Umbilical Cord Blood Lead Level Disparities between Flint and Detroit.

OBJECTIVE: The lead-in-water impact of the Flint water crisis on the youngest and most neurodevelopmentally vulnerable population was largely unknown. The objective of this study was to investigate and compare cord blood lead levels (CBLLs) in newborns in Flint, Michigan, after the Flint water crisis, to a group of Detroit newborns. STUDY DESIGN: Mothers of 99 Flint newborns were surveyed about potential lead exposures. These neonates were born after the recognition of population-wide lead-in-water contamination. CBLLs were measured and maternal-fetal metrics were reviewed. CBLLs and maternal-fetal metrics were then compared with those of a retrospective cohort of 116 Detroit newborns who previously shared the same water source. Analysis involved descriptive statistics, independent t-test, and χ 2 analysis. RESULTS: CBLLs greater than or equal to 1 µg/dL (0.05 µmol/L) were more prevalent among Flint newborns (14%), as compared with Detroit newborns (2%; p = 0.001). This was a sevenfold disparity between Flint and Detroit newborns. No statistically significant differences were found in birth weight, head circumference, small for gestational age status, gestational age, or preterm status among the two groups. CONCLUSION: The Flint water crisis potentially exposed newborns to lead in utero, implicating maternal-fetal outcomes and future health and development. Primary prevention efforts, including identification and mitigation of lead exposure before conception and during pregnancy, are needed. New environmental exposure detection methods and long-term neurodevelopmental follow-up will complement the findings of this study.

Surveying Resident and Faculty Physician Knowledge, Attitudes, and Experiences in Response to Public Lead Contamination.

Environmental health crises can appear anywhere and without warning. After research revealed a significant incidence of elevated pediatric blood lead levels following a water source change, Genesee County declared a public health emergency in Flint, Michigan. Hospital patients and family members began approaching Hurley Medical Center's physicians with questions regarding the health implications of the lead contamination. Many of the physicians voiced concerns about responding appropriately to patient needs and increasing demands for information. As a result, a Hurley research team decided to conduct an informal survey across training programs to determine the need for added education.Because of heightened patient anxiety, it was necessary for the timeline to progress quickly. In creating the survey, the team's objective was to assess resident and faculty physician knowledge, attitudes, and experiences concerning lead contamination. The results revealed a critical need for supplementary training. Therefore, Hurley embarked on an education campaign for its graduate medical education programs, benefiting physicians and patients alike.Patient and physician needs may change drastically following an environmental health emergency. It is the duty of medical centers to ensure their clinicians are well equipped to confront such threats. As prompt treatment is often a key to positive health outcomes, the authors stress the importance of acting quickly and suggest conducting informal surveys to identify gaps in physician knowledge. Likewise, the authors encourage medical educators nationwide to examine their environmental health curricula. It appears lead-contaminated water is not just a Flint problem but may have far-reaching implications for many cities.

Assessing barriers to the identification of elder abuse and neglect: a communitywide survey of primary care physicians.

Elder abuse and neglect represents an extensive medical and social problem in the United States with an estimated prevalence of 4-10% of older persons. Physicians are mandated to report suspected abuse, but <2% of Adult Protective Service reports are filed by physicians. A knowledge or attitude survey was mailed to all adult primary care physicians in the study community. The intent was to explore possible knowledge deficits and perceived barriers to physician reporting. Regarding the attitude measure, physicians expressed that a lack of understanding of reporting mechanisms represented the most significant obstacle. Regarding the knowledge measure, a majority of the responding physicians were unable to recognize key risk factors for abuse. Study findings will be used to develop local educational programs to enhance physician understanding of elder abuse.

"Windshield Tour" - A Journey Towards Cultural Competency.

PURPOSE: Medical educators are directing greater attention to the promotion of cultural competency when prioritizing educational program goals. An innovative educational approach is described here in a community hospital where nearly one-third of its citizens fall below the poverty level. The intent was to provide a very personal, first-hand learning experience via witnessing living conditions of patients from poverty-stricken neighborhoods. METHOD: Hospital educators worked with the community organization FACED (Faith Access to Community Economic Development). This grassroots group developed an educational driving excursion - entitled the "Windshield Tour" - of the city hospital's poorest areas. A knowledge/attitude questionnaire was administered as a pre- and post-test to 80 residents and medical students. RESULTS: Significant changes were observed in participants' understanding of personal/financial hardships faced by their patients, perceptions of availability of resources, understanding of issues related to health care benefits, and rankings of patient/physician characteristics deemed important. CONCLUSION: Hospital educators have met with FACED leaders to explore future collaborative projects that would increase exposure to the community for the residents and students.