CHF and were not associated with increased mortality in any study. There is a need for prospective studies to elucidate mechanisms for this relationship.

Tadiri et al explore the influence of sex and gender domains on COVID-19 cases and mortality. Among the many unknowns regarding severe acute respiratory syndrome SARS-CoV-2 and COVID-19 is the way in which sex and gender affect the risk of acquiring the virus, illness presentation, disease management and outcomes. Sex, a biological attribute, and gender, a social construct, may both influence an individual's susceptibility, vulnerability and exposure to infectious disease. Immune function differs between sexes and has been shown to affect an individual's likelihood of acquiring infection upon exposure, or developing complications. Indeed, early research has shown that these sex differences in immune response may lead to worse COVID-19 outcomes for males in terms of ability to recover from severe infection. Gender, which comprises roles, norms and behaviors that may vary by sex, is associated with an individual's likelihood of exposure. Several institutions, including the Canadian Institutes of Health Research, have appealed to researchers to include sex and gender variables in data analysis, to improve the effectiveness of health interventions and promote gender and health equity goals.

Overview: Post traumatic stress disorder (PTSD) has emerged as a severely debilitating psychiatric disorder associated with critical illness. Little progress has been made in the treatment of post-intensive care unit (ICU) PTSD. Aim: To synthesize neurobiological evidence on the pathophysiology of PTSD and the brain areas involved, and to highlight the potential of music to treat post-ICU PTSD. Methods: Critical narrative review to elucidate an evidence-based neurobiological framework to inform the study of music interventions for PTSD post-ICU. Literature searches were performed in PubMed and CINAHL. The Scale for the Assessment of Narrative Review Articles (SANRA) guided reporting. Results: A dysfunctional HPA axis feedback loop, an increased amygdalic response, hippocampal atrophy, and a hypoactive prefrontal cortex contribute to PTSD symptoms. Playing or listening to music can stimulate neurogenesis and neuroplasticity, enhance brain recovery, and normalize stress response. Additionally, evidence supports effectiveness of music to improve coping and emotional regulation, decrease dissociation symptoms, reduce depression and anxiety levels, and overall reduce severity of PTSD symptoms. Conclusions: Despite the lack of music interventions for ICU survivors, music has the potential to help people suffering from PTSD by decreasing amygdala activity, improving hippocampal and prefrontal brain function, and balancing the HPA-axis.

Background Human papillomavirus (HPV) vaccination programs in Canada primarily target school-aged adolescents (≤ 15 years) through publicly-funded, school-based delivery. In the province of Alberta, publicly-funded HPV vaccination for older youth (age ≤ 26) began with a risk-based program (i.e. availability limited to those at elevated risk for HPV infection and/or progression to disease) in 2018, expanding to an age-based program (i.e. available to all individuals within funded age groups) in July 2020. This study explores HPV vaccination patterns among 16–26-year-olds during this time period, in the context of the COVID-19 pandemic. Methods We conducted a retrospective cross-sectional study using population-wide administrative health data (February 2018–December 2023). Rates of HPV vaccination per 10,000 individuals were calculated by sex and age group, comparing the quarterly absolute and percent difference between the pre-pandemic risk-based period and the pandemic age-based period. We also calculated the quarterly proportion of doses delivered by sex (stratified by age group), delivery site, and individual residence (metro/urban/rural, age of arrival to province). Results HPV vaccine administration rates were higher among females than male throughout the study period (84–224 doses/10,000 compared to 40–135 doses/10,000). Rates dropped sharply after pandemic onset (March 2020), with the largest and most sustained drops among 16–17-year-olds (156 doses/10,000). Rates for 18–21 and 22–26-year-olds, who were newly eligible under the age-based program, returned to or exceeded pre-pandemic levels by 2022. Delivery site distribution shifted, with increased vaccination at post-secondary and STI health centres. Dose delivery remained consistently highest among metro residents, and individuals who entered Alberta after age 16. Conclusions Expansion to an age-based HPV vaccination program may have mitigated pandemic-related declines in vaccination rates among older youth, though overall administration remained low. Results highlight persistent inequities by sex and geography, and underscore the importance of targeted promotion, improved service delivery, and expanded provider engagement to optimize HPV vaccine uptake outside school-based settings.

