Background: There is increasing literature examining the effect of pesticides on people in proximity to pesticide use. However, limited information exists on how bystanders perceive the risk of pesticides to their health. This study aims to explore how school workers perceive the exposure to pesticides in a region where agriculture is the dominant economic driving force, and how these perceptions vary by sociodemographic subgroup. Methods: A total of 143 school workers from five districts in the San Carlos region of Costa Rica responded to the Technical Prevention Notes (NTP-578) perceived risk survey. The Mann-Whitney U test along with a Bonferroni control determined the statistical significance between subgroups. The four main sections for analysis of the results were prior knowledge on pesticide-related risks, perception of control over pesticide exposure, perception of current health risk and general knowledge of pesticide exposure. Results: Statistically significant differences in perceptions were seen by location, sex, age, level of education and position. Males and teachers exhibited higher levels of prior knowledge of hazards, whereas the older population, people without a university degree and administrators had higher perception of control over exposure to pesticides. Conclusion: School workers are knowledgeable on exposure to workplace pesticides and are aware of the severity of risk associated with pesticide exposure. In line with results from other studies, the older population and university educated people had higher perceived control over mitigating affects of pesticides. Our findings suggest that school workers could play a vital role in increasing knowledge dissemination pathways on pesticide-related harms. Further research could help in transforming school workers and bystanders into stakeholders and advocates for buffer zones.
Medical procedures, like IV insertions and pin removals, may cause pain and anxiety in children. While preventable, high rates of procedural pain persist in hospitals. The use of distraction, such as virtual reality (VR), offers a non-pharmacological approach for pain and anxiety management during medical procedures. More specifically, VR is an immersive technology that brings the user into a three-dimensional world that looks and feels real. The illustration depicts how VR works to decrease pain perception through the analogy of a tug-of-war between pain signaling and VR. During a medical procedure, a child``'s attention may be focused on the IV poke, increasing pain perception. However, if the child is immersed in a VR game during their medical procedure, the VR pulls the brain's attention away from the IV poke towards an imaginary and pleasant world. As VR is immersive and interactive, it consumes more attention than pain, thereby decreasing pain perception, and winning the tugr-of-war. Despite the evidence for VR, there is a 20-year gap in the implementation of VR across child healthcare settings. Our team is currently investigating the barriers, facilitators, and contextual challenges for VR use in child healthcare, and in parallel developing tools to disseminate research evidence and facilitate intergation of VR into the standard of care. This illustration serves as reminder of how VR is thought to help with pain management. To learn more about VR, visit: https://www.mcgill.ca/virtualrealityforchildcare/
Dysphagia, a condition marked by difficulty in swallowing, demands a comprehensive approach for effective management. It delves into the collaborative care essential for its successful treatment. Drawing upon the expertise of a multidisciplinary team—comprising speech-language therapists, nurses, physicians, occupational therapists, and physical therapists—this collective effort aims at an all-encompassing evaluation and tailored interventions for individuals grappling with swallowing disorders. Effective communication and mutual respect among team members form the cornerstone, shaping a holistic management strategy to address the challenges posed by dysphagia.
Over the course of the pandemic, Indigenous peoples in Canada experienced firsthand the devastating impact of COVID-19. Despite facing challenges, Indigenous communities, with the support of government organizations, were able to limit the spread of the SARS-CoV-2. Forming collaborative initiatives and integrating Indigenous medicinal practices with public health approaches shows promise in our ability to create effective and culturally-informed healthcare policies.
Background: Touchscreens have become ubiquitous in our daily lives, offering a comfortable and natural human-technology interactive experience. There exists a gap in the literature regarding the usability and efficiency of a touchscreen workstation on wheels (WOW) within an emergency department (ED) workflow, specifically with electronic medical record (EMR) systems designed for keyboard and mouse. Methods: This was a randomized, controlled, 2-intervention-2-period crossover study comparing a touchscreen to a non-touchscreen WOW. Participants were asked to complete a series of seven tasks that are typically done in the ED followed by the completion of a post-study questionnaire. Results: A total of 24 people (12 attendings, 12 resident physicians) participated in the study. Results from the linear mixed model regression analyses showed no evidence to reject the hypothesis that the average time to complete each task and the average total time to complete all tasks combined were similar (p>0.05) between the touchscreen and non-touchscreen WOW. Results from the post-study questionnaire using a 7-point Likert scale (Figure 1) demonstrated that the majority (>50%) of participants agreed to most questions favoring intention to use (BU), ease of use (PEOU), perceived usefulness (PU), and attitude towards utilization (AU) of the touchscreen WOW. Conclusion: This study builds on previous work on touchscreen devices by specifically evaluating the usability and efficiency of touchscreen WOWs in a controlled, simulation-based setting, differentiating from prior studies on tablets at the bedside. Future studies, should evaluate the impact of touchscreen-friendly EMR designs on clinical workflows in the ED.
