A Critical Review of Biomarkers Used for Monitoring Human Exposure to Lead: Advantages, Limitations, and Future Needs

Lead concentration in whole blood (BPb) is the primary biomarker used to monitor exposure to this metallic element. The U.S. Centers for Disease Control and Prevention and the World Health Organization define a BPb of 10 μg/dL (0.48 μmol/L) as the threshold of concern in young children. However, recent studies have reported the possibility of adverse health effects, including intellectual impairment in young children, at BPb levels < 10 μg/dL, suggesting that there is no safe level of exposure. It appears impossible to differentiate between low-level chronic Pb exposure and a high-level short Pb exposure based on a single BPb measurement; therefore, serial BPb measurements offer a better estimation of possible health outcomes. The difficulty in assessing the exact nature of Pb exposure is dependent not so much on problems with current analytical methodologies, but rather on the complex toxicokinetics of Pb within various body compartments (i.e., cycling of Pb between bone, blood, and soft tissues). If we are to differentiate more effectively between Pb stored in the body for years and Pb from recent exposure, information on other biomarkers of exposure may be needed. None of the current biomarkers of internal Pb dose have yet been accepted by the scientific community as a reliable substitute for a BPb measurement. This review focuses on the limitations of biomarkers of Pb exposure and the need to improve the accuracy of their measurement. We present here only the traditional analytical protocols in current use, and we attempt to assess the influence of confounding variables on BPb levels. Finally, we discuss the interpretation of BPb data with respect to both external and endogenous Pb exposure, past or recent exposure, as well as the significance of Pb determinations in human specimens including hair, nails, saliva, bone, blood (plasma, whole blood), urine, feces, and exfoliated teeth

Child Abuse Pocket Atlas Series, Volume 4: Investigation, Documentation, and Radiology

In the investigation of child abuse, consistent investigative protocol and clear, thorough documentation of facts and findings are essential to ensuring justice for victims, both for those who survive and for those who do not. In order to achieve the best possible results in such cases, multidisciplinary investigative teams of first responders, law enforcement, and medical practitioners should be well prepared for the process of investigation and documentation as they work in tandem toward a just end for every case of abuse. This new pocket atlas, part of an ongoing series on child abuse, offers nearly 500 full-color photos detailing proper approaches to crime scene investigation, physical and postmortem examinations, and photodocumentation, as well as a section on radiology and common fractures in cases of child maltreatment. Readers in medicine, law enforcement, and any other readers involved with child abuse and death investigations will enjoy the benefit of a compact and accessible guide to investigation and documentation.https://corescholar.libraries.wright.edu/books/1214/thumbnail.jp

Medical Neglect in Childhood.

This introduction provides an overview to the special issues on medical neglect in childhood guest edited by Barbara L. Knox, MD, FAAP, Clinical Professor of Pediatrics, University of Washington School of Medicine, The Children\u27s Hospital at Providence, Medical Director of Alaska Child Abuse Response and Evaluation Services; Randell C. Alexander, MD, PhD, FAAP, Professor and Chief, Division of Child Protection and Forensic Pediatrics at the University of Florida-Jacksonville; Francois M. Luyet, MD, Clinical Assistant Professor, University of Wisconsin School of Medicine and Public Health; and Debra D. Esernio-Jenssen, Professor of Pediatrics at the Morsani College of Medicine USF Health in Tampa, Florida and the Chief of Child Protection Medicine at Lehigh Valley Reilly Children\u27s Hospital. Ten articles are included in this special edition aiming to explore the role of medical neglect in situations commonly encountered by practitioners

Chadwick\u27s Child Maltreatment

Volume 1. Physical abuse and neglect -- volume 2. Sexual abuse and psychological maltreatment -- volume 3. Cultures at risk and role of professionalshttps://corescholar.libraries.wright.edu/books/1210/thumbnail.jp