Heart work: Indigenous doulas responding to challenges of western systems and revitalizing Indigenous birthing care in Canada

Background In Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations. Population/setting Our paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia. Methods Semi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, “She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas.” Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes. Results Our paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas. Conclusions Both the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.

Novel Effects of the Gastrointestinal Hormone Secretin on Cardiac Metabolism and Renal Function

The cardiac benefits of gastrointestinal hormones have been of interest in recent years. The aim of this study was to explore the myocardial and renal effects of the gastrointestinal hormone secretin in the GUTBAT trial (NCT03290846). A placebo-controlled crossover study was conducted on 15 healthy males in fasting conditions, where subjects were blinded to the intervention. Myocardial glucose uptake was measured with [18F]2-fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography. Kidney function was measured with [18F]FDG renal clearance and estimated glomerular filtration rate (eGFR). Secretin increased myocardial glucose uptake compared to placebo (secretin vs. placebo, mean + standard deviation, 15.5 + 7.4 vs. 9.7 + 4.9 μmol/100g/min, 95% confidence interval (CI) [2.2, 9.4], p=0.004). Secretin also increased [18F]FDG renal clearance (44.5 + 5.4 vs. 39.5 + 8.5 ml/min, 95%CI[1.9, 8.1], p=0.004) and eGFR was significantly increased from baseline after secretin, compared to placebo (17.8 + 9.8 vs. 6.0 + 5.2 Δml/min/1.73m2, 95%CI[6.0, 17.6], p=0.001). Our results implicate that secretin increases heart work and renal filtration, making it an interesting drug candidate for future studies in heart and kidney failure.

Afterword—Therapist Reflections

This is the story of Nell embracing her life in the weeks prior to her death and the author’s part in witnessing and assisting her safe passage. She died peacefully as she had wished and prepared for these many months. The idea of mortal time engaged her and opened up a new period of discovery at the end. The constant presence of her spouse Al as well as her beloved cat Amber was a comfort on the journey. Walking with Nell was an invitation for me to cultivate self-knowledge by not only witnessing her narrative but also living in it with her. Suffering, sadness, and grief were all part of the journey as well as the gestures of kindness and appreciation to me, including naming me her bodhisattva, her guide on the road to eternity. Music and poetry helped ease the way. It was fitting to end our work together by giving the eulogy in the church she attended. The work of seeing Nell and being with her is complete. The heart-work continues, fueled by the images of Nell in mortal time.

Clinically significant subjective features of highly qualified athletes with different types of cardiac rhythm regulation

The aim of the study is to identify the characteristic subjective features of highly qualified athletes with different types of cardiac rhythm regulation. Materials and methods. 202 highly qualified male athletes aged 22.6 ± 2.8 years and engaged in acyclic sports were examined. According to the designed survey protocol, all athletes were interviewed using a specifically designed questionnaire, which included 4 questions pools, each of them characterized certain components of athletes’ subjective assessment of their condition and attitude to it during the previous week, as well as studies using spiroarteriocardiorhythmography (SACR). Results. The SACR study allowed to divide athletes, taking into account heart rate variability (HRV) parameters, into 4 groups according to the types of their cardiac rhythm regulation. Subjective signs that might have clinical significance in the development of cardiovascular overexertion were uncomfortable sensations in the heart, feeling of interruption in the heart work, perspiration at rest, headache after sleep, perspiration at low loads, feeling of fatigue after sleep and night perspiration. Uncomfortable sensations in the heart occurred frequently in 1 % of cases and periodically in 15.3 % of cases, and feeling of interruption in the heart work occurred frequently in 0.5 % of cases and periodically in 14.9 % of cases. These indications were typical of people with cardiac rhythm regulations type I and II. In type III the least number of clinically significant features was noted. In type IV the number of significant features was less than in types I and II; however, this is nonsignificant. Probable differences in the features of perspiration at rest were noticed in athletes with type IV in comparison with type III. Conclusions. Subjective indications can be employed to verify the regulatory features of the cardiovascular system, which are associated with the centralization of effects. Questionnaires can be useful in differentiating states of overexertion according to parasympathetic type and a state of high training level in type IV cardiac rhythm regulation.

