Public health and law collaboration: the Philadelphia Lead Court study.

OBJECTIVES: We determined whether Philadelphia Lead Court is effective in enforcing lead hazard remediation in the homes of children with elevated blood lead levels. METHODS: We created a deidentified data set for properties with an initial failed home inspection (IFHI) for lead hazards from January 1, 1998, through December 31, 2008, and compared compliance rates within the first year and time to compliance for lead hazard remediation between 1998 and 2002 (precourt period) and between 2003 and 2008 (court period). We evaluated predictors of time to compliance. RESULTS: Within 1 year of the IFHI, 6.6% of the precourt and 76.8% of the court cases achieved compliance (P < .001) for the 3764 homes with data. Four years after the IFHI, 18% had attained compliance in the precourt period compared with 83.1% for the court period (P < .001). A proportional hazard analysis found that compliance was 8 times more likely in the court than the precourt period (P < .001). CONCLUSIONS: Lead court was more effective than precourt enforcement strategies. Most properties were remediated within 1 year of the IFHI, and time to compliance was significantly reduced. This model court could be replicated in other cities with similar enforcement problems.

Philadelphia's Lead Court is making a difference.

The Philadelphia Lead Court (PLC) was created as an innovative law enforcement strategy to compel property owners to comply with city health codes to remediate their properties of lead hazards, which had led to elevated blood lead levels and lead poisoning in resident children. This study presents a detailed account of and analyzes the opinions of fifteen key informants drawn from the Philadelphia health and law departments and judicial system that staff and run the PLC in response to a fifteen-question structured survey. Main themes reviewed include the effectiveness of the PLC as compared with precourt law enforcement strategies and within the context of a specialized court, the use of fines, the impact of grant funding for remediation work, the major advantages and disadvantages of the PLC, and suggested changes to improve court function, followed by key recommendations. The article concludes that our informants found that the PLC has been very effective and successful. This model could be replicated by other cities with similar health code enforcement challenges.

The effect of housing compliance status on children's blood lead levels.

In a secondary analysis of data from the Childhood Lead Poisoning Prevention Program of Philadelphia (July 1, 1999 through September 1, 2004), the authors evaluated the effect of housing compliance status and time to achieve compliance on changes in children's blood lead levels. Blood lead level changes were not significantly different between children living in compliant housing and those living in noncompliant housing for periods of 1.5 to 2 years, 2 to 3 years, or more than 3 years (-11.01 microg/dL, -9.72 microg/dL, -12.5 microg/dL, -11.57 microg/dL, and -14.31 microg/dL, and -14.61 microL, respectively). In a stratified analysis of children younger than 2 years, the authors also found no association. Neither a house's lead hazard control status nor the time it took to achieve compliance affected long-term changes in children's lead levels. Current compliance programs may be helpful for primary prevention but did not impact change in blood lead for exposed children.

Ulcerative colitis reactivation after mercury vapor inhalation.

BACKGROUND: After exposure to mercury vapor at three consecutive 10-month intervals, an electrician in an electroplating plant had flare-ups of ulcerative colitis within 24 hr, that subsided in several days, then returned upon re-exposure 10 months later. METHODS: The patient and his workplace were both evaluated for mercury exposure. In addition to workplace inspection, both personal and area monitoring for environmental mercury was performed, using both multiple mercury diffusion badges and direct (instantaneous) readings, during maintenance of mercury-filled electrical blocks. RESULTS: Eight-hour time weighted average (TWA) mercury vapor exposure was measured at 0.41 mg/m3 (ACGIH and NIOSH recommended TWA = 0.025 mg/m3; OSHA permissible exposure limit -0.1 mg/m3) for 5 years since stopping overexposure to mercury, the patient remained symptom free in clinical remission. CONCLUSIONS: In a patient with chronic ulcerative colitis in remission, occupational exposure to mercury vapor led to episodes of disease reactivation.