High Lead Levels Research Articles

Impact of a lagoon with high anthropic activity on a World Heritage Site.

The Ichkeul-Bizerte Lagoon Complex (IBLC), a critical ecosystem for local biodiversity, faces a pressing threat due to climate change and severe pollution. Despite past conservation efforts, pollution persists, particularly in the Bizerte Lagoon. This study investigated the impact of water dynamics and climatic conditions on heavy metal contamination in the IBLC's sediments. During the dry hydrological year of 2019/2020, 80 surface sediment samples were collected and analyzed for heavy metal concentrations using inductively coupled plasma. Sediment quality was first evaluated by comparing heavy metal concentrations against sediment quality guidelines established by NOAA. Additionally, contamination indices, including the contamination factor (CF), pollution load index (PLI), and geo-accumulation index (Igeo), were utilized to provide a more detailed assessment. Spatial and temporal variations in contamination were assessed, with seasonal variations mapped using the inverse distance weighting method. The findings revealed that El-Fouledh, the Menzel Jamil industrial area, and the Menzel Abderrahmane port are the primary pollution sources. The spatial distribution of pollution shows a decreasing gradient from the east (Bizerte Lagoon) to the west (Lake Ichkeul), with high levels of cadmium, lead, and zinc exceeding sediment quality guidelines and posing significant threats to this Ramsar-listed ecosystem. Spearman´s correlation coefficient highlighted the persistence of pollution across seasons, emphasizing the urgent need for comprehensive management strategies to mitigate pollution and preserve the IBLC's ecological integrity.

Association between heavy metal exposure and bacterial vaginosis: A cross-sectional study.

Bacterial vaginosis (BV) is a prevalent cause of vaginal symptoms in women of reproductive age. With the widespread of heavy metal pollutants and their harmful function on women's immune and hormonal systems, it is necessary to explore the association between heavy metal exposure and BV. This study investigates the potential relationship between serum heavy metals and bacterial vaginosis in a cohort of American women. The present study employed a cross-sectional analysis of 2,493 women participating in the 2001-2004 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were utilized in the study to assess the correlation between these variables. A stratified analysis was performed to investigate the relationship among different population groups further, and smooth curve fittings were conducted to intuitively evaluate the correlation. According to the current cross-sectional study results, a significant correlation was identified between the high levels of lead and cadmium in the serum and the likelihood of developing bacterial vaginosis. We found that serum lead (OR = 1.35, 95% CI: 1.06-1.72, p = 0.016) and serum cadmium (OR = 1.41, 95% CI: 1.01-1.98, p = 0.047) increased the risk of bacterial vaginosis by 35% and 41%, respectively, in the highest level group in comparison to the lowest level group in the fully adjusted model. Furthermore, the research discovered no statistically significant association between the levels of total mercury in the serum and a heightened susceptibility to bacterial vaginosis (OR = 0.96, 95% CI: 0.75-1.23, p = 0.763). Results of our study indicated an inverse association between serum heavy metals and bacterial vaginosis risk, including lead and cadmium. Reducing exposure to heavy metals could be vital to preventing and managing bacterial vaginosis.

Development of low-pressure polymeric membrane incorporated with powdered activated carbon and nanosilica for groundwater applications

Groundwater has become a vital alternate supply of freshwater, which has now frequently been contaminated with high iron and lead levels that are harmful to human health and agriculture. Hence, various modifications on membrane surfaces are fabricated in this study to improve the membrane’s performance. Low-pressure PES polymeric membranes are made by combining polyether sulfone (PES) as the polymer, N-methyl-2- pyrrolidone (NMP) as the solvent, and nano-silica (SiO2) and powdered activated carbon (PAC) as additives. The membranes’ performance is tested multiple times to evaluate for their pure water permeation, groundwater filtration flux, the effectiveness of groundwater turbidity, colour, chemical oxygen demand (COD), iron, and lead removal. Results showed that the 5.0 wt.% PES-PAC membrane has the best filtering permeate and flux volume along with the highest removal efficiency for turbidity, colour, COD iron, and lead removal, which are 99.33%, 96.15 %, 96%, 100%, and 100%, respectively. All low-pressure membrane systems successfully reduced the iron concentration in groundwater to the irrigation water standards. Whereas, the 5.0 wt% PES-PAC and 5.0 wt% PES-SiO2 membranes can meet the lead requirements for agricultural water. The membrane with 5.0 wt% PES-PAC fulfils the lead content requirement after treatment for drinking water quality showing the membrane with PAC incorporation as an alternative water treatment technology to ensure water safety.

