Blood lead levels in a group of children: the potential risk factors and health problems

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The main sources of lead and its pollution are mining operations, battery recycling plants, and smelting,<a class="elsevierStyleCrossRefs" href="#bib0175">2,3</a> as well as old lead-based peeled or chipped paint, especially during renovations of old houses,<a class="elsevierStyleCrossRefs" href="#bib0185">4,5</a> contact with contaminated dust or soil,<a class="elsevierStyleCrossRef" href="#bib0195">6</a> lead in plumbing, automobile exhaust, by-products of both mining and metal working, and various consumer products.<a class="elsevierStyleCrossRefs" href="#bib0200">7,8</a> E-scrap recycling is an emerging area of concern as a source of occupational exposures among workers and a source of take-home exposures.<a class="elsevierStyleCrossRef" href="#bib0210">9</a>Lead is not known to serve any physiological function, but it exists in almost all biological systems. It is absorbed via different routes; however, ingestion of contaminated dietary constituents accounts for the majority of lead toxicity in children.<a class="elsevierStyleCrossRef" href="#bib0215">10</a> Children are more likely to be exposed than adults due to a high rate of inhalation and more intestinal absorption. Intense, high-dose exposure to lead causes acute symptomatic poisoning, characterized by colic, anemia, and depression of the central nervous system that may result in coma, convulsions, and death. Low BLLs are now known to affect multiple organs in the absence of apparent symptoms. Toxicity with low lead levels in utero and during childhood constitutes brain and nervous system damage. Exposure to low BLL (less than 10μg/dL) affects also the immune, reproductive and cardiovascular systems. Recent research indicates that, at blood levels of 5μg/dL or lower, neurobehavioural damage is liable to occur. It appears that brain injury can happen at any blood level threshold.<a class="elsevierStyleCrossRefs" href="#bib0220">11–13</a>The goals of the present study were to evaluate the extent of lead exposure in schoolchildren, whose age ranged from 6 to 12 years, in industrial and urban areas in Egypt and to investigate the possible influencing factors in order to clarify the current problem of lead exposure and to improve methods of prevention and control.Subjects and methodsTwo hundred primary school children were randomly chosen in an industrial area in Egypt (Helwan); the same number of primary school children was selected in an urban area in Egypt (Dokki). The study was approved by the Medical Ethical Committee of National Research Centre, Dokki, Cairo, Egypt. Parental consents were obtained. Parents who opted to join the study answered detailed questionnaires on sources of water supply, housing (old houses with defective paints/use of lead-glazed ceramics), living with adults whose job involve battery repair, recycling, or processing, dietary habits (e.g., using newspapers to wrap the children's food), exposure to air pollution (location of the house close to main roads), and outdoor playing in dust areas. History of school performance, behavioral changes (such as anxiety and aggressiveness), and any clinical problems were investigated. Teachers and other school staff were asked to assess each child's performance and behaviors.A thorough clinical examination was performed, including weight, height, blood pressure, cardiac, abdominal, and full neurological examinations. A psychological assessment was also performed through an interview with a specialist. Complete blood count and BLL were assessed.Blood samples were collected according to the instructions of the Centers of Disease Control and Prevention (CDC). All sample collection tubes and materials were pre-screened for lead contamination. Blood samples were analyzed for lead level with the atomic absorption method described by Miller et al.,<a class="elsevierStyleCrossRef" href="#bib0235">14</a> using heating graphite atomization (HGA 600 perkin Elmer). BLLs were considered as “elevated” or “level of concern” if equal to or greater than 10μg/dL, in accordance with the US Centers for Disease Control and Prevention criteria.<a class="elsevierStyleCrossRef" href="#bib0240">15</a>Statistical analysisStatistical analysis was performed using SPSS version 16 for Windows (SPSS Inc., version 16 for Windows, IL, USA). Continuous data (BLLs) were expressed as mean±standard deviation and were compared using Student's t-test. Categorical data were expressed as frequencies and percentages, and were analyzed with the two-tailed chi-squared test. Multiple logistic regression analysis was used to analyze the predictors of BLL≥10μg/dL and to modify the association between the clinical data and high BLL by adding the covariates. p-Values<0.05 were considered to be statistically significant.ResultsA total of 400 children were enrolled in the present study; their age ranged from 6 to 12 years, with a mean of 9.40±2.33. From the total, 205 children were males and 195 were females. Mean BLL was 10.37±7.94μg/dL in Helwan and 5.45±3.90μg/dL in Dokki, with a significant difference between both areas (p<0.05). No significant difference was found between the genders in both areas regarding BLL (p>0.05). In Dokki, 20% of the studied group had BLLs≥10μg/dL, while in Helwan this value was 42%. The percentage of children with BLL≥5μg/dL was 44% in Dokki, versus 64% in Helwan.The social and clinical data of the study population are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, showing that children in Helwan had significantly worse results in health habits, housing with increased exposure, school achievement <60%, abnormal behavior, and pallor than children in Dokki (p<0.05).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The association between clinical data of all children and high BLL is presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. A significant association was observed between BLL≥10μg/dL and children with school achievement <60%, children with abnormal behavior, children with short stature, and pallor, when compared with those with BLL<10μg/dL (p<0.05).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Multiple logistic regression analysis was done to study the predictors of high blood lead level (≥10μg/dL; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). It was found that those living in Helwan, those with bad health habits, and those living in housing with increased exposure were at a significantly higher risk of having BLL≥10μg/dL (OR=2.16, 95% CI 1.35–3.47; OR=1.947, 95% CI 1.22–3.10; OR=1.72, 95% CI 1.09–1.09, respectively, p<0.05 in all).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the association between the clinical data and high BLL after modification by the predictors of high BLL as covariates. Abnormal behavior and pallor were associated with high BLL≥10μg/dL (p<0.05), while school achievement <60% and short stature were not associated with high BLL (p>0.05) after modification by the covariates.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionChildhood lead poisoning is a major problem that can be prevented worldwide. In the current study, mean BLL in an urban area of Egypt (Dokki) was 5.45±3.90μg/dL, while that in an industrial area (Helwan) was 10.37±7.94μg/dL. In Dokki, 20% of the studied group had BLLs≥10μg/dL, versus 42% in Helwan. The percentage of children with BLL≥5μg/dL was 44% in Dokki, versus 64% in Helwan. In Singapore, from 1995 to 1997, the mean reported BLL was 6.6μg/dL in 269 children.<a class="elsevierStyleCrossRef" href="#bib0245">16</a> Children aged 12–19 years were assessed in 1999 in the United States, and a mean BLL of 1.1μg/dL was found<a class="elsevierStyleCrossRef" href="#bib0250">17</a>; from 2007 to 2010, the geometric means at age 1–2 years and 3–5 years were found to be 1.5μg/dL and 1.2μg/dL, respectively.<a class="elsevierStyleCrossRef" href="#bib0255">18</a>A cross-sectional survey for BLLs included 3831 children recruited at hospitals in France. The geometric mean BLL was 1.49μg/dL; 0.09% of the children had BLL exceeding 10μg/dL, and in 1.5%, BLL exceeded 5μg/dL.<a class="elsevierStyleCrossRef" href="#bib0260">19</a>In 2011, a study of blood lead concentrations of 226 schoolchildren was conducted in Alpuyeca, Morelos, Mexico. The mean BLL was 7.23μg/dL; BPb>5μg/dL and >10μg/dL were observed in 64% and 18% of the children, respectively. In almost 50% of the households, the use of lead-glazed ceramics was reported.