Surviving the Continued Assault of Cultural Centers

Staff from cultural centers and diversity, equity, and inclusion (DEI) offices will present their experiences as leaders that are often responding to contested times due to their roles and commitment to diversity, equity, and inclusion as heart work. Examples of contested times include financial constraints, anti-immigrant policies of the Trump administration, Black Lives Matter uprisings in response to increased visibility of police violence, and reimagining the role of centers during the COVID-19 pandemic. The chapter will explore how the authors' identities have shaped their leadership approach to build capacity by centering student needs and engaging campus partners. The chapter ends with the authors outlining approaches and next steps for supporting cultural centers and DEI offices during crises.

Correlations of Clinically Significant and other Subjective Signs of the Body State in Highly Qualified Athletes

The study of the subjective signs of athletes in the training process has the same importance as the study of objective characteristics, which helps to identify overstrain states of systems and their underrecovery. The purpose of the study was to determine the connections of clinically significant subjective signs of athletes with other subjective signs of the body state of highly qualified athletes in the pre-competition period. Material and methods. 202 highly qualified male athletes aged 22.6 ± 2.8 years were examined. They were representatives of acyclic sports. Their sport experience was 10.3±3.1 years. The questionnaire together with other research methods were conducted in the morning on an empty stomach in the pre-competition period. Results and discussion. According to the questionnaire signs we identified some things might be clinically significant, namely: unpleasant sensations in the heart, feeling of interruption in the heart work, sweating at rest, headache after sleep, sweating at low loads, the feeling of fatigue after sleep, sweating at the sleep. Unpleasant sensations in the heart and feeling of interruption in the heart work were the most critical from the perspective of overload or underrecovery of cardiovascular system. This was confirmed by their connections with their weekly duration (r = 0.230, р = 0.021 and r = 0.343, р = 0.000, accordingly) and duration of trainings (r = 0.202, р = 0.042 and r = 0.361, р = 0.000, accordingly). There were no other subjective signs with such connections. Noteworthy was the inverse relationship between sweating at low load and the age of athletes (r = -0.249, р = 0.012) and their training experience (r = -0.275, р = 0.005), which is quite understandable from the perspective of formation of adaptation mechanism with increasing training experience. Sweating at low loads is associated with a feeling of heaviness in working muscles (r = 0.230, р = 0.020), and a feeling of fatigue after sleep with feelings of fatigue at rest the day after training (r = 0.250, р = 0.012), feeling of heaviness during training (r = 0.210, p = 0.035) and a headache after training (r = 0.221, p = 0.026). These clinically significant subjective signs had a number of specific links that could be essential for assessing functional and non-functional overstrain in the athlete’s body. Conclusion. In general, the analysis of associations of clinically significant subjective signs of athletes allowed to determine the most important ones for assessing the condition of athletes. The analysis of other subjective signs should be conducted taking into account the data of objective instrumental research

Quantitative and qualitative blood pressure clusters in patients of Truskavets’ SPA and their hemodynamic accompaniment

Background. The influence of balneotherapy at the Truskavets’ spa on the blood pressure (BP) of his patients is still not in the focus of researchers. Therefore, we initiated the project “Neuroendocrine-immune and metabolic mechanisms of the effect of balneotherapy on BP”. The first swallow of the project is the analysis of a condition of BP and its hemodynamic support of profile patients of a resort. Materials and methods. Under an observations were 44 patients with chronic pyelonephritis and cholecystitis in the phase of remission. Testing was performed twice - on admission and after 7-10 days of standard balneotherapy. The main object of the study was BP (tonometer “Omron M4-I”, Netherlands). Simultaneously the parameters of hemodynamics were determined (echocamera “Toshiba-140”, Japan). Results. The optimal level of systolic BP (range 120÷129 mmHg) stated in 18,2% of cases only, high norm (130÷139 mmHg) in 14,8%, arterial hypertension (AH) I (140÷160 mmHg) – in 39,8%, AH II (over 160 mmHg) in 12,5%, however, in 14,8% of cases the BP was lower than 120 mmHg. In order to identify among the registered parameters of hemodynamics, those for which the BP clusters differ from each other, a discriminant analysis was performed. The program forward stepwise included in the discriminant model 13 parameters out of 17. The most informative among them: contractility index of left ventricle, heart work per minute, ejection fraction and time as well as end-systolic volume. Conclusion. Profile patients of Truskavets’ spa are characterized by a wide range of blood pressure - from low norm to arterial hypertension II that correspond to the hemodynamics parameters.