Category: General

Lead Poisoning

What is it and who is affected?

Lead is a highly toxic substance, exposure to which can produce a wide range of adverse health effects. Both adults and children can suffer from the effects of lead poisoning, but childhood lead poisoning is much more frequent. Over the many years since we have known about the hazards of lead, tens of millions of children have suffered its health effects. Even today, in 2004, there are still at minimum more than four hundred thousand children under the age of six who have too much lead in their blood.

Where is it found?

There are many ways in which humans are exposed to lead: through deteriorating paint, household dust, bare soil, air, drinking water, food, ceramics, home remedies, hair dyes and other cosmetics. Much of this lead is of microscopic size, invisible to the naked eye. More often than not, children with elevated blood lead levels are exposed to lead in their own home.

By far the biggest source of concern is the lead paint that is found in much of our nation’s older housing. Until 1978, lead paint was commonly used on the interiors and exteriors of our homes. Today, the US Department of Housing and Urban Development (HUD) estimates that about 38 million homes in the US still contain some lead paint. While lead paint that is in intact condition does not pose an immediate concern, lead paint that is allowed to deteriorate creates a lead-based paint hazard. It can contaminate household dust as well as bare soil around the house, where children may play. In either situation, a child who comes into contact with lead-contaminated dust or soil is easily poisoned. All it takes is hand-to-mouth activity, which is perfectly normal for young children to engage in. All it takes is the lead dust equivalent of a single grain of salt for a child to register an elevated blood lead level.

According to HUD, about 25% of the nation’s housing stock?some 24 million homes?contains significant lead-based paint hazards, i.e. deteriorating lead paint or lead-contaminated dust. These are the homes producing the vast majority of the childhood lead poisoning cases we see today.

Children and adults too can get seriously lead poisoned when renovation and remodeling activities take place in a home that contains lead paint. Anytime a surface containing lead paint is worked on, the debris and the dust created by the work must be contained and thoroughly cleaned up, and those doing the work must have adequate personal protection to prevent them from breathing in any lead dust generated by the work. It is therefore of critical importance that lead painted surfaces be identified prior to the commencement of any renovation or remodeling work, and that lead-safe work practices are used during such activities. Of course, steps must also be taken to ensure that children, pets, and personal belongings including furniture are protected from exposure to lead while work is ongoing, as well.

The past use of leaded gasoline, only recently banned in this country, contributed greatly to the number of cases of childhood lead poisoning in the US during the last sixty years or so. The lead produced by vehicle emissions continues even today to present a hazard, as much of that lead now remains in soil where it was deposited over the years, especially near well-traveled roads and highways. Children who play in dirt contaminated by lead (whether that lead is from gasoline emissions or from deteriorated house paint) can end up with lead-contaminated soil under their fingernails or on their toys, or they can track it into their homes. Even pets can come into contact with lead-contaminated soil and cause human exposure to lead. In each such case, an elevated blood lead level can easily result.

Drinking water can also sometimes contribute to elevated blood lead levels. Lead can leach into drinking water from certain types of plumbing materials (lead pipes, copper pipes with lead solder, and brass faucets). While water is usually not the primary source of exposure to lead for children with elevated blood lead levels, it is nevertheless important to note that formula-fed infants are at special risk of lead poisoning, if their formula is made with lead-contaminated water.

What are the health effects?

There are many different health effects associated with elevated blood lead levels. Young children under the age of six are especially vulnerable to lead’s harmful health effects, because their brains and central nervous system are still being formed. For them, even very low levels of exposure can result in reduced IQ, learning disabilities, attention deficit disorders, behavioral problems, stunted growth, impaired hearing, and kidney damage. At high levels of exposure, a child may become mentally retarded, fall into a coma, and even die from lead poisoning. Within the last ten years, children have died from lead poisoning in New Hampshire and in Alabama. Lead poisoning has also been associated with juvenile delinquency and criminal behavior.

In adults, lead can increase blood pressure and cause fertility problems, nerve disorders, muscle and joint pain, irritability, and memory or concentration problems. It takes a significantly greater level of exposure to lead for adults than it does for kids to sustain adverse health effects. Most adults who are lead poisoned get exposed to lead at work. Occupations related to house painting, welding, renovation and remodeling activities, smelters, firing ranges, the manufacture and disposal of car batteries, and the maintenance and repair of bridges and water towers, are particularly at risk for lead exposure. Workers in these occupations must also take care not to leave their work site with potentially contaminated clothing, tools, and facial hair, or with unwashed hands. Otherwise, they can spread the lead to their family vehicles and ultimately to other family members.

When a pregnant woman has an elevated blood lead level, that lead can easily be transferred to the fetus, as lead crosses the placenta. In fact, pregnancy itself can cause lead to be released from the bone, where lead is stored?often for decades?after it first enters the blood stream. (The same process can occur with the onset of menopause.) Once the lead is released from the mother’s bones, it re-enters the blood stream and can end up in the fetus. In other words, if a woman had been exposed to enough lead as a child for some of the lead to have been stored in her bones, the mere fact of pregnancy can trigger the release of that lead and can cause the fetus to be exposed. In such cases, the baby is born with an elevated blood lead level.

