Lead effects among secondary lead smelter workers with blood lead levels below 80 microgram/100 ml

Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health

IMPORTANCE

Millions of adults now entering middle age were exposed to high levels of lead, a developmental neurotoxin, as children. Although childhood lead exposure has been linked to disrupted behavioral development, the long-term consequences for adult mental and behavioral health have not been fully characterized.

OBJECTIVE

To examine whether childhood lead exposure is associated with greater psychopathology across the life course and difficult adult personality traits.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study was based on a population-representative birth cohort of individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand, the Dunedin Multidisciplinary Health and Development Study. Members were followed up in December 2012 when they were 38 years of age. Data analysis was performed from March 14, 2018, to October 24, 2018.

EXPOSURES

Childhood lead exposure ascertained as blood lead levels measured at 11 years of age. Blood lead levels were unrelated to family socioeconomic status.

MAIN OUTCOMES AND MEASURES

Primary outcomes were adult mental health disorder symptoms assessed through clinical interview at 18, 21, 26, 32, and 38 years of age and transformed through confirmatory factor analysis into continuous measures of general psychopathology and internalizing, externalizing, and thought disorder symptoms (all standardized to a mean [SD] of 100 [15]) and adult personality assessed through informant report using the Big Five Personality Inventory (assessing neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) at 26, 32, and 38 years of age (all scores standardized to a mean [SD] of 0 [1]). Hypotheses were formulated after data collection; an analysis plan was posted in advance.

RESULTS

Of 1037 original study members, 579 (55.8%) were tested for lead exposure at 11 years of age (311 [53.7%] male). The mean (SD) blood lead level was 11.08 (4.96) μg/dL. After adjusting for study covariates, each 5-μg/dL increase in childhood blood lead level was associated with a 1.34-point increase (95% CI, 0.11-2.57; P = .03) in general psychopathology, driven by internalizing (b = 1.41; 95% CI, 0.19-2.62; P = .02) and thought disorder (b = 1.30; 95% CI, 0.06-2.54; P = .04) symptoms. Each 5-μg/dL increase in childhood blood lead level was also associated with a 0.10-SD increase in neuroticism (95% CI, 0.02-0.08; P = .02), a 0.09-SD decrease in agreeableness (95% CI, -0.18 to -0.01; P = .03), and a 0.14-SD decrease in conscientiousness (95% CI, -0.25 to -0.03; P = .01). There were no statistically significant associations with informant-rated extraversion (b = -0.09; 95% CI, -0.17 to 0.004; P = .06) and openness to experience (b = -0.07; 95% CI, -0.17 to 0.03; P = .15).

CONCLUSIONS AND RELEVANCE

In this multidecade, longitudinal study of lead-exposed children, higher childhood blood lead level was associated with greater psychopathology across the life course and difficult adult personality traits. Childhood lead exposure may have long-term consequences for adult mental health and personality.

Lead induces an osteoarthritis-like phenotype in articular chondrocytes through disruption of TGF-β signaling

Lead remains a significant environmental toxin, and we believe we may have identified a novel target of lead toxicity in articular chondrocytes. These cells are responsible for the maintenance of joint matrix, and do so under the regulation of TGF-β signaling. As lead is concentrated in articular cartilage, we hypothesize that it can disrupt normal chondrocyte phenotype through suppression of TGF-β signaling. These experiments examine the effects of lead exposure in vivo and in vitro at biologically relevant levels, from 1 nM to 10 µM on viability, collagen levels, matrix degrading enzyme activity, TGF-β signaling, and articular surface morphology. Our results indicate that viability was unchanged at levels ≤100 µM Pb, but low and high level lead in vivo exposure resulted in fibrillation and degeneration of the articular surface. Lead treatment also decreased levels of type II collagen and increased type X collagen, in vivo and in vitro. Additionally, MMP13 activity increased in a dose-dependent manner. Active caspase 3 and 8 were dose-dependently elevated, and treatment with 10 µM Pb resulted in increases of 30% and 500%, respectively. Increasing lead treatment resulted in a corresponding reduction in TGF-β reporter activity, with a 95% reduction at 10µM. Levels of phosphoSmad2 and 3 were suppressed in vitro and in vivo and lead dose-dependently increased Smurf2. These changes closely parallel those seen in osteoarthritis. Over time this phenotypic shift could compromise maintenance of the joint matrix.