Analysis of Toxic Element Levels and Health Risks in Different Soybean Species (Glycine max, Vigna radiata, Vigna angularis, Vigna mungo).

Background: Soybeans are a widely consumed legume, essential in Western diets and especially prominent in vegan and vegetarian nutrition. However, environmental contamination from anthropogenic sources, such as industrial emissions, wastewater, and pesticide use, has led to the accumulation of non-essential and toxic elements in legumes, potentially impacting human health. Method: This study quantified the levels of 11 potential toxic elements (Al, B, Ba, Cd, Co, Cr, Li, Ni, Pb, Sr, V) in 90 samples of four soybean species (Glycine max, Vigna radiata, Vigna angularis, Vigna mungo) using inductively coupled plasma optical emission spectrometry (ICP-OES). Results: Results showed that boron had the highest mean content (9.52 mg/kg ww), followed by aluminum (6.73 mg/kg ww). Among the toxic metals, cadmium was most concentrated in green soybeans (0.03 mg/kg ww), and black soybeans had the highest level of lead (0.07 mg/kg ww). Based on an average soybean consumption of 50 g/day, no immediate health risk was detected. However, lithium and nickel were present in substantial amounts, with lithium contributing 31.43-48.57% and nickel 6.81-39.56% of their respective provisional daily intake limits, especially from red soybeans (V. angularis). Conclusions: This study highlights the importance of monitoring toxic elements in soybeans and calls for stricter environmental management practices to minimize contamination, ensuring the safety of soy products as their global consumption rises.

Comprehensive analysis and review of soil contamination and the associated risks at the Poșta-Rât Industrial Site in Turda, Cluj, Romania

The paper synthesizes existing research on contamination and associated risks from industrial activities at the Poșta-Rât site in Turda, Cluj, Romania. Located in an industrial district, the site was contaminated with hazardous substances, including organochlorine pesticide like hexachlorocyclohexane (HCH), dichlorodiphenyltrichloroethane (DDT), and dangerous heavy metals (HM), due to uncontrolled dumping of lindane waste between 1954 and 1983. Recent studies reveal significant HCH contamination up to 70 cm deep and high levels of Zinc (Zn), Lead (Pb), Copper (Cu), Mercury (Hg), and Arsenic (As), far exceeding acceptable limits. The research highlights extreme organochlorine pesticide pollution and bioaccumulative heavy metals, emphasizing the urgent need for remediation and continuous monitoring to mitigate the ecological and health risks in this heavily polluted area.

The Pathography and Art of Beethoven, Revisited

The musician Ludwig van Beethoven suffered from progressive hearing loss and abdominal pain, both of which can be explained by lead intoxication. With genomic analyses, Begg et al. (2023) have confirmed that the five locks of hair attributed to Beethoven were authentic. Moreover, the possible cause of his severe liver disease was revealed. Rifai et al. (2024) have observed unusually high lead levels in authenticated locks of hair from Beethoven. Based on the new pieces of evidence, we conclude that his hearing loss and gastrointestinal complaints were caused by plumbism.

Microhabitat of Endangered Species, Lonchura oryzivora in Malang City, Indonesia

Malang City, located in Java, Indonesia, faces significant anthropogenic pressures but remains an important habitat for the endangered Java sparrow (Lonchura oryzivora). Understanding how Java sparrows adapt to environments with high levels of human activity is essential for their conservation. This study focused on identifying the distribution of Java sparrows and investigating their habitat selection within Malang City. The bird positions were recorded within the tree canopy, and the frequency of canopy use by the birds was determined. Living in the middle of the city impacts the metabolism of birds, as indicated by taking samples and measuring the levels of lead found in their droppings and vegetation used. Encounters near the center of human activity show they can utilize buildings and vegetation they utilize. The Java sparrows predominantly utilize plant parts at the tree level, particularly focusing on the middle canopy part of the edge (TTt) and the middle part (TT). Laboratory tests revealed that the plants utilized by the Java sparrow contain high lead levels. Therefore, to conserve the Java sparrow, it is crucial to improve the quality of their habitat to make it more natural and conduct regular health monitoring to ensure their well-being.

