Lead exposure in female workers who are pregnant or of childbearing age

Blood and Hand Surface Lead in Veterinary Workers Using Lead Shielding During Diagnostic Radiography

OBJECTIVES

The objectives are to compare lead blood concentrations in veterinary workers using lead shielding with concentrations in a control population, to measure hand surface lead before and after use of shielding, and to compare hand surface lead with and without the use of disposable gloves worn under hand shielding.

METHODS

Blood and hand wipe samples were analyzed for lead using inductively coupled plasma mass spectrometry.

RESULTS

There was no difference in blood lead between exposed and control groups. After lead glove use, 69% (18/26) of hand surface lead samples from workers not using disposable gloves were greater than 500 μg, 42% (11/26) were greater than 1000 μg, and 12% (3/26) were greater than 2000 μg.

CONCLUSIONS

If lead shielding use is unavoidable, disposable gloves should be worn, and skin should be decontaminated after use.

Workers should take steps to mitigate surface lead exposure when using lead-containing personal protective equipment

Veterinary workers use lead shielding for protection against harm from ionizing radiation during diagnostic imaging. Surface lead on shielding has been reported as a potential exposure hazard. The purpose of this prospective, analytical, descriptive study was to measure surface lead on lead-containing shielding in the field service and small animal radiology areas of a veterinary teaching hospital, and to examine potential risk factors for surface lead. Surface lead on a convenience sample of 54 lead shielding items was measured in a commercial laboratory using inductively coupled plasma mass spectrometry. The median and range of surface lead for aprons, thyroid collars, and gloves were 3.6 μg/dm² (range, 1.3-22.4 μg/dm² ), 23.1 μg/dm² (range, 2.6-116 μg/dm² ), and 134 μg/dm² (range, 1.5-155 μg/dm² ), respectively. In the final multivariable analysis, the mean surface lead on thyroid collars and gloves was higher than on aprons (relative differences 4.8, 95% confidence interval [CI] 2.2, 10.5, P < 0.001; and 9.5, 95% CI 4.4, 20.6, P < 0.001, respectively). The mean surface lead on shielding in the worst condition was higher than on shielding in the intermediate and best conditions (P < 0.001). Lead shielding provides effective protection against the harmful effects of ionizing radiation, and shielding should always be worn during radiation exposure. Based on our findings and the common use of lead shielding in veterinary workplaces, we recommend that employers inform workers of this hazard and provide training on steps to mitigate exposure, including the use of disposable gloves when wearing lead shielding and handwashing after use.

Educational interventions for preventing lead poisoning in workers

BACKGROUND

Occupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness.

OBJECTIVES

To assess the effect of educational interventions for preventing lead uptake in workers exposed to lead.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions.

SELECTION CRITERIA

We sought randomised controlled trials (RCT), cluster-RCTs (cRCT), interrupted time series (ITS), controlled before-after studies (CBA) and uncontrolled before-after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS-I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence.

MAIN RESULTS

We did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before-after studies studies, conducted between 1982 and 2004. Blood lead levels Educational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short-term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low-certainty evidence). In the medium-term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low-certainty evidence). In the long-term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low-certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI -0.11 to 2.31; one study, 52 participants, very low-certainty evidence). Urine lead levels In the long-term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low-certainty evidence). Behaviour change The evidence is very uncertain about the effect of educational intervention on behaviour change. At medium-term follow-up after the educational intervention, very low-certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40). At long-term follow-up, very low-certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81). Improved knowledge or awareness of the adverse health effects of lead The evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium-term follow-up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low-certainty evidence). At long-term follow-up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low-certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low-certainty evidence). None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention.

AUTHORS' CONCLUSIONS

Educational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.

The associations among lead exposure, bone mineral density, and FRAX score: NHANES, 2013 to 2014

