A rationale for lowering the blood lead action level from 10 to 2 microg/dL

Determinants of lead exposure in children on the outskirts of Salvador, Brazil

Lead (Pb) is a toxic heavy metal that is widely distributed throughout the environment. Pb is an important neurotoxic metal and children are more susceptible to its effect due to their higher absorption rate and greater susceptibility of the developing nervous system. In this work, we evaluated the lead exposure levels in children living near a metallurgical plant and identified risk factors associated with its internal dose. All children, aged 1-10 years and 11 months, living near a metallurgical plant in the great Salvador area, Brazil were evaluated in this cross-sectional study and compared with children from a non exposed area. Occipital hair and blood were used to assess exposure. Air lead levels in the respirable fraction (PM(2.5)) were also measured in both areas. Blood lead levels (BLL), hair lead levels (PbH) and air lead were determined by graphite furnace atomic absorption spectrometry. Spearman correlations analysis was used to evaluate correlations between BLL, PbH and descriptors. Significant risk factors were modeled using multivariate linear regression analysis. Air lead levels were approximately ten-folds lower than EPA reference concentration (0.15 μg/m(3)). Median BLL and PbH were 1.65 ± 1.45 μg/dL and 1.26 ± 3.70 μg/g, respectively, in exposed children. In the referents, medians were BLL 1.20 ± 1.20 μg/dL; PbH 2.09 ± 2.06 μg/g. No significant difference was observed in biomarkers levels between boys and girls. It was observed a positive weak correlation (Spearman rho = 0.197, p = 0.033) between BLL and PbH. Our data show that children's lead body burden measured as BLL or PbH are low when compared with the recommended reference values. Despite that, we were able to identify four risk factors associated with increased biological lead levels: age, living near industrial site, environmental tobacco smoking and, above all, domestic waste burning. In order to prevent such avoidable exposure, environmental education and proper waste management should be implemented, especially in developing countries.

The important health impact of where a child lives: neighborhood characteristics and the burden of lead poisoning

Toxins and other health threats can cause health problems, whether they are present in the child's own home, other neighborhood homes where the child spends time, or common areas such as playgrounds. We assess the impact of where a child lives on the burden of lead poisoning. Statewide lead screening data was obtained from the Rhode Island Department of Health. Block group level indicators of old housing and poverty were obtained from the US Census. Of the 204,746 study children, 35,416 (17.3%) had a blood lead level≥10 μg/dL. The proportion of study children who were lead poisoned in each block group ranged from 0.0 to 48.6%. The proportion of study children with an elevated blood lead level increased from 8% among children living in block groups in the lowest quintile of poverty to 31% for those in the highest quintile for poverty. Old housing also had an important impact on the risk of lead poisoning. The proportion of children with an elevated blood lead level increased from 7% among children living in block groups in the lowest quintile for pre-1950 housing to 27% for those in the highest quintile for pre-1950 housing. The adjusted odds ratio was 1.64 for the highest quintile of poverty and 1.77 for the highest quintile of pre-1950 housing. The findings of this large, statewide study demonstrate the powerful impact of where children live on the risk of lead poisoning. The findings have important implications for understanding the problem of lead poisoning and for planning primary prevention programs.

Environmental determinants of chronic disease and medical approaches: recognition, avoidance, supportive therapy, and detoxification

The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives--biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity.

Metal toxicity at the synapse: presynaptic, postsynaptic, and long-term effects

Metal neurotoxicity is a global health concern. This paper summarizes the evidence for metal interactions with synaptic transmission and synaptic plasticity. Presynaptically metal ions modulate neurotransmitter release through their interaction with synaptic vesicles, ion channels, and the metabolism of neurotransmitters (NT). Many metals (e.g., Pb(2+), Cd(2+), and Hg(+)) also interact with intracellular signaling pathways. Postsynaptically, processes associated with the binding of NT to their receptors, activation of channels, and degradation of NT are altered by metals. Zn(2+), Pb(2+), Cu(2+), Cd(2+), Ni(2+), Co(2+), Li(3+), Hg(+), and methylmercury modulate NMDA, AMPA/kainate, and/or GABA receptors activity. Al(3+), Pb(2+), Cd(2+), and As(2)O(3) also impair synaptic plasticity by targeting molecules such as CaM, PKC, and NOS as well as the transcription machinery involved in the maintenance of synaptic plasticity. The multiple effects of metals might occur simultaneously and are based on the specific metal species, metal concentrations, and the types of neurons involved.

Altered expressions of MMP-2, MMP-9, and TIMP-2 in placentas from women exposed to lead

Experimental studies have shown that prenatal exposure to lead (Pb) produces morphological changes related to extracellular matrix remodelling. To analyse whether the matrix metalloproteinases (MMPs), particularly MMP-2, MMP-9, and the tissue inhibitor of metalloproteinases-2 (TIMP-2), are associated with morphological alterations found in placentas, the expression of these enzymes was evaluated by immunohistochemical and image analyses in placentas of women with histories of environmental exposure to Pb. The median maternal concentration of Pb in blood was 4.68 µg/dL (x = 5.85 ± 6.48 µg/dL). Significant differences related to the exposure to Pb were not detected in newborn or placenta weight. MMP-2, MMP-9, and TIMP-2 were expressed in the syncytiotrophoblast layer of placental villi. A significant increase in both MMP-2 and MMP-9 was observed in placentas of women with concentrations of Pb in blood ≥4.68 µg/dL (p = 0.01 and 0.03 for MMP-2 and MMP-9, respectively) and decrease in TIMP-2 expression (p = 0.01) resulted in a significant increase in MMP-2/TIMP-2 ratio (p < 0.01). Increased expression of MMPs may be induced to aid in repairing placental tissue damaged by the exposure to Pb and that TIMP-2 decreases its expression to permit tissue repair. Increased expression of MMPs may be important to consider as a mechanism for generating placental abnormalities and in the induction of preterm delivery or abortion.

Child neurodevelopment in a Bolivian mining city

This study evaluates the neurodevelopment of children living near contaminated mining industries during their first year of life. Participants from the city of Oruro (Bolivia) were prospectively recruited during pregnancy. Follow-up occurred between May 2007 and November 2009. Information about the socioeconomic status and medical history of the pregnant women were collected using questionnaires. Neurodevelopment was evaluated for 246 children using the Bayley Scales of Infant Development (BSID) at 10.5-12.5 months of age. Exposure to trace elements (Pb, As, Cd, Sb, Cs, Zn, Fe, Cu, Se, Rb, and Sr) during prenatal life was evaluated by testing maternal blood concentrations before delivery. Almost all measured levels were lower than the control limits. The blood lead concentration of pregnant women was low, considering the contaminated environmental context. The geometric mean was 1.76 μg/dL (95% CI: 1.68-1.84), a level comparable with those observed in non-contaminated areas. The only element found to be relatively elevated was antimony, with a geometric mean of 1.03 μg/dL (95% CI: 0.96-1.11). Our results suggest that women from this mining area were not highly exposed. The Bayley Scales of Infant Development (BSID) did not reveal mental or psychomotor abnormalities. Surprisingly, at the observed low levels, lead was positively associated with the children's BSID performance.

