Childhood lead poisoning: the torturous path from science to policy

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Several heavy metals and other chemical elements are natural components of the Earth's crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients' outcomes.

Liquid-liquid equilibrium experiment and mechanism analysis of menthol-based deep eutectic solvents extraction for separation of fuel additive tert-butanol

Deep eutectic solvents (DESs) were synthesized using menthol as hydrogen bond acceptor (HBA) and different carbon chain carboxylic acids as hydrogen bond donors (HBD). The liquid equilibrium (LLE) experiment was used to determine the distribution coefficient (β) and slectivity (S) at standard atmospheric pressure and temperature. The effect of DESs on the separation efficiency was discussed by changing the proportion. Non-random two fluid (NRTL) model was used to correlate the experimental data. The molecular dynamics (MD) simulation method was used to investigate the micro mechanism of the extraction process. The results show van der Waals force plays a leading role in the interaction between solvents and tert-butyl alcohol (TBA) and week force with water. Compared with experimental and simulation results, the interaction between DESs and TBA would also be affected by the change of the number of HBD carbon chains, and DESs with decanoic acid as HBD has the best separation effect, which verifies the feasibility of separating high alcohol compounds from water by DESs and then treating them by DESs.

Reprint of: Elemental dysregulation in psychotic spectrum disorders: A review and research synthesis

Accumulating evidence from observational studies, genetic research, and animal models suggests a relationship between toxic and nutritive elements and psychotic spectrum disorders (PSD). This review systematically evaluates the current research evidence for two hypotheses: 1) that exposures to abnormal levels of toxic and nutritive elements early in life contributes to the subsequent development of PSD, and 2) that an imbalance of element levels is linked to psychotic illness and clinical severity. We focused on the extant literature on five elements, lead (Pb), copper (Cu), magnesium (Mg), manganese (Mn), and zinc (Zn), because of their previously documented associations with psychiatric problems and the availability of pertinent literature. The review identified 38 studies of which 11 measured Pb, 27 measured Cu, 16 measured Mg, 15 measured Mn, and 25 measured Zn concentrations in PSD patients and controls. A majority of research has been conducted on nutritive element imbalance, and findings are largely mixed. While it is biologically plausible that element dysregulation is an important modifiable risk factor for PSD, more research into exposure in early life is needed to better characterize this relationship.

Patterns of Children's Blood Lead Screening and Blood Lead Levels in North Carolina, 2011-2018-Who Is Tested, Who Is Missed?

BACKGROUND

No safe level of lead in blood has been identified. Blood lead testing is required for children on Medicaid, but it is at the discretion of providers and parents for others. Elevated blood lead levels (EBLLs) cannot be identified in children who are not tested.

OBJECTIVES

The aims of this research were to identify determinants of lead testing and EBLLs among North Carolina children and estimate the number of additional children with EBLLs among those not tested.

METHODS

We linked geocoded North Carolina birth certificates from 2011-2016 to 2010 U.S. Census data and North Carolina blood lead test results from 2011-2018. We estimated the probability of being screened for lead and created inverse probability (IP) of testing weights. We evaluated the risk of an EBLL of ≥3μg/dL at <30  months of age, conditional on characteristics at birth, using generalized linear models and then applied IP weights to account for missing blood lead results among unscreened children. We estimated the number of additional children with EBLLs of all North Carolina children using the IP-weighted population and bootstrapping to produce 95% credible intervals (CrI).

RESULTS

Mothers of the 63.5% of children (402,002 of 633,159) linked to a blood lead test result were disproportionately young, Hispanic, Black, American Indian, or on Medicaid. In full models, maternal age ≤20y [risk ratio (RR)=1.10; 95% confidence interval (CI): 1.13, 1.20] or smoking (RR=1.14; 95% CI: 1.12, 1.17); proximity to a major roadway (RR=1.10; 95% CI: 1.05, 1.15); proximity to a lead-releasing Toxics Release Inventory site (RR=1.08; 95% CI: 1.03, 1.14) or a National Emissions Inventory site (RR=1.11; 95% CI: 1.07, 1.14); and living in neighborhoods with more housing built before 1950 (RR=1.10; 95% CI: 1.05, 1.14) or before 1940 (RR=1.18; 95% CI: 1.11, 1.25) or more vacant housing (RR=1.14; 95% CI: 1.11, 1.17) were associated with an increased risk of EBLL, whereas overlap with a public water service system was associated with a decreased risk of EBLL (RR=0.85; 95% CI: 0.83, 0.87). Children of Black mothers were no more likely than children of White mothers to have EBLLs (RR=0.98; 95% CI: 0.96, 1.01). Complete blood lead screening in 2011-2018 may have identified an additional 17,543 (95% CrI: 17,462, 17,650) children with EBLLs ≥3μg/dL.

DISCUSSION

Our results indicate that current North Carolina lead screening strategies fail to identify over 30% (17,543 of 57,398) of children with subclinical lead poisoning and that accounting for characteristics at birth alters the conclusions about racial disparities in children's EBLLs. https://doi.org/10.1289/EHP10335.

Residential dust lead levels and the risk of childhood lead poisoning in United States children

BACKGROUND

The United States Environmental Protection Agency (EPA) recently lowered residential floor and windowsill dust lead hazard standards, but maintained previous post-abatement clearance standards. We examined whether the discrepancy in these regulations places children at higher risk of lead poisoning.

METHODS

In 250 children from Cincinnati, Ohio (2004-2008) living in homes built before 1978, we measured residential floor and windowsill dust lead loadings and blood lead concentrations at ages 1 and 2 years. Using linear regression with generalized estimating equations, we estimated covariate-adjusted associations of dust lead levels with blood lead concentrations and risk of lead poisoning.

RESULTS

An increase in floor dust lead from 10 (revised dust lead hazard standard) to 40 μg/ft² (post-abatement clearance standard) was associated with 26% higher (95% confidence interval (CI):15, 38) blood lead concentrations and 2.1 times the risk of blood lead concentrations ≥5 μg/dL (95% CI: 1.44, 3.06). Extrapolating our findings to US children age 1-5 years, we estimated that 6.9% (95% CI: 1.5, 17.2) of cases of blood lead concentrations ≥5 μg/dL are attributable to floor dust lead loadings between 10 and ≤40 μg/ft².

CONCLUSIONS

The EPA's residential dust lead regulations place children at increased risk of lead poisoning. We recommend adopting more protective dust lead standards.

