The CDC blood lead reference value for children: time for a change View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-12

AUTHORS

Jerome A. Paulson, Mary Jean Brown

ABSTRACT

The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful. More... »

PAGES

16

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12940-019-0457-7

DOI

http://dx.doi.org/10.1186/s12940-019-0457-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112463418

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30819209


Indexing Status Check whether this publication has been indexed by Scopus and Web Of Science using the SN Indexing Status Tool
Incoming Citations Browse incoming citations for this publication using opencitations.net

JSON-LD is the canonical representation for SciGraph data.

TIP: You can open this SciGraph record using an external JSON-LD service: JSON-LD Playground Google SDTT

[
  {
    "@context": "https://springernature.github.io/scigraph/jsonld/sgcontext.json", 
    "about": [
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/1117", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Public Health and Health Services", 
        "type": "DefinedTerm"
      }, 
      {
        "id": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/11", 
        "inDefinedTermSet": "http://purl.org/au-research/vocabulary/anzsrc-for/2008/", 
        "name": "Medical and Health Sciences", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Centers for Disease Control and Prevention (U.S.)", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Child", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Environmental Exposure", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Environmental Pollutants", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Humans", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Lead", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Lead Poisoning", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Primary Prevention", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "Reference Values", 
        "type": "DefinedTerm"
      }, 
      {
        "inDefinedTermSet": "https://www.nlm.nih.gov/mesh/", 
        "name": "United States", 
        "type": "DefinedTerm"
      }
    ], 
    "author": [
      {
        "affiliation": {
          "alternateName": "George Washington University", 
          "id": "https://www.grid.ac/institutes/grid.253615.6", 
          "name": [
            "George Washington University School of Medicine & Health Sciences, and George Washington University Milken Institute School of Public Health, 1113 N Howard St, 22304-1627, Alexandria, VA, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Paulson", 
        "givenName": "Jerome A.", 
        "type": "Person"
      }, 
      {
        "affiliation": {
          "alternateName": "Harvard University", 
          "id": "https://www.grid.ac/institutes/grid.38142.3c", 
          "name": [
            "Harvard TH Chan School of Public Health, 665 Huntington Ave, 02115, Boston, MA, USA"
          ], 
          "type": "Organization"
        }, 
        "familyName": "Brown", 
        "givenName": "Mary Jean", 
        "type": "Person"
      }
    ], 
    "citation": [
      {
        "id": "https://doi.org/10.1016/j.scitotenv.2004.11.021", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1009900865"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1371/journal.pmed.0050115", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1022126963"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1542/peds.2004-2880", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1067824161"
        ], 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://app.dimensions.ai/details/publication/pub.1078712054", 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://app.dimensions.ai/details/publication/pub.1078816437", 
        "type": "CreativeWork"
      }, 
      {
        "id": "https://doi.org/10.1542/peds.2017-0272", 
        "sameAs": [
          "https://app.dimensions.ai/details/publication/pub.1090764477"
        ], 
        "type": "CreativeWork"
      }
    ], 
    "datePublished": "2019-12", 
    "datePublishedReg": "2019-12-01", 
    "description": "The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5\u2009\u03bcg/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels <\u20094\u2009\u03bcg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.", 
    "genre": "non_research_article", 
    "id": "sg:pub.10.1186/s12940-019-0457-7", 
    "inLanguage": [
      "en"
    ], 
    "isAccessibleForFree": false, 
    "isPartOf": [
      {
        "id": "sg:journal.1327425", 
        "issn": [
          "1476-069X"
        ], 
        "name": "Environmental Health", 
        "type": "Periodical"
      }, 
      {
        "issueNumber": "1", 
        "type": "PublicationIssue"
      }, 
      {
        "type": "PublicationVolume", 
        "volumeNumber": "18"
      }
    ], 
    "name": "The CDC blood lead reference value for children: time for a change", 
    "pagination": "16", 
    "productId": [
      {
        "name": "readcube_id", 
        "type": "PropertyValue", 
        "value": [
          "b8ba26fdb7a00cf47aa5362a5f01a30538a9c523434dd97eef57b980f8050ae9"
        ]
      }, 
      {
        "name": "pubmed_id", 
        "type": "PropertyValue", 
        "value": [
          "30819209"
        ]
      }, 
      {
        "name": "nlm_unique_id", 
        "type": "PropertyValue", 
        "value": [
          "101147645"
        ]
      }, 
      {
        "name": "doi", 
        "type": "PropertyValue", 
        "value": [
          "10.1186/s12940-019-0457-7"
        ]
      }, 
      {
        "name": "dimensions_id", 
        "type": "PropertyValue", 
        "value": [
          "pub.1112463418"
        ]
      }
    ], 
    "sameAs": [
      "https://doi.org/10.1186/s12940-019-0457-7", 
      "https://app.dimensions.ai/details/publication/pub.1112463418"
    ], 
    "sdDataset": "articles", 
    "sdDatePublished": "2019-04-11T13:17", 
    "sdLicense": "https://scigraph.springernature.com/explorer/license/", 
    "sdPublisher": {
      "name": "Springer Nature - SN SciGraph project", 
      "type": "Organization"
    }, 
    "sdSource": "s3://com-uberresearch-data-dimensions-target-20181106-alternative/cleanup/v134/2549eaecd7973599484d7c17b260dba0a4ecb94b/merge/v9/a6c9fde33151104705d4d7ff012ea9563521a3ce/jats-lookup/v90/0000000368_0000000368/records_78934_00000001.jsonl", 
    "type": "ScholarlyArticle", 
    "url": "https://link.springer.com/10.1186%2Fs12940-019-0457-7"
  }
]
 

