60-fr occupational medicine garman · rayay ga a , f. garman, md mph department of preventive...

EnvironmentalEnvironmental ChallangesChallanges

Bisphenol A (BPA)M ld th/illMold growth/illnessLead extent/illnessLead extent/illness

Ray F. Garman, MD MPHay Ga a ,

Department of Preventive Medicine and EnvironmentalMedicine and Environmental

HealthUK C ll f P bli H lthUK College of Public Health

BISPHENOL ABISPHENOL A

In polycarbonate plastics, including someIn polycarbonate plastics, including some water bottles and baby bottles, & lining of some canned goodsg

FDA:: “Safe at typical exposure levels fromFDA:: Safe at typical exposure levels from food and drink”FDA Final Report is not out yet; noFDA Final Report is not out yet; no comment yet about hormone effects specificallyp y


American Chemistry Council (Plastic y (Industry Trade Group): If FDA determines that existing margins of safety are g g yinsufficient in infant applications, we will promptly phase out use of BPA in baby p p y p ybottles and infant formula packaging


Natural Resources Defense Council: (NRDC):

FDA has consistently ignored science and sound policy It’s time for the FDA toand sound policy…It s time for the FDA to protect infants and pregnant women.


FDA “ lFDA: “… present consensus among regulatory agencies in the United States, Canada, Europe, and Japan is that current levels of exposure toand Japan is that current levels of exposure to BPA through food packaging do not pose an immediate risk to the general population,immediate risk to the general population, including infants and babies”


CANADA (late October): BPA banned in baby bottles

FDA: Canadian action taken “out of abundance of caution” No proof of harm to babies with typical exposure to BPAto BPA


In polycarbonate plastics, including someIn polycarbonate plastics, including some water bottles and baby bottles, & lining of some canned goodsg

FDA:: “Safe at typical exposure levels fromFDA:: Safe at typical exposure levels from food and drink”FDA Final Report is not out yet; noFDA Final Report is not out yet; no comment yet about hormone effects specificallyp y


WHAT TO TELL–WHAT TO TELL PATIENTS:PATIENTS:

–Still a questionable exposureexposure

ACOEM HHE with Indoor MoldsACOEM HHE with Indoor MoldsACOEM HHE with Indoor MoldsACOEM HHE with Indoor Molds

Important Allergens:Important Allergens:Important Allergens:Important Allergens:5% with allergic airway symptoms lifetime5% with allergic airway symptoms lifetimeMay produce MycotoxinsMay produce MycotoxinsMay produce MycotoxinsMay produce Mycotoxins

“Current scientific evidence does not support the“Current scientific evidence does not support theCurrent scientific evidence does not support the Current scientific evidence does not support the proposition that human health has been proposition that human health has been adversely affected by inhaled mycotoxins in adversely affected by inhaled mycotoxins in ad e se y a ected by a ed ycoto sad e se y a ected by a ed ycoto shome, school, or office environments.”home, school, or office environments.”

MOLD GROWTHMOLD GROWTHMOLD GROWTHMOLD GROWTH

Hydroscopic surfaces supportHydroscopic surfaces supportHydroscopic surfaces support Hydroscopic surfaces support growth, even clay brick and growth, even clay brick and

t if i t it if i t icement if moisture is cement if moisture is sufficiently absorbedsufficiently absorbed

>3>3 4 Molecule depth of water4 Molecule depth of water>3>3--4 Molecule depth of water 4 Molecule depth of water required to allow droplets to runrequired to allow droplets to run

IOM Summary of FindingsIOM Summary of Findingsthe Association between Health Outcomes &the Association between Health Outcomes &the Association between Health Outcomes & the Association between Health Outcomes &

Exposure to Damp Indoor Environments Exposure to Damp Indoor Environments

DAMP INDOOR DAMP INDOOR SPACESSPACES

National Academies National Academies PressPressPressPress

Washington, DC Washington, DC 2004200420042004

Particle Board release ofParticle Board release ofParticle Board release of Particle Board release of Formaldehyde is increased with Formaldehyde is increased with yy

increased Relative Humidityincreased Relative Humidity

PVC backing on carpet tiles PVC backing on carpet tiles increases release of alcohols with increases release of alcohols with

increased Relative Humidityincreased Relative Humidityincreased Relative Humidity increased Relative Humidity

