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Jumah NA, Kewayosh A, Downey B, Campbell Senese L, Tinmouth J. Developing a Health Equity Impact Assessment 'Indigenous Lens Tool' to address challenges in providing equitable cancer screening for indigenous peoples. BMC Public Health 2023; 23:2250. [PMID: 37968666 PMCID: PMC10648620 DOI: 10.1186/s12889-023-16919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND In spite of past efforts to increase screening uptake, the rates of screening-detectable cancers including breast, cervical, colorectal and lung are rising among Indigenous persons in Ontario compared to other Ontarians. The Ontario Ministry of Health has an equity framework, the Health Equity Impact Assessment (HEIA) Tool, that was developed to guide organizations in the provision of more equitable health and social services. Although the HEIA Tool identifies that the health of Indigenous persons may benefit from more equitable provision of health and social services, it provides very little specific guidance on how to apply the HEIA Tool in a culturally relevant way to policies and programs that may impact Indigenous peoples. DISCUSSION Guided by the Calls to Action from the Truth and Reconciliation Commission of Canada and the United Nations Declaration on the Rights of Indigenous Peoples, an Indigenous Lens Tool was developed through a collaborative and iterative process with stakeholders at Cancer Care Ontario and with representatives from Indigenous community-based organizations. The Indigenous Lens Tool consists of four scenarios, with supporting documentation that provide context for each step of the HEIA Tool and thereby facilitate application of the equity framework to programs and policies. The document is in no way meant to be comprehensive or representative of the diverse health care experiences of Indigenous peoples living in Canada nor the social determinants that surround health and well-being of Indigenous peoples living in Canada. Rather, this document provides a first step to support development of policies and programs that recognize and uphold the rights to health and well-being of Indigenous peoples living in Canada. CONCLUSIONS The Indigenous Lens Tool was created to facilitate implementation of an existing health equity framework within Cancer Care Ontario (now Ontario Health). Even though the Indigenous Lens Tool was created for this purpose, the principles contained within it are translatable to other health and social service policy applications.
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Affiliation(s)
- Naana Afua Jumah
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | | | | | | | - Jill Tinmouth
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Jumah NA, Tyler L, Turuba R, Bishop L, Tait M, Renaud A, Mushquash C. On the path to reclaiming Indigenous midwifery: Co-creating the Maternal Infant Support Worker pilot program. Int J Gynaecol Obstet 2021; 155:203-210. [PMID: 34491574 PMCID: PMC9291220 DOI: 10.1002/ijgo.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022]
Abstract
Objective The aim of the Maternal Infant Support Worker (MiSW) pilot program was to implement a virtual training program for lay maternal–infant health providers in remote First Nations communities in Northwestern Ontario, Canada. Methods The MiSW pilot program was administered jointly by a community college and a university and consisted of a 20‐week virtual course followed by a 9‐month mentored work placement in the community. Results The MiSW pilot program was delivered successfully; 11 of 13 participants received a certificate from a community college. MiSWs provided culturally and linguistically appropriate care to women, infants, and families in their respective communities. MiSWs provided doula support in their communities—a first for our region since the policy of forced evacuation for birth was implemented. MiSWs developed a community of practice for ongoing education, as well as to support each other in their work. Conclusion The MiSW pilot program demonstrated that it is possible to provide a virtual training program and then provide continued virtual mentorship as the participants work in their First Nations communities. By prioritizing Indigenous voices above those of the research team, we were able to gain the trust of the MiSWs and maintain engagement with communities. The Maternal Infant Support Worker pilot program successfully implemented a virtual training program for lay maternal–infant workers living in remote communities.
