Island Health

<title>Abstract</title> <bold>Background</bold> People who use substances (PWUS) experience disproportionately higher burden of sexually transmitted and bloodborne infections (STBBIs) compared to the general population. Harm reduction supply distribution sites are recognized as potential access points for STBBI testing among PWUS. However, little is known about the uptake of STBBI testing among PWUS who access these sites. This study aimed to identify factors associated with recent STBBI testing among PWUS accessing harm reduction sites. <bold>Methods</bold> We analyzed cross-sectional data from the 2023 Harm Reduction Client Survey in British Columbia, Canada, which included 433 respondents across 23 sites. Sociodemographic, substance use, and harm reduction-related factors associated with recent testing (previous 12 months) for HIV, hepatitis C virus (HCV), or syphilis were examined. Adjusted risk ratios (aRRs) and corresponding 95% confidence intervals (CIs) were estimated using Poisson regression with robust standard errors. Analysis and interpretation were guided by people with lived or living experience of substance use and/or STBBIs. <bold>Results</bold> Over one-third of respondents (38%) had not been tested for an STBBI in the previous 12 months. Those participating in smaller communities (aRR = 0.7; 95% CI: 0.48, 1.03), from health regions outside Vancouver Coastal (Fraser Health aRR = 0.66; 95% CI: 0.43–1.02), and women (aRR = 0.85; 95% CI = 0.64, 1.12) were less likely to have been recently tested. Participants prescribed alternatives to the toxic drug supply (aRR = 1.21; 95% CI: 0.93, 1.59) were more likely to report recent testing. Among those who reported a previous STBBI test, either within the previous 12 months or earlier (n = 281), HIV testing was the most common (93%), followed by syphilis (88%) and HCV (83%). Nearly one-quarter (23%) of respondents did not know their test results. The majority of respondents (73%) expressed interest in accessing STBBI self-testing kits through harm reduction sites. <bold>Conclusions</bold> Many PWUS accessing harm reduction sites reported no recent STBBI testing, particularly women and those outside large urban centres. Distributing self-testing kits through these sites could potentially help reduce the disproportionate burden of STBBIs among PWUS and contribute to progress toward eliminating STBBIs as a public health threat. <bold>Clinical trial number:</bold> Not applicable.

In their lifetime, every person will experience the loss of someone they care about. In Canada, the COVID-19 pandemic, the ongoing opioid crisis, and the discovery of unmarked graves at residential schools have brought this into particular focus. Research and theory in the area of grief have evolved over the years. Grief literacy challenges us to better understand and support grief in all aspects of our society. The Public Health Model of Bereavement Support was theorized and tested in Australia. The supports people seek are explored and the model identifies low, medium, and high categories of risk of prolonged grief disorder. The purpose of this study is to advance public health understanding of grief and its support. The specific research objectives are to (1) test the Public Health Model of Bereavement Support in the Canadian context and (2) build a grounded theory of grief support. This project uses a sequential mixed methods design. A Canada-wide survey in English and French will produce data that will be used to empirically test the Public Health Model of Bereavement Support. In the second phase, the grounded theory of grief support centers on voices that have not been widely heard in grief research. The mixed methods then fully elucidate grief and grief support in Canada. This is the first study internationally to test this model in a (post)pandemic context, in a jurisdiction that legally permits medical assistance in dying, and in a context with an opioid crisis. The findings will allow us to better understand grief and the current realities of grieving, which has the potential to enhance the wellbeing of the millions of Canadians who are grieving.

Abstract A 3‐year‐old, neutered, male golden retriever was referred for evaluation of the right eye, which was exhibiting marked anterior uveitis and a long, thin, white strand of foreign material within the anterior chamber. Despite a lack of obvious trauma, the dog had been running through an area covered with foxtail 3 months prior. Surgical exploration revealed a one‐inch‐long plant foreign body embedded in the dorsal iris. Postoperative management involved topical and oral medications, leading to resolution of clinical signs and successful healing with mild corneal fibrosis. This case underscores the importance of prompt diagnosis and surgical intervention in ocular foreign body cases, necessitating further research to better understand migration patterns and sequelae of grass awns in the eye.

Spasticity affects up to 80% of individuals with cerebral palsy and can lead to pain and difficulties with performing activities of daily living. If left untreated, spasticity can progress to contracture and neuro-orthopedic deformities. Cryoneurolysis is an emerging and mini-invasive ultrasound-guided technique that causes secondary axonotmesis of peripheral nerves through the formation of an ice ball and may result in months to years of improved range of motion and reduced pain in patients with spasticity. However, the safety of cryoneurolysis has not yet been established in patients with an increased bleeding risk secondary to Hemophilia A. We present a case of cryoneurolysis for cerebral palsy-related spasticity in a 14-year-old male with hemophilia A who previously had minimal benefit from botulinum toxin for increased elbow and wrist flexor tone with contracture. Fifteen minutes prior to cryoneurolysis, an IV infusion of 2000 IU of recombinant antihemophilic factor (FVIII) was administered for bleeding prophylaxis. Targets were identified with ultrasound guidance and nerve stimulation and cryoneurolysis was performed without bleeding complications or adverse events. There was an immediate improvement in tone and range of motion that was maintained at 3- and 8-month follow-ups with reported increased left arm function. This case suggests that cryoneurolysis is an effective mini-invasive procedure for spasticity that improves tone and range of motion and is safe for use in patients with Hemophilia A who receive adequate Factor VIII prophylaxis.

ObjectivesThere are health disparities and inequities in the outcomes of critical illness survivors related to the influence of social determinants of health on recovery. The purpose of this study was to describe the relationship between critical illness recovery and the intermediary social determinants of health in the Canadian context. Because Canadian healthcare is provided within a universal publicly funded system, this analysis sheds light on the role of social determinants of health in the context of universal health services and a relatively robust social safety net.DesignIn this qualitative interpretive description study, data from semi-structured interviews with intensive care unit survivors, family caregivers and healthcare providers were analysed using thematic and constant comparative methods.SettingWestern Canadian Hospital serving a population of 900 000 people.ParticipantsThe 74 study participants included 30 patients (mean age 58 years, 18 men and 12 women) and 25 family caregivers (mean age 55 years, 8 men and 17 women), representing 37 cases, as well as 19 healthcare providers.ResultsChallenges with employment and finances, home set-up, transportation, food and nutrition, medications and social support complicated and hindered critical illness recovery. Critical illness sequelae also altered these social determinants of health, suggesting a reciprocal relationship. Furthermore, individuals experiencing socioeconomic disadvantage before critical illness described being at a greater disadvantage following their critical illness, which interfered with their recovery and suggests an accumulation of risk for some.ConclusionsOur findings underscore the significant influence of social determinants of health on critical illness recovery, highlighting the importance of creating and evaluating comprehensive approaches to health and well-being that address health inequities.