Lead in the environment
Lead exposure can cause several chronic and debilitating health problems, especially in children. In the third article in our series on identifying and managing adverse environmental health effects, Margaret Sanborn and colleagues review sources of lead exposure at work, in and around the home and in other settings. They discuss the hematologic, renal and neurotoxic effects of exposure to the metal. The authors also discuss the identification of affected individuals in high-risk populations, laboratory testing and ways to prevent lead exposure.
See page 1287
Urinary incontinence
Bladder training, pelvic floor exercises, and fluid and caffeine restriction can be helpful in the management of urinary incontinence. In a 6-month trial by Michael Borrie and colleagues, 421 patients experiencing urinary incontinence at least once a week were randomly assigned to either a control group or a group enrolled in a lifestyle and behavioural intervention session every 4 weeks led by nurse continence advisers in collaboration with a physician. Data were analyzed for 188 participants in each group, and the primary outcomes measured were the number of incontinence episodes per 24-hour period and the use of incontinence pads. The mean decrease in incontinent events per 24 hours was greater in the intervention group than in the control group (1.2 v. 0.2). The mean decline in the use of incontinence pads per 24 hours was also greater in the intervention group (0.9 v. 0.1). The authors conclude that nurse continence advisers can play an important role in the management of patients with urinary incontinence.
See page 1267
Family physicians and delivery outcomes
Relations between outcomes and provider volume have been established for a number of procedures in different fields. Michael Klein and colleagues looked for a relation between volume of deliveries by family physicians and maternal and newborn outcomes by studying all singleton births attended primarily by family physicians during a 17-month period at a major maternity teaching hospital. Physicians were divided into 3 groups according to their delivery volume: low volume (fewer than 12 babies delivered per year) (72 physicians, 549 births); medium volume (12–24 babies per year) (34 physicians, 871 births); and high volume (25 or more deliveries per year) (46 physicians, 3024 births). Both before and after adjusting for several maternal and infant characteristics, the authors found no difference among the 3 groups in terms of rates of maternal complications of delivery, 5-minute Apgar scores below 7 or rates of admission of the infant to a special care unit. However, family physicians in the high- and medium-volume groups consulted obstetricians less frequently and were less likely to perform inductions of labour or to transfer care to an obstetrician than were family physicians in the low-volume group. The authors conclude that more research is required to confirm the absence of a volume–outcome relation in smaller centres.
See page 1257
Short bowel syndrome
Short bowel syndrome is characterized by maldigestion and malabsorption caused by extensive resection of the small bowel. In the Practice section, Khursheed Jeejeebhoy reviews digestion and absorption in the normal gastrointestinal tract and shows how changes in intestinal function can be anticipated by knowing which section of the bowel has been resected. He discusses a stepwise medical and dietary approach to managing aspects of short bowel syndrome, including fluid imbalances and diarrhea, nutritional deficiencies and potential complications such as cholelithiasis, nephrolithiasis and D-lactic acidosis.
See page 1297
Walkerton 2 years later
Two years after bacteria-contaminated drinking water in Walkerton, Ont., killed 7 and left more than 2300 others ill, Brad Mackay interviews one of the first physicians who reported her concerns to the public health department as well as the medical officer of health who issued the first boil-water advisory for the area. In addition, Richard Schabas comments on the state of Ontario's public health system and how it could be improved.
See pages 1282 and 1326
Figure.
Figure.
Photo by: Lianne Friesen