1/2. Identifying and managing adverse environmental health effects: 1. Taking an exposure history.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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. The sensitive individual and the indoor environment: case study.This case study describes an indoor environment investigation initiated in response to numerous health and comfort complaints suspected of being associated with a two-story office building. Conventional indoor environment investigation techniques were applied in an attempt to identify one or several contributing factors, such as inadequate outdoor air ventilation and the presence of a respiratory irritant. The air quality satisfaction percentage in the building was well above 80%; however, at least one individual was experiencing a fairly severe reaction only upon entering the subject building. Evaluating the building indoor conditions as acceptable without attempting to address all possible building-related causes and communicating findings to interested occupants would likely have resulted in more occupant complaints and increased the potential for hysteria conditions. This investigation necessarily addressed a sensitive individual and involved an occupational physician as a constructive participant in the investigation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |