Preventing lead poisoning in children: can the US experience inform other countries? The case of Poland

Exposure to excess lead during childhood is preventable, but nowhere has that goal been achieved. In the US, recommendations for prevention of childhood lead poisoning are issued by the Centres for Disease Control and Prevention, based on periodically updated population-based data on the prevalence of lead poisoning by age and blood lead level. A well developed public health infrastructure is to provide case management to the lead exposed children. In Poland, the social and economic transitions of the last decade changed the potential for childhood lead exposure, and there has been a profound restructuring of the health care system. Blood lead testing in children is performed outside the primary care. Data on blood lead levels are not collected and analysed centrally. The range of follow-up services may differ among the regions, depending on the local expertise. An updated approach to prevention of childhood lead poisoning, making better use of the existing expertise and involving primary care providers, needs consideration. Complex public health programs like this of lead poisoning prevention cannot be transplanted whole to other countries. However, experiences gained by the US might provide valuable suggestions for others, even though the US policy has flaws and is not fully implemented. Discussing proposal for Poland in light of the current US practice highlights the necessity of reliable estimates of the exposed population for rational policy. It also helps to define research questions relevant to public health practice in Poland, and confirms that prevention of lead poisoning in children requires the coordinated work of different professionals.     

铅中毒儿童各年龄期血锌、钙、铁分析

目的 探讨铅中毒儿童各年龄期血锌、钙、铁水平,为防治铅中毒、合理补充微量元素提供临床指导。方法 随机选择儿保门诊儿童铅中毒组140例,非铅中毒组140例,分幼儿期、学龄前期、学龄期三个年龄期进行分析。血铅、锌、钙、铁测定采用原子吸收光谱法。结果 铅中毒组儿童各年龄期血铅水平无明显差异,其均值均在轻度铅中毒范围。铅中毒组儿童各年龄期血锌、钙水平明显降低,血锌、钙缺乏检出率明显升高。铅中毒组幼儿期儿童血铁水平明显降低,学龄前期、学龄期儿童血铁水平无明显降低。结论 防治儿童铅中毒应加强锌、钙营养,幼儿应适当加强铁营养。     

Childhood lead poisoning prevention activities within Michigan local public health departments

OBJECTIVE: Local public health departments have a wide array of responsibilities, including coordinating childhood lead poisoning prevention activities. This study was conducted in an effort to understand how local public health officers prioritized lead poisoning prevention activities and the barriers to the delivery of childhood lead poisoning prevention services delivered through local health departments. METHODS: A telephone survey was conducted of health officers in Michigan, a state with a high burden of environmental lead. Analysis included Spearman rank correlation and Fisher's exact test. RESULTS: No association was found between the local risk of lead poisoning and the priority placed by local health departments on lead poisoning prevention activities. Similarly, there was no association between the local risk of lead poisoning and the availability of services. Only 60% of local health departments offered blood lead testing, environmental investigation, and case management. Most (74%) believed that lead poisoning is inadequately addressed within the area served by their local health department. CONCLUSION: New strategies of providing lead poisoning prevention activities are needed to achieve the federal and state goals of eliminating childhood lead poisoning over the next decade.     

儿童铅中毒的原因及预防

儿童铅中毒已成为目前影响儿童健康状况的一个重要的公众卫生问题。就儿童铅中毒的原因、机制、预防进行探讨，以期引起社会和家长的广泛关注，并从环境干预、健康教育、临床治疗3个环节进行预防，让儿童远离铅中毒的危害。     

铅中毒与儿童健康

综述了儿童铅中毒的诊断标准 ,我国儿童铅中毒现状 ,铅中毒对儿童健康的影响 ,阐述了铅中毒对儿童体格发育、血液及造血系统、心理行为及智力发育、学习能力影响的机理。概括了儿童铅中毒的原因 ,论述了当前国内外防治儿童铅中毒的主要措施。旨在提高广大医务工作者对儿童铅中毒的正确认识 ,及时采取切实可行的早期健康教育和有效的防治措施 ,达到保护儿童身心健康的目的。     

Cost of child lead poisoning to taxpayers in Mahoning County, Ohio

Lead poisoning in children imposes both immediate and long-term financial burdens on taxpayers. The District Board of Health of Mahoning County, Ohio, quantified some of the direct costs to taxpayers of providing medical care and public health services to the 279 children diagnosed with lead poisoning in the county in 2002, using methods described by Katrina Korfmacher at the University of Rochester. The Board of Health also attempted to quantify the longer-term costs of special education and juvenile justice services attributable to lead exposure. The realization that lead poisoning costs local government on the order of 0.5 million dollars each year has mobilized community leaders in education and juvenile justice to demand more aggressive action against rental property owners who fail to remediate lead hazards.     