Association between Health Association between Health Outcomes and Damp Indoor Outcomes and Damp Indoor

EnvironmentsEnvironmentsEnvironmentsEnvironments

Damp Space Associations:Damp Space Associations:CausalCausal RelationshipRelationshipCausalCausal RelationshipRelationship

NONENONE

Association between Health Association between Health Outcomes and Damp indoorOutcomes and Damp indoorOutcomes and Damp indoor Outcomes and Damp indoor

EnvironmentsEnvironments

LimitedLimited or or SuggestiveSuggestive EvidenceEvidence

DyspneaDyspneaAsthma developmentAsthma developmentAsthma developmentAsthma developmentLower Respiratory Illness in Lower Respiratory Illness in

otherwise healthy childrenotherwise healthy childrenotherwise healthy children otherwise healthy children

Association between Health Association between Health Outcomes and Damp indoorOutcomes and Damp indoorOutcomes and Damp indoor Outcomes and Damp indoor

EnvironmentsEnvironmentsInadequateInadequate or or InsufficientInsufficient of Associationof Association

Airflow Obstruction in otherwise healthy Airflow Obstruction in otherwise healthy personspersonspersonspersonsCOPDCOPDN O ti l I h l ti FN O ti l I h l ti FNon Occupational Inhalation FeversNon Occupational Inhalation FeversLower Respiratory illness in otherwise Lower Respiratory illness in otherwise

healthy adultshealthy adults

Association between Health Outcomes and Association between Health Outcomes and D i d E i tD i d E i tDamp indoor Environments:Damp indoor Environments:

InadequateInadequate or or InsufficientInsufficient AssociationAssociationAcute Idiopathic Pulmonary Hemorrhage Acute Idiopathic Pulmonary Hemorrhage in Infantsin Infants

Mucous Membrane Irritation Syndrome Mucous Membrane Irritation Syndrome yySkin, GI, Neuropsychiatric, Reproductive Skin, GI, Neuropsychiatric, Reproductive

symptomssymptomssymptomssymptomsFatigueFatigueCCCancerCancerRheumatologic & other immune diseases Rheumatologic & other immune diseases

Association between Health Association between Health Outcomes with Mold and otherOutcomes with Mold and otherOutcomes with Mold and other Outcomes with Mold and other

Agents in Damp Indoor Agents in Damp Indoor EnvironmentsEnvironments

Damp Space Associations:Damp Space Associations:CausalCausal RelationshipRelationshipCausalCausal RelationshipRelationship

NONENONE

Association between Health Association between Health Outcomes and Mold or otherOutcomes and Mold or otherOutcomes and Mold or other Outcomes and Mold or other

agents in Damp Environmentsagents in Damp Environments

Sufficient Evidence of AssociationSufficient Evidence of Association

Nose & Throat SymptomsNose & Throat SymptomsWheezeWheezeWheezeWheezeCoughCoughAsthma Sx in sensitized asthmatic personsAsthma Sx in sensitized asthmatic personsAsthma Sx in sensitized asthmatic personsAsthma Sx in sensitized asthmatic personsHypersensitivity Pneumonitis in susceptibles Hypersensitivity Pneumonitis in susceptibles


agents in Damp Environmentsagents in Damp Environments

LimitedLimited or or SuggestiveSuggestive AssociationAssociation

Lower Respiratory Illness in Lower Respiratory Illness in otherwise healthy childrenotherwise healthy childrenotherwise healthy childrenotherwise healthy children


agents in Damp Environmentsagents in Damp EnvironmentsInadequate or Insufficient EvidenceInadequate or Insufficient Evidence--DyspneaDyspnea

--Airflow obstruction in otherwise healthy personsAirflow obstruction in otherwise healthy persons-- COPDCOPD

Non occupational inhalation feversNon occupational inhalation fevers--Non occupational inhalation feversNon occupational inhalation fevers-- Lower Respiratory Illness in otherwiseLower Respiratory Illness in otherwise

