Analysis of suspected occupational chronic lead poisoning reported online and subsequent diagnosis in Jiangsu Province from 2014 to 2018 / 中华劳动卫生职业病杂志

Objective: To understand the distribution and characteristics of suspected occupational chronic lead poisoning reported online by Jiangsu Province, and to track the final diagnosis of suspected cases. Methods: The suspected occupational chronic lead poisoning cases in Jiangsu Province reported online from 2014 to 2018 were collected as the survey objects. Based on the reporting of the Occupational Disease Report Card from January 1, 2014 to November 5, 2019, the distribution characteristics and reporting institutions of suspected cases and final confirmed cases were analyzed. Results: From 2014 to 2018, 312 cases of suspected occupational chronic lead poisoning were reported online in Jiangsu Province. There were significant differences in the number of online reported cases of occupational chronic lead poisoning, online reported cases of suspected occupational chronic lead poisoning and confirmed cases of suspected occupational chronic lead poisoning in different years (P<0.05) , especially in 2015. Among the suspected occupational lead poisoning cases reported online, 236 cases (75.6%) were male, mainly distributed in the manufacturing industry, and 246 cases (79.1%) were operators. All the suspected occupational chronic lead poisoning cases reported online were concentrated in private enterprises, 229 cases (73.4%) in small and medium-sized enterprises. The top three cities were Suqian with 111 cases (35.6%) , Yangzhou with 79 cases (25.3%) and Huai'an with 50 cases (16.0%) . From 2014 to 2018, 19 suspected cases of occupational chronic lead poisoning were finally confirmed in Jiangsu Province, with a diagnosis rate of 6.1%. Conclusion: The majority of suspected occupational chronic lead poisoning cases reported online in Jiangsu Province are men, manufacturing and small and medium-sized enterprises, and the final diagnosis rate of suspected occupational chronic lead poisoning cases reported online is low.

Análisis de la distribución nacional de intoxicación por plomo en niños de 1 a 4 años. Implicaciones para la política pública en México / Analysis of the national distribution of lead poisoning in 1-4 year-old children. Implications for Mexican public policy

Resumen: Objetivo: Estimar la magnitud de intoxicación por plomo (Pb) (≥5μg/dL en sangre) en niños de 1 a 4 años e identificar la contribución del uso de loza de barro vidriado con Pb (LBVPb) como fuente de exposición en los 32 estados de México. Material y métodos: Muestra de Pb en sangre (PbS) capilar de niños participantes en la Encuesta Nacional de Salud y Nutrición 2018-2019. Se estimó la prevalencia de intoxicación, su asociación con LBVPb y distribución nacional. Resultados: La prevalencia nacional de intoxicación fue 17.4%, lo cual representa 1.4 millones de niños. Esta prevalencia fue 30.7% entre usuarios de LBVPb y 11.8% entre no usuarios. En 17 estados la prevalencia de intoxicación es ≥10%; en 11 es ≥5-10% y en 4 es <5%. Conclusiones: Existe una distribución diferencial geográfica del problema; se confirma la asociación con LBVPb y se estima la contribución de otras fuentes de exposición. Esta información ofrece una guía para implementar acciones de prevención y control en México.

Abstract: Objective: To estimate de magnitude of Pb poisoning (≥5μg/dL blood) in 1-4 year old children and to identify the contribution of lead-glazed ceramics use (LGC) as a source of exposure in the 32 Mexican states. Materials and methods: Using the results from a sample of capillary blood lead (BPb) we estimated the prevalence of Pb poisoning, it's association with LGC and national distribution. Results: The national prevalence of Pb poisoning was 17.4% representing 1.4 million children. The prevalence was 30.7% among LGC users and 11.8% in non-users. In 17 states the prevalence of Pb poisoning was ≥10%, in 11 states between 5-10%, and in 4 states <5%. Conclusions: There is a geographic differential distribution of the problem; confirming the association with LGC and estimating the contribution of other Pb exposure sources. This information offers a guide to implement prevention and control actions in Mexico.

Intoxicación por plomo y nivel de marginación en recién nacidos de Morelos, México / Lead poisoning and marginalization in newborns of Morelos, Mexico

Resumen: Objetivo: Determinar la prevalencia de intoxicación por plomo (IPb) al nacimiento en Morelos, analizar su distribución por nivel de marginación y estimar la asociación con el uso de barro vidriado (BV). Material y métodos: Se midió plomo en sangre (PbS) en cordón umbilical de una muestra representativa de 300 nacimientos seleccionados aleatoriamente de aquéllos atendidos por los Servicios de Salud de Morelos e IMSS estatal. Resultados: La prevalencia de IPb al nacimiento (PbS>5µg/dL) fue 14.7% (IC95%: 11.1, 19.3), y 22.2% (IC95%: 14.4, 32.5) en los municipios más marginados. 57.1% (IC95%: 51.3, 62.7) de las madres usaron BV durante el embarazo y la frecuencia de uso se asoció significativamente con PbS. Conclusión: Este es el primer estudio que documenta la proporción de recién nacidos con IPb que están en riesgo de sufrir los consecuentes efectos adversos. Se recomienda monitorear PbS al nacimiento y emprender acciones para reducir esta exposición, especialmente en poblaciones marginadas.