A population-based study of blood lead levels in relation to depression in the United States

PURPOSE

Lead is a known neurotoxicant. Several studies have suggested that occupational exposure to lead may lead to depression, anxiety and other psychiatric illness, but few studies have examined environmental lead exposure and depression. We evaluated the relationship between blood lead levels (BLL) and depression in a sample representative of the US population.

METHODS

We analyzed data from 4,159 adults ages ≥20 who participated in the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES). Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). Relative risks were calculated using Poisson regression, and odds ratios were calculated with ordinal logistic regression using SUDAAN, controlling for pertinent covariates.

RESULTS

The risk of depression was only slightly elevated with increasing blood lead levels when lead was modeled as a categorical variable, with adjusted relative risks of 1.16 (95% confidence interval (CI) = 0.99-1.36), 1.20 (CI = 1.07-1.36) and 1.16 (CI = 0.87-1.54) for 0.89-1.40 μg/dL, 1.41-2.17 μg/dL and >2.17 μg/dL, respectively, when compared to 0-0.88 μg/dL using Poisson regression. Similar results were obtained with ordinal logistic regression. Analyses using BLL as a continuous variable did not show a significant relationship with depression.

CONCLUSIONS

This cross-sectional study did not provide consistent evidence for an association between environmental lead exposure and depression within the investigated blood lead levels.

Environmental agents affect skeletal growth and development

In this treatise we will examine complexities in the development and function of cells of the musculoskeletal system. Specifically, the role of chondrocytes and their ontogeny and osteoblasts and their ontogeny will be discussed as they regulate cartilage and bone formation. This background information will provide the foundation for evaluating the effects of environmental toxicants on skeletal development. A number of agents such as heavy metals (i.e. lead) and polycyclic aromatic hydrocarbons (i.e. pesticides and cigarette smoke) interact with cells of the skeletal system and adversely affect development. These agents have not been of major research interest, nevertheless, given changes in the environmental profile of the United States and other developed countries, it is important that we understand their effects in bone and cartilage. Research in this area will identify strategies that may be used to help prevent musculoskeletal diseases due to toxicant exposure.

Lead exposure in battery-factory workers is not associated with anemia

Anemia is a manifestation of lead toxicity. However, there are conflicting reports of its prevalence among lead-exposed workers, and it is uncertain whether they should be monitored by periodic hemoglobin (Hb) examinations. To explore the relationship between Hb and lead exposure, we examined the correlation between Hb, blood lead (PbB), and zinc protoporphyrin (ZPP) levels in 961 blood samples obtained from 94 workers in a lead-acid battery plant in Israel between 1980 and 1993. Blood lead levels exceeded 60 micrograms/dL (2.90 mumol/L) in 105 (14%) of the blood samples. The correlation between PbB and logZPP was 0.594. Hb levels did not correlate with PbB or ZPP. We conclude that (a) periodic Hb determinations are not a useful indicator of lead exposure in Israeli industrial workers; (b) the discrepancies between the reported correlation between PbB and Hb levels remain unexplained and in need of further study; and (c) a finding of anemia in a person with PbB levels of up to 80 micrograms/dL should be considered to be due to lead toxicity only after other causes for anemia have been excluded.

Possible oral lead intake via contaminated facial skin

Thirty-six workers exposed to low or moderate levels of lead at low temperature refining processes were surveyed to examine the route of lead intake. Blood lead level (BPb), delta-aminolevulinic acid in urine, lead in facial skin wipes (Face-Pb) and lead in fingernails (Nail-Pb) were measured and their personal hygienic behavior was surveyed by a questionnaire. BPb showed a significant correlation with Face-Pb and Nail-Pb (r = 0.730 and r = 0.590, respectively). Multiple regression analysis extracted the factors of smoking at the workplace, face-Pb and nail-Pb as significantly related to BPb level. Electron-microscopic observation revealed that the majority of dust particles collected from worker's faces were larger than respirable size. Lead ingestion from contaminated face skin and fingers may contribute to elevations in the BPb level among workers.

