The internal burden of lead among children in a smelter town--a small area analysis

High Prevalence of Pneumonia in Children of a Smelter Town

Since German reunification in 1990, most heavy industries in Eastern Germany have been shut down. Although air quality has improved in terms of sulfur dioxide and particulate matter (PM), the content of certain metals in PM in industrial areas is persistently high. Lifetime pneumonia prevalence in schoolchildren born after unification in the heavy-metal industrial area Hettstedt remain elevated. One difference between low and high pneumonia-prevalence areas seems to be the residual concentrations of heavy metals in respirable air. Toxicological and human exposure studies of Hettstedt particles have shown metal-rich PM from Hettstedt to have greater toxicity and inflammatory properties than the PM of the control region. Past industrial emissions might still play a decisive role decades after the closing of sources, and pneumonia should be considered a possible acute health burden caused by metal-rich air pollution.

Contribution of mine wastes to atmospheric metal deposition in the surrounding area of an abandoned heavily polluted mining district (Rio Tinto mines, Spain)

The present study seeks to estimate the impact of abandoned mine wastes on the levels and chemical profile of total atmospheric deposition in one of the oldest and largest mining districts in Europe (Rio Tinto mines, Iberian Pyrite Belt), on the basis of a complete geochemical characterization of particulate matter samples periodically collected in five sampling stations located around the mining district between March 2009 and February 2011. The annual levels of total bulk deposition (soluble and insoluble fractions) registered in the Rio Tinto Mining District ranged between 18 and 43 g/m(2) depending on the distance from the sampling station with regard to the mine waste deposits. As a general pattern in the area, high mass levels of Zn and Cu were deposited in a range of 9-62 mg/m(2) not only in the insoluble but also in the soluble fraction. Other potentially toxic trace elements such as As, Sb, Ba, Pb, Sn and Bi showed greater deposition fluxes in the locations closest to the mine waste deposits. A principal component analysis with a Multilinear Regression Analysis certifies the presence of two common sources in the mining area: 1) a mineral factor composed mainly of elements derived from silicate minerals (Al, Ca, Sr, Ti, Li, Mg, Mn, K, Na and Fe), mixed with other anthropogenic species (NH4(+), SO4(2-), NO3(-)) within the village closest to the mine; and 2) a marine factor composed of Na, Cl, Mg, SO4(2-) and Sr. In addition, a mine waste factor made up of toxic elements (Cu, Zn, Ga, As, Sb, Ba, Pb, Sn, Cd and Bi) has been recognized in the sampling sites exposed to dust-bearing winds downwind of the mining area, suggesting that mine wastes are a relevant source of heavy-mineral particles with potentially adverse environmental effects to surrounding soils, plants and humans.

A study of the routes of contamination by lead and cadmium in Santo Amaro, Brazil

The problem of contamination by cadmium and lead in Santo Amaro, Brazil, has been studied since 1970 and the severity of this contamination case has been demonstrated by many authors. This study evaluates the persistence of the superficial soil contamination around the metallurgical plant and attempts to correlate the lead and cadmium concentrations to the past atmospheric emissions from the lead plant and with the presence of lead debris under urban road surface and in the backyards of homes. Past emissions still play an important role in soil contamination. In areas without debris, about 30% of the soil samples had lead concentrations above the agricultural use limit of 180 parts per million (ppm) (according to CONAMA 420, 2009), 20% of the samples had concentrations above 300 ppm (maximum for residential use) and 9.6% of the samples had concentrations above 900 ppm (maximum for industrial use). These concentrations are higher cldse to the chimney of the metallurgical plant. An average lead concentration of 1316 ppm was found in the backyard samples. About 80% of the houses had lead concentrations above 300 ppm and about 50% of the samples had values above 900 ppm, indicating the importance of the lead debris in the contamination scenario. Although a matter of concern, the cadmium concentrations seem to be less problematic than lead at the present time, probably due to the higher mobility of cadmium. The cadmium concentrations in the atmospheric dispersion and backyard samples showed similar trends, while the influence of the lead debris on the soil contamination is less evident.

Relative contribution of potential modes of surface dust lead contamination in the homes of boatyard caulkers

OBJECTIVES

The aim of this study was to quantify the relative contributions to surface lead contamination of boat-caulkers' houses of three contamination modes, namely "take-home" lead from the caulker, "natural" spatial dispersal from boatyard to household and "redistribution" of accumulated lead-laden dust within the house.

METHODS

Boat-caulkers' houses situated in areas surrounding boat repair yards were recruited. Caulkers' houses that were located close together were divided into location-matched pairs, within which one was randomly assigned to be given a cleaning and designated a CL house, and the other was to be left uncleaned and designated a NCL house. Geographically isolated caulker's houses were randomly assigned to one of the two categories. The nearest non-boatyard worker's house (NB) was additionally recruited for each set. The surface lead loading rate (SLLR), defined as the mass of lead deposited in dust per unit area of surface per unit time, was measured over a period of 3 mo in all houses, and the data were modeled using linear mixed effects regression.

RESULTS

Adjusted values of SLLR differed only slightly between CL and NCL houses (0.96 to 1.02 times) but were between 1.65 and 2.03 times higher in CL and NCL houses than in NB houses depending on proximity to the boatyard and between 2.12 and 2.61 times higher in houses within one km of a boatyard than in more distant houses depending on category of house.