Abstract: Objective: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Materials and methods: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. Results: The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. Conclusion: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.

Proximity of residence to an old mineral storage site in Chile and blood lead levels in children / Proximidade residencial com um velho depósito mineral no Chile e nível de chumbo no sangue em crianças / Proximidad residencial con un viejo depósito mineral en Chile y el nivel de plomo en sangre de niños

Evidence suggests that an old mineral storage site removed in 1998 due to high lead content, remains as a source of exposure in the city of Antofagasta, Chile. The aim was to determine the association between blood lead levels in children and the residential proximity to the old mineral storage site. A cross sectional study was conducted with 185 children aged 7 to 16 years. The outcome variable was blood lead levels measured in 2005. The exposure variable was the distance between the current residence and the old mineral storage site. The distance was measured in meters by Geographic Information System (GIS). The median blood lead level in 2005 was 3.3μg/dL (interquartile range ‒ IQR: 2.0-4.3). A significant inverse association was found between the residential distance to the old mineral storage site and the blood lead levels in children, after adjusting by confounders (β: -0.04; 95%CI: -0.09; -0.01). This result suggests that the old mineral storage site continues to be a source of lead exposure for the children living nearby.

A evidência sugere que um depósito de minerais removido em 1998 por seu alto teor de chumbo ainda poderia ser uma fonte relevante de exposição a este metal, na cidade de Antofagasta, Chile. O objetivo deste trabalho foi determinar a associação entre a distância da residência até o antigo depósito e a concentração de chumbo no sangue. Estudo transversal com 185 crianças de 7-16 anos. A variável dependente foi a concentração de chumbo no sangue medido em 2005; a exposição foi a distância (metros) entre a residência atual e o antigo depósito de chumbo, obtida por meio do Sistema de Informação Geográfica (SIG). A concentração de chumbo no sangue foi de 3,3μg/dL (intervalo interquartil ‒IQR: 2,0-4.3). Constatou-se uma relação inversa entre a distância da casa para o antigo local de recolha e a concentração de chumbo no sangue (β: -0,04; IC95%: -0,09; -0,01). Esse resultado confirma que o antigo lugar de armazenagem do minério continua a ser uma fonte relevante de exposição ao chumbo.

Evidencia sugiere que un antiguo sitio de acopio de minerales removido en 1998 por el alto contenido de plomo, aún sería una fuente de exposición en la ciudad de Antofagasta, Chile. El objetivo fue determinar la asociación entre la concentración de plomo en sangre y la distancia entre la vivienda actual y el antiguo sitio de acopio. Se realizó un estudio de diseño transversal con 185 niños de 7 a 16 años. La variable dependiente fue la concentración de plomo sanguíneo, medida el 2005. La variable de exposición fue la distancia entre la vivienda actual y el antiguo sitio de acopio. Esta distancia fue medida en metros mediante Sistema de Información Geográfica (SIG). La concentración de plomo en sangre fue de 3,3μg/dL (rango intercuartil ‒ RIC: 2,0-4,3). Se encontró una relación inversa y significativa entre la distancia de la vivienda al antiguo sitio de acopio y la concentración de plomo sanguíneo (β: -0,04; IC95%: -0,09; -0,01). Este resultado sugiere que el antiguo sitio de acopio de minerales sigue siendo una fuente de exposición a plomo.

Habilidades sociais, competência acadêmica e problemas de comportamento em crianças com diferentes níveis de plumbemia / Social skills, academic competence and behavior problems in children with different blood lead levels

Este estudo teve como objetivo verificar a relação entre diferentes níveis de plumbemia e o repertório de habilidades sociais, problemas de comportamento e competência acadêmica de crianças e adolescentes. Participaram 155 crianças e adolescentes, com idade média de 13,10 anos, pertencentes a três grupos: alta plumbemia (superior a 10μg/dl), baixa plumbemia (inferior a 5μg/dl) e que viviam em ambiente similar, mas livre da contaminação por chumbo (grupo de comparação). Foram utilizados os instrumentos SSRS-BR e o IHSA-Del-Prette, respondidos pelos participantes e seus professores. Identificou-se comprometimento no repertório comportamental, acadêmico e social, associado ao nível de plumbemia. Esses resultados evidenciam os riscos associados à exposição ao chumbo. São discutidas explicações para alguns resultados contraditórios, levantando-se hipóteses e questões para novos estudos.

This study aimed to investigate the relationship between varying levels of lead poisoning and social skills repertoire, frequency of behavior problems and academic competence in children and adolescents. Participants were 155 children and adolescents, with an average age of 13.10 years, who belonged to three groups: high blood lead levels (over 10μg/dl), low blood lead levels (less 5μg/dl) and children who lived in a similar, but lead-free environment (comparison group). We used the Social Skills Rating System - Brazilian version (SSRS-BR) and the Social Skills Inventory for Adolescents (IHSA-Del-Prette) which were answered by the children and their teachers. Impairment in children's behavioral, academic and social repertoire was associated with blood lead levels. These results show the risks associated to lead exposure. Explanations are discussed for some contradictory results, rising hypotheses and questions for further studies.