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Affiliation(s)
- Naana Afua Jumah
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada.,Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
| | - Leanne Tyler
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada.,School of Access and Success, Confederation College, Thunder Bay, ON, Canada
| | - Roxanne Turuba
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
| | - Lisa Bishop
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Mary Tait
- Sioux Lookout Area Aboriginal Management Board, Sioux Lookout, ON, Canada
| | - Anne Renaud
- School of Access and Success, Confederation College, Thunder Bay, ON, Canada
| | - Christopher Mushquash
- Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
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Fernandez S, Bruni T, Bishop L, Turuba R, Olibris B, Jumah NA. Differences in hospital length of stay between neonates exposed to buprenorphine versus methadone in utero: A retrospective chart review. Paediatr Child Health 2018; 24:e104-e110. [PMID: 30996615 DOI: 10.1093/pch/pxy091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Neonatal abstinence syndrome is a growing concern in neonatal intensive care units in rural and remote settings. Methods A retrospective chart review was conducted of 180 mother-infant dyads born with in utero exposure to buprenorphine (n=60), methadone (n=60) or to other opioids (n=60) to determine neonatal length of stay in hospital, number of days on morphine, day of life of initiation of morphine and the need for phenobarbital. Results The length of stay in hospital for neonates was 5.8 days shorter (95% confidence interval [CI] 6.1 to 8.5 days) for buprenorphine exposure in utero compared to methadone (P=0.001). For neonates requiring treatment for Neonatal abstinence syndrome, those with in utero exposure to buprenorphine required 6.1 fewer days (95% CI 2.5 to 9.7) of treatment with morphine then those exposed to methadone (P<0.0005). There were no statistically significant differences in day of life of initiation of morphine therapy for each of the study groups. The proportion of neonates requiring adjuvant therapy with phenobarbital was statistically significantly higher in neonates exposed to methadone in utero than either buprenorphine or illicit opioids (P<0.0005). Conclusions Retrospective data suggest that neonates with in utero exposure to buprenorphine experience a shorter length of stay in hospital, fewer days of treatment with morphine for neonatal abstinence syndrome, and less use of phenobarbital than neonates exposed in utero to methadone. This suggests that Ontario provincial guidelines should be updated to recommend buprenorphine as first line for replacement therapy in pregnancy.
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Affiliation(s)
- Sarah Fernandez
- Department of Pediatrics, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario
| | - Teresa Bruni
- Department of Pediatrics, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario
| | - Lisa Bishop
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario
| | - Roxanne Turuba
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario
| | - Brieanne Olibris
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario
| | - Naana Afua Jumah
- Department of Obstetrics and Gynecology, Northern Ontario School of Medicine, Thunder Bay, Ontario
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Jumah NA, Bishop L, Franklyn M, Gordon J, Kelly L, Mamakwa S, O'Driscoll T, Olibris B, Olsen C, Paavola N, Pilatzke S, Small B, Kahan M. Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario. Can J Public Health 2018; 108:e616-e620. [PMID: 29356671 PMCID: PMC6972256 DOI: 10.17269/cjph.108.5524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/16/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022]
Abstract
Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.
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Affiliation(s)
- Naana Afua Jumah
- Northern Ontario School of Medicine, Thunder Bay, ON; Thunder Bay Regional Health Research Institute, Thunder Bay, ON; University of Toronto, Toronto, ON.