Toxic Metals Impact Gut Microbiota and Metabolic Risk in Five African-Origin Populations.

Exposure to toxic metals impacts obesity and type 2 diabetes (T2DM) risk. Yet, the underlying mechanisms remain largely unknown. Gut microbiota has been strongly associated with progression of cardiometabolic risk. To determine whether high metal exposures and gut dysbiosis interact to promote metabolic dysregulation and cardiometabolic risk, we assessed relationships between these factors. We analyzed cross-sectional associations between arsenic, lead, mercury, cadmium, and cardiometabolic health markers in 178 randomly selected African-origin adults (52% female, 51% obese, mean age=43.0±6.4 years) from Ghana, South Africa, Seychelles, Jamaica, and USA. Metal levels were dichotomized to high or low at the median level of each metal. We analyzed associations between gut microbiome taxa, metal levels, clinical measures (BMI, fasting blood glucose, and blood pressure) and diagnoses (hypertension, obesity, and diabetes status). High vs. low lead and arsenic exposures had a significant effect on beta diversity (p <0.05). 71 taxa were associated with high lead levels: 30 with elevated BMI, 22 with T2DM, and 23 with elevated fasting blood glucose (p<0.05). 115 taxa were associated with high arsenic levels: 32 with elevated BMI, 33 with T2DM, and 26 with elevated blood glucose (p<0.05). Of the taxa associated with high lead and arsenic exposure and either elevated BMI or fasting blood glucose, porphyrin metabolism was the most enriched metabolic pathway. These data collectively provide the first findings in a human study that the gut microbiome may drive the association between lead and arsenic exposure and obesity and T2DM risk.

Combined Effects of Environmental Metals and Physiological Stress on Lipid Dysregulation.

Cardiovascular diseases (CVD) are a leading cause of mortality worldwide, influenced by genetic, environmental, and behavioral factors. This study examines the relationship between heavy metal exposure, chronic physiological stress (allostatic load), and lipid profiles, which are markers of CVD risk, using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. We utilized structural equation modeling (SEM) to explore the associations between blood levels of lead, cadmium, allostatic load (AL), and lipid measures (low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides). The AL index was derived from cardiovascular, inflammatory, and metabolic biomarkers and categorized into quartiles to identify high-risk individuals, with an index out of 10 subsequently developed. The SEM analysis revealed that both heavy metal exposure and allostatic load are significantly associated with lipid profiles. Higher levels of lead and cadmium were associated with increased LDL and triglycerides, while higher AL scores were linked to increased LDL and triglycerides and decreased HDL levels. Age was also a significant factor, showing positive correlations with LDL and triglycerides, and a negative correlation with HDL. This study underscores the multifactorial nature of CVD, highlighting the combined impact of environmental pollutants and physiological stress on lipid dysregulation. These findings suggest the need for integrated public health strategies that address both environmental exposures and chronic stress to mitigate cardiovascular risk. Further research is warranted to explore the underlying mechanisms and develop targeted interventions.

Токсичные и биогенные элементы в органах и тканях белой куропатки (Lagopus lagopus L., 1758) на севере Красноярского края (обзор)

Studying the concentration of biogenic and toxic microelements in the body tissues of wild animals is relevant for organizing regional environmental monitoring, assessing the state of populations and ensuring the safety of meat and wild products. The studies were carried out to determine the content of biogenic and toxic elements in the organs and tissues of the willow ptarmigan in the north of the Krasnoyarsk Region, Russia, where different levels of technogenic pollution are expected. The iron, copper, nickel, lead, and cadmium content in the pectoral muscles and liver of willow ptarmigan (Lagopus lagopus L.) (n=162), bagged during five hunting seasons in 2005–2019, were determined using atomic absorption spectrometry. The levels of lead, cadmium and iron in the tissues were significantly higher in contaminated areas, while the copper levels did not differ. Element concentrations in liver and skeletal muscle in impact areas were highly correlated with each other. This may be related to common sources of pollutant emissions. Sex differences in micronutrient content can be determined by spatial differentiation of the sexes during migration, seasonal feeding patterns, and the specific birds’ metabolism in reproductive period. Cadmium and lead content in liver and muscle tissue samples from impact areas exceeded current food hygiene standards, which may pose a threat to consumers. Probably, high levels of lead and cadmium reflect the increased content of metals in food items primarily willow sprouts and buds, which are the most important winter food for ptarmigan.

