Reassessment of critical lead effects by the German Human Biomonitoring Commission results in suspension of the human biomonitoring values (HBM I and HBM II) for lead in blood of children and adults

Lead exposure in Chinese children: Urbanization lowers children's blood lead levels (BLLs)

Lead is a toxic metal that can pose a huge threat to children's health. China has experienced rapid urbanization since the reform in 1978; however, there has been no examination of the potential influence of this urbanization on children's blood lead levels (BLLs). This study is the initial investigation to explore the correlation between urbanization and BLLs in Chinese children. Five windows of time are considered: pre-2000, 2001-2005, 2006-2010, 2011-2015 and 2016-2021. The results show that urbanization affected lead distribution in urban soil and agricultural soil during the above periods, especially in northern China. The higher non-carcinogenic risk of lead for children is consistent with the lead pollution in soil (3 < Igeo ≤ 4). Urban children's BLLs are slightly higher than those of rural children in 2001-2010, but rural children's BLLs in 2011-2021 are higher than those of urban children during China's urbanization. The areas of rural decline and the areas of urban growth increased across all the window periods. However, the BLLs decrease in all rural and urban areas during all window periods, especially in urban areas. Children's BLLs have a significantly negative correlation with urban areas (p < 0.01). Therefore, China's urbanization has a significant effect on the decrease in children's BLLs. The significance of this study is to provide a fresh perspective and innovative strategy for policymaking in order to reduce children's BLLs and prevent lead exposure. This can be achieved by transforming their external living environment from a rural lifestyle to an urban one, while also ensuring access to well education and maintaining a balanced nutrient intake.

Lead pollution-related health of children in China: Disparity, challenge, and policy

Lead (Pb) is a neurotoxic metal, and no level of lead exposure is safe for children. China has still experienced problems on child lead poisoning even though the Chinese government has phased out leaded gasoline since 2000. The underlying problem affecting the lead pollution-related health of children in China remains to be comprehensively investigated. It is found that although the significant decline of BLLs, as the Geometric Mean (GM), from 91.40 μg/L^GM in 2001 to 37.52 μg/L^GM in 2018 is observed, the average BLLs of children are still above 50 μg/L or more [average 59.70 (60.50-65.02, 95 % CI) μg/L^GM] after phasing out leaded gasoline since 2000 in China. Lead exposure causes 29.67 MID per 1000 children with a loss of 98.23 (59.40-146.21, 95 % CI) DALYs per 1000 in China, which is greater than the levels reported from the Western Pacific Region and other low- and middle-income countries. A significant correlation is observed between the number of child crimes (NoCCs) and the outcomes of long-term lead exposure for children in China. Although the disparities in BLLs in China are strongly influenced by unequal distributions of potential multi-lead related sources (soil lead, PM2.5 lead, dust lead), unbalance development of local industrialization and economies, as well as incorrect health care for younger children, the notable emissions from coal combustion (CC) and non-ferrous metals (NMS) exploitation dominate the crucial sources of low-level lead exposure to children after phasing out leaded gasoline in China currently. Faced with the unequal and disparate distribution of BLLs in China, the big bottleneck is to decrease the BLLs exertions of 36-45 μg/L in the next few decades. The Chinese government needs to make more efforts on developing more strict guidelines, implementing more policy strategies on prevention and management of blood Pb poisoning, and monitoring the nationwide changes in children's BLLs continuously.

Exposure of preterm neonates to toxic metals during their stay in the Neonatal Intensive Care Unit and its impact on neurodevelopment at 2 months of age

BACKGROUND

Premature neonates might be exposed to toxic metals during their stay in the neonatal intensive care unit (NICU), which could adversely affect neurodevelopment; however, limited evidence is available. The present study was therefore designed to assess the exposure to mercury, lead, cadmium, arsenic, and manganese of preterm neonates who received total parenteral nutrition (TPN) and/or red blood cell (RBC) transfusions during their NICU stay and the risk of neurodevelopment delay at the age of 2 months.

METHODS

We recruited 33 preterm neonates who required TPN during their NICU admission. Blood samples were collected for metal analysis at two different time points (admission and before discharge). Metals in the daily TPN received by preterm neonates were analyzed. Neurodevelopment was assessed using the Ages and Stages Questionnaire Edition 3 (ASQ-3).

RESULTS

All samples of TPN had metal contamination: 96% exceeded the critical arsenic limit (0.3 μg/kg body weight/day); daily manganese intake from TPN for preterm neonates exceeded the recommended dose (1 µg/kg body weight) as it was added intentionally to TPN solutions, raising potential safety concerns. All samples of RBC transfusions exceeded the estimated intravenous reference dose for lead (0.19 µg/kg body weight). Levels of mercury, lead and manganese in preterm neonates at discharge decreased 0.867 µg/L (95% CI, 0.76, 0.988), 0.831 (95%CI, 0.779, 0.886) and 0.847 µg/L (95% CI, 0.775, 0.926), respectively. A decrease in ASQ-3-problem solving scores was associated with higher levels of blood lead in preterm neonates taken at admission (ß = -0.405, 95%CI = -0.655, -0.014), and with plasma manganese (ß = -0.562, 95%CI = -0.995, -0.172). We also observed an association between decreased personal social domain scores with higher blood lead levels of preterm neonates before discharge (ß = -0.537, 95%CI = -0.905, -0.045).

CONCLUSION

Our findings provide evidence to suggest negative impacts on the neurodevelopment at 2 months of preterm infants exposed to certain metals, possibly related to TPN intake and/or blood transfusions received during their NICU stay. Preterm neonates may be exposed to levels of metals in utero.

Spatial distribution and risk assessment of fluorine and cadmium in rice, corn, and wheat grains in most karst regions of Guizhou province, China

The pollution status of crops planted in Guizhou province of Southwestern China with high background values of Fluorine (F) and Cadmium (Cd) has attracted people’s concern. The present study aimed to investigate the spatial distributions of F and Cd in rice, corn and wheat grains, and further evaluate their health risks to residents in Guizhou province. The contents of F and Cd were measured by fluoride ion-selective electrode and inductively coupled plasma mass spectrometry (ICP-MS) methods, respectively. Additionally, the inverse distance weighted (IDW) technique was conducted to analyze spatial distribution, and the health risk was estimated by target hazard quotient (THQ) and hazardous index (HI). The results indicate that Cd contents in samples varied from 0.000 to 0.463 for rice, 0.000 to 0.307 for corn, and 0.012 to 0.537 (mg/kg) for wheat, while F contents ranged from 0.825 to 5.193 (rice), 0.946 to 8.485 (corn), and 0.271 to 9.143 (wheat) mg/kg. The Cd exceeding ratios were 11.600% for rice, 13.500% for corn, and 45.100% for wheat grains, respectively. In terms of spatial distribution, high levels of F and Cd in rice were found in the northern and central in Guizhou, while Cd in corn was distributed in the eastern and F in corn were distributed in the west area of Guizhou. Moreover, the high levels of F and Cd in wheat were distributed in the western and eastern areas. The mean carcinogenic risks (R) of Cd in rice, corn, and wheat in children were 4.150 × 10^–4, 1.670 × 10^–4 and 3.470 × 10^–4, respectively, and that in adults were 3.430 × 10^–4, 0.471 × 10^–4, and 2.190 × 10^–4, respectively. The HI for adults in rice, corn and wheat grains were 0.756, 0.154, and 0.514, respectively, and that for children were 0.913, 0.549, and 0.814, respectively. Collectively, the potential risks produced by F and Cd to the local residents should not be ignored.

