Elevated Blood Lead Research Articles

Improving the Identification of Children with Elevated Blood Lead Levels: A Pilot Project Using an Academic Detailing Approach

Improving the Identification of Children with Elevated Blood Lead Levels: A Pilot Project Using an Academic Detailing Approach

Lead Exposure in Infancy and Subsequent Growth in Beninese Children.

Studies suggest that elevated postnatal blood lead levels (BLLs) are negatively associated with child growth. This study aimed to investigate the associations of childhood BLLs at age one year and growth outcomes at age six years (n = 661) in a cohort of children in Allada, Benin. The growth outcomes studied are weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), BMI-for-age Z-score (BMIZ), weight-for-height Z-score (WHZ), head circumference (HC), growth velocities, underweight, stunting, and wasting. Multivariable regression models examined the associations between BLLs and growth outcomes, with adjustment for potential confounders. The geometric mean BLLs was 59.3 μg/L and 82% of children had BLLs >35 μg/L at the age of 12.8 months. After adjusting for confounding factors, no overall association was found between BLL quartiles and HAZ, WAZ, BMIZ, WHZ, growth velocities, wasting, and underweight. However, boys in the highest quartile had a 1.02 cm lower HC (95% CI: [−1.81, −0.24]) as compared to the lowest quartile. Furthermore, an increased odds of being stunted was observed in children in the highest quartile of exposure compared to the first (OR: 2.43; 95% CI: [1.11–5.33]) which remained statistically significant only among girls in sex-specific strata. Blood lead was found to be associated with an increased risk of childhood stunting and a lower head circumference in a resource-limited setting.

Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020.

Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 μg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 μg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 μg/dL vs. 13.1 μg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 μg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 μg/ft2; dust mean 52.9 vs. 29.9 μg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.

Lead toxicity due to retained intracranial bullet fragments: illustrative case.

BACKGROUNDLead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors’ knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments.OBSERVATIONSThe authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms.LESSONSAlthough rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.

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

Detecting New Sources of Childhood Environmental Lead Exposure Using a Statistical Surveillance System, 2015-2019.

Objectives. To design and implement a statistical surveillance system to prospectively identify potential clusters of elevated blood lead levels (EBLLs) in children younger than 6 years in the Denver, Colorado, metro area. Methods. We evaluated the ability of 2 independent statistical surveillance methods to detect synthetic clusters of EBLLs in Denver between 2015 and 2019. Results. Together, the statistical surveillance methods took an average of 9 months to detect the synthetic clusters. This is faster than similar real-world clusters that have been reported in the past. The system was relatively unaffected by changes in the testing rate and to the blood lead reference value. Conclusions. The adequate design of a statistical surveillance system can help increase the rate at which clusters of EBLLs are detected in Denver, but doing so requires an accurate model of the spatial distribution of EBLLs. Earlier detection of clusters can help guide more effective public health interventions at the local level. (Am J Public Health. 2022;112(S7):S715-S722. https://doi.org/10.2105/AJPH.2022.307009).

Exposure Sources Among Veterans With Elevated Blood Lead Levels, United States, 2015‒2021.

Objectives. To determine characteristics and sources of exposure in veterans with elevated blood lead levels (BLLs). Methods. We included users of US Veterans Health Administration care aged 18 years or older tested for BLL from October 2015 to September 2021. Prevalence of BLL 10 micrograms per deciliter (µg/dL) or higher and 25 µg/dL or higher was determined within demographic groups. Logistic regression analysis measured association of International Classification of Diseases, Tenth Revision, Clinical Modification‒coded conditions with elevated BLL. Electronic notes were reviewed for exposure sources. Results. Among 1007 unique veterans with BLL 10 µg/dL or higher, prevalence of BLL 10 µg/dL or higher and 25 µg/dL or higher peaked at 4.9 and 1.3 per 100 000 veterans, respectively (fiscal year 2019), and was highest in non-Hispanic White men and those aged 25 to 34 years. Conditions predicted by elevated BLL were attention-deficit/hyperactivity disorder (ADHD) and nausea or vomiting. Firearms represented 70.1% of occupational and 85.9% of nonoccupational exposures. Toxicology consults occurred in 17 of 298 (6%) with BLL 25 µg/dL or higher. Conclusions. Firearms were the largest exposure source among veterans with elevated BLL. Clinicians should be alert for potential conditions (including ADHD and nausea or vomiting in our study) associated with lead exposure. Standardization of care regarding toxicology referral practices is warranted. (Am J Public Health. 2022;112(S7):S670-S678. https://doi.org/10.2105/AJPH.2022.306936).