Lead (Pb) in biota and perceptions of Pb exposure at a recently designated Superfund beach site in New Jersey

The Raritan Bay Slag Site (New Jersey) was designated a Superfund site in 2009 because the seawall, jetties, and sediment contained lead (Pb). Our objective was to compare Pb and mercury (Hg) levels in biota and public perceptions of exposure at the Superfund and reference sites. Samples (algae, invertebrates, fish) were collected from the Raritan Bay Slag Site and reference sites and analyzed for Pb and Hg. Waterfront users were interviewed using a standard questionnaire. Levels of Pb in aquatic organisms were compared to ecological and human health safety standards. Lead levels were related to location, trophic level, and mobility. Lead levels in biota were highest at the western side of the West Jetty. Mean Pb levels were highest for algae (Fucus = 53,600 ± 6990 ng/g = ppb [wet weight], Ulva = 23,900 ± 2430 ppb), intermediate for grass shrimp (7270 ± 1300 ppb, 11,600 ± 3340 ppb), and lowest for fish (Atlantic silversides 218 ± 44 ppb). Within species, Pb levels varied significantly across the sampling sites. Lead levels in algae, sometimes ingested by individuals, were sufficiently high to exceed human safety levels. Mercury levels did not differ between the Superfund and reference sites. Despite the fence and warnings, people (1) used the Superfund and reference sites similarly, (2) had similar fish consumption rates, and (3) were not concerned about Pb, although most individuals knew the metal was present. The fish sampled posed no apparent risk for human consumers, but the algae did.

Blood lead levels and associated sociodemographic factors among preschool children in the South Eastern region of China

Children are especially vulnerable to lead toxicity, and exposure to lead has been linked to poor school performance and delinquency in children and adolescents. Even low-level lead exposure [blood lead level (BLL) <10 µg/dL] can cause intellectual deficit. In China, BLLs in children decreased slightly after the phasing out of lead in gasoline, but few studies have examined the sociodemographic factors associated with BLL above 10 µg/dL. In this study, we sought to examine the hypothesis that sociodemographic factors predict BLLs. We measured BLLs of 1344 preschool children (3-5 years old) from the China Jintan Child Cohort Study. Children's sociodemographic and health statuses, as well as parental sociodemographic data, were collected using questionnaires. Regression models were used to explore the association between sociodemographic factors and log-transformed BLLs as well as the relationship between sociodemographic factors and the risk of BLL ≥10 µg/dL. We found the median BLL to be 6.2 µg/dL (range: 1.8-32.0 µg/dL); 8% of children had BLLs ≥10 µg/dL. Boys had a higher median BLL (6.4 µg/dL) than girls and were more likely to have BLL ≥10 µg/dL [odds ratio = 1.77, 95% confidence interval 1.14, 2.74]. BLLs increased as children aged, with a median BLL of 6.6 µg/dL among 5-year-old children. Children with siblings had a higher average BLL and greater prevalence of a BLL ≥10 µg/dL than those without siblings. Living in a crowded neighbourhood was also associated with increased BLLs. Mother's lower education, father's occupation (as professional worker) and parental smoking at home were associated with increased BLLs. This study shows that children in this area still have relatively high BLLs even after the phasing out of leaded gasoline. Both children's and parental factors and community condition are associated with increased BLLs. Future efforts are needed to identify other sources of exposure and develop targeted prevention strategies.

Lessons learned on lead poisoning in children: one-hundred years on from Turner's declaration

There is significant emerging evidence showing life-long negative health, intellectual and socio-behavioural impacts as a result of childhood blood lead concentrations well below the widely used intervention level of 10 µg/dL. This issue raises serious health concerns for children in several Australian smelting and mining towns. Routine educational and home cleanliness advice to wet mop floors rather than to use a brush and pan to reduce lead exposure risks have been shown to have limited efficacy. This paper argues, as advocated 100 years ago by Queensland doctor Alfred Jefferis Turner, that childhood lead poisoning can only be mitigated via primary prevention and reduction of contaminants at source. Given that the effects of lead exposure are irreversible, there is a strong argument for the application of the precautionary principle to dealing with childhood lead exposure. There is a clear need to improve regulatory controls and emissions management to reduce environmental lead exposure risks.

Current needs and future directions of occupational safety and heath in a globalized world

This summary provides a synopsis of talks included in a symposium entitled "Current Needs and Future Directions of Occupational Safety and Heath in a Globalized World". The purpose of the symposium was to (1) highlight national and international agencies with occupational health related activities; (2) address electronic (e-)waste issues in developing countries where exposures are secondary to the handling and scavenging of scrap; and (3) discuss the effects of hazardous materials, such as polycyclic aromatic hydrocarbon (PAH) and tobacco smoke on child intelligence quotient (IQ) in developing countries.

An education initiative concerning lead in an Arkansas community: results from pre- and post-surveys

The Arkansas People Participating in Lead Education (APPLE) Program is a collaborative effort between six Arkansas state, national and community organizations to provide lead awareness, training, and municipal legislation to needy communities in Arkansas. Under this program, APPLE organized and hosted well-designed, hands-on, and effective "call to action" lead awareness workshops for parents and community members in 10 needy communities over a 2 year period. Pre- and post-surveys were given to community members to access knowledge, attitudes and effectiveness of lead workshop activities, with demographic and another 13 and 11 questions on pre- and post-surveys, respectively. There were 709 adult attendees across the 10 workshop (Many children also attended.), with 460 completing pre-surveys, and 199 completed post-survey. Post-surveys were limited to four cities. The majority of those who completed surveys were African-American, reported as 78% on pre-surveys, with the majority also being parents (61%) and females. Although, 71% reported knowing that lead paint was bad for their health, more than 60% reported knowing little about lead exposure, and another 25% did not know the age of their residence. On the post-surveys, the majority of respondents found the workshop to be pleasant and informative (98%), while 45% had changed something in their lives to prevent lead exposure for a child and another 53% planned to make a change to prevent lead exposure for a child.

