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Allaouat S, Reddy VK, Räsänen K, Khan S, Lumens ME. Educational interventions for preventing lead poisoning in workers. Cochrane Database Syst Rev 2020; 2020:CD013097. [PMID: 35819457 PMCID: PMC8095058 DOI: 10.1002/14651858.cd013097.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Occupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness. OBJECTIVES To assess the effect of educational interventions for preventing lead uptake in workers exposed to lead. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions. SELECTION CRITERIA We sought randomised controlled trials (RCT), cluster-RCTs (cRCT), interrupted time series (ITS), controlled before-after studies (CBA) and uncontrolled before-after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS-I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence. MAIN RESULTS We did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before-after studies studies, conducted between 1982 and 2004. Blood lead levels Educational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short-term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low-certainty evidence). In the medium-term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low-certainty evidence). In the long-term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low-certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI -0.11 to 2.31; one study, 52 participants, very low-certainty evidence). Urine lead levels In the long-term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low-certainty evidence). Behaviour change The evidence is very uncertain about the effect of educational intervention on behaviour change. At medium-term follow-up after the educational intervention, very low-certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40). At long-term follow-up, very low-certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81). Improved knowledge or awareness of the adverse health effects of lead The evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium-term follow-up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low-certainty evidence). At long-term follow-up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low-certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low-certainty evidence). None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention. AUTHORS' CONCLUSIONS Educational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.
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Affiliation(s)
- Sara Allaouat
- Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Viraj K Reddy
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Kimmo Räsänen
- Institute of Public Health and Clinical Nutrition, Occupational Health Unit, University of Eastern Finland, Kuopio, Finland
| | - Sohaib Khan
- Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mieke Egl Lumens
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
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Fernández-Macías JC, González-Mille DJ, García-Arreola ME, Cruz-Santiago O, Rivero-Pérez NE, Pérez-Vázquez F, Ilizaliturri-Hernández CA. Integrated probabilistic risk assessment in sites contaminated with arsenic and lead by long-term mining liabilities in San Luis Potosi, Mexico. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 197:110568. [PMID: 32283412 DOI: 10.1016/j.ecoenv.2020.110568] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Mining environmental liabilities (MEL) in San Luis Potosi are the result of more than 450 years of mining activity, which has contaminated the soil mainly with arsenic (As) and lead (Pb) in several areas. Risk assessments are used to estimate the possibility of the occurrence of adverse effects on human health or on ecological receptors; and the most accessible way of performing them is through probabilistic estimates such as the Latin Hypercube Sampling (LHS) model. Therefore, the aim of this study was to carry out an Integrated Probabilistic Environmental Risk Assessment (IPERA) for the estimation of health risks in infants and rodents. The mean concentrations of As and Pb in soil were significantly higher (p<0.05) in all contaminated sites than in their respective reference sites. Villa de la Paz was the site with the highest mean concentration of As (1374 mg/kg), while Charcas was the one with the highest level of Pb (12,929 mg/kg). The Hazard Quotient (HQ) was calculated and Villa de la Paz had the highest values of As in both rodents (11.994) and children (39.32), and Charcas showed the highest values of Pb in both (24.971 and 31.668 for rodents and children respectively). The cumulative hazard Index (HI) reveals there is a very significant health risk due to As and Pb exposure for both rodents and children in contaminated areas of these mining communities.
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Affiliation(s)
- Juan C Fernández-Macías
- Facultad de Medicina-Centro de Investigación Aplicada en Ambiente y Salud, Universidad Autónoma de San Luis Potosí, Coordinación para la Aplicación de la Ciencia y la Tecnología- (CIACyT-CIAAS), San Luis Potosí, México
| | - Donaji J González-Mille
- Cátedras Consejo Nacional de Ciencia y Tecnologí (CONACyT), Universidad Autónoma de San Luis Potosí, México
| | | | - Omar Cruz-Santiago
- Facultad de Medicina-Centro de Investigación Aplicada en Ambiente y Salud, Universidad Autónoma de San Luis Potosí, Coordinación para la Aplicación de la Ciencia y la Tecnología- (CIACyT-CIAAS), San Luis Potosí, México
| | - Norma E Rivero-Pérez
- Centro Regional de Investigación en Salud Pública-Instituto Nacional de Salud Pública (CRISP-INSP), Tapachula, Chiapas, México
| | - Francisco Pérez-Vázquez
- Cátedras Consejo Nacional de Ciencia y Tecnologí (CONACyT), Universidad Autónoma de San Luis Potosí, México
| | - César A Ilizaliturri-Hernández
- Facultad de Medicina-Centro de Investigación Aplicada en Ambiente y Salud, Universidad Autónoma de San Luis Potosí, Coordinación para la Aplicación de la Ciencia y la Tecnología- (CIACyT-CIAAS), San Luis Potosí, México.