CONCLUSIONS

Newly deposited dust lead likely resulted from the take-home and spatial dispersion modes. The contribution of redistribution is very small.

A review on the importance of metals and metalloids in atmospheric dust and aerosol from mining operations

Contaminants can be transported rapidly and over relatively long distances by atmospheric dust and aerosol relative to other media such as water, soil and biota; yet few studies have explicitly evaluated the environmental implications of this pathway, making it a fundamental but understudied transport mechanism. Although there are numerous natural and anthropogenic activities that can increase dust and aerosol emissions and contaminant levels in the environment, mining operations are notable with respect to the quantity of particulates generated, the global extent of area impacted, and the toxicity of contaminants associated with the emissions. Here we review (i) the environmental fate and transport of metals and metalloids in dust and aerosol from mining operations, (ii) current methodologies used to assess contaminant concentrations and particulate emissions, and (iii) the potential health and environmental risks associated with airborne contaminants from mining operations. The review evaluates future research priorities based on the available literature and suggest that there is a particular need to measure and understand the generation, fate and transport of airborne particulates from mining operations, specifically the finer particle fraction. More generally, our findings suggest that mining operations play an important but underappreciated role in the generation of contaminated atmospheric dust and aerosol and the transport of metal and metalloid contaminants, and highlight the need for further research in this area. The role of mining activities in the fate and transport of environmental contaminants may become increasingly important in the coming decades, as climate change and land use are projected to intensify, both of which can substantially increase the potential for dust emissions and transport.

Lead exposure assessment from study near a lead-acid battery factory in China

The production of lead-acid battery in China covered about one-third of the world total output and there are more than 2000 lead-acid battery factories. They may cause the major environment lead pollution. Blood lead levels of several hundreds of residents were over 100 μg/L due to the waste discharges from a lead-acid battery factory in Heyuan, Guangdong province. This study aimed to find out the environmental lead sources, the human lead exposure pathways, and the amplitudes from a lead-acid battery factory. The study results showed that lead levels in soil, dust, tree leaves and human blood declined with the distances increased from the production site. Twenty nine of 32 participants had blood lead levels of over 100 μg/L with an exceptional high value of 639 μg/L for one child. This result suggested that the lead-acid battery production from this factory has caused the elevated lead levels in its neighboring environment and residents. Dust intake was the dominant exposure pathway for humans (over 90%). The lead levels found in adult and toddler (6.19 and 50.1 μg/kg/d, respectively) in the polluted area were far higher than the provisional tolerable weekly intake (PTWI) of 25 μg/kg body weight (translated into 3.5 μg/kg/d), which was established by the joint FAO/WHO Expert Committee. Blood lead levels within the family members were strongly correlated with the house dust lead levels. Our results in this study suggested that further studies in this area should be performed to assess human exposure and relevant human health risks from living close to lead-acid battery factories.

Skin lead contamination of family members of boat-caulkers in southern Thailand

Powdered lead oxide (Pb(3)O(4)) is used in the wooden-boat repair industry as a constituent of the caulking material. This study compared skin lead of household members of caulkers' and control homes, and examined the relationship of household member's skin lead with household floor lead loading (FLL) and dust lead content (DLC). FLL and DLC were measured in 67 caulkers' houses and 46 nearby houses with no known lead exposure. In each household, wipe specimens of skin lead were obtained from one selected family member. Hand lead loading (HdLL) and foot lead loading (FtLL) were significantly higher in family members of caulkers than controls (geometric mean 64.4 vs. 36.2 μg m(-2); p = 0.002 and 77.8 vs 43.8 μg m(-2); p = 0.002, respectively). This pattern mirrored FLL and DLC, which were also higher in caulkers' than in control houses (geometric mean 109.9 vs. 40.1 μg m(-2); p<0.001 and 434.8 vs 80.8 μg g(-1); p<0.001, respectively). Multiple linear regression modelling revealed FLL to be a better predictor than DLC for HdLL in all age groups and for FtLL in adult family members. In conclusion, skin lead levels are elevated in family members living in a lead-exposed worker's house and are related to the levels of household lead contamination.

A power comparison of generalized additive models and the spatial scan statistic in a case-control setting

Background

A common, important problem in spatial epidemiology is measuring and identifying variation in disease risk across a study region. In application of statistical methods, the problem has two parts. First, spatial variation in risk must be detected across the study region and, second, areas of increased or decreased risk must be correctly identified. The location of such areas may give clues to environmental sources of exposure and disease etiology. One statistical method applicable in spatial epidemiologic settings is a generalized additive model (GAM) which can be applied with a bivariate LOESS smoother to account for geographic location as a possible predictor of disease status. A natural hypothesis when applying this method is whether residential location of subjects is associated with the outcome, i.e. is the smoothing term necessary? Permutation tests are a reasonable hypothesis testing method and provide adequate power under a simple alternative hypothesis. These tests have yet to be compared to other spatial statistics.

Results

This research uses simulated point data generated under three alternative hypotheses to evaluate the properties of the permutation methods and compare them to the popular spatial scan statistic in a case-control setting. Case 1 was a single circular cluster centered in a circular study region. The spatial scan statistic had the highest power though the GAM method estimates did not fall far behind. Case 2 was a single point source located at the center of a circular cluster and Case 3 was a line source at the center of the horizontal axis of a square study region. Each had linearly decreasing logodds with distance from the point. The GAM methods outperformed the scan statistic in Cases 2 and 3. Comparing sensitivity, measured as the proportion of the exposure source correctly identified as high or low risk, the GAM methods outperformed the scan statistic in all three Cases.

