Journal of Preventive Medicine and Public Health

Original Articles

Correlations Among Maternal and Infant Factors, Lead Exposure, and Serum Prolactin Levels During Lactation: A Cross-sectional Study in Indonesia: Linda Ratna Wati, Djanggan Sargowo, Tatit Nurseta, Lilik Zuhriyah, Bambang Rahardjo; J Prev Med Public Health. 2023;56(5):422-430. Published online August 22, 2023; DOI: https://doi.org/10.3961/jpmph.23.238

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Abstract Summary PDF: Objectives
Prolactin is vital for breastfeeding and milk production, and its secretion is influenced by factors related to the mother, infant, and environment. To date, no study has concurrently investigated the correlation of these factors with serum prolactin levels during lactation. Therefore, the objective of this study was to investigate the correlations among maternal and infant factors, lead exposure, and serum prolactin levels during lactation.
Methods
A cross-sectional approach was employed in Surabaya, Indonesia, among 110 exclusively lactating mothers. The mothers’ daily diets were determined using multiple 24-hour recalls, while blood lead levels were measured with inductively coupled plasma mass spectrometry. Serum prolactin levels were assessed using the electrochemiluminescence immunoassay. For bivariate analysis, we employed the Spearman correlation, Mann-Whitney, and Kruskal-Wallis tests, while for multivariate analysis, we utilized multiple linear regression.
Results
The average serum prolactin level of the lactating mothers was 129.19±88.96 ng/mL. Positive correlations were found between serum prolactin levels and breastfeeding frequency (p < 0.001), protein intake (p < 0.001), and calcium intake (p = 0.011) but had negative correlation with blood lead levels (p < 0.001) and vitamin B6 intake (p = 0.003). Additionally, prolactin levels were not significantly associated with maternal age; parity; intake of calories, vitamin D, vitamin E, zinc, folic acid, magnesium, or iron; infant age; or infant sex.
Conclusions
Breastfeeding frequency had a stronger positive relationship with serum prolactin levels than protein and calcium intake. However, lead exposure was associated with reduced serum prolactin levels during lactation. Consequently, specific interventions from policymakers are necessary to manage breastfeeding in mothers exposed to lead.; Summary

Key Message
Prolactin secretion is influenced by factors related to the mother, infant, and environment, and this study was to investigate the correlations among maternal and infant factors, lead exposure, and serum prolactin levels during lactation. In total 110 exclusively lactating mothers were included, with information on their socio-demographic, daily diet, blood lead level, prolactin level, and infant characteristics. Breastfeeding frequency had a stronger positive relationship with serum prolactin levels than protein and calcium intake. However, lead exposure was associated with reduced serum prolactin levels during lactation. Consequently, specific interventions from policymakers are necessary to manage breastfeeding in mothers exposed to lead.

Transformational Leadership and Depressive Symptoms in Germany: Validation of a Short Transformational Leadership Scale: Max Leonhard Seegel, Raphael M. Herr, Michael Schneider, Burkhard Schmidt, Joachim E. Fischer; J Prev Med Public Health. 2019;52(3):161-169. Published online May 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.002

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Abstract PDF: Objectives
The objective of the present study was to validate a shortened transformational leadership (TL) scale (12 items) comprising core TL behaviour and to test the associations of this shortened TL scale with depressive symptoms.
Methods
The study used cross-sectional data from 1632 employees of the overall workforce of a middle-sized German company (51.6% men; mean age, 41.35 years; standard deviation, 9.4 years). TL was assessed with the German version of the Transformational Leadership Inventory and depressive symptoms with the Hospital Anxiety and Depression Scale (HADS). The structural validity of the core TL scale was assessed with confirmatory factor analysis. Associations with depressive symptoms were estimated with structural equation modelling and adjusted logistic regression.
Results
Confirmatory factor analysis and structural equation modelling showed better model fit for the core TL than for the full TL score. Logistic regression revealed 3.61-fold (95% confidence interval [CI], 2.20 to 5.93: women) to 4.46-fold (95% CI, 2.86 to 6.95: men) increased odds of reporting depressive symptoms (HADS score >8) for those in the lowest tertile of reported core TL.
Conclusions
The shortened core TL seems to be a valid instrument for research and training purposes in the context of TL and depressive symptoms in employees. Of particular note, men reporting poor TL were more likely to report depressive symptoms.; Summary

Association of Homocysteine Levels With Blood Lead Levels and Micronutrients in the US General Population: Yu-Mi Lee, Mi-Kyung Lee, Sang-Geun Bae, Seon-Hwa Lee, Sun-Young Kim, Duk-Hee Lee; J Prev Med Public Health. 2012;45(6):387-393. Published online November 29, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.6.387

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Abstract PDF

Objectives

Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels.

