At-risk Population Groups Research Articles

Household Coverage of Fortified Staple Food Commodities in Rajasthan, India.

A spatially representative statewide survey was conducted in Rajasthan, India to assess household coverage of atta wheat flour, edible oil, and salt. An even distribution of primary sampling units were selected based on their proximity to centroids on a hexagonal grid laid over the survey area. A sample of n = 18 households from each of m = 252 primary sampling units PSUs was taken. Demographic data on all members of these households were collected, and a broader dataset was collected about a single caregiver and a child in the first 2 years of life. Data were collected on demographic and socioeconomic status; education; housing conditions; recent infant and child mortality; water, sanitation, and hygiene practices; food security; child health; infant and young child feeding practices; maternal dietary diversity; coverage of fortified staples; and maternal and child anthropometry. Data were collected from 4,627 households and the same number of caregiver/child pairs. Atta wheat flour was widely consumed across the state (83%); however, only about 7% of the atta wheat flour was classified as fortifiable, and only about 6% was actually fortified (mostly inadequately). For oil, almost 90% of edible oil consumed by households in the survey was classified as fortifiable, but only about 24% was fortified. For salt, coverage was high, with almost 85% of households using fortified salt and 66% of households using adequately fortified salt. Iodized salt coverage was also high; however, rural and poor population groups were less likely to be reached by the intervention. Voluntary fortification of atta wheat flour and edible oil lacked sufficient industry consolidation to cover significant portions of the population. It is crucial that appropriate delivery channels are utilized to effectively deliver essential micronutrients to at-risk population groups. Government distribution systems are likely the best means to accomplish this goal.

The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data.

ObjectivesThe objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors.MethodsThe present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables.ResultsOf the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to “financial burden” (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to “service not available when needed.” There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to “financial burden” (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to “service not available when needed.”ConclusionsOur finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.

Screening and risk assessment for coronary artery disease in HIV infection: an unmet need.

HIV infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Increased risk of CAD in HIV-infected patients has been associated with the inflammatory sequelae of the infection as well as the greater prevalence of cardiac risk factors in HIV-positive populations and the side effects of life-prolonging antiretroviral therapies. Patients with HIV infection now have a 1.5 to 2-fold greater risk of developing CAD compared with noninfected individuals, raising the independent risk of CAD in HIV infection to levels similar to those in diabetes. Despite this increased risk, screening and other adjuvant assessment tools are lacking. In this paper we explore the current climate of CAD in the contemporary HIV-infected population and look at the tools used in the assessment and management of patients as well as the limitations of these approaches for this at-risk population group.

Risk Factors Associated With HIV Among Men Who Have Sex With Men (MSM) in Ecuador.

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

Household food insecurity access scale (HFIAS).

In 1996, the World Food Summit reaffirmed the inalienable right that each person across the globe has to access safe, adequate and nutritious food. At that time a goal was established to reduce by half the number of undernourished persons worldwide by 2015, in other words the year that we are now commencing. Different countries and organisations considered the necessity of reaching consensus and developing indicators for measuring household food insecurity. The availability of a simple but evidence-based measurement method to identify nutritionally at-risk population groups constitutes an essential instrument for implementing strategies that effectively address relevant key issues.

Sense of Coherence and Adherence to Healthy Lifestyle Amongst Adolescents

The article describes the risk behaviour syndrome in adolescence. WHO established adolescents as individual at-risk population group, we speak about so-called new morbidity of adolescents which is currently the main cause of mortality in this development period. Seriousness of risk behaviour manifestation is within the multi-causal aethiopathogenesis also influenced by salutoprotective factors of lifestyle. High level of sense of coherence prove individual's progress towards active health.