IMPACT

We determined whether children are at increased risk of lead poisoning with the 2019 EPA residential post-abatement lead clearance standards being higher than dust lead hazard standards. In this observational study, 2019 EPA dust lead clearance standards were associated with increased risk of lead poisoning compared to the revised dust lead hazard standard. Both EPA standards were associated with increased risk of lead poisoning compared to more stringent standards employed in our study. Extrapolating our findings to US children, the 2019 EPA dust lead clearance standards could place up to 36,700 children at risk of lead poisoning.

Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh

Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans. We developed and evaluated an intervention to reduce lead exposure among children and their caregivers in rural Bangladesh. We conducted formative research to inform theory-based behavioral recommendations. Lead exposure was one of several topics covered in the multi-component intervention focused on early child development. Community health workers (CHWs) delivered the lead component of the intervention during group sessions with pregnant women and mother-child dyads (<15 months old) in a cluster-randomized trial. We administered household surveys at baseline (control n = 301; intervention n = 320) and 9 months later at endline (control n = 279; intervention n = 239) and calculated adjusted risk and mean differences for primary outcomes. We conducted two qualitative assessments, one after 3 months and a second after 9 months, to examine the feasibility and benefits of the intervention. At endline, the prevalence of lead awareness was 52 percentage points higher in the intervention arm compared to the control (adjusted risk difference: 0.52 [95% CI 0.46 to 0.61]). Safe turmeric consumption and food storage practices were more common in the intervention versus control arm at endline, with adjusted risk differences of 0.22 [0.10 to 0.32] and 0.13 [0.00 to 0.19], respectively. Semi-structured interviews conducted with a subset of participants after the intervention revealed that the perceived benefit of reducing lead exposure was high because of the long-term negative impacts that lead can have on child cognitive development. The study demonstrates that a group-based CHW-led intervention can effectively raise awareness about and motivate lead exposure prevention behaviors in rural Bangladesh. Future efforts should combine similar awareness-raising efforts with longer-term regulatory and structural changes to systematically and sustainably reduce lead exposure.

Elemental dysregulation in psychotic spectrum disorders: A review and research synthesis

Accumulating evidence from observational studies, genetic research, and animal models suggests a relationship between toxic and nutritive elements and psychotic spectrum disorders (PSD). This review systematically evaluates the current research evidence for two hypotheses: 1) that exposures to abnormal levels of toxic and nutritive elements early in life contributes to the subsequent development of PSD, and 2) that an imbalance of element levels is linked to psychotic illness and clinical severity. We focused on the extant literature on five elements, lead (Pb), copper (Cu), magnesium (Mg), manganese (Mn), and zinc (Zn), because of their previously documented associations with psychiatric problems and the availability of pertinent literature. The review identified 38 studies of which 11 measured Pb, 27 measured Cu, 16 measured Mg, 15 measured Mn, and 25 measured Zn concentrations in PSD patients and controls. A majority of research has been conducted on nutritive element imbalance, and findings are largely mixed. While it is biologically plausible that element dysregulation is an important modifiable risk factor for PSD, more research into exposure in early life is needed to better characterize this relationship.

Synergistic protective effect of Beta vulgaris with meso-2,3-dimercaptosuccinic acid against lead-induced neurotoxicity in male rats

Lead (Pb) toxicity is one of the most prevalent causes of human neurotoxicity. The available chelator drugs used now have many adverse effects. So, in this study, the protective role of Beta vulgaris juice (BVJ) on rat neurotoxicity induced by Pb was evaluated and the results were compared with the results of dimercaptosuccinic acid (DMSA, as used drug). Additionally, the synergistic effect of BVJ and DMSA against Pb-induced neurotoxicity was assessed. The study focused on the determination of the antioxidant, anti-inflammatory, and neurological potential of BVJ (alone, and with DMSA) towards lead-induced neurotoxicity. Also, the characterization of BVJ was studied. The results showed that BVJ contains considerable quantities of polyphenols, triterpenoids, and betalains which play an important role as antioxidants and anti-inflammatory. BVJ exhibited a protective effect against neurotoxicity via the reduction of Pb levels in blood and brain. Moreover, BVJ decreased the oxidative stress, inflammation, and cell death induced by Pb. Also, BVJ regulated the activities of acetylcholine esterase and monoamine oxidase-A which changed by Pb toxicity. BVJ and DMSA combination displayed a synergistic antineurotoxic effect (combination index ˂ 1). These results were in harmony with brain histopathology. Conclusion: BVJ has a powerful efficacy in the protection from brain toxicity via diminishing Pb in the brain and blood circulation, resulting in the prevention of the oxidative and inflammatory stress. Treatment with BVJ in combination with DMSA revealed a synergistic effect in the reduction of neurotoxicity induced by Pb. Also, the antioxidant and anti-inflammatory effects of the BVJ lead to the improvement of DMSA therapy.

(Ascorb)ing Pb Neurotoxicity in the Developing Brain

Lead (Pb) neurotoxicity is a major concern, particularly in children. Developmental exposure to Pb can alter neurodevelopmental trajectory and has permanent neuropathological consequences, including an increased vulnerability to further stressors. Ascorbic acid is among most researched antioxidant nutrients and has a special role in maintaining redox homeostasis in physiological and physio-pathological brain states. Furthermore, because of its capacity to chelate metal ions, ascorbic acid may particularly serve as a potent therapeutic agent in Pb poisoning. The present review first discusses the major consequences of Pb exposure in children and then proceeds to present evidence from human and animal studies for ascorbic acid as an efficient ameliorative supplemental nutrient in Pb poisoning, with a particular focus on developmental Pb neurotoxicity. In doing so, it is hoped that there is a revitalization for further research on understanding the brain functions of this essential, safe, and readily available vitamin in physiological states, as well to justify and establish it as an effective neuroprotective and modulatory factor in the pathologies of the nervous system, including developmental neuropathologies.

A Collaborative Approach to Assess Legacy Pollution in Communities Near a Lead-Acid Battery Smelter: The "Truth Fairy" Project

Advocates for civil rights, environmental justice, and movements promoting social justice require data and may lack trust in public authorities, turning instead to academic scientists to help address their questions. Assessing historical exposure to toxic chemicals, especially in situations of a specific industrial source of pollution affecting a community, is critical for informing appropriate public health and policy responses. We describe a community-driven approach to integrate retrospective environmental hazard exposure assessment with community organizing to address concerns about the extent of exposure to toxic metals in a predominantly working-class, Latinx community living near a now-closed lead-acid battery smelter facility. Named the "Truth Fairy Project" by leaders of the community organization East Yard Communities for Environmental Justice, this community-university partnership aimed to assess prenatal and early-life exposures to toxic metals through biomarkers of exposure in baby/deciduous teeth. This partnership integrated community mobilization with empirical research, informing residents about toxic metal exposures and improving the community's capacity to respond to a public health crisis.