δ-Aminolevulinic acid dehydratase single nucleotide polymorphism 2 and peptide transporter 2*2 haplotype may differentially mediate lead exposure in male children

Child low-level lead (Pb) exposure is an unresolved public health problem and an unaddressed child health disparity. Particularly in cases of low-level exposure, source removal can be impossible to accomplish, and the only practical strategy for reducing risk may be primary prevention. Genetic biomarkers of increased neurotoxic risk could help to identify small subgroups of children for early intervention. Previous studies have suggested that, by way of a distinct mechanism, δ-aminolevulinic acid dehydratase single nucleotide polymorphism 2 (ALAD(2)) and/or peptide transporter 2*2 haplotype (hPEPT2*2) increase Pb blood burden in children. Studies have not yet examined whether sex mediates the effects of genotype on blood Pb burden. Also, previous studies have not included blood iron (Fe) level in their analyses. Blood and cheek cell samples were obtained from 306 minority children, ages 5.1 to 12.9 years. (208)Pb and (56)Fe levels were determined with inductively coupled plasma-mass spectrometry. General linear model analyses were used to examine differences in Pb blood burden by genotype and sex while controlling for blood Fe level. The sample geometric mean Pb level was 2.75 μg/dl. Pb blood burden was differentially higher in ALAD(2) heterozygous boys and hPEPT2*2 homozygous boys. These results suggest that the effect of ALAD(2) and hPEPT2*2 on Pb blood burden may be sexually dimorphic. ALAD(2) and hPEPT2*2 may be novel biomarkers of health and mental health risks in male children exposed to low levels of Pb.

Arkansas People Participating in Lead Education (APPLE): results of a lead-safe training program

Lead is still seen as one of the most harmful environmental toxins for young children, with the predominant source being deteriorating lead-based paint. Those at continued risk include those living in homes built before 1978, renovators and remodelers, and especially those with limited access to proper healthcare and diets. Proper training on lead-safe work practices focused on preventing and reducing the spread of lead dust can help reduce lead exposure. Presented in this paper are experiences in delivering lead-safe work practices training in six Arkansas cities, and results from pre- and post- surveys delivered before and immediately after the training. Pre- and post-surveys assess strong and weak areas of training. Participants demonstrated positive shifts in attitude and behavior towards lead-safe work practices following training. However, our research found that more emphasis should be focused on clarifying current lead exposure sources and routes for children.

A Bland-Altman comparison of the Lead Care® System and inductively coupled plasma mass spectrometry for detecting low-level lead in child whole blood samples

Chronic childhood lead exposure, yielding blood lead levels consistently below 10 μg/dL, remains a major public health concern. Low neurotoxic effect thresholds have not yet been established. Progress requires accurate, efficient, and cost-effective methods for testing large numbers of children. The LeadCare® System (LCS) may provide one ready option. The comparability of this system to the "gold standard" method of inductively coupled plasma mass spectrometry (ICP-MS) for the purpose of detecting blood lead levels below 10 μg/dL has not yet been examined. Paired blood samples from 177 children ages 5.2-12.8 years were tested with LCS and ICP-MS. Triplicate repeat tests confirmed that LCS and ICP-MS had comparable repeatability. As compared with ICP-MS, LCS had a negative bias of 0.457 μg/dL with an average variability of 1.0 μg/dL. The reproducibility and precision of the LCS is appropriate for the evaluation and monitoring of blood lead levels of individual children in a clinical setting. Recent research however has suggested that increments as small as 0.5 μg/dL may distinguish those at risk of low-level lead-induced neurotoxicity. Thus, we also conclude that the LCS is not useful for research applications attempting to identify neurotoxic effect thresholds for chronic lowest level lead exposure in children. For these types of research applications, a convenient and low-cost device is needed for the precise detection of child blood lead levels below 10 μg/dL.

A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development

The allostatic load (AL) model represents an interdisciplinary approach to comprehensively conceptualize and quantify chronic stress in relation to pathologies throughout the life cycle. This article first reviews the AL model, followed by interactions among early adversity, genetics, environmental toxins, as well as distinctions among sex, gender, and sex hormones as integral antecedents of AL. We next explore perspectives on severe mental illness, dementia, and caregiving as unique human models of AL that merit future investigations in the field of developmental psychopathology. A complimenting transdisciplinary perspective is applied throughout, whereby we argue that the AL model goes beyond traditional stress–disease theories toward the advancement of person-centered research and practice that promote not only physical health but also mental health.

Community-based participatory research (CBPR) approach to study children's health in China: experiences and reflections

BACKGROUND

Community-based participatory research principles have been successfully applied to public health research in U.S. settings. While there is a long history of collaboration between government and communities in China, to date, community-based participatory research has not been used in children's environmental health studies.

METHOD

This article describes how community-based participatory research principles were applied by an international research group to the China Jintan Child Cohort Study, a longitudinal study of malnutrition and lead exposure on cognitive and neurobehavioral development. Challenges emerged and lessons learned from implementing the study were discussed and recommendations were presented.

CONCLUSION

We conclude that the community-based participatory research model can be applied in conducting and promoting environmental health research in China and researchers should be prepared for special challenges and cultural constraints in the implementation of the research in regards to human subject regulations, information dissemination, and culture.

Effects of lead exposure on oxidative stress biomarkers and plasma biochemistry in waterbirds in the field

Medina lagoon in Andalusia has one of the highest densities of spent lead (Pb) shot in Europe. Blood samples from waterbirds were collected in 2006-2008 to measure Pb concentration (PbB), δ-aminolevulinic acid dehydratase (ALAD), oxidative stress biomarkers and plasma biochemistry. PbB above background levels (>20 μg/dl) was observed in 19% (n=59) of mallards (Anas platyrhynchos) and in all common pochards (Aythya ferina) (n=4), but common coots (Fulica atra) (n=37) and moorhens (Gallinula chloropus) (n=12) were all <20 μg/dl. ALAD ratio in mallards and coots decreased with PbB levels >6 μg/dl. In mallards, an inhibition of glutathione peroxidase (GPx) and an increased level of oxidized glutathione (oxGSH) in red blood cells (RBC) were associated with PbB levels >20 μg/dl. In coots, PbB levels were negatively related to vitamin A and carotenoid levels in plasma, and total glutathione in RBCs; and positively related with higher superoxide dismutase and GPx activities and % oxGSH in RBCs. Overall, the results indicate that previously assumed background levels of PbB for birds need to be revised.

Low-level environmental lead exposure and intellectual impairment in children — The current concepts of risk assessment

Lead is an environmental contaminant. The majority of epidemiological research on the health effects of lead has been focused on children, because they are more vulnerable to lead than adults. In children, an elevated blood lead (B-Pb) is associated with reduced Intelligence Quotient (IQ) score. This paper summarizes the current opinions on the assessment of the health risk connected with the children’s environmental exposure to lead. The B-Pb level of concern of 100 μg/l proposed by the US Centers of Disease Control in 1991 was for a long time accepted as the guideline value. In the meantime there has been a significant worldwide decrease of B-Pb levels in children and present geometric mean values in the European countries range from 20 to 30 μg/l. The recent analyses of the association of intelligence test scores and B-Pb levels have revealed that the steepest declines in IQ occur at blood levels < 100 μg/l and that no threshold below which lead does not cause neurodevelopmental toxicity can be defended. European Food Safety Authority (EFSA) concluded in 2010, on the basis of results of Benchmark Dose (BMD) analysis, that an increase in B-Pb of 12 μg/l (BMDL01) could decrease the IQ score by one point. It seems that this value can be used as a “unit risk” to calculate the possible decrease of IQ and, consequently, influence of the low-level exposure to lead (< 100 μg/l) on the health and socioeconomic status of the exposed population.