Microbial strategies for lead remediation in agricultural soils and wastewater: mechanisms, applications, and future directions.

High lead (Pb) levels in agricultural soil and wastewater threaten ecosystems and organism health. Microbial remediation is a cost-effective, efficient, and eco-friendly alternative to traditional physical or chemical methods for Pb remediation. Previous research indicates that micro-organisms employ various strategies to combat Pb pollution, including biosorption, bioprecipitation, biomineralization, and bioaccumulation. This study delves into recent advancements in Pb-remediation techniques utilizing bacteria, fungi, and microalgae, elucidating their detoxification pathways and the factors that influence Pb removal through specific case studies. It investigates how bacteria immobilize Pb by generating nanoparticles that convert dissolved lead (Pb-II) into less harmful forms to mitigate its adverse impacts. Furthermore, the current review explores the molecular-level mechanisms and genetic engineering techniques through which microbes develop resistance to Pb. We outline the challenges and potential avenues for research in microbial remediation of Pb-polluted habitats, exploring the interplay between Pb and micro-organisms and their potential in Pb removal.

Estimating the impact of the proposed Lead and Copper Rule Improvements

AbstractLead in drinking water can lead to serious health effects, including neurodevelopmental issues and heart disease. In December 2023, the U.S. Environmental Protection Agency (EPA) proposed the Lead and Copper Rule Improvements (LCRI), which lower the Lead and Copper Rule's (LCR's) lead action level (AL) from 15 parts per billion (ppb) to 10 ppb and require both first‐ and fifth‐liter sampling and 90th percentile compliance calculations based on the highest lead levels at sites with lead service lines. A methodology for estimating the likelihood a system will have an AL exceedance (ALE) under the LCRI was developed using Michigan LCR compliance data and applied to national LCR compliance data. Findings were compared to EPA's estimates, indicating EPA may have underestimated the percent of smaller systems (serving 3300) with ALEs and overestimated the percent of larger systems (serving &gt; 10,000), thus underestimating costs and overestimating the benefits of this rulemaking.

From molecules to organisms: A multi-level approach shows negative effects of trace elements from sewage sludge used as soil improver on honeybees

The use of sewage sludge as a soil improver has been promoted in agroecosystems. However, sludges can contain toxic trace elements because of suboptimal wastewater treatment. Nonetheless, field studies investigating the negative effects of these practices on pollinators are lacking. We collected honeybees from an area where sewage sludge use is widespread, and one where it is precluded. Trace elements in soils and bees were quantified. Cadmium, chromium, lead, mercury, and nickel were investigated because they were the least correlated elements to each other and are known to be toxic. Their levels were related to oxidative stress and energy biomarkers, midgut epithelial health, body size and wing asymmetry of honeybees. We found increased carbohydrate content in sites with higher cadmium levels, increased histological damage to the midgut epithelium in the sewage sludge area, and the presence of dark spherites in the epithelium of bees collected from the sites with the highest lead levels. Finally, we found that honeybees with the highest lead content were smaller, and that wing fluctuating asymmetry increased in sites with increasing levels of mercury. To the best of our knowledge, this is the first comprehensive study of the concentration and effects on honeybees of trace elements potentially deriving from soil amendment practices.

“We Called It ‘Cancer Park’”: Soil Contamination and Outdoor Leisure in Southeast Los Angeles

Environmental justice work has long sought to illuminate and challenge the inequitable impacts of pollution. In this case study, we evaluated the impact of soil lead contamination on outdoor leisure in Southeast Los Angeles, where more than 2000 residential properties near a lead-acid battery recycling facility indicated high soil lead levels. This study employed an embedded case study design to (1) evaluate the impact of soil lead contamination on residents’ outdoor leisure and (2) illuminate the socio-political institutions that wield power to shape daily life. Embedded survey results indicated that neither objective nor subjective soil lead measures were associated with outdoor leisure time of adults or children; however, additional forms of evidence illuminated how compounding environmental hazards, inadequate communication, and power inequities shaped outdoor leisure activities in Southeast Los Angeles. These findings sought to critically illustrate that health promoting outdoor leisure spaces are a privilege afforded to some, but not all.

