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American Family Physician Jul 2019Asymptomatic lead poisoning has become more common in children. Blood lead levels of less than 5 µg per dL are associated with impairments in neurocognitive and... (Review)
Review
Asymptomatic lead poisoning has become more common in children. Blood lead levels of less than 5 µg per dL are associated with impairments in neurocognitive and behavioral development that are irreversible. Risk factors for lead poisoning include age younger than five years, low socioeconomic status, living in housing built before 1978, and use of imported food, medicines, and pottery. The U.S. Preventive Services Task Force released a recommendation in 2019 citing insufficient evidence to assess the balance of benefits and harms of universal screening for elevated blood lead levels in asymptomatic children and pregnant women. Local risk factors can be substantial, and the Centers for Disease Control and Prevention (CDC) recommends that states and cities formulate their own targeted screening guidelines. In the absence of local guidance, the CDC recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened. The CDC also recommends universal screening in areas where more than 27% of the housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 µg per dL. Life-threatening lead levels are treated with chelation therapy, and lower levels should prompt case management and environmental investigations to identify and remove the source of exposure. Primary prevention strategies are essential to eliminate the harmful effects of lead on child development.
Topics: Chelation Therapy; Child; Child, Preschool; Housing; Humans; Infant; Lead Poisoning; Mass Screening; Risk Factors; Socioeconomic Factors; United States
PubMed: 31259498
DOI: No ID Found -
Journal of Public Health Management and... 2019
Topics: Humans; Lead Poisoning; Michigan; Water Quality
PubMed: 30507762
DOI: 10.1097/PHH.0000000000000902 -
The Western Journal of Medicine Aug 1994Lead poisoning is the most common disease of environmental origin in the United States today. Adult lead poisoning results primarily from exposure by inhalation in the... (Review)
Review
Lead poisoning is the most common disease of environmental origin in the United States today. Adult lead poisoning results primarily from exposure by inhalation in the workplace. Pediatric lead poisoning results principally from the ingestion of lead from environmental media, including paint chips, dust, soil, drinking water, ceramics, and medications. Lead is toxic to many organ systems, among them developing erythrocytes, the kidneys, and the nervous system. Lead-induced toxicity to the central nervous system causes delayed development, diminished intelligence, and altered behavior. In young children, this effect has been demonstrated convincingly to occur at blood lead levels between 10 and 20 micrograms per dl. The Centers for Disease Control and Prevention has recommended that a blood lead level of 10 micrograms per dl or higher be considered evidence of increased lead absorption, and the National Academy of Sciences has concurred in that recommendation. Unresolved issues in need of further study include the frequency of screening young children for lead, the question of whether women should be offered screening for lead before conceiving a pregnancy, the role of x-ray fluorescence analysis in assessing lead in bone, and the appropriate legislative response of the United States government to lead-based paint abatement.
Topics: Adult; Body Burden; Child; Environmental Monitoring; Environmental Pollution; Epidemiological Monitoring; Female; Humans; Lead; Lead Poisoning; Mass Screening; Preconception Care; Research; United States
PubMed: 7941534
DOI: No ID Found -
Archives of Disease in Childhood Jun 1971
Review
Topics: Air Pollution; Bone and Bones; Child, Preschool; Chronic Disease; Dexamethasone; Dimercaprol; Edetic Acid; Globins; Humans; Hydro-Lyases; Infant; Infant, Newborn; Lead; Lead Poisoning; Mannitol; Nephritis; Paint; Penicillamine; Pica; Porphyrins; Spectrum Analysis; Time Factors; United Kingdom; Water Pollution
PubMed: 4997770
DOI: 10.1136/adc.46.247.233 -
Hong Kong Medical Journal = Xianggang... Dec 2017Childhood lead poisoning is a major public health concern in many countries. In 2015, the Hong Kong SAR Government and its citizens faced a major public health crisis... (Review)
Review
Childhood lead poisoning is a major public health concern in many countries. In 2015, the Hong Kong SAR Government and its citizens faced a major public health crisis due to the presence of lead in the drinking water of a number of public housing estates. Fortunately, no child was diagnosed with lead poisoning that required treatment with chelation. Lead is a ubiquitous, naturally occurring material that exists in air, dust, soil, and water. It is also widely present in industrial products including petrol, paints, ceramics, food cans, candies, cosmetics, traditional remedies, batteries, solder, stained glass, crystal vessels, ammunition, ceramic glazes, jewellry, and toys. It can also be found in human milk. There is no safe blood lead level and it may be impossible to completely eliminate lead from any city. Hence routine measurement of blood lead levels is not considered useful. Acute poisoning, especially with encephalopathy, deserves immediate medical treatment in hospital. Chelation therapy is recommended if blood lead level is 45 μg/dL or higher. For blood levels between 20 and 45 μg/dL, treatment is indicated if the child is symptomatic. For blood levels below 20 μg/dL in otherwise asymptomatic children, the principle of treatment is to provide long-term neurodevelopmental follow-up and counselling. In all cases, immediate removal of the source of lead exposure is vital. Even low levels of lead exposure can significantly impair learning, educational attainment, and neurodevelopment.