Conclusions

The GAM permutation testing methods provide a regression-based alternative to the spatial scan statistic. Across all hypotheses examined in this research, the GAM methods had competing or greater power estimates and sensitivities exceeding that of the spatial scan statistic.

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.

Development and field trial of a household surface lead loading rate sampling device in a lead-contaminated community of southern Thailand

A new dust-collecting device was developed to assess surface lead loading rates in houses in communities contaminated with lead oxide dust used for caulking in nearby boat-repair yards. The device consists of two small glass sheets with total area of 1,200 cm(2) placed in two plastic trays suspended from the ceiling in the house for 3 months before wiping and sending the dust specimen for determination of lead content using flame atomic absorption spectrophotometry. After a pilot trial in four households, further data were collected from 43 matched pairs of boat-caulkers' and neighboring control households. All devices were retained in the house for 3 months without any complaint. Static measurements of lead dust levels were also assessed in all households. The values significantly discriminated high from low lead exposure households (p = 0.015) and provided good correlations with floor lead loading (Spearman rank correlation coefficient, r = 0.39 to 0.62) and dust lead content (r = 0.53 to 0.64). This sampling method is an alternative to others which consume more household space or require a longer collection period.

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.

Power of permutation tests using generalized additive models with bivariate smoothers

In spatial epidemiology, when applying Generalized Additive Models (GAMs) with a bivariate locally weighted regression smooth over longitude and latitude, a natural hypothesis is whether location is associated with an outcome. An approximate chi-square test (ACST) is available but has an inflated type I error rate. Permutation tests provide alternatives. This research evaluated powers of ACST and four permutation tests: the conditional (CPT), fixed span (FSPT), fixed multiple span (FMSPT), and unconditional (UPT) permutation tests. For CPT, the span size was determined by minimizing the Akaike Information Criterion (AIC) and was held constant for models applied to permuted datasets. For FSPT, a single span was selected a priori. For FMSPT, GAMs were applied using 3-5 different spans selected a priori and the significance cutoff was reduced to account for multiple testing. For UPT, the span was selected by minimizing the AIC for observed and for permuted datasets. Data with a cluster of increased/decreased risk centered in a study region were simulated. ACST and CPT had high power estimates when applied with reduced significance cutoffs to adjust for inflated type I errors. FSPT power depended on the span size; FMSPT power estimates were slightly lower. Overall, UPT had low power.

Elevated lead contamination in boat-caulkers' homes in southern Thailand

Surface-wipe lead loading was measured at various locations in the homes of 31 boat-caulkers and 31 location-matched controls to identify factors associated with household lead contamination. Data were obtained by observation checklist and questionnaire. Lead loading was significantly higher in caulkers' than in control households. Median lead loadings (in microg/ft2) of various locations in caulkers' homes were windowsill, 43.9; exterior entrance, 9.5; interior entrance, 21.1; living room floor, 9.8; and bedroom floors 15.6. Corresponding levels in control homes were all less than 0.2 microg/ft2. Regression modeling indicated that lead loading was higher in caulkers' homes that were closer to a boat-yard, in which the caulker had a longer duration of boatyard work, and in which there were no children aged under 6 years resident. Exterior and interior entrance and living room floors had lower lead loading than windowsills. However, bedroom floors had significantly higher lead loading, similar to windowsills.

Lead exposure in an urban community: investigation of risk factors and assessment of the impact of lead abatement measures

INTRODUCTION

A battery recycling plant located in an urbanized area contaminated the environment with lead oxides. The Secretary of Environment of the State of São Paulo demanded an evaluation of lead exposure among the population in the vicinity of the plant.

OBJECTIVES

To assess the lead exposure of children, to propose control measures and evaluate the impact of these measures.

METHODS

Cross-sectional study of all children<13 years old in a radius of 1km from the plant responsible for the contamination. Blood lead levels (BLL) were determined for each child and questionnaires were applied to their parents. Mean BLL were compared before and after control measures were implemented. Logistic regression identified risk factors of lead exposure.

RESULTS

Of the 850 investigated children, 311 presented BLL above the action limit established by the World Health Organization. Overall, the median BLL was 7.3 micro g/dL and it varied according to age of children (higher among 1-5 years old) and distance of the residence from the plant. Risk factors identified for BLL>10 micro g/dL were: to live in unpaved areas, parent working in the plant, distance from the plant, to play on the ground, pica, and to drink locally produced milk. After control measures were implemented (closing the plant, soil removal, dust vacuum-cleaning in the households, etc.), a reduction of 46% in BLL was observed considering the 241 re-evaluated children with levels >10 micro g/dL.

CONCLUSIONS

This study showed that combined abatement measures were effective in reducing BLL in children living close to a contaminating source. These results informed the decision-making process regarding management of contaminated areas in Brazil.

Use of a geographic information system to track smelter-related lead exposures in children: North Lake Macquarie, Australia, 1991-2002

BACKGROUND

To determine patterns of childhood lead exposure in a community living near a lead and zinc smelter in North Lake Macquarie, Australia between 1991 and 2002.