The effect of respiratory protection with biological monitoring on the health management of lead workers in a storage battery industry

Respiratory protection with maintenance free respirator and regular biological monitoring with the measurement of zinc protoporphyrin for one year period not only made significant decreases of biological indices indicative of lead exposure (blood lead, delta-aminolevulinic acid in urine) in a storage battery workers, but also reduced the prevalence of lead related symptoms.

Assessment of thyroid, testes, kidney and autonomic nervous system function in lead-exposed workers

The objective of the study was to assess whether moderate occupational exposure to lead may be associated with early changes in potential target organs (thyroid, testes, kidney, autonomic nervous system). Workers exposed to lead in a lead acid battery factory (n = 98; mean blood lead 51 micrograms/dl, range 40-75 micrograms/dl) and 85 control workers were examined. None of the indicators of kidney function (in urine: retinol-binding protein, beta 2-microglobulin, albumin, N-acetyl-beta-D-glucosaminidase; in serum: creatinine, beta 2-microglobulin), endocrine function (follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, thyroxine, triiodothyronine) and autonomic nervous system (R-R interval variations on the electrocardiogram) were correlated with lead exposure (blood lead or duration of exposure) or showed significantly different mean values between the exposed group and controls. These results and an assessment of the published data suggest that compliance with the Directive of the Council of the European Communities on lead exposure (health surveillance in workers whose lead in blood exceeds 40 micrograms/dl and removal from exposure when blood lead exceeds 70-80 micrograms/dl) would prevent the occurrence of significant biological changes in the majority of lead-exposed workers.

Urinary N-acetyl-beta-D-glucosaminidase activity in lead-exposed workers

The adverse effects of long-term exposure to lead dust on renal tubular functions were studied in 39 male and 7 female workers in a secondary lead refinery. Laboratory examinations showed low or moderate lead absorption levels. The N-acetyl-beta-D-glucosaminidase (NAG) activity in urine showed significant correlation with each of the lead exposure indices. NAG activity increased remarkably in lead workers with blood lead (PbB) above 80 micrograms 100g-1. Blood urea nitrogen (BUN) showed significant correlation with PbB and logarithmic urine delta-amino-levulinic acid (log(ALAU)), but not with urine lead (PbU) and logarithmic urine coproporphyrin (log(CPU)). All the other indices of renal function were almost within the normal range and showed no correlation with lead indices. This study suggests that moderate lead absorption may cause renal tubular impairment, and NAG can be one of the most sensitive indices for estimating renal dysfunction due to lead poisoning.

Effects of lead and mercury intoxications on evoked potentials

Pattern reversal, brain stem auditory and somatosensory evoked potentials (PREPs, BAEPs, SEPs) have been recorded on 13 patients occupationally exposed to inorganic lead compounds, in 9 patients occupationally or accidentally exposed to inorganic mercury compounds and in 26 chronic alcoholics. The results were compared to those of a normal control group. Peripheral conduction velocities were decreased in lead exposed workers and in alcoholics, but not modified in the mercury exposed patients. In the three exposed groups, an amplitude increase (PREPs and upper limb SEP cortical components), more important in the mercury group and an increase of central conduction time in case of lower limb stimulation, could be interpreted as early signs of nervous cortical impairment.

Effects of exposure to lead among lead-acid battery factory workers in Sudan

Health effects of occupational exposure to lead were investigated among 92 exposed workers in lead-acid battery factory and 40 nonexposed workers serving as a control group from an oil mill in Khartoum North industrial area. The two groups were closely similar in age, stature, body weight, and socioeconomic conditions. A highly significant increase (P less than .01) was recorded in blood lead, urinary coproporphyrin, and basophilic stippled red blood cells of the exposed group in comparison to the control group. Central nervous system symptoms (insomnia, fatigue, weakness, and drowsiness) were reported by 50% and other symptoms such as abdominal colic and constipation were reported by 41% of the exposed group. Blue line on the gum was detected only on 2% of the exposed group. Strong associations between exposure to lead and the prevalence of central nervous system symptoms, abdominal colic, and constipation were recorded. Exposure to exceedingly high levels of lead in the working environment causes adverse health effects.

