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Our data show that the lead industry caused serious environmental pollution that led to high BLLs in children living nearby. High concentration of lead in children's blood is among the leading public health issues worldwide. China experienced dramatic industrial and economic growth over the past decades, but at a high cost to the environment and public health. One survey in 19 cities showed that median BLL in children aged 3 to 5 years ranged from 3.
Fujian Province, located in southeast China, is a relatively developed coastal area with abundant mineral resources, including lead. More than lead-related enterprises mines and processing plants were established during the past 2 decades, most of which operated in poorly regulated rural areas. The activities associated with mining, separating, smelting, and transportation resulted in serious environmental pollution and posed a health threat to local residents, particularly children. News media increasingly called attention to high BLLs in local children. However, no tangible effort was made to evaluate the extent of environmental lead pollution and health outcomes in the general population.
We conducted a study in a rural area of Fujian Province, where several town-owned lead-related enterprises operated between and The investigation was triggered by a news report about children living near lead industries who were found to have high BLLs after their parents demanded that they be tested. The report aroused concern among local residents, who successfully advocated for testing all children younger than 15 years living in the vicinity.
Great public pressure led local authorities to require all lead enterprises to close by September We undertook an exposure assessment of environmental lead pollution during October and November of the same year. We aimed to elucidate the relationship between environmental lead pollution and children's BLLs. We studied a polluted region, estimated to contain more than 20 million tons of natural lead and zinc ore deposits, in a rural mountainous area in the center of Fujian Province.
Three lead mines and 2 lead-smelting processing plants had been operating since , producing up to tons of raw lead and 55 tons of lead products annually. This area covered approximately 18 square kilometers, with people residing in 7 villages. Nearly half of the local families had at least 1 member working in a plant or mine. Several partially paved roads, approximately 2 to 3 meters wide, ran through this area and were mainly used to transport lead products.
In addition, several explored ore holes dotted the area Figure 1. Locations in Fujian Province, China, of A—G 7 villages, 5 lead-related enterprises, several lead ore holes, and paved roads that were used mainly for transportation of lead products. Department of Environmental Protection in Fujian Province. Investigation report of children's elevated blood lead level in Youxi County in Fujian [internal report], January According to official registry data, children aged 2 months to 14 years were living in the 7 villages.
We conducted interviews to collect relevant information and measured BLLs in all the children, except for 12 of them whose parents refused consent. We excluded 10 children because of incomplete information, leaving children in our final analytical sample. We also selected 61 children aged younger than 15 years who lived in a village located kilometers away in a mountainous area without lead-related industry. After 1 year, we retested the BLLs of Venous blood samples were drawn into metal-free heparin tubes from cleaned and sanitized skin at the children's elbow area by trained nurses at a local hospital.
BLLs were determined by graphite furnace atomic absorption spectrometry in a certified laboratory. We applied both internal and external laboratory quality controls to ensure that the measurements were accurate. BLLs were expressed as micrograms per deciliter. We followed the same procedures in retesting the children's BLLs after 1 year. We collected soil samples in each village with systematic grid sampling. If a house stood in the center of the grid, we took at least 3 soil samples from the sides and back of the house, as well as from the children's play yards that were present in front of most houses.
Then we combined these samples as composite example of the grid. Altogether, we collected 43 soil specimens in polluted villages and 22 in the control village. We used new plastic spoons to extract these specimens from the surface to 2. We measured soil lead with flame atomic absorption in a certified lab, following American Society for Testing and Materials standards.
For quality control of specimen digestion, we performed identical treatments on blanks and specimens. We checked the precision of lead analyses by running lead content standards before and after each batch of specimens and intercalating a blank between every 10 specimens. The lead concentration of soil was expressed as milligrams per kilogram. The detection limit with our method was 0. Our stratified sampling method drew data from a geographic information system about house location and resident density to select 60 of the households in the polluted villages and 24 of the 53 households in the control village from which to take samples of dust to measure lead levels.
One composite sample was taken from window sills or troughs in living rooms and children's play rooms, where lead-containing dust was known to accumulate. We collected a minimum of 10 grams of household dust from each selected home. We collected dust samples with moist wipes by a standard procedure. Dust lead concentration was expressed as milligrams per kilogram. We provided a structured questionnaire to be used by trained investigators to interview the children's parents and collect information on children's exposures to lead, including location, environment surrounding the house, condition of the house, and length of residence.
The questionnaire probed for other potential sources of lead exposure, including frequency of consuming canned food or drinks; whether any family member worked in a lead industry and whether such workers often brought work suits or tools home; presence of peeling paint on windows, doors, or furniture; storage of other lead-containing materials, such as lead-containing pesticides or lead ore; and use of lead pottery at home.
We also collected information on children's hygienic habits hand washing, bathing frequency, and pica , milk consumption, smoking by family members at home, parental education level, and family income. All of the lead mines and plants were forced to close at the time of our investigations. Lead mining, smelting, and transportation activities in the area stopped completely.
A village-based health education program was launched as part of our study, delivering 1 class every 4 months. The classes focused on the adverse health effects of lead and how to protect children from lead exposure. Local residents were called on to help clean up the environment by, for example, washing yards, removing lead ore from their homes, and performing standard house cleaning.
Annals of Clinical and Laboratory Science. Recall bias and interviewer bias were unlikely, because the BLLs of the children were not known at the time of the interviews. Archived from the original on 4 June We searched for possible determinants of BLL through linear regression analysis Table 3. Prevention measures also exist on national and municipal levels. Chelation challenge, also known as provocation testing, is used to indicate an elevated and mobilizable body burden of heavy metals including lead.
In cooperation with local professionals, we carried out a follow-up evaluation 1 year after these interventions in the polluted area to evaluate their effects on children's BLLs. The data analysis centered on the association between environmental lead pollution and children's BLLs. We used environmental measurements in the different villages as surrogates of personal exposure levels, because no personal exposure data were available and not all soil samples corresponded exactly to the locations of children's homes.
Soil lead corresponded well with the distances of the villages from lead mines or plants and prevailing wind direction. Therefore, we divided the villages and the children residing in them into 3 exposure categories according to the soil lead concentrations: As shown in Figure 1 , villages A and B were nearest to and downwind from lead plants or mines prevailing wind direction was west—northwest.
Village G was located farthest away from the lead enterprises and separated by a river. We applied multivariate linear regression analysis to determine the association between exposure levels and children's BLLs, with adjustment for gender, length of residence in the area, parental occupation and education, milk consumption, and possible sources of lead exposure at home.
We used a stepwise procedure with the criterion of entry 0. We then constructed a final model that incorporated the exposure category and all variables meeting the criteria. We included age and length of residence exclusively because of their colinearity. In determining a relationship between household dust lead and BLLs, we log-transformed both variables and applied Pearson correlation analysis.
To examine changes in BLLs 1 year after closure of the lead enterprises, we used paired t tests to compare the baseline and follow-up BLLs among retested children. We also used a multivariate linear model to compare changes in BLLs with exposure levels, with adjustment for potential confounding factors.
All data analyses were carried out with the SPSS version The geometric mean for soil lead in the low-exposure village was All were higher than in the control village The soil lead level in medium- and high-exposure villages far exceeded the maximum level of milligrams per kilogram considered safe under Chinese regulations.
The geometric mean for household dust lead in the low-exposure village was Table 1 summarizes sociodemographic data and potential risk factors of children by exposure level. The average age of children in the sample was 7 to 8 years, with slightly more boys than girls. Parental education level was lower in the control group.
More than half of parents in the polluted area admitted bringing their work suits or tools home, but very few families used lead pottery at home. Daily milk consumption was more common and bathing was more frequent among children in the polluted area than it was among those in the control area. We identified 29 houses in the polluted area but none in the control village that were storing lead ore.
Fujian Province, China, Table 2 presents children's BLLs. The mean value for children in the polluted area was We found BLLs of 10 micrograms per deciliter or higher in Among children in the polluted area, average BLLs increased with exposure level, suggesting an exposure—response gradient. The local health department sent 25 children with BLLs greater than 25 micrograms per deciliter to the hospital. These children received supportive and chelation therapy.
We searched for possible determinants of BLL through linear regression analysis Table 3. All 3 exposure levels were significantly associated with elevated BLLs compared with the control group. We detected a gradient of BLLs with exposure level: Other significant risk factors were male gender, longer residence in the polluted area, parental lead-related occupations, and parents often bringing work suits or tools home.
Milk consumption and higher parental education were inversely associated with BLL. We used years of residence in the polluted area in the final model. We adjusted for use of lead pottery, house near main road, and lead ore stored in house. Figure 2 is a scatter plot of household dust lead log against BLLs log in 84 children whose household dust was sampled. A significant correlation remained even after excluding the control group.
Scatter plot with fit line between log-household dust lead against log-BLL among 84 children: Children's BLLs rose with increasing household dust lead, with a coefficient of 0. Table 4 shows the changes in BLLs 1 year after the intervention. Among the entire group, the mean BLL decreased from The reduction tended to be greater among children in lower-exposure villages.