Methods

This study was performed with 4089 adults aged ≥20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004.

Results

There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend <0.01, respectively). However, in the case of vitamin B12, there was a stronger positive association between blood lead and homocysteine among subjects with high levels of vitamin B12, compared to those with low levels of vitamin B12. In fact, the levels of homocysteine were already high among subjects low in vitamin B12, irrespective of blood lead levels. When we used hyperhomocysteinemia (homocysteine>15 µmol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance.

Conclusions

In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.

Summary

Citations

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Jia Wei, John S Ji
BMJ Nutrition, Prevention & Health.2020; 3(2): 180. CrossRef
Nonlinear association between blood lead and hyperhomocysteinemia among adults in the United States
Minghui Li, Lihua Hu, Wei Zhou, Tao Wang, Lingjuan Zhu, Zhenyu Zhai, Huihui Bao, Xiaoshu Cheng
Scientific Reports.2020;[Epub] CrossRef
Biomonitoring findings for occupational lead exposure in battery and ceramic tile workers using biochemical markers, alkaline comet assay, and micronucleus test coupled with fluorescence in situ hybridisation
Vilena Kašuba, Mirta Milić, Davor Želježić, Marin Mladinić, Alica Pizent, Zorana Kljaković-Gašpić, Melita Balija, Irena Jukić
Archives of Industrial Hygiene and Toxicology.2020; 71(4): 339. CrossRef
Exposure to Toxic Heavy Metals Can Influence Homocysteine Metabolism?
Caterina Ledda, Emanuele Cannizzaro, Piero Lovreglio, Ermanno Vitale, Angela Stufano, Angelo Montana, Giovanni Li Volti, Venerando Rapisarda
Antioxidants.2019; 9(1): 30. CrossRef
Single Nucleotide Polymorphisms in Key One-Carbon Metabolism Genes and Their Association with Blood Folate and Homocysteine Levels in a Chinese Population in Yunnan
Juan Ni, Yaoxian Liu, Tao Zhou, Xiayu Wu, Xu Wang
Genetic Testing and Molecular Biomarkers.2018; 22(3): 193. CrossRef
α-Tocopherol supplementation and the oxidative stress, homocysteine, and antioxidants in lead exposure
Sławomir Kasperczyk, Michał Dobrakowski, Aleksandra Kasperczyk, Ewa Nogaj, Marta Boroń, Zbigniew Szlacheta, Ewa Birkner
Archives of Environmental & Occupational Health.2017; 72(3): 153. CrossRef
Determinants of hyperhomocysteinemia in healthy and hypertensive subjects: A population-based study and systematic review
Liyuan Han, Yanfen Liu, Changyi Wang, Linlin Tang, Xiaoqi Feng, Thomas Astell-Burt, Qi wen, Donghui Duan, Nanjia Lu, Guodong Xu, Kaiyue Wang, Lu Zhang, Kaibo Gu, Sihan Chen, Jianping Ma, Tao Zhang, Dingyun You, Shiwei Duan
Clinical Nutrition.2017; 36(5): 1215. CrossRef
Effect of occupational exposure to lead on new risk factors for cardiovascular diseases
Adam Prokopowicz, Andrzej Sobczak, Magdalena Szuła-Chraplewska, Marzena Zaciera, Jolanta Kurek, Izabela Szołtysek-Bołdys
Occupational and Environmental Medicine.2017; 74(5): 366. CrossRef
Blood lead, cadmium and mercury in relation to homocysteine and C-reactive protein in women of reproductive age: a panel study
Anna Z. Pollack, Sunni L. Mumford, Lindsey Sjaarda, Neil J. Perkins, Farah Malik, Jean Wactawski-Wende, Enrique F. Schisterman
Environmental Health.2017;[Epub] CrossRef
Blood lead levels, iron metabolism gene polymorphisms and homocysteine: a gene-environment interaction study
Kyoung-Nam Kim, Mee-Ri Lee, Youn-Hee Lim, Yun-Chul Hong
Occupational and Environmental Medicine.2017; 74(12): 899. CrossRef
Evaluation and management of lead exposure
Hwan-Cheol Kim, Tae-Won Jang, Hong-Jae Chae, Won-Jun Choi, Mi-Na Ha, Byeong-Jin Ye, Byoung-Gwon Kim, Man-Joong Jeon, Se-Yeong Kim, Young-Seoub Hong
Annals of Occupational and Environmental Medicine.2015;[Epub] CrossRef
Lead Exposure, B Vitamins, and Plasma Homocysteine in Men 55 Years of Age and Older: The VA Normative Aging Study
Kelly M. Bakulski, Sung Kyun Park, Marc G. Weisskopf, Katherine L. Tucker, David Sparrow, Avron Spiro, Pantel S. Vokonas, Linda Huiling Nie, Howard Hu, Jennifer Weuve
Environmental Health Perspectives.2014; 122(10): 1066. CrossRef

