Background Type 2 diabetes may increase the risk of amnestic mild cognitive impairment (aMCI) through Alzheimer's disease (AD)-related and vascular pathology and may also increase the risk of nonamnestic MCI (naMCI) through vascular disease mechanisms. We examined the association of type 2 diabetes with mild cognitive impairment (MCI) and MCI subtype (aMCI and naMCI) overall and by sex. Methods Participants were Olmsted County, Minnesota residents (70 years and older) enrolled in a prospective, population-based study. At baseline and every 15 months thereafter, participants were evaluated using the Clinical Dementia Rating scale, a neurological evaluation, and neuropsychological testing for a diagnosis of normal cognition, MCI, and dementia by a consensus panel. Type 2 diabetes was ascertained from the medical records of participants at baseline. Results Over a median 4.0 years of follow-up, 348 of 1450 subjects developed MCI. Type 2 diabetes was associated (hazard ratio [95% confidence interval]) with MCI (1.39 [1.08–1.79]), aMCI (1.58 [1.17–2.15]; multiple domain: 1.58 [1.01–2.47]; single domain: 1.49 [1.09–2.05]), and the hazard ratio for naMCI was elevated (1.37 [0.84–2.24]). Diabetes was strongly associated with multiple-domain aMCI in men (2.42 [1.31–4.48]) and an elevated risk of multiple domain naMCI in men (2.11 [0.70–6.33]), and with single domain naMCI in women (2.32 [1.04–5.20]). Conclusions Diabetes was associated with an increased risk of MCI in elderly persons. The association of diabetes with MCI may vary with subtype, number of domains, and sex. Prevention and control of diabetes may reduce the risk of MCI and Alzheimer's disease.

Context: A typical strategy for identifying children with elevated blood lead levels (BLL) is to use a test on a capillary sample as a screening tool and then perform a confirmatory test on a venous sample following an elevated capillary screen. However, tests on capillary samples are prone to false-positive results, which affect surveillance estimates of the prevalence of elevated BLL. Objective: We sought to measure the prevalence and risk of false-positive results in elevated tests on capillary samples based on various potential predictors. Design, Setting, Participants, and Main Outcome Measures: We analyzed blood lead results for children aged 0 to 6 years tested during 2011 to 2017 in Minnesota. A false positive was defined as a test on a capillary sample of at least 5 μg/dL, followed by a test result on a venous sample less than 5 μg/dL within 90 days. Binomial regression was used to estimate the probability of false-positive results dependent on the initial test result and the time between initial and confirmatory tests. Results: Results from 3898 children were included in analyses. Of these, 2330 (60%) had confirmatory results below 5 μg/dL and were classified as false positives. The proportion of false positives varied with time between tests, dependent on the initial result. Extrapolating the model to zero days between tests, without time for any change in the child's true BLL, we predicted 55% false positives in this study group (95% confidence interval: 53%-57%). Conclusion: Caution is warranted when interpreting elevated tests on capillary samples without confirmatory tests on venous samples. Providers should be encouraged to follow up all elevated capillary screens with confirmatory tests on venous samples.

On March 28, 2016, the Minnesota Poison Control System was consulted by an emergency department provider regarding clinical management of a shipyard worker with a blood lead level (BLL) >60 µg/dL; the National Institute for Occupational Safety and Health defines elevated BLLs as ≥5 µg/dL (1). The Minnesota Poison Control System notified the Minnesota Department of Health (MDH). Concurrently, the Wisconsin Department of Health Services (WDHS) received laboratory reports concerning two workers from the same shipyard with BLLs >40 µg/dL. These three workers had been retrofitting the engine room of a 690-foot vessel since January 4, 2016. Work was suspended during March 29-April 4 in the vessel's engine room, the presumptive primary source of lead exposure.

Our findings emphasize the importance of adequate provision and use of PPE to prevent occupational lead exposure.

3-digit ZIP code 132 be "likely~6%" when earlier in the Letter to the Editor they state the rate for Syracuse ZIP codes is 11.5%? The reason for these inconsistencies is unclear.Blatt et al break down the data for Onondaga County and Syracuse separately in 2015, but this raises the question of why 2 adjacent areas have very different rates of elevated and very high BLL in children. Of note is that Syracuse represents 30.9% of the County population (2010, US Census) yet accounts for 90.1% of the elevated BLL and 90.4% of the very high BLL within the County, according to data provided in their letter. Conversely, the County without Syracuse (nearly 70% of the total County population) had less than 10% of the children reported with elevated BLL and very high BLL of the County. Blatt et al state 11 519 children were tested in Onondaga County in 2015. They also state that 639 children had elevated BLL in Syracuse alone, and this represents 11.5% of children tested; thus, approximately 5557 children were tested in Syracuse alone in 2015. This would leave 5962 children in Onondaga County outside Syracuse. Of these 5962 children, 70 (1.17%) had elevated BLL and 15 (0.25%) had very high BLL (70 and 15 are the differences between county and Syracuse-specific numbers provided by Blatt et al). According to our study, only Florida had a lower rate of elevated BLL and only Florida and California had a lower rate of very high BLL. On the basis of the data presented by the pediatricians directing the Central-Eastern New York Poisoning Resource Center, children living in Onondaga County, outside Syracuse, appear to have among the lowest rates of elevated and very high BLL in the entire country, and children within Syracuse would have among the greatest rates in the country. The reason for the stark contrast between 2 adjacent areas is unclear.Only adding to the confusion is the difference between our rates for the 3-digit ZIP code regions 130 and 131 (approximately Onondaga County that does not include Syracuse) and the aforementioned rates. During the study period, we found 4.15% of our 2315 children with capillary specimens and 6.82% of our 1305 children with venous specimens demonstrated elevated BLL. Although these rates are much lower than the rates for the 3-digit ZIP code region 132, which contains Syracuse, they are still greater than the national average and considerably greater than the 1.17% indicated by Blatt et al.We believe listing all of these results only distracts from the main point our study was trying to convey: elevated BLLs are a problem as demonstrated by venous BLL specimens from patients in various regions, including the 3-digit ZIP code region 132. Although we applaud the attempts to reduce BLLs in children of Syracuse, more work is clearly warranted.