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Flores-Ramírez R, Pérez-Vázquez FJ, Medellín-Garibay SE, Camacho Aldrete A, Vallejo-Pérez M, Díaz de León-Martínez L, Carrizales Yáñez L, Díaz-Barriga F. Exposure to Mixtures of Pollutants in Mexican Children from Marginalized Urban Areas. Ann Glob Health 2018; 84:250-256. [PMID: 30873770 PMCID: PMC6748268 DOI: 10.29024/aogh.912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Exposure to contaminant mixtures in developing countries is an important public health issue. Children are identified as the most susceptible group to adverse health effects due to the exposure. Objective: The aim of this study was to conduct a screening for mixture pollutants in Mexican children in urban marginalized communities. Methods: We analyzed children (aged 6–12 years old) who resided in four urban marginalized communities in San Luis Potosi, Mexico: i) Bellas Lomas (BEL), a site with vehicular traffic; ii) Tercera Chica (TC), a site with brick kilns; Iii) Rincon de San Jose (SJR), a site with a hazardous waste landfill; and (iv) Morales (MOR) a metallurgical zone with copper-arsenic and electrolytic zinc smelters. Polycyclic Aromatic Hydrocarbons (1-hydroxypyrene (1-OHP)), benzene (trans, trans-muconic acid (t,t-MA), manganese, arsenic and fluoride were quantified in urine and lead in blood samples. Findings: Our results indicate that median exposures to manganese were 4.4, 5.2, 5.8 and 6.3 µg/L for BEL, TC, SJR and MOR, respectively. For BEL, fluoride was present at a higher concentration with 2.3 mg/L followed by MOR, TC and SJR with 1.7, 1.5 and 1.2 mg/L respectively. The highest concentrations of arsenic that were found were 11 µg/L in MOR and lead concentration was reported between 4.2 and 6.8 µg/dL, in BEL, TC and MOR. 1-OHP and t,t-MA were higher in TC (0.23 µmol/mol creatinine (cr), 429.7 µg/g cr, respectively) followed by SJR (0.09 µmol/mol cr, 427.4 µg/g cr), MOR (0.03 µmol/mol cr, 258.6 µg/g cr) and BEL (0.06 µmol/mol cr, 220.6 µg/g cr). Conclusion: Considering the large number of people, especially children, exposed to multiple pollutants, it is important to design effective intervention programs that reduce exposure and the resultant risk in the numerous urban marginalized communities in Mexico.
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Affiliation(s)
- Rogelio Flores-Ramírez
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, MX
| | - Francisco J Pérez-Vázquez
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
| | - Susanna E Medellín-Garibay
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
| | - Andrea Camacho Aldrete
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
| | - Moisés Vallejo-Pérez
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, SLP, MX
| | - Lorena Díaz de León-Martínez
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
| | - Leticia Carrizales Yáñez
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
| | - Fernando Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, SLP, MX
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Börner S, Albino JCT, Caraveo LMN, Tejeda ACC. Exploring Mexican adolescents' perceptions of environmental health risks: a photographic approach to risk analysis. CIENCIA & SAUDE COLETIVA 2017; 20:1617-27. [PMID: 26017963 DOI: 10.1590/1413-81232015205.11382014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/15/2014] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to explore Mexican adolescents' perceptions of environmental health risks in contaminated urban areas, and to test the environmental photography technique as a research tool for engaging adolescents in community-based health research. The study was conducted with 74 adolescents from two communities in the city of San Luis Potosi, Mexico. Participants were provided with disposable cameras and asked to take photographs of elements and situations which they believed affected their personal health both at home and outside their homes. They were also asked to describe each photograph in writing. Photographs and written explanations were analyzed by using quantitative and qualitative content analysis. Risk perception plays a crucial role in the development of Risk Communication Programs (RCPs) aimed at the improvement of community health. The photography technique opens up a promising field for environmental health research since it affords a realistic and concise impression of the perceived risks. Adolescents in both communities perceived different environmental health risks as detrimental to their well-being, e.g. waste, air pollution, and lack of hygiene. Yet, some knowledge gaps remain which need to be addressed.