<a class="elsevierStyleCrossRef" href="#bib0265">20</a>Ecuadorian infants and young children (n=130) aged 0.33–5.8 years had their BLL assessed; the mean BLL was 29.4μg/dL (SD: 24.3; range: 3.0–128.2; median: 21.7; geometric mean: 20.7μg/dL).<a class="elsevierStyleCrossRef" href="#bib0270">21</a> To measure current lead exposure in Japanese children, blood samples were collected from 229 children aged 9–10 years in Asahikawa, Japan; The geometric mean was 0.96μg/dL.<a class="elsevierStyleCrossRef" href="#bib0275">22</a>Children in six communities near to the now-closed Kabwe mines and smelters in Zambia were studied for BLL; the mean was 4.83μg/dL. The lowest BLL measured was 1.36μg/dL. The highest BLL detected using the testing system was 6.5μg/dL.<a class="elsevierStyleCrossRef" href="#bib0280">23</a>BLL was also assessed in the Bagega community in Nigeria; the median was 71μg/dL (range: 8–332μg/dL). Elevated BLL (≥10μg/dL) was found in 99.5% of the studied group.<a class="elsevierStyleCrossRef" href="#bib0285">24</a> In Wuhan, China, children less than 18 years were investigated throughout the entire year of 2012. For all subjects, the geometric mean was 4.48μg/dL. Elevated BLLs (≥10μg/dL and ≥5μg/dL) were found in 2% and in 44%, respectively.<a class="elsevierStyleCrossRef" href="#bib0290">25</a> In South Africa, a cross-sectional analytical studies including 160 young schoolchildren was performed. The mean BLL was 7.4μg/dL (range: 2.2–22.4μg/dL). BLLs≥5μg/dL were observed in 74% of the children, while 16% had BLL≥10μg/dl.<a class="elsevierStyleCrossRef" href="#bib0295">26</a>BLLs were assessed in children living in Riyadh, Saudi Arabia. The mean (±SD) BLL was 5.2±1.7, ranging from 1.7 to 10.6μg/dL; in 17.8% of children, BLL was greater than 10μg/dL.<a class="elsevierStyleCrossRef" href="#bib0300">27</a>A study conducted in three schools in Nablus, Palestine, assessed BLL in 178 children (140 boys, 38 girls, age range 6–8 years). The mean BLL was 3.2±2.4μg/dL, and levels above 10μg/dL were observed in 4.5% of children.<a class="elsevierStyleCrossRef" href="#bib0305">28</a>In the present study, high BLLs were found in Helwan area, which is an old industrial area with many lead-related industries and factories. Other predictors of high BLL were bad health habits (using newspapers to wrap children's food; no hand washing before meals and after playing outside; contact with contaminated dust, soil and toys; ingestion of preserved eggs; and consumption of fried food) and housing with increased exposure (old lead-based peeled or chipped paint, renovations, lead in plumbing, and use of lead glazed ceramics).No significant differences were detected in the current study between males and females in both Dokki and Helwan regarding BLLs, which can be explained by the similar behavior and outdoor activities of both genders. This result is in agreement with those by Allen Counter et al.<a class="elsevierStyleCrossRef" href="#bib0270">21</a> Cao et al.<a class="elsevierStyleCrossRef" href="#bib0310">29</a> found that the mean BLLs in boys (23.57mg/L) were higher than that in girls (21.2mg/L), which was explained by the greater distinct behavior and outdoor activities found with growing boys, leading to contact with environmental lead pollution.In a multivariable analysis by Spanier et al.,<a class="elsevierStyleCrossRef" href="#bib0190">5</a> mean BLLs of children whose housing underwent interior renovation was 12% higher than that of children whose housing units were not renovated (p<0.01). Renovation, repairs, and painting rule, routine interior housing renovation were associated with a modest increase in children's BLLs, which are in agreement with the present study.In the present study, school achievement <60%, short stature, and pallor (Hb<10g/dL) were associated with high BLLs (≥10μg/dL). Liu et al.<a class="elsevierStyleCrossRef" href="#bib0315">30</a> conducted a prospective cohort study that assessed children in four elementary schools. They detected a significant association between BLL and increased scores for teacher-reported behavioral problems (emotional reactivity, anxiety/depression, and pervasive developmental problems), which is in agreement with the present results. Boys experience the deleterious cognitive effects of lead more than girls do.<a class="elsevierStyleCrossRef" href="#bib0320">31</a>A cross-sectional assessment in children and adolescents aged 0–17 years from six communities in the Corrientes river basin was conducted. Children and adolescents with BLLs>5μg/dL had twice the risk of stunting when compared with those with lower BLLs.<a class="elsevierStyleCrossRef" href="#bib0325">32</a> Fleisch et al.<a class="elsevierStyleCrossRef" href="#bib0330">33</a> concluded that, in peripubertal boys, higher BLLs were associated with lower serum IGF-1, which is attributed to the inhibition of the hypothalamic–pituitary-growth axis by lead exposure, leading to growth delay. The results of the previous two studies are in agreement with the present results, which indicated a significant association between high BLLs and stunting.The present study had some limitations, which included its small sample size; its cross-sectional design, which may not allow the follow-up of the association between clinical data and BLLs; and the questionnaire used to collect information on risk factors, which may have caused recall bias. The measurement of BLL through the gold standard method (graphite atomic absorption method) added strength to the present study.In conclusion, BLL was measured and associated to exposure risk factors in two areas (one urban and one industrial) in Egypt. BLLs were significantly higher in the industrial area than in the urban area. High BLLs were significantly associated with bad health habits and housing with increased exposure, as well as with school achievement <60%, short stature, and pallor (Hb<10g/dL).In Egypt, definitive plans and regulations should be carried out to improve the prevention and control of childhood lead poisoning. Regulatory policies are needed to reduce lead release from different industries. BLL screening and testing should be improved. In industrial areas, screening programs for BLL should be implemented. Finally, the prevention and treatment of childhood lead poisoning should be improved in Egypt.This study examined the relationship between BLL and its risk factors in Egyptian children. The use of a representative sample of the general Egyptian children strengthened the present findings. However, there were some limitations to this study. First, it had a cross-sectional design, and lead exposure throughout the entire childhood development could not be assessed. Second, other hazardous environmental pollutants (e.g., mercury and cadmium) were not evaluated. Finally, the sample size was relatively small.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres935721" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Subjects and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec909667" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres935720" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Indivíduos e método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec909666" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Subjects and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-15" "fechaAceptado" => "2016-12-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec909667" "palabras" => array:6 [ 0 => "Blood lead levels" 1 => "Children" 2 => "Lead exposure" 3 => "Abnormal behavior" 4 => "Short stature" 5 => "Egypt" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec909666" "palabras" => array:6 [ 0 => "Níveis de chumbo no sangue" 1 => "Crianças" 2 => "Exposição ao chumbo" 3 => "Comportamento anormal" 4 => "Baixa estatura" 5 => "Egito" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo investigate blood lead levels in schoolchildren in two areas of Egypt to understand the current lead pollution exposure and its risk factors, aiming to improve prevention politicies. Subjects and methodThis was a cross-sectional study in children (n=400) aged 6–12 years recruited from two areas in Egypt (industrial and urban). Blood lead levels were measured using an atomic absorption method. Detailed questionnaires on sources of lead exposure and history of school performance and any behavioral changes were obtained. ResultsThe mean blood lead level in the urban area of Egypt (Dokki) was 5.45±3.90μg/dL, while that in the industrial area (Helwan) was 10.37±7.94μg/dL, with a statistically significant difference between both areas (p<0.05). In Dokki, 20% of the studied group had blood lead levels≥10μg/dL, versus 42% of those in Helwan. A significant association was found between children with abnormal behavior and those with pallor with blood lead level≥10μg/dL, when compared with those with blood lead level<10μg/dL (p<0.05). Those living in Helwan area, those with bad health habits, and those living in housing with increased exposure were at a statistically significantly higher risk of having blood lead level≥10μg/dL. ConclusionLead remains a public health problem in Egypt. High blood lead levels were significantly associated with bad health habits and housing with increased exposure, as well as abnormal behavior and pallor." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Subjects and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoInvestigar os níveis de chumbo no sangue (NCSs) em crianças em idade escolar em duas áreas do Egito para entender a atual exposição à poluição por chumbo e seus fatores de risco, para melhorar as políticas de prevenção. Indivíduos e métodoEsse foi um estudo transversal em crianças (400) com idades entre 6–12 anos recrutadas de duas áreas no Egito (industrial e urbana). Os NCSs foram medidos por um método de absorção atômica. Foram obtidos questionários detalhados sobre as fontes de exposição ao chumbo e o histórico de desempenho escolar e quaisquer alterações comportamentais. ResultadosO NCS na área urbana do Egito (Dokki) foi 5,45±3,90μg/dL, ao passo que na área industrial (Helwan) foi 10,37±7,94μg/dL, com uma diferença significativa entre ambas as áreas (p<0,05). Na área de Dokki, 20% do grupo estudado apresentaram NCSs ≥10μg/dL, ao passo que na área de Helwan foi 42%. Foi encontrada uma associação significativa entre as crianças com comportamento anormal e aquelas com palidez com NCS≥10μg/dL, em comparação àquelas com NCS<10μg/dL (p<0,05). Aquelas que moram na área de Helwan aquelas com hábitos de saúde ruins e aquelas que moram em moradias com maior exposição estiveram significativamente em alto risco de apresentar NCS≥10μg/dL. ConclusãoO chumbo ainda é um problema de saúde pública no Egito. Altos NCSs foram significativamente associados a hábitos de saúde ruins e moradia com maior exposição, bem como, comportamento anormal e palidez." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Indivíduos e método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: AbuShady MM, Fathy HA, Fathy GA, Fatah Sa, Ali A, Abbas MA. Blood lead levels in a group of children: the potential risk factors and health problems. J Pediatr (Rio J). 2017;93:619–24." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Hb, hemoglobin; BLL, blood lead level." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Character \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Helwan area n=200 (Number – %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dokki area n=200 (Number – %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bad health habits increasing exposure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122 (61%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (32%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housing with increased exposure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (59.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (34.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">School achievement <60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.004<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal behavior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.008<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short stature \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.681 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pallor (Hb<10 gm%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (39.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.005<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BLL≥10μg/dL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (42%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1581556.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "p-Values<0.05 were considered as significant." ] ] ] "descripcion" => array:1 [ "en" => "Clinical and social data of the study population (n=400)." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Hb, hemoglobin; BLL, blood lead level." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Character \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High BLL≥10μg/dL n=124 (Number – %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BLL<10μg/dL n=276 (Number – %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">School achievement <60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (14.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.000<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal behavior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.041<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short stature \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pallor (Hb<10 gm%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (20.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1581555.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "p-Values<0.05 were considered as significant." ] ] ] "descripcion" => array:1 [ "en" => "Association of clinical data of children and high blood lead levels (≥10μg/dL)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "OR, odds ratio; CI, confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residence (Dokki versus Helwan) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.763 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.335 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.447 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Health habits (Good health habits versus bad health habits) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.664 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.943 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.095 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housing exposure (Housing with no exposure versus housing with increased exposure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.565 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.760 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.796 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.077 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.926 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.815 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.053 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.392 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.772 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.932 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.410 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.033 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1581557.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "p-Values<0.05 were considered as significant." ] ] ] "descripcion" => array:1 [ "en" => "Predictors of high blood lead level (≥10μg/dL; multiple logistic regression analysis)." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "OR, odds ratio; CI, confidence interval; Hb, hemoglobin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Covariates</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.07291 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.952 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residence (Dokki versus Helwan) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.525 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.049<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.591 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Health habits (Good health habits versus bad health habits) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.307 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.252 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.736 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.435 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.243 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housing exposure (Housing with no exposure versus housing with increased exposure) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.542 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.581 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.973 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.952 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.284 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.226 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.383 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.798 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.480 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.326 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Clinical data</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">School achievement<60%</td><td class="td" title="table-entry " align="char" valign="top">0.302 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.318 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.352 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.748 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.445 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Abnormal behavior</td><td class="td" title="table-entry " align="char" valign="top">1.794 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.446 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Short stature</td><td class="td" title="table-entry " align="char" valign="top">−0.05999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.924 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.942 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.274 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.234 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Pallor (Hb<10 gm%)</td><td class="td" title="table-entry " align="char" valign="top">1.198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.313 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.845 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.948 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1581558.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "p-Values<0.05 were considered as significant." ] ] ] "descripcion" => array:1 [ "en" => "Association of clinical data and high blood lead level (≥10μg/dL) after modification by covariates (multiple logistic regression analysis)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low level lead exposure: history and discovery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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Níveis de chumbo no sangue em um grupo de crianças: possíveis fatores de risco e problemas de saúde

Mones M. AbuShadya,

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monesshady@ymail.com

Corresponding author.

, Hanan A. Fathyb, Gihan A. Fathya, Samer abd el Fatahb, Alaa Alia, Mohamed A. Abbasa

a National Research Centre, Child Health Department, Cairo, Egypt

b Atomic Energy Authority, National Center for Radiation Research and Technology (NCRRT), Health Radiation Research Department, Cairo, Egypt

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Blood lead level &#40;BLL&#41; is a major health hazard&#44; especially in children&#44; which warrants its frequent monitoring in order to avoid lead exposure as much as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> Lead has been used in many products such as paint&#44; pipes&#44; and ceramics&#44; and remains a public hazard&#46; The main sources of lead and its pollution are mining operations&#44; battery recycling plants&#44; and smelting&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;3</span></a> as well as old lead-based peeled or chipped paint&#44; especially during renovations of old houses&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;5</span></a> contact with contaminated dust or soil&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> lead in plumbing&#44; automobile exhaust&#44; by-products of both mining and metal working&#44; and various consumer products&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">7&#44;8</span></a> E-scrap recycling is an emerging area of concern as a source of occupational exposures among workers and a source of take-home exposures&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Lead is not known to serve any physiological function&#44; but it exists in almost all biological systems&#46; It is absorbed <span class="elsevierStyleItalic">via</span> different routes&#59; however&#44; ingestion of contaminated dietary constituents accounts for the majority of lead toxicity in children&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> Children are more likely to be exposed than adults due to a high rate of inhalation and more intestinal absorption&#46; Intense&#44; high-dose exposure to lead causes acute symptomatic poisoning&#44; characterized by colic&#44; anemia&#44; and depression of the central nervous system that may result in coma&#44; convulsions&#44; and death&#46; Low BLLs are now known to affect multiple organs in the absence of apparent symptoms&#46; Toxicity with low lead levels <span class="elsevierStyleItalic">in utero</span> and during childhood constitutes brain and nervous system damage&#46; Exposure to low BLL &#40;less than 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41; affects also the immune&#44; reproductive and cardiovascular systems&#46; Recent research indicates that&#44; at blood levels of 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL or lower&#44; neurobehavioural damage is liable to occur&#46; It appears that brain injury can happen at any blood level threshold&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The goals of the present study were to evaluate the extent of lead exposure in schoolchildren&#44; whose age ranged from 6 to 12 years&#44; in industrial and urban areas in Egypt and to investigate the possible influencing factors in order to clarify the current problem of lead exposure and to improve methods of prevention and control&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Two hundred primary school children were randomly chosen in an industrial area in Egypt &#40;Helwan&#41;&#59; the same number of primary school children was selected in an urban area in Egypt &#40;Dokki&#41;&#46; The study was approved by the Medical Ethical Committee of National Research Centre&#44; Dokki&#44; Cairo&#44; Egypt&#46; Parental consents were obtained&#46; Parents who opted to join the study answered detailed questionnaires on sources of water supply&#44; housing &#40;old houses with defective paints&#47;use of lead-glazed ceramics&#41;&#44; living with adults whose job involve battery repair&#44; recycling&#44; or processing&#44; dietary habits &#40;<span class="elsevierStyleItalic">e&#46;g</span>&#46;&#44; using newspapers to wrap the children&#39;s food&#41;&#44; exposure to air pollution &#40;location of the house close to main roads&#41;&#44; and outdoor playing in dust areas&#46; History of school performance&#44; behavioral changes &#40;such as anxiety and aggressiveness&#41;&#44; and any clinical problems were investigated&#46; Teachers and other school staff were asked to assess each child&#39;s performance and behaviors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A thorough clinical examination was performed&#44; including weight&#44; height&#44; blood pressure&#44; cardiac&#44; abdominal&#44; and full neurological examinations&#46; A psychological assessment was also performed through an interview with a specialist&#46; Complete blood count and BLL were assessed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Blood samples were collected according to the instructions of the Centers of Disease Control and Prevention &#40;CDC&#41;&#46; All sample collection tubes and materials were pre-screened for lead contamination&#46; Blood samples were analyzed for lead level with the atomic absorption method described by Miller et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> using heating graphite atomization &#40;HGA 600 perkin Elmer&#41;&#46; BLLs were considered as &#8220;elevated&#8221; or &#8220;level of concern&#8221; if equal to or greater than 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; in accordance with the US Centers for Disease Control and Prevention criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 16 for Windows &#40;SPSS Inc&#46;&#44; version 16 for Windows&#44; IL&#44; USA&#41;&#46; Continuous data &#40;BLLs&#41; were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation and were compared using Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; Categorical data were expressed as frequencies and percentages&#44; and were analyzed with the two-tailed chi-squared test&#46; Multiple logistic regression analysis was used to analyze the predictors of BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL and to modify the association between the clinical data and high BLL by adding the covariates&#46; <span class="elsevierStyleItalic">p</span>-Values<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 were considered to be statistically significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 400 children were enrolled in the present study&#59; their age ranged from 6 to 12 years&#44; with a mean of 9&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;33&#46; From the total&#44; 205 children were males and 195 were females&#46; Mean BLL was 10&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;94<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL in Helwan and 5&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;90<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL in Dokki&#44; with a significant difference between both areas &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; No significant difference was found between the genders in both areas regarding BLL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In Dokki&#44; 20&#37; of the studied group had BLLs<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; while in Helwan this value was 42&#37;&#46; The percentage of children with BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL was 44&#37; in Dokki&#44; <span class="elsevierStyleItalic">versus</span> 64&#37; in Helwan&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The social and clinical data of the study population are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; showing that children in Helwan had significantly worse results in health habits&#44; housing with increased exposure&#44; school achievement &#60;60&#37;&#44; abnormal behavior&#44; and pallor than children in Dokki &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The association between clinical data of all children and high BLL is presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; A significant association was observed between BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL and children with school achievement &#60;60&#37;&#44; children with abnormal behavior&#44; children with short stature&#44; and pallor&#44; when compared with those with BLL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Multiple logistic regression analysis was done to study the predictors of high blood lead level &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; It was found that those living in Helwan&#44; those with bad health habits&#44; and those living in housing with increased exposure were at a significantly higher risk of having BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;16&#44; 95&#37; CI 1&#46;35&#8211;3&#46;47&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;947&#44; 95&#37; CI 1&#46;22&#8211;3&#46;10&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;72&#44; 95&#37; CI 1&#46;09&#8211;1&#46;09&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in all&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the association between the clinical data and high BLL after modification by the predictors of high BLL as covariates&#46; Abnormal behavior and pallor were associated with high BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; while school achievement &#60;60&#37; and short stature were not associated with high BLL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; after modification by the covariates&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Childhood lead poisoning is a major problem that can be prevented worldwide&#46; In the current study&#44; mean BLL in an urban area of Egypt &#40;Dokki&#41; was 5&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;90<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; while that in an industrial area &#40;Helwan&#41; was 10&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;94<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46; In Dokki&#44; 20&#37; of the studied group had BLLs<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; <span class="elsevierStyleItalic">versus</span> 42&#37; in Helwan&#46; The percentage of children with BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL was 44&#37; in Dokki&#44; <span class="elsevierStyleItalic">versus</span> 64&#37; in Helwan&#46; In Singapore&#44; from 1995 to 1997&#44; the mean reported BLL was 6&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL in 269 children&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> Children aged 12&#8211;19 years were assessed in 1999 in the United States&#44; and a mean BLL of 1&#46;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL was found<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#59; from 2007 to 2010&#44; the geometric means at age 1&#8211;2 years and 3&#8211;5 years were found to be 1&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL and 1&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A cross-sectional survey for BLLs included 3831 children recruited at hospitals in France&#46; The geometric mean BLL was 1&#46;49<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#59; 0&#46;09&#37; of the children had BLL exceeding 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; and in 1&#46;5&#37;&#44; BLL exceeded 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In 2011&#44; a study of blood lead concentrations of 226 schoolchildren was conducted in Alpuyeca&#44; Morelos&#44; Mexico&#46; The mean BLL was 7&#46;23<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#59; BPb<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL and &#62;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL were observed in 64&#37; and 18&#37; of the children&#44; respectively&#46; In almost 50&#37; of the households&#44; the use of lead-glazed ceramics was reported&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Ecuadorian infants and young children &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>130&#41; aged 0&#46;33&#8211;5&#46;8 years had their BLL assessed&#59; the mean BLL was 29&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;SD&#58; 24&#46;3&#59; range&#58; 3&#46;0&#8211;128&#46;2&#59; median&#58; 21&#46;7&#59; geometric mean&#58; 20&#46;7<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> To measure current lead exposure in Japanese children&#44; blood samples were collected from 229 children aged 9&#8211;10 years in Asahikawa&#44; Japan&#59; The geometric mean was 0&#46;96<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Children in six communities near to the now-closed Kabwe mines and smelters in Zambia were studied for BLL&#59; the mean was 4&#46;83<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46; The lowest BLL measured was 1&#46;36<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46; The highest BLL detected using the testing system was 6&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">BLL was also assessed in the Bagega community in Nigeria&#59; the median was 71<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;range&#58; 8&#8211;332<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41;&#46; Elevated BLL &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41; was found in 99&#46;5&#37; of the studied group&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> In Wuhan&#44; China&#44; children less than 18 years were investigated throughout the entire year of 2012&#46; For all subjects&#44; the geometric mean was 4&#46;48<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46; Elevated BLLs &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL and &#8805;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41; were found in 2&#37; and in 44&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> In South Africa&#44; a cross-sectional analytical studies including 160 young schoolchildren was performed&#46; The mean BLL was 7&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;range&#58; 2&#46;2&#8211;22&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41;&#46; BLLs<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL were observed in 74&#37; of the children&#44; while 16&#37; had BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dl&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">BLLs were assessed in children living in Riyadh&#44; Saudi Arabia&#46; The mean &#40;&#177;SD&#41; BLL was 5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&#44; ranging from 1&#46;7 to 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#59; in 17&#46;8&#37; of children&#44; BLL was greater than 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">27</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">A study conducted in three schools in Nablus&#44; Palestine&#44; assessed BLL in 178 children &#40;140 boys&#44; 38 girls&#44; age range 6&#8211;8 years&#41;&#46; The mean BLL was 3&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; and levels above 10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL were observed in 4&#46;5&#37; of children&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study&#44; high BLLs were found in Helwan area&#44; which is an old industrial area with many lead-related industries and factories&#46; Other predictors of high BLL were bad health habits &#40;using newspapers to wrap children&#39;s food&#59; no hand washing before meals and after playing outside&#59; contact with contaminated dust&#44; soil and toys&#59; ingestion of preserved eggs&#59; and consumption of fried food&#41; and housing with increased exposure &#40;old lead-based peeled or chipped paint&#44; renovations&#44; lead in plumbing&#44; and use of lead glazed ceramics&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">No significant differences were detected in the current study between males and females in both Dokki and Helwan regarding BLLs&#44; which can be explained by the similar behavior and outdoor activities of both genders&#46; This result is in agreement with those by Allen Counter et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> Cao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a> found that the mean BLLs in boys &#40;23&#46;57<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; were higher than that in girls &#40;21&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#44; which was explained by the greater distinct behavior and outdoor activities found with growing boys&#44; leading to contact with environmental lead pollution&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In a multivariable analysis by Spanier et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">5</span></a> mean BLLs of children whose housing underwent interior renovation was 12&#37; higher than that of children whose housing units were not renovated &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Renovation&#44; repairs&#44; and painting rule&#44; routine interior housing renovation were associated with a modest increase in children&#39;s BLLs&#44; which are in agreement with the present study&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the present study&#44; school achievement &#60;60&#37;&#44; short stature&#44; and pallor &#40;Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; were associated with high BLLs &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41;&#46; Liu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> conducted a prospective cohort study that assessed children in four elementary schools&#46; They detected a significant association between BLL and increased scores for teacher-reported behavioral problems &#40;emotional reactivity&#44; anxiety&#47;depression&#44; and pervasive developmental problems&#41;&#44; which is in agreement with the present results&#46; Boys experience the deleterious cognitive effects of lead more than girls do&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">A cross-sectional assessment in children and adolescents aged 0&#8211;17 years from six communities in the Corrientes river basin was conducted&#46; Children and adolescents with BLLs<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL had twice the risk of stunting when compared with those with lower BLLs&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> Fleisch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a> concluded that&#44; in peripubertal boys&#44; higher BLLs were associated with lower serum IGF-1&#44; which is attributed to the inhibition of the hypothalamic&#8211;pituitary-growth axis by lead exposure&#44; leading to growth delay&#46; The results of the previous two studies are in agreement with the present results&#44; which indicated a significant association between high BLLs and stunting&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The present study had some limitations&#44; which included its small sample size&#59; its cross-sectional design&#44; which may not allow the follow-up of the association between clinical data and BLLs&#59; and the questionnaire used to collect information on risk factors&#44; which may have caused recall bias&#46; The measurement of BLL through the gold standard method &#40;graphite atomic absorption method&#41; added strength to the present study&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; BLL was measured and associated to exposure risk factors in two areas &#40;one urban and one industrial&#41; in Egypt&#46; BLLs were significantly higher in the industrial area than in the urban area&#46; High BLLs were significantly associated with bad health habits and housing with increased exposure&#44; as well as with school achievement &#60;60&#37;&#44; short stature&#44; and pallor &#40;Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In Egypt&#44; definitive plans and regulations should be carried out to improve the prevention and control of childhood lead poisoning&#46; Regulatory policies are needed to reduce lead release from different industries&#46; BLL screening and testing should be improved&#46; In industrial areas&#44; screening programs for BLL should be implemented&#46; Finally&#44; the prevention and treatment of childhood lead poisoning should be improved in Egypt&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">This study examined the relationship between BLL and its risk factors in Egyptian children&#46; The use of a representative sample of the general Egyptian children strengthened the present findings&#46; However&#44; there were some limitations to this study&#46; First&#44; it had a cross-sectional design&#44; and lead exposure throughout the entire childhood development could not be assessed&#46; Second&#44; other hazardous environmental pollutants &#40;<span class="elsevierStyleItalic">e&#46;g</span>&#46;&#44; mercury and cadmium&#41; were not evaluated&#46; Finally&#44; the sample size was relatively small&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2016-07-15"
    "fechaAceptado" => "2016-12-22"
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          "palabras" => array:6 [
            0 => "Blood lead levels"
            1 => "Children"
            2 => "Lead exposure"
            3 => "Abnormal behavior"
            4 => "Short stature"
            5 => "Egypt"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "N&#237;veis de chumbo no sangue"
            1 => "Crian&#231;as"
            2 => "Exposi&#231;&#227;o ao chumbo"
            3 => "Comportamento anormal"