Special Article

The Singapore Field Epidemiology Service: Insights Into Outbreak Management: Peng-Lim Ooi, Theresa Seetoh, Jeffery Cutter; J Prev Med Public Health. 2012;45(5):277-282. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.277

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Abstract PDF

Field epidemiology involves the implementation of quick and targeted public health interventions with the aid of epidemiological methods. In this article, we share our practical experiences in outbreak management and in safeguarding the population against novel diseases. Given that cities represent the financial nexuses of the global economy, global health security necessitates the safeguard of cities against epidemic diseases. Singapore's public health landscape has undergone a systemic and irreversible shift with global connectivity, rapid urbanization, ecological change, increased affluence, as well as shifting demographic patterns over the past two decades. Concomitantly, the threat of epidemics, ranging from severe acute respiratory syndrome and influenza A (H1N1) to the resurgence of vector-borne diseases as well as the rise of modern lifestyle-related outbreaks, have worsened difficulties in safeguarding public health amidst much elusiveness and unpredictability. One critical factor that has helped the country overcome these innate and man-made public health vulnerabilities is the development of a resilient field epidemiology service, which includes our enhancement of surveillance and response capacities for outbreak management, and investment in public health leadership. We offer herein the Singapore story as a case study in meeting the challenges of disease control in our modern built environment.

Summary

Citations

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Vaccine.2018; 36(15): 1996. CrossRef

Original Articles

Effect of Glutathione on Lead Induced Modulation of NO Synthesis in RAW 264.7 Cell.: Sae Ron Shin, Gyung Jae Oh, Keun Sang Kwon, Wook Hee Yoon; Korean J Prev Med. 2002;35(4):269-274.

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Abstract PDF: OBJECTIVES
To evaluate the effect of glutathione(GSH) on lead induced modulation of nitric oxide(NO) synthesis, and to examine how lead modulates NO production in macrophages. METHODS: This study was observed in a culture of RAW 264.7 cells, which originated from a tumor in a Balb/c mouse that was induced by the Abelson murine leukemia virus. The compounds investigated were lead chloride, N-acetyl-cystein(NAC), and Buthionine Sulfoximine(BSO). RESUJLTS: ATP synthesis in RAW 264.7 cells was unchanged by each lead concentration exposure in a dose dependent manner. The NO synthesis was decreased when exposed to lead(PbCl2) concentration 0.5 micro M. The presence of 300 micro M NAC, used as a pretreatment in the culture medium, caused the recovery of the lead induced decrease in NO synthesis, but in the presence of 300 micro M BSO as a pretreatment, there was no recoverey. Pretreatment with NAC and BSO had no affect on ATP synthesis at any of the lead concentrations used. CONCLUSIONS: These results indicated that GSH has a protective effect toward lead toxicity, and suggested that the inhibition of NO production in macrophage due to lead toxicity may be related to cofactors of iNOS (inducible nitric oxide synthase); Summary

A Meta-analysis of the Association between Blood Lead and Blood Pressure.: Sang Baek Koh, Chun Bae Kim, Chung Mo Nam, Hong Ryul Choi, Bong Suk Cha, Jong Ku Park, Ho Sung Jee; Korean J Prev Med. 2001;34(3):262-268.

