Elevated Blood Lead Concentrations Research Articles

Environmental Public Health Tracking in England- support for Health Impact Assessments

Abstract Environmental epidemiology is a key function for the public health service with regards to investigating the public health effects of environmental hazards, monitoring the public health efforts to control the environmental risks, and providing the evidence that informs decisions making and preparedness. At the United Kingdom Health Security Agency (UKHSA), the Environmental Public Health Tracking (EPHT) Programme, initiated in 2010, has developed a number of data streams to help link environment and health data, to support Health Impact Assessment (HIA). The main aims of the EPHT programme in England are to: 1. Identify populations at risk from exposure to significant environmental and chemical hazards 2. Investigate relationships between hazard and disease 3. Inform public health policy making 4. Optimise intervention and prevention strategies 5. Generate hypotheses for further research. Such EPHT functions are based on three key components: a) by building a national EPHT program that integrates surveillance of environmental hazards, exposures and related health outcomes, to allow data linkage and assessment of environmental and health information; b) strengthening the epidemiology science, by conducting research and training of the workforce and c) developing strategies for response to immediate risks, incidents and preparing for future risks. Examples to support HIA include a) developing an air pollution exposure surveillance work programme, that has designed a pilot population vulnerability indicator; b) developing indicators for climate change impacts for public health, c) reporting regularly on the health impacts of public fluoridation water supply schemes (as mandated by Government) and d) exploring risk factors associated with elevated blood lead concentration in children, through laboratory reporting to surveillance systems. The talk will highlight some examples of practice and outline how the EPHT programme in England has supported HIA practices.

Lead exposure sources and public health investigations for children with elevated blood lead in England, 2014 to 2022.

Lead exposure at any concentration can adversely impact health, with children being more vulnerable to its effects. In England, children with an elevated blood lead concentration (BLC) are reported to Health Protection Teams (HPTs) for public health investigation. A detailed review of these cases has not yet been conducted. The objectives of this study were to describe the demographics, likely setting and sources of lead exposure, risk behaviours, public health investigations and outcomes for children aged <16 years with a BLC requiring public health action reported to HPTs between 2014-2022 in England. Data were collected via a lookback questionnaire and a live enhanced surveillance questionnaire. Data were deduplicated, cleaned and results summarised as numbers and percentages using R studio. A thematic analysis was conducted on qualitative responses to a question relating to problems experienced during case investigation. There were 340 cases in our study: the majority were aged 1-4 years old (53%) and male (69%). Ethnicity data was poorly recorded. A higher than expected proportion (31%) lived in the most deprived areas. Pica (76%) and learning difficulties (60%) were often present. Cases were primarily exposed to lead in the domestic setting (92%) with paint (43%) and soil (29%) the most common exposures. Most cases lived in rented accommodation (63%), with a higher proportion in social rentals (48%) than privately rented (37%). Case investigations were resource intensive and poor stakeholder engagement/response was most frequently identified as challenging by HPTs. Lead exposure is harmful to children and requires public health and clinical management, which can be complex and challenging. Prevention of lead exposure in children should be the focus of intervention efforts. Outreach, engagement and preventative work should focus on both renters and homeowners. Collecting ethnicity data consistently may enable identification of more specific groups at increased risk of lead exposure in England.

DIETARY FIBER IN REDUCING OF ELEVATED BLOOD LEAD CONCENTRATION IN CHILDREN

The aim of the study was to evaluate the effectiveness of dietary fiber in reducing elevated blood lead concentration (BLC) of Ukrainian children. Materials and methods. 80 random children aged 4 to 15 years were examined. The lead content in venous blood was detected by atomic absorption spectrometry with electro-thermal atomizer (ET AAS). Indicators of morphological and biochemical blood tests were determined by generally accepted methods. Results. About a quarter of the children had BLC ≥ 5μg/dL. They had a higher content of eosinophil cells, an increase of ALT activity in the blood compared to children with lower BLCs. As a nutritional supplement for the rehabilitation of these children, dietary fiber from cereals of 10 g per day was used for 30 days, as an addition to main dishes and salads during lunch. As a result, BLC significantly decreased. At the same time, the number of eosinophils in blood and the activity of ALT significantly decreased. The thiol-disulfide ratio increased. Children tolerated nutritional intervention well. Its safety was also indicated by the absence of changes in indicators of the functional state of the liver. This allows us to recommend this dietary supplement for the improvement of children undergoing environmental lead pressure.

