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Screening Strategies for Lead Poisoning-Reply

George A. Gellert, MD, MPH, MPA; Gerald A. Wagner, MD, MPH; Roberta M. Maxwell, PhD; Douglas Moore, PhD; Len Foster, MPA
JAMA. 1993;270(21):2556-2557. doi:10.1001/jama.1993.03510210041017.
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In Reply.  —We agree with Dr Garza that the San Francisco data indicate how varied are jurisdictions and support test strategies differentiated according to local needs, conditions, and characteristics. The adequacy and validity of screening questions need to be established, and efforts to improve their sensitivity and specificity should not be abandoned in favor of universal blood lead testing. To this end, self-evaluation tools could be developed for use by families in concert with clinicians.Dr Schaffer noted the unclear generalizability of the Orange County findings, but our intent was not to develop a database from which to generalize and develop policy for other jurisdictions, but to illustrate the need for community-based assessment and data-driven local policy. We do not concur that few areas have such low percentages of pre-1950 homes; internal migration to Sunbelt/Southwest states and suburbanization during recent decades have created many new communities so that Orange County


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