Household interventions for secondary prevention of domestic lead exposure in children

A Multigenerational Model of Environmental Risk for Black, Indigenous, and People of Color (BIPOC) Children and Families

BACKGROUND

In recent years, public discourse has increasingly brought institutional and structural racism to the foreground of discussion on the well-being of BIPOC (Black, Indigenous, and People of Color) communities. Environmental toxicity in combination with the social triggers of institutional and structural racism are among the factors that shape the short- and long-term health of BIPOC Americans across multiple lifespans.

OBJECTIVES

We outline a 2 + Generation Model for examining the mechanisms through which institutional and structural racism promotes the intergenerational transmission of environmental health risk and family and interpersonal relationships across the life course and across multiple generations. We present the model's theoretical underpinnings and rationale, discuss model limitations and needed sources of data, and implications for research, policy, and intervention.

DISCUSSION

Parents and children are not only biologically linked in terms of transmission of environmental toxicities, but they are also linked socially and intergenerationally. The 2 + Generation Model foregrounds family and interpersonal relationships occurring within developmental contexts that are influenced by environmental toxicity as well as institutional and structural racism. In sum, the 2 + Generation Model highlights the need for an equity-first interdisciplinary approach to environmental health and redirects the burden of risk reduction away from the individual and onto the institutions and structures that perpetuate the racial disparities in exposure. Doing so requires institutional investment in expanded, multigenerational, and multimethod datasets. https://doi.org/10.1289/EHP13110.

Integral trends in research of lead exposure and child health from 2012 to 2022: a bibliometric analysis

Lead poisoning in children is a non-negligible and ongoing threat to children's health and optimal development worldwide. There is no sufficient scientometric analysis available on this subject, though. Aiming to uncover the research development, hotspots, and possible future orientation, we performed a scientometric analysis of related publications from 2012 to 2022. Initial information was accessed using the "Analysis Results" and "Create Citation Report" sections of the Web of Science core collection database, which were utilized to find original publications in this field of research. Biblioshiny and VOSviewer software were applied to further analyze and visualize the data. The research addressed a range of topics, including yearly publications, highly cited articles, co-cited references, journals, authors, nations, organizations, and keywords. A total of 883 articles were retrieved. From 2018 to 2021, the annual publication output was abundant and peaked in 2019. Among 111 countries, the USA obtained the highest number of documents issued, total citations, and total link strength. Meanwhile, most of the top 15 institutions, including the top four, are located in the USA. Further, we spotted greater scopes with development potential, including enhancing records to lessen exposure to harmful risks, improving methods for observing lead sources, and elucidating the gradient link between lead poisoning symptoms and concentrations. We anticipate that our research will assist researchers in summarizing previous research and providing perspectives for workable prospective study topics.

Role of environmental lead in the occurrence of anemia in Indian children: a systematic review and meta-analysis

Exposure to lead among children, as well as adults, is a major global health issue. With diverse routes of exposure (e.g., food, air, and water) either environmentally or occupationally, lead among children can cause mild, moderate, to severe health complications in the later stages of life. The average blood lead level reported by CDC in 2021 is 3.5 µg/dL, and the level of blood lead toxicity is ≥ 10 μg/dL. In this study, we planned to systematically analyze the association between blood lead levels (BLLs) (≥ 10 μg/dL and < 10 μg/dL) and the risk of anemia (hemoglobin level < 11 g/dL) among Indian children aged between ≥ 1 and ≤ 18 years. An online literature search of 5 databases, PubMed, Ovid, EMBASE, Web of Science, and Google Scholar was accomplished with a search updated until 8^th March 2021. Study designs included cohort, cross-sectional, and case-control studies that have evaluated the association of lead toxicity or exposure with anemia (Hb < 11 g/dL) reported in urban and/or rural Indian children. Meta-analysis was performed among a total of 864 children from 4 cross-sectional studies. The association between lead toxicity (BLLs ≥ 10 μg/dL) and the risk of being anemic was not statistically significant (RR = 1.15 (95% CI: 0.86-1.55, I² = 77%). The risks of bias in all included studies were low according to the Newcastle Ottawa Scale. Increased blood lead levels did not appear to be the major contributor to anemia in Indian Children. We need to focus primarily on improving the nutritional quality, fortified food supplements, and a balanced diet for children to reduce the anemia burden in India. Lead toxicity should be sought as an etiological factor only in areas of high environmental risk factors which were leaded paints, leaded batteries, a house near major road/traffic areas, and pesticide exposure.

Estimating the Effects of Soil Remediation on Children's Blood Lead near a Former Lead Smelter in Omaha, Nebraska, USA

BACKGROUND

Lead exposures from legacy sources threaten children's health. Soil in Omaha, Nebraska, was contaminated by emissions from a lead smelter and refinery. The U.S. Environmental Protection Agency excavated and replaced contaminated soil at the Omaha Lead Superfund Site between 1999 and 2016.

OBJECTIVES

The goal of this study was to assess the association of soil lead level (SLL) and soil remediation status with blood lead levels (BLLs) in children living near or on the site.

METHODS

We linked information on SLL at residential properties with children's BLLs and assigned remediation status to children's BLL measurements based on whether their measurements occurred during residence at remediated or unremediated properties. We examined the association of SLL and remediation status with elevated BLL (EBLL). We distinguished the roles of temporal trend and the intervention with time-by-intervention-status interaction contrasts. All analyses estimated odds ratios (ORs) with a generalized estimating equations approach to ensure robustness under the complex correlations among BLL measurements. All analyses controlled for relevant covariates including children's characteristics.