Effects of proximity to humans on neophilia, foraging ecology and population structure of kea

ABSTRACT Neophilic tendencies in scavenging species living near humans may have adverse consequences for these animals. New Zealand’s kea (Nestor notabilis), an endangered parrot, potentially faces exacerbated mortality risk associated with proximity to humans. Hazards include lead building materials, introduced mammalian predators, and poison baits used to control these predators. How kea respond to these hazards can affect life expectancy. We modelled the effects of (1) proximity to humans, (2) age, (3) presence of conspecifics, and (4) blood lead levels, on the time taken to approach and contact a novel object. We also compared dietary trophic level between populations adjacent to and remote from humans using stable isotopes, and compared the age structure of these populations. Adjacent kea contacted the object faster than remote kea, as did younger individuals and those with elevated blood lead concentration, but conspecific presence did not affect approach latency. We conclude that adjacent kea exhibit enhanced neophilia, which may translate to reduced life expectancy due to interacting with anthropogenic hazards. Kea adjacent to humans were younger and foraged at a lower trophic level than remote kea, with a possible consequence of reduced productivity. Our results should be considered when setting management policy for kea habitat.

Health risk assessment of workers exposed to lead dust in informal e-waste recycling workshops

ABSTRACT Informal recycling of electronic waste (e-waste) has attracted significant attention due to its economic benefits and rapid growth rate in many parts of the world. Unfortunately, unsafe conditions of recycling workshops possess chronic exposure to workers and lead to elevated blood lead concentrations (BLCs). Upon measuring the lead concentration in the dust of recycling workshops and the e-wastes in southwestern region of Iran, the related health risks were assessed in 30 exposed workers and 30 non-exposed habitants cases based on the determination of BLC. The average BLCs in exposed workers and non-exposed habitants cases were 24 μg/dL and 7 μg/dL, respectively. The geo-accumulation index (Igeo) revealed heavy contamination of dust in informal e-waste recycling workshops (IERWs) (5023 μg/kg) and significantly lower levels in unexposed areas (49 μg/kg). Health risk assessment indicated that lead exposure from IERWs appears to be a potential threat to workers and indirectly to their families.

Спіруліна в оздоровленні дітей з підвищеним рівнем свинцю в крові

Introduction. According to literary data, almost one in three children in the world has a blood lead concentration (BLC) of more than 5μg/ dL. This value is the threshold for initiating clinical intervention according to WHO recommendations. At this BLC threshold (referred to as the ‘public health intervention concentration’) public health action is recommended in the USA, Australia, France, England. In Ukraine, there are no programs of this scale yet. Scientific work in this direction is rare. The aim of the study was to evaluate the effectiveness of spirulina in improving the metabolic status in Ukrainian children with elevated BLC. Materials and methods. 33 random children aged 7 to 15 years were examined. The lead content in venous blood was detected by atomic absorption spectrometry with electrothermal atomization. Indicators of morphological and biochemical blood tests were determined by generally accepted methods. Results. About 30% of the children had BLC ≥ 5μg/dL. They had a lower content of hemoglobin and red blood cells, activation of lipid peroxidation processes and a decrease in antioxidant protection reserves compared to children with lower BLCs. According to the WHO recommendations, the children with BLC ≥ 5μg/dL underwent nutritional intervention. As a nutritional supplement, spirulina was used according to the scheme: the first 10 days – 0.5 g 2 times a day, then 1 g 2 times a day for another 20 days. As a result, BLC significantly decreased from 7.56±0.20 to 6.26±0.57 μg/dL, hemoglobin increased from 126.91±2.15 to 137.46±1.46g/L, blood red cells increased from 4.02±0.07 to 4.39±0.05 T/L. The content of diene conjugants decreased from 20.46±1.71 to 13.82±1.27 μmol/L, and the number of sulfhydryl groups increased from 0.93±0.15 to 1.40±0.11μmol/L. The thiol-disulfide ratio increased 1.7 times. Conclusions. Spirulina contributes to the removal of lead from the body and helps to improve the metabolic status in children with elevated BLC. This allows us to recommend this dietary supplement for the rehabilitation of children undergoing environmental lead pressure.

