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Primary Prevention of Lead Poisoning: Shifting the Paradigm A Community-Based Initiative

Primary Prevention of Lead Poisoning: Shifting the Paradigm A Community-Based Initiative. Michael A. Noll, M.D. Walden University School of Health Sciences November 12, 2009. Welcome!. Prenatal Services: You are literally on the Front Lines of Medicine

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Primary Prevention of Lead Poisoning: Shifting the Paradigm A Community-Based Initiative

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  1. Primary Prevention of Lead Poisoning:Shifting the ParadigmA Community-Based Initiative Michael A. Noll, M.D. Walden University School of Health Sciences November 12, 2009

  2. Welcome! Prenatal Services: You are literally on the Front Lines of Medicine You can Affect Meaningful Positive Changes Preventive Measures are Key to Healthy Families and Children

  3. Our Focus Today:Preventing Exposure to Lead in Children • What We Know • Toxic Effects of Lead Exposure • Special Focus of Neurodevelopmental Issues • Sources of Exposure • Current Preventive Measures • Changing the Status Quo

  4. Lead Poisoning in Children • 250,000 U.S. children under age 5 have blood lead levels greater than 10 micrograms of lead per deciliter (mcg/dl). • 10 mcg/dl of lead is the level at which CDC recommends public health actions be initiated (CDC, 2009). • Lead interferes with a variety of body processes (CDC, 2009) including, most notably in children:The Nervous System The Neuron Reference: Center for Disease Control (2009). Lead. Retrieved October 10, 2009, from: http://www.cdc.gov/lead/ Credit: Image of Neuron used with permission from Quasar Jarosz (2009). Retrieved October 25, 2009, from: http://en.wikipedia.org/wiki/File:Neuron

  5. Neurotoxic Effects • High levels of exposure can lead to: • Seizures, coma and death (Cecil, 2008). • Exposure has been linked to: • Learning Disabilities (Meyer & McGeehim, 2003) • Aggression and Delinquency (Needleman, 2004) • ADHD & antisocial behavior (Bellinger, 2008). References Bellinger, C (2008). Very low lead exposures and children's neurodevelopment. Current Opinions in Pediatrics, 20 (2): 172–177 Cecil, M, et al. (2008). Decreased brain volume in adults with childhood lead exposure. PLoS Medicine, 5 (5): 112. Meyer PA; Mcgeehin F (2003). A global approach to childhood lead poisoning prevention. International Journal of Hygiene and Environmental Health, 206 (4-5): 363–9 Needleman, H. (2004). Lead poisoning. Annual Review of Medicine, 55; 209–222.

  6. Persistent Neurological Effects Cerebrums of adults that were exposed to lead as children show decreased volume, especially in the prefrontal cortex. Areas of volume loss are shown as red/orange/ yellow over a normal brain. Reference and Image Source Cecil M, et al. (2008). Decreased brain volume in adults with childhood lead exposure. PLoS Medicine, 5 (5): 112.

  7. Exposure to Lead • Lead-based paint and lead-contaminated dust in older homes are the most common sources of lead poisoning in children (CDC, 2009) • Although lead was banned for use in paints in 1978, 98% of homes built before 1940 still contain lead (HUD, 2009) • More than 30 million homes, roughly 1/3 of the homes in the US are at least 50 years old (Solomon, 2009). References: Center for Disease Control (2009). Lead. Retrieved October 12, 2009, from www..cdc.gov/nceh/lead Solomon C (2009). This old (dangerous?) house. Microsoft Network Real Estate. Retrieved October 25, 2009, from http://realestate.msn.com/article.aspx?cp-documentid=21917660 US Dept. of Housing and Urban Development (HUD) (2009). Retrieved October 20, 2009 from: www.hud.gov/offices/lead/enforcement/lshr.cfm

  8. Lead Paint Image Source: US EPA. Retrieved October 19, 2009, from: http://www.epa.gov/opp00001/factsheets/child-ten-tips.htm