Lead, manganese, and methylmercury as risk factors for neurobehavioral impairment in advanced age

Contamination of the environment by metals is recognized as a threat to health. One of their targets is the brain, and the adverse functional effects they induce are reflected by neurobehavioral assessments. Lead, manganese, and methylmercury are the metal contaminants linked most comprehensively to such disorders. Because many of these adverse effects can appear later in life, clues to the role of metals as risk factors for neurodegenerative disorders should be sought in the exposure histories of aging populations. A review of the available literature offers evidence that all three metals can produce, in advanced age, manifestations of neurobehavioral dysfunction associated with neurodegenerative disease. Among the critical unresolved questions is timing; that is, during which periods of the lifespan, including early development, do environmental exposures lay the foundations for their ultimate effects?

Heavy metals (lead, cadmium and mercury) in maternal, cord blood and placenta of healthy women

Lead, cadmium and mercury were measured in placental tissue, umbilical cord and maternal blood samples of 1578 women who delivered at the Al-Kharj King Khalid Hospital between 2005 and 2006. The aim of this study was to evaluate the status of heavy metal exposure in mothers and their newborns and to identify predictors of maternal exposure. Lead was detected in all cord and maternal blood and in 96% of placental tissues. Only in 0.89% and 0.83% of cord and maternal blood samples were the levels of lead above the CDC threshold limit of 10 μg/dl. Maternal blood lead was also higher (2.3%) than the German Reference value in women of 7 μg/dl. Approximately 9.3% of women had a placental lead above the 95th percentile in the range of 0.83-78 μg/g dry wt., a level of possible developmental toxicity. Cadmium was detected in 94.8% and 97.9% of cord and maternal blood samples respectively, though only five newborns had a cadmium level above the OSHA threshold limit of 5 μg/l. Comparing our results to the newly revised German Reference value for nonsmokers, 48.6% of mothers had blood cadmium levels >1.0 μg/l. We found as well that 25% of women had placental cadmium in the >75th percentile, in the range of 0.048-4.36 μg/g dry wt., which is likely to affect fetal growth and development. Of the maternal and cord blood samples, 11.2% and 13%, respectively, had mercury levels >5.8 μg/l, which is the EPA reference dose. Nearly 49% of women had mercury levels >2.0 μg/l, the German Reference value for those who consume fish ≤3 times a month. Around 50% of the mothers had placental mercury in the range of 0.031-13.0 μg/g dry wt. Regression analyses indicated that the levels of metals in the blood and placenta were influenced by several factors. This study provides informative baseline biomonitoring data and reveals a substantial exposure to heavy metals in non-occupationally exposed Saudi mothers and their newborns that might jeopardize the health of both. Additional research is also urgently needed to explore factors such as environment, diet, lifestyle and/or cultural habits contributing to maternal and fetal exposures. Preventive measures to eliminate or minimize the unnecessary risk of fetus exposure to heavy metals or other pollutants during pregnancy should be initiated once these factors are identified.

Molecular neurobiology of lead (Pb(2+)): effects on synaptic function

Lead (Pb(2+)) is a ubiquitous environmental neurotoxicant that continues to threaten public health on a global scale. Epidemiological studies have demonstrated detrimental effects of Pb(2+) on childhood IQ at very low levels of exposure. Recently, a mechanistic understanding of how Pb(2+) affects brain development has begun to emerge. The cognitive effects of Pb(2+) exposure are believed to be mediated through its selective inhibition of the N-methyl-D: -aspartate receptor (NMDAR). Studies in animal models of developmental Pb(2+) exposure exhibit altered NMDAR subunit ontogeny and disruption of NMDAR-dependent intracellular signaling. Additional studies have reported that Pb(2+) exposure inhibits presynaptic calcium (Ca(2+)) channels and affects presynaptic neurotransmission, but a mechanistic link between presynaptic and postsynaptic effects has been missing. Recent work has suggested that the presynaptic and postsynaptic effects of Pb(2+) exposure are both due to inhibition of the NMDAR by Pb(2+), and that the presynaptic effects of Pb(2+) may be mediated by disruption of NMDAR activity-dependent signaling of brain-derived neurotrophic factor (BDNF). These findings provide the basis for the first working model to describe the effects of Pb(2+) exposure on synaptic function. Here, we review the neurotoxic effects of Pb(2+) exposure and discuss the known effects of Pb(2+) exposure in light of these recent findings.

Same sex, no sex, and unaware sex in neurotoxicology

Males and females of virtually all species differ in how they respond to their environment. Because such differences exist in almost all biological realms, including disease patterns and therapeutic outcomes, they have evoked calls by various bodies to incorporate their assessment in research. Neurobehavioral indices pose special questions because, unlike outwardly visible markers, they are described by complex functional outcomes or subtle alterations in brain structure. These divergent responses arise because they are inscribed in the genome itself and then by endocrine mechanisms that govern sexual differentiation of the brain during development and operate throughout life. Other organ systems that exhibit sex differences include the liver, an important consideration for neurotoxicology because it may process many toxic chemicals differentially in males and females. Despite the scope and pervasiveness of sex differences, however, they are disregarded by much of neurotoxicology research. Males predominate in behavioral experiments, few such experiments study both sexes, some investigators fail to even describe the sex of their subjects, and in vitro studies tend to wholly ignore sex, even for model systems aimed at neurological disorders that display marked sex differences. The public is acutely aware of sex differences in behavior, as attested by its appetite for books on the topic. It closely follows debates about the proportion of women in professions that feature science and mathematics. Neurotoxicology, especially in the domain of laboratory research, will be hindered in its ability to translate its findings into human health measures if it assigns sex differences to a minor role. It must also be sensitive to how such debates are framed. Often, the differences evoking the most discussion are subtle in scope. They do not lend themselves to the typical analyses conducted by experimenters; that is, reliance on mean differences and null hypothesis testing.

Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children

BACKGROUND

The present study assessed the association between blood lead and urinary cotinine levels and inattentive and hyperactive symptoms and neurocognitive performance in children.

METHODS

A total of 667 children (age range 8-11) were recruited from nine schools in five Korean cities. The teachers and parents completed the Korean version of the Attention-deficit/hyperactivity disorder Rating Scales (K-ARS), and the children performed neurocognitive tests. Blood lead and urinary cotinine levels were then measured.

