1. Healthy Environments, Homes, and Children

2. History of Josiah Hill III Clinic The Clinic was formed in 1997 The Clinic was formed in 1997 by the community activist by the community activist and physician assistant, and physician assistant, Josiah Hill III. 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. Josiah and his colleague Rick Bayer, M.D. were concerned lead poisoning was going unnoticed and untreated. Collaboration between PSR, COBM, Collaboration between PSR, COBM, and volunteers who began a free blood lead testing clinic. 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. The presence of lead in the body. Lead can enter any cell so toxicity may occur in any tissue or organ. 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. 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. 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. 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 Inhaling lead dust Ingesting lead dust from hands, toys and other objects Ingesting lead dust from hands, toys and other objects

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

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

10. What Happens When Lead Enters the Body? Enters the blood stream and circulates throughout body Enters the blood stream and circulates throughout body Body tries to excrete the lead Body tries to excrete the lead Some deposits in soft tissues such as kidneys, lungs, brain, spleen, muscles and heart 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) 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 Blood-carries only small fraction, but distributes lead through body Soft tissue-liver, lungs, kidneys highest lead concentration Soft tissue-liver, lungs, kidneys highest lead concentration Mineralizing tissue-Most lead body burden in bones & teeth Mineralizing tissue-Most lead body burden in bones & teeth

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

13. Neuron Growth

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

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

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

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

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

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

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

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

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

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

24. Critical Period of Development End of critical period Most sensitive phase

25. Blood Lead Patterns by Age

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

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

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. 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 10,000 (<5%) of all children under age 6 are actually tested. Each year less than 5,000 adults are 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. Blood lead testing is the only acceptable laboratory test. Capillary-finger or heel stick. Capillary-finger or heel stick. Venous test-more accurate. Venous test-more accurate. All capillary BLLs of 10 μg/dL or higher must have follow-up venous test. All capillary BLLs of 10 μg/dL or higher must have follow-up venous test.

33. JHCs mobile clinics Provides convenient and accessible screening for families Provides convenient and accessible screening for families Within Portland Area neighborhoods Within Portland Area neighborhoods Community centers, parenting classes, head starts, fairs Community centers, parenting classes, head starts, fairs and events, churches 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 Results are reported to Department of Human Services who work with local County Health Departments Referrals to community resources to identify exposure source Referrals to community resources to identify exposure source Re-test in upcoming months to monitor level 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 Working together, especially through *cultural comptency *cultural comptency * health (eduation and testing) * health (eduation and testing) * housing (controlling and * housing (controlling and reducing the sources) reducing the sources) * policy (regulations and * policy (regulations and enforcement) enforcement)

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

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