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

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

Global DNA Methylation in Cord Blood as a Biomarker for Prenatal Lead and Antimony Exposures

DNA methylation is an epigenetic mechanism for gene expression modulation and can be used as a predictor of future disease risks. A prospective birth cohort study was performed to clarify the effects of neurotoxicants on child development, namely, the Tohoku Study of Child Development, in Japan. This study aimed to evaluate the association of prenatal exposure to five toxic metals—arsenic, cadmium, mercury, lead (Pb), antimony (Sb), and polychlorinated biphenyls (PCBs, N = 166)—with global DNA methylation in umbilical cord blood DNA. DNA methylation markers, 5-methyl-2′-deoxycytidine (mC) and 5-hydroxymethyl-2′-deoxycytidine (hmC), were determined using liquid chromatography-tandem mass spectrometry. The mC content in cord blood DNA was positively correlated with Pb and Sb levels (r = 0.435 and 0.288, respectively) but not with cord blood PCBs. We also observed significant positive correlations among Pb levels, maternal age, and hmC content (r = 0.155 and 0.243, respectively). The multiple regression analysis among the potential predictors demonstrated consistent positive associations between Pb and Sb levels and mC and hmC content. Our results suggest that global DNA methylation is a promising biomarker for prenatal exposure to Pb and Sb.

Environmental Substances Associated with Alzheimer's Disease-A Scoping Review

Alzheimer’s disease (AD) is the most common form of dementia, prevalent in approximately 50–70% of the dementia cases. AD affects memory, and it is a progressive disease interfering with cognitive abilities, behaviour and functioning of the person affected. In 2015, there were 47 million people affected by dementia worldwide, and the figure was estimated to increase to 75 million in 2030 and to 132 million by 2050. In the framework of European Human Biomonitoring Initiative (HBM4EU), 18 substances or substance groups were prioritized for investigation. For each of the priority substances, a scoping document was prepared. Based on these scoping documents and complementary review of the recent literature, a scoping review of HBM4EU-priority substances which might be associated with AD was conducted. A possible association between risk of AD and pesticides was detected. For mercury (Hg), association is possible but inconsistent. Regarding cadmium (Cd) and arsenic (As), the results are inconsistent but inclined towards possible associations between the substances and the risk of disease. The evidence regarding lead (Pb) was weaker than for the other substances; however, possible associations exist. Although there is evidence of adverse neurological effects of environmental substances, more research is needed. Environmental chemical exposure and the related hazards are essential concerns for public health, and they could be preventable.

Association of low-level environmental exposure to cadmium and lead with gout flare using a cohort study design

Cadmium (Cd) and lead (Pb) are toxic heavy metals with endocrine-disrupting properties. We investigated the associations of low-level environmental exposure to Cd/Pb and gout status (intercritical gout, gout flare and combined gout) in a cohort study. We measured by ICP-MS the levels of Cd and Pb in blood (Cd-B and Pb-B) and urine (Cd-U and Pb-U) from 408 participants with blood and 346 participants with urine samples recruited from a hospital gout clinic. The median levels of Cd-B and Pb-B (in μg/L) in the gout flare group were 0.87 (range 0.41-2.49) and 31.54 (25.38-41.46), respectively, and the median levels of Cd-U and Pb-U in the gout flare group were 1.05 (0.69-1.91) and 3.86 (3.49-4.44), respectively. These medians were significantly higher than those in the control or intercritical groups (P < 0.05). For Cd-B in tertile 2 (T2) and Cd-U in tertile 3, Cd levels were significantly associated with gout flare status compared to the reference tertile 1 (OR = 4.3, P = 0.041 and OR = 25.1, P = 0.002, respectively) after adjustment under Model 3. For Pb-U, the risk of gout flare status was significantly higher in T2 (OR = 51.0, P = 0.002) compared to the T1 under Model 3. Our results show that median levels of Cd-B, Pb-B, Cd-U and Pb-U in the gout flare group were significantly higher than participants without gout or with gout but in the intercritical period. We provide evidence that the risk of gout flare status is associated with increased Cd levels, and that blood and urine levels of Cd are a risk factor for gout flare status.

Is Time Spent Outside the Family Home a Risk Factor for Lead Exposure in Pre-School Children Living in Broken Hill?

Broken Hill is amongst a group of communities internationally that are at greater risk from lead due to active or historical lead industries. Current evidence suggests there is no safe level of lead for young children. This paper describes places outside the family home where young Broken Hill children spend time and considers the potential for this to contribute to lead risk. We interviewed 65 families of children 3 years old or younger and detailed the top five places children spent time at outside the family home. Exposure to private residences outside the family home was recorded for most (88%) young children. Nearly two thirds stayed there five or more hours per week. Most children went there on a weekly basis over many months (median, 12 months), increasing the likelihood of exposure to lead hazards. Further investigation of the lead hazard and risk behaviour of children at these residences would assist in developing guidelines for remediation of the lead hazard for all private residences in Broken Hill. This approach to elucidating the potential sources and pathways of lead and other heavy metal exposures for young children may have merit in other settings where comprehensive zonal remediation is not feasible or may not be warranted.

Gene Variants Determine Placental Transfer of Perfluoroalkyl Substances (PFAS), Mercury (Hg) and Lead (Pb), and Birth Outcome: Findings From the UmMuKi Bratislava-Vienna Study

Prenatal exposure to perfluoroalkyl substances (PFAS), bisphenol A (BPA), lead (Pb), total mercury (THg), and methylmercury (MeHg) can affect fetal development. Factors influencing placental transfer rate of these toxins are poorly investigated. Whether prenatal exposure to pollutants has an effect on birth weight is incompletely understood. We therefore aimed (1) to determine placental transfer rates of PFAS, BPA, Pb, THg, and MeHg, (2) to analyze relationships between fetal exposure and birth outcome and (3) to analyze gene variants as mediators of placental transfer rates and birth outcome. Two hundred healthy pregnant women and their newborns participated in the study. BPA, 16 PFAS, THg, MeHg, and Pb were determined using HPLCMS/MS (BPA, PFAS), HPLC-CV-ICPMS (MeHg), CV-AFS (THg), and GF-AAS (Pb). Questionnaires and medical records were used to survey exposure sources and birth outcome. 20 single nucleotide polymorphisms and two deletion polymorphisms were determined by real-time PCR from both maternal and newborn blood. Genotype-phenotype associations were analyzed by categorical regression and logistic regression analysis. Specific gene variants were associated with altered placental transfer of PFAS (ALAD Lys59Asn, ABCG2 Gln141Lys), THg (UGT Tyr85Asp, GSTT1del, ABCC1 rs246221) and Pb (GSTP1 Ala114Val). A certain combination of three gene polymorphisms (ABCC1 rs246221, GCLM rs41303970, HFE His63Asp) was over-represented in newborns small for gestational age. 36% of Austrian and 75% of Slovakian mothers had levels exceeding the HBM guidance value I (2 μg/L) of the German HBM Commission for PFOA. 13% of newborns and 39% of women had Ery-Pb levels above 24 μg/kg, an approximation for the BMDL₀₁ of 12 μg/L set by the European Food Safety Authority (EFSA). Our findings point to the need to minimize perinatal exposures to protect fetal health, especially those genetically predisposed to increased transplacental exposure.

Blood lead levels of Chinese children from 1991 to 2020: Based on Monte Carlo simulation

Chinese children have been exposed to high level of lead due to polluted air, dust, contaminated foods and water, etc. In this research, we investigated published blood lead levels (BLLs) reflecting 1,057,832 Chinese children aged at 0-12 and teenagers aged at 13-18 in the past 30 years (1991-2020). The data mining and estimation were performed innovatively by Monte Carlo simulation to remedy the skewed distribution-induced bias. The temporal trend of Chinese children's BLLs showed an obvious decrease in the past decades from 88.74 μg/L (Geometric SD = 4.09) during 1991-1995 to 27.32 μg/L (Geometric SD = 4.18) during 2016-2020. This study also indicated that children's BLLs of Yunnan, Guizhou, Shanxi were at relatively high levels and most provinces showed a downward trend. Chinese boys aged at 1-18 years old had higher BLLs (GM: 44.03 μg/L) compared to girls (GM: 41.32 μg/L) (p < 0.001). At different age groups, Chinese children's BLLs were 42.04 μg/L (1-3 years old), 52.88 μg/L (4-6 years old), 50.49 μg/L (7 and above years old), respectively. Although the BLLs of Chinese children exhibited a continuous declined trend in the past 30 years, it was still higher than that in developed countries, which indicated that more efforts are needed in children's BLLs control.