Blood Lead Level Testing and Retesting Among Newly Arriving Refugee Children, Pennsylvania, 2015-2019.

Objectives. To (1) determine the prevalence of elevated blood lead levels (EBLLs; ≥ 5 µg/dL) among newly arrived refugee children, (2) understand the demographic characteristics of refugee children with EBLLs, and (3) assess health care providers' compliance with Centers for Disease Control and Prevention (CDC) recommendations for retesting. Methods. We matched refugee demographic data (2015-2019) from the CDC's Electronic Disease Notification (EDN) system with lead-testing laboratory report data from the Pennsylvania National Electronic Disease Surveillance System using Match*Pro software. Results. Of 3833 refugee children 16 years or younger in the EDN system, matching identified 3142 children with blood lead level data. Among children with blood lead level data, 578 (18.4%) had EBLLs. Among children with EBLLs, 341 (59.0%) were male. Of the 1370 children aged 6 years or younger with blood level test results, 335 (24.5%) had initial EBLLs, and only 78 (5.7%) were retested within 3 to 6 months. Of the 335 children 6 years or younger with an initial EBLL, only 44 (13.1%) were retested within 3 to 6 months. Conclusions. Following up on refugee children with EBLLs is necessary to ensure that they do not have continued lead exposure. (Am J Public Health. 2022;112(S7):S706-S714. https://doi.org/10.2105/AJPH.2022.306856).

Biomonitoring of exposure of Algerian population to lead

Lead poisoning, is currently recognized as a real public health problem. The WHO classifies lead as one of 10 chemicals of serious public health concern. The assessment and management of health risks and public health interventions are largely based on a detailed knowledge of exposure of the general population. Biomonitoring has become an essential tool in environmental health. In Algeria, to date, no study on the evaluation of lead impregnation has been carried out at the national level. The main objective of this work is to assess the exposure of the general Algerian population to lead This is a cross-sectional study with a descriptive aim, carried out over the entire Algerian national territory, on a population aged between 3 and 74 years old. It was carried out on a representative sample of households. The survey lasted three years. A questionnaire, a clinical examination and a blood sample were carried out for each individual. Analytical methods for the determination of lead in whole blood by ICP-MS were optimized and validated. Generalized linear regression models were used to determine the factors influencing lead levels measured in blood samples. The study population, spread over 39 wilayas and 121 districts, consists of 3674 individuals. The mean lead levels were 28.27 μg/L [27.38–29.17], the median was 22.22 μg/L, and the 95th percentile was 73.83 μg/L. The prevalence of elevated blood lead levels (≥100 μg/L) in the study population was 2.2%. A blood lead value of 75 μg/L was proposed as the Reference Exposure Value (REL) for Algeria. Blood lead levels were influenced by age, gender, wilaya of residence, dietary habits such as consumption of canned food and the way in which water is conserved for daily consumption. The use of kohl has been confirmed as a potential source of lead exposure especially among women. Recommendations have been issued to reduce the blood lead levels of the general population in Algeria in terms of limitation of lead in the sources of exposure, installation of an effective health monitoring system and also an adequate management of lead poisoning.

Blood Lead Level Is Associated with Visceral Adipose Dysfunction in Patients with Type 2 Diabetes.

We aimed to explore whether an elevated blood lead level (BLL) is associated with visceral adipose dysfunction in patients with type 2 diabetes mellitus (T2DM). Four thousand one hundred and fourteen diabetic participants were enrolled from seven communities in Shanghai in 2018 in the cross-sectional METAL study. BLL was measured by graphite furnace atomic absorption spectrometry. Visceral adiposity index (VAI) and lipid accumulation product (LAP)were calculated by simple anthropometric and biochemical parameters. We found that medians (IQR) of BLL were 26.0μg/L (18.0-37.0) for men and 25.0μg/L (18.0-35.0) for women, respectively. In men, each doubling of BLL was associated with a 2.0% higher VAI (95% CI, 0.6 to 3.5%) and 1.8% higher LAP (95% CI, 0.2 to 3.3%) after full adjustment. Using the lowest BLL quartile as the referent group, significant positive trends were observed for BLL with VAI and LAP. In women, each doubling of BLL was associated with a 1.9% higher LAP (95% CI, 0.6 to 3.1%). Additionally, there was a marginally significant positive association between BLL and VAI, either using log2-transformed concentrations as continuous variables or categorized in quartiles. In conclusion, lead exposure is associated with visceral adipose dysfunction in patients with T2DM. Further prospective studies are warranted to confirm our findings.

Lung cancer incidence among workers biologically monitored for occupational exposure to lead: a cohort study.