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Jumah NA, Edwards C, Balfour-Boehm J, Loewen K, Dooley J, Gerber Finn L, Kelly L. Observational study of the safety of buprenorphine+naloxone in pregnancy in a rural and remote population. BMJ Open 2016; 6:e011774. [PMID: 27799240 PMCID: PMC5093362 DOI: 10.1136/bmjopen-2016-011774] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To describe the effect of in utero exposure to the buprenorphine+naloxone combination product in a rural and remote population. SETTING A district hospital that services rural and remote, fly-in communities in Northwestern Ontario, Canada. PARTICIPANTS A retrospective cohort study was conducted of 855 mother infant dyads between 1 July 2013 and 30 June 2015. Cases included all women who had exposure to buprenorphine+naloxone during pregnancy (n=62). 2 control groups were identified; the first included women with no opioid exposure in pregnancy (n=618) and the second included women with opioid exposure other than buprenorphine+naloxone (n=159). Women were excluded if they had multiple pregnancy or if they were part of a methadone programme (n=16). The majority of women came from Indigenous communities. OUTCOMES The primary outcomes were birth weight, preterm delivery, congenital anomalies and stillbirth. Secondary neonatal outcomes included gestational age at delivery, Apgar scores at 1 and 5 min, NAS Score >7 and treatment for neonatal abstinence syndrome (NAS). Secondary maternal outcomes included the number of caesarean sections, postpartum haemorrhages, out of hospital deliveries and transfer of care to tertiary centres. RESULTS No difference was found in the primary outcomes or in the Apgar score and caesarean section rate between in utero buprenorphine+naloxone exposure versus no opioid exposure in pregnancy. Compared to women taking other opioids, women taking buprenorphine+naloxone had higher birthweight babies (p=0.001) and less exposure to marijuana (p<0.001) during pregnancy. CONCLUSIONS Retrospective data suggest that there likely is no harm from taking buprenorphine+naloxone opioid agonist treatment in pregnancy. Larger, prospective studies are needed to further assess safety.
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Affiliation(s)
- Naana Afua Jumah
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Craig Edwards
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kassandra Loewen
- Anishinaabe Bimaadiziwin Research Program, Sioux Lookout, Ontario, Canada
| | - Joseph Dooley
- Integrated Pregnancy Program, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Lianne Gerber Finn
- Integrated Pregnancy Program, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Len Kelly
- Anishinaabe Bimaadiziwin Research Program, Sioux Lookout, Ontario, Canada
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Abstract
The nature, impact, and treatment of substance use during pregnancy are well described for women living in urban settings. Less is known about pregnant substance-using women living in rural communities. The objective of this review is to describe the existing evidence for the management of substance use in pregnant women living in rural areas. A systematic review of the literature was conducted using PubMed, Embase, and the Cochrane Database of Systematic Reviews, and the quality of the evidence was assessed using the GRADE system. Twenty-two articles that met the inclusion criteria were identified. Descriptive studies document high rates of smoking, marijuana, and polysubstance use among rural, substance-using pregnant women compared to their urban counterparts. Management of substance use disorders is limited by access to and acceptability of treatment modalities. Several innovative, integrated addiction and prenatal care programs have been developed, which may serve as models for management of substance use during pregnancy in rural settings.
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Affiliation(s)
- Naana Afua Jumah
- Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Adjunct Lecturer, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Naana Afua Jumah
- Thunder Bay Regional Research Institute, Thunder Bay, Ont., and Department of Obstetrics and Gynaecology (Jumah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Graves), Northern Ontario School of Medicine, Sudbury, Ont.; Department of Family and Community Medicine, University of Toronto, and Substance Use Service, Women's College Hospital (Kahan), Toronto, Ont.
| | - Lisa Graves
- Thunder Bay Regional Research Institute, Thunder Bay, Ont., and Department of Obstetrics and Gynaecology (Jumah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Graves), Northern Ontario School of Medicine, Sudbury, Ont.; Department of Family and Community Medicine, University of Toronto, and Substance Use Service, Women's College Hospital (Kahan), Toronto, Ont
| | - Meldon Kahan
- Thunder Bay Regional Research Institute, Thunder Bay, Ont., and Department of Obstetrics and Gynaecology (Jumah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Graves), Northern Ontario School of Medicine, Sudbury, Ont.; Department of Family and Community Medicine, University of Toronto, and Substance Use Service, Women's College Hospital (Kahan), Toronto, Ont
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Abstract
The hypothesis tested in this study was that the 'traditional build' is the culturally valued body shape by Ghanaian women. Culturally sensitive figural stimuli were designed to assess the current body image (CBI) and the ideal body image (IBI) of Ghanaian women. The most frequently selected model for the CBI was one that represented a slightly overweight woman; the IBI selected was consistent with a representation of normal body mass index; and the least healthy image was that figure that represented morbidly obesity.
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Affiliation(s)
- Rosemary B Duda
- Beth Israel Deaconess Medical Center, Department of Surgery RW871, 330 Brookline Avenue, Boston, MA 02115, USA.