            4 => "Baixa estatura"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To investigate blood lead levels in schoolchildren in two areas of Egypt to understand the current lead pollution exposure and its risk factors&#44; aiming to improve prevention politicies&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Subjects and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study in children &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>400&#41; aged 6&#8211;12 years recruited from two areas in Egypt &#40;industrial and urban&#41;&#46; Blood lead levels were measured using an atomic absorption method&#46; Detailed questionnaires on sources of lead exposure and history of school performance and any behavioral changes were obtained&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean blood lead level in the urban area of Egypt &#40;Dokki&#41; was 5&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;90<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; while that in the industrial area &#40;Helwan&#41; was 10&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;94<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; with a statistically significant difference between both areas &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In Dokki&#44; 20&#37; of the studied group had blood lead levels<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; <span class="elsevierStyleItalic">versus</span> 42&#37; of those in Helwan&#46; A significant association was found between children with abnormal behavior and those with pallor with blood lead level<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; when compared with those with blood lead level<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Those living in Helwan area&#44; those with bad health habits&#44; and those living in housing with increased exposure were at a statistically significantly higher risk of having blood lead level<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lead remains a public health problem in Egypt&#46; High blood lead levels were significantly associated with bad health habits and housing with increased exposure&#44; as well as abnormal behavior and pallor&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigar os n&#237;veis de chumbo no sangue &#40;NCSs&#41; em crian&#231;as em idade escolar em duas &#225;reas do Egito para entender a atual exposi&#231;&#227;o &#224; polui&#231;&#227;o por chumbo e seus fatores de risco&#44; para melhorar as pol&#237;ticas de preven&#231;&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Indiv&#237;duos e m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Esse foi um estudo transversal em crian&#231;as &#40;400&#41; com idades entre 6&#8211;12 anos recrutadas de duas &#225;reas no Egito &#40;industrial e urbana&#41;&#46; Os NCSs foram medidos por um m&#233;todo de absor&#231;&#227;o at&#244;mica&#46; Foram obtidos question&#225;rios detalhados sobre as fontes de exposi&#231;&#227;o ao chumbo e o hist&#243;rico de desempenho escolar e quaisquer altera&#231;&#245;es comportamentais&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O NCS na &#225;rea urbana do Egito &#40;Dokki&#41; foi 5&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;90<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; ao passo que na &#225;rea industrial &#40;Helwan&#41; foi 10&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;94<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; com uma diferen&#231;a significativa entre ambas as &#225;reas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Na &#225;rea de Dokki&#44; 20&#37; do grupo estudado apresentaram NCSs &#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; ao passo que na &#225;rea de Helwan foi 42&#37;&#46; Foi encontrada uma associa&#231;&#227;o significativa entre as crian&#231;as com comportamento anormal e aquelas com palidez com NCS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#44; em compara&#231;&#227;o &#224;quelas com NCS<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Aquelas que moram na &#225;rea de Helwan aquelas com h&#225;bitos de sa&#250;de ruins e aquelas que moram em moradias com maior exposi&#231;&#227;o estiveram significativamente em alto risco de apresentar NCS<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O chumbo ainda &#233; um problema de sa&#250;de p&#250;blica no Egito&#46; Altos NCSs foram significativamente associados a h&#225;bitos de sa&#250;de ruins e moradia com maior exposi&#231;&#227;o&#44; bem como&#44; comportamento anormal e palidez&#46;</p></span>"
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            "titulo" => "Resultados"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; AbuShady MM&#44; Fathy HA&#44; Fathy GA&#44; Fatah Sa&#44; Ali A&#44; Abbas MA&#46; Blood lead levels in a group of children&#58; the potential risk factors and health problems&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;619&#8211;24&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hb&#44; hemoglobin&#59; BLL&#44; blood lead level&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Character&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Helwan area<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200<br>&#40;Number &#8211; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dokki area<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200<br>&#40;Number &#8211; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bad health habits increasing exposure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122 &#40;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housing with increased exposure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;59&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;34&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">School achievement &#60;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;004<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal behavior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;008<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short stature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pallor &#40;Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 gm&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;39&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical and social data of the study population &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>400&#41;&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Character&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High BLL<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124<br>&#40;Number &#8211; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BLL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>276<br>&#40;Number &#8211; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">School achievement &#60;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;14&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abnormal behavior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Short stature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pallor &#40;Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 gm&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;20&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1581555.png"
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            0 => array:3 [
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Association of clinical data of children and high blood lead levels &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41;&#46;</p>"
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        "etiqueta" => "Table 3"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">OR&#44; odds ratio&#59; CI&#44; confidence interval&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Residence &#40;Dokki <span class="elsevierStyleItalic">versus</span> Helwan&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;763&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;335&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;447&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Health habits &#40;Good health habits <span class="elsevierStyleItalic">versus</span> bad health habits&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;664&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;943&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Housing exposure &#40;Housing with no exposure <span class="elsevierStyleItalic">versus</span> housing with increased exposure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;565&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;017<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;760&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;796&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;926&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;392&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;772&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;932&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Predictors of high blood lead level &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#59; multiple logistic regression analysis&#41;&#46;</p>"