Lead exposure has been suspected as a risk factor for osteoporosis. However, in epidemiological studies, the association between environmental lead exposure and bone health were inconsistent. With the decrease of lead exposure in recent decades, we evaluated the association between lead exposure and bone mineral density (BMD) in the general US population in this study. We analyzed data on 1859 adults (aged ≥40 years) from the National Health and Nutrition Examination Survey (NHANES) conducted in 2013-2014 to determine the relationship among lead exposure measured by both blood and urine lead concentration, BMD of total spine and femur, and FRAX score in a cross-sectional study. In premenopausal women, the results showed a 1-unit increase in natural log-transformed blood and urine lead levels was associated with a decrease in total femur BMD of 0.061 g/cm² (S.E. = 0.015; p = 0.001) and 0.046 g/cm² (S.E. = 0.018; p = 0.020), respectively. Moreover, in premenopausal women, a 1-unit increase in natural log-transformed blood level was associated with a decrease in total spine BMD of 0.054 g/cm² (S.E. = 0.019; p = 0.013). Both FRAX scores were positively correlated with blood and urine lead levels in subjects without fractures, while the 10-year hip fracture risk score was positively associated with lead exposure in subjects with a history of fracture or vertebral fracture. In conclusion, lead exposure was associated with decreased total femur and spine BMD, and FRAX score in the general US population. Further research is needed to elucidate the causal relationship among lead exposure, BMD, and fracture risk.

Allicin alleviates lead-induced hematopoietic stem cell aging by up-regulating PKM2

Hematopoietic stem cells (HSCs) aging is associated with hematopoietic dysfunction and diseases. Our previous study showed that lead exposure induced a functional decline in HSCs. Allicin, a chemical extracted from the garlic (Allium sativum L.), has been reported to have antioxidative and anti-inflammatory effects. However, the biological activities of allicin on lead-induced toxicity, especially in the hematopoietic system, remain unclear. Here, we found that lead exposure elicited aging phenotypes in HSCs, including perturbed cell quiescence, disabled self-renewal function and colony-forming ability, and myeloid-biased differentiation, all of which contributed to significant hematopoietic disorders in mice. Intragastric administration of allicin substantially ameliorated lead-induced HSCs aging phenotypes in vivo. Lead exposure induced a peroxide condition in HSCs leading to DNA damage, which reduced expression of the glycolytic enzyme pyruvate kinase M2 isoform (PKM2), a phenotype which was significantly ameliorated by allicin treatment. These findings suggested that allicin alleviated lead-induced HSCs aging by up-regulating PKM2 expression; thus, it could be a natural herb for preventing lead toxicity.

Lead poisoning risk assessment of radiology workers using lead shields

Purpose: Lead containing dust may be present on the exterior surfaces of shields used to prevent radiation exposure. We determined whether use of lead shields poses an exposure risk for radiology personnel.Methods: We collected hand dustwipe and blood samples from 58 Radiology Department employees of an academic hospital. Samples were analyzed for lead content by atomic absorption spectroscopy. Results were compared between lead apron users (46) and nonusers (12).Results: Hand dustwipe lead was undetectable (<3 µg/sample) in all cases. Blood lead levels ranged from 0-3 µg/dL.Conclusions: In this study of Radiology Department workers, we did not find an increased risk of lead contamination on their hands or in their blood. Although our sample size is small, we conclude that lead poisoning is unlikely to occur with high frequency in lead shield users.

Methylmercury Exposure Induces Sexual Dysfunction in Male and Female Drosophila Melanogaster

Mercury, an environmental health hazard, is a neurotoxic heavy metal. In this study, the effect of methylmercury (MeHg) exposure was analyzed on sexual behavior in Drosophila melanogaster (fruit fly), because neurons play a vital role in sexual functions. The virgin male and female flies were fed a diet mixed with different concentrations of MeHg (28.25, 56.5, 113, 226, and 339 µM) for four days, and the effect of MeHg on copulation of these flies was studied. While male and female control flies (no MeHg) and flies fed with lower concentrations of MeHg (28.25, 56.5 µM) copulated in a normal manner, male and female flies exposed to higher concentrations of MeHg (113, 226, and 339 µM) did not copulate. When male flies exposed to higher concentrations of MeHg were allowed to copulate with control female flies, only male flies fed with 113 µM MeHg were able to copulate. On the other hand, when female flies exposed to higher concentrations of MeHg were allowed to copulate with control male flies, none of the flies could copulate. After introduction of male and female flies in the copulation chamber, duration of wing flapping by male flies decreased in a MeHg-concentration-dependent manner from 101 ± 24 seconds (control) to 100.7 ± 18, 96 ±12, 59 ± 44, 31 ± 15, and 3.7 ± 2.7 seconds at 28.25, 56.5, 113, 226, and 339 µM MeHg, respectively. On the other hand, grooming in male and female flies increased in a MeHg-concentration-dependent manner. These findings suggest that MeHg exposure causes sexual dysfunction in male and female Drosophila melanogaster. Further studies showed that MeHg exposure increased oxidative stress and decreased triglyceride levels in a concentration–dependent manner in both male and female flies, suggesting that MeHg-induced oxidative stress and decreased triglyceride levels may partly contribute to sexual dysfunction in fruit flies.