The limits of lead (Pb) phytoextraction and possibilities of phytostabilization in contaminated soil: a critical review

This review article focuses on lead (Pb), one of the most ubiquitous and harmful toxicants found in soil. Our objective is to address misconceptions regarding the ability of plants to uptake Pb through their roots and translocate it to above-ground tissues, and their ability to act as hyperaccumulators and thereby phytoextract Pb. In accordance with a number of cited definitions, we suggest that species capable of Pb phytoextraction can be rated with the following three criteria: (1) root uptake above a nominal threshold of 1,000 mg Pb/kg, (2) bioconcentration factor (BCF or shoot/soil concentration) >1, and (3) translocation factor (TF or shoot/root concentration) > 1. We review the literature in the updated USDA Phytoremediation Database and conclude that without amendments: no plant has met all three criteria; no plant has been confirmed as a Pb hyperaccumulator. Our analysis suggests that Pb phytoextraction is not a viable remediation option. Pb phytostabilization, however, may be an effective remediation tool in a variety of settings. Planting some of the many species capable of tolerating soil Pb exposure and sequestering it in or around the root zone will limit Pb movement into other ecosystems, prevent resuspended dusts, and mitigate Pb exposure.

Developmental lead (Pb)-induced deficits in redox and bioenergetic status of cerebellar synapses are ameliorated by ascorbate supplementation

Neurotoxicity induced by exposure to heavy metal lead (Pb) is a concern of utmost importance particularly for countries with industrial-based economies. The developing brain is especially sensitive to exposure to even minute quantities of Pb which can alter neurodevelopmental trajectory with irreversible effects on motor, emotive-social and cognitive attributes even into later adulthood. Chemical synapses form the major pathway of inter-neuronal communications and are prime candidates for higher order brain (motor, memory and behavior) functions and determine the resistance/susceptibility for neurological disorders, including neuropsychopathologies. The synaptic pathways and mechanisms underlying Pb-mediated alterations in neuronal signaling and plasticity are not completely understood. Employing a biochemically isolated synaptosomal fraction which is enriched in synaptic terminals and synaptic mitochondria, this study aimed to analyze the alterations in bioenergetic and redox/antioxidant status of cerebellar synapses induced by developmental exposure to Pb (0.2 %). Moreover, we test the efficacy of vitamin C (ascorbate; 500 mg/kg body weight), a neuroprotective and neuromodulatory antioxidant, in mitigation of Pb-induced neuronal deficits. Our results implicate redox and bioenergetic disruptions as an underlying feature of the synaptic dysfunction observed in developmental Pb neurotoxicity, potentially contributing to consequent deficits in motor, behavioral and psychological attributes of the organisms. In addition, we establish ascorbate as a key ingredient for therapeutic approach against Pb induced neurotoxicity, particularly for early-life exposures.

Assessment of zeolite and compost-zeolite mixture as permeable reactive materials for the removal of lead from a model acidic groundwater

Column experiments were performed to assess the effectiveness of zeolite and compost-zeolite mixture in removing dissolved lead (Pb²⁺) from acidic water of pH 2.4. The acid neutralizing ability and hydraulic performance of the materials were also studied. Fitting the advection-dispersion equation (ADE) and mathematical models (i.e. the Dose-Response, Adams-Bohart, and Yoon-Nelson models) to the Pb²⁺ experimental breakthrough curves (BTCs) was also performed. The compost-zeolite mixture proved to be better than zeolite alone both: in removing Pb²⁺ and in buffering the acidic pH. The maximum adsorption capacity, q_o obtained for zeolite was 0.097 mg/g and 0.151 mg/g for the compost-zeolite mixture, respectively. Lead removal was attributed to ion exchange and adsorption. Observed Pb²⁺ BTCs demonstrated sorption-related nonequilibrium effects in the columns. The hydraulic conductivity of zeolite decreased by 2% and by 28.8% in the case of compost-zeolite mixture at the end of the experiment. The entire experimental BTC of Pb²⁺ was well described by the Dose-Response model while the Adams-Bohart model was better in describing only the initial part of the lead BTCs.

Mechanisms of children's soil exposure

Pollution is a concerning and highly studied area, especially in the arena of children's health. The focus of this concern, however, is typically limited to air and water pollution, leaving an important source under-studied and out of the concern of the general public. Soil pollution provides a unique threat to children's health, due to their increased exposure and susceptibility to its contaminants. The microbiome of a child is developed prior to birth and continues to evolve over their lifetime with each encounter to the outside world. The environment a child inhabits directly affects their microbiome and their overall health, and through interactions with contaminated soil, a child can accumulate adverse health outcomes. The aim of this article is to summarize the methods by which soil becomes contaminated and how children become exposed to the resulting toxicants.

The concurrent decline of soil lead and children's blood lead in New Orleans

The inextricable link between topsoil lead (Pb) and children’s blood lead (BPb) has not been widely accepted. Pb is associated with multiple health adversities. Urban residents are at risk from exposure to legacy Pb dust in topsoil resulting from smelting, industrial discharges, leaded gasoline emissions, leaded paint, and incineration. In New Orleans, topsoil median Pb decreased in ∼15 y from 99 mg/kg to 54 mg/kg, or ∼2.4 mg⋅kg⋅y⁻¹. In ∼12 y, children’s median BPb declined from 3.6 μg/dL to 1.3 μg/dL, or ∼0.2 μg⋅dL⋅y⁻¹. We argue that depletion of topsoil Pb is an important factor in the continuous decline of children’s BPb. Similar processes are expected in all US cities. Primary prevention requires curtailing Pb in all sources, including topsoil.

Lead (Pb) is extremely toxic and a major cause of chronic diseases worldwide. Pb is associated with health disparities, particularly within low-income populations. In biological systems, Pb mimics calcium and, among other effects, interrupts cell signaling. Furthermore, Pb exposure results in epigenetic changes that affect multigenerational gene expression. Exposure to Pb has decreased through primary prevention, including removal of Pb solder from canned food, regulating lead-based paint, and especially eliminating Pb additives in gasoline. While researchers observe a continuous decline in children’s blood lead (BPb), reservoirs of exposure persist in topsoil, which stores the legacy dust from leaded gasoline and other sources. Our surveys of metropolitan New Orleans reveal that median topsoil Pb in communities (n = 274) decreased 44% from 99 mg/kg to 54 mg/kg (P value of 2.09 × 10⁻⁰⁸), with a median depletion rate of ∼2.4 mg⋅kg⋅y⁻¹ over 15 y. From 2000 through 2005 to 2011 through 2016, children’s BPb declined from 3.6 μg/dL to 1.2 μg/dL or 64% (P value of 2.02 × 10⁻⁸⁵), a decrease of ∼0.2 μg⋅dL⋅y⁻¹ during a median of 12 y. Here, we explore the decline of children’s BPb by examining a metabolism of cities framework of inputs, transformations, storages, and outputs. Our findings indicate that decreasing Pb in topsoil is an important factor in the continuous decline of children’s BPb. Similar reductions are expected in other major US cities. The most contaminated urban communities, usually inhabited by vulnerable populations, require further reductions of topsoil Pb to fulfill primary prevention for the nation’s children.