Earlier studies have reported increased risks of lung, kidney and brain cancers for exposure to lead. The International Agency for Research on Cancer (IARC) Working Group evaluated inorganic lead and its compounds probably carcinogenic to humans. This study aimed to assess the association between blood lead level in occupational exposure and risk of lung cancer. The study was based on the follow-up of lung cancer incidence during 1973-2014 among 20 729 employees biologically monitored for their occupational lead exposure in 1973-1983. Duration of employment in the monitored work was assessed using records from the Finnish Centre for Pensions; and potential confounding by other occupational carcinogens using longitudinal information on the occupation in censuses and the Finnish National Job-Exposure Matrix (FINJEM). Occupation- and gender-specific prevalence of regular tobacco smoking and the socioeconomic status were also utilized in the adjustments for potential confounding. Positive trends were found for the elevated blood lead levels on the lung cancer risk. Among employees with the duration of employment of ≥60 months, the relative risk (RR) of lung cancer was 1.72 [95% confidence interval (CI) 1.28-2.31] for mean blood lead 1.0-1.9 µmol/L and RR 2.63 (95% CI 1.71-4.05) for mean blood lead ≥2.0 µmol/L, compared with mean lead <0.5 µmol/L. The studied potential confounders did not explain the findings on the increased risk for lead exposure. The current study lends support to the findings that exposure to lead increases lung cancer risk. Increased risks were seen already at rather low blood lead levels.

Industry-specific prevalence of elevated blood lead levels among Pennsylvania workers, 2007–2018

ObjectivesTo use industry-specific denominators to more accurately examine trends in prevalence rates for occupational cases of elevated blood lead levels (eBLLs) in Pennsylvania.MethodsWe used adult (aged ≥16 years) blood lead...

Patterns of Children's Blood Lead Screening and Blood Lead Levels in North Carolina, 2011-2018-Who Is Tested, Who Is Missed?

Background:No safe level of lead in blood has been identified. Blood lead testing is required for children on Medicaid, but it is at the discretion of providers and parents for others. Elevated blood lead levels (EBLLs) cannot be identified in children who are not tested.Objectives:The aims of this research were to identify determinants of lead testing and EBLLs among North Carolina children and estimate the number of additional children with EBLLs among those not tested.Methods:We linked geocoded North Carolina birth certificates from 2011–2016 to 2010 U.S. Census data and North Carolina blood lead test results from 2011–2018. We estimated the probability of being screened for lead and created inverse probability (IP) of testing weights. We evaluated the risk of an EBLL of at of age, conditional on characteristics at birth, using generalized linear models and then applied IP weights to account for missing blood lead results among unscreened children. We estimated the number of additional children with EBLLs of all North Carolina children using the IP-weighted population and bootstrapping to produce 95% credible intervals (CrI).Results:Mothers of the 63.5% of children (402,002 of 633,159) linked to a blood lead test result were disproportionately young, Hispanic, Black, American Indian, or on Medicaid. In full models, maternal age [; 95% confidence interval (CI): 1.13, 1.20] or smoking (1.14; 95% CI: 1.12, 1.17); proximity to a major roadway (1.10; 95% CI: 1.05, 1.15); proximity to a lead-releasing Toxics Release Inventory site (1.08; 95% CI: 1.03, 1.14) or a National Emissions Inventory site (1.11; 95% CI: 1.07, 1.14); and living in neighborhoods with more housing built before 1950 (1.10; 95% CI: 1.05, 1.14) or before 1940 (1.18; 95% CI: 1.11, 1.25) or more vacant housing (1.14; 95% CI: 1.11, 1.17) were associated with an increased risk of EBLL, whereas overlap with a public water service system was associated with a decreased risk of EBLL (0.85; 95% CI: 0.83, 0.87). Children of Black mothers were no more likely than children of White mothers to have EBLLs (0.98; 95% CI: 0.96, 1.01). Complete blood lead screening in 2011–2018 may have identified an additional 17,543 (95% CrI: 17,462, 17,650) children with EBLLs .Discussion:Our results indicate that current North Carolina lead screening strategies fail to identify over 30% (17,543 of 57,398) of children with subclinical lead poisoning and that accounting for characteristics at birth alters the conclusions about racial disparities in children’s EBLLs. https://doi.org/10.1289/EHP10335

Risk of lead exposure from wild game consumption from cross-sectional studies in Madre de Dios, Peru