Characteristics and Risk Assessment of Soil Polluted by Lead around Various Metal Mines in China

The contamination of soil by lead (Pb) is a serious and widespread problem in China, especially in mining areas. This paper summarized the available data regarding Pb-contaminated soils around various metal mines in China. Based on these data, the Pb concentration in the soil and its temporal and spatial changes were analyzed. Potential ecological hazards and adult lead models were also used to estimate ecological and health risks. The results indicated that the concentration of Pb was closely related with the type of mine. Compared with other types of mine, soil around lead-zinc (Pb-Zn) and tin (Sn) mines with high Pb contents in the metallic ores and high pollutant emission coefficient were more strongly polluted by Pb. The characteristic spatial and temporal variations of Pb pollution status in China were clarified, and the results showed that the concentration was high in the southern, southwestern, and central regions of China where many mining areas were located, and the mean value passed a turning point in 2012. Ecological risk assessments indicated that some areas around mines were at considerable to high risk, and the risk was relatively severe in Pb-Zn mining areas. According to the adult lead model, Pb-Zn mines had a greater impact on blood Pb concentration than the other types of mine.

Iron Status in Relation to Low-Level Lead Exposure in a Large Population of Children Aged 0-5 Years

There are limited data regarding low lead exposure and iron status in Chinese children. This study aimed to examine the association between low-level lead exposure and iron status in a large population of children aged 0-5 years. We reviewed the records of children aged 0-5 years who had blood lead, iron, ferritin, and hemoglobin measurements during 2014-2017 at the Guangdong Women and Children Hospital. We identified 17,486 children with a blood lead level < 100 μg/L. Multiple linear and logistic regression analyses were performed to estimate the associations between blood lead levels and blood iron, serum ferritin, and hemoglobin. The mean concentrations of blood lead, iron, ferritin, and hemoglobin were 31.50 μg/L, 7.50 mmol/L, 46.98 ng/mL, and 120.41 g/L, respectively. Adjusting for age and sex, blood lead was negatively correlated with iron (r = - 0.073, p < 0.05), ferritin (r = - 0.043, p < 0.05), and hemoglobin (r = - 0.047, p < 0.05). Compared with the 1st quintile of lead exposure, the 5th quintile of lead exposure was associated with a 0.146 mmol/L decrease in blood iron, a 4.678 ng/mL decrease in serum ferritin, and a 1.245 g/L decrease in hemoglobin. Adjusted odds ratios (95% confidence interval) for the 5th quintile of blood lead were 1.39 (1.25-1.55) for iron deficiency and 1.45 (1.26-1.67) for anemia, relative to the 1st quintile. Our study findings confirmed the previously established association of blood lead levels with decreasing iron status and extended previous findings to even low-level lead exposure in Chinese children.

[Lead in drinking water-an old problem, a new EU directive]

BACKGROUND

Lead pipes have been used in drinking water installations for a long time. Only since 1973 have their use in new buildings been strongly discouraged; nevertheless, they are still found in old buildings. Furthermore, lead-containing alloys are still used today in components such as fittings. This results in an avoidable pollution of drinking water. The health significance of this pollution is acknowledged by a reduction of the currently valid limit value from 10 µg/l to 5 µg/l by the new EU drinking water directive passed in 2020. This directive provides for a transition period of 15 years.

OBJECTIVES

The relevance of a stricter limit value for lead in drinking water will be evaluated based by the results of routine analyses, and the necessary public health measures to prevent exposure of vulnerable groups will be formulated.

MATERIAL AND METHODS

A retrospective analysis of routine samples from the city of Bonn, which an accredited drinking water laboratory had examined in the years 1997-2019, was performed.

RESULTS

Of the 16,060 samples analyzed, 75.36% were below the quantitative limit of quantification. The median of the quantifiable samples was above the future limit for lead in drinking water in each year considered. No effect of the last transition period of 10 years (2003-2013) could be detected.

DISCUSSION

Even though no systematic studies on lead pollution in German municipalities are available, the subject is still highly topical. Lead exposure from drinking water installations is a completely avoidable health risk, but it can only be regulated by consistent enforcement of the applicable rules by the health authorities. The health authorities must be adequately equipped in terms of personnel, material, and financial resources.

Blood Lead Level in a Paediatric Population of South-Eastern Spain and Associated Risk Factors

Objective: To determine blood lead levels (BLL) in a healthy paediatric population and to analyse related sociodemographic, dietary and haematological factors. Methods: A cross-sectional study was made of 1427 healthy subjects aged 1–16 years from the city of Almería (south-eastern Spain). BLL, iron parameters and erythropoietin were determined, and sociodemographic and dietary data obtained. The study paramateters was analyses in BLL toxic and BLL no toxic group by multiple logistic regression. Results: The mean BLL was 1.98 ± 1.1 µg/dL (95% CI:1.91–2.04). For 5.7% of the population, mean BLL was 2–5 µg/dL, for 2.1% it was >5 µg/dL and for 0.15% it was >10 µg/dL. Multivariate analysis showed that immigrant origin (OR:11.9; p < 0.0001), low level of parental education (OR:4.6; p < 0.02) and low dietary iron bioavailability (OR: 3.2; p < 0.02) were all risk factors for toxic BLL. Subjects with toxic and non-toxic BLL presented similar iron and erythropoiesis-related parameters, except erythrocyte protoporphyrin, which was significantly higher in the BLL >5 µg/dL group. Conclusions: BLL and the prevalence of toxic BLL in healthy subjects aged 1–16 years living in south-eastern Spain are low and similar to those found in other developed countries. The factors associated with toxic BLL are immigrant origin, low level of parental education and dietary iron deficiency. The toxicity of BLL was not related to changes in the analytical parameters studied.

Heavy metals in indoor dust: Spatial distribution, influencing factors, and potential health risks

Given the large proportion of time that people spend indoors, the potential health risks posed by heavy metals in the indoor environment deserve greater attention. A global-scale assessment of heavy metal contamination in indoor dust was conducted in this study based on >127 articles published between 1985 and 2019. The pollution levels, spatio-temporal variations, sources, bioaccessibilities, influencing factors, and health risks of heavy metals associated with indoor dust were analyzed. Children's blood lead levels (BLLs) were also estimated using the integrated exposure uptake biokinetic model. The results indicated that the median concentrations of Cu and Zn in 71.9% and 71.0% of the study sites surpassed the corresponding permissible limits, 100 and 300 mg/kg, respectively; thus, their control should be given priority. Heavy metal concentrations in indoor dust from different areas of the world varied greatly, which was closely associated with the type of local human activities, such as mining, melting, e-waste recycling and Pb-related industries. The bioaccessibilities of some key elements, e.g., Pb, Cd, Cu, and Zn, in household dust were high. The levels of heavy metals in indoor dust were mainly affected by a combination of outdoor and indoor sources and related critical factors, and future studies should focus on quantifying the contributions of different sources. Based on the health risk assessment, dust Pb exposure is a major health concern in e-waste recycling areas, which warrants greater attention. 49.8%, 36.8% and 14.4% of study sites showed BLLs exceeding 35 μg/L (threshold limit in Germany), 50 μg/L (threshold limit in the USA), or 100 μg/L (threshold limit in China), respectively. Finally, Pb exposure from indoor dust represents a major contributor to children's blood Pb poisoning in many developing countries. This study details the overall heavy metal contamination status of indoor dust and provides insights for policymakers with respect to pollution prevention measures.