Lead-based paints and children's PVC toys are potential sources of domestic lead poisoning - A review

Lead (Pb) both in paints and children's Polyvinyl chloride (PVC) toys is a major public health concern which has attracted attention of the international community. Concentrations of Pb both in lead-based paints and children's PVC toys have been assessed through various studies across the globe. Therefore, the purpose of this article was to summarize the results reported in these studies and provide some comprehension on their implications to human health for law enforcement as well as for awareness raising to the general public. Highlights on identified gaps have been provided to pave ways for further research interventions in order to establish comprehensive information on the subject. Regardless of regulatory limits on the content of lead, both in paints and children's PVC toys existing in different countries in the world, some of the reviewed articles have revealed significant levels of lead in these two items far above the permissible limits. High lead levels in paints have been recorded in China (116,200 ppm), Cameroon (500,000 ppm), South Africa (189,000 ppm), Tanzania (120,862.1 ppm), Uganda (150,000 ppm), Thailand (505,716 ppm) and Brazil (170,258.4 ppm) just to mention a few. Lead poisoning cases in children have been reported in several countries including France, Morocco, South Africa and United States. Countries where high levels of lead in children's PVC toys have been recounted include; China (860,000 ppm), South Africa (145,000 ppm), United States (22,550 ppm), Thailand (4,486.11 ppm), Palestine (6,036 ppm) and India (2,104 ppm). Awareness raising among parents is vital to impart them with knowledge on the matter so that they can take strenuous measures to protect their children from lead poisoning emanating from playing with toys and paint dust. Law enforcement on phasing out lead-based paints and control of lead content in children's PVC toys worldwide is also highly recommended.

Recommendations towards standards for quantitative MRI (qMRI) and outstanding needs

LEVEL OF EVIDENCE

5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019.

Dysfunction of cortical synapse-specific mitochondria in developing rats exposed to lead and its amelioration by ascorbate supplementation

BACKGROUND

Lead (Pb) is a widespread environmental neurotoxin and its exposure even in minute quantities can lead to compromised neuronal functions. A developing brain is particularly vulnerable to Pb mediated toxicity and early-life exposure leads to permanent alterations in brain development and neuronal signaling and plasticity, culminating into cognitive and behavioral dysfunctions and elevated risk of neuropsychiatric disorders later in life. Nevertheless, the underlying biochemical mechanisms have not been completely discerned.

METHODS

Because of their ability to fulfill high energy needs and to act as calcium buffers in events of high intensity neuronal activity as well as their adaptive regulatory capability to match the requirements of the dynamicity of synaptic signaling, synapse-specific or synaptic mitochondria (SM) are critical for synaptic development, function and plasticity. Our aim for the present study hence was to characterize the effects of early-life Pb exposure on the functions of SM of prepubertal rats. For this purpose, employing a chronic model of Pb neurotoxicity, we exposed rat pups perinatally and postnatally to Pb and used a plethora of colorimetric and fluorometric assays for assessing redox and bioenergetic properties of SM. In addition, taking advantage of its ability as an antioxidant and as a metal chelator, we employed ascorbic acid (vitamin C) supplementation as an ameliorative therapeutic strategy against Pb-induced neurotoxicity and dysfunction of SM.

RESULTS

Our results suggest that early-life exposure to Pb leads to elevated oxidative stress in cortical SM with consequent compromises in its energy metabolism activity. Ascorbate supplementation resulted in significant recovery of Pb-induced oxidative stress and functional compromise of SM.

CONCLUSION

Alterations in redox status and bioenergetic properties of SM could potentially contribute to the synaptic dysfunction observed in events of Pb neurotoxicity. Additionally, our study provides evidence for suitability of ascorbate as a significant ameliorative agent in tacking Pb neurotoxicity.

Developmental lead (Pb)-induced deficits in hippocampal protein translation at the synapses are ameliorated by ascorbate supplementation

BACKGROUND

Lead (Pb) is a persistent environmental neurotoxin and its exposure even in minute quantities has been known to induce neuronal defects. The immature brain is singularly sensitive to Pb neurotoxicity, and its exposure during development has permanent detrimental effects on the brain developmental trajectory and neuronal signaling and plasticity, culminating into compromises in the cognitive and behavioral attributes which persists even later in adulthood. Several molecular pathways have been implicated in the Pb-mediated disruption of neuronal signaling, including elevated oxidative stress, alterations in neurotransmitter biology, and mitochondrial dysfunction. Nevertheless, the neuronal targets and biochemical pathways underlying these Pb-mediated alterations in synaptic development and function have not been completely deduced. In this respect, recent studies have shown that synaptic signaling and its maintenance and plasticity are critically dependent on localized de novo protein translation at the synaptic terminals.

MATERIALS AND METHODS

The present study hence aimed to assess the alterations in the synapse-specific translation induced by developmental Pb exposure. To this end, in vitro protein translation rate was analyzed in the hippocampal synaptoneurosomal fractions of rat pups pre- and postnatally exposed to Pb using a puromycin incorporation assay. Moreover, we evaluated the therapeutic effects of ascorbic acid supplementation against Pb-induced deficits in synapse-localized protein translation.

RESULTS

We observed a significant loss in the rates of de novo protein translation in synaptoneurosomes of Pb-exposed pups compared to age-matched control pups. Interestingly, ascorbate supplementation lead to an appreciable recovery in Pb-induced translational deficits. Moreover, the deficit in activity-dependent synaptic protein translation was found to correlate significantly with the increase in the blood Pb levels.

CONCLUSION

Dysregulation of synapse-localized de novo protein translation is a potentially critical determinant of Pb-induced synaptic dysfunction and the consequent deficits in behavioral, social, and psychological attributes of the organisms. In addition, our study establishes ascorbate supplementation as a key ameliorative agent against Pb-induced neurotoxicity.

