Purpose: The substantial impact of indoor air quality and environmental hazards in the home on one’s health has long been recognized in the field of public health. This cross-sectional study investigates the risk between home based hazards, specifically lead, and respiratory health in children. The objective of this study is to examine the extent to which children testing positive for blood lead exposure are at an increased risk for having poor respiratory health. Methods: A nationally representative sample of 977 children ages 1- 6 years was obtained from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Information from the demographic, blood lead level, and respiratory health questionnaire databases were combined to assess the impact of lead exposure on respiratory health. Blood lead exposure (BLL) was assessed at the following cut-off values: 1, 2, 3, 4, 5 and 10ug/dL. Respiratory health status was dichotomized as good and poor respiratory health based on the study participant’s answers to the questionnaire. Logistic regression was used to determine the relationship between blood lead levels and respiratory health status while controlling for the following potential confounders: race, age, sex, and annual family income. Results: This study was unable to establish a relationship between lead exposure and poor respiratory health in children ages 1-6 years, and the lack of relationship held for increasing levels of lead exposure. However, this study did reveal the significant impact of low level lead exposure in children with approximately 77% exposed at BLL ≥ 1ug/dL and 39% at BLL ≥ 2ug/dL. It is important to note that this is only a snapshot of the amount of lead exposure within this population; it is very likely that the levels fluctuate. Conclusion: While the percentage of study population decreases as the lead exposure increases, it is still alarming at the number of children exposed to low levels of lead. A large and growing body of literature documents the adverse health effects associated with low levels of lead exposure in children. This finding further supports the need for continuing research in examining the true impact of low level lead exposure and in determining a threshold dose level. In addition, a stronger study with a larger sample size and a more clearly defined respiratory health variable would allow for the relationship to be more closely examined before a definitive “no association” result can be made.

Les jeunes enfants sont les plus exposés au plomb et les plus sensibles à ses effets sur la santé, notamment sur le développement. Une enquête d’imprégnation sur 3831 enfants vivant en France a permis d’établir la moyenne géométrique des expositions au plomb à 14,9 (+/- 0,5) µg/L de sang avec 76000 enfants au-delà du seuil d’intervention obligatoire de 50µg/L. Les critères actuels de dépistage se sont avérés peu aptes à repérer ces enfants surexposés et de nouveaux critères sont proposés. En complément, une enquête environnementale avec mesures de plomb dans le logement a été réalisée dans 484 logements. Les poussières au sol des habitations et l’eau du robinet sont des facteurs important de surexposition, ainsi que l’utilisation de vaisselle et cosmétiques traditionnels. Les politiques de prévention doivent être poursuivies compte tenu de la persistance de sources d’exposition et de la toxicité même à faible dose. / Young children are most exposed to lead and the most susceptible to its health effects, notably on development. A nationwide representative survey on 3831 children in France has established the geometric mean of lead exposures at 14.9 (+/- 0.5) µg/L of blood with 76000 children beyond the mandatory action level of 50μg / L. The current screening criteria have proved insufficient to identify these overexposed children and new ones are proposed. In addition, an environmental investigation with lead measurements in housing was performed in 484 homes. Household floor dust and tap water are major factors of overexposure, and also the use of traditional dishes and cosmetics. Prevention policies must be pursued in light of the continuing sources of exposure and toxicity even at low doses.

Around the world, women are subject to an earlier incidence of cataracts, have a higher risk for cataracts, and also have a higher risk for other vision-related problems than men. Previous research has indicated an association between endogenous lead stored in long bones and cataracts in men over 60 years of age; however, a similar study in women did not reveal an association. This case control study was conducted to investigate whether perimenopausal mobilization of endogenous lead serves as a possible causative factor for women's generalized vision issues and cataract incidence in particular. Secondary data were gathered from 1,416 women aged 40 to 55 years of age from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Surveys. Variables of interest included vision-related issues, cataract surgeries, bone density data, blood lead levels, and markers of lead mobilization. The results of the logistic regression analysis in the absence of confounders (OR = 1.50, 95% CI [1.08, 2.09]) indicated that endogenous lead is a possible causative factor for the low-level vision problems women experience during their perimenopausal years. Chi-square analysis of mobilized lead was also associated with cataract surgeries, p < .05. This appears to be the first report of a possible association between lead and cataracts in women and highlights the need for women to be studied in the context of their biology when their clinical results differ from those of men. These results should engender positive social change initiatives to minimize women's perimenopausal exposure to endogenous lead. Recommendations for further research include a case control study, which includes plasma lead levels, and a longitudinal study.