Environmental Substances Associated with Osteoporosis-A Scoping Review

Introduction: Osteoporosis is a disease having adverse effects on bone health and causing fragility fractures. Osteoporosis affects approximately 200 million people worldwide, and nearly 9 million fractures occur annually. Evidence exists that, in addition to traditional risk factors, certain environmental substances may increase the risk of osteoporosis. Methods: The European Human Biomonitoring Initiative (HBM4EU) is a joint program coordinating and advancing human biomonitoring in Europe. HBM4EU investigates citizens’ exposure to several environmental substances and their plausible health effects aiming to contribute to policymaking. In HBM4EU, 18 priority substances or substance groups were selected. For each, a scoping document was prepared summarizing existing knowledge and health effects. This scoping review is based on these chemical-specific scoping documents and complementary literature review. Results: A possible link between osteoporosis and the body burden of heavy metals, such as cadmium (Cd) and lead (Pb), and industrial chemicals such as phthalates and per- and poly-fluoroalkyl substances (PFASs) was identified. Conclusions: Evidence shows that environmental substances may be related to osteoporosis as an adverse health effect. Nevertheless, more epidemiological research on the relationship between health effects and exposure to these chemicals is needed. Study results are incoherent, and pervasive epidemiological studies regarding the chemical exposure are lacking.

Where are we at with lead? Current levels, time trend, and determinants of blood lead in New Zealand children and adults

AIMS

A national biomonitoring survey was conducted in 2014-2016, to determine current blood lead levels (BLL) in New Zealand children and adults and identify determinants of BLL.

METHODS

Blood samples were provided by 191 children (age 5-18) and 304 adults (age 20-65) and analysed for BLL using inductively coupled mass spectroscopy. Linear regression on log-transformed BLL was used to assess associations between BLL and demographic and lifestyle factors collected via questionnaire.

RESULTS

The geometric mean (GM) BLL was 0.86 μg/dl (95%CI 0.80-0.92) for children and 1.31 μg/dl (1.23-1.39) for adults, representing a 90% reduction in BLL over the past 36 years. For children, shellfish consumption was associated with 20% higher BLL. Adult BLLs were positively associated with age, beer consumption, spirits consumption, having roof water as the home's water supply, and having worked in glass manufacturing. Determinants of reduced BLL were tofu and canned food consumption. For women, menopause was associated with 34% higher BLL.

CONCLUSIONS

Although significant reductions in New Zealanders' BLL have been achieved in the past decades, this study identified several additional opportunities to reduce further background exposure to lead. In particular, consideration needs to be given to reducing lead levels in New Zealand roof water supplies.

Contemporary blood lead levels of children aged 0-84 months in China: A national cross-sectional study

Despite the global abundance of studies on children's lead (Pb) exposure, the magnitude of Pb exposure among children across China remains unclear, especially for rural areas. In 2000, Pb was removed from petrol, marking a change in the sources of Pb exposure in China. To better understand children's Pb exposure and inform potential approaches to exposure reduction, we conducted a national blood Pb survey of 31,373 children (0-84 months old) from May 2013 to March 2015, using a multi-stage and multi-strata sampling method. Blood lead levels (BLLs) were tested using graphite furnace atomic absorption spectrometry with a detection limit of 1 µg/L. The results show that Chinese children had a contemporary geometric mean (GM) BLL of 26.7 μg/L, with 8.6% of BLLs exceeding 50 µg/L. Boys had higher BLLs (GM 27.2 μg/L) compared to girls (GM: 25.9 μg/L) (p < 0.001). Children at the age of 0-36 months had a lower PbB (GM 25.7 μg/L) level compared with those aged 36-84 months (GM 27.9 μg/L) (p < 0.001). When taking into account sociodemographic factors, a multivariate logistic regression analysis shows that the odds ratios (OR) of having a BLL of 27 µg/dL (i.e., median BLL of this study) or higher were 1.88 (95% CI: 1.76, 2.02) and 1.35 (95% CI: 1.22, 1.49) for homes using coal and biomass fuels, respectively, compared to those using gas or electricity. Meanwhile, children in homes close to roads were more likely to have BLLs exceeding 27 µg/dL (OR: 1.11, 95% CI: 1.03, 1.20). In China, rural children had higher BLLs compared to urban children. As a result of pediatric exposure to Pb, there were approximately 144 million and 36 million IQ points lost for rural children and urban children, respectively, revealing a disparity of Pb exposure between rural and urban areas in China. Cleaner domestic fuels and improved cooking/heating equipment will reduce contemporary Pb exposure in rural areas. In addition, the association between contemporary BLLs and distance away from roads further suggests that resuspension of legacy soil/dust Pb should not be neglected in future remediation programs and household interventions. As a large scale survey, this study provides evidence for revising the reference value of BLL, improving the guideline for clinical and public health management, and implementing interventions to prevent adverse health outcomes associated with low-level Pb exposure in children.

Selenium status in lactating mothers-infants and its potential protective role against the neurotoxicity of methylmercury, lead, manganese, and DDT

A total of 206 lactating mothers and their infants (3-12 months) were included in this study to evaluate postnatal exposure to neurotoxic pollutants such as methylmercury (MeHg), lead (Pb), manganese (Mn), dichlorodiphenyltrichloroethane (DDT) and its metabolites [dichlorodiphenyldichloroethane (DDD), and dichlorodiphenyldichloroethylene (DDE)] and their association with delayed neurological development and to explore the protective role of selenium (Se) against chemical neurotoxicity. Neurodevelopmental performance was evaluated using Denver Developmental Screening Test II and Parents' Evaluation of Developmental Status (PEDS). Multivariate log-binomial regression modeling was applied for both single and multiple exposures to chemicals using a principal component analysis that generated six principal components. Both mothers and their infants had been exposed to metals and DDT metabolites, with some exceeding the accepted permissible limits. The geometric means of MeHg, Pb, Mn, DDD, DDE and DDT levels in breast milk were 1.333, 45.327, 15.576, 0.069, 0.542 and 1.08 μg/l, respectively. A single-exposure model identified a high risk of reduced PEDS performance significantly associated with DDD in breast milk [relative risk (RR) = 1.484; 95% confidence interval (95%CI) = 1.091-2.019] and marginally significantly associated with Pb in the mothers' blood (RR = 2.164; 95%CI = 0.87-5.382). We did not find a protective role of Se in neurodevelopment due to its high levels in the mothers. Models of multi-chemical exposure indicated that Mn in blood and breast milk, Se in blood and Pb in the mothers' urine were marginally significantly associated with a high risk of reduced PEDS performance (RR = 0.424; 95%CI = 0.176-1.022). The use of multi-chemical exposure approach in early life risk assessments is important because it indicates real-world exposure. Our results were not conclusive because the sample size was small, so future studies examining the implications to health of the impact of prenatal/postnatal exposure to a mixture of chemicals in the Saudi population are merited.

Childhood lead poisoning from domestic products in China: A case study with implications for practice, education, and policy

OBJECTIVE

This study aimed to report three representative childhood lead poisoning cases in China from domestic products exposure and to highlight their critical implications for practice, education, and policy in prevention and treatment of childhood lead poisoning by health care providers, especially public health nurses.

DESIGN AND SAMPLE

Three representative childhood lead poisoning cases occurring in 2017 were collected and analyzed.

RESULTS

The lead exposure sources of three cases were evaluated by experts in the field and determined to be tin pots, home factories for tinfoil, and contamination of folk medicine, respectively. These cases demonstrated that the lack of lead exposure risk assessment, insufficient knowledge of potential lead exposure sources, underdeveloped policy, and regulations were areas for improvement.

