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Ethical challenges and lessons learned from Inuulluataarneq - "Having the Good Life" study: a community-based participatory research project in Greenland.

https://arctichealth.org/en/permalink/ahliterature114085
Source
J Empir Res Hum Res Ethics. 2013 Apr;8(2):110-8
Publication Type
Article
Date
Apr-2013
Author
Elizabeth Rink
Ruth Montgomery-Andersen
Anders Koch
Gert Mulvad
Dionne Gesink
Author Affiliation
Montana State University, Bozeman, MT 59717, USA. elizabeth.rink@montana.edu
Source
J Empir Res Hum Res Ethics. 2013 Apr;8(2):110-8
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Arctic Regions - epidemiology
Community-Based Participatory Research - ethics
Community-Institutional Relations
Cooperative Behavior
Cultural Competency
Decision Making
Ethics Committees, Research
Greenland - epidemiology
Health Policy
Humans
International Cooperation
Practice Guidelines as Topic
Research Design
Residence Characteristics
Sexually Transmitted Diseases - epidemiology
Social Responsibility
Sociology, Medical - ethics
Abstract
We present the ethical challenges and lessons learned over the course of a four-year community-based participatory research (CBPR) project conducted on sexually transmitted infections (STIs) in Greenland. Specifically discussed is Inuulluataarneq-the "Having the Good Life" study. Inuulluataarneq is an interdisciplinary international, collaborative CBPR study involving the University of Toronto in Canada, the Greenlandic Medical Research Council, the Centre for Primary Care in Nuuk, the University of Greenland, local health partners and communities in Greenland, the Statens Serum Institut in Denmark, and Montana State University in the United States. Inuulluataarneq is the first CBPR project implemented in Greenland. Ethical issues discussed are: (1) the complexity of working with multiple institutional review boards on an international health research project using a CBPR framework; (2) unexpected influences on health policy; and (3) the dynamic of balancing community decision making and practices with academic research requirements and expectations. Inuulluataarneq's primary contribution to understanding ethical issues when conducting research in the Arctic involves an acceptance of the time, patience, and dedication of researchers and community partners it takes to discuss, understand, and process differing ethical viewpoints and procedures.
PubMed ID
23651935 View in PubMed
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Literature review: the 'logics' of birth settings in Arctic Greenland.

https://arctichealth.org/en/permalink/ahliterature108462
Source
Midwifery. 2013 Nov;29(11):e79-88
Publication Type
Article
Date
Nov-2013
Author
Ruth Montgomery-Andersen
Vasiliki Douglas
Ina Borup
Author Affiliation
Nordic School of Public Health NHV, Nya varvet byggnad 25, Box 12133, SE-402 42, Gothenburg Sweden; Ilisimatusarfik-University of Greenland, Manutooq 1, P.O. Box 1061, DK-3900 Nuuk, Greenland. Electronic address: juumooq@gmail.com.
Source
Midwifery. 2013 Nov;29(11):e79-88
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Community Networks - organization & administration
Culture
Female
Greenland - epidemiology
Health Policy
Healthcare Disparities
Humans
Infant, Newborn
Inuits - psychology
Parturition - psychology
Perinatal Care - methods
Pregnancy
Residence Characteristics
Abstract
to review literature on the physical place of childbirth in Greenland between 1953 and 2001, using a narrative review theory and a content analysis framework, the paper seeks to describe and analyse the change in perinatal health care structure in Greenland.
findings were discussed within the framework of Daviss' Logics bringing into account scientific, clinical, personal, cultural and intuitive logics as well as economic, legal and political 'logics' concerning perinatal health care policies.
the literature study concerns the place of birth in Greenland, a self-governing constituency of 57,000 people, the world's largest island and with a predominately Inuit population with its own language and culture. Inuit population with its own language and culture.
the place of birth in Greenland has changed and focus has moved from birth as a personal and community act to birth within the private and political arena. New policies and guidelines for pregnancy and childbearing decisions are seldom negotiated with the women, families and their communities.
policy changes have an influence on the social and cultural development of Greenland and it poses a challenge and a counter weight to the political and economic limitations that the government works within. Women and children are vulnerable groups and are directly affected by the changing perinatal health care and policy. It is important that when changing policy, the women and their families are part of the dialogue around change.
PubMed ID
23886547 View in PubMed
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Mycoplasma genitalium presence, resistance and epidemiology in Greenland.