Information management is a key part of conducting a systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses clearly summarizes essential steps during the meta-analytic project and their reporting. Preparing for data extraction is generally suggested to be done at the stage of the protocol. However, in complex projects that aim to synthesize data from studies performed over a long time period or with a wide variability in study protocols, it is often impossible to fully account for all variations in data presentation before completing the full text screening. Here, we describe a protocol to methodically consider different aspects of the selected studies in order to update the data extraction template for the meta-analytic portion of the project. The protocol incorporates a process of identifying and removing non-compatible studies prior to the extraction of study-level outcomes, which is important for avoiding a potential confirmation bias. Using this protocol in combination with a pre-established data coding scheme simplifies data extraction and informs the subsequent meta-analysis.
Syncope, the transient and abrupt loss of consciousness with spontaneous recovery, is estimated to make up 1% of all emergency department presentations in Canada. (1) Syncopal cases are enigmatic as patients frequently present themselves as fully recovered from the episode, even though its etiology can still be present and life-threatening. It is up to the clinician to conduct a strong history, physical exam and the appropriate follow-up investigations to confirm a diagnosis. This Approach To article aims to provide an overview and step-wise approach to diagnosing and managing a syncopal presentation.
McGill Journal of Medicine (MJM) Podcast Series, MJM MedTalks, interviews members of the medical and health sciences community from McGill, and beyond to gain insights into their careers, research, advocacy, and more. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical science. In this episode, Vanessa Ross, MJM podcast team member and fourth-year medical student at McGill University, interviews guest-expert and trauma surgeon Dr. Evan Wong, Assistant Professor of Surgery and Lead for Trauma and General Surgery Services in Nunavik. This conversation covers Dr. Wong’s experience working for communities in Northern Quebec, the role of research, collaboration, and community involvement, as well as some advice for trainees. The show notes include a glossary of terms, links to publications referenced in the episode, and a full transcript of our conversation.
Welcome to the McGill Journal of Medicine (MJM) LMCC review. This podcast series was created to aid medical students studying for the Canadian Medical Council’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into 2 parts. In part one we provide an overview of the topic with the help of experts in the field, followed by Part 2 where we review LMCC styled questions to help consolidate knowledge. In this episode of “Approach to Chest Pain” Dr Esther Kang, resident in Anesthesiology at McGill University and MJM Podcast Team co-lead had the opportunity to chat with our expert advisors, Dr. Jesse Li, a family and emergency physician practicing in Richmond Hill and Lakeridge Ontario, and Dr. Gordon Yao a family physician in Richmond Hill with extended practice in long term care, coroner duties and clinical tutorship at Queens University. Objective 14 : Chest Pain. This episode was written by Esther SH Kang, edited by Jesse Li, Gordon Yao, and the MJM Podcast Team Please see our website www.mjmmed.com for more information, including a link to show notes.
Welcome to McGill Journal of Medicine (MJM)’s Let’s Talk LMCC. This podcast series was designed to support medical students preparing for the Canadian Medical Council (MCC)’s licensing exam. Each episode aligns with specific LMCC objectives and is structured into two parts. Part one features an expert-led overview of the topic, followed by part two where we discuss LMCC-styled questions to reinforce learning. In this episode, we are joined by our expert advisor, Dr. Susan Wang, a second year Internal Medicine resident, to delve into LMCC Objective 99-2: Hyponatremia. This episode was written by Zachary Rehany and Dr. Weixiang Yan and edited by Dr. Susan Wang and Dr. Esther Kang.