’As safe as houses; the risk of childhood lead exposure from housing in England and implications for public health’

Background and aimExposure to lead can harm a child’s health, including damage to the nervous system, delayed growth, hearing loss, and many other adverse health effects, as well as implications for social, economic, educational and social well-being. Lead exposure in children is still a concern and cases require public health management to find the exposure source and interrupt the exposure pathway. Housing characteristics can indicate the presence of lead-contaminated paint and leaded water supply pipes. We aimed to explore the relationship between housing characteristics and elevated blood lead concentration (BLC) in children in England.MethodsWe used a retrospective cohort design and included all cases of lead exposure in children reported to the UK Health Security Agency between 2014 and 2020 via surveillance. A case was a child aged under 16 years, resident in England, BLC of ≥ 0.48 μmol/L (10 µg/dL) and referred for public health management. We collected case demographic details and housing characteristics (age and type). We explored associations between elevated BLC and risk factors, using generalised linear mixed effects models and compared cases’ housing type to that expected nationally.ResultsTwo hundred and sixty-six out of 290 cases met the case definition. There was no difference in BLCs between genders, age groups, deprivation, and housing type. After adjusting for reporting source, housing age and type, cases residing in housing built pre-1976 had a BLC of 0.32 (95%CI 0.02, 0.63) µmols/L (6.63 (95%CI 0.42, 13.0) µg/dL) higher than cases living in housing built after this time. Cases were 1.68 times more likely to be living in terraced housing (housing adjoined to one another) than other children and less likely to live in apartments and detached properties.ConclusionThis study suggests an association between housing characteristics and BLC in children. Housing age and type may act as a proxy for lead exposure risk through exposure to leaded paint, lead water pipes, and lead contaminated dust from indoor and outdoor sources. Public health action should consider targeting families more at risk in older housing by raising awareness of the potential presence of lead pipes and paint. Interventions should include working with wider stakeholders including other housing and environmental professionals, the private sector, as well as parents and carers.

As safe as houses; the risk of childhood lead exposure from housing in England

Background and Aim: Exposure to lead can harm a child’s health, including damage to the nervous system. Lead exposure in children is still a concern and cases require public health management to find the exposure source. Housing characteristics can indicate the presence of lead-contaminated paint and leaded water supply pipes. We aimed to explore the relationship between housing characteristics and elevated blood lead concentration (BLC) in children in England. Methods: We used a retrospective cohort design and included all cases of lead exposure in children reported to the UK Health Security Agency between 2014 and 2020 via surveillance. A case was a child aged under 16 years, resident in England, BLC of &amp;#x2265;0.48&amp;#x3bc;mol/L and referred for public health management. We collected case demographic details and housing characteristics (age and type). We explored associations between elevated BLC and risk factors, using generalised linear mixed effects models and compared cases’ housing type to that expected nationally. Results: 266 cases met the case definition. There was no difference in BLCs between genders, age groups, deprivation and housing type. After adjusting for reporting source, housing age and type, cases residing in housing built pre-1976 had a BLC of 0.32 (95%CI 0.02, 0.63) µmols/L higher than cases living in housing built after this time. Cases were 1.68 times more likely to be living in terraced housing than other children and less likely to live in apartments and detached properties. Conclusion: This study suggests an association between housing characteristics and BLC in children. Housing age and type may act as a proxy for lead exposure risk through exposure to leaded paint, lead water pipes and lead contaminated dust from outdoor sources. Public health action should consider targeting families more at risk in older housing raising awareness of lead pipes and paint. Keywords: Lead, children, housing

Case series of chronic occupational lead exposure in shooting ranges

IntroductionDespite existing occupational lead exposure prevention regulations, Lithuanian shooting range workers still complain of chronic lead poisoning related symptoms. This indicates a poor understanding of occupational safety when working in lead-polluted environments. Case presentation20 men, whose age ranged from 32 to 57 (mean 41.8 ± 10 years), were consulted at the Toxicology Centre at the Republican Vilnius university hospital in Vilnius, Lithuania in the 2016–2019 year period. All of the patients were working as shooting instructors, with their work experience varying from 2 to 30 years. Clinical examination showed blood lead levels ranging from 5.64 μg/dL to 45.8 μg/dL (norm for occupational exposure - <40 μg/dL). Main symptoms were fatigue (12 patients out of 20), dizziness (5/20), arthralgia (5/20). Other symptoms included impaired memory (3/20), nausea (3/20), sleep disorders (3/20), metallic or sweet taste (3/20), dermatological disorders (3/20), coxarthrosis (2/20), balance disorders (2/20), paresthesia (2/20), abdominal pain (2/20) and others. 4 patients were asymptomatic. DiscussionShooting range employees are highly vulnerable to daily lead exposure. Even low constant elevated blood lead concentrations can have significant toxic effects over time.

