Reflections on a journey, doing unfinished business, and homage to Balfour Mount

As a medical student at McGill in 1972, I was honored to meet Dr. Balfour Mount. He made it possible for me to accompany him to St. Christopher’s Hospice. We were 8 students from all over the world. Dr. Cicely Saunders felt the best way to learn to be with dying patients was to work as a nurse. So, in that summer of my third year of medical school, I did. My career has gone on, first at Mc Gill and since 1987 at UC San Diego. I have been privileged to teach generations of students and faculty a humanistic empowering model of healthcare, seeing the patient as teacher. Our role is to create environments where people take charge of their lives and achieve wellbeing. My first teacher in doing unfinished business was my father. I was 17. He was 72. He had a MI, called me and my mother into the CCU and said, “The last 25 years with you and Ellen have been the best years of my life. If I should die, I want to say thank you and goodbye.” Then he lived for 20 years and we got to know each other. Present at these moments in people’s lives, we can facilitate unfinished business, whether a mother with cancer, who wrote letters for the next 20 years of her daughter’s life, knowing she wouldn’t be there, a Somali family saying goodbye in the ICU to a loved one or my Dad, opening doors to the future.

Factors Associated with COVID-19 Testing among People who Inject Drugs: Missed Opportunities for Reaching those Most at Risk

People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services or venues representing potential opportunities (i.e., "touchpoints") where COVID-19 testing could have been offered. Between October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression was used to identify factors associated with COVID-19 testing prior to enrollment. Of 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive in our study (30.1%), 50.3% encountered at least one touchpoint within the prior six months where COVID-19 testing could have been offered. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego (versus Tijuana), having recently been incarcerated or attending substance use disorder (SUD) treatment and having at least one chronic health condition. In addition, recent homelessness, having had at least one COVID-19 vaccine dose and having been tested for HIV or HCV since the pandemic began were independently associated with COVID-19 testing. We identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.

Equitable COVID-19 Vaccination for Hispanics in the United States: A Success Story from California Border Communities

The ongoing 2019 novel coronavirus disease (COVID-19) pandemic continues to impact the health of individuals worldwide, including causing pauses in lifesaving cancer screening and prevention measures. From time to time, elective medical procedures, such as those used for cancer screening and early detection, were deferred due to concerns regarding the spread of the infection. The short- and long-term consequences of these temporary measures are concerning, particularly for medically underserved populations, who already experience inequities and disparities related to timely cancer care. Clearly, the way out of this pandemic is by increasing COVID-19 vaccination rates and doing so in an equitable manner so that communities most affected receive preferential access and administration. In this article, we provide a perspective on vaccine equity by featuring the experience of the California Hispanic community, who has been disproportionately impacted by the pandemic. We first compared vaccination rates in two United States–Mexico border counties in California (San Diego County and Imperial County) to counties elsewhere in California with a similar Hispanic population size. We show that the border counties have substantially lower unvaccinated proportions of Hispanics compared to other counties. We next looked at county vaccination rates according to the California Healthy Places Index, a health equity metric and found that San Diego and Imperial counties achieved more equitable access and distribution than the rest of the state. Finally, we detail strategies implemented to achieve high and equitable vaccination in this border region, including Imperial County, an agricultural region that was California’s epicenter of the COVID-19 crisis at the height of the pandemic. These United States–Mexico border county data show that equitable vaccine access and delivery is possible. Multiple strategies can be used to guide the delivery and access to other public health and cancer preventive services.

Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012–2019

Objectives. To determine the effect of heat waves on emergency department (ED) visits for individuals experiencing homelessness and explore vulnerability factors. Methods. We used a unique highly detailed data set on sociodemographics of ED visits in San Diego, California, 2012 to 2019. We applied a time-stratified case–crossover design to study the association between various heat wave definitions and ED visits. We compared associations with a similar population not experiencing homelessness using coarsened exact matching. Results. Of the 24 688 individuals identified as experiencing homelessness who visited an ED, most were younger than 65 years (94%) and of non-Hispanic ethnicity (84%), and 14% indicated the need for a psychiatric consultation. Results indicated a positive association, with the strongest risk of ED visits during daytime (e.g., 99th percentile, 2 days) heat waves (odds ratio = 1.29; 95% confidence interval = 1.02, 1.64). Patients experiencing homelessness who were younger or elderly and who required a psychiatric consultation were particularly vulnerable to heat waves. Odds of ED visits were higher for individuals experiencing homelessness after matching to nonhomeless individuals based on age, gender, and race/ethnicity. Conclusions. It is important to prioritize individuals experiencing homelessness in heat action plans and consider vulnerability factors to reduce their burden. (Am J Public Health. 2022;112(1):98–106. https://doi.org/10.2105/AJPH.2021.306557 )

Virgin Territories

In this wide-ranging conversation, David Serlin (University of California, San Diego) and Roland Betancourt (University of California, Irvine) discuss questions of sexual consent and sexual violence in the visual culture of early Christian art as inspired by Betancourt’s recent book, Byzantine Intersectionality: Sexuality, Gender, and Race in the Middle Ages (2020). Drawing on rare manuscripts and other objects of worship from institutional archives, Betancourt analyzes and contextualizes numerous Byzantine visual texts featuring often confounding representations of sexual acts or gendered behavior that later Christian interpreters would treat as conventional or settled. For Betancourt, early Christian authors and artists were far more open to troubling and experimenting with depictions of sexual and gendered narratives than many medievalists (and, importantly, non-medievalists) have been trained to see.