Palpable breast masses are common reasons for presenting to the primary care or emergency clinic setting. Although most palpable masses are benign in etiology, the possibility of malignancy exists and may be anxiety-inducing to patients. A systematic approach to history-taking, to clinical breast examination and to imaging is important for the adequate evaluation of a palpable breast mass. This article aims to provide medical students with a stepwise approach to the evaluation and diagnosis of palpable breast masses. Given the wide spectrum of diseases associated with palpable masses, the differential diagnosis and management is out of the scope of this paper. However, we will touch upon the breast cancers most commonly associated with breast masses and briefly mention their respective treatments.
Introduction: Naltrexone is an opioid receptor antagonist prescribed for alcohol use disorder and opioid use disorder. Naltrexone has a high affinity for the mu-opioid receptors, which are the primary binding site of beta-endorphin. Beta-endorphin is an endogenous opioid that functions as the mediator of behavioral reward and reinforcement. Antagonism of the mu-opioid receptors with naltrexone improves certain outcomes in patients with substance use disorder but may alter the positive endogenous reinforcement associated with naturally rewarding and healthy activities including exercising, socializing, and eating. Discussion: In this paper, we review medical literature exploring the potential negative effects of chronic naltrexone therapy on healthy lifestyle modification. Conclusion: Although the data is preliminary, there exists a possibility that naltrexone therapy may adversely impact the endogenous reward system associated with health promoting activities. Relevance: Mortality amongst subjects with substance use disorder has increased to epidemic proportions since fentanyl became widely available. Until relatively recently, behavior modification and Twelve Step programs have been the cornerstones of recovery from substance use disorder. Previous reports have confirmed that exercise, positive social networking, and proper nutrition are important adjunctive therapies in early recovery. The possibility exists that the naturally occurring endorphin mediated reward of these activities may be adversely impacted by naltrexone therapy. Further investigation is warranted to determine whether long-term naltrexone therapy is associated with decreased healthy behaviors and if dose modifications such as low dose or an intermittent dosing scheduling could attenuate this possible unintended consequence of therapy.
McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the medical and health science communities are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical sciences. In a two-part episode, Samy Amghar, MJM Podcast Team member and second-year medical student at McGill University interviews guest-expert and global ophthalmologist Dr. Nathan Congdon. The first episode covers Dr. Congdon’s career, his experience practicing ophthalmology in low- and middle-income countries, and the importance of multidisciplinary teams in global health. The second episode focuses on some of Dr. Congdon’s research projects, including the ENGINE trials, discusses the future of global ophthalmology, and offers advice for trainees interested in ophthalmology and global health. The show notes include a glossary of terms, links to publications referenced in the episode, and a full transcript of our conversation.
McGill Journal of Medicine (MJM) MedTalks is a podcast series where members of the medical and health science communities from McGill and beyond are interviewed on topics related to career, research, advocacy, and more. The aim of MedTalks is to create a space where experienced professionals and researchers share information and advice for trainees in healthcare and medical sciences. In this episode, McGill medical student and MJM Podcast member Vanessa Ross, alongside McGill MSc graduate Khiran Arumugam interview Larry Funnell, a dedicated advocate for osteoporosis awareness and patient engagement. Larry shares his personal journey from his unexpected diagnosis of osteoporosis to becoming a leading patient partner in research and advocacy, particularly for men with osteoporosis. This discussion explores the value of patient engagement, strategies for involving men in osteoporosis initiatives, Larry’s contributions to the 2023 Osteoporosis Canada guidelines, and his advice for trainees in healthcare. The show notes include a glossary of terms, links to resources discussed in the episode, and a full transcript of the conversation.