CONCLUSIONS

The best strategies for preventing lead poisoning include an appropriate risk assessment of lead exposure, implementation of comprehensive parental health education, conduction of further research by public health providers, and the application of policy strategies by the government. It was determined that public health nurses are at the frontline of prevention of lead poisoning in children.

Status of lead accumulation in agricultural soils across China (1979-2016)

The first national-scale assessment of lead (Pb) contamination in agricultural soils across China was conducted based on >1900 articles published between 1979 and 2016. Pb concentrations, temporal and spatial variations, and influencing factors were analyzed. Children's blood lead levels (BLLs) were also estimated using the integrated exposure uptake biokinetic (IEUBK) model. Pb concentrations in different areas of China varied greatly, which was closely associated with the distribution of Pb-related industries, especially Pb-zinc mine smelting, non-ferrous polymetallic mine smelting, e-waste recycling, and leaded gasoline consumption. The year 2000 was a significant transition year for Pb concentrations, with a rapid increase pre-2000 and a subsequent slow upward trend. Pb concentrations were found to be strongly associated with indicators of economic and social development including gross domestic product (GDP), population size, and vehicle ownership. Leaded gasoline, coal combustion, and non-ferrous smelting were the main sources of atmospheric Pb during the different periods. Predicted BLLs were higher in South China than those in the north. This study details the overall Pb contamination status of agricultural soils in China, and thus provides insights for policymakers with respect to pollution prevention measures.

Exposure to lead and its effect on sleep quality and digestive problems in soldering workers

Some studies show that exposure to lead affects sleep quality and causes digestive disorders. The aim of this study was to evaluate the quality of sleep and digestive disorders in solderers exposed to lead. In a cross-sectional study, the occupational exposure of 40 soldering workers to lead fume and their blood lead levels were measured in the electronics industry of Neyshabur city, according to standard methods. The sleep quality of workers was measured by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and their digestive disorders were recorded in a checklist. This study showed that 67.5% of subjects had poor sleep quality. There was a significant relation between sleep quality, air lead (p = 0.02), and blood lead (p = 0.03). Bad sleep quality was 2.4 times higher in subjects exposed to lead above the threshold (p = 0.03). 92.5% of the population under study suffered from at least one digestive disorder. Digestive disorders such as hiccupping (85%) and nausea (67%) were more common among the workers, and their odds was 3.09 and 2.00 times higher in workers exposed to lead above the threshold, compared with others. Bad sleep quality and gastrointestinal disorders were prevalent among workers exposed to lead. The results of this study confirm the need for further research about the side effects of lead on humans. It also clarifies the need for a revision in the recommended occupational exposure level for lead.

Investigation of occupational exposure to lead and its relation with blood lead levels in electrical solderers

Occupational exposure to lead compounds can cause headache, nausea, encephalopathy, anemia, chronic muscle pain, and saturnism. Exposure to lead in women can affect fertility, and cause abortion or low IQ in the offspring. The aim of this study was to investigate occupational exposure to lead and its relation with blood lead levels in female electrical parts solderers. This cross-sectional (descriptive and analytical) study was carried out on 40 female solderers, working in two electrical parts manufacturing factories in Neyshabur city in 2017-2018. Occupational exposure to lead was determined by the OSHA 121 method, and the NIOSH 8003 method was used to determine the concentration of lead in blood. Lead in blood and air samples were determined by using a flame atomic absorption analyzer. Blood was measured using a Cell Dyn Hematology device. Data were analyzed using STATA 15. The mean age of the solderers was 35.42 ± 6.80 years, and their average work experience was 7.85 ± 5.60 years. Mean occupational exposure to lead was 0.09 ± 0.01 mg/m³, and the mean levels of lead in the blood of solderers were 10.59 ± 3.25 μg/dL. The mean of red blood cells (RBC) was 4.88 mil/uL, white blood cells (WBC) = 8.53 Tho/uL, hemoglobin = 14.02 g/dL, and hematocrit = 42.38%. There was a significant correlation between the concentrations of lead in air and the level of lead in workers' blood (p = 0.012, r = 0.31). The level of lead in the workers' respiratory region (β = 0.36, p = 0.033), body mass index (β = 0.25, p = 0.028), and the season of the year (β = 0.21, p = 0.019) were the strongest factors affecting blood lead levels. There was a significant relation between lead in workers' air and their blood, although all blood indices were in normal range. Using lead-free alloys and local ventilation systems, and reducing exposure times are recommended to decrease exposure to lead among solderers.

Blood lead levels of children in urban and suburban areas in China (1997-2015): Temporal and spatial variations and influencing factors

Blood lead (Pb) poisoning is a worldwide heath problem, especially in developing countries. As the largest developing country in the world, China faces severe health challenges, in particular the threat of blood Pb poisoning. In this study, the temporal trend of Chinese children's blood lead levels (BLLs) and blood lead poisoning incidence (BLPI) (percentage of BLL>100μg/L) and its influencing factors were investigated. We collected articles on children's BLLs published from 1997 to 2017 with sampling time from 1997 to 2015 by searching the databases of VIP Medical Information System (VMIS), China National Knowledge Infrastructure (CNKI) and Wanfang Data. After a rigorous investigation, 259 articles with eligible inclusion criteria were reviewed. Meanwhile, the data of Pb concentrations in the soil of 23 cities and the annual mean PM10 (particulate matter<10μm) concentrations of 24 provincial cities were collected. The temporal trend of children's BLLs and BLPIs could be divided into three stages: upward trend from 1997 to 2000, downward trend from 2001 to 2013, and upward trend from 2014 to 2015. The decline of BLLs from 2001 was primarily due to the phasing out of leaded gasoline since 2000 in China, while the descending air quality could explain the upward trend of BLLs in the period from 2014 to 2015. The correlation and regression analysis indicated that soil and air were two major pathways of Pb exposure for children in China. Although a noticeable decrease has been shown, the Chinese children's BLLs were still significantly higher than the levels of developed countries. We highly recommended that the critical value of blood Pb poisoning should be lowered to 50μg/L in China. Guidelines on the prevention and management of blood Pb poisoning are needed in China.

Occupational exposure to ultrafine particles in police officers: no evidence for adverse respiratory effects

Background

Inhalation exposure to fine and ultrafine particles (UFPs) has been associated with respiratory diseases. However, little is known on the quality, threshold levels and concentration of these particles causing adverse health effects.

Methods

The impact of occupational exposure to submicrometer and UFPs was assessed in 30 healthy police shooting instructors by clinical investigation, self-assessment questionnaire, sputum and spirometry and compared to a control group. General laboratory chemistry parameters, circulating cytokines (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, interferon-gamma [IFN-γ]), and granulocyte macrophage colony-stimulating factor (GM-CSF) in serum were measured. UFP exposure was recorded by Scanning Mobility Particle Sizer.

Results

Concentrations of submicrometer sized airborne particles (< 700 nm) measured between 3.34 × 10⁵/cm³ and 7.58 × 10⁵/cm³ at shooting sites, with highest concentrations found in the UFP range (< 100 nm). The size of the monodispersed particles ranged from 54.74 ± 16.25 nm to 98.19 ± 22.83 nm. Short term exposure (4 h) to high levels of UFPs caused an increase of IFN-γ in exposed subjects (p = 0.022). 24 h after exposure a significant decrease of IgG, albumin fibrinogen and factor VII was found. Neither directly after 4 h of high levels UFPs exposure nor 24 h after exposure subjective complaints or objective measurements indicating adverse respiratory effects in exposed subjects were found.

Conclusions

No consistent indications for adverse respiratory or inflammatory effects directly following exposure and 24 h after exposure to high levels of UFPs in our study group were detected. However we showed the assessment of short-term exposure effects at a genuine occupational setting, which might is relevant when a risk assessment of high level occupational exposures to UFPs is considered.