Topics: Child; Hong Kong; Humans; Lead Poisoning
PubMed: 29026055
DOI: 10.12809/hkmj176214 -
Internal Medicine (Tokyo, Japan) Nov 2022
Topics: Humans; Medicine, Ayurvedic; Lead Poisoning
PubMed: 35342137
DOI: 10.2169/internalmedicine.9178-21 -
Journal of Alzheimer's Disease : JAD 2018Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children. Evidence from animal-model and human observational... (Review)
Review
Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children. Evidence from animal-model and human observational studies suggest that childhood lead exposure may raise the risk of adult neurodegenerative disease, particularly dementia, through a variety of possible mechanisms including epigenetic modification, delayed cardiovascular and kidney disease, direct degenerative CNS injury from lead remobilized from bone, and lowered neural and cognitive reserve. Within the next ten years, the generation of children with the highest historical lead exposures, those born in the 1960s, 1970s, and 1980s, will begin to enter the age at which dementia symptoms tend to emerge. Many will also enter the age in which lead stored in the skeleton may be remobilized at greater rates, particularly for women entering menopause and men and women experiencing osteoporosis. Should childhood lead exposure prove pro-degenerative, the next twenty years will provide the last opportunities for possible early intervention to forestall greater degenerative disease burden across the aging lead-exposed population. More evidence is needed now to characterize the nature and magnitude of the degenerative risks facing adults exposed to lead as children and to identify interventions to limit long-term harm.
Topics: Animals; Child; Humans; Lead; Lead Poisoning; Neurodegenerative Diseases
PubMed: 29865081
DOI: 10.3233/JAD-180267 -
Journal of Public Health Management and...Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing...
CONTEXT
Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then.
PROGRAM
Childhood Lead Poisoning Prevention & Healthy Housing.
METHODS
Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps.
EVALUATION
Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children's blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades.
DISCUSSION
The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation's main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing.
Topics: Child; United States; Humans; Lead; Nutrition Surveys; Environmental Exposure; Lead Poisoning; Housing
PubMed: 36442070
DOI: 10.1097/PHH.0000000000001664 -
The Milbank Quarterly Mar 2023Policy Points Child lead poisoning is associated with socioeconomic inequity and perpetuates health inequality. Methods for testing and detection of child lead poisoning...
Policy Points Child lead poisoning is associated with socioeconomic inequity and perpetuates health inequality. Methods for testing and detection of child lead poisoning are ill suited to the current demographics and characteristics of the problem. A three-pronged revision of current testing approaches is suggested. Employing the suggested revisions can immediately increase our national capacity for equitable, inclusive testing and detection. ABSTRACT: Child lead poisoning, the longest-standing child public health epidemic in US history, is associated with socioeconomic inequity and perpetuates health inequality. Removing lead from children's environments ("primary prevention") is and must remain the definitive solution for ending child lead poisoning. Until that goal can be realized, protecting children's health necessarily depends on the adequacy of our methods for testing and detection. Current methods for testing and detection, however, are no longer suited to the demographics and magnitude of the problem. We discuss the potential deployment and feasibility of a three-pronged revision of current practices including: 1) acceptance of capillary samples for final determination of lead poisoning, with electronic documentation of "clean" collection methods submitted by workers who complete simple Centers for Disease Control and Prevention-endorsed online training and certification for capillary sample collection; 2) new guidance specifying the analysis of capillary samples by inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectrometry with documented limit of detection ≤0.2 μg/dL; and 3) adaptive "census tract-specific" universal testing and monitoring guidance for children from birth to 10 years of age. These testing modifications can bring child blood lead level (BLL) testing into homes and communities, immediately increasing our national capacity for inclusive and equitable detection and monitoring of dangerous lower-range BLLs in US children.
Topics: United States; Humans; Child; Lead; Health Status Disparities; Lead Poisoning; Child Health; Centers for Disease Control and Prevention, U.S.; Environmental Exposure
PubMed: 36717973
DOI: 10.1111/1468-0009.12596 -
American Family Physician Mar 2010The prevalence and severity of childhood lead poisoning have been greatly reduced since the removal of lead from paint and gasoline in the 1970s. Despite these efforts,... (Review)
Review
The prevalence and severity of childhood lead poisoning have been greatly reduced since the removal of lead from paint and gasoline in the 1970s. Despite these efforts, approximately 310,000 U.S. children younger than five years have elevated blood lead levels. Health care professionals should perform targeted screening for lead poisoning in children who are Medicaid-enrolled or -eligible, foreign born, or identified as high risk by the Centers for Disease Control and Prevention (CDC) location-specific recommendations or by a personal risk questionnaire. Venous sampling is the preferred method for measuring blood lead levels, but a carefully collected finger-stick sample is an acceptable alternative. Capillary samples of elevated levels should be confirmed by a venous sample. The CDC recommends that the threshold for follow-up and intervention of lead poisoning be a blood lead level of 10 microg per dL or higher. Recommendations for treatment of elevated blood levels include a thorough environmental investigation, laboratory testing when appropriate, iron supplementation for iron-deficient children, and chelation therapy for blood lead levels of 45 microg per dL or more. Prevention consists of education and avoidance of lead-contaminated products.
Topics: Child; Child, Preschool; Humans; Infant; Lead Poisoning; Practice Guidelines as Topic; Public Health Practice; Risk Factors
PubMed: 20229974
DOI: No ID Found