Download the RDF metadata as:  json-ld nt turtle xml License info

HOW TO GET THIS DATA PROGRAMMATICALLY:

JSON-LD is a popular format for linked data which is fully compatible with JSON.

curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1186/s12940-019-0457-7'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1186/s12940-019-0457-7'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1186/s12940-019-0457-7'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1186/s12940-019-0457-7'


 

This table displays all metadata directly associated to this object as RDF triples.

132 TRIPLES      21 PREDICATES      45 URIs      31 LITERALS      19 BLANK NODES

Subject Predicate Object
1 sg:pub.10.1186/s12940-019-0457-7 schema:about N0b124868531b43529f550b7fb2b0325f
2 N149df346647346829239c4317f936085
3 N22dbc780460349c080ef039acbe9a323
4 N36ebdbbcb34447f299693eba51fb9689
5 N3e5dce0821544f889cf35f7d424af062
6 N72cf39acc2d343939cd2c4445dd35fcf
7 N73fe4d664a3d43f7bfb3e18c0563168c
8 N79db367192cc497a91a36b75478e9c7e
9 Na8feda9d7ad347edbd159013d97ef336
10 Nd8ba4cb851d1488985f40125a7011451
11 anzsrc-for:11
12 anzsrc-for:1117
13 schema:author N54f30560c46341208fe10103234005e5
14 schema:citation https://app.dimensions.ai/details/publication/pub.1078712054
15 https://app.dimensions.ai/details/publication/pub.1078816437
16 https://doi.org/10.1016/j.scitotenv.2004.11.021
17 https://doi.org/10.1371/journal.pmed.0050115
18 https://doi.org/10.1542/peds.2004-2880
19 https://doi.org/10.1542/peds.2017-0272
20 schema:datePublished 2019-12
21 schema:datePublishedReg 2019-12-01
22 schema:description The purpose of this article is to consider alternate uses of the blood lead reference value for children. There are two possible approaches. Historically the reference value has been used to guide clinical and public interventions for individual children. As the distribution of blood lead levels in the population has been lowered over time, the blood lead level at which interventions are recommended has also been reduced. The use of a reference value of 3.5 μg/dL, based on the 98 percentile of blood lead levels for children in 2011-2014 National Health and Nutrition Examination Survey is under review. For several reasons, adopting the new reference value to guide clinical and public health management puts practitioners in an untenable position. First, the changes in the brain caused by lead are significant and persistent. However, these adverse impacts are subtle and although clearly identified at the population level, not predictive for individual children. In addition, the recommended interventions have not been shown to reduce blood lead levels once they are elevated. Finally, clinical laboratory and office-based blood lead testing devices are not required to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test for low blood lead levels. Revising the reference value also will undoubtedly result in diversion of resources away from those population-based interventions which have demonstrated success. We argue for second approach, in the management of lead poisoning in the US from one of evaluation and management at the individual level to one of population based primary prevention. This would require a strategy directed at controlling or eliminating lead in children's environment before they are exposed. The reference value, as a benchmark, is essential to ensure that primary prevention efforts are successful.