Assessment of liver disease in Tower Hamlets, London, UK: foundation for integrated solutions

BackgroundAlthough most liver disease is preventable and rates are falling across Europe, morbidity and mortality are increasing in England. The London Borough of Tower Hamlets has one of the highest liver disease mortality rates in England (29·1/100 000 compared with 18·9/100 000 national average). We undertook a collaborative needs assessment with our local clinical commissioning group to better understand this local problem and identify priorities for intervention. MethodsData collation and descriptive analysis of information from primary care, secondary care, public health, and national sources were conducted over 6 months during 2013–14. The disease burden, common causes, and trends were identified, with particular focus on at-risk population groups. Service provision was reviewed and measured against need. Two-stage stakeholder engagement was undertaken: initial consultation with key partners and subsequent borough-wide consultation. FindingsAlcohol-related disease, non-alcoholic fatty liver disease, and viral hepatitis all contributed to local burden of disease. Tower Hamlets had the highest rates of cirrhosis admissions and liver cancer mortality in England. There were increasingly high rates of alcohol-related admissions (2290/100 000 vs 1912/100 000 for London and 1895/100 000 for England). 51% of the Tower Hamlets population (133 989/262 723, based on 2012 census estimates) were non-alcohol drinkers, but 43% of alcohol drinkers exhibited harmful drinking patterns. We noted high levels of obesity (30% in adults) and diabetes (6·1% prevalence, rapidly rising), proxy measures for non-alcoholic fatty liver disease. We found high rates of hepatitis B infection (incidence per 100 000, 2·38 vs 1·04 nationally) and hepatitis C infection (fourth highest rate nationally [1089/100 000], despite high rates of underdiagnosis). Important factors included ethnicity, deprivation, population movement, and hazardous alcohol use in subgroups. Although specialist services exist for all major disease subtypes, we found evidence of mismatch between service targeting and high-risk groups, and underdeveloped service integration. InterpretationComplex factors contribute to the picture of liver disease in Tower Hamlets. For example, high rates of hazardous alcohol use within some population groups are masked by high abstinence rates among others (such as the large Bangladeshi population). Insights from this work have facilitated the development of a joined-up tailored approach to address various contributing components. We are working with partners to develop clear care pathways, improve service provision, increase hepatitis screening, and consider universal hepatitis B immunisation in areas of high prevalence. FundingNone.

Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective

At the 13th meeting of the European Society for Traumatic Stress Studies in 2013, a symposium was held that brought together international researchers and clinicians who were involved in psychosocial responses to disaster. A total of six disasters that occurred in five countries were presented and discussed. Lessons learned from these disasters included the need to: (1) tailor the psychosocial response to the specific disaster, (2) provide multi-dimensional psychosocial care, (3) target at-risk population groups, (4) proactively address barriers in access to care, (5) recognise the social dimensions and sources of resilience, (6) extend the roles for mental health professionals, (7) efficiently coordinate and integrate disaster response services, and (8) integrate research and evaluation into disaster response planning.

Lung Cancer Detection with Digital Chest Tomosynthesis: Baseline Results from the Observational Study SOS

Observational studies consistently support strategies for early cancer diagnosis and treatment. Owing to its high prevalence, mortality rate, and easily identifiable at-risk population groups, lung cancer seems ideal for early detection programs. We present the baseline results of the SOS study, a single-arm observational study of digital chest tomosynthesis for lung cancer detection in an at-risk population. Accrual of study participants started in December 2010 and ended in December 2011. Participants considered eligible were smokers or former smokers aged 45 to 75 years, with a smoking history of at least 20 pack-years, without malignancy in the 5 years before the start of the study. A tomosynthesis examination was performed at baseline and another the year after. Of the 1919 candidates assessed, 1843 (96%) were enrolled into the study: the mean age was 61 years (range, 48-73 years); 1419 (77%) were current smokers. The most prevalent comorbidities were hypertension, chronic obstructive pulmonary disease, and cardiovascular diseases. A total of 1843 tomosynthesis studies were obtained. Pulmonary abnormalities were detected in 268 subjects (14.5%). First-line basal computed tomography (CT) was subsequently carried out in 132 subjects (7.2%), 68 (4.9%) of which were referred for follow-up CT. Positron-emission tomography/CT was performed on 27 individuals (1.46%), and lung cancer was detected in 18 (0.98%) of them. The detection rate of noncalcified lung nodules for tomosynthesis was comparable with rates reported for CT. A small subgroup underwent low-dosage CT and entered a follow-up program. Overall, lung cancer was detected in approximately 1% of cases. Digital chest tomosynthesis holds promise as a first-line lung cancer screening tool.