Healthy adultsHealthy adultsHealthy adultsHealthy adultsAcute Idiopathic Pulmonary Hemorrhage in Infants Acute Idiopathic Pulmonary Hemorrhage in Infants

Association between Biological &Association between Biological &Association between Biological & Association between Biological & Chemical Exposures and Chemical Exposures and

Exacerbation of Asthma in Exacerbation of Asthma in Sensitive PersonsSensitive PersonsSensitive PersonsSensitive Persons

From:From: Clearing the AirClearing the AirFrom: From: Clearing the AirClearing the AirIOMIOM20002000

ASTHMA ASTHMA SSOC O / O SSSOC O / O SASSOCIATION/RELATIONSHIPASSOCIATION/RELATIONSHIP

Biological Agents Chemical AgentsBiological Agents Chemical Agents

Sufficient Evidence of Causal RelationshipSufficient Evidence of Causal Relationship

Cat ETS in preschoolersCat ETS in preschoolersCockroachCockroachHouse Dust Mite House Dust Mite

ASTHMA ASSOCIATION/RELATIONSHIP

Biological ChemicalBiological Chemical

ASSOCIATION/RELATIONSHIP

Biological ChemicalBiological Chemical

Sufficient evidence of an AssociationSufficient evidence of an AssociationSufficient evidence of an AssociationSufficient evidence of an AssociationDog Dog NONOxx NONO22

Rhinoviruses Rhinoviruses

ASSOCIATION/RELATIONSHIP

Biological ChemicalBiological ChemicalASTHMA

Limited Evidence of an AssociationLimited Evidence of an AssociationDomestic Birds ETS is school age adultsDomestic Birds ETS is school age adultsDomestic Birds ETS is school age, adults Domestic Birds ETS is school age, adults

Chlamydia trachoma is FormaldehydeChlamydia trachoma is FormaldehydeMycoplasma pneumoniae FragrancesMycoplasma pneumoniae FragrancesMycoplasma pneumoniae FragrancesMycoplasma pneumoniae FragrancesRSVRSV

BiologicalBiological ChemicaChemicallInadequate or Insufficient Evidence for Inadequate or Insufficient Evidence for AssociationAssociation

Cow, horse PesticidesCow, horse PesticidesRodents PlasticizersRodents PlasticizersChlamydia Trachomatis Chlamydia Trachomatis HouseplantsHouseplantsppPollen ExposurePollen Exposure

(in indoor environment) (in indoor environment) Insects other than CockroachesInsects other than CockroachesInsects other than Cockroaches Insects other than Cockroaches

Inadequate Evidence of Inadequate Evidence of AssociationAssociation

MM M b I it ti S dM b I it ti S dMucousMucous Membrane Irritation SyndromeMembrane Irritation SyndromeSkin ,GI, Neuropsychiatric, Reproductive SxSkin ,GI, Neuropsychiatric, Reproductive SxFatigueFatigueCancerCancerRheumatologic & other immune diseasesRheumatologic & other immune diseases

Presence of fungus does not indicate moldPresence of fungus does not indicate moldPresence of fungus does not indicate mold Presence of fungus does not indicate mold damagedamage

“Indicator Fungi” that exceed outdoor “Indicator Fungi” that exceed outdoor t ti i di tt ti i di t M ld C l i tiM ld C l i ticoncentration indicate concentration indicate Mold ColonizationMold Colonization

ASTHMA ASTHMA ASSOCIATION/RELATIONSHIPASSOCIATION/RELATIONSHIP

Other IOther Impactsmpacts not Addressednot AddressedOther IOther Impactsmpacts not Addressednot AddressedHouse Dust MitesHouse Dust MitesVirusesVirusesTobacco SmokeTobacco SmokeCockroachesCockroachesPesticidesPesticidesNONO22 NONOxx

See IOM Report See IOM Report Clearing the Air, 2000Clearing the Air, 2000Indoor Allergens, 1993Indoor Allergens, 1993g ,g ,

Indicator Fungi:Indicator Fungi:Indicator Fungi:Indicator Fungi:

******Aspergillus fumigatusAspergillus fumigatusAspergillus fumigatus Aspergillus fumigatus A. versicolorA. versicolorA penecilloides Actinomyctes A penecilloides Actinomyctes