RESULTS

EBLL (>5μg/dL) was associated with both residential SLL [e.g., OR=2.00; 95% confidence interval (CI): 1.83, 2.19; >400-800 vs. ≤200 ppm] and neighborhood SLL [e.g., OR=1.85 (95% CI: 1.62, 2.11; >400-800 vs. ≤200 ppm)] before remediation but only with neighborhood SLL after remediation. The odds of EBLL were higher before remediation [OR 1.52 (95% CI: 1.34, 1.72)]. Similarly, EBLL was positively associated with preremediation status in our interaction analysis [interaction OR=1.18 (95%CI: 1.02, 1.37)].

DISCUSSION

Residential and neighborhood SLLs were important predictors of EBLLs in children residing near or on this Superfund site. Neighborhood SLL remained a strong predictor following remediation. Our data analyses showed the benefit of soil remediation. Results from the interaction analyses should be interpreted cautiously due to imperfect correspondence of remediation times between remediation and comparison groups. https://doi.org/10.1289/EHP8657.

Effectiveness of interventions for the remediation of lead-contaminated soil to prevent or reduce lead exposure - A systematic review

OBJECTIVE

To summarize the evidence on the effectiveness of soil remediation to prevent or reduce lead exposure.

METHODS

We systematically searched MEDLINE, the Agricultural & Environmental Science Database, Web of Science, and Scopus from 1980 to February 15, 2021. We also performed reference list checking, hand-searched websites, and contacted experts. Eligible studies evaluated the effect of soil remediation to prevent or reduce lead exposure in humans of any age. We screened all records dually; one investigator performed the data extraction; a second checked for completeness and accuracy. Two investigators independently rated the risk of bias of included studies and graded the certainty of evidence. We synthesized findings narratively.

RESULTS

We identified 6614 potentially relevant publications, all focused on children, of which five studies (six records) fulfilled our prespecified inclusion criteria. The number of evaluated participants ranged from 31 to 1425, with follow-up periods of 11 months to one year. The primary soil remediation method was the replacement of the upper layer with clean soil. Outcomes were limited to blood lead levels (BLL), dust lead levels, and soil lead levels. The largest study, a controlled before- after study (n = 1425) reported favorable effects of soil remediation compared to no intervention. This finding was consistent with results from two cross-sectional studies and one uncontrolled before-after study. One year post-remediation, the mean reduction in BLL was 2.1 μg/dL (p < 0.0001) greater in the intervention group than in the control group. Two randomized controlled trials with a total of 511 participants showed no statistically significant incremental effect of soil remediation when combined with paint and/or dust abatement. The certainty of evidence for all outcomes was low.

CONCLUSION

Soil remediation appears to reduce BLL in children when used as a single intervention. The incremental benefit of soil remediation when part of other interventions is limited.

Assessment of Urinary Lead (Pb) and Essential Trace Elements in Autism Spectrum Disorder: a Case-Control Study Among Preschool Children in Malaysia

Lead (Pb) is a heavy metal which is abundant in the environment and known to cause neurotoxicity in children even at minute concentration. However, the trace elements calcium (Ca), magnesium (Mg), zinc (Zn) and iron (Fe) are essential to children due to its protective effect on neurodevelopment. The primary objective of this study was to assess the role of Pb and trace elements in the development of autism spectrum disorder (ASD) among preschool children. A total of 81 ASD children and 74 typically developed (TD) children aged between 3 and 6 years participated in the study. Self-administered online questionnaires were completed by the parents. A first-morning urine sample was collected in a sterile polyethene urine container and assayed for Pb, Ca, Mg, Zn and Fe using an inductively coupled plasma mass spectrometry (ICP-MS). Comparisons between groups revealed that the urinary Pb, Mg, Zn and Fe levels in ASD children were significantly lower than TD children. The odds of ASD reduced significantly by 5.0% and 23.0% with an increment of every 1.0 μg/dL urinary Zn and Fe, respectively. Post interaction analysis showed that the odds of ASD reduced significantly by 11.0% and 0.1% with an increment of every 1.0 μg/dL urinary Zn and Pb, respectively. A significantly lower urinary Pb level in ASD children than TD children may be due to their poor detoxifying mechanism. Also, the significantly lower urinary Zn and Fe levels in ASD children may augment the neurotoxic effect of Pb.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

[Psychological stress during the COVID-19 pandemic: consequences for psychiatric patients and therapeutic implications]

BACKGROUND

The outbreak of the COVID-19 disease and the rapid spread of the inducing coronavirus SARS-CoV‑2 threatens not only people's physical health but also their mental health. Its influence on incidence and course of existing illnesses in the psychiatric outpatient sector in Germany is still unknown.

METHODS

The medical reports of 682 persons in psychiatric treatment were retrospectively investigated, regarding their subjective response to this pandemic and its clinical relevance.

RESULTS

Of the patients 60.5% (n = 378) experienced greater psychological stress, 14.5% (n = 99) reported fear of the SARS-CoV‑2 and the possible danger of infection, 25.5% (n = 174) reported fear resulting from the protective measures taken (lock down) and 4.3% (n = 29) reported fear of both. This differed significantly across diagnoses: people with anxiety disorders reported significantly greater stress as well as greater fear of the virus, whereas people with psychoses were significantly less affected than the other patients. Of the participants 43.7% (n = 132) were so strongly affected that acute treatment had to be implemented and 6.0% (n = 18) had to be referred to inpatient care.

DISCUSSION

People with mental illnesses are particularly vulnerable to the psychological strain of the COVID-19 pandemic. Long-term studies on the further course of disease will be necessary. Additional studies that test interventions to build resilience in this population will also be needed.