Food safety attitudes in college students: a structural equation modeling analysis of a conceptual model.

College students are one of the most at-risk population groups for food poisoning, due to risky food safety behaviors. Using the Likert Scale, undergraduate students were asked to participate in a Food Safety Survey which was completed by 499 students ages 18–25. Data was analyzed using SPSS and AMOS statistical software. Four conceptual definitions regarding food safety were defined as: general food safety, bacterial food safety, produce food safety, and politics associated with food safety. Knowledge seems to be an important factor in shaping students attitudes regarding general and bacterial safety. Ethnicity plays a role in how people view the politics of food safety, and the safety of organic foods.

Innovations in primary mental healthcare

We review the evidence on innovations in Tier 2 of the Access to Allied Psychological Services (ATAPS) program, which is designed to facilitate the provision of primary mental healthcare to hard-to-reach and at-risk population groups (including women with perinatal depression, people at risk of self-harm or suicide, people experiencing or at risk of homelessness, people affected by the 2009 Victorian bushfires, people in remote locations, Aboriginal and Torres Strait Islanders and children with mental disorders) and the trialling of new modalities of service delivery (e.g. telephone-based or web-based CBT). The primary focus is on the uptake, outcomes and issues associated with the provision of ATAPS Tier 2. Drawing on data from an ongoing national ATAPS evaluation, including a national minimum dataset, key informant interviews and surveys, the impact of ATAPS innovations is analysed and illustrated through program examples. ATAPS Tier 2 facilitates access to, uptake of and positive clinical outcomes from primary mental healthcare for population groups with particular needs, although it requires periods of time to implement locally. Relatively simple innovations in mental health program design can have important practical ramifications for service provision, extending program reach and improving mental health outcomes for target populations. What is known about the topic? It is recognised that innovative approaches are required to tailor mental health programs for hard-to-reach and at-risk population groups. Divisions of General Practice have implemented innovations in the Access to Allied Psychological Services (ATAPS) program for several years. What does this paper add? Drawing on data from an ongoing national ATAPS evaluation, this paper presents a systematic analysis of the uptake, outcomes and issues associated with provision of the innovative ATAPS program. What are the implications for practitioners? The findings highlight the benefits of introducing innovations in primary mental healthcare in terms of increased access to care and positive consumer outcomes. They also identify challenges to and facilitators of the implementation process, which can inform innovation efforts in other primary care contexts.

Using a Formative Research Rapid Assessment Method to Support the Development of a HIV/AIDS Antiretroviral Therapy Communication Campaign in Kenya

Researchers have suggested that it is those groups of individuals who lack the knowledge, skills and resources to protect themselves and their partners from HIV infection, which are most vulnerable to the disease [2]. Many of these most at-risk population groups have been found to: (i) have poor access to information and services; (ii) be more likely to engage in activities that place them at risk of HIV infection; and (iii) have fewer resources to manage the impact of HIV/AIDS in their lives. This stresses the importance of effective communication, including informed decisions on appropriate messages and communication channels, in supporting protective behavioural responses to HIV/AIDS.

OC-099 Increased at risk screening and recognition of atypical presentation does not fully explain the 6.5-fold increase in paediatric coeliac disease (CD) incidence in the last 20 years in SE Scotland

IntroductionCurrent diagnostic practice for paediatric CD in the UK includes increased screening of family members and at- risk groups for example, diabetes mellitus.AimsTo identify all incident cases of CD in...