Gram Negative BacteriaGram Negative BacteriaGram Negative BacteriaGram Negative Bacteria***Penecillium***Penecillium

^Stachybotrys chartarum^Stachybotrys chartarum^Chartomium PLUS: ^Chartomium PLUS: Trichoderma sp. ActinomyctesTrichoderma sp. ActinomyctesUrocladum sp. Gram Neg BacteriaUrocladum sp. Gram Neg BacteriaUrocladum sp. Gram Neg Bacteria Urocladum sp. Gram Neg Bacteria

Some Mold Toxic ProductsSome Mold Toxic ProductsSome Mold Toxic ProductsSome Mold Toxic Products

Fusarium producing DONFusarium producing DONFusarium producing DON Fusarium producing DON (deoxynivalenol); called vomitoxin(deoxynivalenol); called vomitoxin

OTA (ochratoxin A); leads to DNA breaksOTA (ochratoxin A); leads to DNA breaks

AFBAFB11 (Aflatoxin); leads to expoxide through (Aflatoxin); leads to expoxide through PP450450 SystemSystemPP450450 System System

“Hypersensitivity Pneumonitis Antigens” “Hypersensitivity Pneumonitis Antigens” yp y gyp y gTesting (IgG Antibodies) of limited prognostic Testing (IgG Antibodies) of limited prognostic Values, rather indicators of exposure. Values, rather indicators of exposure.

Perhaps better test is StachylsenPerhaps better test is Stachylsen(protein hemolysin) as indicator of exposure to(protein hemolysin) as indicator of exposure to(protein hemolysin) as indicator of exposure to (protein hemolysin) as indicator of exposure to

Stachybotrys chartarum, [not the same as Stachybotrys chartarum, [not the same as satratoxin H a trichothecene]satratoxin H a trichothecene]satratoxin H, a trichothecene]satratoxin H, a trichothecene]

Bacteria Genera Isolates from Building Materials:Bacteria Genera Isolates from Building Materials:AcinatobacterAcinatobacterBacillus NocardiaBacillus NocardiaClavibacter StreptomycesClavibacter StreptomycesCorybacterium ThermonosporiaCorybacterium ThermonosporiaFlavo BacteriumFlavo BacteriumMycobacteriaMycobacteria

Remediation TasksRemediation TasksRemediation TasksRemediation Tasks

STOP Water IntrusionSTOP Water IntrusionIdentify Vulnerable PopulationsIdentify Vulnerable Populationsy py pDetermine Extent & Location of Determine Extent & Location of

Fungal ContaminationFungal Contamination(i.e. water and nutrients)(i.e. water and nutrients)

Identify Moisture DynamicIdentify Moisture DynamicControl source of moisture and nutrientsControl source of moisture and nutrients

after initial remediationafter initial remediation

DECONTAMINATION OF MOLDDECONTAMINATION OF MOLD--11DECONTAMINATION OF MOLDDECONTAMINATION OF MOLD 11

(Work site example)(Work site example)(Work site example)(Work site example)Internal Capsule in large room; wiped withInternal Capsule in large room; wiped withf i id i di t lf i id i di t lfungicide immediatelyfungicide immediatelyAir lock at both ends, 4 chambersAir lock at both ends, 4 chambersHazHaz Mat SuitsMat Suits


(Work site example)(Work site example)(Work site example)(Work site example)Office items into Chamber #1Office items into Chamber #1M d F i id it i #2M d F i id it i #2Move, and Fungicide items in #2Move, and Fungicide items in #2Move, and HEPA vacuum in #3Move, and HEPA vacuum in #3Move, Move, rewiperewipe in #4in #4Out of airlock for inspection possiblyOut of airlock for inspection possiblyOut of airlock for inspection, possiblyOut of airlock for inspection, possibly

repassagerepassage


(Work site example)(Work site example)(Work site example)(Work site example)DISCARD: Plants, Paper, insulation ceiling DISCARD: Plants, Paper, insulation ceiling tiles insulationtiles insulationtiles, insulationtiles, insulationCLEAN: Drip pans, Office Machines, CLEAN: Drip pans, Office Machines, C t U h l t d tC t U h l t d tCarpets, Upholstered seatsCarpets, Upholstered seats

