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PubMedDate not supplied

Identifying housing that poisons: a critical step in eliminating childhood lead poisoning.

The purpose of our study was to develop a method to identify and prioritize "high-risk" buildings in Chicago that could be targeted for childhood lead poisoning prevention activities. We defined "high-risk" buildings as those where multiple children younger than 6 years with elevated blood lead levels (BLLs) had lived and where lead hazards were previously identified on environmental inspection. By linking 1997-2003 Chicago elevated blood lead surveillance, environmental inspection, and building footprint data, we found that 49,362 children younger than 6 years with elevated BLLs lived at 30,742 buildings. Of those, 67 were "high-risk" buildings and these were associated with 994 children with elevated BLLs. On average, 15 children with elevated BLLs had lived in each building (range: 10-53, median: 13). Almost two thirds (n = 43) of the high-risk buildings had two or more referrals for inspection to the same apartment or housing unit; of those, 40 percent (n = 17) failed to maintain lead-safe status after compliance. Linking blood lead surveillance, environmental inspection, and building footprint databases allowed us to identify individual high-risk buildings. This approach prioritizes lead hazard control efforts and may help health, housing, and environmental agencies in targeting limited resources to increase lead-safe housing for children.

Chicago↗
PubMed1987

Hazards of 'deleading' homes of children with lead poisoning.

"Deleading" the homes of children with lead poisoning is a necessary step to terminate the child's exposure to lead. Lead poisoning as a result of lead exposure during the process of deleading has occurred in deleading workers but has not been well documented among children whose homes are deleaded. We treated four children with classes I through III lead poisoning (range of blood lead [Pb-B] level, 1.6 to 2.75 mumol/L [33 to 57 micrograms/dL]) who had significant elevation of their Pb-B levels (range, peak 4.34 to 6.27 mumol/L [90 to 130 micrograms/dL]) following deleading of their homes. The methods used for deleading included scraping, sanding, and burning of the paint. Symptoms included irritability (n = 3) and vomiting (n = 1). The elevation of the Pb-B levels was detected early, allowing prompt chelation therapy. Because exacerbation of lead poisoning may occur in children following deleading of their homes, safer approaches of deleading should be determined.

Chelating Agents↗
PubMed1996

Use of the Centers for Disease Control and Prevention childhood lead poisoning risk questionnaire to predict blood lead elevations in pregnant women.

OBJECTIVE: To assess the accuracy of a questionnaire developed by the Centers for Disease Control and Prevention (CDC), given to pregnant women for identification of children at risk for lead poisoning. METHODS: The study population consisted of all 314 new prenatal patients enrolled in health department clinics in 1990-1992. Lead was measured in venous blood, and patients completed written questionnaires to gather information about lead exposure risk factors. The relationship between elevated maternal blood lead levels (at or greater than 10 micrograms/dL or 0.483 mumol/L) and responses to the CDC questionnaire and other questions were examined using chi 2 statistical analysis. RESULTS: Two hundred ninety-nine women provided responses to questions about lead exposure risk. Thirty-nine women (13%) had elevated blood lead levels. A woman with a positive response to at least one CDC question was more likely to have elevated blood lead than a woman who answered negatively to all four CDC questions (relative risk = 2.39, 95% confidence interval 1.17-4.89; P = .01). Using the CDC definition of high risk ("yes" to at least one question), the questionnaire had a sensitivity of 75.7% and a negative predictive value of 93.1%. A questionnaire that combined housing conditions, smoking status, and high consumption of canned foods had a sensitivity of 89.2% and a negative predictive value of 96.4%. A high prevalence of elevated blood lead in children living with women with elevated blood lead was observed. CONCLUSION: Querying pregnant women about risk factors for lead exposure can aid in assessing prenatal lead exposure risk. The sensitivity and negative predictive value of the CDC questionnaire, when used with high-risk women, are comparable to its reported accuracy in young children.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

Can antioxidants be beneficial in the treatment of lead poisoning?