Lead-sheathed telecom cables and historic leaded gasoline emissions substantially raise environmental lead levels in Portland, Oregon

We conducted a high-resolution study of lead in an urban moss, Orthotrichum lyellii, to better understand lead distributions and sources in Portland, Oregon (United States). The outdoor lead landscape is found to be heterogenous, with lead concentrations varying with age of neighborhood: on average 8.3× and 19× the rural background in newer (≥1948) and older neighborhoods (≤1915), respectively. This study finds leaded gasoline to be a pervasive and persistent lead source, decades after the complete phase out of leaded gasoline use by on-road vehicles. The highest lead levels, up to 590× the rural background, are found in older residential neighborhoods where relic lead-sheathed telecommunication cables were identified. Leaching of lead from these cables is thought to be responsible for elevated lead in older residential neighborhoods in cities across the country. Targeted research is needed to quantify the impact of these cables on lead exposures in affected communities.

Evaluation of Lead and Cadmium Levels in Individuals Exposed to Cement Dust

Background: Heavy metals such as lead and cadmium, which are present in cement dust, are elements with a density of more than 5 g/cm3 that are harmful to both the environment and living creatures. This study was set out to evaluate levels of lead and cadmium in individuals exposed to cement dust in Nnewi metropolis. Study Design: This case-control study was carried out among male and female workers in cement depots in Nnewi metropolis who were selected by simple random sampling. Methods: Thirty-five individuals exposed to cement dust defined as test participants and thirty-five individuals not exposed to cement dust defined as control participants within the age range of 18 and 51 years were selected into this study. Test participants were sub-grouped based on years of exposure to cement dust into 3 years and below, 4 to 6 years and 7 years and above. Five millilitres of whole blood was collected from each selected participant and levels of lead and cadmium were determined using atomic absorption spectrometry. Data were analysed using Independent Student’s T-test and ANOVA with least significant difference post hoc. Data was presented as mean ± standard deviation and significance level was taken at p&lt; 0.05. Results: The blood levels of lead and cadmium in test participants were significantly higher than blood levels in control participants. The lead levels were significantly higher in test participants exposed to cement dust for 7 years and above than in test participants exposed to cement dust between 4 to 6 years and test participants exposed to cement dust for 3 years and below (p&lt;0.001). There was no significant difference in serum levels of cadmium between test participants exposed to cement dust for 3 years and below, test participants exposed to cement dust between 4 years to 6 years and test participants exposed to cement dust for 7 years and above (p&gt;0.05). Conclusion: Occupational exposure to cement dust causes high blood levels of lead and cadmium in the body and this accumulation is dangerous to health.

A novel vacuum roasting technology applied to the processing of mineral medicine pyritum: low heavy metal and environmentally friendly

A novel vacuum roasting technology applied to the processing of mineral medicine pyritum: low heavy metal and environmentally friendly

Assessment of Heavy Metal Contamination and Potential Health Risk of Selected Fish Species in Dhaka District

Fish is a rich source of quality protein and fatty acids. Bangladesh's average daily fish consumption is 67.8 grams per people. Fish species are also prone to heavy metal contamination from their surrounding environment. The main objective of this research was to assess the degree of risk associated with the consumption of various fish species in Dhaka, Bangladesh. Three fish species—Tilapia (Oreochromis mossambicus), Shorputi (Systomus sarana), and Mola (Amblypharyngodon mola)—from three local markets in Savar Union, Dhaka, Bangladesh, were selected for analysis. The Kjeldahl technique, Folch method, and several formulae were used to determine the protein, fat, ash, and moisture content for the proximate analysis. The concentration of heavy metals was determined using Atomic Absorption Spectrophotometry (AAS). The estimated daily intake (EDI), target hazard quotient (THQ), total target hazard quotient (TTHQ), hazard index (HI), and cancer risk (CR) were used to evaluate the danger to human health. Tilapia had the highest moisture and lipid content, whereas Shorputi and Mola had the highest protein and ash contents, ranging from 20.77% to 18.16%, respectively. The mean concentration of heavy metals in fish was determined to be Pb&gt;Ni&gt;Cr&gt;Cd in this study. Every fish species had extremely high levels of lead (Pb), with the Shorputi fish having the highest levels. Fish from the Shorputi species had the highest EDI value. Pb&gt;Ni&gt;Cr&gt;Cd was the trace element EDI for adults. Among all species, only Pd had a THQ value higher than 1. The CR value across all species were within E-3 and E-6 range, while the HI value was &gt;1. In conclusion, the highest average Pb concentrations were detected in Shorputi, while the highest amounts of Cd, Cr, and Ni were observed in Tilapia. The findings of this study recommended that the Bangladeshi government regularly assess the levels of dangerous heavy metal and metalloid contamination in the daily meals of its citizens in order to enforce regulatory limits and determine the likelihood of long-term exposure. Bioresearch Commu. 10(2): 1524-1531, 2024 (July)

