Guidelines for the Identification and Management of Lead Exposure

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EstimateStudy Study of Prenatal Lead Levels Outcome Age atYear Study N ResultsSite Type Exposure (in µg/dL) Measure(s) OutcomeMeasuredReduced intellectualFull-scale IQ (FSIQ)as assessed usingthe Wechsler Multivariate regression analysisdevelopment GeometricMaternal Intelligence Scale showed IQ reduction associatedin children with Mexico City, Cohort mean 8.2;2006 150 BLL (12-20 for Children– 6-10 years with BLL increase (β = -1.45, 95%prenatal lead Mexico study 3.0–20.7, 5thweeks)Revised (WISC-R; CI = -4.75 to 2.00), but was notexposure (Schnaas et 95th percentileal. 2006)Spanish version) statistically significant (p = 0.42).under standardizedconditionsReduced intellectualFSIQ as assessed Multivariate regression analysisdevelopment GeometricMaternal using WISC-R; showed IQ reduction associatedin children with Mexico City, Cohort mean 7.8;2006 150 BLL (28-36 Spanish version 6-10 years with BLL increase (β = -4.00,prenatal lead Mexico study 2.5–24.6, 5thweeks)under standardized 95% CI = -6.37 to -1.65) and wasexposure (Schnaas et 95th percentileal. 2006)conditions statistically significant (p = 0.001).Reduced intellectualdevelopmentFSIQ as assessed Multivariate regression analysisMaternal using WISC-R; showed IQ reduction associatedin children with Mexico City, Cohort2006 112 BLL (at Not reported Spanish version 6-10 years with BLL increase (β = -1.29, 95%prenatal lead Mexico studyexposure (Schnaas etal. 2006)delivery) under standardized CI = -4.41 to 1.83) but was notconditions statistically significant (p = 0.41).Reduced intellectualdevelopmentFSIQ as assessed Multivariate regression analysisusing WISC-R; showed IQ reduction associatedin children with Mexico City, Cohort Umbilical2006 109 Not reported Spanish version 6-10 years with BLL increase (β = -0.95, 95%prenatal lead Mexico study cord BLLexposure (Schnaas etal. 2006)under standardized CI = -3.65 to 1.75) but was notconditions statistically significant (p = 0.49).15
EstimateStudy Study of Prenatal Lead Levels Outcome Age atYear Study N ResultsSite Type Exposure (in µg/dL) Measure(s) OutcomeMeasuredSchizophrenia(includesschizophrenia,Maternal Dichotomized schizoaff ectivePrenatal lead delta-ALA to estimated disorderexposure, delta from 2nd (from delta- schizophrenia,OR for schizophrenia associatedNested case 15-22 with exposure, corresponding to2004 aminolevulinic acid, Oakland, CA 119 trimester ALA) maternal schizotypalcontrol years 15 μg/dL of blood lead was 2.43and schizophrenia frozen BLLs in 2nd personality(Opler et al. 2004) blood trimester of disorder, delusionalsamples ≥15 and
Page 1 and 2: GUIDELINES FOR THE IDENTIFICATION A
Page 3 and 4: This document is dedicated to the m
Page 5 and 6: XIV Template for Letter to Construc
Page 8 and 9: EXECUTIVE SUMMARYDespite improvemen
Page 10 and 11: pregnant women with BLL
Page 12 and 13: MEMBERS OF THE WORK GROUP ON LEAD A
Page 14 and 15: MEMBERS OF THE ADVISORY COMMITTEE O
Page 16 and 17: Sally OdlePresident and Owner, Safe
Page 18 and 19: GLOSSARYabatement: any set of measu
Page 20 and 21: cumulative: increasing by successiv
Page 22 and 23: lead-safe work practices: low-techn
Page 24: enovation: construction and/or home
Page 27 and 28: Finally, there is evidence that a s
Page 30 and 31: CHAPTER 2.ADVERSE HEALTH EFFECTS OF
Page 32 and 33: lead exposure (Tabacova et al. 1994
Page 34 and 35: The strongest evidence to date is a
Page 36 and 37: Epidemiologic Evidence for Neurodev
Page 38 and 39: Table 2-1. Summary of Studies Estim
Page 44 and 45: EstimateStudy Study of Prenatal Lea
Page 52 and 53: CHAPTER 3.BIOKINETICS AND B
Page 54 and 55: this biomarker may be a useful rese
Page 56 and 57: Recent studies have documented that
Page 58: Figure 3-1. Major Lead Exposure Pat
Page 61 and 62: Additionally, recent evidence has s
Page 63 and 64: in the study population was 12%
Page 65 and 66: Mobilization of Endogenous Bone Lea
Page 67 and 68: Most of the published literature re
Page 69 and 70: On occasion, imported foods and foo
Page 71 and 72: Case Study 4-3. A Case of Lead Pois
Page 73 and 74: Table 4-1. Risk Factors for Lea
Page 76 and 77: CHAPTER 5.BLOOD LEAD TESTING
Page 78 and 79: Blood Lead Testing in the General P
Page 80 and 81: absorption spectrophotometry (GFAAS
Page 82 and 83: ally, the measured BLL of pregnant
Page 84 and 85: Table 5-2. Schedule for Follow-up B
Page 86 and 87: Figure 5-1. New York City Departmen
Page 88 and 89: CHAPTER 6.MANAGEMENT OF PRE
Page 90 and 91:
y providing information to health d
Page 92 and 93:
upon eliciting accurate information
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tivity that disturbs paint can incr
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Case management of pregnant women w
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Interpretation and follow-up of blo
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Table 6-2. Suggested Factors to Ass
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Decades of laboratory and clinical
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tion of skeletal mineral. Observati
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of follow up, suggesting decreased
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Supplemental Nutrition Program for
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Inadequate vitamin D status is comm
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CHAPTER 8.CHELATION OF PREGNANT
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CLINICAL EVIDENCE IN PREGNANCY AND
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Table 8-1. Chelating Agents Used
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Table 8-3. Published Experience wit
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CHAPTER 9.BREASTFEEDINGKey Consid
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maternal blood exceeds 40 µg/dL (L
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guidance for breastfeeding by women
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Table 9-1. Frequency of Maternal Bl
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Table 9-3. Estimated a Increase in
Page 132 and 133:
CHAPTER 10.RESEARCH, POLICY, AND HE
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Identification and development of n
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Mandatory Reporting of All Adult Bl