RESULTS

The inattentive, hyperactive, and total scores of the teacher-rated K-ARS were positively associated with blood lead level, and the results of the continuous performance test (CPT), Stroop Color-Word Test, and Children's Color Trails Test were inversely associated with urinary cotinine level when controlled for age, gender, father's educational level, maternal IQ, child's IQ, residential area, birth weight, and cotinine (for lead) or lead (for cotinine). The association between blood lead level and commission errors score on the CPT disappeared when the effect of urinary cotinine level was controlled.

CONCLUSIONS

These findings indicate that environmental exposure to tobacco smoke in children is associated with poor neurocognitive performance, and low levels of lead are associated with inattention and hyperactivity symptoms.

Chronic low-level Pb exposure during development decreases the expression of the voltage-dependent anion channel in auditory neurons of the brainstem

Lead (Pb) exposure is a risk factor for neurological dysfunction. How Pb produces these behavioral deficits is unknown, but Pb exposure during development is associated with auditory temporal processing deficits in both humans and animals. Pb disrupts cellular energy metabolism and efficient energy production is crucial for auditory neurons to maintain high rates of synaptic activity. The voltage-dependent anion channel (VDAC) is involved in the regulation of mitochondrial physiology and is a critical component in controlling mitochondrial energy production. We have previously demonstrated that VDAC is an in vitro target for Pb, therefore, VDAC may represent a potential target for Pb in the auditory system. In order to determine whether Pb alters VDAC expression in central auditory neurons, CBA/CaJ mice (n=3-5/group) were exposed to 0.01mM, or 0.1mM Pb acetate during development via drinking water. At P21, immunohistochemistry reveals a significant decrease for VDAC in neurons of the Medial Nucleus of the Trapezoid Body. Western blot analysis confirms that Pb results in a significant decrease for VDAC. Decreases in VDAC expression could lead to an upregulation of other cellular energy producing systems as a compensatory mechanism, and a Pb-induced increase in brain type creatine kinase is observed in auditory regions of the brainstem. In addition, comparative proteomic analysis shows that several proteins of the glycolytic pathway, the phosphocreatine circuit, and oxidative phosphorylation are also upregulated in response to developmental Pb exposure. Thus, Pb-induced decreases in VDAC could have a significant effect on the function of auditory neurons.

Barriers to pediatric lead screening: implications from a web-based survey of Vermont pediatricians

The pernicious effects of lead on child health are well documented. The Vermont Department of Health (VDH) recommends screening all 12- and 24-month-old children for elevated blood lead levels (BLL). In 2006, only 41.4% of 24-month-old Vermont children were screened. To identify barriers preventing pediatricians from performing blood lead screening, a survey was distributed to Vermont primary care pediatricians-divided in higher and lower screening groups. Vermont pediatricians were more likely to be lower screeners if they reported negative health outcomes began at BLL >" xbd="641" xhg="618" ybd="1456" yhg="1421"/> 10 microg/dL (odds ratio [OR] = 3.64, 95% confidence interval [CI] = 1.12-11.99), practiced in Chittenden County (OR = 3.34, 95% CI = 1.14-9.78), or disagreed with the VDH's recommendation (OR = 4.90, 95% CI = 1.66-15.50). Adjusted analysis indicated the most significant determinants of lower screening rates were male gender, a perceived dangerous BLL as >10 microg/dL and low self-reported Medicaid population. The VDH may have an opportunity to increase BLL screening emphasizing the significant health risks associated with BLL < or = 10 microg/dL.

Effects of sub-chronic low-level lead exposure on the homeostasis of copper and zinc in rat tissues

Information about the health risks or the subtle adverse health effects that might be associated with low-level lead exposure on micronutrient metabolism are scarce in the literature. The present work investigated the subtle adverse health effects of exposure to progressively low levels of lead on the metabolism of two micronutrients, copper and zinc in different tissues of the rat. Rats were exposed to 200, 300 and 400 ppm lead in their drinking water for 12 weeks. Lead, copper and zinc concentrations were determined in blood, liver, kidney, heart, spleen and brain of the animals. While the imbalance in zinc metabolism was characterized by a deposition of zinc in the kidney and to a lesser extent in the heart of the animals, imbalance in copper metabolism was characterized by a depletion of blood and splenic copper concentrations as well as renal and cardiac accumulation of copper. Hepatic and brain copper and zinc contents, together with blood zinc were not affected by the 12-week lead exposure. A linear relationship was observed between lead dose and lead accumulation in the spleen, whereas a non-linear relationship was observed between lead dose and lead accumulation in blood, liver, kidney and heart. Our findings indicate that exposure to progressively low-level lead concentrations results in imbalance in copper and zinc in the organism and this might be a factor in propensity toward behavioral disorders observed in lead exposure.

The relevance of the individual genetic background for the toxicokinetics of two significant neurodevelopmental toxicants: mercury and lead

The heavy metals mercury and lead are well-known and significant developmental neurotoxicants. This review summarizes the genetic factors that modify their toxicokinetics. Understanding toxicokinetics (uptake, biotransformation, distribution, and elimination processes) is a key precondition to understanding the individual health risks associated with exposure. We selected candidate susceptibility genes when evidence was available for (1) genes/proteins playing a significant role in mercury and lead toxicokinetics, (2) gene expression/protein activity being induced by these metals, and (3) mercury and lead toxicokinetics being affected by gene knockout/knockdown or (4) by functional gene polymorphisms. The genetic background is far better known for mercury than for lead toxicokinetics. Involved are genes encoding L-type amino acid transporters, organic anion transporters, glutathione (GSH)-related enzymes, metallothioneins, and transporters of the ABC family. Certain gene variants can influence mercury toxicokinetics, potentially explaining part of the variable susceptibility to mercury toxicity. Delta-aminolevulinic acid dehydratase (ALAD), vitamin D receptor (VDR) and hemochromatosis (HFE) gene variants are the only well-established susceptibility markers of lead toxicity in humans. Many gaps remain in our knowledge about the functional genomics of this issue. This calls for studies to detect functional gene polymorphisms related to mercury- and lead-associated disease phenotypes, to demonstrate the impact of functional polymorphisms and gene knockout/knockdown in relation to toxicity, to confirm the in vivo relevance of genetic variation, and to examine gene-gene interactions on the respective toxicokinetics. Another crucial aspect is knowledge on the maternal-fetal genetic background, which modulates fetal exposure to these neurotoxicants. To completely define the genetically susceptible risk groups, research is also needed on the genes/proteins involved in the toxicodynamics, i.e., in the mechanisms causing adverse effects in the brain. Studies relating the toxicogenetics to neurodevelopmental disorders are lacking (mercury) or very scarce (lead). Thus, the extent of variability in susceptibility to heavy metal-associated neurological outcomes is poorly characterized.