METHODS

An analysis of serial blood lead levels (BLL) of children less than 13 years of age in North Lake Macquarie participating in voluntary blood lead screening. Distance to the smelter and soil lead concentration of the child's place of residence was calculated. Categorical analysis of BLL by residential distance from smelter, residential soil lead concentration, age and year of sample was calculated. Linear regression models were fit for blood lead levels against residential distance from smelter, the log of residential soil lead concentration, age and year of BLL sample.

RESULTS

Geometric mean BLLs were statistically significantly higher for distances less than 1.5 kilometres from the smelter and for residential soil lead concentrations greater than 300 ppm. Yearly BLLs since 1995 were statistically significantly lower than for preceding years, with an average decrease of 0.575 microg/dL per year since 1991. BLLs are statistically significantly higher for children whose age is 1 to 3 years old. Linear regression modelling of BLL predicted a statistically significant decrease in BLL of 3.0831 microg/dL per kilometre from the smelter and a statistically significant increase in BLL of 0.25 microg/dL per log of lead in residential soil. The model explained 28.2% of the variation in BLL.

CONCLUSION

Residential distance to the smelter, log of residential soil lead concentration, child's age and year of BLL sample are statistically significant factors for predicting elevated BLLs in children living near a North Lake Macquarie lead smelter.

Environmental and childhood lead contamination in the proximity of boat-repair yards in southern Thailand--I: pattern and factors related to soil and household dust lead levels

High blood lead levels have recently been documented in schoolchildren living in communities adjacent to boat-repair yards in southern Thailand. In this study, the spatial pattern of lead contamination of soil and household dust in an area surrounding several boat-repair yards is described, and household factors associated with elevated dust lead are identified. A cross-sectional spatial study was conducted in a coastal residential area within a distance of 2 km from three major boat-repair yards situated on the east coast of peninsular Thailand. Household dust specimens were collected from an undisturbed position in the residences of children, aged 4-14 years, sampled randomly from all children living in the study area. Soil specimens were obtained from the interstices of a square grid, 70 x 70 m2, superimposed on the area. Geographic coordinates of residence and soil sampling positions were recorded and semivariograms and kriging used to contour the spatial distribution of lead in dust and soil. Environmental lead levels were also modeled in terms of direction and minimum distance from a boat-repair yard and, for household dust lead content, in terms of household variables, including occupation of household members in boat-repair work, type of house construction, and general cleanliness. Household dust and soil lead content ranged from 10 to 3025 mg/kg and from 1 to 7700 mg/kg, respectively. The distribution of soil lead peaked at the location of the boat-repair yards, but outside the yards the distribution was generally below 400 mg/kg and irregular. About 24% of household dust lead specimens were equal to or above 400 mg/kg, but showed significant decrease with increasing distance from the boat-repair yards, at rates of between 7% and 14% per 100 m. In houses where a family member was a worker in one of the major boatyards and in houses where occasional repair of small boats was undertaken, household dust lead levels were significantly elevated, by 65% (95% CI: 18-130%) and 31% (95% CI: 5-63%), respectively. Siting of boat-repair yards at a distance from residential areas and measures to reduce the spread of lead-containing dust are recommended to alleviate the problem of elevated household dust lead levels.

Biological monitoring of exposure: trends and key developments

The concept of biological monitoring (BM) has gained the special interest of individual scientists and international organizations. Today, when analytical problems have almost ceased due to new laboratory techniques and quality assurance systems, the methods for interpretation of results have become the most important issue. There are important discrepancies regarding the role of biological monitoring of occupational exposure between Europe and the United States. BM has been an important tool of medical health surveillance in the European countries. In the United States it belongs rather to the field of occupational hygiene. It seems that both the approaches can be accepted. More attention should be paid to the development of the truly health-based biomarkers of exposure based on the dose-effect and dose-response relationships. New areas of application of BM of occupational exposure include determination of DNA and protein adducts, unchanged volatile organic compounds in urine, monitoring of exposure to pesticides, antineoplastic drugs, hard metals, and polycyclic aromatic hydrocarbons. In the general environment BM is the most valuable tool for acquiring knowledge of current levels of internal exposure to xenobiotics, identifying the hot spots and developments in trends of exposure. BM can provide policy makers with more accurate information on the control measures undertaken. At present, the main areas include heavy metals, persistent organic pollutants and pesticides. BM of chemical exposure has become increasingly important in the assessment of the health risk in occupational and environmental medicine. Therefore it would be worthwhile to include BM in the curricula for the training of occupational hygienists.

Environmental contamination and human exposure to lead in Brazil

Adverse effects caused by environmental lead pollution are well recognized. Being a widespread agent in the environment and a major harmful element to organic systems, mostly to children, lead has been investigated all over the world, aiming to improve measures regarding its control. The purpose of this chapter is to present a review of the situation of production, uses, assessment of exposure, and adverse effects from environmental lead contamination in Brazil. It also presents aspects of Brazilian legislation setting up maximum permissible levels of lead in several environmental compartments such as surface and drinking water, soils, sediment, urban air, and also in commercially sold food, vegetables, fish, and meat, in an effort to control industrial emissions. Epidemiological investigations on children's lead exposure around industrial and mining areas are revised, showing that many situations where lead contamination is potentially present still need to be addressed by governmental agencies. In Brazil, lead was withdrawn from gasoline by the end of the 1980s, and the last lead mining and primary smelting plant was closed in 1995, leaving residual environmental lead contamination, which has recently been investigated using a multidisciplinary approach. Nevertheless, there are hundreds of small secondary battery recycling plants all over the country, running smelting facilities that produce local urban areas of lead contamination.