Blood lead concentration and its associated factors in preschool children in eastern Iran: a cross-sectional study

BackgroundLead is a toxic metal that affects almost every organ in the body. Children are more susceptible to lead toxicity because they ingest non-food items (pica), have oral exploratory habits, absorb more substantial amounts of ingested lead compared to adults, and have a developing central nervous system. This study describes venous blood lead concentrations (BLC) in young children living in Birjand, Iran.MethodsA cross-sectional study was performed in 2016 on children 1–7 years of age who were referred to healthcare centers in Birjand City. Demographic information was obtained, and their BLC was tested using atomic absorption spectrometry (AAS).ResultsFour hundred children were tested. Their mean age was 52.37 ± 23.77 months; their mean BLC was 2.49 ± 2.64 μg/dL (median 1.85 μg/dL). Thirty-two (8%) children had a BLC > 5 μg/dL. A logistic regression model revealed that per one unit of increase in age, the chance of an elevated BLC decreased by 3% (OR (95%CI): 0.97 (0.96–0.99), p < 0.01). The risks of an elevated BLC was 61% lower in girls compared to boys (OR (95%CI): 0.39 (0.17–0.92), p = 0.03). Further, per one rate of increase in the BMI, the chance of an elevated BLC was higher (OR (95%CI): 1.13 (1.02–1.24), p = 0.01). Children whose fathers were laborers had higher BLC than those with employee fathers (p = 0.01).ConclusionOf 400 children aged 1–7 years old living in Birjand, Iran, 8% had elevated BLC. BLC correlated with the child ‘s age, gender, body mass index, and father’s occupation.

Risk assessment of elevated blood lead concentrations in the adult population using a decision tree approach

Lead is a common toxin which has detrimental effects on human health. Since lead poisoning is not associated with specific symptoms, diagnosing elevated blood lead concentration (EBLC) should be taken seriously. The purpose of this study was to propose a prediction model for EBLC based on demographic and clinical variables through a decision-tree model. In this cross-sectional study, 630 subjects (above 40 years old) living in South Khorasan Province, Iran in 2017 were selected via cluster random sampling method. From among the 630 participants who met the inclusion criteria, 70% (N = 456) were chosen randomly to achieve a set for developing the decision tree and multiple logistic regression (MLR). The other 30% (N = 174) were placed in a holdout sample to examine the function of the decision tree and MLR models. The predictive performance for various models was studied using the Receiver Operating Characteristic (ROC) curve. In the decision tree model, the parameters of hematocrit (HCT), White Blood Cell (WBC), Red Blood Cell (RBC), Mean corpuscular volume (MCV), creatinine concentration, abdominal pain, gender, route of administration, and history of cigarette smoking were the most critical factors in identifying people at risk of EBLC. The HCT concentration was the most critical variable, which was chosen as the root node of the tree. Based on the ROC curve, the decision tree model had better predictive accuracy than the logistic regression model. Our results indicated that the decision tree model offers far greater predictive precision than the logistic regression model. Doctors should pay more attention to some factors including the hematological parameters such as MCV, RBC, HCT, leukocytosis, creatinine levels, male sex, history of cigarette, and opium consumption for the screening of EBLCs.

The management of embedded metal fragment patients and the role of chelation Therapy: A workshop of the Department of Veterans Affairs-Walter Reed National Medical Center.

Exposure to retained metal fragments from war-related injuries can result in increased systemic metal concentrations, thereby posing potential health risks to target organs far from the site of injury. Given the large number of veterans who have retained fragments and the lack of clear guidance on how to medically manage these individuals, the Department of Veterans Affairs (VA) convened a meeting of chelation experts and clinicians who care for embedded fragment patients to discuss current practices and provide medical management guidance. Based on this group's clinical expertise and review of published literature, the evidence presented suggests that, at least in the case of lead fragments, short-term chelation therapy may be beneficial for embedded fragment patients experiencing acute symptoms associated with metal toxicity; however, in the absence of clinical symptoms or significantly elevated blood lead concentrations (greater than 80 µg/dL), chelation therapy may offer little to no benefit for individuals with retained fragments and pose greater risks due to remobilization of metals stored in bone and other soft tissues. The combination of periodic biomonitoring to assess metal body burden, longitudinal fragment imaging, and selective fragment removal when metal concentrations approach critical injury thresholds offers a more conservative management approach to caring for patients with embedded fragments.

