Maternal perceptions of lead poisoning in children with normal and elevated lead levels.

INTRODUCTION: The purpose of this study was to examine mothers' perceptions of the severity and susceptibility of their children to lead poisoning and to determine if a correlation existed between mothers' knowledge of lead poisoning and their children's blood lead levels. It was thought that mothers of children with lead poisoning (lead levels > or = 10 micrograms/dL) would score lower on a test of their perceptions and knowledge of lead poisoning than would mothers of children with normal lead levels (lead levels < or = 9 micrograms/dL). METHOD: A cross-sectional study comparing scores of a questionnaire completed by mothers whose children had elevated blood lead levels and mothers whose children had normal blood lead levels was conducted. RESULTS: No difference was found in the median test score between the 2 groups. For the correct responses on a question-by-question comparison, significant difference existed between groups; however, the percentage of correct responses was not always greater for the mothers of children with normal blood lead levels. DISCUSSION: Mothers' perceptions and knowledge of lead poisoning were not associated with their children's blood lead levels.

Home abatement and blood lead changes in children with class III lead poisoning.

We studied the effect of home abatement on blood lead (PbB) levels in children from central Massachusetts who had not undergone chelation therapy and whose homes were abated between 1987 and 1990, when stricter abatement guidelines were enacted. One hundred and thirty-two children with a mean preabatement PbB of 25.9 micrograms/dL (1.25 mumol/L) were studied: their mean postabatement PbB (up to 1 year later) was 21.1 micrograms/dL (1.02 mumol/L) (P < .001). This reduction correlated with preabatement PbB; 32 of 33 (97%) with preabatement PbB > or = 30 micrograms/dL (> or = 1.45 mumol/L) were lower postabatement, and 64 of 79 (81%) with PbB 20 to 29 micrograms/dL (0.97-1.40 mumol/L) were lower. However, in children with preabatement PbB < 20 micrograms/dL (< 0.97 mumol/L), only seven of 20 (35%) were lower postabatement and, in fact, there was a significant rise in PbB from 16.8 to 19.3 micrograms/dL (0.81 to 0.93 mumol/L) (P = 0.05). Continued improvement in home abatement technology is needed if that strategy is to be effective in achieving the lower PbB levels now mandated in the 1991 Centers for Disease Control guidelines. Primary prevention of the initial blood lead level elevation remains the most desirable strategy.

No evidence of developmental III effects of low-level lead exposure in a developing country.

Despite substantial controversy regarding the blood levels at which lead adversely affects neurobehavioral development, public health policy in some industrialized countries is prescribing ever more stringent screening criteria for all ages. This study addressed the question of ill effects of lead exposure at the new lower levels, specifically during the late infancy period, which has been targeted for maximum surveillance in pediatric practice. The sample of 184 participants consisted of 12- to 23-month-old healthy infants and toddlers who participated in a community-based study in a developing Central American country (Costa Rica) where extensive family and developmental information was collected. The mean infant blood lead level was 11.0 micrograms/dL, ranging from 5.4 to 37.0 micrograms/dL. Lead levels were not related to the Mental or Psychomotor Developmental Index of the Bayley Scales of Infant Development. When the children were 5 years old, they were reevaluated with complete physical and psychological testing. Blood lead levels in infancy did not predict any of the developmental outcome measures. Thus, among a group of healthy toddlers in a developing country, no ill effects on development of low blood lead levels were observed.

Blood and placental lead levels in an Indian city: a preliminary report.

A preliminary investigation was carried out in a hospital in the city of Lucknow, India, to provide information on the possible range of lead (Pb) exposure in pregnant women and fetuses, to correlate high Pb levels with various socioenvironmental factors, and to examine any possible association between reproductive outcome and Pb levels in this population. The results indicate that maternal blood lead levels were higher in those who experienced abnormal deliveries and in those who ate nonvegetarian diets or drank groundwater compared with the respective control groups. Placenta, cord blood, and fetal membranes from both normal and abnormal delivery cases showed no significant differences in their Pb content. Other socioenvironmental factors did not influence these Pb levels. However, incidence of higher Pb levels in maternal blood (17% and 38% with Pb > 25 micrograms/dl in normal and abnormal deliveries, respectively) and cord blood (> 10 micrograms/dl) reflect a need for regular monitoring and lowering of environmental Pb exposure.

