Increased Blood Lead Research Articles

Internal blood lead exposure levels in permanent residents of Jiangxi Province and its effects on routine hematological and biochemical indices.

Lead exposure levels are closely linked to human health and can cause damage to multiple organ systems, including the blood system and liver. However, due to insufficient evidence, the effects of lead exposure on hematological and biochemical indices have not been fully established. This study aims to explore the blood lead levels of permanent residents in Jiangxi Province and analyze the factors affecting blood lead levels and the impact of blood lead levels on hematological and biochemical indices. We conducted a cross-sectional study including questionnaires, health examinations, and blood sample examinations on 720 randomly selected permanent residents (3-79 years) in Jiangxi Province in 2018. The blood lead levels were measured using inductively coupled plasma mass spectrometry. Routine hematological and biochemical tests were determined by qualified medical institutions using automated hematology analyzers and biochemistry analyzers. The geometric mean of blood lead concentration in permanent residents of Jiangxi Province was 20.45 μg/L. Gender, age, annual household income, smoking, and hypertension were the influencing factors for blood lead levels. For each 1 μg/L increase in blood lead, the risks of elevated red blood cell count (from low to high), platelet volume distribution width, alkaline phosphatase (from low to high), and cholesterol increased by 2.4, 1.6, 3.6, and 2.3%, respectively, whereas the risks of elevation of direct bilirubin and total bilirubin both decreased by 1.7%. The blood lead level in permanent residents of Jiangxi Province is higher than the national average. Higher blood lead levels were found in men than in women; blood lead levels were positively correlated with age but negatively correlated with annual household income; smoking and hypertension are risk factors for elevated blood lead; and blood lead levels affect routine hematological and biochemical markers such as red blood cell count, platelet volume distribution width, direct bilirubin, total bilirubin, alkaline phosphatase, and cholesterol.

Comparison of empirical and mechanistic blood lead models for children

Childhood exposure to lead can result in increased blood lead levels, which can have detrimental health effects. Models that can predict blood lead level based on exposure to floor and window sill dust lead at varying concentrations are useful tools for informing policy decisions. We compare an empirical model relating blood lead in children to the lead content of household dust, with a mechanistic model that simulates lead exposure in children through their daily activities. The empirical model is constructed using 1999–2004 NHANES data, while the mechanistic model is validated using 2011–2016 NHANES data. The models are evaluated at dust loadings ranging from 0.18 – 43 µg/ft2 and the resulting blood leads are compared. Specific demographic variables are chosen to simulate individuals are generated with “typical,” “high end,” and “low end” exposures in the empirical model; these are directly compared with the median, 95th, and 5th percentile results from the mechanistic model. For a child with “typical” lead exposure, the 95 % confidence interval for computed blood lead values contained the median blood lead value from the mechanistic model at all dust lead exposure levels considered. Similar results hold when comparing the 95th percentile to “high end” and 5th percentile to “low end”. The blood lead level computed by the mechanistic model increases more quickly with respect to dust loading than the empirical model, particularly at higher loadings. The empirical and mechanistic models generate similar blood lead distributions across the range of dust loadings considered, particularly at low loadings. The mechanistic model may be more appropriate for higher loadings due to limitations inherit in the structure of the empirical model.