Intoxicación por plomo y su tratamiento farmacológico / Lead poisoning and pharmacological treatment

La intoxicación por plomo es un problema de saludpública. La evidencia de poblaciones afectadas por nivelestóxicos de plomo en sangre, confirma que hay que seguirtrabajando desde una visión pluridisciplinar. Es necesariodefinir políticas para la prevención, detección, diagnosticoy tratamiento de los efectos nocivos del plomo sobre lasalud. Los niños constituyen el segmento de la poblaciónmás vulnerable, con consecuencias de alto impactosocial, como una disminución del coeficiente intelectual ydeficiente desarrollo neurológico. En la práctica clínica, haycuatro medicamentos que se usan para el tratamiento de laintoxicación crónica, son el edetato cálcico disódico IV e IM,el dimercaprol IM, la penicilamina VO y el succímero VO.Si se tiene en cuenta que sólo penicilamina está autorizadaen nuestro país, el problema se torna mayor. Esta breverevisión pretende brindar información sobre la intoxicaciónpor exposición al plomo, los tratamientos recomendados ylos disponibles en nuestro país.

Lead exposure and poisoning is a public health concern.Evidence of people with toxic level of lead in blood confirmsINTOXICACIÓN PORPLOMO Y SU TRATAMIENTOFARMACOLOGICORecibido: 25 de Setiembrede 2012. Aprobado: 4 denoviembre de 2012Lead poisoning and pharmacological treatmentFontana Daniela,Lascano Valeria María,Solá Nancy,Martinez Samanta,Virgolini Miriam,Mazzieri Maria Rosa.Departamento de Farmacia,Facultad de Ciencias Químicas,Universidad Nacional deCórdoba.Medina Allende y Haya de laTorre, Ciudad Universitaria,(5000) Córdoba, ArgentinaTEL/FAX +54 351 535 3850(int 53351). E-mail: mrmazzie@fcq.unc.edu.ar that it is necessary to keep on working from a multidisciplinary approach. There shouldbe a well-defined policy for the prevention, detection, diagnosis and treatment of theharmful effects of lead. Children are the population at major risk, with high social impactconsequences such as lower IQ and inadequate neurological development. There arefour drugs used to treat chronic toxicity: sodium calcium edetate IV and IM, succimer(oral), dimercaprol IM, and penicillamine (oral). If we consider that the last one is theonly authorized drug in our country, the problem grows bigger. This brief review offersinformation about lead exposure and poisoning, the recommended drug treatments andtheir market availability.

Evaluation of serum lead levels in children with constipation and normal controls in Northern Iran

Constipation is a major debilitating problem in children. We aimed to assess the serum lead levels of 2-13 year-old children complaining from constipation who referred to our center in Guilan province, Northern Iran. This cross-sectional study was done on ninety 2-13 year-old children referring to 17[th] Shahrivar Hospital, complaining from constipation [case group] and 90 healthy children The demographic data as well as the children's serum lead levels were evaluated and recorded. Data were analyzed using SPSS software. Chi-square test was used as applicable. Lead poisoning was significantly more frequent in the case group [37.8%] compared with the control group [8.9%]. The frequency of lead poisoning in the case group compared with the control group, was significantly higher in children <7 years old [40.2% vs. 10%], boys [40.9% vs. 9.3%], girls [34.8% vs 8.3%], residents of old houses [43.1% vs. 9.7%], residents of new houses [28.1% vs. 8.5%], residents of low-traffic areas [26.8% vs. 5.3%], urban residents [40.5% vs. 9.9%], children whose fathers had low risk [33.3% vs. 10.9%] and high risk jobs [40.7% vs. 3.8%]. The frequency of lead poisoning was higher in children suffering from constipation .No significant difference was found between the two groups with respect to their sex, age, father's job, and living in urban or rural areas

Environmental lead poisoning among children in Porto Alegre state, Southern Brazil / Intoxicação ambiental por chumbo em crianças de Porto Alegre / Intoxicación ambiental por plomo en niños de Porto Alegre, Sur de Brasil

OBJECTIVE: To estimate the prevalence of lead poisoning in children and to identify associated factors, as well as possible local sources of contamination. METHODS: A cross-sectional prevalence study conducted in 2006 with a random sample of 97 children age zero to five years from a neighborhood in Porto Alegre, Southern Brazil. Blood lead levels were measured and a questionnaire administered to collect information on sociodemographics, recycling and dwelling. A preliminary environmental evaluation was carried out with direct analysis of soil and indirect analysis of air pollution with bioindicators to identify possible sources of contamination. To analyze lead concentrations from the different collection sites, for each type of material studied, ANOVA was performed with a Brown-Forsythe adjustment for heteroscedasticity and with Dunnett's T3 procedure for multiple comparisons of unequal variances. RESULTS: Blood lead levels > 10.0 µg/dL was found in 16.5 percent of children. Recycling of waste at home, low father's education level, and increased age of children were associated with increase blood lead levels. High lead levels were found in soil, and there was little indication of lead air pollution. CONCLUSIONS: A high prevalence of lead poisoning was identified, and the potential sources of contamination in this community appear related to waste recylcing activities. Studies should be conducted with other populations of Brazilian children and evaluate potential sources of local and general contamination, to accurately characterize this issue in Brazil.

