RESUMEN
Our study provides the most comprehensive dataset for high-precision radiogenic isotopes of lead (Pb) in blood for the western European population. It investigates their potential for elucidating the contribution of soil Pb to blood Pb using a human biomonitoring survey involving 81 adults and 4 children living in the urban area of Liège (Belgium). Soils in the area show moderate (median of 360 mg/kg) to high (95th percentile of 1000 mg/kg) Pb concentrations, due to former metal processing activities. Blood lead levels (BLL) measured in the study population are, on average, quantitatively consistent with a â¼ 20 % increase due to the exposure to Pb from soils, as estimated by a single-compartment biokinetic model. Consistently, its isotopic composition does not represent an endmember that fully accounts for the variability of Blood lead isotope (BLI) compositions measured in the study population. While some individuals show more thorogenic BLI ratios (relatively more enriched in 208Pb), which could be consistent with a greater exposure to local soils and/or by their country of birth, the BLI data mostly follow a trend roughly parallel to the European Standard Lead Pollution (ESLP) line, within the European leaded gasoline field, even two decades after the withdrawal of this source. Differences in BLI are probably associated with factors related to the presence of Pb in dwellings (pipes, paint) and drinking water distribution system, suggesting that the anthropogenic Pb in use, relevant to human exposure, may contain ore components of different origins, including the Australian Pb ore signature.
Asunto(s)
Exposición a Riesgos Ambientales , Plomo , Contaminantes del Suelo , Plomo/sangre , Contaminantes del Suelo/análisis , Contaminantes del Suelo/sangre , Humanos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Exposición a Riesgos Ambientales/análisis , Bélgica , Niño , Adulto , Radioisótopos de Plomo/análisis , Monitoreo del Ambiente/métodos , Suelo/química , Monitoreo Biológico/métodosRESUMEN
Eighty eight adult gardeners and their relatives volunteered to provide urine and blood samples for a human biomonitoring survey among users of one of the biggest allotment garden from Wallonia, showing high trace metal(oid) concentrations in soils. The purpose was to determine if environmental levels of lead (Pb), cadmium (Cd) and arsenic (As) led to concentrations of potential health concern in the study population. Blood and urine biomarkers were compared to reference and intervention cut-off values selected from the literature. The study population exhibited (i) moderately high blood lead levels with median value of 23.1 µg/L, (ii) high urinary concentrations of speciated As (inorganic arsenic and its metabolites) with a median value of 7.17 µg/g.cr., i.e. twice the median values usually observed in general populations, and (iii) very high Cd levels in urine with a median value of 1.23 µg/L, in the range of 95th-97.5th percentiles measured in general adult populations. Biomarker levels in the study population were also mostly above those measured in adults from local populations living on contaminated soils, as reported in the current literature. All biomarkers of Pb, Cd and As showed weak to strong statistically significant correlations, pointing towards a joint environmental source to these three contaminants as being at least partially responsible for the high exposure levels observed. Urine and blood biomarkers show statistically significant associations with variables related to individual characteristics (age, smoking status, ) and Pb domestic sources (Pb pipes, cosmetics, ) but involves also behavioral and consuming habits related to gardening activities on the contaminated allotment garden. At such levels, owing to co-exposure and additive effects of Cd, As and Pb regarding renal toxicity known from literature, the study strongly suggests that this population of gardeners is at risk with respect to chronic kidney diseases.
Asunto(s)
Arsénico , Metales Pesados , Contaminantes del Suelo , Adulto , Arsénico/análisis , Monitoreo Biológico , Cadmio/análisis , Monitoreo del Ambiente/métodos , Humanos , Plomo/análisis , Metales Pesados/análisis , Suelo , Contaminantes del Suelo/análisis , Zinc/análisisRESUMEN
BACKGROUND: Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. PURPOSE: This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. METHOD: We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. FINDINGS: The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. IMPLICATIONS: Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.
Asunto(s)
Accidentes por Caídas/prevención & control , Visita Domiciliaria , Terapia Ocupacional/organización & administración , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Femenino , Estado de Salud , Humanos , Masculino , Factores de Riesgo , Estrés Psicológico/psicología , Visión OcularRESUMEN
BACKGROUND: Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. METHODS: The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. RESULTS: The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. CONCLUSION: The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.