Blood lead levels among Broken Hill children born 2009-2015: a longitudinal study to inform prevention strategies.

OBJECTIVES: To describe blood lead levels (BLLs) and their distribution among children in Broken Hill, New South Wales (NSW), at each of the scheduled testing points aligned with childhood immunisation and to determine how BLLs change over time for individual children. These data can inform action to prevent future lead exposure in Broken Hill children. STUDY TYPE: Retrospective longitudinal study. METHODS: Data were extracted from the Lead Management Program ACCESS database on children born between 2009 and 2015 and living in Broken Hill. BLLs were calculated using capillary blood collected via finger prick, classified according to specific blood lead thresholds and grouped according to the testing schedule. A subset of children tested at each of the first three annual testing points provided data to determine the blood lead trajectories for individual Broken Hill children. Data were analysed using SPSS and ArcGIS. RESULTS: At the first test at 12 months, around half the children recorded a BLL of <5 µg/dL, one in three had a BLL of 5-9 µg/dL and one in five had a BLL of ≥10 µg/dL. A similar pattern was observed for subsequent test points at 18 months, 2 years, 3 years and 4 years. Of the 336 children who had results recorded at each of the 12-month, 2-year and 3-year test points, BLLs in around one-third remained below the recommended threshold of 5 µg/dL. Another one-third of these children had at least one test result ≥10 µg/dL, and the BLL in the remainder did not exceed 5-9 µg/dL at any of the test points. The geospatial distribution of children with very high BLLs shows clustering of these children in some localities, as well as their widespread distribution throughout Broken Hill. CONCLUSIONS: It should be possible to keep BLLs below 5 µg/dL for the majority of young children in Broken Hill throughout their preschool years. This could be achieved by an integrated prevention strategy that includes population-level interventions such as targeted zonal remediation for high-risk areas and early intervention for individuals during the first 12 months and beyond, particularly for those who may not benefit directly from targeted zonal remediation. Routinely collected data could be used to guide the development, and monitor the effectiveness, of these interventions.

Is Time Spent Outside the Family Home a Risk Factor for Lead Exposure in Pre-School Children Living in Broken Hill?

Broken Hill is amongst a group of communities internationally that are at greater risk from lead due to active or historical lead industries. Current evidence suggests there is no safe level of lead for young children. This paper describes places outside the family home where young Broken Hill children spend time and considers the potential for this to contribute to lead risk. We interviewed 65 families of children 3 years old or younger and detailed the top five places children spent time at outside the family home. Exposure to private residences outside the family home was recorded for most (88%) young children. Nearly two thirds stayed there five or more hours per week. Most children went there on a weekly basis over many months (median, 12 months), increasing the likelihood of exposure to lead hazards. Further investigation of the lead hazard and risk behaviour of children at these residences would assist in developing guidelines for remediation of the lead hazard for all private residences in Broken Hill. This approach to elucidating the potential sources and pathways of lead and other heavy metal exposures for young children may have merit in other settings where comprehensive zonal remediation is not feasible or may not be warranted.

Putting the genie back in the bottle: protecting children from lead exposure in the 21st century. A report from the field.

This paper highlights progress on an important public health issue which, despite significant progress, has now stalled and is in need of renewed investment. The objective is to describe the effectiveness of efforts to reduce childhood lead exposure in Broken Hill - a historic mining town in western NSW - and what is required to further reduce exposure. Lead has no known function in the human body, and emerging evidence suggests that no level of exposure is without health effects. A 1991 blood lead survey of 1-4-year-old children identified lead exposure as a significant public health issue in Broken Hill. A major NSW Government-funded program to reduce lead exposure began in 1994, and, by 2001, blood lead levels had reduced by two-thirds. The program was then integrated into other services and funding significantly reduced; blood lead levels have remained relatively unchanged since 2005. At present, 53% of children in Broken Hill have blood lead levels above the recently released National Health and Medical Research Council draft reference value for lead. Participation in annual blood lead screening declined from 52% to 38% after project funding decreased, but recent changes have doubled participation rates. A comprehensive abatement program is required to further reduce lead exposure in this community, and further research is required into how to maintain low blood lead levels and how best to engage the community about reducing individual lead risks. Findings from such studies would be relevant to the broader Australian community.

New South Wales and Australian Capital Territory Researcher Development Program 2005-07: modest investment, considerable outcomes.

This evaluation of the Researcher Development Program (RDP) in NSW and ACT aimed to determine whether the RDP was effective in assisting novice researchers to undertake primary health care research. In mid-2008, 47 participants of the NSW and ACT RDP during 2005-07 were invited to participate in a postal survey. The survey included questions regarding previous research training and experience, outcomes during and after participation in the program, and organisational aspects of the program. Follow-up interviews were conducted with selected participants. Interview questions covered time in the program, supervision, organisational support and placement outcomes. Thirty-seven participants responded to the survey and 23 (62%) participants took part in the semi-structured interviews. Seventy-eight per cent of survey respondents felt that the RDP helped them move from novice to a more experienced researcher with effective supervision identified by participants as a key element in determining the success of the program. Many felt that time allocation was inadequate and 20% thought their capacity to maintain their workload was adversely affected by participating. Outcomes were considerable given the modest nature of the program. Notable outcomes were that most participants published their research and presented their research at a conference. Furthermore, one-fifth of survey respondents had enrolled in higher degrees. Several interviewees reported that their research led to changes in practice. Most respondents found the RDP valuable and considered that undertaking the program increased their research knowledge.

Frequent users of the Royal Flying Doctor Service primary clinic and aeromedical services in remote New South Wales: a quality study.

OBJECTIVE: To examine activity patterns of the Royal Flying Doctor Service of Australia (RFDS) in far western New South Wales and to determine whether frequent use of RFDS services, particularly emergency evacuations, is a useful indicator of patients who may benefit from care planning and review. DESIGN, SETTING AND PARTICIPANTS: We conducted a retrospective audit of the RFDS South Eastern Section's Broken Hill patient database. Patients with a residential address in the study area who had accessed at least one RFDS medical service between 1 July 2000 and 30 June 2005 were included in the study. MAIN OUTCOME MEASURES: Number of evacuations, clinic consultations and remote consultations; clinic usage by frequent evacuees; number of primary diagnoses recorded for frequent evacuees; number of frequent users who might benefit from multidisciplinary care or specialist shared care. RESULTS: Between July 2000 and June 2005, the number of residents requiring evacuation or remote consultations declined by 26% and 19%, respectively, and the number of residents accessing clinics declined by 6%. (Over the same period, the population of the study area fell by about 24%.) Of the 78 patients who were identified as frequent users of the evacuation service (> or = 3 evacuations/year), 34 had three or more primary diagnoses recorded; 15 were infrequent or non-users of the clinics (< or = 3 attendances/year); 53 may have benefited from multidisciplinary care, and 41 from specialist shared care. CONCLUSIONS: Simple, practical clinical review systems can help health care organisations in rural and remote communities to achieve better outcomes by identifying patients who may benefit from planned care.