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Abstract PDF: OBJECTIVES
To integrate the results of studies which assess an association between blood lead and blood pressure. METHODS: We surveyed the existing literature using a MEDLINE search with blood lead and blood pressure as key words, including reports published from January 1980 to December 2000. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers exposed to lead, and 2) both blood pressure and blood lead must have been measured and presented with sufficient details so as to estimate or calculate the size of the association as a continuous variable. Among the 129 articles retrieved, 13 studies were selected for quantitative meta-analysis. Before the integration of each regression coefficient for the association between blood pressure and blood lead, a homogeneity test was conducted. RESULTS: As the homogeneity of studies was rejected in a fixed effect model, we used the results in a random effect model. Our quantitative meta-analysis yielded weighted regression coefficients of blood lead associated with systolic blood pressure and diastolic blood pressure results of 0.0047 (95% confidence interval [CI]: -0.0061, 0.0155) and 0.0004 (95% CI: -0.0031, 0.0039), respectively. CONCLUSIONS: The published evidence suggested that there may be a weak positive association between blood lead and blood pressure, but the association is not significant.; Summary

Trend of the Changes in the Level of Blood Lead, Urinary Arsenic and Urinary Cadmium of Children in Ulsan: 3-year Follow-up Study.: Choong Ryeol Lee, Cheol In Yoo, Ji Ho Lee, Hun Lee, Yangho Kim; Korean J Prev Med. 2001;34(2):166-174.

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Abstract PDF: OBJECTIVES
To obtain basic data on blood lead level and urinary level of arsenic and cadmium of children living near a petrochemical estate and a suburban area in Ulsan, Korea and to observe the trend of the changes in the level of these metals in these children. METHODS: The study subjects comprised 626 children living near a petrochemical estate and 299 children living in a suburban area of Ulsan. We analyzed the level of lead, arsenic and cadmium using atomic absorption spectrometer. RESULTS: The mean levels of blood lead in children living near the petrochemical estate were 5.25 microgram/dl, 5.24 microgram/dl, and 7.24 microgram/dl in the years 1997, 1999, and 2000, respectively, whereas those of children living in the suburban area were 3.81 microgram/dl, 4.75 microgram/dl, and 7.19 microgram/dl respectively. The mean levels of urinary arsenic in children living near the petrochemical estate were 4.57 microgram/g creatinine, 4.78 microgram/g creatinine, and 6.02 microgram /g creatinine in the year 1997, 1999, and 2000 respectively, whereas those of children living in suburban area were 2.35 microgram/g creatinine, 4.75 microgram/g creatinine, and 7.07 microgram/g creatinine, respectively. The mean levels of urinary cadmium in children living near the petrochemical estate were 1.15 microgram/g creatinine, 1.05 microgram/g creatinine, and 1.71 microgram/g creatinine in the year 1997, 1999, and 2000, respectively, whereas those of the children living in the suburban area were 0.74 microgram/g creatinine, 1.29 microgram/g creatinine, and 1.48 microgram/g creatinine, respectively. There were increasing trends in the level of blood lead, urinary arsenic and cadmium of children in Ulsan, and the differences in the level of these metals were disappearing between the children living in other areas year by year. CONCLUSIONS: These results suggest that the amount of exposure to lead, arsenic, and cadmium is increasing from year to year, and there is a need for periodic biological and atmospheric monitoring of these metals in Ulsan.; Summary

Blood Lead, Manganese, Aluminium and Silicon Concentrations in Korean Adults.: Jung Man Kim, Jung Mo Ahn, Won Sul Kim, Jung Il Kim, Hai Rim Shin, Kap Yeol Jung, Joon Youn Kim; Korean J Prev Med. 2000;33(2):157-164.