百色市0～6岁儿童铅中毒调查分析

目的:了解百色市0～6岁儿童血铅水平及铅中毒流行情况,为儿童的铅防治提供科学指导。方法:自2008年1月～2010年12月对百色市妇幼保健院儿童保健科及百色市城区幼儿园1 544例0～6岁儿童采用原子吸收光谱仪进行末梢血铅测定,观察儿童血铅水平及铅中毒检出率,同时对不同性别及不同年龄组儿童的血铅水平进行比较。结果:1 544例儿童末梢血铅浓度呈正态分布,血铅水平0μg/L～304μg/L,平均(59.3±23.5)μg/L;其中1 433例儿童血铅在正常范围内,其余111例血铅均超过正常范围。男童组与女童组血铅水平无统计学差异,983例男童中,62例铅中毒,561例女童中,49例铅中毒。0～1岁,1～2岁,2～3岁,血铅水平及铅中毒检出率呈逐渐增高趋势,3～4岁,4～5岁血铅水平有所下降,5～6岁血铅水平又再次回升。结论:百色市0～6岁儿童铅中毒发生率较高,应引起儿童家长、老师及社区的高度重视,并结合多方面的力量,尽量避免铅中毒的各种危险因素,为儿童铅中毒的防治提供保障,促进儿童健康成长。     

妇幼保健人员对儿童铅中毒知识的认知现状调查

目的:了解妇幼保健人员对儿童铅中毒知识的认知现状,以便为环境铅污染与儿童铅中毒的健康促进项目设计提供依据。方法:采用匿名自填问卷方式,对整群随机抽取的云南楚雄、大理两地20~65岁765名妇幼保健人员的基本特征、铅污染源、转运转化、不良行为、危害防治进行了现况调查。结果:该人群对儿童铅中毒知识正确回答率较高(73.89%),合并总分为25.86±6.11分,但对我国儿童铅中毒的流行势态、污染源、诊断标准的认识相对不足,对儿童铅中毒知识的认知水平存在年龄、职业和职称的差异。结论:开展专题教育,加强铅污染源的系统调查,有利于提高儿童铅中毒的干预水平。     

儿童铅中毒及防治的回顾与新进展

铅是一种多亲和性毒物,主要损害中枢神经系统,尤其是发育中的大脑。儿童血铅目前公认没有安全阈值,血铅水平仅用于界定是否需要实施干预措施。儿童铅中毒已成为一个全球性的公共安全问题。随着我国近年来对环境铅污染的治理,儿童铅中毒防治取得了实质性进步。儿童铅中毒重在预防,健康教育和减少铅暴露机会为主,排铅治疗为辅。驱铅主要药物目前仍是沿用了数十年的金属络合剂,儿童用药安全性尚存争议。经口暴露作为儿童铅摄入的主要途径,阻断铅消化道吸收有望成为儿童铅中毒防治的新举措之一。     

Understanding childhood lead poisoning preventive behaviors: the roles of self-efficacy, subjective norms, and perceived benefits

INTRODUCTION: Understanding individual and social influences on behaviors commonly recommended to prevent lead poisoning in children can guide more effective educational interventions. METHODS: In-person interviews were conducted with primary caregivers (n = 380) of American Indian and White children aged 1 to 6 living in or near the Tar Creek Superfund site in northeastern Oklahoma. Caregivers' perceived health benefits, self-efficacy, and subjective norms were assessed for four lead poisoning prevention behaviors (i.e., annual blood lead testing, playing in safe areas, washing hands before eating, and dusting with a damp cloth). RESULTS: Caregivers spoke with their own mothers, spouses, and other female family members most often when they had concerns or worries about taking care of their children. In multivariate models, subjective norms, perceived benefits, and self-efficacy were positively associated with the hand-washing and damp-dusting behaviors, while only self-efficacy was associated with playing in safe areas. None of the variables were found to have significant influence on the blood lead testing behavior. CONCLUSIONS: Education programs should address individual level factors such as self-efficacy and perceived health benefits but also consider new strategies that incorporate a normative dimension to lead poisoning prevention.     

Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

Background  

Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services.     

广州市10012例儿童血铅检测与分析

目的了解广州市儿童血铅水平分布状况,为预防儿童铅中毒提供依据。方法随机选择2009年广州市某三级甲等妇幼保健院门诊就诊的儿童10012例,年龄0～10岁,采用原子吸收石墨炉法测定血铅值。结果儿童血铅均值为49.47μg/L,铅中毒检出率为3.96%。在0～5岁期间,随着年龄增加血铅均值及铅中毒检出率呈现逐渐增高的趋势,并在学龄前期达到高峰;之后的学龄期儿童血铅均值不再增高,而铅中毒率也呈现下降的趋势。男童铅中毒检出率高于女童。结论广州市儿童铅中毒率接近国内其他城市平均水平,但在学龄前血铅水平有随年龄增长而增加的趋势,铅污染对儿童身体健康危害应引起重视。     

"Getting the lead out" in Hartford, Connecticut: a multifaceted lead-poisoning awareness campaign