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CHAPTER 11. RESOURCES AND REFERRAL
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Offce of Pollution Prevention and T
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Marino PE, Landrigan PJ, Graef J, N
Page 144 and 145:
Dietrich KN, Ris MD, Succop PA, Ber
Page 146 and 147:
McMichael AJ, Vimpani GV, Robertson
Page 148 and 149:
Vigeh M, Yokoyama K, Mazaheri M, Be
Page 150 and 151:
Gulson BL, Jameson CW, Mahaffey KR,
Page 152 and 153:
Satin KP, Neutra RR, Guirguis G, Fl
Page 154 and 155:
Centers for Disease Control and Pre
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Lee MG, Chun OK, Song WO. 2005. Det
Page 158 and 159:
Simpson E, Mull JD, Longley E, East
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Rothenberg SJ, Khan F, Manalo M, Ji
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Piazza C, Fisher W, Hanley G, LeBla
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Godwin HA. 2001. The biological che
Page 166 and 167:
Looker AC, Loyevsky M, Gordeuk VR.
Page 168 and 169:
Willoughby RA, Thirapatsakun T, McS
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Bachrach VR, Schwarz E, Bachrach LR
Page 172 and 173:
U.S. Food and Drug Administration.
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Appendices 149
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Appendix IExisting State Legislatio
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Guidelines for the Identification &
Page 180 and 181:
Appendix IICharge Questions to the
Page 182 and 183:
Page 184 and 185:
Appendix IIICommonly Ingested Subst
Page 186 and 187:
Page 188 and 189:
Appendix IVList of Occupations and
Page 190 and 191:
Page 192 and 193:
Appendix VAlternative Cosmetics, Fo
Page 194 and 195:
Page 196 and 197:
Appendix VIRecommendations for Medi
Page 198 and 199:
Research | Mini-Monograph Recommend
Page 200 and 201:
Recommendations for medical manag
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Recommendations for medical manag
Page 204 and 205:
Recommendations for medical managem
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Recommendations for medical managem
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Appendix VIIMedical Management Guid
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Medical Management Guidelines for L
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Because lead interferes with bioche
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The clinician, with the patient’s
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i.e., at least monthly. In general,
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If elevated maternal blood lead is
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TABLE 2Non-occupational and Environ
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TABLE 4TABLE 4Health Based Health M
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Gulson BL, Mizon KJ, Korsch MJ, Pal
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Appendix VIIIPregnancy Risk Assessm
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EDC:_________________ID:___________
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ID:___________________________B. HO
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ID:___________________________10. I
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ID:___________________________14a.
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ID:___________________________G. NO
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ID:___________________________I. PA
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SUMMARYInstructions: Check all thos
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ID:___________________________APPEN
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Appendix IXAssessment Interview For
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RISK ASSESSMENT INTERVIEW FORMDate:
Page 248 and 249:
Appendix XLead Based Paint Risk Ass
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Lead-Based Paint Risk Assessment Re
Page 252 and 253:
(Use one of the following sentences
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Appendix ATesting Locations229
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Appendix CDust Wipe and Soil Sample
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Appendix XIPrimary Prevention Infor
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LI #:NEW YORK CITY DEPARTMENT OF HE
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LI #:8a. If yes >> Please tell me h
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Appendix XIIChild Risk Assessment F
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CHILD ID: Page 1 of 12PNEW YORK CIT
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CHILD ID: Page 3 of 126. Does [chil
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CHILD ID: Page 5 of 1217a. If yes >
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CHILD ID: Page 7 of 1224. [Imported
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CHILD ID: Page 9 of 12Home renovati
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CHILD ID: Page 11 of 12Provide the
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Appendix XIIINutritional Reference
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Nutrition Reference InformationRECO
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Blood hemoglobin levels are routine
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Beef, chuck, blade roast, lean, coo
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Sunflower oil, 1 TbspCottonseed oil
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Appendix XIVTemplate for Letter to
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Template for Letter to Construction
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Appendix XVWorkplace Hazard Alert f
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WORKPLACE HAZARD ALERTNew Health Da
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What should I tell my doctor?Your d
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Make sure you don’t accidentally
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Worksite Evaluation FormWhat your e
Page 302:
CS2016857
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Guidelines for the Identification and Management of Lead Exposure

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