Prenatal exposure to lead in France: Cord-blood levels and associated factors: Results from the perinatal component of the French Longitudinal Study since Childhood (Elfe)

BACKGROUND

As a result of the ban on lead in gasoline on 2nd January 2000, the French population's exposure to lead has decreased in recent years. However, because of the acknowledged harmful cognitive effects of lead even at low levels, lead exposure remains a major public health issue. In France, few biomonitoring data are available for exposure to lead in pregnant women and newborn. The purpose of the perinatal component of the French human biomonitoring (HBM) program was to describe levels of various biomarkers of exposure to several environmental pollutants, including lead, among mother-baby pairs. In this paper, we aimed to describe the distribution of cord blood lead levels (CBLL) in French mother-baby pairs, and to estimate the contribution of the main lead exposure risk factors to these levels.

METHOD

A total of 1968 mother-baby pairs selected from the participants of the perinatal component of the French HBM program were included in the study on lead. Lead levels were analyzed in cord blood collected at child delivery by inductively coupled plasma-mass spectrometry (ICP-MS). The data collected included biological sample, socio-demographic characteristics, environmental and occupational exposure, and information on dietary factors.

RESULTS

CBLL were quantified for 99.5% of the sample. The CBLL geometric mean was 8.30 μg/l (95% CI [7.94-8.68]) with a 95th percentile of 24.3 μg/l (95% CI [20.7-27.1]). Factors significantly associated with CBLL were tap water consumption, alcohol consumption, shellfish consumption, vegetable consumption, bread consumption, smoking, and the mother being born in countries where lead is often used.

CONCLUSION

This study provides the first reference value for CBLL in a random sample of mother-baby pairs not particularly exposed to high levels of lead (24.3 μg/l). A substantial decrease in CBLL over time was observed, which confirms the decrease of exposure to lead among the general population. CBLL observed in this French study were in the range of those found in recent surveys conducted in other countries.

Lead, Mercury, and Cadmium Exposure in the Korean General Population

BACKGROUND

Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population.

METHODS

This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0-83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer.

RESULTS

The geometric mean, median and 95th percentile of blood Pb was 1.82 μg/dL, 1.83 μg/dL, and 3.78 μg/dL, respectively. The respective values were 2.92 μg/L, 2.87 μg/L, 9.12 μg/L for Hg, and 0.56 μg/L, 0.59 μg/L, 2.20 μg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0-4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age.

CONCLUSION

This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea.

Geophagy during pregnancy: Is there a health risk for infants?

Prenatal lead exposure is a public health concern. Geophagy, the practice of soil eating, is documented for pregnant women of sub-Saharan Africa to treat pregnancy-related malaise. The soils however can contain substantial amounts of lead. In an exploratory study on 48 mother-child pairs in the Democratic Republic of Congo, we found striking site-specific differences in prenatal lead exposure, i.e., higher lead levels at Kisangani than at Isiro. Kisangani women consumed 1/ more often soil during the first trimester of pregnancy as well as 2/ a different type of soil compared to Isiro women (P<0.05). We conclude geophagy may be a potential source of prenatal lead exposure.

Arsenic, cadmium, lead and mercury levels in blood of Finnish adults and their relation to diet, lifestyle habits and sociodemographic variables

The Northern Finland Birth Cohort program (NFBC) is the epidemiological and longitudinal prospective general population research program, which was established to promote health and wellbeing of the population in northern Finland. The aim of present study, as a part of the NFBC program, was to analyze the blood levels of arsenic (B-As), cadmium (B-Cd), lead (B-Pb), total mercury (B-Hg) and selenium (B-Se); to compare these levels with threshold limits; to study sociodemographic factors; and to correlate these levels with calcium and haemoglobin. The study was comprised of 249 NFBC subjects, of which 123 were female and 126 were male (ages 31.1 ± 0.3 and 31.1 ± 0.4, respectively). All participants were asked to complete a questionnaire regarding diet and living habits. The geometric means (± SD) of B-As were 0.49 ± 2.80 μg/l and 0.44 ± 2.72 μg/l; B-Cd were 0.18 ± 4.02 μg/l and 0.12 ± 3.21 μg/l; B-Pb were 17.0 ± 1.8 μg/l and 9.06 ± 2.20 μg/l; B-Hg were 2.18 ± 2.02 μg/l and 1.85 ± 1.78 μg/l; and B-Se were 106.0 ± 1.3 and 94.3 ± 1.3 μg/l in males and females, respectively. Among the subjects in the present analysis, 23 % of males and 17.1 % of females had B-As levels above the ATSDR normal human levels of B-As in unexposed individuals (1.0 μg/l). The B-Pb geometric mean (12.44 μg/l) was approximately one eighth the CDC toxicological cut-off point of 100 μg/l. Twenty-one individuals (8.4 %) exceeded a B-Hg level of 5.8 μg/l. Fifty-eight females (47 %) had a B-Hg higher than 2.0 μg/l, the German Federal Environmental Agency cut-off point for women (18-69 years) who consume fish at least three times/month; therefore, their babies could be at risk of adverse effects during development.

Longitudinal trends of blood lead levels before and after leaded gasoline regulation in Korea

The objective of this study was to verify a change in the longitudinal trend of blood lead levels for the Korean population, before and after the regulation of leaded gasoline- which occurred between 1987 and 1993 in Korea. A total of 77 reports on blood lead levels among general Korean population between 1981 and 2014 were selected, and the results were summarized to have the variables of year, number of subjects, the subjects' range in age, gender, and blood lead concentrations (arithmetic mean). The annual average atmospheric lead levels for four major cities (i.e., Seoul, Busan, Daegu and Gwangju) were collected from the Air Pollution Monitoring Database from 1991, and pilot studies from 1985 to 1990 before the national air quality monitoring system was launched in 1991. Blood lead levels were visualized in a bubble plot in which the size of each bubble represented the sample size of each study, and the annual average concentrations in ambient air were depicted on line graphs. Blood lead levels in the Korean population tended to gradually increase from the early 1980s (approximately 15-20 μg/dL) until 1990-1992 (20-25 μg/dL). Blood lead levels then began to rapidly decrease until 2014 (<2 μg/dL). Similar patterns were observed for both adults (≥20 years) and younger children/adolescents. The same longitudinal trend was observed in annual average atmospheric lead concentration, which suggests a significant correlation between air lead concentration and blood lead concentration in the general population. In conclusion, the regulation of leaded gasoline has significantly contributed to the rapid change in blood lead concentrations. And, the regulation of other sources of lead exposure should be considered to further decrease blood lead levels in the Korean population.

Predictors of cadmium and lead concentrations in the blood of residents from the metropolitan area of Athens (Greece)

The Cd and Pb blood contents of healthy adult subjects who are non-occupationally exposed and living in the metropolitan area of Athens (Greece) have not been assessed thus far. Additionally, Greeks rank first among EU27 in terms of smoking habits. To fill the existing gap, we aimed to evaluate the predictors and propose reference values (RVs) of the Cd (CdB) and Pb (PbB) blood concentrations in residents of the metropolitan area of Athens (Greece). Age, sex, smoking, alcohol drinking, educational status and nutritional habits were used as variables, with an emphasis on smoking. CdB and PbB determinations were performed directly by graphite furnace atomic absorption spectrometry (GFAAS) following the appropriate dilution of the samples with Triton-X-100. The RVs of CdB and PbB proposed for the general adult population of the Metropolitan area of Athens, Greece (upper limit of the 95% CI of the 95th percentile of the distribution of values), were 2.3 and 88μgL(-1) (P95: 1.8 and 77μgL(-1); 95% CI (P95): 1.5-2.3 and 70-88μgL(-1)), respectively. Males had a higher median CdB (0.69μgL(-1)) than females (0.55μgL(-1)). Subjects aged <40years had a lower median CdB (0.51μgL(-1)) than the elderly (≥60years; 0.60μgL(-1)). The CdB in smokers (1.2μgL(-1)) was almost threefold higher than in non-smokers (0.46μgL(-1)). The PbB levels were higher in males (31μgL(-1)) than females (20μgL(-1)). Subjects aged <40years had a lower median PbB (17μgL(-1)) than the elderly (≥60years; 32μgL(-1)). A multiple linear regression analysis demonstrated that the predictor variables for the CdB levels were the standardized beta weight, smoking, age, alcohol consumption, and intake of leafy vegetables, whereas for the PbB levels they were sex and age.