Exposure to lead is estimated by measuring levels of lead in the blood (in micrograms of lead per deciliter of blood). The US Centers for Disease Control and Prevention (CDC) has set a “level of concern” for children at 10 micrograms per deciliter. At this level, it is generally accepted that adverse health effects can begin to set in. However, recent research published in the New England Journal of Medicine provides new evidence that there could well be very harmful effects occurring at even lower levels of exposure, even as low as 5 micrograms of lead per deciliter of blood. In other words, science is now telling us that there is in fact no level of lead exposure that can be considered safe.

How can I check my home to see if it contains lead-based paint hazards?

If you live in a home built before 1960, it is very likely that it contains some lead paint. Homes built between 1960 and 1978 may also contain lead paint, but they are less and less likely to, the closer you get to 1978, when the Consumer Product Safety Commission finally issued its ban against lead-based paint. If you live in a home built before 1978 that also has been allowed to deteriorate for a few years, you may have a lead-contaminated dust problem. To find out if your home contains lead paint or a lead-based paint hazard, you should hire a professional.

If all you want to do is find out if there is lead paint in your home, you should hire a lead inspector to test all the paint. Depending on the size of your home, this normally takes between one and four hours. You will know the results of the inspection on the spot. The inspector will be able to tell you whether or not there is lead paint in the home, where it is, and the concentration of lead in the paint. (Older homes contain higher concentrations of lead in paint than homes built after the early 1950s. The higher the concentration, the greater the hazard once the paint deteriorates.)

If you also want to find out if your home contains any lead-contaminated dust, which is the most dangerous of all lead-based paint hazards, you should hire either a risk assessor or a sampling technician. They will take samples of dust throughout your home and then send them to a laboratory for analysis. You should be able to learn the results within three to seven days. You will learn whether there is any lead-contaminated dust in your home and where it was found. A risk assessor can also tell you what you should do next to take care of the problem. Alternatively, you can buy a dust sampling kit and carefully do the sampling yourself, send the samples to an appropriate laboratory for analysis, and get the results directly from the lab.

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Preventing Pressure Ulcers

The federal government has published guidelines on the prevention of pressure ulcers.? In accordance with the federal guidelines, the following steps should be followed by the nursing home staff (or home care provider) to prevent pressure ulcers:

  • Complete a physical on admission to a facility (including skin condition and wounds).
  • Reassess whenever the patient?s condition changes.
  • Use a reliable and standardized tool for doing a risk assessment such as the Braden Scale which is available at: www.bradenscale.com/braden.PDF.
  • Document risk assessment scores and implement prevention procedures and protocols.
  • Assess skin daily.
  • Clean skin at time of soiling–avoid hot water and irritating cleaning agents.
  • Use moisturizers on dry skin.
  • Don?t massage bony prominences (that means tail bones, hips, heels, etc.)
  • Protect skin of incontinent patients from exposure to moisture (which means CHANGE the patient often!).
  • Use lubricants, protective dressings, and proper lifting techniques to avoid skin injury from friction/shear during transferring and turning of clients (don?t drag skin across a bed, or chair ? be careful!).
  • Turn and reposition bedbound patients every 2 hours if consistent with overall care goals and use a written schedule for turning and repositioning clients.
  • Use pillows or other devices to keep bony prominences from direct contact with each other.
  • Raise heels of bedbound patients off the bed — don?t use donut-type devices.
  • Keep head of the bed at lowest height possible.
  • Reposition chair or wheelchair bound patients EVERY HOUR. In addition, if the patient is capable have them do small weight shifts every 15 MINUTES.
  • Keep the patient as active as possible, encourage mobilization.
  • Manage nutrition: Consult a dietician and correct nutritional deficiencies by increasing protein and calorie intake and provide A, C, or E vitamin supplements as needed.
  • Manage Hydration: Offer a glass of water with turning schedules to keep patient hydrated.
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Erb’s Palsy – What Is It, How Is It Caused

Erb’s Palsy is a nerve injury that effects the movement of a child’s shoulder, arm, and hand.?
Erbs palsy usually happens when too much force is applied to the baby’s head, while trying to pull out a baby stuck in the birth canal.? The baby may be too large to fit easily through the birth canal.?
When the baby’s shoulder gets stuck in the birth canal, it is called shoulder dystocia.? Pulling on the baby’s head stretches and injures the nerves in the stuck shoulder. The injured nerves are between the shoulder and the neck.? These nerves provide movement to the arm, hand, and fingers.? This collection of nerve fibers is called the brachial plexus or Erb’s Point. Most of the time these nerves are only somewhat injured and the baby may regain movement in a few months.? About 20 percent of the time, the injury is so severe, or the nerves are torn from their points of attachment to the spine or they may be ruptured, so that paralysis of the arm and shoulder is permanent.? This injury may result in varying degrees of weakness or paralysis of the shoulder, arm, or hand.? Which part of the arm is involved, depends on which nerves are injured.? A baby with this injury holds his limp arm down by his side with forearm turned inward and wrist bent.? The baby cannot lift the arm up.?? A baby with a very bad injury may also have a droopy eyelid on the side that was injured. There are tests that can diagnosis brachial plexus injury. Your baby’s physician may order an x-ray of the neck, an MRI, and maybe even nerve conduction tests. A pediatric neurologist may be asked to evaluate the degree of injury and therapists might be called in to design slings or splints, to perform and teach the parents to do exercises to keep the arm limber, and to be part of a rehabilitation process.? Sometimes surgeries have been helpful to restore some function.