OBJETIVO: Estimar a prevalência de intoxicação por chumbo em crianças e identificar fatores associados, bem como possíveis fontes de contaminação local. MÉTODOS: Estudo transversal de prevalência com amostra aleatória de 97 crianças de zero a cinco anos de uma vila em Porto Alegre, RS, em 2006. O nível de chumbo no sangue foi medido e foi aplicado questionário para coletar informações sociodemográficas, reciclagem e moradia. Foi realizada avaliação ambiental preliminar com análise direta do solo e indireta da poluição atmosférica utilizando bioindicadores para averiguar possíveis fontes de contaminação. Para avaliar diferenças significantes entre as concentrações encontradas nos pontos de coleta, para cada tipo de material estudado, foi realizada ANOVA com correção de Brown-Forsythe para heterocedasticidade com comparações múltiplas de Dunnett T3 para variâncias desiguais. RESULTADOS: O total de 16,5 por cento das crianças apresentou chumbo sanguíneo > 10,0µg/dL. Reciclagem de lixo no local de moradia, baixo nível educacional do pai e maior idade das crianças estiveram associados com maior concentração de chumbo no sangue. Foram encontrados níveis elevados de chumbo no solo e pouca indicação de poluição atmosférica por esse metal. CONCLUSÕES: Foi observada prevalência significativa de intoxicação por chumbo e as possíveis fontes de contaminação nessa comunidade parecem relacionar-se a atividades de reciclagem de lixo. Estudos devem ser conduzidos com outras populações infantis brasileiras, avaliando possíveis fontes de contaminação locais e gerais, para que se possa dimensionar corretamente essa questão no País.

OBJETIVO: Estimar la prevalencia de intoxicación por plomo en niños e identificar factores asociados, así como posibles fuentes de contaminación local. MÉTODOS: Estudio transversal de prevalencia con muestra aleatoria de 97 niños de cero a cinco años de una villa en Porto Alegre, Sur de Brasil, en 2006. El nivel de plomo en la sangre fue medido y se aplicó cuestionario para colectar informaciones sociodemográficas, reciclaje y vivienda. Se realizó evaluación ambiental preliminar con análisis directo del suelo e indirecto de la polución atmosférica utilizando bioindicadores para investigar posibles fuentes de contaminación. Para evaluar diferencias significativas entre las concentraciones encontradas en los puntos de colecta, para cada tipo de material estudiado, se realizó ANOVA con corrección de Brown-Forsythe para heterocedasticidad con comparaciones múltiples de Dunnett T3 para varianzas desiguales. RESULTADOS: Un total de 16,5 por ciento de los niños presentó plomo sanguíneo > 10,0µg/dL. Reciclaje de basura en el lugar de vivienda, bajo nivel educacional del padre y mayor edad de los niños estuvieron asociados con mayor concentración de plomo en la sangre. Se encontraron niveles elevados de plomo en el suelo y poca indicación de polución atmosférica por dicho metal. CONCLUSIONES: Se observó prevalencia significativa de intoxicación por plomo y las posibles fuentes de contaminación en la comunidad evaluada parecen relacionarse con actividades de reciclaje de basura. Estudios deben realizarse con otras poblaciones infantiles brasileñas, evaluando posibles fuentes de contaminación locales y generales, para que se pueda dimensionar correctamente este tema en el País.

Lead exposure among children from native communities of the Peruvian Amazon basin / Exposición al plomo en niños de comunidades indígenas de la cuenca del Amazonas en el Perú

Objective. To assess potential risk factors associated with elevated blood lead levels (BLLs) among children in two communities from the Corrientes River basin in the Peruvian Amazon.Methods. Children aged 0–17 years were screened for BLLs, hemoglobin levels, and anthropometric measures. Dwelling, family, and child data were collected through a parental questionnaire. Statistical analysis included descriptive and bivariate analysis. Multiple linear and logistic regressions using generalized estimating equations were also conducted to determine associated risk factors. A map of each community was drawn to examine the spatialdistribution of BLLs. Results. Of 208 children (88 from 23 households of the Peruanito community and 120 from28 households of Santa Isabel), 27.4% had BLLs ≥ 10 μg/dL. The geometric mean (± standard deviation) BLL was 8.7 ± 4.0 μg/dL (range 3.0–26.8 μg/dL). In the total population, linearregression analysis indicated that age was positively associated with BLLs (P < 0.05). Logistic regression analysis showed that boys had 2.12 times greater odds of having BLLs ≥ 10 μg/dLthan girls (P < 0.05). Among the children 0–3 years, those whose mothers had BLLs ≥ 10 μg/ dL had 45.0% higher odds of presenting BLLs ≥ 10 μg/dL than children whose mothers had BLLs < 10 μg/dL (P < 0.05). Conclusions. Older age, male gender, and mothers’ BLL ≥ 10 μg/dL were the main risk factors for elevated BLLs. The higher risk in boys 7–17 years suggests that exposure could berelated to specific activities in this group, such as fishing and hunting. Continuous monitoring of BLLs in the Corrientes River population is recommended.

