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Climate change brings about novel types of public health emergencies. Unforeseen challenges put additional pressure on health systems and require innovative approaches to address emerging needs. The health of Indigenous Peoples is particularly impacted by the changing climate, because of their close connection to the land. For instance, the physical, emotional, mental, and spiritual well-being of coastal First Nations in British Columbia (BC), Canada, is interconnected with the abundance of healthy marine food sources that form the base of local traditional diets. The 2018 discovery of Vibrio cholerae illness in those who had eaten contaminated herring eggs not only had a clinical health impact but also created concerns for the safety of local food systems. The limited magnitude of the outbreak demonstrates the critical importance of collaborative partnerships between coastal First Nations communities in BC and health authorities working together in outbreak investigations. Yet, the lack of procedures that address cultural and institutional differences led to unnecessary discrepancies in the approach. This paper introduces the public health intervention used during the first ever Vibrio cholerae outbreak in coastal BC. The intervention has the potential to inform best practices when developing emergency response protocols potentially affecting Indigenous people and traditional foods. In this qualitative case study of the formal institutional documents and narratives of the key partners involved in the response, we assess the intervention, highlight the challenges and enablers, share lessons learned, and identify knowledge requirements to improve confidence in the traditional food system and support early warning systems.

OBJECTIVES: Very few studies in Canada address the sexual health of young Aboriginal people who use drugs; the focus in established literature has been on parenteral risks. This study sought to identify the risk factors associated with inconsistent condom use in a cohort of young Aboriginal people who live in British Columbia and use drugs. METHODS: This analysis includes baseline questionnaire data from October 2003 to April 2005. Multivariable modeling stratified by gender identified independent demographic, traumatic, sex and drug use risk factors associated with inconsistent condom use. RESULTS: Of the 292 women and 313 men at baseline, prevalence of inconsistent condom use during insertive sex was 59% and 46%, respectively. In multivariable logistic regression, after adjusting for age and location, inconsistent condom use among women was significantly associated with ever being enrolled in a drug/alcohol treatment program (AOR: 1.95, 95% CI: 1.06-3.60), and ever being sexually abused (AOR: 1.80, 95% CI: 1.01-3.20). Among men, inconsistent condom use was significantly associated with having more than 20 lifetime sex partners (AOR: 2.06, 95% CI: 1.24-3.44). CONCLUSION: Our study demonstrates high rates of inconsistent condom use among young Aboriginal people who use drugs, highlighting their vulnerability to contracting sexually transmitted infections. Culturally tailored sexual health interventions must be made a priority and need to incorporate the reality of gendered differences in the context of multigenerational trauma, including non-consensual sex.

Family physicians commonly use bupropion for treatment of tobacco abuse. Here we present a case of acute psychosis after treatment with bupropion. It represents the first case of bupropion-induced psychosis at a low dose in an otherwise healthy patient. Case A 28-year-old woman presented with a chief complaint of tobacco abuse and a desire to quit. Her medical history was remarkable for one previous anxiety attack, which was self-limited and required no medical intervention, and occasional gastrointestinal spasms treated with hyoscyamine. The patient’s surgical history was unremarkable; so was her family history, which was negative for psychiatric diagnoses. The patient’s social histories revealed a 3 pack per year smoking history, minimal alcohol use, and no elicit drug use. Given her desire to quit smoking, the patient was started on bupropion (Wellbutrin SR, GlaxoSmithKline, Brentford, United Kingdom) 100 mg daily for 1 week, with goal titration to 150 mg twice daily by the end of week 2. Risk and benefits were discussed and the patient was told to call with any concerns. Seven days into treatment the patient called stating she could not leave her home for fear that someone was going to hurt her and her children. In addition to the paranoia, the patient developed panic attacks, suicidal ideation, and auditory hallucinations suggesting she should hurt herself. Despite the abnormal psychiatric symptoms, orientation and memory were preserved. The patient refused to come to be evaluated and insisted that she would not hurt herself despite the new ideation, commenting that what she was experiencing was “silly” and “not real.” When buproprion was discontinued, all symptoms resolved over the course of 1 week. At a 2-month follow-up she displayed no residual symptoms.