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Abstract PDF: OBJECTIVES
This study was performed to determine the reference values of blood lead, manganese, aluminium, and silicon in healthy adults. METHODS: The subjects were 132 (67 male and 65 female), and classified to three age groups (< or =39, 40~49, and 50< or =). Blood lead, manganese and aluminium were analyzed by atomic absorption spectrophotometer, and blood silicon was analyzed by direct current plasma optical emission spectrometer. RESULTS: Blood lead levels(geometric mean, S.D) were (3.49, 1.70) microgram/dL in male and (3.04, 1.65) microgram/dL in female, but the difference is not significant, and there was no significant difference between age groups. Mean blood manganese level was 0.99+/-0.41 microgram/dL, and there was no significant difference between sex or age groups. Mean blood aluminium level was 0.59+/-0.35 microgram/dL, and there was no significant difference between sex or age groups. Mean blood silicon level was 54.41+/-27.64 microgram/dL in male and 43.34+/- 23.51 microgram/dL in female, and the level in male was significantly higher than that in female (p<0.05). There was significant difference between age groups, and the oldest showed the highest level in male (p<0.05), but no significant difference between age groups in female. CONCLUSIONS: Authors hope that this study would provide basic data for determining reference values and evaluating health effects.; Summary

Different Effect of Blood Lead on Zinc Protoporphyrin by Gender in Korean Lead Workers.: Hyun Cheol Ahn, Yong Bae Kim, Gap Soo Lee, Kyu Yoon Hwang, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1999;32(4):499-504.

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Abstract PDF: OBJECTIVES
To evaluate whether a relation between blood lead and zinc proto porphyrin(ZPP) was modified by gender in Korean lead workers. METHODS: A cross-sectional study was conducted with 1,304 male and 101 female subjects in 1997. The relation between blood lead and ZPP were evaluated with linear, exponential, and quadratic models. Then, the different effect of gender on the relation was examined by adding the interaction terms in the each model. RESULTS: Mean+/-SD of blood lead and ZPP level was different between male(27.7+/-10 microgram /dl and 51.3+/-23.4 microgram/dl) and female subjects(22.5+/-9.2 microgram/dl and 78.7+/-38.6 microgram/dl). After adjusting for possible confounders, the effect modification by gender was significant in linear(beta=1.119, p<0.001), exponential(beta=Exp(0.008), p<0.05), and quadratic model(beta= 1.388, p<0.001). In separate analysis, a quadratic relation between blood lead and ZPP was shown in male lead workers(beta=0.036, p<0.001), but an exponential relation in female lead workers(n=Exp(0.029), p<0.001). CONCLUSION: Our data showed that the increasing rate of ZPP in female were always higher than in male lead workers, suggesting that females were more susceptible to occupational lead exposure than males.; Summary

The effect of smoking and drinking habit on the health status of lead workers.: Choong Koo Lee, Yong Bae Kim, Gap Soo Lee, Kyu Yoon Hwang, Hwa Sung Kim, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1998;31(4):708-718.

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Abstract PDF: To investigate the effect of smoking and drinking habit on the health status in lead using industries, 2,785 male workers in lead using industries (7 storage battery industries, 7 secondary smelting and related industries, and 4 primary metal and other manufacturing industries) were selected for this study. This study was carried out as a part of periodic health examination. Selected study variables were zinc protoporphyrin in whole blood (ZPP), SGOT and SGPT for laboratory test. Questionnaire for lead related symptoms and smoking and drinking habit was provided to all the workers and filled up by themselves and reconfirmed by physician. The results obtained were as follows; 1. The overall smoking and drinking rate of study population were 69.8% and 73.6%, respectively. While the smoking and drinking rate of storage battery workers were 68.8% and 72.3%, those of secondary smelting industries and other industries were 66.0% and 66.4% and 74.6 and 80.3% respectively. 2. While the mean values of blood ZPP of lead exposed workers were significantly higher than other group, those of SGOT of storage battery workers were significant higher than other worker. But there were no differences of mean values of other variables. 3. Smoking habit did not affect on the mean value of blood ZPP of workers in special health examination group, but there were significant differences of blood ZPP and SGOT between drinker and non-drinker. 4. Symptom prevalence of lead exposure were higher in drinking and smoking group than non-drinking and non-smoking group. 5. In multiple regression analysis of the total lead related symptoms, blood ZPP, SGOT, and SGPT as dependent variable, respectively, and age, work duration, blood ZPP, pack year and amount of alcohol drinking as independent variables, work duration, pack year, amount of alcohol drinking, age contributed to total symptoms; and age, work duration, pack year contributed to blood ZPP; and age, amount of alcohol drinking, work duration contributed to SGOT; and pack year contributed to SGPT.; Summary

Lipid Peroxidation and Antioxidants in Workers Exposed to Lead.: Won Jin Lee, Cheon Hyun Hwang, Cheong Sik Kim, Soung Hoon Chang, Yang Ho Kim, Hae Joon Kim; Korean J Prev Med. 1998;31(3):449-459.