https://arctichealth.org/en/permalink/ahliterature124622
Source
Int J Circumpolar Health. 2012;71:1-8
Publication Type
Article
Date
2012
Author
Dionne C Gesink
Gert Mulvad
Ruth Montgomery-Andersen
Upaluk Poppel
Stephan Montgomery-Andersen
Aka Binzer
Lee Vernich
Gillian Frosst
Flemming Stenz
Elizabeth Rink
Ove Rosing Olsen
Anders Koch
Jørgen Skov Jensen
Author Affiliation
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. dionne.gesink@utoronto.ca
Source
Int J Circumpolar Health. 2012;71:1-8
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Azithromycin - therapeutic use
Chlamydia Infections - epidemiology
Chlamydia trachomatis - isolation & purification
Cross-Sectional Studies
Drug Resistance, Bacterial
Drug Resistance, Microbial
Female
Greenland - epidemiology
Health Surveys
Humans
Male
Middle Aged
Mycoplasma Infections - drug therapy - epidemiology - microbiology
Mycoplasma genitalium - isolation & purification
Prevalence
Sexually Transmitted Diseases - drug therapy - epidemiology - microbiology
Young Adult
Abstract
Greenland reports the highest rates of chlamydial infection and gonorrhea in the Arctic. Our objective was to determine the presence, and describe the basic epidemiology, of Mycoplasma genitalium for Greenland.
Cross-sectional study.
314 residents from Nuuk and Sisimiut, between the ages of 15 and 65 years, participated in "Inuulluataarneq" (the Greenland Sexual Health Project) between July 2008 and November 2009. Participants provided self-collected samples for sexually transmitted infection (STI) testing and completed a sexual health survey. Descriptive statistics and logistic regression were used to summarize the basic characteristics of STI cases overall and M. genitalium and Chlamydia trachomatis specifically. Clinically relevant characteristics in each full model were gender (male or female), age (in years), age at sexual debut (in years), number of sexual partners in the past 3 months (continuous) and history of forced sex and community.
The overall prevalence of STIs was 19.0%, specifically: 9.8% for M. genitalium and 9.4% for C. trachomatis; 100% of M. genitalium-positive cases carried macrolide resistance determinants. Being female [OR = 3.2; 95% confidence interval (CI): 1.1-9.8] and younger age (OR = 0.9; 95% CI: 0.9-1.0) were associated with M. genitalium positivity. Age was also associated with C. trachomatis (OR = 0.9; 95% CI: 0.8-0.9) and STI positivity overall (OR = 0.9; 95% CI: 0.9-0.9).
We observed a high prevalence of M. genitalium and macrolide resistance in this study. A better understanding of M. genitalium sequelae is needed to inform policy around testing, treatment, control and antibiotic use.
Notes
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PubMed ID
22564463 View in PubMed
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The practical application of community-based participatory research in Greenland: initial experiences of the Greenland Sexual Health Study.

https://arctichealth.org/en/permalink/ahliterature147343
Source
Int J Circumpolar Health. 2009 Sep;68(4):405-13
Publication Type
Article
Date
Sep-2009
Author
Elizabeth Rink
Dionne Gesink Law
Ruth Montgomery-Andersen
Gert Mulvad
Anders Koch
Author Affiliation
Department of Health and Human Development, Montana State University, Bozeman, MT 59717-3540, USA. elizabeth.rink@montana.edu
Source
Int J Circumpolar Health. 2009 Sep;68(4):405-13
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Community-Institutional Relations
Consumer Participation
Female
Greenland - epidemiology
Humans
Male
Middle Aged
Prevalence
Sexually Transmitted Diseases - epidemiology - prevention & control
Young Adult
Abstract
Increasingly, community-based participatory research (CBPR), with its emphasis on engaging communities as full and equal partners in all phases of the research process is being promoted to address the health needs of peoples living in the North American Arctic. However, the CBPR approach is not without its challenges in Arctic countries such as Greenland, where research capacity, different languages, distance, time and cost become barriers to remaining true to the purest form of CBPR. In this paper, we describe the practical application of CBPR principles and methodologies to a sexual health project investigating sexually transmitted infections in Greenland. We present the initial challenges encountered in the early stages of the pilot CBPR sexual health study, and solutions to these challenges. We also provide recommendations for expanding the capacity in Greenland to conduct CBPR projects.
PubMed ID
19917192 View in PubMed
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Vaginal microbiome in women from Greenland assessed by microscopy and quantitative PCR.

https://arctichealth.org/en/permalink/ahliterature259138
Source
BMC Infect Dis. 2013;13:480
Publication Type
Article
Date
2013
Author
Raluca Datcu
Dionne Gesink
Gert Mulvad
Ruth Montgomery-Andersen
Elisabeth Rink
Anders Koch
Peter Ahrens
Jørgen Skov Jensen
Source
BMC Infect Dis. 2013;13:480
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Bacteria - genetics - isolation & purification
Female
Greenland - epidemiology
Humans
Microbiota
Microscopy
Middle Aged
Polymerase Chain Reaction
Pregnancy
ROC Curve
Trichomonas vaginalis - genetics - isolation & purification
Vagina - microbiology
Vaginosis, Bacterial - epidemiology - microbiology
Young Adult
Abstract
Bacterial vaginosis (BV) is a common condition, although its aetiology remains unexplained. The aim of this study was to analyse the composition of vaginal microbiota in women from Greenland to provide a quantitative description and improve the understanding of BV.
Self-collected vaginal smears and swabs were obtained from 177 women. The vaginal smears were graded for BV according to Nugent's criteria. The vaginal swab samples were analysed by 19 quantitative PCRs (qPCRs) for selected vaginal bacteria and by PCR for four sexually transmitted infections (STIs).
STIs were common: Mycoplasma genitalium 12%, Chlamydia trachomatis 7%, Neisseria gonorrhoeae 1%, and Trichomonas vaginalis 0.5%. BV was found in 45% of women, but was not associated with individual STIs. Seven of the 19 vaginal bacteria (Atopobium vaginae, Prevotella spp., Gardnerella vaginalis, BVAB2, Eggerthella-like bacterium, Leptotrichia amnionii, and Megasphaera type 1) had areas under the receiver operating characteristic (ROC) curve > 85%, suggesting they are good predictors of BV according to Nugent. Prevotella spp. had the highest odds ratio for BV (OR 437; 95% CI 82-2779) in univariate analysis considering only specimens with a bacterial load above the threshold determined by ROC curve analysis as positive, as well as the highest adjusted odds ratio in multivariate logistic regression analysis (OR 4.4; 95% CI 1.4-13.5). BV could be subdivided into clusters dominated by a single or a few species together.
BV by Nugent score was highly prevalent. Two of seven key species (Prevotella spp. and A. vaginae) remained significantly associated with BV in a multivariate model after adjusting for other bacterial species. G. vaginalis and Prevotella spp. defined the majority of BV clusters.
Notes
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PubMed ID
24131550 View in PubMed
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