Rye Grass StaggersRye Grass StaggersRye Grass StaggersRye Grass Staggers

ld t i t d f d t h dld t i t d f d t h dmold contaminated feed to herd mold contaminated feed to herd animalsanimals

ASTHMA ASTHMA SSOC O / O SSSOC O / O SASSOCIATION/RELATIONSHIPASSOCIATION/RELATIONSHIP

Mucous Membrane Irritation SyndromeMucous Membrane Irritation Syndromeyy(MMI):(MMI):

RhinorrheaRhinorrheaNasal CongestionNasal CongestionSore ThroatSore Throat

(?Inflammatory Cytokine based) (?Inflammatory Cytokine based)

A M ld Q ti ?A M ld Q ti ?Any Moldy Questions?Any Moldy Questions?

Heavy lead is not always musicHeavy lead is not always music

Lead PoisoningLead PoisoningLead has no known biological function.Lead has no known biological function.

Lead PbLead Pb++++, competes with Ca, competes with Ca++++, Fe, Fe++++

It is cheap, useful, easy to mine, thereforeIt is cheap, useful, easy to mine, thereforeIt is cheap, useful, easy to mine, thereforeIt is cheap, useful, easy to mine, thereforeLead is ubiquitousLead is ubiquitous-- in air, food, water, soil, ceilings in air, food, water, soil, ceilings etc.etc.

There is no consensus for safe lower limit for lead.There is no consensus for safe lower limit for lead.

4848

Number of new cases with blood lead levels Number of new cases with blood lead levels >> 25 25 g/g/dLdL that occurred among 100,000 employed that occurred among 100,000 employed

d lt 16d lt 16 64 ld i 2005 N ll t64 ld i 2005 N ll tadults 16adults 16--64 years old in 2005. Null category 64 years old in 2005. Null category states did not report.states did not report.

Uses and Sources of Uses and Sources of LeadLead

Paint (until 1970)Paint (until 1970)Household dust (via settlement of airHousehold dust (via settlement of airHousehold dust (via settlement of air Household dust (via settlement of air

pollution, paint removal)pollution, paint removal)C ili d tC ili d tCeiling dustCeiling dustOccupationalOccupationalSolderSolderCeramic glazesCeramic glazes

5050

Ceramic glazesCeramic glazesMines, smeltersMines, smelters

More Uses and More Uses and Sources of Lead Sources of Lead

TV's, Computer monitorsTV's, Computer monitorsBatteries, Bullets SinkersBatteries, Bullets SinkersAviationAviationXX--ray shieldsray shieldsCrystalCrystal--ware (high levels in decanters)ware (high levels in decanters)ExplosivesExplosivesNN ti k li i f t (i th t)ti k li i f t (i th t)NonNon--stick linings of pots (in the past)stick linings of pots (in the past)Plastic colouring (wire, blinds)Plastic colouring (wire, blinds)PewterPewter

5151

PewterPewter

Home Lead TestingHome Lead TestingHome Lead TestingHome Lead Testing

Reduction of Lead Reduction of Lead hazards in the homehazards in the home

5353

Absorption of LeadAbsorption of Lead

5454

Absorption of Absorption of LeadLead

Lead goes down iron or calcium absorption pathway in Lead goes down iron or calcium absorption pathway in g p p yg p p yGIT.GIT.Children absorb lead well orally (~50%) cf adults poorly Children absorb lead well orally (~50%) cf adults poorly ( 10%) Child l h h d t th ti it( 10%) Child l h h d t th ti it(~10%). Children also have more hand to mouth activity.(~10%). Children also have more hand to mouth activity.Lead absorption is enhanced if diet is poor in iron or Lead absorption is enhanced if diet is poor in iron or calcium.calcium.calcium.calcium.Pica is one of the worst risk factors.Pica is one of the worst risk factors.Lead can be inhaled.Lead can be inhaled.[Tetraethyl lead can be absorbed via skin].[Tetraethyl lead can be absorbed via skin].