Background Patient attitudes about health and healthcare have emerged as important outcomes to assess in clinical studies. Gender is increasingly recognized as an intersectional social construct that may influence health. Our objective was to determine potential sex differences in self-reported overall health and access to healthcare and whether those differences are influenced by individual social factors in two relatively similar countries. Methods Two public health surveys from countries with high gender equality (measured by UN GII) and universal healthcare systems, Canada (CCHS2014, n  = 57,041) and Austria (AT-HIS2014, n  = 15,212), were analysed. Perceived health was assessed on a scale of 1 (very bad) to 4 (very good) and perceived unmet healthcare needs was reported as a dichotomous variable (yes/no). Interactions between sex and social determinants (i.e. employment, education level, immigration and marital status) on outcomes were analysed. Results Individuals in both countries reported high perceived health (Scoring > 2, 85.0% in Canada, 79.9% in Austria) and a low percentage reported unmet healthcare needs (4.6% in Canada, 10.7% in Austria). In both countries, sex and several social factors were associated with high perceived health, and a sex-by-marital status interaction was observed, with a greater negative impact of divorce for men. Female sex was positively associated with unmet care needs in both countries, and sex-by-social factors interactions were only detected in Canada. Conclusions The intersection of sex and social factors in influencing patient-relevant outcomes varies even among countries with similar healthcare and high gender equality.

Numerous studies have demonstrated that sex (a biological variable) and gender (a psychosocial construct) impact health and have discussed the mechanisms that may explain these relationships. Funding agencies have called for all health researchers to incorporate sex and gender into their studies; however, the way forward has been unclear to many, particularly due to the varied definition of gender. We argue that just as there is no standardized definition of gender, there can be no standardized measurement thereof. However, numerous measurable gender-related variables may influence individual or population-level health through various pathways. The initial question should guide the selection of specific gender-related variables based on their relevance to the study, to prospectively incorporate gender into research. We outline various methods to provide clarification on how to incorporate gender into the design of prospective clinical and epidemiological studies as well as methods for statistical analysis. •Sex, a biological construct, and gender, a social construct are two distinct variables that may independently influence human health.•Despite calls for inclusion of sex and gender into health sciences research, gender is often ignored or conflated with sex.•In this commentary, we provide clarification of the distinction between these two variables and concrete examples of gender-related variables that can be collected under the four domains of gender identity, gender roles, gender relations, and institutionalized gender.•We also provide methods for incorporating these variables into statistical analysis.•We hope these guidelines will help researchers in their efforts to incorporate gender into their studies, thereby meeting requirements of funding agencies and ultimately improving health equity and precision medicine.

Sharing health data for research purposes across international jurisdictions has been a challenge due to privacy concerns. Two privacy enhancing technologies that can enable such sharing are synthetic data generation (SDG) and federated analysis, but their relative strengths and weaknesses have not been evaluated thus far. In this study we compared SDG with federated analysis to enable such international comparative studies. The objective of the analysis was to assess country-level differences in the role of sex on cardiovascular health (CVH) using a pooled dataset of Canadian and Austrian individuals. The Canadian data was synthesized and sent to the Austrian team for analysis. The utility of the pooled (synthetic Canadian + real Austrian) dataset was evaluated by comparing the regression results from the two approaches. The privacy of the Canadian synthetic data was assessed using a membership disclosure test which showed an F1 score of 0.001, indicating low privacy risk. The outcome variable of interest was CVH, calculated through a modified CANHEART index. The main and interaction effect parameter estimates of the federated and pooled analyses were consistent and directionally the same. It took approximately one month to set up the synthetic data generation platform and generate the synthetic data, whereas it took over 1.5 years to set up the federated analysis system. Synthetic data generation can be an efficient and effective tool for enabling multi-jurisdictional studies while addressing privacy concerns.

PurposeUnsupervised item-response theory (IRT) models such as polytomous IRT based on recursive partitioning (IRTrees) and mixture IRT (MixIRT) models can be used to assess differential item functioning (DIF) in patient-reported outcome measures (PROMs) when the covariates associated with DIF are unknown a priori. This study examines the consistency of results for IRTrees and MixIRT models.MethodsData were from 4478 individuals in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry who received cardiac angiography in Alberta, Canada, and completed the Hospital Anxiety and Depression Scale (HADS) depression subscale items. The partial credit model (PCM) based on recursive partitioning (PCTree) and mixture PCM (MixPCM) were used to identify covariates associated with differential response patterns to HADS depression subscale items. Model covariates included demographic and clinical characteristics.ResultsThe median (interquartile range) age was 64.5(15.7) years, and 3522(78.5%) patients were male. The PCTree identified 4 terminal nodes (subgroups) defined by smoking status, age, and body mass index. A 3-class PCM fits the data well. The MixPCM latent classes were defined by age, disease indication, smoking status, comorbid diabetes, congestive heart failure, and chronic obstructive pulmonary disease.ConclusionPCTree and MixPCM were not consistent in detecting covariates associated with differential interpretations of PROM items. Future research will use computer simulations to assess these models’ Type I error and statistical power for identifying covariates associated with DIF.