Assessment of lead exposure and associated risk factors in urban children in Silesia, Poland

A program of childhood lead poisoning prevention was conducted in six cities of Silesia, the most industrialized region of Poland. We analyzed records of 11,877 children aged 24-84 months, tested between 1993 and 1998, to assess children's exposure to lead and associations of blood lead levels (BLL) with season of sampling, questionnaire data, and environmental levels of lead. Air lead concentrations and lead fallout, as measured in the ambient air monitoring system, were below current Polish air quality standards and gradually decreased. The geometric mean (GM) BLL was 6.3 microg/dL (range from 0.6 to 48 microg/dL), and >13% of children had BLL > or =10 microg/dL. Mean BLL declined from 6.8 microg/dL in 1993-1994 to almost 5.5 microg/dL in 1998. GM BLL in spring and summer ('nonheating' season) months were 10% higher than BLL in children tested in fall and winter ('heating' season), although air lead concentrations were lower in nonheating and higher in the heating season. For both the heating and nonheating seasons, there was a significant increase in the mean BLL with increasing air lead concentrations. Poor housing (odds ratio (OR): 1.82; 95% CI: 1.4, 2.3), two or more siblings in the family (OR: 3.12; 95% CI: 2.6, 3.7), lack of recreational trips outside the region (OR: 1.66; 95% CI: 1.47, 1.89), and the time child spent outdoors were associated with elevated BLL. Variables found to affect BLL in the Silesian children should be used to propose criteria to improve identification of children at risk and to focus prevention activities more effectively.

A study of pediatric blood lead levels in a lead mining area in South Africa

This study aimed to determine the blood lead distributions among young children in the lead mining town of Aggeneys in South Africa's Northern Cape Province, and in the comparison community of Pella, about 40 Km away. A further objective of the study was to explore factors associated with elevated blood lead levels. Children aged between 6 and 10 years (average age, 8 years) were studied, 86 from Aggeneys and 68 from Pella. The results showed that blood lead levels among the children of Aggeneys averaged around 16 microg/dL, while in Pella the mean blood lead level equaled 13 microg/dL. Overall, children with raised blood lead levels performed less well at school relative to other children. Within Aggeneys, fathers of "high" lead children tended to shower at work rather than at home, which may have been insufficient to prevent lead from being transported into the home. In conclusion, more stringent environmental control measures are needed, as well as stricter personal hygiene measures, to prevent childhood lead exposure in the mining community.

Temporal changes in blood lead levels of children in east Germany

This analysis investigates the temporal changes in blood lead levels (BLL) in repeated cross-sectional surveys of 5-7 year old children conducted in 1992-93, 1995-96 and 1998-99 and in a prospective cohort from a smelter town and an agricultural control region in east Germany. The region of Hettstedt has a long history of mining and smelting resulting in high levels of heavy metal pollution whereas the region of Zerbst has no known industrial sources of heavy metals. In the region of Hettstedt lead content in ambient dust fall declined since the early 1990s due to the closure of many factories, whilst in Zerbst lead in ambient dust fall was constantly low in the 1990s. Blood lead levels decreased during the observation period both in children from the smelter town and in children from the agricultural control region. From 1992-93 to 1998-99 the mean BLLs of school entrants fell by 20% (41.6 to 33.3 micrograms/l) in Hettstedt and by 30% (34.2 to 23.8 micrograms/l) in Zerbst. In the same observation period mean BLLs of cohort children declined by 35% (41.9 to 27.3 micrograms/l) in Hettstedt and by 39% (32.3 to 19.8 micrograms/l) in Zerbst. At the beginning of the observation period cohort children were 5-7 years of age and were followed up to the age of 11-14. Adjustment for sociodemographic factors, city area and environmental uptake of lead did not influence the percentage changes in BLL of school-entrants. It seems that the decline in ambient lead fall had an impact on the body burden of lead, but the overall decrease in BLL in these two regions is caused by the overall decrease of lead in gasoline and thus in food.

Hay fever and predictive value of prick test and specific IgE antibodies: a prospective study in children

Little is known from population-based studies in children about the diagnostic values of allergen-specific IgE antibodies (RAST) and skin prick test (SPT) with respect to hay fever. We aimed to determine and compare the diagnostic values of SPT and RAST to aeroallergens with respect to the incidence of hay fever cases in schoolchildren at different cut-off points. A prospective cohort study was performed on 1100 school children (5-7 and 8-10 years). Information on a doctor's diagnosis of hay fever was obtained by questionnaire and allergic sensitization to grass and birch pollen, cat, and Dermatophagoides pteronyssinus were measured using SPT and RAST between September 1992 and July 1993. Thirty-eight children give a history of hay fever (3.5%) in 1992/93 and additionally 37 cases occurred until 1996. Allergic sensitization was present in 17.9% (SPT), 30.2% (RAST) and more frequent in children with a history of hay fever (SPT: OR 11.7, 5.5-24.7; RAST: OR 10.6, 4.3-26.4). This difference was most pronounced for sensitization to pollen allergens. The sensitivity, specificity, positive and negative predictive values (PPV, NPV) for SPT and RAST were 65.6, 83.7, 11.9, 98.6 and 79.3, 71.6, 9.3, 99.0, respectively, with differences for specificity being significant (p < 0.001). Whereas NPV were equally high for SPT (99.2) and RAST (99.3), the incidence of hay fever cases were predicted rather poorly though somewhat better by SPT than by RAST (PPV 16.7 vs. 9.8; p < 0.001) initially. With increasing cut-off point for RAST reactivity, the PPV increased and reached 25.0 at 17.5 kU/l, whereas the NPV decreased to 97.9, which was lower than that of SPT reactivity (p < 0.01). At the cut-off point of 1.5 kU/l almost identical predictive values for SPT and RAST were obtained. SPT and RAST perform better in the negative than positive prediction of hay fever cases in epidemiological studies. Differences in the predictive capabilities depend on the chosen cut-off point for RAST reactivity.