Blood lead in the 21st Century: The sub-microgram challenge

In the US the dominant sources of lead through much of the 20th Century (eg, vehicular emissions, plumbing, household paint) have been significantly diminished. The reductions in adult and pediatric average blood lead levels in the US have been extraordinary. Progress continues: the US Environmental Protection Agency recently developed a new air standard for lead. In the 21st Century, the average blood lead level in a society may be seen as a marker of the status of their public's health. However, the threat of lead exposure remains a significant public health problem among subpopulation groups in the US and in many less developed countries. This paper examines some of the specific issues involved in the reduction of blood lead in a post-industrial era. These involve the control of the remaining exogenous primary sources, both general (eg, industrial emissions) and specific (eg, at-risk occupations), exogenous secondary sources (eg, contaminated urban soils, legacy lead-based paints), an endogenous source (ie, cumulative body lead burden) and emergent sources.

Lead and children: clinical management for family physicians

OBJECTIVE

To provide family physicians with a practical, evidence-based approach to screening for and preventing children's exposure to lead.

SOURCES OF INFORMATION

MEDLINE was searched using terms relevant to lead exposure and poisoning. We reviewed English-language articles published in 2003 to 2008. Most cited studies provide level 2 or 3 evidence.

MAIN MESSAGE

Lead is a developmental neurotoxin. Children are most commonly exposed and they are most vulnerable. Lead exposure has been associated with many cognitive and motor deficits, as well as distractibility and other characteristics of attention deficit hyperactivity disorder. Although children's blood lead levels have declined considerably over the past 3 decades with removal of lead from gasoline and paint, children can still be exposed to lead from lead paint in older homes, toys, and other sources. Because post-exposure treatment cannot reverse the cognitive effects of lead exposure, preventing lead exposure is essential.

CONCLUSION

Family physicians have an important role in screening for children at high risk of lead exposure, and in educating families to prevent the exposure of children to lead.

Prenatal and adolescent blood lead levels in South Africa: child, maternal and household risk factors in the Birth to Twenty cohort

INTRODUCTION

The risk factors for lead exposure in developing countries have not been fully described. This study looks at child, maternal and household factors associated with increased risk of lead exposure at birth and at 13 years of age in the Birth to Twenty cohort.

METHODS

Mothers were recruited from antenatal clinics in the Johannesburg-Soweto metropolitan area in 1990 (n=3273). Lead levels were analysed in cord blood collected at birth (n=618) and at 13 years (n=1546). Data on selected child, maternal and household factors were collected using a structured questionnaire in the third trimester and at 13 years of age. Statistical analyses were conducted to determine the associated risk factors.

RESULTS

The mean blood lead level at birth was 5.85 microg/dl, and at 13 years of age it was 5.66 microg/dl. The majority of children had blood lead levels above 5 microg/dl (52% at birth and 56% at 13 years). At birth, being a teenage mother and having low educational status were strong predictors for elevated cord blood lead levels. Being a male child, having an elevated cord blood level, and lack of household ownership of a phone were significant risk factors for high blood lead levels at 13 years.

CONCLUSION

Significant associations found in the study point to the low socio-economic status of lead-affected mothers and children. These poor circumstances frequently persist into later childhood, resulting in continued high lead levels. Thus broader measures of poverty alleviation and provision of better education may help decrease the risk of exposure.

Whole blood, serum, and saliva lead concentrations in 6- to 8-year-old children

With increasing evidence of adverse health effects of lower lead levels (below 10microg/dL in whole blood), studies on novel internal dose biomarkers are needed. This study aimed at: (1) assessing the lead exposure by measuring this element in whole blood (Pb-blood), serum (Pb-serum), and 3 different types of saliva: whole (Pb-whole-saliva), submandibular/sublingual (Pb-sub-saliva) and parotid saliva (Pb-parotid-saliva); (2) correlating Pb-blood with Pb-serum; and (3) relating Pb-blood and Pb-serum with the lead found in the different salivas. The study population included 444 children aged 6 to 8 years attending 4 government schools in the district of Campos Eliseos, in Ribeirao Preto, Sao Paulo State, Brazil. Whole blood, serum, parotid, submandibular/sublingual ("sub-saliva"), and whole saliva were collected in trace element-free tubes. Lead concentrations were determined by inductively coupled plasma-mass spectrometry (ICP-MS). Median Pb-blood and Pb-serum were 2.1microg/dL and 0.4microg/L, respectively. Ten percent of the children had Pb-blood between 4.0 and 9.4microg/dL. Boys showed higher Pb-blood than girls (2.3 vs. 2.0microg/dL, p<0.0003). Lead concentrations in whole, sub, and parotid saliva were 1.7, 1.4, and 1.3microg/L, respectively. No significant correlations were found between Pb-blood and Pb-serum, between Pb-blood and lead in the 3 different salivas, or between Pb-serum and Pb-whole-saliva or Pb-sub-saliva. However, there was a weak statistically significant correlation between Pb-serum and Pb-parotid-saliva. In conclusion, the mean Pb-blood concentration was 2.4microg/dL, with 10% of the children exhibiting Pb-blood between 4.0 and 9.4microg/dL. Boys presented higher Pb-blood. Results suggest that Pb-blood has no correlation with Pb-serum or lead in the 3 different salivas collected here. A weak but statistically significant correlation between Pb-serum and Pb-parotid-saliva was found. Our results also point to the need for carrying out more studies on sources of exposure and lead levels in children in Brazil.

Higher infant blood lead levels with longer duration of breastfeeding

OBJECTIVE

To determine whether longer breastfeeding is associated with higher infant lead concentrations.

STUDY DESIGN

Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients.

RESULTS

More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 microg/dL (Costa Rica, 12-23 months), 7.8 microg/dL (Chile, 12 months), and 2.5 microg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001).

CONCLUSIONS

Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered.

Cross-sectional audit of blood lead levels in regular outpatient haemodialysis patients dialysing in north London

AIM

Blood lead was measured and found to be high in one haemodialysis patient with atypical abdominal pain and peripheral neuropathy. This prompted an audit of blood lead concentrations in prevalent haemodialysis patients under the care of a University Teaching hospital.

METHODS

Blood lead was determined in 271 prevalent adult haemodialysis patients regularly dialysing three times a week, in five dialysis centres and/or on the home dialysis programme. All samples were carefully collected into lead-free plastic containers, and measured by graphite furnace atomic absorption spectrometry.

RESULTS

25.5% of haemodialysis patients had abnormal blood lead concentrations (>200 microg/L), compared with 59% with high-normal values of 100-200 microg/L, and only 15.5% with normal values (<100 microg/L). Blood lead increased with haemodialysis vintage (r = 0.38, P < 0.001), the use of a single carbon filter and reverse osmosis water purification device unit (r = 0.29, P < 0.001), but reduced by urine output (r = -0.44, P < 0.001).