Neurobehavioural effects of occupational exposure to lead

A set of neurobehavioural tests selected on the basis of information processing theory was used to study the effect of low level occupational lead exposure on 59 lead workers compared with a matched control group of the same number. Only one of the lead exposed group had a blood lead concentration above the current threshold limit value of 3.81 mumol/l at the time of testing (mean 2.36 mumol/l, range 1.19-3.92 mumol/l) and none had been detected above that level in the previous three years. Nevertheless, most neurobehavioural functions tested showed some impairment in the lead workers. Visual sensory function was affected and, perhaps as a consequence, sustained attention and psychomotor tasks were performed more slowly by the lead exposed group. Cognitive functions were also impaired, with sensory store memory, short term memory, and learning abilities all showing deficits in lead workers. Such cognitive deficits may also be partly due to initial degradation of the visual input. Long term memory performance compared equally with control levels possibly because of development of a compensatory strategy such as rehearsal by the lead exposed subjects. Multiple linear regression analysis relating to lead workers test performance and their lead exposure showed that performance on the sensory store memory test alone was significantly related to exposure. This was probably due to the homogeneity of the lead exposed group with regard to blood lead concentrations and the use of blood lead as a measure of chronic lead exposure.

Neurophysiological studies on workers exposed to lead

Nerve conduction and somatosensory evoked potential studies were undertaken on 46 workers exposed to a combination of organic and inorganic lead. In addition electroencephalograms were carried out on 20 of the workers; the results were compared with those obtained for workers not exposed to lead. The workers exposed to lead had a mean blood lead concentration of 2.35 mumol/l (48.7 micrograms/100 ml), whereas the concentration for workers not exposed to lead was 0.76 mumol/l (15.8 micrograms/100 ml). The mean maximum motor conduction velocities of the median and the posterior tibial nerves were significantly lower in the workers exposed to lead than in the controls. Similarly, the distal latency for these two nerves was significantly prolonged for the workers exposed to lead. No significant differences for the two groups of workers were seen in the nerve conduction and distal latency measurements of the median (sensory) and the sural nerves. The EEG studies of the 20 workers exposed to lead showed no abnormalities. The somatosensory evoked potential of the median (sensory) and posterior tibial nerves were significantly prolonged when measured at the negative and positive deflections. The results suggest that, in addition to nerve conduction velocities, somatosensory evoked potential and distal latency are suitable measurements to detect subclinical neurological damage among workers exposed to lead. As these changes were seen at blood lead concentrations of 2.35 mumol/l (48.7 micrograms/100 ml) there may be a need for more stringent monitoring of workers exposed to lead.

Saccadic eye movements among copper smelter workers

Saccade accuracy was studied in 87 copper smelter workers. Findings were compared with those obtained in 52 lead-exposed automobile production workers and 52 controls examined as part of a separate study. Both groups of workers showed a decrease in saccade accuracy compared to controls. Saccade accuracy was reduced in copper smelter workers over 50 years of age compared to automobile production workers in this age group. Decreased saccade accuracy was not correlated with blood lead (Pb-B), zinc protoporphyrin (ZPP), or urinary arsenic (As-U) levels among copper smelter workers, but was significantly correlated with both Pb-B and ZPP in the group of automobile production workers. Saccade accuracy decreased significantly with age and duration of exposure only in the group of copper smelter workers. Complex exposures to lead and other toxic agents present in the smelter may account for the reduction in saccade accuracy among copper smelter workers.