Question A 75-year-old male presents to the ophthalmology service with a drooping left upper eyelid. Upon further questioning, he states that he feels his visual acuity has deteriorated in the left eye, but only in the dark. On testing his best corrected visual acuity is 20/25 in the right eye and 20/30 in the left eye. His pupils are equal, round, and reactive to light and accommodation. His intraocular pressures are 14mmHg bilaterally. His past medical history is significant for type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obesity. He states that his dropping eyelid does not get better or worse during the day and he first noticed his drooping eyelid this morning. He also states that he has been experiencing some horizontal diplopia since this morning. Your clinical examination reveals no significant ocular misalignment, but the patient is unable to fully adduct, infraduct, or supraduct his left eye. His margin to reflex distance 1 is 2mm and his levator function is markedly decreased. His ESR and CRP are within normal limits. He is scheduled for a follow-up visit in 6 weeks at which point his symptoms have almost completely resolved. Third Nerve palsy Myasthenia gravis Congenital ptosis Horner syndrome Aponeurotic ptosis Answer • A) Given his history and clinical examination, this patient likely has a third cranial nerve palsy. Furthermore, given no pupillary involvement and systemic risk factors (obesity, diabetes mellitus, hypertension, hypercholesterolemia), an ischemic third nerve palsy is favoured. Typically, ischemic third nerve palsies are self-resolving and the patient can be scheduled for follow-up in 4-6 weeks. Pupil involvement or a lack of improvement at follow-up are indications for head imaging (CT angiography) to rule out an aneurysm or other compressive causes. In this case, since the ptosis does not worsen as the day goes on and improve after rest, myasthenia gravis is unlikely. Additionally, this autoimmune condition would present at an earlier age than 75. Similarly, congenital ptosis would present in the first years of life. Horner syndrome would include miosis and facial anhidrosis alongside the ptosis. Aponeurotic ptosis is a possible diagnosis, however, is less likely given this presentation with an inability to fully adduct, infraduct, or supraduct his left eye.
The McGill Journal of Medicine (MJM) Podcast Series, MJM MedTalks, interviews members of the medical and health sciences community from McGill, and beyond to gain insights into their careers, research, advocacy, and more. This series aims to enhance knowledge sharing between experts and trainees in the medical field. In this episode, Renée-Claude Bider, a Master’s student in medical physics and Podcast Associate at the McGill Journal of Medicine, interviews Prof. Annmarie Adams, who is jointly appointed in McGill University's School of Architecture and the Department of Social Studies of Medicine. Dr. Annmarie Adams trained as an architect and architectural historian at UC Berkeley. Her research focuses on how medicine, gender, and architecture intersect. In the first part of their conversation, Bider and Prof. Adams discuss the history of hospital architecture, starting in the late 1800s and focusing on Montreal and Canadian institutions, including the Royal Victoria Hospital, Montreal Neurological Institute, Montreal General Hospital, The McGill University Health Centre (Montreal, Canada), Sick Kids (Toronto, Canada) and McMaster Children’s Hospital (Hamilton, Canada). In the second part of their conversation, Bider and Prof. Adams discuss the architecture of specialized healthcare spaces, such as long-term care homes, birthing suites, palliative care, and cancer centers. They end their conversation by discussing Prof. Adams' ongoing research into the life of influential physician Maude Abbott and advice for trainees in the medical field. A glossary of terms, a content overview, a list of relevant links and research articles, supplementary images from Prof. Adams’ collection, and a transcript of the interview are included in the show notes for this episode.
Welcome to the McGill Journal of Medicine (MJM) LMCC review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into 2 parts. In part one we provide an overview of the topic with the help of experts in the field, followed by Part 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Tricia Peters, Endocrinologist and Associate Professor in the Faculty of Medicine and Health Sciences at McGill University to complete our series on LMCC Objective 37-2: Diabetes Mellitus by speaking about antihyperglycemic agents. This episode was written by Susan Wang, Meryem Talbo and Dr. Tricia Peters, with feedback from the entire MJM Podcast Team.
McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the medical and health science communities from McGill and beyond are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical sciences. In this episode, Susan Wang, MJM Podcast Team Co-Lead and first year Internal Medicine Resident at McGill University interviews guest-experts and endocrinologists Dr. Michael Tsoukas, Assistant Professor in the Department of Medicine at McGill University, and Dr. Vanessa Tardio, Assistant Professor in the Department of Medicine and Program Director of the Endocrinology and Metabolism Residency Training Program at McGill University. This conversation covers GLP-1 agonists, what they are, their uses, the media hype, new and exciting research, and some advice for trainees. The show notes include a glossary of terms, links to publications referenced in the episode, and a full transcript of our conversation.