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Abstract PDF: This study was started to find out if plasma malondialdehyde(MDA), alpha-tocopherol and erythrocyte superoxide dismutase(SOD) activity could be markers of biological activity resulting from exposed to lead in workers. Blood samples were randomly obtained from lead -exposed workers(n=29), CO2 welders(n=60) and office workers(n=60). We used whole blood to analyse blood lead with atomic absorption spectrophotometer. Superoxide dismutase activity in erythrocyte was measured with spetrophotometer. MDA and alpha-tocopherol in plasma were measured with high performance liquid chromatography. Lead-exposed workers was significantly high in blood lead concentration(29.37 ng/dl) compared with welders(6.42 ng/dl) and office workers(5.01 ng/dl). The level of plasma MDA was significantly higher in the lead-exposed workers(1.87 nmol/g cholesterol) than the welders(1.41 nmol/g cholesterol) and office workers(1.41 nmol/g cholesterol). Erythrocyte SOD activity in lead-exposed workers(56.80 U/g Hb) was significantly increased than those of welders(37.63 U/g Hb) and office workers(20.47 U/g Hb). The plasma alpha-tocopherol level of lead-exposed workers(4.93 ng/g cholesterol) was statistically different from welders(4.25 ng/g cholesterol) and office workers(4.28 ng/g cholesterol). Neither age nor smoking was related to SOD or MDA level. Blood lead was significantly correlated with erythrocyte SOD activity(r=0.405), plasma MDA(r=0.296) and alpha-tocopherol(r=0.207). Plasma MDA was also significantly correlated with SOD (r=0.217). In multiple regression analysis, the change of MDA and SOD activity level related to the blood lead concentration. These results suggested that the increase of plasma MDA and erythrocyte SOD activity in lead-exposed workers had a close relationship with the oxidative stress induced by lead.; Summary

Blood Lead Levels of Children in Ulsan Industrial Area.: Cheol In Yoo, Ji Ho Lee, Choong Ryeol Lee, Sung Ryul Kim, Seon Ho Lee; Korean J Prev Med. 1998;31(2):240-248.

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Abstract PDF: We conducted this study, to obtain basic data of lead concentrations in children of Ulsan industrial area and to evaluate the difference in blood lead levels between industrial area and suburban area. The study subjects were composed of 348 school children residing in industrial area and 100 school children of suburban area. There is no difference in age and sex distribution of study participants between industrial and suburban area. The obtained results were as follows: l. The geometric means of blood lead levels of study participants were 4.90 ng/dl, which is lower than current acceptable value 10 ng/dl. 2. The children residing in industrial area had the higher blood lead levels(5.26 ng/dl) than suburban children(3.81 ng/dl) with statistical significance(P<0.001).; Summary

A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory.: Man Joong Jeon, Joong Jeong Lee, Joon Sakong, Chang Yoon Kim, Jung Man Kim, Jong Hak Chung; Korean J Prev Med. 1998;31(1):112-126.

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Abstract PDF: To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin(ZPP) concentrations of 131 workers ( 100 exposed subjects and 31 controls ) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was 16.45+/-4.83 microgram/dashliter at the preemployment examination and slightly increased to 17.77+/-5.59 microgram/dashliter after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was 17.36+/-5.20 microgram/dashliter on employment and it was increased to 23.00+/-13.06 microgram/dashliter after 3 months. The blood ZPP concentration was increased to 27.25+/-6.40 microgram/dashliter on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 25.48 microgram/dashliter and 26.61 microgram/dashliter in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was 14.34+/-6.10 microgram/dashliter on employment and it was increased to 28.97+/-7.14 microgram/dashliter (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between 26.96 microgram/dashliter and 27.96 microgram/dashliter. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was 21.34+/-5.25 microgram/dashliter on employment and it was gradually increased to 23.37+/-3.86 microgram/dashliter (p<0.01) after 3 months, 23.93+/-3.64 microgram/dashliter after 6 months, 25.50+/-3.01 microgram/dashliter (p<0.01) after 9 months, and 25.50+/-3.10 microgram/dashliter after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 microgram/m4, and after the intervention the levels were decreased to 0.216 microgram/m4 and 0.208 microgram/m4 in follow-up test. The Pb-A of part II which was resulted in lower value than part I was decreased from 0.232 microgram/m4 to 0.148 microgram/m4, and 0.120 microgram/m4 after the intervention. The Pb-A of part III was tested after the intervention and resulted in 0.124 microgram/m4 in January 1988 and 0.081 microgram/m4 in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in 0.110 microgram/m4 in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.; Summary