SummaryBackgroundStudies have shown elevated blood lead levels (BLL) in residents of remote communities in the Amazon, yet sources of lead exposure are not fully understood, such as lead ammunition consumed in wild game.MethodsData was collected during two cross-sectional studies that enrolled 307 individuals in 26 communities. Regression models with community random effects were used to evaluate risk factors for BLLs, including diet, water source, smoking, sex, age, and indigenous status. The All-Ages Lead Model (AALM) from the Environmental Protection Agency (EPA) was used to estimate background and dose from wild game consumption.FindingsIndigenous status and wild game consumption were associated with increased BLLs. Indigenous participants had 2.52 μg/dL (95% CI: 1.95−3.24) higher BLLs compared to non-indigenous. Eating wild game was associated with a 1.41 μg/dL (95% CI: 1.20−1.70) increase in BLLs. Two or more portions per serving were associated with increased BLLs of 1.66 μg/dL (95% CI: 1.10−2.57), compared to smaller servings. Using the AALM, we estimate background lead exposures to be 20 μg/day with consumption of wild game contributing 500 μg/meal. Lastly, we found a strong association between BLLs and mercury exposure.InterpretationConsumption of wild game hunted with lead ammunition may pose a common source of lead exposure in the Amazon. Communities that rely on wild game and wild fish may face a dual burden of exposure to lead and mercury, respectively.

Investigating aluminum cookpots as a source of lead exposure in Afghan refugee children resettled in the United States

BackgroundAfghan refugee children resettled in Washington State have the highest prevalence of elevated blood lead levels (BLLs) of any other refugee or immigrant population. Resettled families brought several lead-containing items with them from Afghanistan, including aluminum cookpots.ObjectivesTo evaluate the potential contribution of lead-containing cookpots to elevated BLLs in Afghan children and determine whether safer alternative cookware is available.MethodsWe screened 40 aluminum cookpots for lead content using an X-ray fluorescence (XRF) analyzer and used a leachate method to estimate the amount of lead that migrates into food. We also tested five stainless steel cookpots to determine whether they would be safer alternatives.ResultsMany aluminum cookpots contained lead in excess of 100 parts per million (ppm), with a highest detected concentration of 66,374 ppm. Many also leached sufficient lead under simulated cooking and storage conditions to exceed recommended dietary limits. One pressure cooker leached sufficient lead to exceed the childhood limit by 650-fold. In contrast, stainless steel cookpots leached much lower levels of lead.SignificanceAluminum cookpots used by refugee families are likely associated with elevated BLLs in local Afghan children. However, this investigation revealed that other U.S. residents, including adults and children, are also at risk of poisoning by lead and other toxic metals from some imported aluminum cookpots.Impact StatementSome aluminum cookware brought from Afghanistan by resettled families as well as cookpots available for purchase in the United States represent a previously unrecognized source of lead exposure.

Elevated blood lead levels of refugee children in the United States: a systematic review of recent literature (2011-2021).

Lead is an environmental hazard; even small elevations in blood lead level can cause serious negative health effects in children, including irreversible impacts such as learning difficulties, attention disorders, and behavioral issues. Previous research has shown that some groups are at higher risk for lead poisoning including racial/ethnic minorities, those with low economic status, and immigrants, especially refugees. This systematic review explores recent literature studying disparities in lead poisoning in refugee children. Search terms were chosen with the assistance of a medical librarian, and two independent reviewers assessed articles using a PICOS criteria (Population, Intervention, Comparison, Outcome, Study Design) following the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRIMSA-P) guidelines, a set of evidence-based minimum standards for reporting in systematic reviews. 321 article titles were reviewed, 61 abstracts screened, and 17 methods sections reviewed, ultimately including 13 studies. The studies found a high prevalence of elevated blood lead level among refugee populations when compared to reference populations. Both pre-migration and post-migration factors were identified as contributors to the disparity, and associations were identified between elevated blood lead levels and factors such as country of origin, age, and other health variables. Health providers and resettlement workers should be aware of these disparities and related factors. Testing, care, education and consistent follow-up should be provided.

Age at Menarche in Urban Girls Exposed to Lead in the Copper Basin, Poland.

Simple SummaryLead is an environmental pollutant that negatively affects human growth, development and health. However, research into its effect on age at menarche (first menstruation), a proxy for maturation, is, to some extent, inconclusive. In this study, we identified that lower than currently acceptable blood lead level was related to later menarche. However, body weight and fatness had a moderating effect on this relationship, decreasing its significance.Lead negatively affects human growth and development. In this research, we aimed to assess the effect of elevated blood lead level on age at menarche (AM), controlling for body mass index (BMI) and estimated fatness. The sample included 490 girls aged 7–16 examined in Polkowice town (Copper Basin, Poland) in 2008. Measurements included height, weight, skinfold thicknesses and estimated percentage of body fat. AM was assessed using the status quo method. Blood samples were taken for lead level assessment. Two groups were defined based on the median blood lead level for the total sample of children (3.7 µg/dL). Logistic regression models were used to assess the association between AM and independent variables. The results indicated that menarche in the higher blood lead level group was significantly later compared to the lower blood lead level group (p < 0.01). This relationship remained only marginally significant when BMI (p < 0.10), sum of skinfolds (p < 0.09) or percentage of fat (p < 0.08) were controlled. The results revealed that a lower blood lead level (3.7 µg/dL) than the currently acceptable threshold (5 µg/dL) is related to a later AM; however, this relationship is moderated by body fatness, which may decrease its significance.