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      3 => array:8 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Covariates</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;07291&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Residence &#40;Dokki <span class="elsevierStyleItalic">versus</span> Helwan&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;049<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;591&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Health habits &#40;Good health habits <span class="elsevierStyleItalic">versus</span> bad health habits&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;252&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;736&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;435&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Housing exposure &#40;Housing with no exposure <span class="elsevierStyleItalic">versus</span> housing with increased exposure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;039<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;581&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;798&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Clinical data</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>School achievement<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60&#37;</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;748&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abnormal behavior</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Short stature</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;05999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;924&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;274&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pallor &#40;Hb<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 gm&#37;&#41;</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;313&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;948&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Association of clinical data and high blood lead level &#40;&#8805;10<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dL&#41; after modification by covariates &#40;multiple logistic regression analysis&#41;&#46;</p>"
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      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low level lead exposure&#58; history and discovery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Needleman"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.annepidem.2009.01.022"
                      "Revista" => array:6 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19344860"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
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                ]
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              "identificador" => "bib0175"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of environmental lead sources and pathways in a mining and smelting town&#58; Mount Isa&#44; Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;K&#46; Mackay"
                            1 => "M&#46;P&#46; Taylor"
                            2 => "N&#46;C&#46; Munksgaard"
                            3 => "K&#46;A&#46; Hudson-Edwards"
                            4 => "L&#46; Burn-Nunes"
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                  "host" => array:1 [
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                      "doi" => "10.1016/j.envpol.2013.05.007"
                      "Revista" => array:6 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23770073"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0180"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Air and blood lead levels in lead acid battery recycling and manufacturing plants in Kenya"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;H&#46; Were"
                            1 => "G&#46;N&#46; Kamau"
                            2 => "P&#46;M&#46; Shiundu"
                            3 => "G&#46;A&#46; Wafula"
                            4 => "C&#46;M&#46; Moturi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/15459624.2012.673458"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Occup Environ Hyg"
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                        "volumen" => "9"
                        "paginaInicial" => "340"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22512792"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
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            ]
            3 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of lead-based paint hazards in U&#46;S&#46; housing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Jacobs"
                            1 => "R&#46;P&#46; Clickner"
                            2 => "J&#46;Y&#46; Zhou"
                            3 => "S&#46;M&#46; Viet"
                            4 => "D&#46;A&#46; Marker"
                            5 => "J&#46;W&#46; Rogers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2002"
                        "volumen" => "110"
                        "paginaInicial" => "A599"
                        "paginaFinal" => "A606"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12361941"
                            "web" => "Medline"
                          ]
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            4 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The contribution of housing renovation to children&#39;s blood lead levels&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Spanier"
                            1 => "S&#46; Wilson"
                            2 => "M&#46; Ho"
                            3 => "R&#46; Hornung"
                            4 => "B&#46;P&#46; Lanphear"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1476-069X-12-72"
                      "Revista" => array:5 [
                        "tituloSerie" => "Environ Health"
                        "fecha" => "2013"
                        "volumen" => "12"
                        "paginaInicial" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23981571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exposure of U&#46;S&#46; children to residential dust lead&#44; 1999&#8211;2004&#58; II&#46; The contribution of lead-contaminated dust to children&#39;s blood lead levels"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Dixon"
                            1 => "J&#46;M&#46; Gaitens"
                            2 => "D&#46;E&#46; Jacobs"
                            3 => "W&#46; Strauss"
                            4 => "J&#46; Nagaraja"
                            5 => "T&#46; Pivetz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1289/ehp.11918"
                      "Revista" => array:6 [
                        "tituloSerie" => "Environ Health Perspect"
                        "fecha" => "2009"
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2016.12.006

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	3	9
2024 October	29	43	72
2024 September	39	22	61
2024 August	32	94	126
2024 July	36	34	70
2024 June	21	17	38
2024 May	28	16	44
2024 April	22	24	46
2024 March	16	14	30
2024 February	28	28	56
2024 January	24	24	48
2023 December	16	19	35
2023 November	19	26	45
2023 October	18	31	49
2023 September	34	29	63
2023 August	36	18	54
2023 July	30	14	44
2023 June	79	12	91
2023 May	67	16	83
2023 April	38	9	47
2023 March	49	21	70
2023 February	35	13	48
2023 January	24	15	39
2022 December	48	25	73
2022 November	43	31	74
2022 October	50	38	88
2022 September	33	34	67
2022 August	31	38	69
2022 July	34	46	80
2022 June	37	41	78
2022 May	45	36	81
2022 April	53	40	93
2022 March	43	46	89
2022 February	23	26	49
2022 January	16	16	32
2021 December	21	30	51
2021 November	10	18	28
2021 October	14	16	30
2021 September	8	9	17
2021 August	5	9	14
2021 July	6	11	17
2021 June	6	11	17
2021 May	13	8	21
2021 April	19	21	40
2021 March	16	12	28
2021 February	9	11	20
2021 January	5	11	16
2020 December	8	10	18
2020 November	10	13	23
2020 October	13	11	24
2020 September	13	10	23
2020 August	5	15	20
2020 July	6	6	12
2020 June	5	7	12
2020 May	6	20	26
2020 April	10	7	17
2020 March	6	3	9
2020 February	14	10	24
2020 January	10	15	25
2019 December	8	8	16
2019 November	7	2	9
2019 October	12	10	22
2019 September	4	8	12
2019 August	9	7	16
2019 July	7	8	15
2019 June	4	8	12
2019 May	4	10	14
2019 April	12	7	19
2019 March	7	9	16
2019 February	4	8	12
2019 January	7	4	11
2018 December	7	7	14
2018 November	26	3	29
2018 October	152	7	159
2018 September	24	7	31
2018 August	10	4	14
2018 July	8	3	11
2018 June	15	31	46
2018 May	14	41	55
2018 April	7	3	10
2018 March	15	3	18
2018 February	17	5	22
2018 January	24	9	33
2017 December	21	13	34
2017 November	27	13	40
2017 October	1	3	4
2017 September	0	7	7
2017 August	2	1	3
2017 July	0	1	1
2017 June	2	2	4
2017 May	0	11	11
2017 April	0	11	11

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