Objetivo. Evaluar los potenciales factores de riesgo asociados con niveles elevados de plomo en sangre (Pbs) en niños de dos comunidades de la cuenca del río Corrientes en la Amazonia peruana. Métodos. Se estudiaron de manera sistemática los niveles de PbS, la concentración de hemoglobina y las medidas antropométricas en niños de 0 a 17 años. A través de un cuestionario efectuado a los padres se recopilaron datos sobre la vivienda, la familiay los niños. El análisis estadístico incluyó el análisis descriptivo y de dos variables. También se llevaron a cabo análisis de regresión logística y lineal múltiple usando ecuaciones predictivas generales para determinar los factores de riesgo asociados. Se trazó un mapa de cada comunidad para examinar la distribución espacial de los niveles de PbS. Resultados. De 208 niños (88 de 23 hogares de la comunidad de Peruanito y 120 de 28 hogares de Santa Isabel), 27,4% presentaron niveles de PbS ≥ 10 μg/dL. La mediageométrica (± desviación estándar) de los niveles de PbS fue 8,7 μg/dL ± 4,0 (amplitud 3,0 a 26,8 μg/dL). En la población total, el análisis de regresión lineal indicó que la edad se asociaba de manera positiva con los niveles de PbS (P < 0,05). El análisis de regresión logística demostró que los varones presentaron una probabilidad 2,12 vecesmayor de tener niveles de PbS ≥ 10 μg/dL que las niñas (P < 0,05). En los niños de ambos sexos de 0 a 3 años, aquellos cuyas madres tuvieron niveles de PbS ≥ 10 μg/ dL presentaron 45,0% más probabilidades de exhibir niveles de PbS ≥ 10 μg/dL que los niños cuyas madres tuvieron niveles de PbS < 10 μg/dL (P < 0,05).

Epidemia de intoxicação por chumbo em empresa de fundição secundária / Occupational lead poisoning epidemic in a secondary melting facility

A intoxicação por chumbo constitui importante problema de saúde dos trabalhadores em nosso meio, sendo causada principalmente pela montagem, reforma e reciclagem de baterias automotivas. Neste artigo, são apresentados os resultados de uma investigação realizada em uma empresa de fundição secundária de chumbo localizada na região metropolitana de Belo Horizonte. A empresa foi inspecionada para estudo dos riscos à saúde dos trabalhadores. Foi ainda realizada revisão bibliográfica e estudo dos prontuários médicos dos trabalhadores atendidos no Centro de Referência Estadual em Saúde dos Trabalhadores- CEREST/MG ,no período de janeiro de 2005 a setembro de 2007. Os 18 trabalhadores do setor produtivo da empresa são homens e estavam expostos e intoxicados pelo chumbo. A idade média era de 33,6 anos. Quanto à escolaridade, 61,1% possuíam primeiro grau incompleto. O tempo médio de exposição ao chumbo metálico foi de 17,8 meses. Constatou-se que 66,7% dos trabalhadores mostraram níveis séricos de chumbo acima de 60µg/dl, e 33,3% mostraram níveis entre 40 e 60µg/dl. Os sintomas mais frequentes foram parestesias (72,2%), dor nas pernas (66,7%), fraqueza (55.6%), cefaleia (50%), irritabilidade (50%) e dor abdominal (44,4%). Dentre os pacientes, 61.1% foram submetidos à terapia quelante com versenato de sódio. O tempo médio de afastamento do trabalho dos pacientes que concluíram o tratamento foi de 14,3 meses. Os autores alertam para a gravidade do problema e enfatizam a necessidade de maior integração entre as agências públicas que implementam ações de proteção ambiental e saúde do trabalhador visando melhorar as condições de trabalho e eliminar a intoxicação por chumbo nas empresas de fundição secundária de chumbo.

Lead intoxication remains a significant occupational health concern in our environment, being primarily caused by the process of assembly, restoration, and recycling of automotive batteries. This paper presents research data collected from an automotive battery board recycling facility in greater Belo Horizonte, Minas Gerais, and points out inappropriate workplace conditions. The facility was visited for researching workplace processes and identifying all risks to the workers’ health, a bibliographical review was conducted, as well as a study of facility's workers medical records from their visits to the Centro de Referência Estadual em Saúde dos Trabalhadores de Minas Gerais - CEREST/MG. All the 18 workers practically performed the same activities and were poisoned by lead. The mean age was 33.6 years and 100% of them were male. The mean time of metallic lead exposure was 17,8months. 66,7% of workers showed serum lead levels above 60µg/ dl, and 33,3% between 40 and 60µg/dl . The main symptoms were leg pain, paresthesia (72,2%), leg ache (66,7%),faintness (55,6%), headache (50%), irritation (50%) and abdominal pain (44,4%). Chelation therapy with calcium versenate was the treatment in 61,1% of them. The mean time sickleaves of patients that concluded the treatment was 14,3 months. The authors stress the need of institutional integration among public agencies that implemented occupational health andenvironmental protection actions, in order to improve the work conditions in secondary melting facilites.