Proximity to roads, but not exposure to metal pollution, is associated with accelerated developmental telomere shortening in nestling great tits

Comprehensively understanding the factors affecting physiology and fitness in urban wildlife requires concurrently considering multiple stressors. To this end, we simultaneously assessed how metal pollution and proximity to roads affect body condition and telomere shortening between days 8 and 15 of age in nestling great tits (Parus major), a common urban bird. We employed a repeated-measures sampling design to compare telomere shortening and body condition between nestlings from four urban study sites south of Antwerp, Belgium, which are located at different distances from a metal pollution point source. In addition, we explored associations between metal exposure and telomere dynamics on the individual level by measuring blood concentrations of five metals/metalloids, of which lead, copper and zinc were present at concentrations above the limit of detection. To assess whether roadway-associated stressors (e.g. noise and air pollution) might affect nestling condition and telomere shortening, we measured the proximity of nest boxes to roads. Metal exposure was not associated with nestling telomere length or body condition, despite elevated blood lead concentrations close to the metal pollution source (mean ± SE = 0.270 ± 0.095 μg/g wet weight at the most polluted study site), suggesting that nestlings may have some capacity to detoxify metals. However, nestlings from nest boxes near roads exhibited more telomere shortening between days 8 and 15 of age, and shorter telomeres at day 15. Nestlings in poorer condition also had shorter telomeres, but proximity to the road was unrelated to body condition. Thus, nutritional stress is unlikely to mediate the relationship between proximity to roads and telomere length. Rather, proximity to roads could have affected telomere shortening by exposing nestlings to air or noise pollution. Our study highlights that traffic-related pollution, which is implicated in human health problems, might also affect urban wildlife.

Case epidemiology from the first three years of a pilot laboratory-based surveillance system for elevated blood-lead concentrations among children in England, 2014-17: implications for public health action.

BackgroundChildren incur lead toxicity even at low blood-lead concentrations (BLCs), and testing in England is opportunistic. We described epidemiology of cases notified to a passive laboratory-based surveillance system (SS), the Lead Poisoning in Children (LPIC) SS to inform opportunities to prevent lead exposure in children in England.MethodsSurveillance population: children <16 years of age and resident in England during the reporting period September 2014–17. Case definition: children with BLC ≥0.48 μmol/l (10 μg/dl). We extracted case demographic/location data and linked it with laboratory, area-level population and socio-economic status (SES) data. We described case BLCs and calculated age-, gender- and SES-specific notification rates, and age-sex standardised regional notification rates.ResultsBetween 2014 and 2017 there were 86 newly notified cases, giving an annual average notification rate of 2.76 per million children aged 0–15 years. Regionally, rates varied from 0.36 to 9.89 per million. Rates were highest in the most deprived quintile (5.38 per million), males (3.75 per million) and children aged 1–4 years (5.89 per million).ConclusionsMales, children aged 1–4 years, and children in deprived areas may be at higher risk, and could be targeted for primary prevention. Varied regional notification rates suggest differences in clinician awareness of lead exposure and risk factors; guidelines standardising the indications for BLC-testing may assist secondary prevention.

Association between maternal blood cadmium and lead concentrations and gestational diabetes mellitus in the Japan Environment and Children's Study.

To examine the association between elevated blood cadmium (Cd) and lead (Pb) concentrations and increased risk of gestational diabetes mellitus (GDM). This cross-sectional study included pregnant women (n = 16,955) enrolled in the Japan Environment and Children's Study. Concentrations of Cd and Pb in blood samples collected at 22-28weeks' gestation were measured by inductively coupled plasma mass spectrometry. GDM was diagnosed according to the 2011 Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists criteria. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression analysis. Blood Cd and Pb concentrations were slightly higher among women with GDM than among those without GDM; however, these differences were not statistically significant. Elevated blood Cd and Pb concentrations were not associated with increased GDM risk in the nulliparous group (Cd OR 0.76; 95% CI 0.28-2.08 for high vs low category; Pb OR 2.51; 95% CI 0.72-8.72) or the parous group (Cd OR 0.64; 95% CI 0.29-1.44; Pb OR 0.31; 95% CI 0.04-2.29). This study demonstrates that Cd and Pb exposure, in the range of blood levels observed, has no significant relationship with the development of GDM. Further prospective studies would be valuable to confirm these findings.