Recent studies have shown that lead causes oxidative stress by inducing the generation of reactive oxygen species, reducing the antioxidant defense system of cells via depleting glutathione, inhibiting sulfhydryl-dependent enzymes, interfering with some essential metals needed for antioxidant enzyme activities, and/or increasing susceptibility of cells to oxidative attack by altering the membrane integrity and fatty acid composition. Consequently, it is plausible that impaired oxidant/antioxidant balance can be partially responsible for the toxic effects of lead. Where enhanced oxidative stress contributes to lead-induced toxicity, restoration of a cell's antioxidant capacity appears to provide a partial remedy. Several studies are underway to determine the effect of antioxidant supplementation following lead exposure. Data suggest that antioxidants may play an important role in abating some hazards of lead. To explain the importance of using antioxidants in treating lead poisoning the following topics are addressed: (i) Oxidative damage caused by lead poisoning; (ii) conventional treatment of lead poisoning and its side effects; and (iii) possible protective effects of antioxidants in lead toxicity.

Aminolevulinic Acid↗
PubMedDate not supplied

Lead poisoning: II. Biological standards for occupational lead exposure--where do we stand now?

Lead poisoning is an occupational and environmental disease of great public health concern. During the past two decades major efforts have been made in many countries to minimize exposure to lead both in the occupational and general environment. Blood lead concentrations at which adverse effects can be detected have become progressively lower. Despite legislation concerning medical surveillance of lead-exposed workers and improvement in environmental control measures that took place during the 1980s, review of recent surveillance data indicates that excessive lead absorption among workers is still a problem in Israel. An approach is suggested for the reporting of surveillance data that will provide safety managers with the information necessary for introducing effective environmental control measures.

Adult↗
PubMed2003

Lead poisoning of seabirds: environmental risks from leaded paint at a decommissioned military base.

The sources and risk factors for lead exposure to humans are relatively well recognized, yet much less is known about lead exposure risks and effects to wildlife. Here we utilized lead isotopic fingerprinting to investigate sources of elevated lead exposure to Laysan albatross (Phoebastria immutabilis) chicks in the Midway Island National Wildlife Refuge, which was established on the site of a decommissioned military base that previously had undergone lead remediation. Whole blood from chicks as well as soil and paint chips from the chicks' nests were collected from birds nesting close to (<5 m, building site) and distant from (>100 m, reference site) buildings and analyzed for lead levels and isotopic compositions using magnetic sector ICP-MS. Blood lead levels of chicks from the building site had a geometric mean of 190 microg/dL (average = 320 +/- 310 SD, range = 6.8-1400, n = 21) as compared to 4.5 microg/dL (average = 6.0 +/- 4.2 SD, range = 1.2-13, n = 15) in chicks from the reference site. Nest soil lead levels from both sites were similar and relatively low (0.05-11 microg/g) unless visibly contaminated with paint chips (building site). Isotopic analyses confirmed that leaded paint was the source of lead poisoning in these chicks and showed that the pathway of exposure was via direct ingestion of paint chips and not through contaminated soil. This study found continued risk to wildlife and possibly humans from lead hazards in a wildlife refuge established on a decommissioned military base. In addition, this study demonstrates the utility of lead isotopes to identify environmental lead hazards and exposure pathways to wildlife.

Animals↗
PubMed1997

Childhood Lead Poisoning in Russia: A Site-specific Pediatric Blood Lead Evaluation.

Lead poisoning in children is an international concern. Health effects vary according to a child's blood lead level. Historically, the problem of lead poisoning in Russia had been defined by analysis of hair samples. In Saratov, Russia, during the spring of 1996, the authors conducted the first evaluation of blood lead levels among Russian children. The mean blood lead level of 579 samples analyzed at the Centers for Disease Control and Prevention was 7.7 µg/dL (range 3.0 to 35.7 µg/dL). The sensitivity of hair analysis in identifying blood lead levels above 10 µg/dL was 50%. Most of the environmental samples evaluated (including water, dust, paint, and soil) were within acceptable U.S. remediation standards. Almost one-fourth of the Russian children evaluated during this site-specific investigation had blood lead levels capable of causing adverse health effects in children. Hair analysis is not an adequate method for identifying these children. Additional investigations in other Russian cities are necessary in order to determine the extent of lead poisoning in Russia's children.

Journal Article↗
PubMed2005

[Weight loss, abdominal pain and anemia after a holiday abroad--case report of lead poisoning].