Setting the optimal erythrocyte protoporphyrin screening decision threshold for lead poisoning: a decision analytic approach.

Erythrocyte protoporphyrin (EP) was introduced in the 1970s as an inexpensive screening test for lead poisoning. As greater knowledge of lead poisoning has accumulated, the recommended EP level at which further evaluation for lead poisoning should be initiated has been lowered from greater than or equal to 50 micrograms/dL to greater than or equal to 35 micrograms/dL. The purpose of this study was to evaluate the utility of this EP threshold. A receiver operator characteristic curve was constructed to assess the relationship between the true-positive rate and false-positive rate of EP at various decision thresholds. The receiver operator characteristic curve was constructed with data from the second National Health and Nutrition Examination Survey from 1976 to 1980, which included 2673 children 6 years of age or younger who had both blood lead and EP level determinations. Decision analysis was then used to determine the optimal EP decision threshold for detecting a blood lead level greater than or equal to 25 micrograms/dL. The receiver operator characteristic curve demonstrated that EP is a poor predictor of a blood lead level greater than or equal to 25 micrograms/dL. At the currently recommended EP decision threshold of 35 micrograms/dL, the true-positive rates and false-positive rates of EP are 0.23 and 0.04, respectively. As a result of the inadequate performance of EP screening for lead poisoning, when the prevalence of lead poisoning is greater than 8%, there is no EP decision threshold that optimizes the relationship between the cost of screening normal children and the benefit of detecting lead-poisoned children. Erythrocyte protoporphyrin measurement is not sufficiently sensitive to be recommended uniformly as a screening test for lead poisoning.

[Lead poisoning in children. Apropos of 129 cases]. / Saturnisme de l'enfant. A propos de 129 cas.

One hundred and twenty nine children with chronic lead poisoning were followed from August 1985 to July 1989. Old lead paint was recognized as the contaminant source at home. Pica of paint flakes was the main mode of intoxication. Children were classified according to the Center for Disease Control 1985 as follows: class IV (39 cases), class III (45 cases), class II (30 cases), class I (15 cases). Nineteen of those in class IV had blood lead levels above 700 micrograms/l and received BAL + EDTA followed by EDTA alone for a mean of 4.6 +/- 3.5 courses. With this treatment, blood lead level decreases were 50 +/- 17%. Nine of these class IV children had an evaluation at last 3 months after the last chelation course: 5 became class I or II, and 2 class III with a negative provocative test. The remaining 20 children in class IV were given a mean of 2.7 +/- 1.4 courses of EDTA. Blood lead levels decreased by 52 +/- 15%; 11 children were evaluable at least 3 months after the last chelation course: 4 became class I, and 7 class II. Thus overall 80% of class IV moved under treatment to class I or II. Among those 45 children in class II, 30 underwent a provocative test and 24 one to three courses of EDTA: 8 were further studied: 3 became class I and 5 class II. Combination of screening, medical treatment and sociocultural approach led to avoid acute effects of severe chronic childhood lead poisoning. The efficacy of such an approach in preventing chronic effects has still to be evaluated.

[Principles for classification of diseases of a biogeochemical nature]. / Printsipy klassifikatsii zabolevanii biogeokhimicheskoi prirody.

The principles of working classification of human pathology associated with excess, deficiency and dysbalance of trace elements are presented on the basis of many-year analysis of the literature and own experimental and clinico-morphological observations. According to the most important variants of human contact with the environment abnormal with regard to the content of trace elements, the following types of diseases are distinguished: (1) natural, (2) technogenic, and (3) iatrogenic. In their turn, technogenic diseases are subdivided into industrial, neighbouring, transgressive. Among these diseases, monomicroelementoses and polymicroelementoses should be distinguished. The former include fluorosis, arsenosis, berilliosis, cadmium nephropathy, cobalt myocardiopathy, etc., the latter anemias of biogeochemical nature, endemic goiter, tooth caries, urolithiasis, selenium-deficient myocardiopathy, and others.