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PubMed2004

"Getting the lead out" in Hartford, Connecticut: a multifaceted lead-poisoning awareness campaign.

As part of a citywide effort to increase lead poisoning awareness within the city of Hartford, Connecticut, the Hartford Health Department implemented a multifaceted public health campaign involving several novel elements and partnerships, including the use of municipal sanitation trucks to disseminate lead-poisoning prevention messages throughout the city. To evaluate campaign reach and effectiveness, Health Department personnel collected measures of lead-poisoning knowledge, recall of campaign components, and reports of steps taken to prevent lead poisoning from 180 largely ethnic minority parents of preschool-age children. Key results were as follows: a) Recall of campaign components ranged from 21.5 to 62.6%, with newspaper advertisements and signs on buses and billboards recalled most often and a video broadcast on public-access television recalled least often. b) More than 45% of respondents reported that they took steps to prevent lead poisoning because of at least one of the campaign components, with the newspaper advertisements being the most effective component in terms of prompting lead-poisoning prevention behavior. c) Respondents' awareness was particularly low in terms of how medical personnel and procedures can and cannot detect and prevent lead poisoning in children. This campaign prompted caregivers to take steps to prevent lead poisoning and may help public health professionals in other communities to develop novel ideas through which to embark on similar initiatives.

Adult↗
PubMed1998

Retrospective study of the diagnostic criteria in a lead-poisoning survey of waterfowl.

Between 1983 and 1986 the National Wildlife Health Center (NWHC) conducted a nationwide study of lead poisoning of waterfowl from federal and state refuges. This survey was done to assist in identifying zones with lead-poisoning problems. One thousand forty one moribund or dead waterfowl were collected and examined. The presence or absence of 13 gross lesions selected as indicators of lead poisoning and three lesions indicating body condition was recorded. Lead-poisoning diagnoses were based on the finding of at least 6-8 ppm (wet weight) lead in the liver and either lead shot in the gizzard content or at least one convincing gross lesion indicative of lead poisoning. Four hundred twenty-one of these waterfowl were diagnosed as lead poisoned. The NWHC survey provided a comprehensive basis for estimating the sensitivities, specificities, and likelihood ratios of the gross lesions of lead poisoning and the associated hepatic lead concentrations for several species of waterfowl. Some of the 13 defined gross lesions were more common than others; frequencies ranged from 3% to 80% in the 421 lead-poisoned waterfowl. The most reliable indicators of lead poisoning were impactions of the upper alimentary tract, submandibular edema, myocardial necrosis, and biliary discoloration of the liver. Each of the 13 lesions occurred more frequently in the lead-poisoned birds, but each of the lesions also occurred in waterfowl that died of other causes. The number of lead shot present in a bird's gizzard was only weakly correlated with its hepatic lead concentration; however, this weak correlation may have been adequate to account for differences in hepatic lead concentrations among species, once the weights of the species were taken into account. Although lead-poisoned ducks tended to have higher hepatic mean lead concentrations than did lead-poisoned geese or swans, the differences were probably a result of a greater dose of shot per body weight than to kinetic differences between species. Hepatic lead concentrations were independent of age and sex. Ninety-five percent of waterfowl diagnosed as lead poisoned had hepatic lead concentrations of at least 38 ppm dry weight (10 ppm wet weight). Fewer than 1% of the waterfowl that died of other causes had a concentration that high. This fifth percentile, of 38 ppm dry weight (10 ppm wet weight), is a defensible criterion for identifying lead-poisoned waterfowl when interpreting hepatic lead concentrations in the absence of pathological observations.

Animals↗
PubMed1961

The anaemia of lead poisoning.

Three cases of lead poisoning with a hypochromic anaemia, despite adequate iron stores, are presented and discussed.

Anemia↗
PubMed1986

Lead poisoning in a child with a gunshot wound.

Lead poisoning has infrequently resulted from gunshot wounds with retained lead particles in adults. This has not been previously found in children. The case of an 8-year-old boy in whom lead poisoning developed soon after a gunshot wound is reported. The child had no symptoms directly related to lead poisoning, but he received chelation therapy. The case demonstrates the need to consider lead poisoning in children with retained particles following gunshot wounds.

Chelating Agents↗
PubMed1994

Pharmacokinetics of meso-2,3-dimercaptosuccinic acid in patients with lead poisoning and in healthy adults.