Comparison of blood and tissue lead concentrations from cattle with known lead exposure

Blood lead (Pb) is used to diagnose Pb poisoning and exposure in cattle, but there are limited data comparing circulating Pb with concentrations in beef from the same cattle. This study determines whether there is a correlation between blood Pb and tissue Pb concentrations in accidentally exposed cattle. Pb analyses were carried out on ante-mortem blood and post-mortem tissues (including, if available, brain, liver, skeletal muscle, bone, gastrointestinal contents and kidney, and also foetal tissues from one cow) collected from 13 cattle known to have accidental Pb exposure and from three control cows with no known exposure. Variables from cattle were analysed statistically using a Shapiro-Wilk normality test and non-parametric descriptive and association statistics. Blood Pb from exposed cattle rank-correlated with liver, bone and kidney Pb concentrations, but not with the Pb concentrations of brain, skeletal muscle or gastrointestinal contents. The lowest blood Pb concentration associated with a detectable skeletal muscle Pb concentration (> 0.1 mg kg^-1 dry matter) was 4.57 μg dl^-1. Based on these findings, we recommend that cattle with blood Pb > 2.5 μg dl^-1 be withheld from slaughter and that liver, bone and kidney from all cattle with known Pb exposure be withheld from the human food chain.

Tobacco smoke exposure during pregnancy increases maternal blood lead levels affecting neonate birth weight

To assess the effect of lead exposure from cigarette smoke on fetal growth, blood lead concentrations were measured using inductively coupled plasma mass spectrometry in 150 healthy pregnant women. Mean lead concentrations in plasma and whole blood were significantly higher in the smoking group compared with the nonsmoking group in each trimester of pregnancy (p < 0.001). Logistic regression analysis showed the highest impact of the number of cigarettes smoked per day for serum lead concentration (β = 0.238; p < 0.05), while in whole blood, it was duration of smoking before conception (β = 0.297; p < 0.001). Birth weight of the smoking mothers' infants was significantly lower (mean ± SEM, 3,192 ± 50.8 and 3,569 ± 49.6 g, respectively; p < 0.001) and negatively correlated with lead levels in plasma (r = -0.38; p < 0.001) and in whole blood (r = -0.27; p < 0.001). Therefore, it is suggested that smoking during pregnancy increases lead concentrations in maternal blood. Fetal exposure to low doses of lead in utero may be a serious risk factor causing lower birth weight.

Distribution of lead in selected organs and its effect on reproduction parameters of pheasants (Phasianus colchicus) after an experimental per oral administration

Lead poisoning has been reported in almost every country on earth. In this study the effect of experimental lead pellet intake (2-6 pellets per week [groups B2, B4, B6] and ad libitum [BAD] accessibility for 10 weeks) on its distribution in liver, kidney, pectoral muscle, ovary, eggs and the effect of selected reproductive parameters (egg weight, fertilization, hatchability) was analyzed in breeding pheasants. Lead pellets were force fed to the digestive tract (struma, ingluvies) and the ingestion was controlled. Concentration of lead was detected using the atomic absorption spectrophotometry. Analysis of the lead concentration in liver showed a significantly higher concentration in all group after the lead pellets intake. The increase of the lead concentration was dose-dependent and the concentration detected in group BAD was similar as in group B2. Very similar tendencies were detected for the lead concentration in kidney. The accumulation of lead in pectoral muscle was lower, in comparison with liver and kidney. Compared to lead concentration detected in ovary of the control group a significant increase was detected in all experimental groups, reaching the maximum in the group B6. Similar significant increase of lead concentration was detected in eggs. The average weight of eggs was 32.01 ± 2.71 g in the control group and lower in all experimental groups, but this decrease was significant only in the group B6. The fertilization rate was the highest in the control group and a dose-dependent decrease was detected with the lowest value in the group B6. For egg hatching ratio a significant decrease was detected in groups B4 and B6. Results of this study clearly describe accumulation of lead in the body and a its negative effect on the reproductive parameters. In the ad libitum experimental group the most similar results were found as in group B2, suggesting a rate of "natural" lead pellet intake.