Indiana University-Purdue University Indianapolis (IUPUI)

No description available.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13438号 / 論医博第2237号 / 新制||医||1054(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 滝田 順子, 教授 万代 昌紀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

The issue of lead exposure through drinking water was re-examined in light of modern public health goals, recent high-profile cases of elevated lead in water, and emerging concerns regarding the efficacy of legally mandated remedial strategies. A critical literature review revealed that serious lead-in-water hazards are present at many US schools and homes, and that the threat to individuals is not eliminated by existing regulations. Health studies have provided strong links between lead in water and lead in blood of exposed populations, even at relatively low levels of exposure compared to reported lead occurrence in US tap water samples. As efforts shift from addressing pervasive lead sources that once elevated the blood lead of large percentages of the population, to more isolated individual cases requiring exceptional attention, the importance of carefully considering lead in water as a potential source for elevated blood lead increases. Consistent with decades of prior research linking elevated water lead to elevated blood lead (EBL), lead-contaminated water in the high-profile case of Washington DC markedly increased the incidence of EBL for very young children. Specifically, incidence of EBL for children aged ≤ 1.3 years increased more than 4 times during 2001-2003 when lead in water was high, compared to 2000 when lead in water was low. The incidence of EBL for children aged ≤ 1.3 years was highly correlated (R² = 0.81) to 90th percentile lead-in-water levels from 2000-2007, and the risk of exposure to high water lead levels varied markedly in different neighborhoods of the city. Analysis conducted herein focused on identifying "worst-case" neighborhoods and populations. Specifically, this was the first study of the Washington DC case to focus on infants who are most vulnerable to harm from lead in water, and to perform smaller area analysis at the neighborhood (i.e., zip code) level in order to capture pockets of high risk among local communities. Prior biokinetic modeling efforts, examining the potential adverse impacts of lead-in-water exposure, were re-examined to explicitly consider new public health goals. This included impacts on the most sensitive population groups (e.g., young children and particularly formula-fed infants), the potential variability in blood lead levels (BLLs) amongst exposed individuals within those groups (e.g., most sensitive children at the upper tail of the BLL distribution), more conservative BLL thresholds reflecting low-level adverse effects (e.g., 5, 2 and 1 µg/dL versus 10 µg/dL), and the possibility of acute health impacts. This re-evaluation creates a paradigm shift, in that levels of lead in water that were previously considered inconsequential are demonstrated to be of concern in specific circumstances. The replacement of lead service lines in front of consumers' homes is a costly, federally mandated remedial action if a water utility exceeds the US EPA lead action level. Because utilities do not own the entire lead service line, they often only replace the portion of the service line up to the property line, typically with copper pipe. Experiences in Washington DC, as revealed by Freedom of Information Act requests, indicated that partial pipe replacements were not decreasing lead in water, and were actually associated with relatively high incidence of childhood lead poisoning. This prompted the first comprehensive investigation of potential long-term problems arising from galvanic corrosion between the remaining lead pipe and the newly installed copper pipe. Bench-scale experiments demonstrated that galvanic connections between lead pipe (new or aged) and copper pipe increased lead release into the water by 1.1-16 times, when compared to a full length of lead pipe alone. The small area of lead pipe adjacent to the copper joint (<0.5 ft) was gravely affected by galvanic corrosion, and accumulated a thick lead-rust layer (1 inch wide) that constituted a reservoir for semi-random particulate lead detachment into the water. The work on simulated partial pipe replacements revealed that under worst-case scenarios of highly contaminated water samples, most of the lead was not quantified if water samples were not mixed thoroughly after standard preservation (i.e., after addition of 0.15% v/v HNO₃), or if water samples were transferred from one bottle to another prior to preservation. While there is no reason to believe that sample handling and pre-treatment dramatically skew regulatory compliance with the US EPA lead action level, slight variations from one approved protocol to another may cause lead-in-water health risks to be dramatically underestimated. This is of special concern in unusual situations of "worst-case" individual exposures to highly contaminated water, associated with childhood lead poisoning. This work provides the water industry and health agencies with important new insights and perspectives on an old problem. Results can improve strategies to detect and mitigate lead-in-water hazards for individuals or populations, and inform future revisions to the US EPA Lead and Copper Rule. / Ph. D.