We compared the pharmacokinetics of meso-2,3-dimercaptosuccinic acid (DMSA) in three children with lead poisoning, three adults with lead poisoning, and five healthy adult volunteers. All subjects received DMSA orally. Maximum blood concentration and time to maximum blood concentration of total DMSA concentration were not statistically different among the groups. Unaltered DMSA was detected in the blood of all poisoned patients but in only one of five healthy volunteers. Elimination half-life of total DMSA (parent drug plus oxidized metabolites) was longer in children with lead poisoning (3.0 +/- 0.2 hours) than in adults with lead poisoning (1.9 +/- 0.4 hours) and healthy adults (2.0 +/- 0.2 hours). Renal clearance of total DMSA was greater in healthy adults (77.0 +/- 13.2 ml/min per square meter) than in either adults (24.7 +/- 3.3 ml/min per square meter) or children with lead poisoning (16.6 ml/min per square meter); renal clearance of the metabolites of DMSA was also greater in healthy adults (64.6 +/- 10.1 ml/min per square meter) than in either adults (35.4 +/- 8.4 ml/min per square meter) or children with lead poisoning (19.5 ml/min per square meter). The DMSA appeared to enter the erythrocytes of patients with lead poisoning to a greater extent than in healthy adults. We conclude that renal clearance of DMSA and its metabolites may be impaired and that the distribution of DMSA in children with lead poisoning may be different from that in adults.

Adult↗
PubMed1991

Lead poisoning in Hawaii: 1990.

Although lead (Pb) is one of the oldest known and most thoroughly described toxins, it continues to be a significant health hazard in 1990. There has been much progress in defining the nature and extent of low-level lead toxicity during the past decade. There continues to be insidious sources of lead toxicity in our environment, in water, food, paint and contaminated soil. As the epidemiology of lead poisoning is more clearly defined, toxicities are recognized as the result of lower and lower levels of exposure. Recognition of low-level lead exposure and the primary prevention of its effects on health requires a keen awareness of high-risk environments as well as the subtle symptoms and signs of lead poisoning. A high index of suspicion by primary care physicians plus government support are necessary to implement successful prevention programs.

Child, Preschool↗
PubMed1994

The treatment of lead poisoning from gunshot wounds with succimer (DMSA)

Lead poisoning is an unusual complication of gunshot wounds that occurs when retained lead bullet fragments are in contact with body fluids capable of solubilizing lead. The epidemic of violence by gunfire may result in increasing numbers of lead poisoning cases from this exposure. The use of oral chelation for toxicity resulting from this mode of exposure has not been previously discussed. Cases of lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest, and pleural space are reported. A combination of surgical debridement and chelation therapy with oral succimer produced a satisfactory outcome in all three cases. Oral succimer may be a safe and effective chelation agent for treating lead toxicity in adults with high lead levels secondary to gun shot wounds.

Adult↗
PubMed2004

Lead poisoning.

Understanding of lead toxicity has advanced substantially over the past three decades, and focus has shifted from high-dose effects in clinically symptomatic individuals to the consequences of exposure at lower doses that cause no symptoms, particularly in children and fetuses. The availability of more sensitive analytic methods has made it possible to measure lead at much lower concentrations. This advance, along with more refined epidemiological techniques and better outcome measures, has lowered the least observable effect level until it approaches zero. As a consequence, the segment of the population who are diagnosed with exposure to toxic levels has expanded. At the same time, environmental efforts, most importantly the removal of lead from gasoline, have dramatically reduced the amount of lead in the biosphere. The remaining major source of lead is older housing stock. Although the cost of lead paint abatement is measured in billions of dollars, the monetized benefits of such a Herculean task have been shown to far outweigh the costs.

Adolescent↗
PubMedDate not supplied

Preventing lead poisoning and its consequences.

The harmful effects of lead poisoning have been clearly espoused in the literature. All health care providers should be aware of these dangers and of current recommendations for screening for lead poisoning risks and follow-up of blood lead levels. Health education is an important aspect of health care. Pediatric nurses need to understand the hazards of lead poisoning, screening and follow-up recommendations, and have information about lead poisoning and abatement procedures available to families.

Aftercare↗
PubMed1998

Childhood lead poisoning and managed care.