HISTORY AND ADMISSION FINDINGS: A 58-year-old woman with type 1 diabetes and coronary artery disease was admitted to hospital because of diminished appetite, weight loss, abdominal pain and anemia. Earlier treatment of duodenal ulcer and cholecystectomy had not achieved sustained relief. On physical examination paleness and general weakness was noted. INVESTIGATIONS: Laboratory tests showed a normocytic, normochromic anemia, anisocytosis, polychromasia and basophilic stippling of erythrocytes. Bone marrow examination revealed a hyperreactive erythropoesis with basophilic stippling of erythrocytes and incomplete differentiation of erythroid progenitor cells. Inherited or acquired enzymopathies of erythrocytes were ruled out. Urinary collection showed remarkable elevation of porphyrin concentration. DIAGNOSIS, TREATMENT AND COURSE: Suspected poisoning was confirmed by elevated lead concentrations in whole-blood (85.8 microg/dl) and urine (106.3 microg/l). A souvenir of Rhodes, a ceramic mug with lead-containing glaze, was identified as the source of the lead poisoning, the lead dissolving into hot tea put in the mug. Treatment with D-penicillamine was begun, and within five weeks anemia disappeared and the patient achieved complete resolution of symptoms. CONCLUSION: Recognition of the cause of lead poisoning is of critical importance. This case report demonstrates difficulties in diagnosing and identifying the source of poisoning.

Abdominal Pain↗
PubMed2002

Childhood lead poisoning.

Although the average blood lead levels of Americans have markedly declined, a significant number of children remain at risk. This article discusses the mechanisms of lead poisoning and the screening of children for lead poisoning, and the treatment of symptomatic and asymptomatic children.

Chelation Therapy↗
PubMedDate not supplied

A videotape to improve parental knowledge of lead poisoning.

BACKGROUND: Disadvantaged children are at high risk for lead poisoning. Their parents often have poor knowledge of lead poisoning and do not know how to prevent lead poisoning in their child. OBJECTIVE: To assess an educational videotape's impact on parental knowledge and behavior about lead poisoning. DESIGN: Prospective study by self-administered parental survey immediately before (pretest) and after (posttest 1) well visits and mailed 2-4 weeks later (posttest 2). The intervention group watched the videotape immediately after the pretest. SETTING: Pediatric clinic in tertiary care hospital. PARTICIPANTS: Consecutive sample of parents of 6-month-old to 6-year-old children (n = 146). MAIN OUTCOME MEASURES: Survey included demographic questions, the shortened Chicago Lead Knowledge Test (sCLKT), and questions about parental behaviors. RESULTS: Mean pretest scores were 5.8 (SD, 2.8) and 5.3 (SD, 2.2), posttest 1 scores were 6.0 (SD, 2.6) and 10.6 (SD, 2.1), and posttest 2 scores were 6.1 (SD, 2.8) and 9.5 (SD, 2.8) of 14 in the control and intervention groups, respectively. Control and intervention group posttest 1 and posttest 2 score differences were statistically significant (P <.05). Intervention group parents reported more frequent washing of their child's hands (P <.05) and windows, walls, or floors at study completion (P <.05). CONCLUSIONS: The videotape significantly increased sCLKT scores and behaviors that may decrease children's risk of developing lead poisoning. Improvement persisted throughout the study period.

Analysis of Variance↗
PubMed2000

Ohio APNs: lead poisoning knowledge and practices.

PURPOSE: To determine lead poisoning knowledge and practices of Ohio's advanced practice nurses (APNs). DATA SOURCES: Original research conducted by mailed survey sent to all APNs registered in Ohio (N = 1448). The response rate was 72%. APNs from nine specialties and 70% of counties responded. CONCLUSIONS: Respondents correctly answered approximately 80% of the questions. Knowledge gaps in primary prevention strategies were noted. Of APNs serving pregnant women and/or children < 6 years, 57% screen for lead poisoning and 16% report no one provides lead education. IMPLICATIONS FOR PRACTICE: Lead poisoning is a preventable health problem. Education of APN students and preceptors is needed in the areas of primary lead poisoning prevention issues and practice protocols. Results from this study can help focus educational efforts and outreach programs.