Lead dust in broken hill homes--a potential hazard for young children?

OBJECTIVE

To determine the potential hazard posed by indoor lead dust to young children in Broken Hill, a silver-lead-zinc mining town in outback Australia, and the degree to which lead flux is influenced by factors such as geographical location, house construction type and condition.

METHODS

116 homes were selected and 93 (80%) studied from 10 localities in Broken Hill during the spring of 1995. Lead flux was measured using 85 mm diameter polystyrene petri dishes. Dishes were placed in four rooms of each house to collect dust over a six-to-eight-week period. Data on the location, condition and construction type of each house were recorded. Multiple linear regression was used to determine predictors of lead flux. Flux data were log transformed for the analysis.

RESULTS

Average household lead flux varied nearly seven-fold across districts from a low of 166 (distant from the mines), to a high of 1,104 microg/m2/30-day period (adjacent to the mines). Houses that were 'adequately sealed' had 2.9 times the lead flux, and 'poorly sealed' houses 4.3 times the flux, of 'very well sealed' houses. Construction material did not significantly affect these flux levels, and no statistically significant interactions were found between house condition and location or house type.

CONCLUSIONS

Many Broken Hill homes have high levels of lead flux that pose a potential risk to young children. Quantification of this hazard provides useful information for the community that can help focus efforts on actions required to minimise lead dust in the home.

IMPLICATIONS

Household dust is a potential source of lead for young children in at-risk communities. Information on lead flux in homes can assist these communities and public health agencies to better understand and deal more effectively with the problem.

Exposure of children to lead and cadmium from a mining area of Brazil

During the past 50 years the Ribeira river valley, in the southern part of the state of São Paulo, Brazil, had been under the influence of the full activity of a huge lead refinery and mine working by the side of the river. The plant completely stopped all kinds of industrial activities at the end of 1995, and part of the worker population and their families still remain living nearby in small communities. The objective of the study was to assess the exposure of children to lead and cadmium in these areas, where residual environmental contamination from the past industrial activity still exists. Blood samples of 295 children aged 7 to 14 years, residing in rural and urban areas around the mine and the refinery, were collected. A questionnaire was given to gather information on food habits, leisure activities, father's past employment, current and former residential places, and other variables. Blood lead and cadmium concentrations were analyzed by graphite furnace atomic absorption spectrometry using Zeeman background correction. Cadmium values obtained in this population were mostly below established quantification limits (0.5 microg/dl). The median of blood lead level (BLL) obtained in children living close to the lead refinery was 11.25 microg/dl, and the median in other mining regions far from the refinery was 4.4 microg/dl. Logistic regression analysis was conducted to examine the independent contribution of selected variables in predicting BLL in these children. The following variables showed significant association with high BLL: residential area close to the lead refinery [odds ratio (OR)=10.38 (95% confidence interval (Cl)=4.86-23.25)], former father's occupational lead exposure [OR=4.07 (95% Cl=1.82-9.24)], and male gender [OR=2.60 (95% Cl=1.24-5.62)].

Lead contamination in tap water of households with children in Lower Saxony, Germany

Lead has numerous acute and chronic adverse effects on human beings. This is especially true for infants and children. The main path of lead ingestion in children can be different according to housing and living situation. The intake of lead through drinking water is commonly due to metal corrosion. The users plumbing can be an important factor. In recent years, many lead pipes in Germany have been replaced by pipes made of an alternative material. The aim of this study is to assess the present state of drinking water contamination and the resulting exposure of infants to lead. For this purpose mothers of new-born babies were offered a free examination of their drinking water. After a written declaration of consent had been obtained and after the infant in question had reached an age of 3 months, a stagnation sample of cold tap-water after overnight stagnation together with a random daytime sample was obtained from the family. The collected samples were analysed by atomic absorption spectrometry for their lead concentration. In total, 1485 samples from households were collected. Of the 1434 stagnation samples, 3.1% had lead concentrations greater than 0.01 mg/l (recommended limit of the WHO) and 0.6% had concentrations above the limit of the German drinking water regulation (0.04 mg/l). The values for the 1474 random daytime samples were 2.1% above 0.01 mg/l and 0.2% greater than 0.04 mg/l, respectively. By region, the areas Bovenden, Friedland, Duderstadt, Northeim and Rosdorf were particularly affected. The highest measured concentrations of lead in the stagnation samples were 0.11 mg/l and 0.15 mg/l in the random daytime samples, respectively.

Small area estimation of incidence of cancer around a known source of exposure with fine resolution data

OBJECTIVES

To describe the small area system developed in Finland. To illustrate the use of the system with analyses of incidence of lung cancer around an asbestos mine. To compare the performance of different spatial statistical models when applied to sparse data.