S:S:\\LeadgpcLeadgpc\\BB Lead Poisoning.pptBB Lead Poisoning.ppt 5555

Contribution ofContribution ofSourcesSourcesSourcesSources

5656

Distribution ofDistribution ofDistribution of Distribution of LeadLead

95% long bones.95% long bones.Binds into matrix.Binds into matrix.R l d d iR l d d iReleased during Released during osteolysis.osteolysis.4% brain,liver, kidneys.4% brain,liver, kidneys.4% brain,liver, kidneys.4% brain,liver, kidneys.1% blood.1% blood.Crosses placenta, foetal Crosses placenta, foetal

5757

BBB is openBBB is open

Release of lead during Release of lead during osteolysisosteolysis

Pregnancy increases mobilization of lead from Pregnancy increases mobilization of lead from maternal skeletonmaternal skeletonGulson BL, Jameson CW, Mahaffey KR, Mizon KJ, Korsch MJ, Vimpani G.. J Lab Clin Med 1997a;130:51Gulson BL, Jameson CW, Mahaffey KR, Mizon KJ, Korsch MJ, Vimpani G.. J Lab Clin Med 1997a;130:51--62 62 yy

Mobilization of lead from the skeleton during the postMobilization of lead from the skeleton during the post--natal period is larger than duringnatal period is larger than during ppregnancyregnancy..Gulson BL, Mahaffey KR, Jameson CW, Mizon KJ, Korsch MJ, Cameron MA, Eisman JA. J Lab Clin Med Gulson BL, Mahaffey KR, Jameson CW, Mizon KJ, Korsch MJ, Cameron MA, Eisman JA. J Lab Clin Med yy1998a;131:3241998a;131:324--99

Lead is released in menopausal bone lossLead is released in menopausal bone lossLead levels have second peak in middle ageLead levels have second peak in middle age-- more inmore inLead levels have second peak in middle ageLead levels have second peak in middle age more in more in men than women (NHANES 3).men than women (NHANES 3).Lead follows calcium into and out of bone.Lead follows calcium into and out of bone.

5858

Lead movementLead movement

In childhood, blood lead levels reflect In childhood, blood lead levels reflect the environmental lead level ie the environmental lead level ie exogenousexogenous lead. Protection requires lead. Protection requires placing barriers between the child and placing barriers between the child and p gp gthe lead.the lead.In adults lead levels reflect the releaseIn adults lead levels reflect the releaseIn adults, lead levels reflect the release In adults, lead levels reflect the release of of endogenousendogenous lead from bone, as well lead from bone, as well as the intake ofas the intake of exogenousexogenous leadlead

5959

as the intake of as the intake of exogenousexogenous lead. lead. Protection requires prevention of Protection requires prevention of exposure plus preservation of boneexposure plus preservation of bone

Data from the US NHANES 3 study showing Data from the US NHANES 3 study showing the second peak of lead levels in adulthood. the second peak of lead levels in adulthood. Hi h d lt l l l fl t tiHi h d lt l l l fl t tiHigher adult male levels reflect occupation Higher adult male levels reflect occupation and hobby. High risk occupations would be and hobby. High risk occupations would be

even higher. Women get a posteven higher. Women get a post--menopausal menopausal peak.peak.

6060

Lead and Race. Data from the UIS Lead and Race. Data from the UIS NHANES 3 study showing differences NHANES 3 study showing differences

with racewith race probably reflectingprobably reflectingwith race with race ––probably reflecting probably reflecting differences in accommodation and differences in accommodation and

occupationoccupation

6161

U S Lead Situation 1U S Lead Situation 1U.S. Lead Situation 1U.S. Lead Situation 11.1. 1978 Lead banned from paint1978 Lead banned from paintpp2.2. 1980's1980's-- Levels higher than AustraliaLevels higher than Australia3.3. Late 1980's Removal of lead from gasolineLate 1980's Removal of lead from gasoline44 1980' U i l ti i i1980' U i l ti i i4.4. 1980's Universal questionnaire screening1980's Universal questionnaire screening5.5. 1991 Universal blood testing1991 Universal blood testing6.6. 1990's Public housing program1990's Public housing program66 990 s ub c ous g p og a990 s ub c ous g p og a7.7. 1990's Private housing program1990's Private housing program8.8. 1990's Massive EPA environmental program1990's Massive EPA environmental program

6262

Health Health Eff t fEff t fEffects of Effects of

LeadLeadeadeadConcentration Concentration relatedrelatedIQ/ delinquency IQ/ delinquency related to total related to total dosage in childhooddosage in childhood

6363

dosage in childhooddosage in childhood

Symptoms from lead are rare!Symptoms from lead are rare!Symptoms from lead are rare!Symptoms from lead are rare!