Lead is a toxic heavy metal that has been extensively used in modern society, causing widespread environmental contamination, even in isolated parts of the world. There is now overwhelming evidence associating lead exposure with wideranging health effects, including reductions in intelligence scores, hyperactivity, shortened concentration spans, poor school performance, violent/aggressive behaviour, hearing loss, delayed onset of puberty, anaemia, and in severe cases, coma and death. In recent years consensus has been reached in respect of the absence of a threshold of safety for key health effects associated with lead exposure, and the permanent and irreversible nature of many of the health and social consequences of exposure to lead. The public health problem of environmental lead exposure has been widely investigated in developed countries such as the United States of America where, since the 1970s, policies and interventions have been followed by significant reductions in blood lead levels amongst children. In developing countries, and in African countries in particular, there is a relative dearth of information on the sources, mechanisms of exposure and blood lead distributions in children, and little action has been taken to protect children against lead poisoning. This study was undertaken to determine the current distribution of blood lead concentrations, and associated risk factors, amongst selected groups of first grade school children in the South African urban settings of Cape Town, Johannesburg 7 and Kimberley, a lead mining town (Aggeneys) and two rural towns in the Northern Cape province. A further objective of the study was to compare blood lead distributions determined in the current study with the findings of similar studies undertaken prior to the introduction in 1996 of unleaded petrol in South Africa. The results show that over the past decade, blood lead concentrations amongst first grade school children have declined considerably, but that large proportions of children, especially those living or attending school in impoverished areas, continue to have intolerably high blood lead concentrations, within a range that puts them at risk of detrimental health and social outcomes. The major sources of exposure to lead in the samples studied were leaded petrol, lead-based paint used to decorate homes and schools, lead solder used in “cottage industries” and other home-based lead-related activities, as well as the transfer of lead particles from lead-related work settings into homes. Recommendations for policy and relevant interventions for the South African context are discussed.

No description available.