People, planet and profit: Unintended consequences of legacy building materials

Although an explosion of new building materials are being introduced into today's market, adequate up-front research into their chemical and physical properties as well as their potential health and environmental consequences is lacking. History has provided us with several examples where building materials were broadly deployed into society only to find that health and environmental problems resulted in unintended sustainability consequences. In the following paper, we use lead and asbestos as legacy building materials to show their similar historical trends and sustainability consequences. Our research findings show unintended consequences such as: increased remediation and litigation costs; adverse health effects; offshoring of related industries; and impediments to urban revitalization. As numerous new building materials enter today's market, another building material may have already been deployed, representing the next "asbestos." This paper also proposes an alternative methodology that can be applied in a cost-effective way into existing and upcoming building materials, to minimize and prevent potential unintended consequences and create a pathway for sustainable communities. For instance, our findings show that this proposed methodology could have prevented the unintended incurred sustainability costs of approximately $272-$359 billion by investing roughly $24 million in constant 2014 U.S. dollars on up-front research into lead and asbestos.

Child lead poisoning in South Africa: implications for psychological research

Lead is a toxic heavy metal that is associated with lowered intelligence quotient scores, behavioural problems, and physical health impairments in children. Current consensus is that there is no safe level of child lead exposure and that even low doses of lead can have negative effects. Several reviews conducted in South Africa have revealed the sources and potential risk factors associated with child lead poisoning. However, no South African reviews have focused on the quality of studies focusing on child lead poisoning and psychological outcomes (intelligence, cognitive, and behavioural outcomes). This study reviews epidemiological studies of child lead poisoning with a particular focus on the association between child lead poisoning and psychological outcomes in South Africa over a 30-year time span (1986–2016). The review pays particular attention to study design, measurement, sampling, and confounding variables. Nine studies that measured child lead poisoning were included in the review. Just two of the nine studies (one cross-sectional and one follow-up) measured psychological outcomes and neither study adequately adjusted for confounding. In all studies, sampling was purposive and lead exposure indicators were suited to short-term acute exposure. There is, therefore, insufficient evidence to determine the magnitude of the association between child lead poisoning and psychological outcomes in South Africa. More rigorous epidemiological studies are needed to strengthen the evidence base. The article also highlights opportunities for psychological research in intervention studies and studies that are framed by an environmental justice agenda.

Findings from the Initial Use of the Healthy Homes Rating System (HHRS) in Three American Cities

HUD's Healthy Homes Rating System (HHRS) is a modification of the English version, using scoring values developed in England. The goal of the HUD Three-City Healthy Homes Rating System (HHRS) study was to create a baseline of the prevalence and severity of 29 home health hazards in three cities-Detroit, MI; Greensboro, NC; and Alameda County, CA-and to compare the results to the prevalence and severity found in England. We analyzed 978 housing assessments over 3 years. Hygrothermal hazards (e.g., excess cold) were the most prevalent across the sites. However, significant differences in the type and severity of hazards across communities were found and were more severe in US sample homes than in their English counterparts. The results suggest that the tool shows promise in its ability to identify home health hazards.

Selective removal Pb(ii) ions form wastewater using Pb(ii) ion-imprinted polymers with bi-component polymer brushes

Ion imprinted polymers (IIPs) are very difficult to apply in actual wastewater containing solid particles and floccules due to the imprinting hole blockage of losing adsorption performance.

Pb exposure prolongs the time period for postnatal transient uptake of 5-HT by murine LSO neurons

Pb exposure is associated with cognitive deficits including Attention Deficit Hyperactivity Disorder (ADHD) in children and alters auditory temporal processing in humans and animals. Serotonin has been implicated in auditory temporal processing and previous studies from our laboratory have demonstrated that developmental Pb decreases expression of serotonin (5-HT) in the adult murine lateral superior olive (LSO). During development, certain non-serotonergic sensory neurons, including auditory LSO neurons, transiently take up 5-HT through the serotonin reuptake transporter (SERT). The uptake of 5-HT is important for development of sensory systems. This study examines the effect of Pb on the serotonergic system in the LSO of the early postnatal mouse. Mice were exposed to moderate Pb (0.01mM) or high Pb (0.1mM) throughout gestation and postnatal day 4 (P4) and P8. We found that Pb exposure prolongs the normal developmental expression of 5-HT by LSO neurons and this is correlated with expression of SERT on LSO cell bodies. The prolonged expression of 5-HT by postnatal LSO neurons is correlated with decreased synaptic immunolabeling within the LSO. This Pb-associated decrease in synaptic density within the LSO could contribute to the auditory temporal processing deficits and cognitive deficits associated with developmental Pb exposure.

Ten-Year Monitored Natural Recovery of Lead-Contaminated Mine Tailing in Klity Creek, Kanchanaburi Province, Thailand

BACKGROUND

Klity Creek has become Thailand's first official remediation ordered by the court in 2013, 15 years after the spill of lead (Pb)-contaminated mine tailing into the creek. The Pollution Control Department (PCD) decided to restore the creek through monitored natural recovery (MNR) since 2006 but has not been successful. Interestingly, the most recent remediation plan in 2015 will still apply MNR to five out of the seven portions of the creek, despite no scientific feasibility evaluation of using MNR to restore the creek.

OBJECTIVE

This study qualitatively and quantitatively evaluated the feasibility of using MNR to clean up the creek in order to protect the Klity children from excess Pb exposure.

METHODS

We analyzed the physical and chemical transformation of Pb contaminated sediment in the creek and developed a remedial action goal and cleanup level using the Integrated Exposure Uptake Biokinetic model (IEUBK). We empirically determined the natural recovery (NR) potentials and rates using 10 years of data monitoring the water and sediment samples from eight monitoring stations (KC1 to KC8).

RESULTS

Klity Creek has NR potential for water except at KC2, which is closest to the spill and the other improperly managed Pb sources. However, the creek has no NR potential for sediment except at the KC8 location (NR rate = 11.1 ± 3.0 × 10-3 month-1) farthest from the spill.

CONCLUSION

The MNR method is not suitable to use as the sole remedial approach for Klity Creek (KC2 to KC7). Although MNR is applicable at KC8, it may require up to 377 ± 76 years to restore the sediment to the background Pb concentration.

CITATION

Phenrat T, Otwong A, Chantharit A, Lowry GV. 2016. Ten-year monitored natural recovery of lead-contaminated mine tailing in Klity Creek, Kanchanaburi Province, Thailand. Environ Health Perspect 124:1511-1520; http://dx.doi.org/10.1289/EHP215.