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Affiliation(s)
- Susanne Börner
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México,
| | - Juan Carlos Torrico Albino
- Institute for Technology and Resources Management in the Tropics and Subtropics, Cologne University of Applied Sciences, Germany
| | | | - Ana Cristina Cubillas Tejeda
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México,
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Flores-Ramírez R, Pérez-Vázquez FJ, Rodríguez-Aguilar M, Medellín-Garibay SE, Van Brussel E, Cubillas-Tejeda AC, Carrizales-Yáñez L, Díaz-Barriga F. Biomonitoring of persistent organic pollutants (POPs) in child populations living near contaminated sites in Mexico. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 579:1120-1126. [PMID: 27908622 DOI: 10.1016/j.scitotenv.2016.11.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/05/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to conduct a POP biomonitoring programme for children in high-risk areas. We evaluated 247 serum samples from children between the ages of 6 and 12years old from two zones in Mexico: (1) indigenous zones, which included Cuatlamayan (CUA), Tocoy (TOC), and Santa Maria Picula (SAM); and (2) industrial zones, which included Tercera Chica (TC), Industrial San Luis (IND) and Rincon de San Jose (SJR); Mundo Nuevo (MN); and Alpuyeca (ALP). Our results showed that α-endosulfan was similar to CUA, TOC, SAM, TC and MN (178.6-306.9ng/g lipid). β-Endosulfan levels were higher in ALP (901.5ng/g lipid), followed by CUA (139.9ng/g lipid) and TOC, SAM, TC and MN, which had similar levels (55.4-64.5ng/g lipid). For endosulfan sulfate, the ALP community had the highest concentration levels (1096.4ng/g lipid), whereas CUA and TOC (212.3 and 289ng/g lipid, respectively) had concentrations similar to those found in SAM and TC (99.5 and 119.1ng/g lipid, respectively). DDE levels were found in malaria-endemic areas of SAM, CUA and TOC (1782.2, 1358.3 and 57.0ng/g lipid), followed by MN (35.1ng/g lipid). HCB concentration levels were found to be higher in MN and SJR (691.8 and 575.4ng/g lipid, respectively), followed by CUA and TC (363.9 and 269.1ng/g lipid, respectively), with levels similar to those found in TOC and SAM (191.8 and 181.9ng/g lipid, respectively). Finally, PCB 101 concentration levels were found to be the highest in ALP (1032.7ng/g lipid), followed by similar levels of SJR and IND (567.5 and 327.3ng/g lipid, respectively) and TC and MN, with 109.1 and 144.5ng/g lipid, respectively. The evidence provided by this exploratory study indicates that the evaluation of the health risks posed to children living in contaminated areas is a high priority health issue.
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Affiliation(s)
- R Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Mexico.
| | - F J Pérez-Vázquez
- Department of Physics & Astronomy, The University of Texas at San Antonio (UTSA), San Antonio, TX, USA
| | - M Rodríguez-Aguilar
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Laboratorio de Salud Total, Mexico
| | | | - E Van Brussel
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Laboratorio de Salud Total, Mexico
| | - A C Cubillas-Tejeda
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, Mexico
| | - L Carrizales-Yáñez
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Laboratorio de Salud Total, Mexico
| | - F Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Laboratorio de Salud Total, Mexico
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Alegría-Torres JA, Carrizales-Yánez L, Díaz-Barriga F, Rosso-Camacho F, Motta V, Tarantini L, Bollati V. DNA methylation changes in Mexican children exposed to arsenic from two historic mining areas in San Luis potosí. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2016; 57:717-723. [PMID: 27862296 DOI: 10.1002/em.22062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/24/2016] [Indexed: 05/24/2023]
Abstract
Arsenic is a carcinogen and epimutagen that threatens the health of exposed populations worldwide. In this study, we examined the methylation status of Alu and long interspersed nucleotide elements (LINE-1) and their association with levels of urinary arsenic in 84 Mexican children between 6 and 12 years old from two historic mining areas in the State of San Luis Potosí, Mexico. Urinary arsenic levels were determined by atomic absorption spectrophotometry and DNA methylation analysis was performed in peripheral blood leukocytes by bisulfite-pyrosequencing. The geometric mean of urinary arsenic was 26.44 µg/g Cr (range 1.93-139.35). No significant differences in urinary arsenic or methylation patterns due to gender were observed. A positive correlation was found between urinary arsenic and the mean percentage of methylated cytosines in Alu sequences (Spearman correlation coefficient r = 0.532, P < 0.001), and a trend of LINE-1 hypomethylation was also observed (Spearman correlation coefficient r = -0.232, P = 0.038) after adjustment for sex and age. A linear regression model showed an association with log-normalized urinary arsenic for Alu (β = 1.05, 95% CI: 0.67; 1.43, P < 0.001) and LINE-1 (β = -0.703, 95% CI: -1.36; -0.38, P = 0.038). Despite the low-level arsenic exposure, a subtle epigenetic imbalance measured as DNA methylation was detected in the leukocytes of Mexican children living in two historic mining areas. Environ. Mol. Mutagen. 57:717-723, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jorge Alejandro Alegría-Torres
