ABSTRACT
This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities.
Subject(s)
Health Equity , Health Impact Assessment/methods , Health Policy , Transients and Migrants , Capacity Building , Humans , OntarioABSTRACT
Introducción: La obesidad y el índice de masa corporal (IMC) actúan como factores de riesgo para diversas neoplasias, sin una clara relación con el cáncer gástrico no cardial. La cirugía bariátrica es el manejo más efectivo contra la obesidad. La incidencia de cáncer gástrico posterior a la gastrectomía vertical es aún incierta. El primer caso de cáncer gástrico, 4 años posterior a una gastrectomía vertical, se publicó en 2014, y hasta la fecha se han descrito 11 casos en la literatura. Caso Clínico: Masculino de 52 años, con antecedente de gastrectomía vertical, presenta cuadro clínico, endoscópico e histopatológico compatible con adenocarcinoma de cuerpo gástrico 5 años posterior a cirugía bariátrica. Recibe tratamiento neoadyuvante con quimioterapia esquema FLOT 6 ciclos, luego gastrectomía total oncológica laparoscópica con disección ganglionar D2 y adyuvancia con esquema FOLFOX 6 ciclos. Estudio histopatológico resulta adenocarcinoma pobremente diferenciado con 90% de regresión tumoral, sin metástasis ganglionar en lo extraído (pT1bN0M0). Seguimiento por 6 meses sin signos clínicos e imagenológicos de recidiva tumoral. Discusión: Existiría una relación directa entre el IMC y cáncer de unión gastroesofágica, la que no ha sido demostrada para cáncer gástrico no cardial. El estudio con endoscopía digestiva alta previo a cirugía bariátrica no está estandarizado, sin embargo, es recomendable realizarlo. La cirugía bariátrica podría disminuir el riesgo de ciertas neoplasias, mientras que la incidencia de cáncer gástrico posterior a dicha cirugía aún no está bien definida. Es recomendable realizar seguimiento endoscópico a los pacientes posoperados de gastrectomía vertical, más aún en sintomáticos.
Introduction: Obesity and body mass index (BMI) are risk factors for different types of cancer, yet there is no clear association to non-cardia gastric cancer. Bariatric surgery is the most effective treatment for obesity. Incidence of gastric cancer after bariatric surgery remains unclear. The first case report of gastric cancer 4 years following a vertical sleeve gastrectomy was reported in 2014 and up until now, only 11 cases have been reported. Case report: 52-year-old man, who had undergone a sleeve gastrectomy 5 years ago, presented clinical, endoscopic, and histological features, compatible with a gastric body adenocarcinoma. He received neoadjuvant chemotherapy of 6 cycles of FLOT, an oncological laparoscopic total gastrectomy with D2 lymph node dissection and adjuvant chemotherapy with 6 cycles of FOLFOX. Biopsy reported a poorly differentiated adenocarcinoma with a 90% of tumor regression, with no signs of ganglion metastases (pT1bN0M0). 6-month follow-up showed no clinical or imaging signs of relapse. Discussion: There is a direct association between higher BMI and gastroesophageal junction cancer, but no clear evidence of this association with non-cardia gastric cancer. The preoperative evaluation with an upper endoscopy before bariatric surgery is not standardized, yet it is possible to recommend it. Bariatric surgery could lower the risk of certain cancers, yet the incidence of gastric cancer after this procedure is not yet defined. Endoscopic follow-up is recommended to all postoperative patients, especially if they become symptomatic.