A exposição a baixos níveis de chumbo é associada a desordens cognitivas e neurológicas em crianças. Foi descrito um aumento dos níveis de chumbo no sangue de crianças que vivem em comunidades que recebem água fluoretada. Este estudo testou se flúor a 100 ppm na forma de ácido fluorsilícico na água induziria aumento na concentração de chumbo no sangue e tecidos calcificados de ratos Wistar expostos a baixos níveis de chumbo desde a idade gestacional. Ratas foram separadas em quatro grupos: controle e grupos que receberam água que continham 100 mg/L de fluoreto (F), 30 mg/L de chumbo (Pb), ou 100 mg/L de F e 30 mg/L de Pb (F+Pb), desde uma semana antes do acasalamento até que os filhotes completassem 81 dias. Todos os animais foram pesados ao longo do experimento. Sangue e tecidos calcificados foram coletados com 81 dias para análise de chumbo, flúor e fósforo em esmalte, dentina, osso total, osso superficial e sangue. Chumbo foi determinado por ICP-MS (Inductively Coupled Plasma Mass Spectrometry). Flúor foi medido através de elétrodo íon-específico e fósforo foi determinado por reação colorimétrica. As concentrações de chumbo triplicaram no grupo F+Pb (76.7±11.0 µg/dL) em comparação ao grupo Pb (22.6±8.5 µg/dL)(p <0.001), com a mesma tendência observada em todos os tecidos calcificados analisados (p <0.001 para todas as comparações). No esmalte, as concentrações de chumbo analisadas foram 2.5 vezes mais altas no grupo F+Pb em comparação ao grupo Pb (4,369±1,353 µg/g versus 1,768±1,892 µg/g). Na dentina, a concentração de chumbo encontrada no grupo F+Pb era 8.5±2.0 µg/g versus 4.9±1.7 µg/g no grupo Pb. Na superfície óssea, a concentração de chumbo encontrada no grupo F+Pb era 3.1 vezes maior do que as determinadas no grupo Pb, com 28.0±10.6 e 9.0±3.7 µg/g nos grupos F+Pb e Pb, respectivamente. No osso total, os valores de chumbo dobraram no grupo F+Pb (14.2±2.6 µg/g) em comparação com o grupo Pb (6.8±1.7 µg/g). Os valores de chumbo estavam abaixo do limite de detecção na maioria das amostras dos grupos Controle e F. As concentrações de flúor aumentaram em ambos os grupos expostos a flúor (F e F+Pb), com diferenças estatisticamente significantes dos grupos controle e Pb, mas nenhuma diferença foi encontrada nas concentrações de F entre os grupos F e F+Pb em quaisquer dos tecidos calcificados testados. Em conclusão, este estudo mostra um aumento nas concentrações de chumbo no sangue total, esmalte, dentina, superfície óssea e osso total em ratas com 81 dias expostas ao flúor e chumbo desde o período pré-natal. / Low-level lead exposure is linked to cognitive and neurological disorders in children. An increased risk for higher blood lead levels was described for children living in communities that receive fluoridated-water. This study tested whether water fluoride would induce increases in the blood and calcified tissue lead concentrations in Wistar rats exposed to low lead levels since gestational age. Female rats were allocated in four groups: control, and 3 groups that received water containing 100 mg/L of fluoride (F), 30 mg/L of lead (Pb), or 100 mg/L of F and 30 mg/L of Pb (F+Pb). Females mated and delivered their pups receiving the same water treatment. Female pups were maintained on the same water regimen until day 81. Lead was determined by ICP-MS (Inductively Coupled Plasma Mass Spectrometry), and fluoride was measured by ion-specific electrode in the whole blood, superficial enamel, dentine, surface bane, and whole bane. Mean whole blood lead concentrations triplicated in the F+Pb group (76.7±11.0 µg/dL) in comparison to the Pb group (22.6±8.5 µg/dL)(p < 0.001), with the same trend observed in all calcified tissues analyzed (p < 0.001 for all comparisons). In the enamel, mean lead concentrations were 2.5 times higher in the F+Pb group compared with the Pb group (4,369±1,353 µg/g versus 1,768±892 µg/g). In dentine, mean lead concentration found in F+Pb group was 8.5 ±2.0 µg/g versus 4.9±1.7 µg/g in the Pb group. In the bane surface, the mean lead concentration found in the F+Pb group was 3.1 times that determined in the Pb animals, with 28.0±10.6 and 9.0±3.7 µg/g in the F+Pb and Pb groups, respectively. In whole bane, mean lead values doubled in the F+Pb group (14.2±2.6 µg/g) in comparison with the Pb group (6.8±1.7 µg/g). Lead values were below detection limit in most Control and F group samples. Fluoride concentrations were increased in both groups exposed to fluoride (F and F+Pb), with statistically significant differences from the control and Pb groups, but no differences in the F concentrations were found between the F and F+Pb group in any of the calcified tissues tested. In conclusion, this study shows a fluoride-induced increase in the concentrations of lead of whole blood, enamel, dentine, surface bane and whole bane of 81-day female rats exposed to lead since gestational age, suggesting that a biological effect not recognized so far may underlie the epidemiological association between increased blood lead levels in children living in water-fluoridated communities.