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Duda RB, Jumah NA, Hill AG, Seffah J, Biritwum R. Interest in healthy living outweighs presumed cultural norms for obesity for Ghanaian women. Health Qual Life Outcomes 2006; 4:44. [PMID: 16857048 PMCID: PMC1544332 DOI: 10.1186/1477-7525-4-44] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 07/20/2006] [Indexed: 11/28/2022] Open
Abstract
Background Cultural norms indicate that obesity reflects increased wealth and prosperity. Yet obesity is linked to serious medical illnesses. The purpose of this study was to determine if Ghanaian women would change their body image if it meant a healthier life. Methods A questionnaire was administered to 305 Ghanaian women waiting for clinic appointments at Korle Bu Teaching Hospital, Accra Ghana. This survey included questions on current health, selection of figural stimuli, decision making on health and social determinants and 5 questions on self-perception of health from SF-36. Anthropometric measures were taken and body mass index calculated. Women were also provided with health related information at the conclusion of the interview. Results The majority of all women surveyed would reduce their current body image if it meant that they would have an overall healthier life and reduce the risks of obesity-linked illnesses and complications. Currently obese women were significantly more likely than non-obese women to reduce their body image to reduce the risk of hypertension (OR 2.03 [1.64 – 2.51],<0.001); cardiovascular accident (OR 1.96 [1.61 – 2.38],<0.001); diabetes (OR 2.00 [1.63 – 2.44],<0.001); myocardial infarction (OR 2.27 [1.80 – 2.86],<0.001); if requested by a spouse(OR 2.64 [1.98 – 3.52],<0.001); and to improve overall health (OR 1.95 [1.60 – 2.37], <0.001). There was no association with current body image and responses to SF-36. The decision to select a new body image was not influenced by education, income, marital status or parity. Age 50 years old and less was significantly associated with the body image size reduction to reduce the risk of hypertension, diabetes, and a cardiovascular accident. Conclusion The Ghanaian women interviewed in this study are interested in living a healthy life and are willing to reduce their body size to reduce the risk of obesity-linked illnesses. The target group for any interventional studies and measures to reduce obesity appears to be women age 50 and younger.
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Affiliation(s)
- Rosemary B Duda
- Department of Surgery, Beth Israel Deaconess Medical Center, RW871, 330 Brookline Ave, Boston, MA 02215, USA
| | | | - Allan G Hill
- Department of Population and International Health, Harvard School of Public Health, Huntington Ave, Boston, MA 02115, USA
| | - Joseph Seffah
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Department of Community Medicine, Korle Bu Teaching Hospital, University of Ghana, Accra, Ghana
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Jumah NA, Ameer-Beg SM, White NS, Prasad KVR, Bellhouse BJ. Identification of second harmonic optical effects from vaccine coated gold microparticles. Phys Med Biol 2004; 49:3603-12. [PMID: 15446791 DOI: 10.1088/0031-9155/49/16/008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigates the optical effects observed from uncoated and protein vaccine coated gold microparticles while imaging with two-photon excitation in the Mie scattering regime. When observed with time correlated single photon counting fluorescence lifetime microscopy, the emission from the gold microparticles appeared as an intense instrument-limited temporal response. The intensity of the emission showed a second-order dependence on the laser power and frequency doubling of the emitted light was observed for fundamental light between 890 and 970 nm. The optical effect was attributed to two-photon induced second harmonic generation. The vaccine coated gold microparticles had a much weaker second harmonic signal than the uncoated gold microparticles. Chemical analysis of the surface of the gold microparticles revealed that the vaccine coating decreases the surface charge thereby diminishing the observed second harmonic signal. These optical properties can be exploited to identify both the location of the protein vaccine coating as well as the gold microparticles in vitro and potentially to investigate the vaccine delivery kinetics in vivo.
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Affiliation(s)
- N A Jumah
- University of Oxford, Oxford, OX1 6PE, UK.
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