Human biomonitoring of heavy metals in the vicinity of non-ferrous metal plants in Ath, Belgium

BACKGROUND

A previous study revealed an environmental contamination by heavy metals in the vicinity of two non-ferrous metal plants in Ath, Belgium. The purpose of the current cross-sectional study was to estimate exposure of the population to heavy metals in the vicinity of the plants, in comparison with population living further away.

METHODS

We did a random sampling in the general population of Ath in two areas: a central area, including the plants, and a peripheral area, presumably less exposed. We quantified cadmium, lead, nickel, chromium and cobalt in blood and/or urine of children and adults in three age groups: (i) children aged 2.5 to 6 years (n = 98), (ii) children aged 7 to 11 years (n = 74), and (iii) adults aged 40 to 60 years (n = 106). We also studied subclinical health effects by quantifying retinol-binding protein and microalbuminuria, and by means of a Strengths and Difficulties Questionnaire.

RESULTS

We obtained a participation rate of 24 %. Blood lead levels were significantly higher in young children living in the central area (18.2 μg/l ; 95 % CI: 15.9-20.9) compared to the peripheral area (14.8 μg/l ; 95 % CI: 12.6-17.4). We observed no other significant mean difference in metal concentrations between the two areas. In the whole population, blood lead levels were higher in men (31.7 μg/l ; 95 % CI: 27.9-36.1) than in women (21.4 μg/l ; 95 % CI: 18.1-25.3). Urine cadmium levels were 0.06 μg/g creatinine (95 % CI: 0.05-0.07), 0.21 μg/g creatinine (95 % CI: 0.17-0.27), and 0.25 μg/g creatinine (95 % CI: 0.20-0.30) for children, men, and women, respectively.

CONCLUSIONS

Despite higher blood lead levels in young children living close to the plants, observed metal concentrations remain in the range found in other similar biomonitoring studies in the general population and are below the levels of concern for public health.

Human biomonitoring of metals in adults living near a waste-to-energy incinerator in ante-operam phase: Focus on reference values and health-based assessments

The human biomonitoring (HBM) of metals is a part of the ongoing project SPoTT for the longitudinal health surveillance of the population living near a waste-to-energy (WTE) incinerator (Turin, Italy). The HBM of metals in the SPoTT population aimed to evaluate: i) reference values (RVs) before the WTE incinerator started operation; ii) differences in exposure by variables; iii) variations respect to other HBM studies; iv) exposure that exceeds the available health-based benchmarks as the Biomonitoring Equivalents (BEs) for urine Cd and Human Biomonitoring (HBM-I and HBM-II) values for urine Hg, Tl, and blood Pb; v) risk assessment by generating hazard quotients (HQs) for the single metal and hazard index (HI) for the co-occurrence of metals. Eighteen metals in urine and Pb in blood were determined by sector field inductively coupled plasma mass spectrometry. Metal concentrations were comparable with RVs reported in other countries, except for slightly higher As, Be, Ir, Pd, Pt, Rh, and Tl levels. Smoking was associated with Cd; age with Pb; drinking bottled water with As and Cd; consumption of fish with As and Hg; amalgams with Hg and Sn; dental restorations with Pd and Pt; use of jewelry with Co and Rh, and piercing with Ni. While HQs for urine Cd, Hg, Tl and blood Pb suggested that adverse effects were unlikely, the HQ value raised the question of whether additive interactions of these metals could produce health concern. The obtained HBM data can be an early warning for accumulations of metals and identification of subgroups at risk.

Human Health Risk Assessment of Artisanal Miners Exposed to Toxic Chemicals in Water and Sediments in the Prestea Huni Valley District of Ghana

A human health risk assessment of artisanal miners exposed to toxic metals in water bodies and sediments in the PresteaHuni Valley District of Ghana was carried out in this study, in line with US EPA risk assessment guidelines. A total of 70 water and 30 sediment samples were collected from surface water bodies in areas impacted by the operations of artisanal small-scale gold mines in the study area and analyzed for physico-chemical parameters such as pH, TDS, conductivity, turbidity as well as metals and metalloids such as As, Cd, Hg and Pb at CSIR-Water Research Institute using standard methods for the examination of wastewater as outlined by American Water Works Association (AWWA). The mean concentrations of As, Cd, Hg and Pb in water samples ranged from 15 μg/L to 325 μg/L (As), 0.17 μg/L to 340 μg/L (Cd), 0.17 μg/L to 122 μg/L (Pb) and 132 μg/L to 866 μg/L (Hg), respectively. These measured concentrations of arsenic (As), mercury (Hg), cadmium (Cd) and lead (Pb) were used as input parameters to calculate the cancer and non-cancer health risks from exposure to these metals in surface water bodies and sediments based on an occupational exposure scenario using central tendency exposure (CTE) and reasonable maximum exposure (RME) parameters. The results of the non-cancer human health risk assessment for small-scale miners working around river Anikoko expressed in terms of hazard quotients based on CTE parameters are as follows: 0.04 (Cd), 1.45 (Pb), 4.60 (Hg) and 1.98 (As); while cancer health risk faced by ASGM miners in Dumase exposed to As in River Mansi via oral ingestion of water is 3.1 × 10(-3). The hazard quotient results obtained from this study in most cases were above the HQ guidance value of 1.0, furthermore the cancer health risk results were found to be higher than the USEPA guidance value of 1 × 10(-4) to 1 × 10(-6). These findings call for case-control epidemiological studies to establish the relationship between exposure to the aforementioned toxic chemicals and diseases associated with them as identified in other studies conducted in different countries as basis for developing policy interventions to address the issue of ASGM mine workers safety in Ghana.

Effectiveness of introducing point of care capillary testing and linking screening with routine appointments for increasing blood lead screening rates of young children: a before-after study

Background

Lead has significant neuro-toxic effects, particularly for young children. Voluntary screening of pre-school aged children for elevated blood lead levels has been an important part of the lead management program in the mining town of Broken Hill (NSW, Australia) since 1991, where lead remains a significant public health issue for young children despite average blood lead levels having fallen by two-thirds. The annual proportion of children screened declined to 0.39 in 2008. The objective of this study was to determine the impact of changing to capillary screening and linking screening with existing routine health programs on participation in blood lead screening by young children in the community.

Methods

We used a before-after study. Screening rates were determined from routinely collected service data and analysed using cross-sectional and cohort analyses.

Results

The proportion of children screened annually increased from 0.39 in 2008 to 0.75 in 2012, with the greatest increases among 11–23 and 48–59 month old children. The proportion of children screened at least once by 24 months increased from 0.63 for children born in 2007 to 0.98 for children born in 2010. Attendance stabilized after capillary screening was introduced, and increased markedly after screening was offered at immunization.

Conclusons

Changing from venous to capillary screening stabilized attendance and improving convenience was associated with dramatically increased screening. Linking screening with well-accepted mainstream child health programs is an effective strategy to improve participation in blood lead screening programs. The findings have implications for improving participation in other health screening programs.

Lead exposure in preterm infants receiving red blood cell transfusions

BACKGROUND

Preterm infants may inadvertently be exposed to lead from the packed red blood cell (pRBC) transfusions with almost no or very limited data available. The aim of the study was to quantify this exposure in preterm infants ≤30 wk gestational age (GA).