ASSOCIATION BETWEEN LOW LEVEL BLOOD LEAD EXPOSURE AND MORTALITY IN US ADULTS WITH CHRONIC KIDNEY DISEASE

Objective: This study aimed to explore the association between blood lead and both chronic kidney disease (CKD) and cardiovascular and all-cause mortality among participants with or without CKD in the US adults. Design and method: Date from the National Health and Nutrition Examination Survey (2007-20018) was used and all participants were followed up regularly until December 31, 2019. CKD was defined as an eGFR <60 ml/min/1.73 m2 and/or a urine albumin and creatinine ratio >= 30 mg/g. Logistic regression models were constructed to explore the associations between blood lead and CKD. The Kaplan–Meier analysis with a log-rank test was performed to estimate the cumulative incidence of mortality between groups. Cox proportional-hazards models were used to explore the associations between blood lead and cardiovascular and all-cause mortality. Results: Totally, this study enrolled 22,951 participants, including 4,078 CKD participants. Multivariable logistic regression analysis showed that higher level of blood lead (>=1.82 vs. <0.73) was associated with the increased risk of CKD (OR:1.35, 95% CI: 1.13–1.62, p=0.001). During a mean follow-up duration of 85.21±43.58 months, a total of 2,139 all-cause mortality and 525 cardiovascular mortality were recorded. In multivariable Cox model, compared with the lowest quartiles, highest blood lead level (>=1.82 vs. < 0.73) was associated with a higher risk of cardiovascular mortality (HR:3.36, 95% CI: 1.32–8.53) and all-cause mortality (HR:1.85, 95% CI: 1.18–2.90) in participants with CKD. Conclusions: In conclusion, in this US cohort, low level blood lead exposure may also be a predictive factor for CKD, and increasing blood lead concentrations significantly contributed to enhanced risk of cardiovascular and all-cause mortality in CKD patients. Hence, the reduce of blood lead exposure may reduce risk of mortality in high-risk individuals with CKD.

Effect of blood lead levels on periodontitis in American adults: a cross-sectional analysis from the national health and nutrition examination survey

BackgroundThe primary objective of this study was to assess the impact of blood lead levels on the development and progression of periodontitis.MethodsThis study included 8600 participants from the National Nutrition and Health Examination Survey conducted the United States between 2009 and 2014. The exposure variable was the blood lead level, while the outcome variable was periodontitis. To evaluate the relationship between the blood lead level and periodontitis, a multivariate logistic regression model was used.ResultsA positive association was observed between blood lead levels and the risk of periodontitis in Model 1 (OR = 7.04, 95% CI = 5.95–8.31). After adjusting for age (continuous), sex, ethnicity, and BMI (continuous) in Model 2, the significant association between blood lead levels and periodontitis risk remained evident (OR = 3.06, 95% CI: 2.54–3.70). Consequently, even after comprehensive adjustment for potential confounding factors in Model 3, the robust association between blood lead levels and periodontitis risk persisted (OR = 2.08, 95% CI = 1.67–2.60). When considering the serum lead concentration as a categorical variable and after adjusting for potential confounders in Model 3, we observed that the odds ratios (ORs) of periodontitis in the T2 (0.94 µg/dL-1.60 µg/dL) and T3 (lead ≥ 1.60 µg/dL) groups increased from 1.27 (OR = 1.27, 95% CI: 1.11–1.44) to 1.57 (OR = 1.57, 95% CI: 1.36–1.81) compared to T1 group. Subgroup analysis revealed no effect modifiers.ConclusionsOur main findings suggest that there is no safe range of blood lead levels regarding periodontitis risk and that increasing blood lead levels can significantly increase the prevalence of periodontitis.

IEUBK Modeling of Children's Blood Lead Levels in Homes Served by Private Domestic Wells in Three Illinois Counties.

Lead is known to impair neurocognitive development in children. Drinking water is routinely monitored for lead content in municipal systems, but private well owners are not required to test for lead. The lack of testing poses a risk of lead exposure and resulting health effects to rural children. In three Illinois counties, we conducted a cross-sectional study (n = 151 homes) examining water lead levels (WLLs), water consumption, and water treatment status to assess risk of lead exposure among residents using private water wells. Since blood lead levels (BLLs) were not available, EPA's Integrated Exposure Uptake Biokinetic (IEUBK) modeling was used to estimate the incremental contribution of WLL to BLL, holding all other sources of lead at their default values. Nearly half (48.3%) of stagnant water samples contained measurable lead ranging from 0.79 to 76.2 µg/L (median= 0.537 µg/L). IEUBK modeling showed BLLs rose from 0.3 to 0.4 µg/dL when WLLs rose from 0.54 µg/L (the tenth percentile) to 4.88 µg/L (the 90th percentile). Based on IEUBK modeling, 18% of children with a WLL at the 10th percentile would have a BLL above 3.5 µg/dL compared to 27.4% of those with a WLL at the 90th percentile. These findings suggest that the consumption of unfiltered well water likely results in increased blood lead levels in children.

The role of geophagy and artisanal gold mining as risk factors for elevated blood lead levels in pregnant women in northwestern Tanzania.