Childhood lead poisoning is a problem that disproportionately affects impoverished children. Many aspects of affected children's lives may be involved in the prevention and treatment of this disease. Changes in child health services are occurring in the context of fundamental changes of virtually all human services. Managed care changes may alter the sites where children get primary care services, the content of that care, and linkages of medical services to public health, nutrition support, housing, mental health, education, and social services. This article discusses the opportunities and the dangers that managed care changes may pose to the prevention and treatment of childhood lead poisoning.

Child Health Services↗
PubMed1974

Lead poisoning in chickens and the effect of lead on interferon and antibody production.

The effect of aqueous lead acetate given per os to chickens for 35 consecutive days and the effect of lead on interferon and antibody production was investigated. Chickens were found to tolerate levels of lead as high as 160 mg/kg/day without exhibiting clinical signs or hematological changes in spite of very high levels of lead in the blood (6.2 ppm). It is apparent from these findings that chickens are more resistant to lead poisoning than humans, horses, dogs and wild fowl such as ducks. Subclinical lead doses did not affect interferon induction in response to statolon and Newcastle Disease virus (NDV)-B(1). Interferon concentrations and duration in serum were markedly decreased in chickens which received lead at the 320 mg/kg level. Long time lead exposure had no marked effect on antibody production to NDV in chickens. No consistent correlation was observed between blood lead concentration and antibody titer. The results of these studies indicate that long term subclinical lead intake suppresses neither interferon nor antibody production in chickens.

Acetates↗
PubMed1970

Demyelinating encephalomyelopathy associated with lead poisoning in nonhuman primates.

Lead poisoning was diagnosed in four primates by the finding of toxic amounts of lead in tissues. Abnormalities in the brain and spinal cord were characterized by vascular lesions and demyelination. These findings suggest a new animal model for the study of demyelination and strengthen the supposition that lead may be a factor in some idiopathic demyelinating diseases.

Animals↗
PubMed2002

Childhood lead poisoning investigations: evaluating a portable instrument for testing soil lead.

The Childhood Lead Poisoning Prevention Branch of the California Department of Health Services evaluated a portable X-ray fluorescence (XRF) instrument for use as a soil lead-testing tool during environmental investigations of lead-poisoned children's homes. A Niton XRF was used to test soil at 119 sampling locations in the yards of 11 San Francisco Bay Area houses. Niton XRF readings were highly correlated with laboratory results and met the study criteria for an acceptable screening method. The data suggest that the most health-protective and time-efficient approach to testing for soil lead above regulatory levels is to take either surface readings or readings of a test cup of soil prepared by grinding with a mortar and pestle. The advantage of the test cup method is that the test cup with soil may be submitted to a laboratory for confirmatory analysis.

Child↗
PubMed2006

Lead poisoning as a result of infertility treatment using herbal remedies.

INTRODUCTION: Lead poisoning remains a major problem in our society due to the lack of awareness of its ill effects among the clinical community. The non-availability of blood lead levels at primary health centers results in many lead-poisoned cases being treated symptomatically, without the diagnosis being sought. CASE REPORT: We report a case here, presenting with colicky abdominal pain receiving symptomatic treatment initially; lead poisoning was confirmed following the estimation of blood lead levels. DISCUSSION: The consumption of unbranded herbal medicines as a causative factor for lead poisoning was confirmed by high lead content in the medicines. Surely, this demands public health programs to disseminate strategies to the medical personnel about the clinical implication of lead poisoning, as well as the general public for awareness and to prevent lead poisoning.

Abdominal Pain↗
PubMed1991

Setting the optimal erythrocyte protoporphyrin screening decision threshold for lead poisoning: a decision analytic approach.

Erythrocyte protoporphyrin (EP) was introduced in the 1970s as an inexpensive screening test for lead poisoning. As greater knowledge of lead poisoning has accumulated, the recommended EP level at which further evaluation for lead poisoning should be initiated has been lowered from greater than or equal to 50 micrograms/dL to greater than or equal to 35 micrograms/dL. The purpose of this study was to evaluate the utility of this EP threshold. A receiver operator characteristic curve was constructed to assess the relationship between the true-positive rate and false-positive rate of EP at various decision thresholds. The receiver operator characteristic curve was constructed with data from the second National Health and Nutrition Examination Survey from 1976 to 1980, which included 2673 children 6 years of age or younger who had both blood lead and EP level determinations. Decision analysis was then used to determine the optimal EP decision threshold for detecting a blood lead level greater than or equal to 25 micrograms/dL. The receiver operator characteristic curve demonstrated that EP is a poor predictor of a blood lead level greater than or equal to 25 micrograms/dL. At the currently recommended EP decision threshold of 35 micrograms/dL, the true-positive rates and false-positive rates of EP are 0.23 and 0.04, respectively. As a result of the inadequate performance of EP screening for lead poisoning, when the prevalence of lead poisoning is greater than 8%, there is no EP decision threshold that optimizes the relationship between the cost of screening normal children and the benefit of detecting lead-poisoned children. Erythrocyte protoporphyrin measurement is not sufficiently sensitive to be recommended uniformly as a screening test for lead poisoning.