In a further multiple linear regression, in which the difference between baseline and follow-up BLLs was the outcome variable, we found smaller reductions among children with medium 1. We examined environmental lead pollution resulting from industrial sources and its impact on the BLLs of children in a rural area of China. The lead concentrations in soils were well above the already lax national standards.
We did not report lead concentrations in the air because air samples were taken after the closure of lead industries and did not reflect environmental exposure levels. The poorly regulated activities of mining, separating, transportation, and smelting of lead were responsible for the serious lead pollution in the area.
After ruling out other potential exposure sources, we found that lead exposure levels resulting from industrial pollution were strongly associated with elevated BLLs in children. From Wikipedia, the free encyclopedia. Lead poisoning Synonyms Plumbism, colica pictorum, saturnism, Devon colic , painter's colic An X ray demonstrating the characteristic finding of lead poisoning in humans—dense metaphyseal lines.
Specialty Toxicology Symptoms Intellectual disability , abdominal pain, constipation , headaches, irritability, memory problems, inability to have children , tingling in the hands and feet [1] [2] Complications Anemia , seizures , coma [1] [2] Causes Exposure to lead via contaminated air, water, dust, food, consumer products [2] Risk factors Being a child [2] Diagnostic method Blood lead level [2] Differential diagnosis Iron deficiency anemia , malabsorption , anxiety disorder , polyneuropathy [3] Prevention Removing lead from the home, improved monitoring in the workplace, laws that ban lead in products [2] [4] [5] [6] Treatment Chelation therapy [4] Medication Dimercaprol , edetate calcium disodium , succimer [7] Deaths , [2] Lead poisoning is a type of metal poisoning caused by lead in the body.
Archived from the original on 18 October Retrieved 14 October Annual Review of Medicine. American Journal of Health-System Pharmacy. Archived from the original on 4 May Retrieved 18 May Archived from the original on Archived from the original on 9 October Pediatric Clinics of North America. Advantages, Limitations, and Future Needs". Principles of Biochemical Toxicology 4th ed.
Exposure, evaluation, and treatment". Andrews' Diseases of the Skin: A single group non-randomized clinical trial". Indian Journal of Dermatology. Archived from the original on 14 July Advances in Pediatrics, E-Book. Baran and Dawber's Diseases of the Nails and their Management. Toxicology and Applied Pharmacology. An International Pooled Analysis". Who Is at Risk of Lead Exposure? Environmental Health and Medicine Education. Department of Health and Human Services. Archived from the original on February 4, The Journal of Rheumatology. Effect Modification by Chronic Lead Exposure".
Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do". The American Journal of Nursing. Part A, Clinical and Molecular Teratology. International Journal of Hygiene and Environmental Health. Current Opinion in Pediatrics. An year follow-up report". The New England Journal of Medicine.
International Journal of Environmental Health Research. Archived from the original PDF on Archived from the original on September 20, Retrieved September 24, Lead contamination in Uruguay: Reviews of Environmental Contamination and Toxicology. Canadian Medical Association Journal.
A Short, Sad History". Archived from the original on March 21, Archived from the original on January 24, Explicit use of et al.
Archived from the original on June 27, Inorganic Lead Exposure and Intoxications. Archived from the original on May 3, Retrieved September 18, Archived from the original on September 12, Archived from the original on 23 January Archived from the original on August 25, Retrieved September 26, Acta Radiologica Stockholm, Sweden: Morbidity and Mortality Weekly Report. Potential for Human Dietary Exposure". Archived from the original on 14 January Archived from the original on 21 May New Delhi , India. Archived from the original on 25 May Retrieved 20 May The Times of India.
Archived from the original on 16 October Retrieved 3 June Retrieved June 4, The two-minute death of a India's favourite noodle brand". Archived from the original on 4 June Archived PDF from the original on Wisconsin department of natural resources. Archived PDF from the original on 28 July Retrieved 10 December Retrieved 9 February Association between blood lead levels and wild game consumption". Assessment of human health risk from consumption of wild game meat with possible lead contamination among the residents of the State of North Dakota" PDF.
Archived from the original PDF on May 26, Retrieved March 2, US Center for Disease Control. The Indian Journal of Medical Research. A Computational Modeling Experiment". Angewandte Chemie International Edition. Journal of Biological Chemistry. Archived from the original on 5 November Where Does It Lead? Archived from the original on 3 April Retrieved 30 October The Tohoku Journal of Experimental Medicine.