Neither artisanal and small-scale gold mining (ASGM) or geophagy practices have received substantial attention related to blood lead levels despite the well documented deleterious effects of lead. This cross-sectional analytical study aimed to document the risk of lead exposure from geophagy and mining-related occupational activities for pregnant women. The study recruited 1056 pregnant women (883 in an ASGM area and 173 in a non-ASGM area) between April 2015 -April 2017. Generalized Linear Model with an identity link function was used to model the association between blood lead levels (BLLs) and geophagy practices and involvement in gold mining. The prevalence of geophagy was 36.2% (95% CI: 33.6, 39.4%) and 6.3% engaged in mining as a primary occupation. Practicing geophagy increased BLLs by 22% (β = 1.22, 95% CI: 1.116, 1.309, p<0.0001). Living in a gold mining area increased BLLs by 33.4% (β = 1.334, 95% CI: 1.2, 1.483, p<0.0001). Having mining as a primary occupation increased BLLs by 1.3% β = 1.013, 95% CI: 0.872, 1.176, p = 0.869) even though the association was not statistically significant. Socioeconomic wealth quantile (β = 1.037, 95% CI: 1.021, 1.054, p<0.001) increased blood lead levels by 3.7%. Developing a comprehensive inventory capturing sources of community-level lead exposure is essential. Further, increasing public health campaigns and education are crucial to limit geophagy practices and to minimize work in gold mining activities during pregnancy.

Physical activity can reduce the risk of blood cadmium and blood lead on stroke: Evidence from NHANES

The detrimental impact of heavy metals on cardiovascular well-being is a global concern, and engaging in suitable physical activity has been shown to confer cardiovascular advantage. Nevertheless, the potential of exercise to mitigate the deleterious effects of heavy metals on stroke remains uncertain. We conducted a cross-sectional survey to assess the influence of blood cadmium and blood lead on stroke occurrence, while also examining the role of physical activity. Weighted multivariate regression analysis was employed to examine the potential correlation, while subgroup and interaction analyses were used to investigate the sensitivity and robustness of the results. After controlling risk factors, it revealed a positive correlation between blood cadmium and lead levels and the occurrence of stroke. Specifically, a 50% increase in blood cadmium was associated with a 28% increase in stroke incidence, while a 50% increase in blood lead was associated with a 47% increase in stroke incidence. To estimate the non-linear relationship, we employed restricted cubic models. The results demonstrate a gradual decrease in the slope of the model curve as the intensity of physical activity increases, implying that engaging in physical activity may contribute to a reduction in the occurrence of stroke caused by blood cadmium and lead. Our findings suggest that blood cadmium and lead could be considered an autonomous risk factor for stroke within the general population of the United States. Moreover, engaging in physical activity has the potential to mitigate the potential detrimental consequences associated with exposure to heavy metals.

Associations with Blood Lead and Urinary Cadmium Concentrations in Relation to Mortality in the US Population: A Causal Survival Analysis with G-Computation

Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through 31 Dec 31 2015. Time and cause of death were determined from the National Death Index records. We used the parametric g-formula with pooled logistic regression models to estimate the relative and absolute risk of all-cause, cardiovascular, and cancer mortality under different potential threshold interventions for BLLs and UCd concentrations. Median follow-up was 22.5 years. A total of 5167 (36%) participants died by the end of the study, including 1550 from cardiovascular diseases and 1135 from cancer. Increases in BLLs and creatinine-corrected UCd levels from the 5th to the 95th percentiles were associated with risk differences of 4.17% (1.54 to 8.77) and 6.22% (4.51 to 12.00) for all-cause mortality, 1.52% (0.09 to 3.74) and 1.06% (-0.57 to 3.50) for cardiovascular disease mortality, and 1.32% (-0.09 to 3.67) and 0.64% (-0.98 to 2.80) for cancer mortality, respectively. Interventions to reduce historical exposures to lead and cadmium may have prevented premature deaths, especially from cardiovascular disease.

Melatonin therapy reverses lead exposure-induced testicular damage in rats despite the lack of effect on serum testosterone levels.