23 schema:genre non_research_article
24 schema:inLanguage en
25 schema:isAccessibleForFree false
26 schema:isPartOf N8b606cf38b634d0c8e3dd6fa353f5dbd
27 Nac14318ca48e4fb6b04261e361e70c3b
28 sg:journal.1327425
29 schema:name The CDC blood lead reference value for children: time for a change
30 schema:pagination 16
31 schema:productId N308b24ab9db4411c821499125ffb0589
32 N790ee0e6d33e46e7b48deda30c47c954
33 N7cab068b16da4899af5bb4cb4665eb58
34 N7ece0f5e336e43ce90b99657135d5b34
35 Nd83a854ee8844e4e9f574df0dc67e45b
36 schema:sameAs https://app.dimensions.ai/details/publication/pub.1112463418
37 https://doi.org/10.1186/s12940-019-0457-7
38 schema:sdDatePublished 2019-04-11T13:17
39 schema:sdLicense https://scigraph.springernature.com/explorer/license/
40 schema:sdPublisher Na56e09225b1648328f6aaac19bed0a97
41 schema:url https://link.springer.com/10.1186%2Fs12940-019-0457-7
42 sgo:license sg:explorer/license/
43 sgo:sdDataset articles
44 rdf:type schema:ScholarlyArticle
45 N0b124868531b43529f550b7fb2b0325f schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
46 schema:name Humans
47 rdf:type schema:DefinedTerm
48 N149df346647346829239c4317f936085 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
49 schema:name Environmental Exposure
50 rdf:type schema:DefinedTerm
51 N22dbc780460349c080ef039acbe9a323 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
52 schema:name Reference Values
53 rdf:type schema:DefinedTerm
54 N304925ec208c4dfea49527dc86216839 schema:affiliation https://www.grid.ac/institutes/grid.38142.3c
55 schema:familyName Brown
56 schema:givenName Mary Jean
57 rdf:type schema:Person
58 N308b24ab9db4411c821499125ffb0589 schema:name nlm_unique_id
59 schema:value 101147645
60 rdf:type schema:PropertyValue
61 N36ebdbbcb34447f299693eba51fb9689 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
62 schema:name Lead Poisoning
63 rdf:type schema:DefinedTerm
64 N3e5dce0821544f889cf35f7d424af062 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
65 schema:name Centers for Disease Control and Prevention (U.S.)
66 rdf:type schema:DefinedTerm
67 N54f30560c46341208fe10103234005e5 rdf:first N5864fb08e84941c9bf0969944d7da984
68 rdf:rest Ncf2c8bd058ff40cbaa33d93238efcb0e
69 N5864fb08e84941c9bf0969944d7da984 schema:affiliation https://www.grid.ac/institutes/grid.253615.6
70 schema:familyName Paulson
71 schema:givenName Jerome A.
72 rdf:type schema:Person
73 N72cf39acc2d343939cd2c4445dd35fcf schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
74 schema:name Environmental Pollutants
75 rdf:type schema:DefinedTerm
76 N73fe4d664a3d43f7bfb3e18c0563168c schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
77 schema:name United States
78 rdf:type schema:DefinedTerm
79 N790ee0e6d33e46e7b48deda30c47c954 schema:name readcube_id