Occupational lead exposure. Effects on saccadic eye movements

Quantitative measures of saccadic eye movements were examined in 52 lead exposed autobody shop workers and 52 age matched controls with no history of occupational lead exposure. Three characteristics of saccadic eye movements were studied: 1) saccade accuracy; 2) number of overshoots; and 3) maximum velocity. The results indicated that workers exposed to inorganic lead showed a decrease in saccade accuracy and an increase in overshoots compared with controls. Saccade maximum velocity was lower in lead exposed workers than in controls but the difference was just short of statistical significance. Correlations between measures of saccadic eye movements and indicators of lead absorption--blood lead (Pb-B) and zinc protoporphyrin (ZPP) levels--were analyzed in the lead exposed workers. Saccade accuracy was negatively correlated with both Pb-B and ZPP levels. The number of overshoots was not correlated with either Pb-B or ZPP levels. Saccade maximum velocity was not correlated with Pb-B, however, there was a significant negative correlation with ZPP. Age effects observed in the control group were disrupted in lead exposed workers. In addition, saccadic eye movements in younger workers (below 30 years old) were more affected by exposure to inorganic lead than were saccadic eye movements in older workers (50 years and older). It is proposed that these findings are consistent with a relatively rapid buildup of metabolically active lead burden observed in the study group. The data suggest that quantitative assessment of eye movements may be an important tool for studying subclinical central nervous system (CNS) dysfunction due to inorganic lead exposure.

Lead neuropathy

The still unexplained nature of the neurotropic action of lead has prompted this chronological survey of the course of development of the medical attitude towards the problems of lead neuropathy all along the centuries--from ancient times up to the present. Once a conspicuous, severe, and even frequent clinical type of plumbism, peripheral lead neuropathy has received due attention in the early classics (Tanquerel des Plances, Duchenne, Aran, Remak, Romberg, Erb, etc.) and of the pioneers in industrial medicine (Legge, Aub, Teleky, Hamilton). Even the modern era, however, has not come further than to state that lead produces different neurological effects in different animal species and even in humans--different patterns of neuromuscular involvement. With the advent of electrophysiology, conflicting and inconsistent findings have also appeared, particularly in regard to overt and latent lead neuropathies. Theories regarding the mode and site of the neurotoxic action of lead are reviewed and data which might be used as arguments both in favor and against are presented.

Blood lead and the symptoms of lead absorption

ABSTRACT Eighty-one percent of all hourly paid men who had been employed for more than six months in a factory making lead acid batteries and plastics completed a modified Cornell medical index health questionnaire. Blood lead and erythrocyte protoporphyrin (EPP) were also measured. The questions were grouped into symptom categories as follows: all physical, all psychological, “potentially lead induced,” pulmonary, cardiovascular, gastrointestinal, skin, nervous system, genitourinary, and fatigue. For each symptom category the pooled percentages of men whose symptom scores were above the common median of the three blood lead groups 10-, 40-, and 60 and over μg/100 ml (0·48-, 1·93-, and 2·90 and over μmol/l) within age/smoking subgroups were calculated. In every symptom category the percentages in the two lower blood lead groups differed little, but the percentages were consistently higher in men with blood concentration of 60 μg/100 ml (2·90 μmol/l) and over. Differences between a combined 10-59 μg/100 ml (0·48-2·85 μmol/l) blood lead group and the 60 and over μg/100 ml (≥2·90 μmol/l) group were statistically significant at the 0·01 level for “potentially lead induced” symptoms and at the 0·05 level for skin and psychological symptoms. Broadly similar results were obtained with four log₁₀ EPP groups 0·6-, 1·5-, 1·7-, and ≥2·0, but differences did not reach statistical significance. There was no obvious explanation as to why symptoms that are not found in classic lead poisoning should be increased almost as much as those that are. It was thought that these results could be biased due to the men's knowledge of the symptoms associated with lead exposure, but the possibility that they may be partly due to lead absorption cannot be excluded.

Health effects of low level occupational exposure to lead: the trail, British Columbia study

Blood lead (PbB) was measured in a sample of 245 lead smelter employees and their wives in Trail, B.C. and 144 controls in Nelson, B.C. Smelter workers were divided into three groups according to lead exposure: (1) directly-exposed, (2) indirectly-exposed, and (3) office workers. The average PbB values found (41, 33, and 16 micrograms/dl, respectively) reflected exposure level. In the highest exposure group, male smokers had significantly higher PbB concentrations than nonsmokers (44 vs. 37 micrograms/dl). For exposed males, average number of "days off work ill" increased with increasing PbB range and significant correlations were found between PbB values and five biologically plausible health symptoms. None of those symptoms planted to detect response bias correlated. Because of a 4-month strike, PbB values were measured in a sub-sample from each exposure group before and 1, 2, and 4 months after smelter operation resumed. Exposed workers' PbB levels stabilized after 1 month's operation.