Lead (Pb) exposure induces testicular damage and infertility. The aim of this study was to analyze and compare the therapeutic effects of antioxidants or vitamin D and calcium, which have previously been shown to reduce the toxic effects of Pb co-exposure, in rats. Rats were exposed to Pb for 28 days and subsequently treated with antioxidant (melatonin, silymarin), vitamin D and calcium (VitDCa) or a combination (melatonin or silymarin with VitDCa) for 28 days. Control groups included untreated rats (no Pb exposure or therapy), rats exposed only to melatonin or silymarin and rats exposed to Pb without post exposure therapy. Pb exposure induced testicular damage, increased blood lead level (BLL) and reduced serum testosterone level (STL). Rats exposed to Pb and left untreated for 28 days showed persistent pathological testicular alterations. The two treatments that were most effective in reversing pathological testis damage and restoring spermatogenesis were melatonin and silymarin. However, silymarin and melatonin treatment resulted in significantly different serum testosterone levels in rats. Whereas melatonin therapy reduced serum testosterone to levels lower than those in control rats, silymarin increased serum testosterone to levels higher than those in controls. Our pathological analysis of testes revealed that melatonin promoted spermatogenesis and regression of Pb exposure-induced degenerative changes, despite the associated reduction in serum testosterone levels. This result suggests that circulating testosterone may not have an important role in spermatogenesis. Collectively, our results suggest that melatonin and silymarin are effective therapies against the toxic effects Pb exposure in the male reproductive system.

Long-termindoor gunshot exposure of special police forces induces bronchitic reactions and elevated blood lead levels-The Berlin shooting range study.

Gunshot emissions contain toxic elements that can harm those frequently exposed, such as police officers. Several years ago, police indoor firing ranges were closed by the Berlin municipality in response to police officer health complaints, and an investigation was launched into the possible respiratory health risks of frequent gunshot emission exposure. We, therefore, conducted an exploratory cross-sectional study to investigate clinical and functional parameters of respiratory health as well as the burden of trace elements in policemen with long-term high exposure to indoor gunshot emissions, compared to low-exposure and control groups. We conducted lung function tests and collected blood and urine samples from Berlin police officers and government employees who were divided into three subject groups based on exposure to gunshot emissions: high exposure (n=53), low exposure (n=94) and no exposure (n=76). Lung function was examined using body plethysmography. Blood and urine samples were tested via inductively coupled plasma mass spectrometry for the presence of common gunshot powder elements (antimony, lead and manganese). Exposure and symptoms were assessed using records as well as questionnaires. Higher exposure was associated with more respiratory symptoms during gun shooting practice (64% vs. 21%, P<0.001) compared to the low-exposure group. Headache, cough, discoloured mucous and shortness of breath were also more common as were some other symptoms. The cough symptomatology of the high-exposure group also persisted significantly longer (median: 0.67 vs. 0.01days, range: 0 to 5days, P=0.029) compared to the low-exposure group. They also showed a lower forced expiratory volume in 1s/forced vital capacity quotient (Tiffeneau index), P=0.018 between the three groups and P=0.005 for the high-exposure group, a possible marker of early, subclinical bronchial obstruction. We observed increased blood lead concentrations depending on subject's age (+1.2% per year, 95% confidence interval: 0.5-1.9%, P<0.001) and cumulative gunshot exposure (+0.34% per 100000 shots, 0.02-0.66%, P=0.037). These first results suggest that long-term exposure to indoor gunshot emissions induces bronchitic reactions due to repeated irritation of the airways. Higher levels of exposure lead to more negatively impacted lung function and higher blood lead levels with the possible reason that more frequent exposure may mean shorter regeneration phases for the respiratory mucous membrane. We recommend a reduction of exposure to gunshot emissions in order to decrease symptoms and avoid any-even small-deterioration in spirometry.

Relationship between Postural Stability, Lead Content, and Selected Parameters of Oxidative Stress.

