Brewster Ryan Cl, Acosta Keith, Story Diane, Bayuh Frehiwot, Shah Shalini, Woolf Alan, Buncher Noah, Hauptman Marissa
Department of Pediatrics (RCL Brewster, K Acosta, D Story, S Shah, A Woolf, and M Hauptman), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Department of Pediatrics (RCL Brewster and F Bayuh), Boston Medical Center, Boston University School of Medicine, Boston, Mass; Department of Neonatology (RCL Brewster), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Department of Pediatrics (RCL Brewster, K Acosta, D Story, S Shah, A Woolf, and M Hauptman), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (K Acosta, S Shah, A Woolf, N Buncher, and M Hauptman), Boston, Mass.
Acad Pediatr. 2025 Aug;25(6):102844. doi: 10.1016/j.acap.2025.102844. Epub 2025 Apr 17.
Despite there being no safe amount of lead in the body, most public health and clinical interventions are focused on secondary prevention. A greater emphasis on early outreach may reduce cumulative lead exposure. Towards this end, we aimed to assess the feasibility of a virtual model for lead poisoning prevention and management among at-risk populations.
We developed the Take the Lead on Lead (TLOL) clinic, a telemedicine-based program to facilitate educational visits, lead identification, and individualized resource allocation. We recruited patients aged 9 months-5 years with detectable, but low, BLLs (≥2 μg/dL and <10 μg/dL) from two urban academic medical centers in Boston, MA. Virtual visits featured a remote residential inspection to identify potential lead hazards and inform targeted counseling. Families also received a lead testing and temporary mitigation kit, community referrals, and follow-up BLL surveillance, as indicated.
Among 35 participants, most were Black, non-Latinx (51.4%) with residence in homes constructed before 1970 (60%). Potential lead hazards were visualized in the majority of homes that underwent a virtual home inspection (71.4%). On a post-participation survey, most families found that TLOL participation addressed their clinical concerns; provided actionable resources; and helped identify lead sources.
The TLOL program enabled detailed residential lead identification and early resource access with high levels of participant satisfaction. Further work is needed to assess the efficacy and cost-effectiveness of telemedicine-based care models applied towards lead poisoning prevention efforts.
尽管体内不存在安全的铅含量，但大多数公共卫生和临床干预措施都集中在二级预防上。更加强调早期干预可能会减少铅的累积暴露。为此，我们旨在评估一种针对高危人群预防和管理铅中毒的虚拟模型的可行性。
我们开发了“率先应对铅中毒”（TLOL）诊所，这是一个基于远程医疗的项目，旨在促进教育性问诊、铅检测以及个性化资源分配。我们从马萨诸塞州波士顿的两家城市学术医疗中心招募了年龄在9个月至5岁之间、血铅水平可检测到但较低（≥2μg/dL且<10μg/dL）的患者。虚拟问诊包括对住所进行远程检查，以识别潜在的铅危害并提供有针对性的咨询。根据需要，家庭还会收到铅检测和临时缓解工具包、社区推荐以及后续血铅水平监测。
在35名参与者中，大多数是黑人、非拉丁裔（51.4%），居住在1970年以前建造的房屋中（60%）。在大多数接受虚拟家庭检查的房屋中都发现了潜在的铅危害（71.4%）。在参与后的调查中，大多数家庭发现参与TLOL项目解决了他们的临床担忧；提供了可行的资源；并帮助识别了铅源。
TLOL项目能够实现详细的家庭铅识别和早期资源获取，参与者满意度很高。需要进一步开展工作来评估基于远程医疗的护理模式在预防铅中毒方面的有效性和成本效益。