Profiling Private Water Systems to Identify Patterns of Waterborne Lead Exposure

Although extensive literature documents corrosion in municipal water systems, only minimal data is available describing corrosion in private water systems (e.g., wells), which serve as a primary source of drinking water for approximately 47 million Americans. This study developed a profiling technique specifically tailored to evaluate lead release in these systems. When applied in an intensive field study of 15 private systems, three patterns of lead release were documented: no elevated lead or lead elevated in the first draw only (Type I), erratic spikes of particulate lead (Type II), and sustained detectable lead concentrations (Type III). While flushing protocols as short as 15-30 s may be sufficient to reduce lead concentrations below 15 μg/L for Types I and III exposure, flushing may not be an appropriate remediation strategy for Type II exposure. In addition, the sustained detectable lead concentrations observed with Type III exposure likely result from corrosion of components within the well and therefore cannot be reduced with increased flushing. As profiling techniques are labor- and sample-intensive, we discuss recommendations for simpler sampling schemes for initial private system surveys aimed at quantifying lead and protecting public health.

Dust metal loadings and the risk of childhood acute lymphoblastic leukemia

We evaluated the relationship between the risk of childhood acute lymphoblastic leukemia (ALL) and the levels of metals in carpet dust. A dust sample was collected from the homes of 142 ALL cases and 187 controls participating in the California Childhood Leukemia Study using a high volume small surface sampler (2001-2006). Samples were analyzed using microwave-assisted acid digestion in combination with inductively coupled plasma mass spectrometry for arsenic, cadmium, chromium, copper, lead, nickel, tin, tungsten, and zinc. Eight metals were detected in at least 85% of the case and control homes; tungsten was detected in <15% of homes. Relationships between dust metal loadings (μg metal per m(2) carpet) and ALL risk were modeled using multivariable logistic regression, adjusting for the child's age, sex, and race/ethnicity and confounders, including household annual income. A doubling of dust metal loadings was not associated with significant changes in ALL risk (odds ratio (95% confidence interval): arsenic: 0.96 (0.86, 1.07), cadmium: 0.92 (0.81, 1.05), chromium: 1.01 (0.90, 1.14), copper: 0.97 (0.91, 1.03), lead: 1.01 (0.93, 1.10), nickel: 0.95 (0.82, 1.09), tin: 0.96 (0.86, 1.08), and zinc: 0.94 (0.84, 1.05)). Our findings do not support the hypothesis that metals in carpet dust are risk factors for childhood ALL.

Reducing lead in air and preventing childhood exposure near lead smelters: learning from the U.S. experience

Childhood lead exposure and poisoning near primary lead smelters continues in developed and developing countries. In the United States, the problem of lead poisoning in children caused by smelter emissions was first documented in the early 1970s. In 1978, Environmental Protection Agency set National Ambient Air Quality Standards for lead. Attainment of this lead standard in areas near operating lead smelters took twenty to thirty years. Childhood lead exposure and poisoning continued to occur after the lead National Ambient Air Quality Standards were set and before compliance was achieved. This article analyzes and discusses the factors that led to the eventual achievement of the 1978 lead National Ambient Air Quality Standards near primary smelters and the reduction of children's blood lead levels in surrounding communities. Factors such as federal and state regulation, monitoring of emissions, public health activities such as blood lead surveillance and health education, relocation of children, environmental group and community advocacy, and litigation all played a role.

Longitudinal epigenetic drift in mice perinatally exposed to lead

An understanding of the natural change in DNA methylation over time, defined as "epigenetic drift," will inform the study of environmental effects on the epigenome. This study investigates epigenetic drift in isogenic mice exposed perinatally to lead (Pb) acetate at four concentrations, 0 ppm (control), 2.1 ppm (low), 16 ppm (medium), and 32 ppm (high) prior to conception through weaning, then followed until 10 months of age. Absolute values of DNA methylation in a transposon-associated metastable locus, Cdk5-activator binding protein (Cabp(IAP)), and three imprinted loci (Igf2, Igf2r, and H19) were obtained from tail tissue in paired samples. DNA methylation levels in the controls increased over time at the imprinted Igf2 and Igf2r loci (both P = 0.0001), but not at the imprinted H19 locus or the Cabp(IAP) metastable epiallele. Pb exposure was associated with accelerated DNA hypermethylation in Cabp(IAP) (P = 0.0209) and moderated hypermethylation in Igf2r (P = 0.0447), and with marginally accelerated hypermethylation at H19 (P = 0.0847). In summary, the presence and magnitude of epigenetic drift was locus-dependent, and enhancement of drift was mediated by perinatal Pb exposure, in some, but not all, loci.

Tracing the long-term legacy of childhood lead exposure: a review of three decades of the port Pirie cohort study

Several prospective cohort studies have demonstrated that childhood lead levels show small but statistically significant adjusted associations with subsequent development in later childhood and adolescence. The Port Pirie Cohort study is one of the few prospective cohort studies to follow participants into adulthood. This paper reviews all childhood and adulthood findings of the Port Pirie Cohort study to date. Cohort members (initially, 723 infants born in/around the lead-smelting town of Port Pirie) showed a wide range of childhood blood lead levels, which peaked around 2 years old (M=21.3μg/dL, SD=1.2). At all childhood assessments, postnatal lead levels - particularly those reflecting cumulative exposure - showed small significant associations with outcomes including cognitive development, IQ, and mental health problems. While associations were substantially attenuated after adjusting for several childhood covariates, many remained statistically significant. Furthermore, average childhood blood lead showed small significant associations with some adult mental health problems for females, including anxiety problems and phobia, though associations only approached significance following covariate adjustment. Overall, there did not appear to be any age of greatest vulnerability or threshold of effect, and at all ages, females appeared more susceptible to lead-associated deficits. Together, these findings suggest that the associations between early childhood lead exposure and subsequent developmental outcomes may persist. However, as the magnitude of these effects was small, they are not discernible at the individual level, posing more of a population health concern. It appears that the combination of multiple early childhood factors best predicts later development. As such, minimising lead exposure in combination with improving other important early childhood factors such as parent-child interactions may be the best way to improve developmental outcomes.

Prenatal lead exposure and relationship with maternal exposure determinants in a public maternity hospital of La Plata, Argentina

Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning.