This study attempts to determine whether the increased blood lead concentration affects the posturographic test and to determine the relationship between the parameters of posture stability and selected parameters of oxidative stress. The study population consisted of 268 male employees and was divided into two equal subgroups, depending on the lead content in the blood. A posturographic examination was performed. Concentrations of lead, cadmium, zinc protoporphyrin, selected essential elements, and selected markers of oxidative stress in the blood were tested. Higher blood lead concentrations positively affected the values of the sway results: the field and the mean velocity of the center of the feet pressure in posturography. The absolute value of the proprioception ratio was similar in both subgroups. The content of malondialdehyde shows a statistically significantly higher value in a subgroup with high blood lead concentration and exhibits significant correlations only with some of the posturography parameters. The lipofuscin content in erythrocytes correlates with the results of the posturography test. Zinc protoporphyrin, total oxidant status, total antioxidant capacity, selected minerals, and metals did not correlate with the results of the posturography test. In conclusion, posturographic results correlate only with selected markers of oxidative stress, so it can be assumed that the effect on the body balance is only partial.

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.

Bloodlettings in Hemochromatosis Result in Increased Blood Lead (Pb) Concentrations

Hemochromatosis is a hereditary disorder, most often associated with mutations of the HFE (High FErrum) gene. If left untreated, it can result in severe parenchymal iron accumulation. Bloodletting is the mainstay treatment. We have previously shown that treatment of hemochromatosis by repeated bloodlettings may induce changes in the serum levels of several trace elements. The aim of this work was to evaluate if whole blood concentrations of the environmental pollutants lead (Pb), mercury (Hg), and cadmium (Cd) could be affected by bloodlettings. We recruited 28 patients and 21 healthy individuals (control group). Whole blood and urine levels of Pb, Hg, and Cd were measured before the start and after the completion of treatment using inductively coupled plasma mass spectrometry, together with serum iron and liver function tests. Concentrations of blood Pb, but not Hg or Cd, were significantly increased after treatment. The increase in Pb was higher in C282Y homozygous patients than in the other patients, and it was positively correlated with the serum concentration of alkaline phosphatase. Bloodlettings in hemochromatosis result in an increase in the blood concentration of Pb. Augmented absorption due to iron loss or Pb mobilization from bone may contribute to the higher blood Pb level.

Association of α-klotho and lead and cadmium: A cross-sectional study

Epigenetic aging is associated with harmful health effects such as oxidative stress from heavy metal exposure. We considered the relationship between genes and heavy metals in association with oxidative stress and then investigated the association between serum α- klotho and lead and cadmium exposure among adults in the United States from 2007 to 2016 participating in the National Health and Nutrition Examination Survey (NHANES). Samples included 9800 adults aged 40 to 79 years with measurements of serum α-klotho, lead and cadmium, and complete covariate data. Lead and cadmium levels were measured by inductively coupled plasma mass spectrometry and serum α-klotho levels were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate linear regression analysis was used to estimate the association between serum α-klotho and blood lead, blood cadmium, and urinary cadmium. A percent increase in blood lead, blood cadmium, and urinary cadmium was associated with a statistically significant 4.0 % (p < 0.001), 2.0 %, (p = 0.003) and 1.0 % (p = 0.020) decrease in serum klotho. After adjustment, a percent increase in blood lead was associated with a statistically significant 4.0 % (p < 0.001) decrease in serum klotho; blood and urinary cadmium did not show any statistically significant associations after adjustment (β (95 % CI), p-value for blood cadmium: 0.00 (−0.02–0.01), p = 0.573; urinary cadmium: −0.01 (−0.03–0.01), p = 0.210). Mean serum klotho levels showed a statistically significant decreasing trend with increasing blood lead quartiles (unadjusted and all-adjusted geometric means and 95 % confidence intervals of serum klotho (in pg/mL) for Q1, Q2, Q3, and Q4: unadjusted: 827.49 (814.20–840.92), 811.92 (794.73–829.48), 791.48 (775.11–808.19), and 772.01 (754.23–790.29); adjusted: 830.64 (805.53–856.45), 816.07 (789.18–843.87), 800.71 (773.71–828.57), and 784.31 (757.94–811.59)). Blood lead and levels were negatively associated with serum α-klotho levels in a representative population of US adults. These results suggest that blood lead levels may be associated with the serum levels of a protein associated with cognition and aging. Further research is recommended to investigate the causality behind such relationship.