6464

Lead and Lead and NeurodevelopmentNeurodevelopment

Each 0.48 µmol/l(10µg/dl)Each 0.48 µmol/l(10µg/dl) in children.in children.µ ( µg )µ ( µg )= 4 to 7 IQ points (US Acad. Pediatrics).= 4 to 7 IQ points (US Acad. Pediatrics).Industry/ Industry/ Australian Australian government consensusgovernment consensusof 3of 3 55 IQ pointsIQ pointsof 3of 3--55 IQ points.IQ points.Effects on behaviour are FAR WORSE.Effects on behaviour are FAR WORSE.Delinquency rates are 8 times higher in the top 30% Delinquency rates are 8 times higher in the top 30% of bone lead. Needleman 1996.of bone lead. Needleman 1996.Needleman, Herbert L. et al, "Bone Lead Levels and Delinquent Behavior," JOURNAL OF THE AMERICAN Needleman, Herbert L. et al, "Bone Lead Levels and Delinquent Behavior," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Vol. 275, No. 5 (February 7, 1996), pgs.363MEDICAL ASSOCIATION Vol. 275, No. 5 (February 7, 1996), pgs.363--369.369.

Measurable adverse behaviour changes in 2 yearMeasurable adverse behaviour changes in 2 yearMeasurable adverse behaviour changes in 2 year Measurable adverse behaviour changes in 2 year olds Mendelsohn 1999. olds Mendelsohn 1999. Alan L. Mendelsohn, Benard P. Dreyer, Arthur H. Fierman, Alan L. Mendelsohn, Benard P. Dreyer, Arthur H. Fierman, Carolyn M. Rosen, Lori A. Legano, Hillary A. Kruger, Sylvia W. Lim, and Cheryl D. Courtlandt "Carolyn M. Rosen, Lori A. Legano, Hillary A. Kruger, Sylvia W. Lim, and Cheryl D. Courtlandt "LowLow--Level Level Lead Exposure and Behavior in Early Childhood“Lead Exposure and Behavior in Early Childhood“ PPediatrics 1998; 101: e10 ediatrics 1998; 101: e10

6565

Lead and IQLead and IQ

6666

Lead and the ElderlyLead and the ElderlyLead and the ElderlyLead and the Elderly

Risk of dementia increases with leadRisk of dementia increases with leadRisk of dementia increases with lead Risk of dementia increases with lead burdenburdenRisk of accidental lead ingestionRisk of accidental lead ingestionRisk of accidental lead ingestionRisk of accidental lead ingestion

6767

Unresolved QuestionsUnresolved QuestionsUnresolved QuestionsUnresolved Questions

How much does lead contribute toHow much does lead contribute toHow much does lead contribute to How much does lead contribute to cognitive decline and Alzheimer’s cognitive decline and Alzheimer’s disease?disease?disease?disease?Do bone preserving therapies or calcium Do bone preserving therapies or calcium supplements reduce cognitive decline?supplements reduce cognitive decline?supplements reduce cognitive decline?supplements reduce cognitive decline?Is lead a modifiable risk factor for Is lead a modifiable risk factor for d ti ?d ti ?dementia?dementia?

6868

Childhood Risk FactorChildhood Risk FactorQuestionnaireQuestionnaireQuestionnaireQuestionnaire

Does your child….

H b h i h NHave a brother or sister, housemate or playmate with an elevated blood lead level?

No Yes

Sometimes eat non-food items such as soil or i t?

No Ypaint? Yes

Have any of the following conditions NoHave any of the following conditions sometimes associated with lead poisoning, eg iron deficiency anaemia, behaviour problem, learning problem or developmental delay?

No Yes

learning problem or developmental delay?

60-fr occupational medicine garman · rayay ga a , f. garman, md mph department of preventive...

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