Neuropsychological test results and symptoms among workers with well-defined long-term exposure to lead

Lead intoxication is a classical environmental hazard that can cause encephalopathy. During recent years several studies have suggested poor performances in psychological tests and increased numbers of subjective symptoms among workers with comparatively low blood lead concentrations. Forty-nine long-term lead-exposed male workers with time-weighted average blood lead concentrations between 1.3 and 3.3 mumol/l calculated from at least seven years' results have been compared with a referent group of 27 male industrial workers with normal blood lead concentrations and comparable intellectual backgrounds. Several indices of exposure were used. Both groups were examined with neuropsychological tests and a questionnaire covering neuropsychiatric symptoms. The exposed group performed less well in 11 of 14 non-verbal tests, and there were significant differences in tests of memory and reaction time. A non-linear dose-effect trend was indicated. The results are in accordance with those found in similar studies, and it is concluded that the blood lead concentration should be below 2.5 mumol/l to avoid the effects shown in this study.

Subjective symptoms in workers with low-level exposure to lead

In an attempt to identify health effects associated with low-level lead exposure, 45 cable-manufacturing workers underwent clinical examinations in a cross-sectional study. Thirteen workers were in direct contact with lead-containing stabilizers, while 31 were only indirectly exposed. The directly exposed had a higher prevalence of reported neurological and gastrointestinal symptoms than those with low or insignificant lead exposure. None of the directly exposed had blood lead levels exceeding 60 micrograms per 100 ml. The clinical symptoms correlated with blood lead and zinc protoporphyrin. However, when the data were subjected to hierarchical log-linear modeling, a partial association was found between zinc protoporphyrin and symptoms, but not between blood lead and symptoms. The data suggest that non-specific neurological and gastrointestinal symptoms may occur at relatively low blood lead and zinc protoporphyrin levels, and that measurement of zinc protoporphyrin and exploration of clinical symptoms are valuable components in lead screening programs.

A composite index of lead effects. Comparative study of four occupational groups with different levels of lead absorption

Biological indicators of lead effects on the central nervous system (CNS), hematogenous bone marrow, and kidney function as measured by performance tests, hemoglobin (Hgb) and BUN levels respectively were combined in an integrative index (INDEX). Such an index was calculated by removing age effects in measures of performance and kidney function and then transforming all the variables to Z (standard) units. The relationships between INDEX and biological indicators of lead exposure and absorption (Pb-B and ZPP) were studied in four groups: 191 non-lead exposed males (control group), 169 copper smelter workers, 133 autobody shop workers and 87 secondary lead smelter workers. We found that: 1) the magnitude of the correlation coefficient between INDEX and ZPP was much higher than were the correlations between the various single indicators of lead effects (performance test scores, Hgb, and BUN); and 2) the magnitude of the correlation coefficients was related to the degree of lead exposure and absorption (as reflected in distribution patterns of Pb-B and ZPP) in each group. The concept of an integrative index of biological effects of lead is important for the evaluation of early manifestations of lead toxicity and also for the correct assessment of adverse health effects of lesser intensity than those characteristic for the classic picture of overt lead poisoning.

Additive statistical effects of cadmium and lead on heart-related disease in a North Carolina autopsy series

The association of heart-related mortality with tissue cadmium and lead in a study of autopsies performed on persons who resided in a soft-water, leached-soil area of North Carolina was examined. Liver cadmium concentrations and aortic lead level were indices of these elements. Both cadmium and lead levels had statistically significant correlations with cause of death (heart-related disease vs. non-heart-related disease, excluding cancer). Although cause of death was significantly associated with age, the association with cadmium and lead persisted after statistical adjustment for the effect of age. The combined effects of cadmium and lead provided sufficient information in an additive model to predict cause of death correctly for 80% of the cases, with age contributing insignificantly. These findings indicate the intimate relation of these two trace metals with increased risk of heart-related mortality, even in light of known conventional causes of such deaths.