Evaluation of calcium-fortified municipal water as a public health intervention to mitigate lead burdens

Abstract Lead has adverse effects on health, society, and the economy. Lead exposure results in increased blood lead levels and storage in bones. Calcium and lead are competitively absorbed and as such calcium can be used to mitigate the body lead burden. Twenty-eight quantitative research studies were reviewed that examined lead exposure (in blood, bone, or breastmilk) and calcium intake or serum calcium to evaluate the efficacy and safety of fortifying potable water supplies with calcium to mitigate lead absorption or resorption. Eighteen of the studies reported a significant inverse relationship between biomarker lead levels and calcium intake or serum calcium. The relationship was most evident with high calcium intake, suggesting a dose-dependent relationship. An intervention with calcium-fortified water could offer an accessible source of supplemental calcium to help meet the recommended dietary allowance (RDA) and mitigate lead absorption. A concentration of 60 mg-Ca/L can supply 22.0 and 16.3% of a 1,000 mg-Ca RDA for men and women, respectively, at the recommended daily water intake.

Alcohol Consumption Moderated the Association Between Levels of High Blood Lead or Total Urinary Arsenic and Bone Loss.

Metal exposure and lifestyle are important risk factors for osteoporosis. Our study aimed to investigate the association between red blood cell lead and cadmium, total urinary arsenic, and plasma selenium levels and bone mineral density (BMD). In addition, we explored whether alcohol and coffee consumption modified the association between BMD and metals and metalloids. In total, 437 participants who underwent adult or senile physical examinations were recruited. Bone loss was defined as a calcaneus BMD T-score of <-1. Blood cadmium and lead and plasma selenium levels were measured using inductively coupled plasma mass spectrometry. Levels of urinary arsenic species were determined using high-performance liquid chromatography–hydride generator–atomic absorption spectrometry. The total urinary arsenic level was defined as the sum of the levels of urinary arsenic species. The BMD T-scores decreased significantly with increasing blood lead levels. The BMD T-scores also showed a downward trend with increasing total urinary arsenic levels. The odds ratio (OR) and 95% confidence interval (CI) for bone loss in patients with blood lead levels >57.58 versus 35.74 μg/dL were 1.98 and 1.17–3.34. In addition, the greater the lead or arsenic exposure and alcohol intake was the higher the OR for bone loss with multivariate ORs of 2.57 (95% CI 1.45–4.56) and 2.96 (95% CI 1.67–5.22), respectively. To the best of our knowledge, this study is the first to demonstrate that high total urinary arsenic or blood lead levels and frequent or occasional alcohol consumption had a significant multiplicative interaction for increasing the OR for bone loss.

Making the grade with quality reports

The current volume of The Journal includes a study from Fogel et al at Penn State, which reports on the results of a quality improvement study at their institution. These workers aimed to improve adherence with current guidelines on lead screening in children in some of their affiliated practices. The study found that an educational intervention produced very little change in practitioner behavior, as assessed by medical record documentation of appropriate lead testing. However, introduction of a point of care (POC) testing device in one of the clinics resulted in striking and durable improvement in screening. Quality improvement initiatives are ubiquitous in children's hospitals these days, and clearly provide value added to the children and families served. However, we rarely publish single-center studies such as this one. We believe that QI initiatives are generally specific to the institutions conducting them, and rarely have the type of generalized impact that we like to see in manuscripts we publish. That being said, there were 3 reasons we believed that this study was appropriate for The Journal. First, of course, the problem was important. Beyond that, the study was very nicely designed, undertaken, and reported. As such, it can provide a model for such reports in the future. Finally, the report drives home a common observation in quality intervention science. "Education," while admirable, rarely produces lasting changes in behavior. Meaningful change in provider behavior in this study only occurred when a novel intervention (a technology) made it possible to change a process, making it easy for the test to be ordered and performed while the child was still in the clinic. Article page 206 ▸ Point-of-Care Testing Improves Lead Screening Rates at 1- and 2-Year Well VisitsThe Journal of PediatricsVol. 233PreviewTo increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5 μg/dL. Full-Text PDF

Flavonoid fractions of diosmin and hesperidin mitigate lead acetate-induced biochemical, oxidative stress, and histopathological alterations in Wistar rats.