Child↗
PubMedDate not supplied

Childhood lead poisoning in Washington state: A statewide survey.

Although childhood lead poisoning is an important health issue in the United States, it is not distributed evenly across the country. To estimate the prevalence of childhood lead poisoning in Washington State, the authors conducted a birth certificate follow-back survey of 1- to 2-year-old children. Interviewers visited participating families at their homes to conduct blood lead tests with a portable testing device. The estimated prevalence of lead poisoning for all 1- to 2-year-old children in the state was 0.9% (95% confidence interval [CI]: 0.3-2.7); for Hispanic children in central Washington, it was 3.7% (95% CI: 1.3-10.2), and their risk of lead poisoning was significantly higher than that of all other children in the state (relative risk [RR] = 5.8, 95% CI: 1.3-24.9). Lead poisoning prevalence in Washington State children is lower than the US average and is highest among Hispanic children in central Washington.

Child, Preschool↗
PubMed2001

Bite the bullet: lead poisoning after ingestion of 206 lead bullets.

A 45-y-o male with a history of schizophrenia was admitted to a local VA psychiatric unit. Five days later, endoscopy due to abdominal pain, gastrointestinal bleeding and blood hemoglobin of 5.6 g/dL revealed bullets in the stomach. On subsequent radiograph, > 50 bullets were visualized in the stomach and intestines. Poison Center recommendations included whole bowel irrigation and a blood lead level. After poor results with gastrointestinal decontamination and a repeat radiograph showing > 100 cartridges, surgical intervention was considered but not performed due to perceived risk of bullet detonation from electrocautery. The blood lead was reported as 391 mcg/dL. Calcium EDTA therapy was initiated, followed by aggressive gastrointestinal decontamination. Four days of whole bowel irrigation facilitated passage of 206 cartridges over the next 10 days. The patient was discharged on a 14-day course of 600 mg Succimer tid to treat the bone lead deposits and blood lead level of 49 mcg/dl. An outpatient visit 6 w later showed the blood lead level had dropped to 24 mcg/dl. Aggressive gastrointestinal decontamination and calcium EDTA and Succimer administration successfully treated an ingestion lead bullets and the resulting lead poisoning.

Antidotes↗
PubMedDate not supplied

Needs assessment and intervention strategies to reduce lead-poisoning risk among low-income Ohio toddlers.

OBJECTIVE: Examine parental receipt of lead-poisoning prevention information and preferred methods of receiving this information. DESIGN: Cross-sectional mailed survey of parents with children 1-2-year-old-enrolled in Medicaid. SAMPLE: Respondents (n=532) were primarily female, white, with at least a high school education, and between the ages of 20-30 years. MEASUREMENTS: Items from the Blood Lead Education and Screening Tool concerning parental receipt of lead-poisoning prevention information, persons with whom parents had discussed lead-poisoning prevention, parental receipt of a reminder about blood lead testing, and parents' preferred methods of obtaining lead-poisoning prevention information. RESULTS: Most respondents had obtained lead-poisoning prevention information, but only 28% reported receiving a reminder to have their child's blood lead level assessed. Brochures and discussions with health care providers were the preferred methods of obtaining lead-poisoning prevention information. More minority respondents preferred receiving information via videos, billboards, and home visits. Younger parents preferred brochures, billboards, and speaking with someone at the health department or women, infants, and children supplemental nutrition (WIC). Most respondents identified multiple means by which they would like to receive lead-poisoning prevention information. CONCLUSIONS: Implementation of individual, community, and system-level interventions by public health nurses are needed for comprehensive lead-poisoning prevention education.

Adult↗