Características epidemiológicas y clínicas de niños intoxicados con plomo en el Instituto Nacional del Niño / Children's epidemiological and clinical characteristics poisoned with lead in the National Institute of the Child

El objetivo de este estudio es describir y conocer las características epidemiológicas y clínicas de la intoxicación por plomo en pacientes pediátricos atendidos en el Instituto Nacional de Salud del Niño entre los años 2000-2009. Para este estudio tipo, Descriptivo y observacional, re revisaron 93 historias clínicas de pacientes atendidos en el INSN entre los años 2000-2009. Se obtuvo que la media de los niveles de plomo en sangre fue 17.074 µg/dl (IC 95 por ciento=4.758). Se encontró que el 35.71 por ciento sobrepasaba los 10µg/dl de plomo en sangre. Los casos de intoxicación tuvieron un pico de presentación entre los 2 y 4 años y otro en mayores de 10 años. La mayoría de casos procedian de Lima Metropolitana (50,54 por ciento), seguida de regiones como Pasco, Áncash y Cajamarca. Dentro de Lima, La Victoria, Puente Piedra, San Juan de Lurigancho y Ate. Sin embargo, los mayores niveles de contaminación se registraron en regiones mineras como Áncash y Pasco: media de niveles de plomo en sangre de 44.94 y 39.53µg/dl respectivamente. Los factores epidemiológicos más importantes fueron: cercanía a zonas mineras y depósito de minerales, existencia de fundiciones, talleres de pintura y reparación de autos cercanos a la vivenda...

Avaliação dos fatores de risco relacionados à exposição ao chumbo em crianças e adolescentes do Rio de Janeiro / Evaluation of risk factors related to lead exposure in children and adolescents from Rio de Janeiro

A importância do chumbo atmosférico na contaminação global do ambiente tem recebido crescente atenção científica. A principal forma de monitorização da exposição é biológica, mas a ambiental tem um papel importante, já que o ambiente é a principal fonte de exposição ao chumbo. O estudo transversal busca identificar fontes de contaminação e potenciais fatores de risco da exposição em 64 crianças de zero a dezesseis anos de uma comunidade economicamente desfavorecida do Rio de Janeiro. Foram determinadas as concentrações de chumbo em solo, água, poeira e ar e calculados os fatores de risco neurológico e carcinogênico de inalação e ingestão. O sangue coletado foi utilizado para análise de Pb-S, ALA-D por cento e genotipagem da ALA-D. O fator de risco neurológico observado foi 549 vezes superior à dose de referência para poeira e 554 vezes superior no caso de ingestão. O fator de risco carcinogênico para ingestão foi de quatro vezes. A média de Pb-S foi 5,6μg/dL e 40 por cento das crianças apresentaram valores de Pb-S acima do ponto de corte de 6μg/dL. A média de ALA-D por cento foi 40,3 por cento e foi observada correlação entre Pb-S e ALA-D por cento. O genótipo ALAD1-2 foi identificado em 10 por cento das crianças. Os resultados deste estudo permitirão o conhecimento da nossa realidade, subsidiando os órgãos de saúde pública e meio ambiente nas ações de controle e vigilância ambiental integrada

The importance of atmospheric lead in environmental global contamination is receiving increasing scientific attention. The main exposure monitoring approach is biological, but the environmental one has a key role, since the environment is the major source of exposure. The study aimed to identify the contamination sources and potential risk factors of the exposure in a 64 subject group formed by 0-16 years-old children from an economically deprived community in Rio de Janeiro. Lead concentrations in soil, water, dust and air were determined and neurological and carcinogenic risk factors for ingestion and inhalation were calculated. Blood samples were collected and used in the analysis of Pb-B, ALA-D percent and ALA-D genotyping. The observed neurological risk factor was 549 times higher than reference dose for dust and 554 times higher in the case of ingestion. The carcinogenic risk factor for ingestion was about 4 times. Mean Pb-B was 5.6μg/dL and 40 percent of the children presented Pb-B levels above the 6μg/dL cutoff value. Mean ALA-D percent was 40.3 percent and a correlation between Pb-B and ALA-D percent was observed. ALAD1-2 genotype was identified in 10 percent of the children. The results will allow the understanding of our reality, supporting public health and environment organizations to carry out control actions and all-encompassing environmental surveillance.