Journal of Negative Results in Biomedicine. Reviews on Environmental Health. Retrieved August 25, Annals of Clinical and Laboratory Science. Wintrobe's clinical hematology Thirteenth ed. American Journal of Physiology. Heart and Circulatory Physiology. Implications for Assessing the Efficacy of Lead Abatement". Centers for Disease Control and Prevention. Archived PDF from the original on 9 January Retrieved 5 January Disposition of Toxic Drugs and Chemicals in Man 8th ed.
The Cochrane Database of Systematic Reviews. Archived from the original on June 4, Archived from the original on August 27, Welcome to Our Town. Retrieved 14 June The Veterinary Clinics of North America. Am J Health Syst Pharm. Occupational and Environmental Medicine. Needleman June 28, University of North Carolina. Archived PDF from the original on March 3, Journal of Occupational Health. N Engl J Med. Proceedings of the National Academy of Sciences. Tales of the Living Dead: Poisoned Roman Babies television.
Brighton TV for National Geographic. Did lead poisoning contribute to the fall of the Empire?
American Journal of Industrial Medicine. Eberhard Gockel and the colica Pictonum". Journal of Occupational and Environmental Medicine. The Life and Times of Benjamin Franklin. Environmental Science 8th ed. Archived from the original on February 10, An Interview with Herber Needleman". Archived from the original on 3 September Retrieved 31 August The Center for Science and Democracy.
Union of Concerned Scientists. Archived from the original on 25 October Retrieved 8 October US House of Representatives. Archived from the original PDF on 24 October Retrieved 28 August Retrieved 21 August Mihara; Associate Justice Eugene M. Premo; Associate Justice Franklin D. ConAgra Grocery Products Company et al".
Judicial Council of California. Journal of Dairy Science. Journal of Wildlife Diseases. California Department of Fish and Game. Goodman and Gilman's Manual of Pharmacology and Therapeutics. Casarett and Doull's Toxicology: The Basic Science of Poisons 7th ed.
At the time of writing, the topic of lead pollution is the subject of an intense and sometimes heated debate. The argument centres upon possible adverse health effects arising from exposure of children to current environmental levels of lead. Any effective control strategy for lead. At the time of writing, the topic of lead pollution is the subject of an intense and sometimes heated debate. The argument centres upon possible adverse health.
Oski's Essential Pediatrics 2nd ed. Medical Toxicology 3rd ed. Human Exposures and Their Health Effects 3rd ed. Goldfrank's Toxicologic Emergencies 8th ed. Diagnosis and Management of the Critically Poisoned Patient. Basic and Clinical Pharmacology. Poisoning and Drug Overdose 5th ed. Child Neurology 7th ed. Principles and Methods of Toxicology 5th ed. Diagnosis and Management of the Poisoned Child.
Current Medical Diagnosis and Treatment 46th ed. Rudolph's Pediatrics 21st ed. Clinicopathologic Foundations of Medicine 5th ed. Environmental Engineering 5th ed.
John Wiley and Sons. Environmental metals and metalloids". Biological and Health Effects of Pollutants. Poisoning Toxicity Overdosing T36—T65 , — Sulfuric acid Selenium Chlorine Fluoride. Pesticides Aluminium phosphide Organophosphates. Cyanide Nicotine Nitrogen dioxide poisoning. Alezzandrini syndrome Vogt—Koyanagi—Harada syndrome. Piebaldism Waardenburg syndrome Tietz syndrome. Oculocutaneous albinism Ocular albinism.
Vasospastic macule Woronoff's ring Nevus anemicus. Nevus depigmentosus Postinflammatory hypopigmentation Pityriasis alba Vagabond's leukomelanoderma Yemenite deaf-blind hypopigmentation syndrome Wende—Bauckus syndrome. Dermatopathia pigmentosa reticularis Pigmentatio reticularis faciei et colli Reticulate acropigmentation of Kitamura Reticular pigmented anomaly of the flexures Naegeli—Franceschetti—Jadassohn syndrome Dyskeratosis congenita X-linked reticulate pigmentary disorder Galli—Galli disease Revesz syndrome.
Incontinentia pigmenti Scratch dermatitis Shiitake mushroom dermatitis. Acanthosis nigricans Freckle Familial progressive hyperpigmentation Pallister—Killian syndrome Periorbital hyperpigmentation Photoleukomelanodermatitis of Kobori Postinflammatory hyperpigmentation Transient neonatal pustular melanosis. Argyria Chrysiasis Arsenic poisoning Lead poisoning Titanium metallic discoloration.