METHODS

In the small area system, cancer and population data are available by sex, age, and socioeconomic status in adjacent "pixels", squares of size 0.5 km x 0.5 km. The study area was partitioned into sub-areas based on estimated exposure. The original data at the pixel level were used in a spatial random field model. For comparison, standardised incidence ratios were estimated, and full bayesian and empirical bayesian models were fitted to aggregated data. Incidence of lung cancer around a former asbestos mine was used as an illustration.

RESULTS

The spatial random field model, which has been used in former small area studies, did not converge with present fine resolution data. The number of neighbouring pixels used in smoothing had to be enlarged, and informative distributions for hyperparameters were used to stabilise the unobserved random field. The ordered spatial random field model gave lower estimates than the Poisson model. When one of the three effects of area were fixed, the model gave similar estimates with a narrower interval than the Poisson model.

CONCLUSIONS

The use of fine resolution data and socioeconomic status as a means of controlling for confounding related to lifestyle is useful when estimating risk of cancer around point sources. However, better statistical methods are needed for spatial modelling of fine resolution data.

Environmental lead exposure in a population of children in northern France: factors affecting lead burden

BACKGROUND

This study is part of the assessment of a site in northern France polluted by lead from industrial emissions. Our objectives were to look for the factors that influence lead burden in children aged 8-11 years.

METHODS

A cross-sectional population-based study took place in 1996-97 and included 400 children (200 of whom lived on the metal-polluted site).

RESULTS

The geometric mean of the blood-lead levels of children living on the polluted site was 39.5 microg/l (95% CI = 36.3-43.1); that of the non-exposed children was 30.6 microg/l (95% CI = 27.8-33.6) (P < 0.0001). Analysis of the variations in the mean blood-lead levels showed associations with: distance from the smelting plants (mean blood-lead level fell by a factor of 1/1.3 (95% CI = 1/1.2-1/1.4) for each km from the smelter over the range of 1-3 km and was constant thereafter) and consumption of tap water (when the water pipes were made of lead, the mean blood-lead level of children who drank tap water was twice as high (95% CI = 1.2-3.4) as that of children who did not).

CONCLUSIONS

The children's blood-lead levels were essentially linked to two factors: proximity to the smelters and drinking tap rather than bottled water.

Environmental lead contamination and pediatric lead intoxication in an Andean Ecuadorian village

Environmental lead (Pb) contamination was measured in samples of soil and locally grown food produce in a remote Ecuadorian village where Pb glazing of ceramics is the local cottage industry. The Pb concentration levels of local soil samples collected at varying distances from a cluster of backyard Pb baking kilns were 29,213 ppm (microg/g) at 0.001 km, 172 ppm at 0.005 km, 81 ppm at 0.01 km, 55 ppm at 1 km, 19 ppm at 2 km, and 1.4 ppm at 6 km, significantly higher than levels in control soil samples from non-Pb-glazing reference areas. Samples of locally grown food produce were also found to be Pb contaminated. Venous blood samples from 166 schoolchildren (ages 4 months to 15 years) in the study area and 56 children in the reference area showed mean blood lead levels of 40.0 microg/dl (SD: 24.5; range: 6.2. - 119.1 microg/dL) and 6.6 microg/dL (SD: 3.4; range: 1.9 - 18.1 microg/dL), respectively, which were significantly different (p = 0.0001). The Pb levels in milk from breastfeeding mothers ranged from 1.44 to 39 ng/g. Lead isotope ratios of the children's blood and of samples of village soil revealed a common Pb source or "fingerprint."

The effect of low-level blood lead on hematologic parameters in children

A health survey of school children living in polluted regions of eastern Germany provided us with data necessary to examine the effects of lead on the blood system at levels below current standards for blood lead content. Data collected for 797 children, aged 5-14 years, with low blood lead levels (GM, 33.3 microg Pb/L; range, 7.5-239 microg Pb/L) allowed us to examine the relationship between blood lead content and hematological parameters. Using linear regression analyses and controlling for a number of potential confounding factors, we found that increasing blood lead levels by 10 microg/L were associated with a small increase in the number of red blood cells and in girls with reduced MCV and MCH. The reasons for our observation, especially the gender difference, are still uncertain. In conclusion the morphology and function of erythrocytes might be sensitive parameters of low dose lead toxicity.

Satisfaction with the process of lead remediation in an urban Australian community

OBJECTIVE

To assess householders' satisfaction with the process of residential lead abatement in an urban Australian population.

METHOD

The study area consisted of suburbs immediately surrounding a lead-related industry on Australia's east coast. Nineteen of 20 remediated households in the study area agreed to participate in the survey. One trained interviewer conducted semi-structured qualitative interviews with one 'key' person from each remediated household. Participants were asked for their personal views as well as general household views about the rationale for, process and results of lead remediation.

RESULTS

The 19 households varied from three to seven people and contained 1-5 children (16 years or under). The opinions of residents of remediated households were polarised, with the majority being either greatly satisfied or greatly dissatisfied with the process. Level of satisfaction was clearly linked to perceived quality of the remediation works.

CONCLUSIONS

Satisfaction with household lead remediation could be improved by ensuring effective communication between all parties; providing clear, simple, but detailed information about the remediation works to be undertaken on each household; providing timely support for householders when problems arise; and ensuring that all contractors are skilled, reputable and have acceptable communication skills.

