Broken Hill Centre for Remote Health Research - Joint Initiative of the University of Sydney and Greater Western Area Health Service, PO Box 457, Broken Hill 2880, Australia.
Sci Total Environ. 2009 Dec 20;408(2):202-8. doi: 10.1016/j.scitotenv.2009.10.013. Epub 2009 Oct 24.
In 1994 a comprehensive program was established to reduce children's blood lead levels in Broken Hill, NSW, Australia. Home remediation (abatement of lead hazards in a child's home) was included as part of a case management strategy for children with blood lead levels >or=15 microg/dL. Children with blood lead levels >or=30 microg/dL were offered immediate home remediation. Children with blood lead levels of 15-29 microg/dL were allocated to 'immediate' or 'delayed' home remediation; a subset of these participated in a randomized controlled trial (RCT) to evaluate the effectiveness of home remediation for reducing blood lead levels. One hundred and seventeen children received home remediation. One hundred and thirteen returned for follow-up blood tests, 88 of whom participated in the RCT. On average children's blood lead levels decreased by 1.7 microg/dL (10%) in the 6 months after remediation and by 2.2 microg/dL (13%) in the 6-12 months after remediation. However, remediation did not significantly change the rate of decline in blood lead levels (P=0.609). There was no evidence of association between change in children's blood lead levels and changes in lead loading in their homes. The results are consistent with the published literature, which suggests that home remediation does not reduce children's exposure to lead sufficiently to cause a moderate or greater decrease in their blood lead level. In communities where lead is widely dispersed, the study suggests that it is important to assess potential sources and pathways by which children are exposed to lead when developing an intervention plan, and the need for multiple interventions to effectively reduce blood lead levels. The findings reinforce the ongoing need for rigorous epidemiological evaluation of lead management programs to improve the evidence base, and for effective primary prevention to avoid children being exposed to lead in the first place.
1994 年,澳大利亚新南威尔士州的布罗肯希尔(Broken Hill)制定了一项全面的计划,以降低儿童的血铅水平。家庭修复(消除儿童家中的铅危害)作为患有血铅水平≥15μg/dL 的儿童的病例管理策略的一部分。血铅水平≥30μg/dL 的儿童立即接受家庭修复。血铅水平为 15-29μg/dL 的儿童被分配到“立即”或“延迟”家庭修复;其中一部分参加了一项随机对照试验(RCT),以评估家庭修复降低血铅水平的有效性。共有 117 名儿童接受了家庭修复。有 113 名儿童返回进行随访血液检查,其中 88 名参加了 RCT。平均而言,在修复后的 6 个月内,儿童的血铅水平降低了 1.7μg/dL(10%),在修复后的 6-12 个月内降低了 2.2μg/dL(13%)。然而,修复并没有显著改变血铅水平的下降速度(P=0.609)。儿童血铅水平的变化与家中铅负荷的变化之间没有证据表明存在关联。这些结果与已发表的文献一致,表明家庭修复并不能充分降低儿童对铅的暴露,从而导致其血铅水平适度或更大幅度的下降。在铅广泛分布的社区中,研究表明,在制定干预计划时,评估儿童接触铅的潜在来源和途径以及需要采取多种干预措施来有效降低血铅水平是非常重要的。这些发现强化了对铅管理项目进行严格的流行病学评估以改善证据基础的持续需求,以及进行有效的初级预防以避免儿童首先接触铅的必要性。