As part of a citywide effort to increase lead poisoning awareness within the city of Hartford, Connecticut, the Hartford Health Department implemented a multifaceted public health campaign involving several novel elements and partnerships, including the use of municipal sanitation trucks to disseminate lead-poisoning prevention messages throughout the city. To evaluate campaign reach and effectiveness, Health Department personnel collected measures of lead-poisoning knowledge, recall of campaign components, and reports of steps taken to prevent lead poisoning from 180 largely ethnic minority parents of preschool-age children. Key results were as follows: a) Recall of campaign components ranged from 21.5 to 62.6%, with newspaper advertisements and signs on buses and billboards recalled most often and a video broadcast on public-access television recalled least often. b) More than 45% of respondents reported that they took steps to prevent lead poisoning because of at least one of the campaign components, with the newspaper advertisements being the most effective component in terms of prompting lead-poisoning prevention behavior. c) Respondents' awareness was particularly low in terms of how medical personnel and procedures can and cannot detect and prevent lead poisoning in children. This campaign prompted caregivers to take steps to prevent lead poisoning and may help public health professionals in other communities to develop novel ideas through which to embark on similar initiatives.     

The "malnutrition-infection" complex, the most widespread public health problem in underprivileged populations.

The synergistic association between malnutrition and infection remains today the most worrisome public health problem in the world. Although the high level of mortality among children in developing countries is mainly due to infectious and parasitic diseases, more than half of these children die in a state of overt undernourishment. Energy and nutrient deficiencies adversely affect various aspects of immunocompetence, thus malnourished people are particularly sensitive to many opportunistic infections. These, in turn, induce anorexia, various metabolic changes and malabsorption, which affect nutritional reserves, and lead to malnutrition if prolonged. In the absence of efficient measures to break this vicious cycle, malnutrition and morbidity lead to high levels of mortality. Experience from developing countries suggests that to improve the prevention and treatment of infectious diseases in such a context of poverty, one need to take into account simultaneously the basic environment of underprivileged groups and their dietary intake as well as their level of access to health care services.     

Within but without: human rights and access to HIV prevention and treatment for internal migrants

Worldwide, far more people migrate within than across borders, and although internal migrants do not risk a loss of citizenship, they frequently confront significant social, financial and health consequences, as well as a loss of rights. The recent global financial crisis has exacerbated the vulnerability internal migrants face in realizing their rights to health care generally and to antiretroviral therapy in particular. For example, in countries such as China and Russia, internal migrants who lack official residence status are often ineligible to receive public health services and may be increasingly unable to afford private care. In India, internal migrants face substantial logistical, cultural and linguistic barriers to HIV prevention and care, and have difficulty accessing treatment when returning to poorly served rural areas. Resulting interruptions in HIV services may lead to a wide range of negative consequences, including: individual vulnerability to infection and risk of death; an undermining of state efforts to curb the HIV epidemic and provide universal access to treatment; and the emergence of drug-resistant disease strains. International human rights law guarantees individuals lawfully within a territory the right to free movement within the borders of that state. This guarantee, combined with the right to the highest attainable standard of health set out in international human rights treaties, and the fundamental principle of non-discrimination, creates a duty on states to provide a core minimum of health care services to internal migrants on a non-discriminatory basis. Targeted HIV prevention programs and the elimination of restrictive residence-based eligibility criteria for access to health services are necessary to ensure that internal migrants are able to realize their equal rights to HIV prevention and treatment.     

Community-based DM approach slashes incidence of lead poisoning in children

While lead poisoning among children is on the decline, it is still a serious health problem that affects an estimated 930,000 children between the ages of one and five. Baltimore health care providers have--with great success--turned to the tools of disease management to cut blood lead levels in children while simultaneously cutting overall costs.     

Minnesota childhood blood lead guidelines

Lead poisoning continues to pose a major environmental health threat to Minnesota's children. Currently, about 2,000 children a year in Minnesota are identified as having elevated blood lead (greater than 10 micrograms/dL). The Minnesota Department of Health has developed statewide guidelines for screening, case management, and clinical treatment of children who have been exposed to lead. The screening guidelines target children with the highest risk of exposure. The case management guidelines provide information to public health agencies on recommended steps for dealing with an elevated blood lead case. The clinical treatment guidelines assist physicians and other health care professionals with the medical aspects of a lead case. These guidelines are based on state data, were developed using diverse work groups, and have been endorsed by the medical community. They provide Minnesota-specific guidance on how to best identify and treat a child exposed to lead and to minimize exposure.     

衡水地区0～14岁儿童血铅水平分析

摘要:目的　对衡水地区儿童进行血铅浓度的测定,了解衡水地区儿童血铅水平的情况,为防治铅中毒提供科学依据。方法　对2 735名0～14岁儿童进行静脉采血1 ml,用微量分析仪QL800测定血铅浓度,并对结果进行分析。结果　血铅浓度正常2 504例,轻度铅中毒205例,中度铅中毒26例,无重度和极重度铅中毒。4～≤6岁（学龄前组）的儿童铅中毒检出率最高10.7%,城镇儿童铅中毒检出率要高于农村儿童（χ2＝9.78,P＜0.05）,男童的铅中毒检出率高于女童（χ2＝15.56,P＜0.05）。结论　本地区儿童的铅中毒检出率低于国内平均水平,但也要注意铅暴露对儿童健康的潜在危险,对防治铅中毒也要给予足够的重视,做到防患于未然。     

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley-Liss, Inc.