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Asbestos Causes Cancer

Exposure to asbestos is unlikely to cause any short term (acute) effects beyond irritation of the nose or throat. It is the long-term (chronic) effects that are debilitating and deadly. Every kind of asbestos causes cancer, and every kind of asbestos can cause asbestosis. People are exposed to asbestos mainly through inhalation of fibers in the air they breathe. This may occur during mining and processing of asbestos, during the production of asbestos-containing products, or during the installation of asbestos insulation. It may also occur when older asbestos-containing materials begin to break down. In any of these situations, asbestos fibers tend to create a dust composed of tiny particles that can float in the air. In addition, asbestos can enter the body through ingestion. This may occur when people consume contaminated food or liquids (such as water that flows through asbestos cement pipes). It may also occur when people cough up asbestos they have inhaled, then swallow their saliva. Many people are exposed to very low levels of naturally occurring asbestos in outdoor air as a result of erosion of asbestos-bearing rocks. Family members of asbestos workers are also potentially exposed to higher levels of asbestos because the fibers are carried home on the workers’ clothing, and can then be inhaled by others in the household. Inhalation of asbestos fibers has been proven to cause lung cancer.

The most common way for asbestos fibers to enter the body is through breathing. In fact, asbestos containing material is not generally considered to be harmful unless it is releasing dust or fibers into the air where they can be inhaled or ingested. Many of the fibers will become trapped in the mucous membranes of the nose and throat where they can then be removed, but some may pass deep into the lungs, or, if swallowed, into the digestive tract. Once they are trapped in the body, the fibers can cause health problems. The most serious hazard of exposure to asbestos is cancer, and it takes less exposure to asbestos to cause cancer than to cause asbestosis. Two kinds of cancer are very strongly related to asbestos: lung cancer and mesothelioma. In addition, asbestos also causes cancer of the throat, stomach, esophagus, and bowel. Lung cancer caused by asbestos exposure is the same kind of cancer as that caused by smoking. It is hard to diagnose early, it spreads rapidly, and can rarely be cured.

Lung cancer in asbestos-exposed and unexposed individuals is similar in both the type of cancer and its signs and symptoms. The link between cigarette smoking, asbestos and cancer of the lung itself does not apply to cancer of the lining of the lung (see malignant mesothelioma section below). Diagnosis and treatment of lung cancer is a complex topic and a pulmonary specialist should be involved in the workup of a suspected lung cancer. Exposure to asbestos fibers, either at home or in the workplace, is also considered a risk factor for lung cancer. Studies show that compared to the general population, asbestos workers are seven times more likely to die from lung cancer. Asbestos workers who smoke increase their risk of getting lung cancer by 50-100 times. The risk of asbestos-related abnormalities and disease generally increases with increasing levels of exposure. This dose-response relationship is less clear for mesothelioma, where even short-term occupational exposures or secondary household exposures (e.g., household contacts of asbestos workers) have been associated with the occurrence of this malignancy. As asbestos exposures have declined in the workplace due to regulatory control, cases of severe interstitial disease have also decreased. Mesothelioma is a fast spreading cancer that is almost always caused by exposure to asbestos. It can take 30 or 40 years after exposure to develop. Mesothelioma usually starts in the membrane that wraps around the lungs, called the pleura. The cancer cells cause a build-up of fluid between the pleura and the lungs, which in turn causes pressure on the lungs. The symptoms are shortness of breath and a dry, painful cough. The cancer may eventually grow into the chest wall. Sometimes, the cancer can develop in the lining of the abdomen, the membranes of the heart or reproductive organs. Among many recently screened cohorts, pleural changes are more prevalent than interstitial changes. There is little evidence that general environmental exposures are associated with significant disease except in several regions of the world with endemic mesothelioma due to exposures from naturally-occurring deposits of asbestos.

Lung cancer causes the largest number of deaths related to asbestos exposure. The incidence of lung cancer in people who are directly involved in the mining, milling, manufacturing and use of asbestos and its products is much higher than in the general population. The most common symptoms of lung cancer are coughing and a change in breathing. Other symptoms include shortness of breath, persistent chest pains, hoarseness, and anemia. The association between lung cancer and asbestos exposure is now well established. In the case of smokers who have had significant asbestos exposure, the risk of lung cancer is extraordinarily high. Lung cancer in asbestos exposed workers is thought to occur at a slightly earlier age than other lung cancers and are more common in the lower lobes.

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Brazil’s Aviation Radar Goes Dark

A radar failure over the Amazon forced Brazil to turn back or ground a string of international flights Saturday, deepening a national aviation crisis just hours after the president unveiled safety measures prompted by the country’s deadliest air disaster

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