Epidemiologic characteristics of haemorrhagic fever with renal syndrome in Mainland China from 2006 to 2010

To design effective prevention and control strategies for haemorrhagic fever with renal syndrome (HFRS) in Mainland China, we evaluated the epidemiologic characteristics and trends of HFRS cases reported between 2006 and 2010. HFRS data from 1970 to 2010 were obtained from the China Notifiable Disease Reporting System (CNDRS). The cases analysed included clinical cases and laboratory-confirmed cases. Data was extracted for statistical analysis by time, region and profession; the incidence rate was obtained directly from CNDRS. In this study, we analysed the morbidity and mortality data of HFRS from 2006 to 2010. HFRS cases trended downward from 2006 (15 098) to 2009 (8745), but exhibited a slight increase in 2010 (9526). Twenty-nine of 31 provinces reported HFRS cases between 2006 and 2010. Five provinces, namely, Heilongjiang, Jilin and Liaoning in the North-eastern, Shandong in the east, and Shaanxi in the central part of China, were characterized as high-endemic areas. Seasonal case distribution was bimodal, with peaks of cases in spring and winter. Young male farmers were the most susceptible population to HFRS. Early- to middle-aged adults (20-50 years old) represented the largest groups of HFRS cases. The overall number of cases of HFRS in China has trended downward possibly due to national vaccine and rodent vector control programmes implemented in the past 25 years. However, this trend slowed down in the last five years. High-endemic regions and at-risk population groups still exist and will benefit from further targeted prevention strategies.

Single Nucleotide Polymorphisms Upstream from the β-Carotene 15,15'-Monoxygenase Gene Influence Provitamin A Conversion Efficiency in Female Volunteers 4

β-Carotene, the most abundant provitamin A carotenoid in the diet, is converted to retinal by β-carotene 15,15'-monoxygenase (BCMO1). However, β-carotene absorption and conversion into retinal is extremely variable among individuals, with proportions of low responders to dietary β-carotene as high as 45%. Recently, 2 common nonsynonymous single nucleotide polymorphisms (SNPs) within the BCMO1 coding region (R267S; rs12934922 and A379V; rs7501331) revealed reduced catalytic activity, confirming that genetic variations contribute to the low responder phenotype. Because 4 SNPs 5' upstream from the BCMO1 gene were recently shown to affect circulating carotenoid concentrations, the current study aimed to investigate the effects of these SNPs on β-carotene conversion efficiency. Three of the 4 polymorphisms (rs6420424, rs11645428, and rs6564851) reduced the catalytic activity of BCMO1 in female volunteers by 59, 51, and 48%, respectively. The TG-rich lipoprotein fraction retinyl palmitate:β-carotene ratio was negatively correlated with the G allele of rs11645428 (r = −0.44; P = 0.018), whereas it was positively correlated with the G allele of rs6420424 (r = 0.53; P = 0.004) and the T allele of rs6564851 (r = 0.41; P = 0.028). Furthermore, large inter-ethnic variations in frequency of affected alleles were detected, with frequencies varying from 43 to 84% (rs6420424), 52 to 100% (rs11645428), and 19 to 67% (rs6564851). In summary, a range of SNPs can influence the effectiveness of using plant-based provitamin A carotenoids to increase vitamin A status in at-risk population groups and this effect may vary depending on ethnic origin.