METHODS

Prospective cohort study, infants ≤30 wk GA were eligible, infants < 23 wk GA and known chromosomal diseases were excluded. Blood lead levels (BLLs) were obtained at birth, before and after each transfusion, and at discharge. BLLs were also obtained from the donor pRBC aliquot transfused. A linear mixed model analysis was done.

RESULTS

Of 75 infants, 34 received a total of 126 pRBC transfusions. Each infant had an average of 3.7 transfusions. 92% of lead levels in the transfused aliquot were ≤ 5 mcg/dl, 6.8% were between 6-8 mcg/dl and 1 had a level of 56 mcg/dl. Average total lead load was 1.3 mcg/dl. For each 1 mcg/dl increase in transfused pRBC lead level, infant's post-transfusion BLL increased by 0.20 mcg/dl (95% CI: 0.07 mcg/dl, 0.33 mcg/dl; P = 0.002), adjusting for GA and birth weight. There was no significant increase in discharge BLLs, which were similar for both transfused and nontransfused infants.

CONCLUSION

Post-transfusion infant BLLs correlate significantly with the transfused pRBCs lead level.

Environmental determinants of different blood lead levels in children: a quantile analysis from a nationwide survey

Blood lead levels (BLLs) have substantially decreased in recent decades in children in France. However, further reducing exposure is a public health goal because there is no clear toxicological threshold. The identification of the environmental determinants of BLLs as well as risk factors associated with high BLLs is important to update prevention strategies. We aimed to estimate the contribution of environmental sources of lead to different BLLs in children in France. We enrolled 484 children aged from 6months to 6years, in a nationwide cross-sectional survey in 2008-2009. We measured lead concentrations in blood and environmental samples (water, soils, household settled dusts, paints, cosmetics and traditional cookware). We performed two models: a multivariate generalized additive model on the geometric mean (GM), and a quantile regression model on the 10th, 25th, 50th, 75th and 90th quantile of BLLs. The GM of BLLs was 13.8μg/L (=1.38μg/dL) (95% confidence intervals (CI): 12.7-14.9) and the 90th quantile was 25.7μg/L (CI: 24.2-29.5). Household and common area dust, tap water, interior paint, ceramic cookware, traditional cosmetics, playground soil and dust, and environmental tobacco smoke were associated with the GM of BLLs. Household dust and tap water made the largest contributions to both the GM and the 90th quantile of BLLs. The concentration of lead in dust was positively correlated with all quantiles of BLLs even at low concentrations. Lead concentrations in tap water above 5μg/L were also positively correlated with the GM, 75th and 90th quantiles of BLLs in children drinking tap water. Preventative actions must target household settled dust and tap water to reduce the BLLs of children in France. The use of traditional cosmetics should be avoided whereas ceramic cookware should be limited to decorative purposes.

Blood levels of cadmium and lead in residents near abandoned metal mine areas in Korea

We analyzed national data on blood lead levels (BLL) and blood cadmium levels (BCL) in residents living near 38 abandoned metal mining areas (n = 5,682, 18-96 years old) in Korea that were collected by the first Health Effect Surveillance for Residents in Abandoned Metal mines (HESRAM) from 2008 to 2011. The geometric mean BCL and BLL were 1.60 μg/L (95 % CI = 1.57-1.62 μg/L) and 2.87 μg/dL (95 % CI = 2.84-2.90 μg/dL), respectively, notably higher than levels in the general population in Korea and other countries. We found significantly higher BLL and BCL levels in people living within 2 km of an abandoned metal mine (n = 3,165, BCL = 1.87 μg/L, BLL = 2.91 μg/dL) compared to people living more than 2 km away (n = 2,517, BCL = 1.31 μg/L, BLL = 2.82 μg/dL; P < 0.0001) and to the general population values reported in the literature.

Blood and urine levels of heavy metal pollutants in female and male patients with coronary artery disease

BACKGROUND

Heavy metal pollutants such as cadmium (Cd), lead (Pb), and mercury (Hg) are rarely the subjects of cardiovascular research although they have been suspected for decades to negatively impact the circulatory system.

METHODS

Apart from detailed anamnestic data, urinary levels of Cd and full blood levels of Pb and Hg were measured in 53 female (mean age: 68.04±7.03 years) and 111 male (mean age: 60.68±11.43 years) nonsmoking or never-smoking patients with angiographically verified and precisely quantified coronary artery disease (CAD).

RESULTS

Although Cd was quantifiable in 68.3% of subjects, only 34.1% of these patients exceeded the critical 1 μg/L Human Biomonitoring (HBM)-I level. Median Pb (20 μg/L) and Hg (0.55 μg/L) levels were lower than the HBM-I, as well as reference levels of Pb. Wine consumption was the main source for Pb, fish and wine consumption for Hg, and previous nicotine abuse for Cd. There was no correlation between Cd, Pb, or Hg and severity of CAD although severity correlated positively with atherosclerosis parameters (uric acid, creatinine, triglycerides, blood urea nitrogen, C-reactive protein) and negatively with high density lipoprotein cholesterol.

CONCLUSION

Cd levels detected in CAD patients were high compared to German and European reference levels but it could not be proven that urine levels of Cd and blood levels of Hg or Pb played a major role in the genesis of CAD, particularly when compared to well-known biomarkers such as blood pressure, glucose, and lipids.

Blood lead levels and risk factors in young children in France, 2008-2009

BACKGROUND

The exposure of children to lead has decreased in recent years, thanks notably to the banning of leaded gasoline. However, lead exposure remains a matter of public health concern, because no toxicity threshold has been observed, cognitive effects having been demonstrated even at low levels. It is therefore important to update exposure assessments. A national study was conducted, in 2008-2009, to determine the blood lead level (BLL) distribution in children between the ages of six months and six years in France. We also assessed the contribution of environmental factors.

METHODS

This cross-sectional survey included 3831 children recruited at hospitals. Two-stage probability sampling was carried out, with stratification by hospital and French region. Sociodemographic characteristics were recorded, and blood samples and environmental data were collected by questionnaire. Generalized linear model and quantile regression were used to quantify the association between BLL and environmental risk factors.

RESULTS

The geometric mean BLL was 14.9μg/l (95% confidence interval (CI)=[14.5-15.4]) and 0.09% of the children (95% CI=[0.03-0.15]) had BLLs exceeding 100μg/l, 1.5% (95% CI=[0.9-2.1] exceeding 50μg/l. Only slight differences were observed between French regions. Environmental factors significantly associated with BLL were the consumption of tap water in homes with lead service connections, peeling paint or recent renovations in old housing, hand-mouth behavior, passive smoking and having a mother born in a country where lead is often used.

CONCLUSIONS

In children between the ages of one and six years in France, lead exposure has decreased over the last 15 years as in the US and other European countries. Nevertheless still 76,000 children have BLL over 50μg/l and prevention policies must be pursued, especially keeping in mind there is no known toxicity threshold.

Philadelphia's Lead Court is making a difference

The Philadelphia Lead Court (PLC) was created as an innovative law enforcement strategy to compel property owners to comply with city health codes to remediate their properties of lead hazards, which had led to elevated blood lead levels and lead poisoning in resident children. This study presents a detailed account of and analyzes the opinions of fifteen key informants drawn from the Philadelphia health and law departments and judicial system that staff and run the PLC in response to a fifteen-question structured survey. Main themes reviewed include the effectiveness of the PLC as compared with precourt law enforcement strategies and within the context of a specialized court, the use of fines, the impact of grant funding for remediation work, the major advantages and disadvantages of the PLC, and suggested changes to improve court function, followed by key recommendations. The article concludes that our informants found that the PLC has been very effective and successful. This model could be replicated by other cities with similar health code enforcement challenges.