A Randomized Controlled Trial to Reduce Childhood Lead Exposure and Lead-Associated Neurobehavioral Deficits: The HOME Study

Background: Childhood lead exposure is associated with neurobehavioral impairments in children. No randomized trials have tested whether a comprehensive residential lead hazard intervention can prevent elevated blood lead concentrations and associated neurobehavioral outcomes.Objectives: We tested whether an intervention designed to reduce residential lead exposure completed during pregnancy could prevent elevated blood lead concentrations and improve neurobehavioral outcomes in children.Methods: We enrolled 355 pregnant women from the Cincinnati, OH metropolitan area in a randomized controlled trial. We randomly assigned women to receive either residential lead or injury hazards. The lead hazard intervention included elements designed to reduce or eliminate lead exposure from paint, drinking water, and soil. We assessed residential dust lead loadings at baseline and when children were ages 1 and 2 years. From ages 1-8 years, we measured blood lead concentrations and assessed cognition, behavior, and executive functions.Results: The intervention reduced floor, windowsill, and window trough dust lead loadings at ages 1 and 2 years by 24% (95% CI: -43, 1), 40% (95% CI: -60, -11), and 47% (95% CI: -68, -10), respectively. The intervention non-significantly reduced children&amp;#8217;s blood lead concentrations (-6%; 95% CI:-17, 6). Race modified the intervention effect on children&amp;#8217;s blood lead concentrations (intervention x race p-value&amp;#61;0.03); Black children had greater reductions in blood lead concentrations (-31%; 95% CI:-50, -5) than White children (-2%; 95% CI:-14, 12). Neurobehavioral test scores were subtly better among children in the intervention group than control group; all were statistically non-significant, except for a reduction in anxiety scores (-1.6; 95% CI:-3.2, -0.1).Conclusions: This intervention reduced residential lead exposures and, among Black children, blood lead concentrations, but did not result in substantive neurobehavioral improvements.

Lead in Air in Bangladesh: Exposure in a Rural Community with Elevated Blood Lead Concentrations among Young Children.

Previous evaluations of a birth cohort in the Munshiganj District of Bangladesh had found that over 85% of 397 children aged 2–3 years had blood lead concentrations above the United States Centers for Disease Control and Prevention’s reference level of 5 μg/dL. Studies in urban areas of Bangladesh have found elevated levels of lead in the air due to industries and remaining contamination from the historic use of leaded gasoline. Sources of lead in rural areas of Bangladesh remain unknown. We conducted air sampling in both residential and industrial sites in Munshiganj to determine whether children are exposed to elevated lead concentrations in the air and study the association between the children’s blood lead levels and sampled air lead concentrations. Residential and industrial air samples in Munshiganj were found to have elevated lead concentrations (mean 1.22 μg/m3) but were not found to be associated with the observed blood lead concentrations. Lead in air is an important environmental health exposure risk to the for children in Munshiganj, and further research may shed light on specific sources to inform exposure prevention and mitigation programs.

Effect of Residential Lead-Hazard Interventions on Childhood Blood Lead Concentrations and Neurobehavioral Outcomes