Results from the National Strategy for Improvement of Iodine Nutrition in Bulgaria. A study of children and pregnant women living in an iodine-deficient area

A significant part of Bulgaria is considered an iodine-deficient area. The National Strategy for Prevention and Control of Iodine Deficiency Disorders (IDD) was developed in 1994, and regular surveys undertaken in 2000–2003 indicated a normalization of the iodine supply in the Bulgarian population, including some at-risk population groups (children, schoolchildren, pregnant women). Despite the results achieved, mandating periodic cohort surveys for tracking the elimination of iodine deficiency is necessary. The aim of this study was to evaluate the results of the the national strategy for improvement of iodine nutrition in children and pregnant women living in an iodine-deficient area in Bulgaria 15 years after its update. Study subjects were 73 children aged 9.21 ± 2.07 years (29 boys and 44 girls) and 16 pregnant women living in the town of Asenovgrad. Urinary iodine concentration was measured and used as an index of iodine intake. The median urinary iodine of the inspected children was between 100–199 μg/l, which is an indicator of optimal iodine nutrition. Almost 1/3 of the children (31.5%) had iodine deficiency. The median urinary iodine concentration of the 16 pregnant women investigated was 127.0 μg/l, which is an indicator of insufficient iodine intake. Despite the normalization of the iodine supply in the past years in the at-risk population groups of children and pregnant women, a considerable portion of them still has iodine deficiency. Recommendations for improving health education and iodine nutrition in at-risk population groups were made.

Optimization Model and Algorithm Help to Screen and Treat Sexually Transmitted Diseases

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are two common sexually transmitted diseases among women in the United States. Publicly funded programs usually do not have enough money to screen and treat all patients. Therefore, the authors propose a new resource allocation model to assist clinical managers to make decisions on identifying at-risk population groups, as well as selecting a screening and treatment strategy for CT and GC patients under a fixed budget. At the same time, the authors also develop a two-step branch-and-bound algorithm tailor-made for our model. Running on real-life data, the algorithm calculates the optimal solution within a very short time. The new algorithm also improves the accuracy of an approximate solution obtained by Excel Solver. This study has shown that a resource allocation model and algorithm might have a significant impact on real clinical issues.

The Growing Need for Service Provision for People Living with HIV in Bangladesh

Despite the fact that the first case of HIV in Bangladesh was detected in 1989, there has been a strong and coordinated approach to preventing HIV and AIDS in the country since 1985. Guided by the National AIDS Committee and its technical subcommittees and led by the National AIDS/STD Programme within the Directorate General of Health Services, Bangladesh has seen the roll out of a National Strategic Plan (NSP) and comprehensive guidelines relating to the prevention and management of HIV and AIDS (1). The Government of Bangladesh deserves to be congratulated on its early and comprehensive response to the issue of HIV and AIDS. Twenty-one years after the first case was detected, Bangladesh remains a low-prevalence country with an estimated prevalence of <1% in the most at-risk population groups. However, complacency at this point could prove disastrous. Although the numbers remain low, data show a steady rise in the number of new HIV-positive cases, new AIDS cases, and deaths due to AIDS (Table and Fig.). Further, although the overall prevalence among the most at-risk population groups is still <1%, it is 7% among injecting drug-users in Dhaka and rates as high as 10.5% have been reported in a localized neighbourhood in Dhaka (1). More recently, an emerging HIV epidemic has been detected among female sex workers from a town bordering West Bengal, India (2). There is clearly a likelihood of ‘spill over’ or ‘seeding’ of HIV to sex workers and then into the general population. Even if the prevalence of HIV among the general population remains low, given the size of the population, the absolute numbers of people living with HIV (PLHIV) could be very high. It is unlikely that the existing healthcare system would be able to cope with a large number of HIV-positive individuals, especially because what services exist are located in the main urban areas, although PLHIV are known to be distributed across the whole country and frequently in rural areas (National AIDS and STD Programme. Estimating numbers of those most affected by HIV/AIDS in different locations to support efficient service delivery, capacity building and community mobilization. 2009 [unpublished]). Table. HIV/AIDS: the Bangladesh Scenario, 2009 Fig. Number of reported HIV and AIDS cases, 1989–2009 One of the five priority areas for the NSP is the provision of services and care for PLHIV, and yet for most PLHIV, the only accessible healthcare services are provided by non-governmental organizations (NGOs). NGOs provide a limited range of services, including voluntary counselling and testing, counselling, treatment for sexually transmitted infections, and outpatient-based management of medical problems, including opportunistic infections (National AIDS and STD Programme, 2009). The provision of antiretroviral drugs (ARVs) is patchy and depends on the NGO's funding and support as there is still no national provision of ARVs. ARVs are manufactured by two companies in Bangladesh but they provide only limited first-line treatment, and no paediatric formulations are available. CD4 counts and more complicated diagnostic tests are available only in Dhaka, and even in Dhaka, basic diagnostic tests for common opportunistic infections are not available (Matin N et al. Personal communication, 2010). The situation regarding hospitalization and care of acutely-ill patients is even worse. The Government of Bangladesh has a dedicated centre for treating PLHIV but this single ward is dependent on a single doctor who obviously cannot be available 24 hours a day. PLHIV frequently report that they do not disclose their status to healthcare providers for fear of stigma and of being denied care which further complicates the situation, but perhaps the greatest barrier to providing inpatient care to PLHIV is the lack of trained clinicians—doctors, nurses, counsellors, and others—and the lack of a team-based approach to the care of individuals in a holistic manner. As the case report by Pervez et al. in this issue of JHPN demonstrates, even well-meaning clinicians who are not used to treating PLHIV are likely to make understandable errors in the management of such individuals (3). It is against this background that the contribution of Matin and colleagues in describing the clinical epidemiology of severe disease among PLHIV in Bangladesh should be supported (Matin N et al. Personal communication, 2010). While the national response of the Government of Bangladesh to the issue of HIV and AIDS, and of the donors which support it, has necessarily focused on community-based interventions, the time is fast approaching when large numbers of PLHIV will require hospital-based services. Unless the lack of antiretrovirals, diagnostics, and clinical capacity (in its broadest sense) is addressed quickly, a disaster looms.