The change of validity of blood zinc protoporphyrin test by different cut-off level in level workers.: Yong Bae Kim, Hyun Cheol Ahn, Young Hwangbo, Gap Soo Lee, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee; Korean J Prev Med. 1997;30(4):741-751.

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Abstract PDF: Measurement of blood lead (PbB) and blood zinc protoporphyrin (ZPP) are most common biological indices to identify the individual at risk for excess or the health sequences by lead exposure. Because PbB is known most important and reliable index of lead exposure, PbB is often regarded as a gold standard to detect lead exposure. But in Korea PbB is a secondary test item of detailed health check-up with positive finding of screening test in most occasion. Our lead standard requires all lead workers to take annual heath-check twice a year for investigation of their health effect due to lead exposure. Blood ZPP is one of most important index to detect high lead absorption in lead workers as a screening test. Measurement of blood ZPP is known well to correlate with PbB in steady state of exposure in most lead workers and is often used as a primary screening test to detect high lead absorption of lead workers with the advantage of simplicity, easiness, portability and low cost. The current cut-off criteria of blood ZPP for further detailed health check-up is 100 ng/dl which is supposed to match the level of 40 ng/dl of PbB according to our standard. Authors tried to investigate the validity of current criteria of cut-off level(100 ng/dl) of blood ZPP and possible another better cut-off level of it to detect the lead workers whose PbB level over 40 ng/dl. The subjects in our study were 212 male workers in three small scale storage battery industries. Blood ZPP, PbB and hemoglobin(Hb) were selected as the indices of lead exposure. The results were as follows. 1. The mean of blood ZPP, PbB and Hb in lead workers were 79.5+/-46.7 ng/dl, 38.7+/-15.1 ng/dl, and 14.8+/-1.2 g/dl, respectively. There were significant differences in blood ZPP, PbB and Hb by industry(P<0.01). 2. The percents of lead workers whose blood ZPP were above 100 ng/dl in the group of work duration below 1, 1-4, 5-9 and above 10 years were 8.6%, 17.2%, 47.6%, and 50.0%, respectively. The percents of lead workers whose PbB were above 40 ng/dl in those were 31.4%, 40.4%, 71.4%, and 86.4%, respectively. 3. The percents of lead workers whose PbB were below 40 ng/dl, 40-59 ng/dl and above 60 ng/dl were 54.7%, 34.9% and 10.4%, respectively. Those of lead workers whose blood ZPP were below 100 ng/dl, 100-149 ng/dl and above 150 ng/dl were 79.2%, 13.7% and 7.1%, respectively. 4. Simple linear regression of PbB on blood ZPP was statistically significant(P<0.05) and as PbB was 40 ng/dl, blood ZPP was 82.1 ng/dl. 5. While the highest sensitivity and specificity of blood ZPP test to detect lead workers with PbB over 40 ng/dl were observed in the cut-off level of 50 ng/dl and 100 ng/dl of blood ZPP, respectively, the highest validity(sensitivity+specificity) of blood ZPP to detect lead workers with PbB over 40 ng/dl was observed in the cut-off level of around 70 ng/dl of blood ZPP. But even with optimal cut-off level of around 70 ng/dl of blood ZPP, still 25.0% of false negative and 20.7% false positive lead workers were found. As the result of this study, it was suggested that reconsideration of current blood ZPP cut-off of our lead standard from 100 ng/dl to somewhat lower level such as around 70 ng/dl and the inclusion of PbB measurement as a primary screening test for lead workers was highly recommended for the effective prevention of lead workers.; Summary

A study on lead exposure indices of male workers exposed to lead less than 1 year in storage battery industries.: Young Hwangbo, Yong Bae Kim, Gap Soo Lee, Sung Soo Lee, Kyu Dong Ahn, Byung Kook Lee, Joung Soon Kim; Korean J Prev Med. 1996;29(4):747-764.