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, México
- Laboratorio de Investigación Molecular en Nutrición (LIMON), Universidad del Centro de México UCEM, San Luis Potosí, México
| | - Leticia Carrizales-Yánez
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, México
| | - Fernando Díaz-Barriga
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, México
| | - Fernando Rosso-Camacho
- Laboratorio de Investigación Molecular en Nutrición (LIMON), Universidad del Centro de México UCEM, San Luis Potosí, México
| | - Valeria Motta
- Department of Clinical Sciences and Community Health, EPIGET - Epidemiology, Epigenetics and Toxicology Laboratory, University of Milano, Milan, Italy
- Epidemiology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Tarantini
- Department of Clinical Sciences and Community Health, EPIGET - Epidemiology, Epigenetics and Toxicology Laboratory, University of Milano, Milan, Italy
- Epidemiology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, EPIGET - Epidemiology, Epigenetics and Toxicology Laboratory, University of Milano, Milan, Italy
- Epidemiology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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Pfadenhauer LM, Burns J, Rohwer A, Rehfuess EA. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review. ENVIRONMENTAL RESEARCH 2016; 147:525-36. [PMID: 26990846 DOI: 10.1016/j.envres.2016.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 05/19/2023]
Abstract
OBJECTIVES The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels (BLLs) and associated health outcomes in children, pregnant women and the general population. METHODS Searches were run in MEDLINE, EMBASE and the Global Health Library up until August 2015. Studies were eligible for inclusion if they assessed the impact of regulatory, environmental or educational interventions, stand-alone or in combination, on BLLs among children, pregnant women or the general population through randomized controlled trials (RCT), controlled before-after (CBA), interrupted time series (ITS), uncontrolled before-after (UBA) or repeated cross-sectional studies. Studies assessing the impact of interventions to reduce exposure to lead in paint or household dust as well as studies concerned exclusively with environmental concentrations of lead were not included. As documented in a detailed protocol, screening, data extraction and quality appraisal were largely undertaken according to Cochrane standards. Harvest plots were used to graphically summarize evidence of effectiveness. RESULTS The searches yielded 6466 unique records, of which five met our eligibility criteria; two additional eligible studies were identified by experts. We did not find any studies regarding the effectiveness of regulatory, educational or environmental interventions targeting exposure to lead in consumer products. Evidence regarding the effectiveness of interventions in reducing BLLs from exposures through drinking water is limited in both quantity and quality. Stand-alone targeted educational interventions showed no statistically significant reductions in children's BLL (two RCT) when compared to general educational interventions. Likewise, instructing women to reduce or eliminate lead-contaminated drinking water showed no effect on BLL (one RCT). Stand-alone environmental interventions appeared more promising in reducing BLL (three UBA). Combining educational and environmental interventions and targeting multiple settings may be effective in reducing BLL, as suggested by one uncontrolled before-after study. No studies examining the effectiveness of regulatory interventions were found. CONCLUSIONS The limited quantity and quality of the evidence measuring BLL and associated health outcomes points to an urgent need for more robust research into the effectiveness of interventions to reduce lead exposure from consumer products and drinking water, especially for regulatory interventions.
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Affiliation(s)
- Lisa Maria Pfadenhauer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Jacob Burns
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Anke Rohwer
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl drive, Parow, 7500, South Africa
| | - Eva Annette Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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