Adult↗
PubMed2004

Interactions between iron deficiency and lead poisoning: epidemiology and pathogenesis.

Iron deficiency and lead poisoning are common among infants and children in many parts of the world, and often these two problems are associated. Both conditions are known to cause anemia and appear to produce a more severe form of anemia when in combination. Although the nature of their relationship is not completely elucidated, characterization of a common iron-lead transporter and epidemiological studies among children strongly suggest that iron deficiency may increase susceptibility to lead poisoning. Recent human studies suggest that high iron intake and sufficient iron stores may reduce the risk of lead poisoning. Future clinical trials are necessary to assess the effect of iron supplementation in the public health prevention of lead poisoning and the kinetics of lead in the body.

Anemia, Iron-Deficiency↗
PubMed1999

Rural residents' knowledge of lead poisoning prevention.

This cross-sectional study assessed rural adults' knowledge of lead poisoning prevention. Residents of three rural Ohio counties were randomly selected to answer 15 True/False lead poisoning prevention questions and 12 demographic questions via telephone. Because not all residents have a phone, the survey was also mailed to Women, Infants and Children (WIC) recipients without phones in the three counties using Dillman's (1978) mailed survey methods. Both groups of respondents correctly answered an average of two-thirds of the questions. In the random sample (n = 1,211) correct scores were related to being elderly, unemployed, female, having a high school education or less, and not being exposed to lead poisoning prevention education during the previous week. Factors predictive of lower lead knowledge scores for the WIC respondents without phones (n = 69) were age (22 and 27 years), unemployment, marital status (married), type of dwelling (other than a single family home or apartment), and having fewer children. Most respondents were able to identify groups at high-risk for lead poisoning, that lead poisoning could occur in ways other than ingestion of lead paint chips, lead poisoning results in long-term learning problems in children, and a blood test is used to determine blood lead levels. Respondents were less knowledgeable about methods of lead exposure and the importance of prevention measures. Gaps in lead poisoning prevention knowledge exist for rural residents and educational efforts should focus on decreasing these gaps.

Adolescent↗
PubMed2006

Abdominal pain due to lead-contaminated opium: a new source of inorganic lead poisoning in Iran.

Although the incidence of occupational and adult lead poisoning has declined, the problem still exists. We encountered three patients with lead poisoning in Iran, all of whom associated with presented with diffuse abdominal pain, which was at times colicky in nature, anemia, constipation, nausea, vomiting, and slightly abnormal liver biochemistries. A history of opium ingestion was present in each of these patients. None of the patients reported known occupational exposure to toxins. Diagnoses of lead poisoning were confirmed through the detection of elevated blood lead levels. The cause of lead poisoning was attributed to the ingestion of contaminated opium. Opium adulterated with lead had not been previously recognized as a source of lead poisoning in Iran. It is, therefore, pointed out that lead poisoning should be considered as a differential diagnosis for acute abdominal colic of unclear cause in patients with opium addiction.

Abdominal Pain↗
PubMed1997

Caregivers' knowledge and perceptions of preventing childhood lead poisoning.

Philadelphia is considered a high-risk area for lead poisoning. The Philadelphia Department of Public Health conducts education and outreach to screen children and promote prevention. Prior to this study there were no systematic data on the community's knowledge and perceptions of lead poisoning prevention. A 32-item questionnaire was developed to assess knowledge and perceptions of family caregivers of children younger than age 8. The survey was interviewer administered in pediatric clinics in two geographic areas of the city with documented severe and moderate lead poisoning rates. Eighty family caregivers were interviewed while waiting to see the pediatrician. Caregivers in the sample were connected to a health care system and resided in areas where lead community outreach was concentrated. Nevertheless, results suggest that even caregivers of children in high-risk areas do not mention lead poisoning as a health concern. About 61% of the sample identified eating paint chips as a cause of lead poisoning, whereas only 15% identified lead paint dust as a source of lead poisoning. Approximately 49% of the caregivers reported that they "never" or only "sometimes" perform recommended prevention activities. The Philadelphia Department of Public Health used these findings to review and modify education and outreach to prevent lead poisoning.

Attitude to Health↗