Childhood lead exposure is associated with neurobehavioral deficits. The effect of a residential lead hazard intervention on blood lead concentrations and neurobehavioral development remains unknown. To determine whether a comprehensive residential lead-exposure reduction intervention completed during pregnancy could decrease residential dust lead loadings, prevent elevated blood lead concentrations, and improve childhood neurobehavioral outcomes. This longitudinal, community-based randomized clinical trial of pregnant women and their children, the Health Outcomes and Measures of the Environment (HOME) Study, was conducted between March 1, 2003, and January 31, 2006. Pregnant women attending 1 of 9 prenatal care clinics affiliated with 3 hospitals in the Cincinnati, Ohio, metropolitan area were recruited. Of the 1263 eligible women, 468 (37.0%) agreed to participate and 355 women (75.8%) were randomized in this intention-to-treat analysis. Participants were randomly assigned to receive 1 of 2 interventions designed to reduce residential lead or injury hazards. Follow-up on children took place at 1, 2, 3, 4, 5, and 8 years of age. Data analysis was performed from September 2, 2017, to May 6, 2018. Residential dust lead loadings were measured at baseline and when children were 1 and 2 years of age. At 1, 2, 3, 4, 5, and 8 years of age, the children's blood lead concentrations as well as behavior, cognition, and executive functions were assessed. Of the 355 women randomized, 174 (49.0%) were assigned to the intervention group (mean [SD] age at delivery, 30.1 (5.5) years; 119 [68.3%] self-identified as non-Hispanic white) and 181 (50.9%) to the control group (mean [SD] age at delivery, 29.2 [5.7] years; 123 [67.9%] self-identified as non-Hispanic white). The intervention reduced the dust lead loadings for the floor (24%; 95% CI, -43% to 1%), windowsill (40%; 95% CI, -60% to -11%), and window trough (47%; 95% CI, -68% to -10%) surfaces. The intervention did not statistically significantly reduce childhood blood lead concentrations (-6%; 95% CI, -17% to 6%; P = .29). Neurobehavioral test scores were not statistically different between children in the intervention group than those in the control group except for a reduction in anxiety scores in the intervention group (β = -1.6; 95% CI, -3.2 to -0.1; P = .04). Residential lead exposures, as well as blood lead concentrations in non-Hispanic black children, were reduced through a comprehensive lead-hazard intervention without elevating the lead body burden. However, this decrease did not result in substantive neurobehavioral improvements in children. ClinicalTrials.gov identifier: NCT00129324.

Factors influencing patient preferences for oral versus intravenous (IV) enzyme replacement medication

Despite existing occupational lead exposure prevention regulations, Lithuanian shooting range workers still complain of chronic lead poisoning related symptoms. This indicates a poor understanding of occupational safety when working in lead-polluted environments.20 men, whose age ranged from 32 to 57 (mean 41.8 ± 10 years), were consulted at the Toxicology Centre at the Republican Vilnius university hospital in Vilnius, Lithuania in the 2016–2019 year period. All of the patients were working as shooting instructors, with their work experience varying from 2 to 30 years. Clinical examination showed blood lead levels ranging from 5.64 μg/dL to 45.8 μg/dL (norm for occupational exposure - <40 μg/dL). Main symptoms were fatigue (12 patients out of 20), dizziness (5/20), arthralgia (5/20). Other symptoms included impaired memory (3/20), nausea (3/20), sleep disorders (3/20), metallic or sweet taste (3/20), dermatological disorders (3/20), coxarthrosis (2/20), balance disorders (2/20), paresthesia (2/20), abdominal pain (2/20) and others. 4 patients were asymptomatic.Shooting range employees are highly vulnerable to daily lead exposure. Even low constant elevated blood lead concentrations can have significant toxic effects over time.

The South Carolina Environmental Public Health Tracking Program's Role in Monitoring and Reducing Occupational Exposure to Lead: Public Health Actions in Collaboration with the South Carolina Occupational Safety and Health Administration.

Per South Carolina (SC) Law §44-29-10, all blood lead test records are reportable. The SC Environmental Public Health Tracking (SC EPHT) program is directly involved in blood lead surveillance in SC, as it maintains the blood lead record database. Although Adult Blood Lead Epidemiology and Surveillance funding from the Centers for Disease Control and Prevention was discontinued in 2013, SC EPHT has continued to monitor and record adult blood lead test records.In 2012, SC EPHT signed a memorandum of understanding with the SC Occupational Safety and Health Administration (SC OSHA). Per this agreement, quarterly reports of elevated adult blood lead concentrations (≥25 μg/dL) are supplied to SC OSHA, along with North American Industry Classification System codes of employers. This information is used for industrial inspections, mitigation, and abatement related to lead. The SC EPHT program's collaboration with SC OSHA has resulted in a number of public health actions that have improved the health and well-being of workers in SC. Of the 3 nationally accepted SC public health actions related to occupational lead exposure, 2 detail investigations and citations by SC OSHA. The other describes internal analyses conducted by the SC EPHT program regarding elevated blood lead levels in adults and associations with specific North American Industry Classification System codes.In this review, we outlined the role of SC EPHT related to adult blood lead surveillance in SC, including implementation of the memorandum of understanding with SC OSHA. We also examined demographics of adult blood lead records in SC for 2010-2015 and summarized public health actions related to occupational lead exposure in SC. Since federal funding for the SC EPHT program was initiated in 2009, the program has played an important part in lead surveillance in SC. The resulting health benefits to those with the potential for occupational exposure to lead are extremely important.