CONCLUSION

Despite UK government legislation to reduce permissible lead contamination of drinking water, blood lead was increased in 84.5% of prevalent haemodialysis patients. Single reverse osmosis machines and carbon filters may not be as effective at filtering out possible lead contamination compared with large industrial reverse osmosis devices and carbon filters, and thus blood lead testing should be considered for home haemodialysis patients, particularly in those areas where monochloramines are used to sterilize domestic water supplies.

Lead loadings in household dust in Delhi, India

Lead in household dust is dangerous to children who ingest lead from playing close to the ground, and having frequent hand-to-mouth contact. Although there have been several investigations of lead levels in India in air, blood and new paint, the literature is sparse on the levels of lead in household dust. This study analyzed 99 samples of dust taken from bare floors and 49 samples of dust taken from windowsills in a cross-section of Delhi, India houses for lead loadings. The arithmetic mean of lead loading for floor samples and windowsill dust samples was found to be 36.24 microg/ft(2) and 129.5 microg/ft(2), respectively. The geometric mean of dust lead loading for floor and interior windowsill samples was found to be 19.7 microg/ft(2) and 75.5 microg/ft(2), respectively. Comparing the results with US geometric mean dust lead levels from a national cross-section of US housing, which in 2000 were 1.1 microg/ft(2) and 9.4 microg/ft(2) on floors and windowsills, respectively as reported by Jacobs et al. (2002) suggests that the lead content of the dust in Delhi homes is much higher than that in the national data in the US and that the levels pose a hazard to children. Practical Implications The present study is first of its kind in this part of the world. In the context of ongoing efforts to eliminate lead from paints worldwide this research will help the scientists and policy makers in assessing the Children's exposure to lead in developing country as well. Since more than one half of the housing units tested had at least one dust lead sample exceeding US health-based standards, health care providers and public health officials need to give attention to possible lead poisoning in Delhi children. Routine blood lead screening of children should follow recommended public health practice for children at risk. Additional larger-scale studies are needed in Delhi and elsewhere to determine how representative these findings are and to attempt to delineate the sources of the high dust lead which are expected to vary depending on the location. Knowledge of the sources is needed to appropriately allocate resources. From other studies performed in India it is likely that lead-based paint is one of the sources and its continued use should be discontinued.

Considering changes in exposure and sensitivity in an early life cumulative risk assessment

A cumulative risk assessment is generally intended to address concurrent exposure by all exposure routes to a group of chemicals that share a common mechanism of toxicity. However, the contribution of different exposure routes will change over time. This is most critical when estimating risks to infants and children because their exposure sources change rapidly during the first few years of life because of dietary and behavioral changes. In addition, there may be changes in sensitivity to toxicants during this time period, associated with various developmental stages. Traditional risk assessments do not address this progression. Examples of how these factors might be incorporated into an early life risk assessment are provided for lead, dioxins and furans, and organophosphate pesticides. The same concepts may apply to other potentially susceptible subpopulations, such as the elderly.

Children's blood lead and standardized test performance response as indicators of neurotoxicity in metropolitan New Orleans elementary schools

This study analyzes pre-Katrina variation in aggregate student performance and children's blood lead (BPb) in 117 elementary school districts in metropolitan New Orleans. Fourth grade student achievement on Louisiana Educational Assessment Program (LEAP) tests were analyzed as a function of BPb for children 1-6 years old within school districts, controlling for student-teacher ratios, percent of students eligible for a free or discounted lunch, and school racial demography. Measures of performance across subject areas (English Language Arts, Science, Mathematics, and Social Studies) include school Achievement Test Scores (ATS) and indices of agreement and variation in student achievement. ATS are measured on a 5-point scale, corresponding to achievement categories of advanced=5 to unsatisfactory=1. Regression results show that median BPb (microg/dL) and percent of children with BPb > or =10 microg/dL are significantly associated with reductions in test scores across all subjects and depress variation in student performance across achievement categories. These data suggest that assisting children with improved school performance requires alleviation of pre-school Pb exposure and its associated neurotoxic damage. Cost-benefit calculations suggest that it is more cost effective to pay for onetime primary prevention instead of paying continuous expenses focused on reversing neurotoxic damage.

A personal perspective on the initial federal health-based regulation to remove lead from gasoline

OBJECTIVE

This article describes the personal experience and perspective of the authors, who had primary responsibility for drafting the initial health-based regulation limiting lead content of gasoline during the early 1970s while employed by the U.S. Environmental Protection Agency (EPA).

DATA SOURCE

Information used by the U.S. EPA in developing the initial health-based regulation limiting lead content of gasoline in December 1973 and studies documenting the impact of that and subsequent actions.

DATA EXTRACTION

Among the lessons learned from this experience is the importance of having input from independent scientists to the regulatory decision-making process. This also demonstrates the critical role of independent peer-reviewed research, such as that supported by the National Institutes of Health, as well as research conducted by scientists from the Centers for Disease Control and Prevention, in delineating the consequences of lead exposure in the population.

DATA SYNTHESIS

Removal of lead from gasoline in the United States has been described as one of the great public health achievements of the 20th century, but it almost did not happen. The experience of the authors in developing this regulation may be helpful to others involved in developing health-based regulatory policy in the future.

CONCLUSION

The initial U.S. EPA health-based regulation to remove lead from gasoline is clearly an example where science successfully affected public policy. The leadership of the U.S. EPA at that time deserves much credit for establishing an atmosphere in which this was possible.

Blood lead levels in Egyptian children from high and low lead-polluted areas: impact on cognitive function

OBJECTIVES

Many children are harmed by low-level lead exposure which impairs cognitive development with subsequent poor scholastic achievement. We investigated blood lead levels in children in relation to cognitive function.

MATERIALS AND METHODS

Blood lead levels were measured in 100 children recruited from high (n = 50) and low (n = 50) lead-polluted areas.

RESULTS

Blood lead levels ranged between 3 and 28 microg/dl (median 9, interquartile range 6 microg/dl). In addition, 43% of children had levels > or =10 microg/dl, of whom 90.1% were living in high-risk areas for lead pollution. Cognitive dysfunction was found in 37% of children. Children with cognitive dysfunction had significantly higher blood lead and lower hemoglobin than those without (P < 0.001).

CONCLUSIONS

Increased blood lead level in many children is one of the health problems in Egypt which may be the reason, at least in part, for cognitive dysfunction with subsequent poor scholastic achievement. Thus, interventions to control lead exposure are mandatory.