This study aims at investigating the protective effects of flavonoid fractions of diosmin and hesperidin in mitigating sub-chronic lead acetate-induced biochemical, oxidative stress, and histopathological alterations in adult male Wistar rats. Forty animals were randomly assigned into five groups, each consisting of eight animals. Group I animals was treated with deionised water only, group II, IV, and V were administered lead acetate 90mg/Kg body weight (1/20th of the LD50), groups III, and IV was administered Daflon (100mg/Kg), while group V was administered Daflon (200mg/Kg), 30min prior treatment with lead acetate. All treatments lasted for 42days. Blood lead levels, electrolyte parameters, zinc protoporphyrin (ZPP) levels, activities of antioxidant enzymes, and histopathology of vital organs, were evaluated following standard practice. Sub-chronic lead acetate exposure induced a decrease in levels of serum electrolytes, and activities of antioxidant enzymes, while blood lead levels, ZPP, and malondialdehyde levels were increased. Lead exposure also instigated marked variation in histopathology of vital organs. Conversely, co-treatment with graded doses of daflon improved the levels of blood lead, electrolytes, ZPP, activities of antioxidant enzymes, and histopathology of vital organs. Data obtained from the current study indicate that rats exposed to sub-chronic doses of lead acetate show increased blood lead levels, electrolyte imbalance, alongside impairment in ZPP levels, activities of antioxidant enzymes, and histopathology, while pretreatment using daflon mitigated the ensued perturbations. This, therefore, suggests that consumption of foods enriched with flavonoid fractions of diosmin and hesperidin may be beneficial for individuals inhabiting lead-polluted environments.

Point-of-Care Testing Improves Lead Screening Rates at 1- and 2-Year Well Visits

To increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5μg/dL. Baseline data were collected July 2017 to June 2018. All providers received education on screening recommendations and local prevalence of elevated blood lead levels in July 2018. POC testing began June 2019 at 1 of the 4 practice sites. Screening rates were measured by electronic medical record abstraction. Rates were plotted monthly on statistical process control charts during implementation and analyzed using logistic regression under an interrupted time series approach for program evaluation. There was a small but significant increase in screening following provider education (OR 1.04 per month, 95% CI 1.02-1.07). POC testing was associated with a substantial immediate increase (OR 4.17, 95% CI 2.45-7.09) and a substantial continued increase (OR 1.34 per month, 95% CI 1.17-1.54) in screening at the site that implemented POC. POC testing substantially increases blood lead level screening rates at 12- and 24-month well visits and may be beneficial in other primary care settings.

Associations between Blood Lead Levels and Coronary Artery Stenosis Measured Using Coronary Computed Tomography Angiography.

Background:Lead exposure is a risk factor for increased blood pressure and cardiovascular disease, even when blood lead levels (BLLs) are within the normal range.Objective:This study aimed to investigate the association between BLL and coronary artery stenosis (CAS) in asymptomatic adults using 128-slice dual-source coronary computed tomography (CT) angiography.Methods:We analyzed medical records data from 2,193 adults (1,461 men and 732 women) who elected to complete a screening health examination, coronary CT angiography, and BLL measurement during 2011–2018 and had no history of CAS symptoms, cardiovascular disease, or occupational exposure to lead. Logistic regression models were used to estimate associations between moderate-to-severe CAS ( stenosis) and a increase in blood lead, with and without adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, regular exercise, smoking status, and alcohol drinking.Results:BLLs ranged from , with an arithmetic mean of . The arithmetic mean was higher for men than for women ( vs. , ) and higher in the moderate-to-severe CAS group than in the no-CAS or stenosis group ( vs. , ). Moderate-to-severe CAS was significantly associated with BLL before and after adjustment, with an adjusted odds ratio for a increase in BLL of 1.14 (95% CI: 1.02, 1.26), .Conclusions:BLL was positively associated with the prevalence of moderate-to-severe CAS in Korean adults who completed an elective screening examination for early cardiovascular disease, 94% of whom had a BLL of . More efforts and a strict health policy are needed to further reduce BLLs in the general population. https://doi.org/10.1289/EHP7351