Intoxicación por plomo: una revisión con énfasis en la población pediátrica / Lead poisoning: a literature review focusing on the paediatric population

La Intoxicación por Plomo (“Saturnismo”) es una patología relativamente común originada por una exposición crónica al metal, ya sea por fuente ambiental, laboral o accidental. El cuadro clínico es variado, pudiendo incluir disminución en el nivel cognitivo, insomnio, irritabilidad, alucinaciones, anemia, debilidad, cólicos abdominales, náuseas y vómito. Diversos estudios han¿ relacionado la exposición crónica al Plomo en niños, incluso a niveles bajos, con una disminución de su coeficiente intelectual, lo cual genera una preocupación acerca de los actuales protocolos de vigilancia y promoción de la salud. El diagnóstico se basa principalmente en la medición del metal en distintos elementos del paciente, tales como cabello y uñas; otros exámenes de utilidad son las radiografías convencionales. El tratamiento se basa en la descontaminación del tracto gastrointestinal, medidas generales de soporte y el uso de terapia de quelación.

Lead Poisoning (“Saturnism”) is a relatively common entity caused by a chronic exposure to the said metal, be it by environmental, occupational or accidental source. The clinical picture may include a diminished cognitive status, insomnia, irritability, hallucinations, anaemia, peripheral weakness, abdominal pain, nausea and vomiting. A number of studies have found a relationship between early exposition to Lead, even in a low concentration fashion, and a latter decline in the Intellectual Quotient of pediatric patients; these findings have risen concern about current epidemiologic protocols. Diagnosis is based mainly on the measurement of the metal on different parts of the patient, including hair and fingernails. Treatment is based on gastrointestinal tract decontamination, basic support measures and chelation theraphy.

Caracterização das alterações de linguagem em crianças com histórico de intoxicação por chumbo / Characterization of language disorders in children with lead poisoning

TEMA: a intoxicação por chumbo pode causar deficiências neuropsicológicas, que incluem a linguagem, devido aos danos provocados no desenvolvimento do SNC. OBJETIVO: verificar a ocorrência de alterações de linguagem em crianças com histórico de intoxicação por chumbo e a correlação entre o índice de chumbo sangüíneo e as alterações de linguagem apresentadas pelas crianças. MÉTODO: avaliação da linguagem de 20 crianças em idade pré-escolar, com índice de chumbo sangüíneo acima de 10 µg/dl. RESULTADOS: 13 crianças apresentaram distúrbio de linguagem envolvendo somente a Fonologia ou mais de um subsistema lingüístico. A análise estatistica revelou não existir correlação entre a gravidade das alterações e os índices de chumbo apresentado. CONCLUSÃO: a ocorrência de crianças com distúrbio de linguagem aponta a contaminação por chumbo como um fator de risco para as alterações apresentadas, mesmo tendo sido encontrados outros fatores que levem à defasagem no desenvolvimento da linguagem e ausência de correlação entre as referidas variavéis.

BACKGROUND: lead poisoning can have a negative impact on the neuropsychological functions, including language, due to the damage it causes to the development of the Central Nervous System. AIM: to verify the occurrence of language disorders in children who suffered from led poisoning and to verify the correlation between the lead concentration level in the blood and the language disorders presented by the children. METHOD: language evaluation of 20 preschoolers, with lead concentration level in the blood above 10µg/dl. RESULTS: 13 children presented language impairment involving only phonology or more than one language subsystem. The statistical analysis indicated that no correlation exists between the severity of the language impairment and the concentration levels of lead. CONCLUSION: the number of children with language impairment indicates lead poisoning as a risk factor for the present alterations, even though other risk factors for language disorders were found and the absence of correlation between the investigated variables.

Estudio epidemiológico de una población expuesta laboralmente a plomo / Epidemiologic study of population exposed to lead

La exposición y los efectos de la contaminación por plomo en los trabajadores son una situación bien conocida desde la antigüedad. En Uruguay puede ser catalogada, desde el punto de vista epidemiológico, como una situación reemergente. Se realizó un estudio descriptivo durante el año 2003 en una población trabajadora de una fábrica de acumuladores eléctricos (baterías) donde, por los procesos que allí se realizan, los operarios se encuentran expuestos a plomo. El valor obtenido de plomo en sangre durante la actividad laboral muestra que todos los valores superaban el nivel máximo admitido para trabajadores expuestos -30 µg/dl-, según la Ordenanza 337 del Ministerio de Salud Pública. El valor de plomo luego de suspendida la exposición muestra una media que se mantiene en este límite (29,4 µg/dl). El porcentaje de descenso de la plombemia en el período de un año sin exposición podría ser interpretado como un indicador indirecto de la carga corporal. Los valores de plomo en sangre no muestran correlación con la presencia de síntomas o signos clínicos, o ambos, estudiados, ni alteraciones hematológicas o bioquímicas características de la intoxicación por plomo. Estos resultados confirman el valor de la cuantificación de plomo en sangre como indicador de exposición durante el período que el trabajador está expuesto, y su relativo valor como criterio diagnóstico de intoxicación.