Diverse effects of lead nitrate on the proliferation, differentiation, and gene expression of stem cells isolated from a dental origin

Lead (Pb²⁺) exposure continues to be a significant public health problem. Therefore, it is vital to have a continuous epidemiological dataset for a better understanding of Pb²⁺ toxicity. In the present study, we have exposed stem cells isolated from deciduous and permanent teeth, periodontal ligament, and bone marrow to five different types of Pb²⁺ concentrations (160, 80, 40, 20, and 10 µM) for 24 hours to identify the adverse effects of Pb²⁺ on the proliferation, differentiation, and gene expression on these cell lines. We found that Pb²⁺ treatment altered the morphology and adhesion of the cells in a dose-dependent manner. There were no significant changes in terms of cell surface phenotypes. Cells exposed to Pb²⁺ continued to differentiate into chondrogenesis and adipogenesis, and a severe downregulation was observed in osteogenesis. Gene expression studies revealed a constant expression of key markers associated with stemness (Oct 4, Rex 1) and DNA repair enzyme markers, but downregulation occurred with some ectoderm and endoderm markers, demonstrating an irregular and untimely differentiation trail. Our study revealed for the first time that Pb²⁺ exposure not only affects the phenotypic characteristics but also induces significant alteration in the differentiation and gene expression in the cells.

Lead Exposure Induces Telomere Instability in Human Cells

Lead (Pb) is an important environmental contaminant due to its widespread use over many centuries. While it affects primarily every organ system of the body, the most pernicious effects of Pb are on the central nervous system leading to cognitive and behavioral modification. Despite decades of research, the mechanisms responsible for Pb toxicity remain poorly understood. Recent work has suggested that Pb exposure may have consequences on chromosomal integrity as it was shown that Pb exposure leads to the generation of γH2Ax foci, a well-established biomarker for DNA double stranded break (DSB formation). As the chromosomal localization of γH2Ax foci plays an important role in determining the molecular mechanism responsible for their formation, we examined the localization of Pb-induced foci with respect to telomeres. Indeed, short or dysfunctional telomeres (uncapped or damaged telomeres) may be recognized as DSB by the DNA repair machinery, leading to “telomere-Induced Foci” (TIFs). In the current study, we show that while Pb exposure did not increase intra-chromosomal foci, it significantly induced TIFs, leading in some cases, to chromosomal abnormalities including telomere loss. The evidence suggests that these chromosomal abnormalities are likely due to perturbation of telomere replication, in particular on the lagging DNA strand. We propose a mechanism by which Pb exposure leads to the loss of telomere maintenance. As numerous studies have demonstrated a role for telomere maintenance in brain development and tissue homeostasis, our results suggest a possible mechanism for lead-induced neurotoxicity.

Protective effects of mangiferin in subchronic developmental lead-exposed rats

Lead is a ubiquitous environmental and industrial pollutant. Exposure to excessive amounts of lead is especially harmful to the central nervous systems of infants and young children, and oxidative stress has been reported as a major mechanism of lead-induced toxicity. To evaluate the ameliorative potential of antioxidant mangiferin (MGN) on lead-induced toxicity, Morris water maze test, determination of blood and bone lead concentration, determination of antioxidant status in plasma, as well as observation of ultrastructural changes in the hippocampus were carried out. In the present study, under a transmission electron microscope, ameliorated morphological damages in the hippocampus were observed in MGN-treated groups. Blood and bone lead concentration in MGN-treated groups lowered to some extent (p < 0.05, p < 0.01). The activities of antioxidant enzymes, glutathione (GSH) content, and the GSH/oxidized glutathione ratio in MGN-treated groups were increased, respectively. Further studies are needed to establish whether the observed differences were a direct cause of mangiferin on lead-induced toxicity or not. This study might provide clues for the treatment of lead-induced toxicity.

Blood lead levels and enzymatic biomarkers of environmental lead exposure in children in Cordoba, Argentina, after the ban of leaded gasoline

Lead (Pb) is a developmental neurotoxicant found in industrial activities, many of them already prohibited worldwide. This study aimed to evaluate current blood Pb (PbB) levels in children in Cordoba, Argentina, and to compare these with similar studies performed before Pb was banned in gasoline in 1996. We also sought to identify mechanistically relevant biomarkers by measuring δ-aminolevulinic acid dehydratase (δ-ALAD), superoxide dismutase (SOD), and catalase (CAT) activities. We finally aimed to determine whether sociodemographic characteristics are associated with Pb toxicity. Blood samples collected from 161 healthy children between September 2009 and February 2010 revealed mean PbB levels of 2.58 ± 0.30 µg/dl. Enzymatic δ-ALAD, CAT, and SOD activities showed no significant variations when plotted against PbB levels. Finally, children living in the suburbs have higher PbB levels than their city counterparts, while low socioeconomic status increased δ-ALAD inhibition compared with that of middle-income children. Overall, these results evidenced a substantial reduction in exposure to Pb in this pediatric population over a decade after Pb was restricted in gasoline and reveal the importance of pursuing novel biomarkers of toxicity along with the sociodemographic profile to complement Pb diagnosis.

Lead neurotoxicity: effects on brain nitric oxide synthase

Lead (Pb), a ubiquitous and potent neurotoxicant, induces several neurophysiological and behavioural changes, while Pb alters the function of multiple organs and systems, it primarily affects the central nervous system. In human adults, encephalopathy resulting from Pb intoxication is often characterized by sleeplessness, poor attention span, vomiting, convulsions and coma; in children, Pb-induced encephalopathy is associated with mental dullness, vomiting, irritability and anorexia; diminished cognitive function resulting in a mental deficit has been also observed during Prolonged exposure to Pb. Pb can produce oxidative stress, disrupt the blood-brain barrier and alter several Ca(2+)-dependent processes, including physiological processes that involve nitric oxide synthesis on central nervous system in development and adult animals. This review summarizes recent evidence showing that Pb can interfere with the production of nitric oxide and can disrupt the function of nitric oxide synthase. Lead interferes with nitric oxide-related physiological mechanisms, and Pb neurotoxicity may affect processes involved in learning and memory.

Conceptual environmental justice model for evaluating chemical pathways of exposure in low-income, minority, native American, and other unique exposure populations

Risk assessment determines pathways, and exposures that lead to poor health. For exposures that fall disproportionately on urban low-income communities, minorities, and Native Americans, these pathways are often more common than in the general population. Although risk assessors often evaluate these pathways on an ad hoc basis, a more formal way of addressing these nonstandard pathways is needed to adequately inform public health policy. A conceptual model is presented for evaluating nonstandard, unique, or excessive exposures, particularly for environmental justice communities that have an exposure matrix of inhalation, dermal, ingestion, and injection. Risk assessment can be improved by including nonstandard and unique exposure pathways as described in this conceptual model.