The more things change the more they stay the same: Persistent spatial inequity in pediatric lead poisoning in Chicago

Lead poisoning remains a major environmental health threat and a persistent source of health disparities in the United States, particularly in large cities such as Chicago. However, little research has considered the rapidly changing urban environment, due to processes like gentrification, when examining risk factors for pediatric lead poisoning. In this retrospective study, spatio-temporal analysis and spatial regression models have been applied to examine the distribution of elevated blood lead levels (EBLL) in children in 77 Chicago community areas annually from 1999 to 2013. Sociodemographic and built environment variables are calculated for each year of the study to account for changing urban community characteristics. Results show that while the overall rate of children with EBLL decreased greatly from 1999 to 2013, inequality between areas still persists. Hotspots of EBLL persist over time in communities in the South and Southwest Side. Spatial regression results indicate that, over the duration of the study period, higher rates of EBLL are frequently associated with higher minority populations, older house age in the community area and greater amounts of renter occupied houses. However, our closer examination on several representative communities indicate that different community development trajectories and renovation histories are associated with varying EBLL declines. Taking a dynamic perspective when understanding EBLL over time can highlight places where improvements in EBLL are the result of population displacement versus places where improvements in EBLL are related to changing housing stock, as well as areas of a city where lead poisoning prevention efforts can have the greatest impact.

Elevated serum lead levels in neonates born to mothers suffering from opiate use disorder.

This study was performed to investigate lead levels in neonates born to the mothers suffering from opiate use disorder (OUD) and the association of lead levels with the Apgar score. The present cross-sectional study included 56neonates who were referred to the neonatal ward of Amir-Al Momenin Hospital, Zabol. The neonates were divided into two groups: the neonates whose mothers suffered OUD and the control group. Data were collected using aresearcher-prepared questionnaire, and blood lead level was determined using the atomic absorption method. Data were statistically analyzed. In all, 56neonates (28from OUD mothers and 28from the control mothers) were included in this study. Among the women with OUD, 16 (57%) used inhaled opium, while12 (43%) consumed opium orally. There was asignificant difference regarding Apgar score (9.76 ± 2.11 versus. 7.11 ± 4.21; p = 0.02) and the neonate's blood lead level (2.33 ± 1.3 µg/dl versus 7.33 ± 5.9 µg/dl) between the control and OUD groups (p < 0.001). The odds ratio of abnormally elevated blood lead level rose with increasing duration of maternal opiate disorder for opiate usage durations of 3to 5years (adjusted odds ratio [OR] 42.82, 95% confidence interval [CI] 3.27-561, p = 0.004) and > 5years (adjusted OR 45.5, 95% CI 2.97-698, p = 0.006). The results of this study suggested asignificant relationship between maternal opium consumption during pregnancy and neonatal serum lead levels, as well as decreased neonatal Apgar score.

Spatial Analysis and Lead-Risk Assessment of Philadelphia, USA.

Childhood lead poisoning is an issue that continues to plague major U.S. cities. Despite efforts by the Philadelphia Department of Public Health to curtail systemic childhood lead poisoning, children continue to be identified with elevated blood lead levels. The persistence of elevated blood lead levels in children is concerning because lead poisoning has been linked to decreases in academic achievement and IQ, with associated repercussions for entire communities. This paper reports the results of an analysis of the spatial distribution of houses with lead paint (i.e., pre‐1978), demolitions, and occurrence of historic smelters, in West and North Philadelphia, relative to elevated blood lead level data, to determine which lead sources act as primary lead‐risk factors. The presence of lead paint in homes and the number of demolitions of older properties were found to have the highest correlations to elevated blood lead levels for children in Philadelphia. Using lead‐risk factors including lead paint, housing code violations, demolitions, and owner‐occupied housing units, a lead‐risk assessment was performed at the census tract level to identify future soil sampling sites and high‐risk neighborhoods in Philadelphia. These sites of high risk for lead exposure, and in particular the census tracts 175 and 172, should be prioritized for lead poisoning prevention initiatives.