Factors affecting lead and cadmium levels in house dust in industrial areas of eastern Germany

The indoor exposure of 381 women (52-59 years old) to lead and cadmium was assessed by measuring the levels of the contaminants in sedimented house dust. The study was conducted in the areas surrounding the towns of Hettstedt, a region of mining and smelting of non-ferrous ores, of Bitterfeld, a centre of chemical production and coal mining, and of Zerbst, a primarily agricultural area. Factors that were significantly associated with lead and cadmium surface loading rates included the city area of residence, urban environment of dwelling, ventilation behaviour, type of heating, year of construction of building and crowding in the sampling room. In metal-contaminated areas, the transport of heavy metals into the home from external sources and their subsequent resuspension into the air due to normal household activities are significant factors in the exposure to heavy metals, whereas in unpolluted areas indoor sources play the major role.

Indoor risk factors for atopic eczema in school children from East Germany

This study aimed to investigate the relation between environmental influences such as arsenic, cadmium, lead, and mercury, as well as environmental tobacco smoke, pet keeping, and heating systems on the prevalence of atopic eczema. Therefore, a multicenter cross-sectional study of school children aged 5-14 years, including a standardized questionnaire, blood and urine analyses, and a dermatological examination, was undertaken. A cases-control approach was chosen in order to identify relevant risk factors. A total of 2200 school children (response 79.1%) of two areas (Bitterfeld, Hettstedt) polluted by industrial activities and an agricultural control region (Zerbst) of the former German Democratic Republic were examined. Atopic eczema as identified by dermatological examination and history was the outcome variable of interest. Body burden of arsenic and heavy metals and questionnaire data on environmental tobacco smoke exposure, pet keeping, and heating system were investigated as potential risk factors. The overall prevalence of atopic eczema was 2.6%, with higher prevalences in the industrial areas (2.5 and 2.9%) compared to the control area (1.6%, not significant). Bivariate analyses did not reveal statistically significant associations between atopic eczema and tobacco smoke exposure or the body burden of arsenic and heavy metals. According to multiple logistic regression analysis, atopic eczema was significantly more frequent in predisposed families and those who reported keeping guinea pigs (OR=4.37, CI 2.15-8.91), but not other pets, like dogs, cats, and hamsters. In comparison to a distant heating system, a decreased risk was observed in households with central heating system (OR=0.30, CI 0.10-0.90), whereas the presence of a gas heater with an exhaust pipe connection to the wall was associated with a significantly elevated risk for eczema (OR=8.22, CI 2.44-27.66). The heating system and exposure to certain animal allergens are related to the manifestation of atopic eczema. Further studies are needed to clarify how far a causal relationship is reflected by these findings.

Factors affecting lead, cadmium, and arsenic levels in house dust in a smelter town in eastern Germany

Hettstedt, a city in eastern Germany with a long history of mining and smelting of nonferrous ores, has several industrial sources of heavy metals. The indoor exposure to metals of children (5 to 14 years old) in the Hettstedt area was assessed by measuring the levels of lead, cadmium, and arsenic contamination in sedimented house dust. Factors which influence the dust loading rate and the surface loading rates of these contaminants in house dust were investigated. The geometric mean of the dust loading rate was 8.9 mg/m2 day. The geometric means of surface loading rates were 1.14, 0. 024, and 0.023 microg/m2 day for lead, cadmium, and arsenic, respectively. Factors that were significantly associated with surface loading rates included the city area of residence, automobile traffic near home, parent with occupational exposure to heavy metals, type of heating, housing characteristics, whether child's home is damp, number of persons living in the child's home, and parents' education. The most significant of these factors was the city area of residence, which reflects the distance from the metal sources; this factor accounted for about half of the variances explained by the regression models.

High concentrations of heavy metals in neighborhoods near ore smelters in northern Mexico

In developing countries, rapid industrialization without environmental controls has resulted in heavy metal contamination of communities. We hypothesized that residential neighborhoods located near ore industries in three northern Mexican cities would be heavily polluted with multiple contaminants (arsenic, cadmium, and lead) and that these sites would be point sources for the heavy metals. To evaluate these hypotheses, we obtained samples of roadside surface dust from residential neighborhoods within 2 m of metal smelters [Torreón (n = 19)] and Chihuahua (n = 19)] and a metal refinery [Monterrey (n = 23)]. Heavy metal concentrations in dust were mapped with respect to distance from the industrial sites. Correlation between dust metal concentration and distance was estimated with least-squares regression using log-transformed data. Median dust arsenic, cadmium, and lead concentrations were 32, 10, and 277 microg/g, respectively, in Chihuahua; 42, 2, and 467 microg/g, respectively, in Monterrey, and 113, 112, and 2,448 microg/g, respectively, in Torreón. Dust concentrations of all heavy metals were significantly higher around the active smelter in Torreón, where more than 90% of samples exceeded Superfund cleanup goals. At all sites, dust concentrations were inversely related to distance from the industrial source, implicating these industries as the likely source of the contamination. We concluded that residential neighborhoods around metal smelting and refining sites in these three cities are contaminated by heavy metals at concentrations likely to pose a health threat to people living nearby. Evaluations of human exposure near these sites should be conducted. Because multiple heavy metal pollutants may exist near smelter sites, researchers should avoid attributing toxicity to one heavy metal unless others have been measured and shown not to coexist.