  9. Paint Flakes Image Source: County of Marin, California (2009). Retrieved October 20, 2009, from: www.co.marin.ca.us/depts/hh/main/hs/clinicalsvcs/

  10. Primary Prevention:The Status Quo. • Current Recommendations: • “Screen 12-month-old infants for lead poisoning if they live in communities in which the prevalence of lead levels requiring intervention is high or undefined” (AAP, 2005) • Reference: American Academy of Pediatrics (2005). Lead exposure in children: prevention, detection, and management. Pediatrics 2005; 116:1036-46. • “All children should receive a screening blood lead test at 12 months and 24 months of age; children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning” (CDC, 2005) • Reference: Centers for Disease Control and Prevention. Blood Lead Levels - United States, 1999-2002. MMWR 2005;54(20):513-6.

  11. The Clinical Intervention Model Image Source:www.ushersyndrome.nih.gov/join/blood.html

  12. True Prevention Screen Homes for Lead Prior to Bringing a Newborn Home Image Source: http://spokanepublishing.files.wordpress.com

  13. Community and Clinic-Based Intervention Image Source: www.ksre.ksu Let us Truly Prevent the Problem

  14. Methods • FREE lead dust kit available to NJ residents The Lead Kit Image Source: State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, from: http://www.state.nj.us/dca/dcr/leadsafe/

  15. If Lead is Detected in the Home • Hire a Certified Lead Abatement Contractor • NJ Lead Abatement Hot-line at (609) 633-6224. • Financial assistance is available. Image source: http://rwss.ap.nic.in/pred/images/contractor.gif Reference: State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, from: http://www.state.nj.us/dca/dcr/leadsafe/

  16. Image courtesy of: http://burningourmoney.blogspot.com

  17. For Further Information • EPA Website: www.epa.gov/lead • EPA (New Jersey regional) info: (732) 321-6671 • CDC Childhood Lead Poisoning Prevention Program: www.cdc.gov/nceh/lead/about/program • National Lead Info Center: 800-424-LEAD • Lead Safe NJ Program (To Obtain the Free Lead Detection Kit): 856-665-6000 ext 327

  18. References: • American Academy of Pediatrics (2005). Lead exposure in children: prevention, detection, and management. Pediatrics, 116: 1036-46. • Bellinger, C (2008). Very low lead exposures and children's neurodevelopment. Current Opinions in Pediatrics, 20 (2): 172–177 • Cecil, M, et al. (2008). Decreased brain volume in adults with childhood lead exposure. PLoS Medicine, 5 (5): 112. • Centers for Disease Control and Prevention. Blood Lead Levels - United States, 1999-2002. MMWR; 54(20):513-6. • Center for Disease Control (2009). Lead. Retrieved October 10, 2009, from: www.cdc.gov/lead/ • Environmental Protection Agency (EPA) 2009. Lead. Retrieved October 12, 2009, from: http://www.epa.gov/lead/pubs/rrpamph.pdf • Meyer PA; Mcgeehin F (2003). A global approach to childhood lead poisoning prevention. International Journal of Hygiene and Environmental Health, 206 (4-5): 363–9.

  19. References (continued) • Moeller, DW (2005). Environmental Health (3rd ed.). Boston: Harvard University Press. • Needleman, H. (2004). Lead poisoning. Annual Review of Medicine, 55; 209–222. • Solomon C (2009). This old (dangerous?) house. Microsoft Network Real Estate. Retrieved October 26, 2009, from: http://realestate.msn.com/article.aspx?cp-documentid=21917660 • State of NJ (2009). Lead Safe NJ Program. Retrieved October 15, 2009, from: http://www.state.nj.us/dca/dcr/leadsafe/ • US Dept. of Housing and Urban Development (HUD) (2009). Retrieved October 20, 2009 from: www.hud.gov/offices/lead/enforcement/lshr.cfm

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