80 schema:value b8ba26fdb7a00cf47aa5362a5f01a30538a9c523434dd97eef57b980f8050ae9
81 rdf:type schema:PropertyValue
82 N79db367192cc497a91a36b75478e9c7e schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
83 schema:name Primary Prevention
84 rdf:type schema:DefinedTerm
85 N7cab068b16da4899af5bb4cb4665eb58 schema:name doi
86 schema:value 10.1186/s12940-019-0457-7
87 rdf:type schema:PropertyValue
88 N7ece0f5e336e43ce90b99657135d5b34 schema:name dimensions_id
89 schema:value pub.1112463418
90 rdf:type schema:PropertyValue
91 N8b606cf38b634d0c8e3dd6fa353f5dbd schema:issueNumber 1
92 rdf:type schema:PublicationIssue
93 Na56e09225b1648328f6aaac19bed0a97 schema:name Springer Nature - SN SciGraph project
94 rdf:type schema:Organization
95 Na8feda9d7ad347edbd159013d97ef336 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
96 schema:name Lead
97 rdf:type schema:DefinedTerm
98 Nac14318ca48e4fb6b04261e361e70c3b schema:volumeNumber 18
99 rdf:type schema:PublicationVolume
100 Ncf2c8bd058ff40cbaa33d93238efcb0e rdf:first N304925ec208c4dfea49527dc86216839
101 rdf:rest rdf:nil
102 Nd83a854ee8844e4e9f574df0dc67e45b schema:name pubmed_id
103 schema:value 30819209
104 rdf:type schema:PropertyValue
105 Nd8ba4cb851d1488985f40125a7011451 schema:inDefinedTermSet https://www.nlm.nih.gov/mesh/
106 schema:name Child
107 rdf:type schema:DefinedTerm
108 anzsrc-for:11 schema:inDefinedTermSet anzsrc-for:
109 schema:name Medical and Health Sciences
110 rdf:type schema:DefinedTerm
111 anzsrc-for:1117 schema:inDefinedTermSet anzsrc-for:
112 schema:name Public Health and Health Services
113 rdf:type schema:DefinedTerm
114 sg:journal.1327425 schema:issn 1476-069X
115 schema:name Environmental Health
116 rdf:type schema:Periodical
117 https://app.dimensions.ai/details/publication/pub.1078712054 schema:CreativeWork
118 https://app.dimensions.ai/details/publication/pub.1078816437 schema:CreativeWork
119 https://doi.org/10.1016/j.scitotenv.2004.11.021 schema:sameAs https://app.dimensions.ai/details/publication/pub.1009900865
120 rdf:type schema:CreativeWork
121 https://doi.org/10.1371/journal.pmed.0050115 schema:sameAs https://app.dimensions.ai/details/publication/pub.1022126963
122 rdf:type schema:CreativeWork
123 https://doi.org/10.1542/peds.2004-2880 schema:sameAs https://app.dimensions.ai/details/publication/pub.1067824161
124 rdf:type schema:CreativeWork
125 https://doi.org/10.1542/peds.2017-0272 schema:sameAs https://app.dimensions.ai/details/publication/pub.1090764477
126 rdf:type schema:CreativeWork
127 https://www.grid.ac/institutes/grid.253615.6 schema:alternateName George Washington University
128 schema:name George Washington University School of Medicine & Health Sciences, and George Washington University Milken Institute School of Public Health, 1113 N Howard St, 22304-1627, Alexandria, VA, USA
129 rdf:type schema:Organization
130 https://www.grid.ac/institutes/grid.38142.3c schema:alternateName Harvard University
131 schema:name Harvard TH Chan School of Public Health, 665 Huntington Ave, 02115, Boston, MA, USA
132 rdf:type schema:Organization
 




Preview window. Press ESC to close (or click here)


...