Cognitive development and low-level lead exposure in poly-drug exposed children

The impact of early postnatal lead exposure measured at age 4 on children's IQ and academic achievement at and 11 years of age was examined. The sample consisted of 278 inner-city, primarily African American children who were polydrug exposed prenatally. Regression analyses indicated a linear effect of lead exposure on outcomes and no moderating effects of polydrug exposure. An IQ loss of about 4.1-5.4 Full Scale IQ points was estimated for each 10 microg/dL increase in blood lead level at ages 4, 9, and 11 years as a function of blood lead level at age 4. Decrements in scores on tests of non-verbal reasoning were consistently associated with higher lead levels at age 4, while verbal decrements became apparent only at age 11. Lower reading summary scores at 9 and 11 years were consistently associated with higher lead exposure, while decrements in mathematics were not apparent until 11 years. Subgroup analyses on children with blood lead levels <10 microg/dL showed detrimental lead effects even at the 5 microg/dL level, providing additional evidence of adverse effects occurring at blood lead levels below the current 10 microg/dL public health blood lead action level.

Elevated blood lead levels in a riverside population in the Brazilian Amazon

Lead (Pb) is recognized as one of the most toxic metals. Sources of Pb exposure have been widely documented in North America, and the removal of Pb additives from gasoline was reflected in a dramatic lowering of blood Pb concentration. In Latin America, the removal of Pb from gasoline resulted in decreased exposure, but Pb levels in many areas remain high due to occupational and environmental sources of exposure. While many of the Pb sources have been identified (mining, industries, battery recycling, lead-based paint, ceramics), new ones occasionally crop up. Here we report on blood Pb (B-Pb) levels in remote riverside communities of the Brazilian Amazon. Blood Pb (B-Pb) levels were determined in 448 persons from 12 villages of the Lower Tapajós River Basin, Pará, Brazil. Socio-demographic and dietary information, as well as occupational, residential and medical history was collected using an interview-administered questionnaire. B-Pb, measured by ICP-MS, showed elevated concentrations. Mean B-Pb was 13.1 microg/dL +/- 8.5, median B-Pb was 11.2 microg/dL and ranged from 0.59 to 48.3 microg/dL. Men had higher B-Pb compared to women (median: 15.3 microg/dL vs 7.9 microg/dL respectively). B-Pb increased with age for women, while it decreased for men. For both genders, B-Pb decreased with education. There were significant differences between villages. Exploratory analyses, using linear partition models, showed that for men B-Pb was lower among those who were involved in cattle-raising, and higher among those who hunted, farmed and fished. The distribution profile of B-Pb directed us towards artisanal transformation of manioc to flour (farinha), which requires heating in a large metal pan, with stirring primarily done by young men. In the village with the highest B-Pb, analysis of Pb concentrations (dry weight) of manioc (prior to transformation) and farinha (following transformation) from 6 houses showed a tenfold increase in Pb concentration (mean: 0.017 +/- 0.016 to 0.19 +/- 0.10 microg/g). This was confirmed in one of these villages where we sampled manioc paste (just before roasting) and the roasted farinha (0.05 microg/g vs 0.20 microg/g). While there may be other sources (ammunition, sinkers for fishing nets), the high concentrations in farinha, a dietary staple, assuredly makes an important contribution. Further action needs to reduce Pb sources in this region.

Emerging aspects of assessing lead poisoning in childhood

This review covers the epidemiology of lead poisoning in children on a global scale. Newer sources of lead poisoning are identified. The methods that are used to assess a population of children exposed to lead are discussed, together with the ways of undertaking an exposure risk assessment; this includes assessing the time course and identifying sources of lead exposure. Human assessment measures for lead toxicity, such as blood lead concentrations, deciduous tooth lead, and use of zinc protoporphyrin estimations are evaluated. The role of isotopic fingerprinting techniques for identifying environmental sources of exposure is discussed. Among emerging data on the cognitive and behavioral effects of lead on children, the review considers the growing evidence of neurocognitive dysfunction with blood lead concentrations even below 10 µg/dl. The challenge of assessing and explaining the risk that applies to an individual as opposed to a population is discussed. Intervention strategies to mitigate risk from lead are examined together with the limited role for and limitations of chelation therapy for lead. Lessons learned from managing a population lead-dust exposure event in Esperance, Western Australia in 2007 are discussed throughout the review.

Motor alterations induced by chronic lead exposure

Lead (Pb) as other environmental neurotoxicants substances has the capability to interfere with many biochemical events present in cells throughout the body and it can produce a wide spectrum of alterations in many organs and systems. Among that alterations induced by Pb exposure in adults and children those involving motor system dysfunction represent a common public health problem. The review summarizes the sources of lead exposures in both occupational and residential environments and motor deficits induced by chronic Pb exposure taking in account the last literature in the field. We wish to focus on the current state of knowledge concerning the long-lasting neurological effects of Pb in motor functions and to correlate the neurological deficits induced by Pb exposure in animal models with those reported in humans. The great interest in whether exposure to Pb can cause long-term, progressive declines in central nervous system (CNS) function have revealed that Pb exposure is involved in chronic CNS diseases such Parkinson's and poor motor coordination in children.

Lead bullet fragments in venison from rifle-killed deer: potential for human dietary exposure

Human consumers of wildlife killed with lead ammunition may be exposed to health risks associated with lead ingestion. This hypothesis is based on published studies showing elevated blood lead concentrations in subsistence hunter populations, retention of ammunition residues in the tissues of hunter-killed animals, and systemic, cognitive, and behavioral disorders associated with human lead body burdens once considered safe. Our objective was to determine the incidence and bioavailability of lead bullet fragments in hunter-killed venison, a widely-eaten food among hunters and their families. We radiographed 30 eviscerated carcasses of White-tailed Deer (Odocoileus virginianus) shot by hunters with standard lead-core, copper-jacketed bullets under normal hunting conditions. All carcasses showed metal fragments (geometric mean = 136 fragments, range = 15-409) and widespread fragment dispersion. We took each carcass to a separate meat processor and fluoroscopically scanned the resulting meat packages; fluoroscopy revealed metal fragments in the ground meat packages of 24 (80%) of the 30 deer; 32% of 234 ground meat packages contained at least one fragment. Fragments were identified as lead by ICP in 93% of 27 samples. Isotope ratios of lead in meat matched the ratios of bullets, and differed from background lead in bone. We fed fragment-containing venison to four pigs to test bioavailability; four controls received venison without fragments from the same deer. Mean blood lead concentrations in pigs peaked at 2.29 microg/dL (maximum 3.8 microg/dL) 2 days following ingestion of fragment-containing venison, significantly higher than the 0.63 microg/dL averaged by controls. We conclude that people risk exposure to bioavailable lead from bullet fragments when they eat venison from deer killed with standard lead-based rifle bullets and processed under normal procedures. At risk in the U.S. are some ten million hunters, their families, and low-income beneficiaries of venison donations.