Biomonitoring of lead and cadmium in the hair and fingernails of elderly Korean subjects

Lead and cadmium are toxic to humans at excessive levels, and monitoring the human body burden of these metals is important in preventing adverse health effects. In this study, we assessed the exposure to lead and cadmium among an elderly population 60 years of age or older. Based on data from 115 participants, we found that the geometric mean lead concentrations in hair and fingernails were 1.11 μg/g [95% confidence interval (CI) 0.78-1.58] and 1.11 μg/g (95% CI 0.81-1.51), respectively. The lead concentrations in hair and fingernails were significantly related to cigarette smoking. The geometric mean cadmium concentrations in hair and fingernails were 52.6 ng/g (95% CI 42.0-65.9) and 40.1 ng/g (95% CI 29.9-53.9), respectively. Cadmium concentrations in hair were significantly related to body mass index and cigarette smoking, whereas higher fingernail cadmium concentrations were related to alcohol drinking. Correlations between hair and fingernail concentrations of lead and of cadmium were slightly positive. Our findings suggest that the body burden of lead and cadmium varies according to demographic factors, and hair and fingernails could be used differentially as a biological medium for metal exposure.

Disproportionate exposures in environmental justice and other populations: the importance of outliers

We examined traditional environmental justice populations and other groups whose exposure to contaminants is often disproportionately high. Risk assessment methods may not identify these populations, particularly if they are spatially dispersed. We suggest using a National Health and Nutrition Examination Survey approach to oversample minority communities and develop methods for assessing exposure at different distances from pollution sources; publishing arithmetic and geometric means and full distributions for minority populations; and paying particular attention to high-end exposures. Means may sufficiently characterize populations as a whole but are inadequate in identifying vulnerable groups and subgroups. The number of individuals above the 95th percentile of any distribution may be small and unrepresentative, but these outliers are the ones who need to be protected.

Simple reaction time: it is not what it used to be

This article calls attention to the large amount of evidence indicating that simple visual reaction time (RT) has increased. To show that RT has increased, the RTs obtained by young adults in 14 studies published from 1941 on were compared with the RTs obtained by young adults in a study conducted by Galton in the late 1800s. With one exception, the newer studies obtained RTs longer than those obtained by Galton. The possibility that these differences in results are due to faulty timing instruments is considered but deemed unlikely. Of several possible causes for longer RTs, two are regarded as tenable: that RT has been increased by the buildup of neurotoxins in the environment and by the increasing numbers of people in less than robust health who have survived into adulthood. The importance of standardizing tests of RT in order to enable more refined analyses of secular trends in RT is emphasized.

Blood lead levels and major depressive disorder, panic disorder, and generalized anxiety disorder in US young adults

CONTEXT

Lead is a ubiquitous neurotoxicant, and adverse cognitive and behavioral effects are well-documented in children and occupationally exposed adults but not in adults with low environmental exposure.

OBJECTIVE

To investigate the association of current blood lead levels with 3 common psychiatric disorders-major depression, panic, and generalized anxiety-in young adults.

DESIGN

Cross-sectional epidemiologic survey.

SETTING

Nationally representative sample of US adults.

PARTICIPANTS

A total of 1987 adults aged 20 to 39 years who responded to the National Health and Nutrition Examination Survey (1999-2004).

MAIN OUTCOME MEASURES

Twelve-month DSM-IV criteria-based diagnoses of major depressive disorder, panic disorder, and generalized anxiety disorder assessed using the Composite International Diagnostic Interview.

RESULTS

The mean (SD) blood lead level was 1.61 (1.72) microg/dL (range, 0.3-37.3 microg/dL) (to convert to micromoles per liter, multiply by 0.0483). Increasing blood lead levels were associated with higher odds of major depression (P = .05 for trend) and panic disorder (P = .02 for trend) but not generalized anxiety disorder (P = .78 for trend) after adjustment for sex, age, race/ethnicity, education status, and poverty to income ratio. Persons with blood lead levels in the highest quintile had 2.3 times the odds of major depressive disorder (95% confidence interval [CI], 1.13-4.75) and 4.9 times the odds of panic disorder (1.32-18.48) as those in the lowest quintile. Cigarette smoking was associated with higher blood lead levels and outcome, but models that excluded current smokers also resulted in significantly increased odds of major depression (P = .03 for trend) and panic disorder (P = .01 for trend) with higher blood lead quintiles.

CONCLUSIONS

In these young adults with low levels of lead exposure, higher blood lead levels were associated with increased odds of major depression and panic disorders. Exposure to lead at levels generally considered safe could result in adverse mental health outcomes.

Elevated blood lead levels in a riverside population in the Brazilian Amazon

Lead (Pb) is recognized as one of the most toxic metals. Sources of Pb exposure have been widely documented in North America, and the removal of Pb additives from gasoline was reflected in a dramatic lowering of blood Pb concentration. In Latin America, the removal of Pb from gasoline resulted in decreased exposure, but Pb levels in many areas remain high due to occupational and environmental sources of exposure. While many of the Pb sources have been identified (mining, industries, battery recycling, lead-based paint, ceramics), new ones occasionally crop up. Here we report on blood Pb (B-Pb) levels in remote riverside communities of the Brazilian Amazon. Blood Pb (B-Pb) levels were determined in 448 persons from 12 villages of the Lower Tapajós River Basin, Pará, Brazil. Socio-demographic and dietary information, as well as occupational, residential and medical history was collected using an interview-administered questionnaire. B-Pb, measured by ICP-MS, showed elevated concentrations. Mean B-Pb was 13.1 microg/dL +/- 8.5, median B-Pb was 11.2 microg/dL and ranged from 0.59 to 48.3 microg/dL. Men had higher B-Pb compared to women (median: 15.3 microg/dL vs 7.9 microg/dL respectively). B-Pb increased with age for women, while it decreased for men. For both genders, B-Pb decreased with education. There were significant differences between villages. Exploratory analyses, using linear partition models, showed that for men B-Pb was lower among those who were involved in cattle-raising, and higher among those who hunted, farmed and fished. The distribution profile of B-Pb directed us towards artisanal transformation of manioc to flour (farinha), which requires heating in a large metal pan, with stirring primarily done by young men. In the village with the highest B-Pb, analysis of Pb concentrations (dry weight) of manioc (prior to transformation) and farinha (following transformation) from 6 houses showed a tenfold increase in Pb concentration (mean: 0.017 +/- 0.016 to 0.19 +/- 0.10 microg/g). This was confirmed in one of these villages where we sampled manioc paste (just before roasting) and the roasted farinha (0.05 microg/g vs 0.20 microg/g). While there may be other sources (ammunition, sinkers for fishing nets), the high concentrations in farinha, a dietary staple, assuredly makes an important contribution. Further action needs to reduce Pb sources in this region.