Acute lead poisoning associated with backyard lead smelting in Jamaica / Envenenamiento agudo con plomo asociado con la fundición casera de plomo en Jamaica

Long-term backyard smelting of lead in a district known as Mona Commons, Kingston, Jamaica, has produced lead burdens as high as 30 000 mg/kg in soils near to the smelter, and indoor dust loadings of 373 microg/f2 in the residents' home. The blood lead levels (BPb) of 107 children from the district were in the range 2.2-202 microg/dL. Fifty-nine per cent of these had BPb levels above 10 microg/dL and the population mean was an unacceptably high 25.1 microg/dL. The highest levels were observed for five siblings, two of whom presented with lead encephalopathy. This severe chronic exposure to lead was exacerbated by a significant history of pica, and chronic nutritional anaemia. Chelation therapy significantly reduced the BPb levels but due to lead storage in other organs, the values after several months were still higher than desirable. This study emphasizes the importance of reducing the exposure of children to lead.

Estudio sobre contaminación ambiental por plomo en niños de la localidad de Abra Pampa (Jujuy - Argentina) / Study of environmental lead contamination in children in the area around Jujuy - Argentina

El objetivo del estudio fue evaluar la exposición de los niños de Abra Pampa- Jujuy al plomo existente en el medio ambiente, proveniente de una fundición ubicada en el área urbana de esa ciudad que funcionó hasta finales de ladécada del 80 y en la que el mineral no fue retirado del lugar y se encuentra al descubierto. La investigación se realizó sobre 144 niños de ambos sexos, de edad comprendida entre 5 y 16 años, que representaron el 3,3 % de la población infantil de Abra Pampa. En todas las muestras se midió la actividad de la enzima ∂-ALA deshidratasa (método estandarizado europeo) y en 25 se determinó la plombemia (absorción atómica-atomización electrotérmica). De las 144 muestras estudiadas, el 3,5 % tuvieron valores de ∂-ALA deshidratasa inferiores al valor referencial (21 U/l). En el 40% de los casos estudiados (N=25) la plombemia estuvo por encima de 10 μg/dl. El máximo valor de plomo en sangre hallado fue de 41,3 μg/dl en un niño de 5 años. El hecho de haber encontrado valores de plomo elevados en los niños de Abra Pampa indica que la contaminación ambiental por este metal persiste, a pesar de la inactividad de la empresa y avalan la necesidad de su total erradicación así como la realizaciónde estudios clínicos-toxicológicos que comprenda a la población en riesgo (niños y mujeres embarazadas, principalmente) a fin de prevenir y/o tratar los múltiples efectos adversos provocados por el plomo.

The objective of this study was to evaluate the exposure of children from Abra Pampa, to environmental lead, which comes from an old smelting factory, located in the urban area of this city, that was opened until the late 1980's, and from where the mineralhas not been removed, so it still remains out in the open. The research was made using 144 blood samples from 5 to 16-year old children, both male and female, which represented 3.3% of the children population of Abra Pampa. In all of the samples, the activity of the enzyme ∂-aminolevulinic acid dehydratasewas determined (standardized European method) an in 25 of the samples, the lead blood levels were determined (atomic absorption - electro-thermal atomization). Of the 144 samples that were studied, 3.5% showed values of ∂-aminolevulinic acid dehydratase inferior to the reference values (21 U/L). In 40% of the cases studied (N = 25) lead blood levels were above the 10 ug/dl recommended by the Center ofDisease Control of USA. The highest level found was 41.3 ug/dl in a 5-year old child. The fact that we found high lead blood levels indicates that the environmental pollution still continues despite the closing of the factory, it also supports the need to fully eradicate it, as well as the need to make clinical and toxicological studies that includethe risk population (children and pregnant women, mainly) in order to prevent and/or treat the multiple adverse effects provoked by the metal.

Exposición ocupacional a plomo y cadmio en personal / Occupational exposure to lead and cadmium among healthcare workers

Con el fin de contribuir a evitar las consecuencias potencialmente graves derivadas de la exposición crónica a plomo y cadmio, se describe la situación de exposición ocupacional a estos metales de un grupo de trabajadores de un hospital público de la Región Metropolitana. Se describen parámetros bioquímicos relacionados con la exposición a Pb y Cd al momento de detectarse el problema y al cabo de dos años de haber implementado medidas protectoras. Se trata de un estudio de cohorte histórico único, usando información secundaria. Inicialmente se encuentra niveles promedio de plomo en sangre, ZPP y cadmio en orina dentro del rango normal; después de la intervención se observa una variación significativa en estos parámetros lo cual señala la efectividad de la intervención preventiva. Los exámenes funcionales de órganos o sistemas potencialmente afectados por la exposición no muestran alteraciones ni variaciones significativas pre y post intervención. Se pone en evidencia que las intoxicaciones por plomo y cadmio son un problema presente en el ámbito laboral chileno y que las medidas de protección aplicadas a los trabajadores son eficaces, especialmente si se detecta precozmente el problema, antes de que se evidencien repercusiones derivadas de la intoxicación crónica.