Childhood blood-lead level predicts lower general, non-selective hippocampal subfield volumes in midlife

Millions of adults and children are exposed to high levels of lead, a neurotoxicant, each year. Recent evidence suggests that lead exposure may precipitate neurodegeneration, particularly if the exposure occurs early or late in life, with unique alterations to the structure or function of specific subfields of the hippocampus, a region involved in memory and Alzheimer's disease. It has been proposed that specific hippocampal subfields may thus be useful biomarkers for lead-associated neurological disease. We turned to a population-representative New Zealand birth cohort where the extent of lead exposure was not confounded by social class (the Dunedin Study; born 1972-1973 and followed to age 45) to test the hypothesis that early life lead exposure (blood-lead level at age 11 years) is associated with smaller MRI-assessed gray matter volumes of specific subfields of the hippocampus at age 45 years. Among the 508 Dunedin Study members with childhood lead data and adult MRI data passing quality control (93.9 % of those with lead data who attended the age-45 assessment wave, 240[47.2 %] female), childhood blood-lead levels ranged from 4 to 31 µg/dL (M[SD]=10.9[4.6]). Total hippocampal volumes were lower among adults with higher childhood blood-lead levels (b=-102.6 mm3 per 5 ug/dL-unit greater blood-lead level, 95 %CI: -175.4 to -29.7, p=.006, β=-.11), as were all volumes of the 24 hemisphere-specific subfields of the hippocampus. Of these 24 subfields, 20 demonstrated negative lead-associations greater than β=-.05 in size, 14 were statistically significant after adjustment for multiple comparisons (pFDR<.05), and 9 remained significant after adjustment for potential confounders and multiple comparisons. Children exposed to lead demonstrate smaller volumes across all subfields of the hippocampus in midlife. The hypothesis that lead selectively impairs specific subfields of the hippocampus, or that specific subfields may be markers for lead-associated neurological disease, requires further evaluation.

Plomo en sangre y su relación con hemoglobina y hematocrito en niños expuestos a la contaminación minera, Apurímac 2023

Exposure to heavy metals causes a high level of lead in the blood, which causes various problems in various organs, including a deficit in the production of hemoglobin, which causes anemia. This circumstance was the impetus to carry out this research study. The objective of the research was to determine the relationship between blood lead levels and hemoglobin and hematocrit levels in children aged 0 to 11 years exposed to mining pollution in the community of the district and province of Andahuaylas in the department of Apurímac. . A non-experimental quantitative and descriptive design was used. 98 minors from 0 to 11 years of age, registered in the district and province of Andahuaylas in the department of Apurímac, participated in the "lead in blood and its relationship with hemoglobin and hematocrit" campaign from April to May 2023. The study on anemia found that fifty percent (50%) of the subjects did not have anemia. The percentages of mild (6 subjects), moderate (33 subjects), and severe (9 subjects) anemia were 6.1% to 33.7% and 9.2%, respectively. Regarding lead poisoning, 64 (65.3%) of the subjects did not show significant levels, while 34 (34.7%) of the subjects showed toxic levels. The relationship of lead levels with hemoglobin was not significantly influenced by age group, sex or area of ​​residence. Hemoglobin decreases by 0.755 for every one unit increase in blood lead level, with a p-value &lt;0.001 and a 95% confidence interval of -0.839 - 0.671. This study demonstrates a significant correlation between blood lead levels and low hemoglobin levels (corrected for height), underscoring the importance of interventions focused on prevention and health promotion in at-risk populations.