Children and young people in out-of-home care: are GPs ready and willing to provide comprehensive health assessments for this vulnerable group?

Children living in out-of-home care because of abuse or neglect are among the most vulnerable in Australia. In 2005 the Royal Australasian College of Physicians highlighted the need for increased attention to the health of such children and recommended regular health assessment. This qualitative study explored the views of a purposive sample of 20 GPs about what would influence GP willingness and readiness to undertake comprehensive health assessments for children entering out-of-home care. Ethical concerns, training, professional development needs, medico-legal issues, workforce and financial pressures and communication problems with the child protection sector were among key factors identified. Professional values about continuity of health care for children emerged as a new issue with important policy implications. This is the first in-depth study in Australia of GP perspectives about systematic health assessments for children in child protection and sheds new light on the low GP uptake of such assessments for at-risk population groups.

The U.S. Food and Drug Administration Risk Assessment on Lead in Women’s and Children’s Vitamins Is Based on Outdated Assumptions

BackgroundFollowing a recent report of lead in certain commercial vitamin products, the U.S. Food and Drug Administration (FDA) conducted a nationwide survey to determine the Pb content in 324 multivitamin/mineral products labeled for use by women and children. The FDA compared estimated Pb exposures from each product with safe/tolerable exposure levels, termed provisional total tolerable intake (PTTI) levels, previously developed for at-risk population groups in 1992.ObjectiveWe investigated the FDA’s conclusions that Pb concentrations in all vitamin products examined do not pose a hazard to health because they are below the PTTI levels for all groups considered.DiscussionFor their initial estimations of PTTI levels, the FDA used a blood lead level (BLL) of 10 μg/dL as the threshold for adverse effects in children and in pregnant or lactating women. Studies have repeatedly linked chronic exposure to BLLs < 10 μg/dL with impairments in cognitive function and behavior in young children despite the absence of overt signs of toxicity. The FDA analysis also omitted any consideration of nonfood sources of Pb exposure, which is inconsistent with our current understanding of how most children develop elevated BLLs.ConclusionWe feel that based on these oversights, the FDA’s conclusions are unduly reassuring and that reconsideration of their current recommendations appears warranted.