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Abstract PDF: This study intended to obtain an useful information for health management of lead exposed measuring the lead exposure indices and workers and determine biological monitoring interval in early period of exposure by work duration in all male workers (n=433 persons) exposed less than 1 year in 6 storage battery industries and in 49 males who are not exposed to lead as control. The examined variables were blood lead concentration(PBB), Zinc-protoporphyrin concentration(ZPP), Hemoglobin(HB) and personal history; also measured lead concentration in air(PBA) in the workplace. According to the geometric mean of lead concentration in the air, the factories were grouped into three categories: A; When it is below 0.05mg/m3, B; When it is between 0.05 and 0.10mg/m3, and C; When it is above 0.10mg/m3. The results obtained were as follows: 1. The means of blood lead concentration(PBB), ZPP concentration and hemoglobin(HB) in all male workers exposed to lead less than 1 year in storage battery industries were 29.5+/-12.4 microgram/100ml, 52.9+/-30.0 microgram/100ml and 15.2+/-1.1 gm/100ml. 2. The means of blood lead concentration(PBB), ZPP concentration and hemoglobin(HB) in control group were 5.8+/-1.6 microgram/100ml, 30.8+/-12.7 microgram/100ml and 15.7+/-1.6 microgram/100ml, being much lower than that of study group exposed to lead. 3. The means of blood lead concentration and Zpp concentration among group A were 21.9+/-7.6 microgram/100ml, 41.4+/-12.6 microgram/100ml; those of group B were 29.8+/-11.6 microgram/100ml, 52.6+/-27.9 microgram/100ml; those of group C were 37.2+/-13.5 microgram/100ml, 66.3+/-40.7 microgram/100ml. Significant differences were found among three factory group(P<0.01) that was classified by the geometric mean of lead concentration in the air, group A being the lowest. 4. The mean of blood lead concentration of workers who have different work duration(month) was as follows; when the work duration was 1-2 month, it was 24.1+/-12.4 microgram/100ml,; When the work duration was 3-4 month, it was 29.2+/-13.4 microgram/100ml; and it was 28.9+/-34.5 microgram/100ml for the workers who had longer work duration than other. Significant differences were found among work duration group(P<0.05). 5. The mean of ZPP concentration of workers who have different work duration(month) was as follows; When the work duration was 1 2 month, it was 40.6 18.0 g/100ml, When the work duration was 3-4 month, it was 53.4+/-38.4 microgram/100ml; and it was 51.5+/-60.4 microgram/100ml for the workers who had longer work duration than other. Significant differences were found among work duration group(P<0.05). 6. Among total workers(433 person), 18.2% had PBB concentration higher than 40 microgram/100ml and 7.1% had ZPP concentration higher than 100 microgram/100ml; In workers of factory group A, those were 0.9% and 0.0%; In workers of factory group B, those were 17.1% and 6.9%; In workers of factory group C, those were 39.4% and 15.4%. 7. The proportions of total workers(433 person) with blood lead concentration lower than 25 microgram/100ml and ZPP concentration lower than 50 microgram/100ml were 39.7% and 61.9%, respectively; In workers of factory group A, those were 65.5% and 82.3%; In workers of factory group B, those were 36.1% and 60.2%; In workers of factory group C, those were 19.2% and 43.3%. 8. Blood lead concentration (r=0.177, P<0.01), ZPP concentration (r=0.135, P<0.01), log ZPP (r=0.170, P<0.01) and hemoglobin (r=0.096, P<0.05) showed statistically significant correlation with work duration (month). ZPP concentration (r=0.612, P<0.01) and log ZPP(r=0.614, P<0.01) showed statistically significant correlation with blood lead concentration. 9. The slopes of simple linear regression between work duration(month, independent variable) and blood lead concentration(dependent variable) in workplace with low air concentration of lead was less steeper than that of poor working condition with high geometric mean air concentration of lead. The study result indicates that new employees should be provided with biological monitoring including blood lead concentration test and education about personal hygiene and work place management within 3~4 month.; Summary

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