Benefits and risks of pesticide testing on humans.
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Adult↗
Biomedical subjects
J Routt Reigart
Publications and source records attributed to J Routt Reigart.
Environmental pediatrics and its impact on government health policy.
Recent public recognition that children are different from adults in their exposures and susceptibilities to environmental contaminants has its roots in work that began >46 years ago, when the American Academy of Pediatrics (APA) established a standing committee to focus on children's radiation exposures. We summarize the history of that important committee, now the AAP Committee on Environmental Health, including its statements and the 1999 publication of the AAP Handbook of Pediatric Environmental Health, and describe the recent emergence of federal and state legislative and executive actions to evaluate explicitly environmental health risks to children. As a result in large part of these efforts, numerous knowledge gaps about children's health and the environment are currently being addressed. Government efforts began in the 1970s to reduce childhood lead poisoning and to monitor birth defects and cancer. In the 1990s, federal efforts accelerated with the Food Quality Protection Act, an executive order on children's environmental health, the Agency for Toxic Substances and Disease Registry/Environmental Protection Agency Pediatric Environmental Health Specialty Units, and National Institute of Environmental Health Sciences/Environmental Protection Agency Centers of Excellence in Research in Children's Environmental Health. In this decade, the Children's Environmental Health Act authorized the National Children's Study, which has the potential to address a number of critical questions about children's exposure and health. The federal government has expanded efforts in control and prevention of childhood asthma and in tracking of asthma, birth defects, and other diseases that are linked to the environment. Efforts continue on familiar problems such as the eradication of lead poisoning, but new issues, such as prevention of childhood exposure to carcinogens and neurotoxins other than lead, and emerging issues, such as endocrine disruptors and pediatric drug evaluations, are in the forefront. More recently, these issues have been taken up by states and in the international arena.
Congenital Abnormalities↗
Does anything beat DEET?
In comparison trials, DEET is more effective than any other insect repellent. Despite some reports of serious adverse events, when comparing the thousands of other reports of exposure and millions of past users, DEET has a good safety record. The appropriate and safest concentration to use on children remains unclear, however. Due to potential absorption through the skin, prudence would dictate that the lowest effective concentration for the time period of exposure be used. Because research has shown that solvents with less skin permeation may be used as an alternative to the ethanol used in some commercial DEET preparations, manufacturers could develop products that are less likely to be absorbed. Pediatricians should be familiar with the duration of action of various formulations of DEET and the efficacy (and in some cases lack of efficacy) of other products in order to advise patients on safe but effective methods of insect control.
Animals↗
Inaccuracy in parental reporting of the age of their home for lead-screening purposes.
OBJECTIVE: To determine the proportion of children living in pre-1950 housing who are correctly identified by parental report as being at risk for lead poisoning. DESIGN: Cross-sectional survey of parents. Parents' answers about the age of their home were compared with the age of the home found in tax assessor records. SETTING: The resident continuity clinic at an urban medical center and 4 private pediatric practices. PARTICIPANTS: A convenience sample of 199 parents accompanying children to their 9-month to 2-year well-child care visits. All parents agreed to participate. Twenty-six were excluded because they lived outside the predetermined geographic area or because the age of their home could not be confirmed, leaving 173 in the sample. MAIN OUTCOME MEASURE: We calculated the sensitivity of asking parents the age of their home in determining which children were at risk for lead poisoning because of residence in pre-1950 housing. RESULTS: According to tax assessor records, 42 children lived in or spent time in homes built before 1950. Of these 42 children, 22 of their parents reported this exposure when asked, for a sensitivity of 52% (95% confidence interval, 37%-67%). If a questionnaire was used to determine whether the child should be tested for lead poisoning, 20 of the 42 children who lived in older homes would not have been tested. CONCLUSION: Asking parents about the age of their home is no better than chance at determining which children are at risk for lead poisoning because of residence in older housing.
Adult↗
Preventive services: blood pressure checks at well child visits.
The objective of this study was to determine rates of blood pressure (BP) screening at well-child visits as recommended by the Task Force on Blood Pressure Control in Children. The 1985 and 1996 National Ambulatory Medical Care Surveys were analyzed for changes in proportion of well visits for children aged 3-18 years at which BP was checked. Patient and physician demographics are described. BP screening increased from 50% in 1985 to 61% in 1996. For pediatricians, the estimates were 50% (95% CI, 43-57) and 60% (95% CI, 53-68). For family/general medicine the estimates were 51% (95% CI, 34-69) and 58% (95% CI, 43-74). Age, geographic location, and length of a visit were significant in predicting BP screening. Gender, race, ethnicity, or urban location were not. A stepwise logistic regression confirmed these results. Rates of screening BP at well-child visits have increased but fall short of current recommendations. High-risk children are not screened at a rate different from their lower risk peers.
Adolescent↗
Environmental health for practicing pediatricians.
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Child↗
Using geographic information systems to assess risk for elevated blood lead levels in children.
OBJECTIVES: Targeted screening for childhood lead poisoning depends on assessment of risk factors including housing age. Using a geographic information system (GIS), we aim to determine high-risk regions in Charleston County, South Carolina, to assist public health officials in developing targeted lead-screening. METHODS: Properties built before 1978 were geocoded (assigned latitude and longitude coordinates) from tax assessor data. Addresses of Charleston County children who have been screened for lead poisoning were also geocoded. Locations of all housing, lead poisoning cases, and negative screens were created as separate map layers. Prevalence ratios of lead poisoning cases were calculated, as were relative risks for each category of housing. RESULTS: Maps of Charleston County were produced showing the location of old housing, where screening took place, and where cases were found. One thousand forty-four cases were identified. Twenty percent of children living in pre-1950 homes had elevated blood lead levels (EBLL). Children living in pre-1950 housing were 3.9 times more likely to have an EBLL than children living in post-1977 housing. There was no difference in risk of living in a 1950-1977 home vs. a post-1977 home. A large number of cases were also found in an area of newer houses, but near a potential point source. Eighty-two percent of all screens were from children in post-1977 homes. CONCLUSIONS: Children living in pre-1950 housing were at higher risk for lead poisoning. GIS is useful in identifying areas of risk and unexpected clustering from potential point sources and may be useful for public health officials in developing targeted screening programs.
Child↗