Lead poisoning and the blood-brain barrier

Lead exposure may produce varying degrees of neuropsychiatric manifestations from discrete phenomena, quite often seen in children and as an occupational disease, to the rate fulminant lead encephalopathy. It was determined whether or not damage of the blood-brain barrier permeability in adult rats, as has been demonstrated in neonatal animals exposed to lead, could also play a role. Massive lead exposure did not induce any change in the transfer (facilitated diffusion) of phenylalanine any tyrosine measured by means of the indicator dilution technique. Ultrastructural examination, after application of horseradish peroxidase, did not reveal any pathological changes in the permeability to the tracer. It is concluded that in adult rats, in contrast to neonatal animals, the observed pathological signs clearly seen in the chronically exposed animals must be ascribed to a noxious influence of lead on the extravascular side of the blood-brain barrier.

An integrative index of biological effects of lead

Biological indicators of lead effects on the central nervous system (as measured by performance tests), hematogenous bone marrow (hemoglobin levels) and kidney function (BUN Levels) can be combined in an integrative index (INDEX). This integrative index can be in turn related to indicators of lead exposure and absorption. Such an index was calculated by removing age effects in measures of performance and kidney function and then transforming all the variables to Z (standard) units. Secondary lead smelter workers and a control group were studied. In secondary lead smelter workers this INDEX was found to be significantly correlated with ZPP, blood lead levels, and duration of lead exposure. In this population the magnitude of the correlation coefficients with ZPP levels was much higher than than for blood lead levels. INDEX had a higher correlation with ZPP than with each of its components: performance test scores, hemoglobin, and BUN levels. Although performance test scores, hemoglobin, and BUN levels were shown to discriminate between the control, non-lead-exposed population, and the lead-exposed group, INDEX (and particularly one pair of its components, CNS and hemoglobin levels) achieved the best discrimination between groups. The concept of an integrative index of biological effects of lead may be especially useful in defining populations at high risk for developing chronic, potentially irreversible neurologic and kidney dysfunction, and in assessing the severity of lead effects in individual cases.

Zinc protoporphyrin, blood lead and clinical symptoms in two occupational groups with low-level exposure to lead

The results of cross-sectional clinical field surveys of 45 cable manufacturing workers and 90 telephone cable splicers are presented. Despite the rare occurrence of clinically overt lead poisoning among these occupational groups, high prevalence of lead-associated central nervous system symptoms and gastrointestinal symptoms was found. Hierarchical log-linear models for multidimensional contingency tables were fitted to those data and indicate that there is a partial correlation between reported symptoms and zinc protoporphyrin: individuals with high zinc protoporphyrin levels were more likely to report symptoms than those with low levels. No significant partial association was found between symptoms and blood lead. Because of the intermittent lead exposure encountered in one of the populations, individuals were identified with "normal" blood lead levels associated with "elevated" zinc protoporphyrin concentrations, thus indicating the difference in the biological significance between indicators of lead absorption (blood lead) and of biological response tests (ZPP). Suggestion is made that both types of diagnostic tests be utilized in the medical surveillance of lead-exposed workers.

Lead exposure and behavioral changes: comparisons of four occupational groups with different levels of lead absorption

The association between lead absorption and objective psychological performance tests in five groups with different levels of lead absorption was studied in the following groups: (1) a control, non-lead-exposed group; (2) cable splicers, (3) cable manufactures, and (4) secondary lead smelter workers. The following performance tests were used: Block Design, Digit Symbol, and Embedded Figures. Age-corrected performance test scores and the average of three test scores (INDEX) were used throughout. A significant association between performance tests scores and increased lead absorption was found. Zinc protoporphyrin level was a more "powerful" (in the statistical sense) indicator of lead-induced CNS effects than blood lead levels. This study provides additional evidence that neurotoxic effects associated with occupational exposure to lead can be demonstrated by means of performance tests. It has been known and widely accepted that increased lead absorption is associated with "non-specific" subjective symptoms: tiredness, sleep disturbance, irritability, etc. Psychometric techniques (including an appropriate statistical analysis strategy) are highly sensitive for the early detection of CNS neurotoxicity, such as metal toxicity. Moreover, even in lead-exposed but asymptomatic individuals, a significant correlation (negative) between test scores and levels of lead absorption could be detected. It is concluded that workers exposed to lead at levels considered "safe" might be at risk of developing brain dysfunction with long term exposure.