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Good Morning from Minnesota. I would like to use some of Dr. Ben Balzer's slides from his power point presentation for a series of Lead Case management workshops we are conducting in Minnesota. How do I obtain permission to use the slides? Thank you very much.

Myron Falken PhD MPH Epidemiologist Minnesota Department of Health

Dear Myron,

I grant you full permission to use these slides for educational purposes, and I wish you well with your endeavours. You would be aware that these slides have not been recently updated and we need to include a slide incorporating Canfield et al's findings published in NEJM of 17 April 2003, wherein the children with a lead level of 10 had an IQ averaging 7 points lower than those with a lead of 1. I would hasten to add that an average drop of 7, means some children will be 4 and others will be 10 points lower.

Also please note the UK study Lewendon et al (abstract below) showing that elevated blood lead above 10 (in their units 100 µg/litre) are 17 times (12/0.7) in children with behavioural or developmental disorders.

Arch Dis Child 2001;85:286-288
Abstract Aim - To test the hypothesis that children with behavioural and/or developmental problems have significantly higher blood lead concentrations than the general childhood population.

Methods - Blood samples were taken from 69 children with behavioural and/or developmental problems and 136 controls (children admitted for elective day case surgery under general anaesthetic). Blood lead estimations were carried out using graphite furnace atomic absorption
Results - Children with behavioural and/or developmental problems had higher lead concentrations than controls, both in terms of their distribution across the group (mean geometric lead concentrations: 40.7 (cases), 29.2 (controls), ratio of the means geometric 1.35 (95% CI 1.17, 1.58)) and the proportion of children with lead concentrations above those commonly defined as "toxic"-that is, 100 µg/l (12% (cases), 0.7% (controls); p (0.001). Multiple linear regression suggested that this difference was not explained by differences in age, sex, or socio-economic status of the two comparison groups.

Conclusions - Children with behavioural and/or developmental problems are more likely to have significantly higher blood lead concentrations than the general childhood population. Lead, a known and more importantly, a treatable neurotoxin, would further contribute to the impairment suffered by these children. We argue that this group of children should be routinely screened for lead.

(Arch Dis Child 2001;85:286-288)

With kind regards
Yours sincerely
Ben

Dr Ben Balzer
109 Morgan St
Beverly Hills 2209
Tel +612 9502 3355 Fax +612 9502 4243

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