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Identifying and managing adverse environmental health effects: 1. Taking an exposure history.

https://arctichealth.org/en/permalink/ahliterature190247
Source
CMAJ. 2002 Apr 16;166(8):1049-55
Publication Type
Article
Date
Apr-16-2002
Author
Lynn Marshall
Erica Weir
Alan Abelsohn
Margaret D Sanborn
Author Affiliation
Environmental Health Clinic, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.
Source
CMAJ. 2002 Apr 16;166(8):1049-55
Date
Apr-16-2002
Language
English
Publication Type
Article
Keywords
Adult
Canada
Environmental health
Environmental Pollutants - adverse effects
Female
Headache - chemically induced - therapy
Humans
Male
Medical History Taking - methods
Occupational Exposure
Sick Building Syndrome - diagnosis - physiopathology
Abstract
Public concern and awareness are growing about adverse health effects of exposure to environmental contaminants. Frequently patients present to their physicians with questions or concerns about exposures to such substances as lead, air pollutants and pesticides. Most primary care physicians lack training in and knowledge of the clinical recognition, management and avoidance of such exposures. We have found that it can be helpful to use the CH2OPD2 mnemonic (Community, Home, Hobbies, Occupation, Personal habits, Diet and Drugs) as a tool to identify a patient's history of exposures to potentially toxic environmental contaminants. In this article we discuss why it is important to take a patient's environmental exposure history, when and how to take the history, and how to interpret the findings. Possible routes of exposure and common sources of potentially toxic biological, physical and chemical substances are identified. A case of sick-building syndrome is used to illustrate the use of the mnemonic.
Notes
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Comment In: CMAJ. 2002 Apr 16;166(8):1041-312002981
Comment In: CMAJ. 2002 Oct 1;167(7):744; author reply 744, 74612389832
PubMed ID
12002983 View in PubMed
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Potential gaps in congestive heart failure management in a rural hospital.

https://arctichealth.org/en/permalink/ahliterature173480
Source
Can J Rural Med. 2005;10(3):155-61
Publication Type
Article
Date
2005
Author
Margaret D Sanborn
Douglas G Manuel
Ewa Ciechanska
Douglas S Lee
Author Affiliation
South Bruce Grey Health Care Centre, Chesley, Ont. msanborn@sbghc.on.ca
Source
Can J Rural Med. 2005;10(3):155-61
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health Care Surveys
Health Services Accessibility - standards - statistics & numerical data
Heart Failure - drug therapy - epidemiology - therapy
Hospitals, Community - standards - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Middle Aged
Ontario - epidemiology
Patient Care Planning - standards - statistics & numerical data
Retrospective Studies
Rural Health
Rural Health Services - standards - statistics & numerical data
Rural Population - statistics & numerical data
Abstract
Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care.
A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management.
The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting.
There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.
PubMed ID
16079031 View in PubMed
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