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Healthy Environments, Homes, and Children

Healthy Environments, Homes, and Children. History of Josiah Hill III Clinic. The Clinic was formed in 1997 by the community activist and physician assistant, Josiah Hill III. Working together to identify the “invisible threat”.

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Healthy Environments, Homes, and Children

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  1. Healthy Environments, Homes, and Children

  2. History of Josiah Hill III Clinic • The Clinic was formed in 1997 by the community activist and physician assistant, Josiah Hill III.

  3. Working together to identify the “invisible threat” • Josiah and his colleague Rick Bayer, M.D. were concerned lead poisoning was going unnoticed and untreated. • Collaboration between PSR, COBM, and volunteers who began a free blood lead testing clinic. * After Josiah passed in 2000, the clinic was established as a non-profit and named after our founder.

  4. What Is Lead Poisoning? • The presence of lead in the body. • Lead can enter any cell so toxicity may occur in any tissue or organ.

  5. Lead Levels and Threshold Dose • Even small amounts of lead can cause severe and lasting harm, especially to children. No level of lead exposure is safe. • The Center for Disease Controls level of concern is 10 µg/dL for children and 25 µg/dL for adults. • Josiah Hill Clinic provides consultation and resources for levels over 5 µg/dL to help families reduce exposure sources and monitor levels.

  6. Lead Levels of Concern

  7. Exposure Pathways Inhaling lead dust Ingesting lead dust from hands, toys and other objects

  8. Exposure Sources • Remodeling • Lead based paint (pre-1978) chipping or flaking • Soil • Charms and jewelry • Toys • Glazes • Cultural home remedies

  9. Inhalation Ingestion 5-50% 30-50 % Metabolism of Lead Blood RBC Soft Tissue Central Nervous System Bone Marrow Kidney Bone Teeth ½ life-28-36 days Renal Excretion 1/2 life- 20 years 1/2 life-40 days

  10. What Happens When Lead Enters the Body? Enters the blood stream and circulates throughout body Body tries to excrete the lead Some deposits in soft tissues such as kidneys, lungs, brain, spleen, muscles and heart Remainder (majority) moves into bones and teeth (and some into hair)

  11. Lead In The Bloodstream Primarily distributed 3 compartments: Blood-carries only small fraction, but distributes lead through body Soft tissue-liver, lungs, kidneys highest lead concentration Mineralizing tissue-Most lead body burden in bones & teeth

  12. Biochemical Effects Lead inhibits or mimics the actions of calcium. This can affect calcium-dependent or related processes. Enzyme function decreases as lead binds with protein components of enzymes.

  13. Neuron Growth

  14. Neurologic Effects Encephalopathy-RARE. BLL’s > 70-80 μg/dL S/S: Hyperirritability, ataxia, convulsions, stupor, coma, death. Disruption of balance Impaired peripheral nerve function Hearing impairment

  15. Neuropsychological/behavioral IQ loss:average 4-7 point drop for every 10 μg/dL BLL increase. ADHD Deficits in vocabulary, fine motor skills, reaction time, hand-eye coordination Delinquent and aggressive behavior

  16. Lead inhibits hemoglobin synthesis This interferes with other heme-dependent processes Blood/hematologic Effects • Lead shortens the average lifespan of RBC’s

  17. Cardiovascular Effects Several epidemiological studies have linked lead to hypertension, including low lead level exposure and absence of classic symptoms. ECG abnormalities, degenerative changes in cardiac muscle.

  18. Renal Effects Proximal tubules of kidney are sensitive to lead levels > 25 µg/dl. Lead forms protein complexes that lead to fibrous connective tissue and gout.

  19. Colic is a consistent early symptom of exposure: abdominal pain constipation cramps nausea vomiting anorexia weight loss Gastrointestinal Effects

  20. Auditory: negative impact on auditory function. Endocrine: decreases in human growth hormone. Vitamin D metabolism: interferes with the conversion of vitamin D to its hormonal form. Growth: growth retardation in height, weight and chest circumference. Other Effects

  21. Reproductive Effects Decreased sperm count Increase of abnormal sperm Increased miscarriages, stillbirths and premature birth. Impotency

  22. Developmental Effects Reduced birth weight and growth. Negative impact on neurologic development. Minor congenital anomalies, including: skin anomalies and undescended testicles.

  23. Why Are Children At Greatest Risk? • Greater exposure • High “hand-to-mouth” activity • Crawling, chewing and sucking • Play in dirt and/or on floor • Higher lead absorption rate • Negative impact on nervous system development

  24. Critical Period of Development Most sensitive phase End of criticalperiod

  25. Blood Lead Patterns by Age

  26. The Warning Signs of Lead Poisoning • Lead poisoning is an invisible danger • Children with lead poisoning do not always look or act sick

  27. General fatigue and lethargy Hyperactivity and ADHD Irritability Colic Trouble sleeping Myalgia or paresthesia Headaches Tremor Signs & Symptoms

  28. Receiving a Test is the Only Way to Know…

  29. Lead Poisoning IS a Problem in Oregon • Estimated 1,000-2,000 children with elevated levels. In Portland, nearly 1 in every 50 children are poisoned each year and 1 in every 30 have dangerous levels. • Each year less than 10,000 (<5%) of all children under age 6 are actually tested. • Each year less than 5,000 adults are tested.

  30. Screening Guidelines • Eight questions to determine need for blood lead test. • Children should be assessed at 1 and 2 years of age. • Questionnaires available in different formats and languages.

  31. Diagnostic Lead Testing • Behavioral problems: aggression, hyperactivity, ADD, school and learning problems, pica behavior. • Developmental: growth, speech and language delays and/or hearing loss. • S/S consistent with lead poisoning: irritability, headaches, vomiting, seizures or other neurological symptoms, anemia, loss of appetite, colic. • Ingestion of foreign body.

  32. Blood Lead Testing • Blood lead testing is the only acceptable laboratory test. • Capillary-finger or heel stick. • Venous test-more accurate. • All capillary BLLs of 10 μg/dL or higher must have follow-up venous test.

  33. JHC’s mobile clinics • Provides convenient and accessible screening for families • Within Portland Area neighborhoods • Community centers, parenting classes, head starts, fairs and events, churches

  34. What happens with an elevated level? • Results are reported to Department of Human Services who work with local County Health Departments • Referrals to community resources to identify exposure source • Re-test in upcoming months to monitor level

  35. Identifying Environmental Hazards

  36. Chelation • Chelating agents are drugs that bind with heavy metals in the blood. • Does not improve neurological outcomes. • Side effects: Increased GI problems, bone-marrow & liver problems, strips necessary minerals-calcium,iron, zinc

  37. Reducing lead poisoning • Working together, especially through *cultural comptency * health (eduation and testing) * housing (controlling and reducing the sources) * policy (regulations and enforcement)

  38. Ways to become involved • Volunteer • Donate • Host an event • Spread the word

  39. Erin McNally, Executive Director www.jhillclinic.org *Thanks to Barbara Zeal and the Department of Human Services for providing slides and information* Josiah Hill III Clinic

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