Cadmium and Lead Levels in Blood and Arsenic Levels in Urine among Schoolchildren Living in Contaminated Glassworks Areas, Sweden

The Kingdom of Crystal, an area in southern Sweden famous for its many glassworks, is historically heavily burdened by pollution from this industry. Glass crust containing cadmium (Cd), lead (Pb), and arsenic (As) has been deposited around the area and used as filling. The purpose of this study was to monitor whether the high levels of metals in the contaminated soil were reflected in blood and urine among school children in this area. Blood and urine samples were collected from 87 children in 2017. The levels of cadmium (Cd-B) and lead (Pb-B) found in blood were determined by inductively coupled plasma mass spectrometry (ICP-MS). The speciation of As in urine (As-U) was performed by ion chromatography. The geometric mean of Cd-B and Pb-B among the children were 0.09 μg/L and 9.9 μg/L respectively. The geometric mean of inorganic As (AsIII and AsV) with metabolites in urine was 6.1 μg/L and 6.94 μg/g creatinine. Children in the study area had blood levels of Pb and Cd that correspond to levels generally found in Swedish children. The levels of inorganic As and its metabolites in urine were low and in the same magnitude as other children in Europe and the U.S.


Do you and your child want to help us with a blood test?
We want to investigate if there is any impact from the glassworks' pollution in primary school students (grades 2-4) born and raised in Lessebo municipality. It is a voluntary examination which means that the child leaves a small blood sample of 5 ml (a teaspoon) and a urine sample.
The study is carried out by the division of Occupational and Environmental Medicine in Lund to determine whether children who grow up in areas adjacent to old industrial properties and landfills risk having slightly elevated metal levels in the body. Since 1978, we have been carrying out corresponding measurements on children living in Landskrona and Trelleborg to investigate whether urban children have a higher metal exposure than children raised in rural areas due to for example, increased exposure from traffic and air pollution. Our studies there indicate that the surrounding environmental exposure to these substances has decreased sharply. We now want to do a similar study in your municipality to see if old industrial pollutants can have any effect on your children's blood and urine concentrations of these substances.
The project is funded by the Swedish Environmental Protection Agency's funds for health-related environmental monitoring.
(Translate from Swedish, original in Swedish below)

What is inculded in the survey?
The blood test is performed in the most gentle way possible by nurses with great sampling habits in children. Your child gets a needle stick in the arm. During the sampling session, the child will also be allowed to submit a urine sample. We also ask you to fill in a short questionnaire about the child about leisure activities, dietary habits and about parents' smoking habits. After the sample, the child receives a compensation of SEK 100.

What do we want to measure?
We want to measure (possible) levels of lead, cadmium and mercury in blood and arsenic in the urine.

If you do not want to participate?
Your child can cancel their participation at any time. Of course, interrupting your participation has no effect on your child's care, either now or in the future.

What happens to the results?
The results and interpretation of the metal analysis will in the spring of 2018 be sent to your residential address. It is unlikely that any elevated levels of metals in the blood and urine would be drastically elevated in the children in the area due to the contaminated soil, but if the results indicate a higher exposure, this will be communicated to the residents in the area. If deviating test results have occurred, this will be investigated by the clinic to clarify the cause. A popular science report will be published in the autumn of 2018 in the Occupational and Environmental Medicine South report series. (http://sodrasjukvardsregionen.se/amm/rapporter/).
The survey has been reviewed and approved by the Regional Ethics Review Board in Lund.
The blood test will be conducted on:

Kvarndammskolan
The 26th or 27th of September We need your approval as a guardian. Fill in the enclosed consent form and, if your child wishes to participate, the questionnaire and send this in the attached reply envelope no later than 7 September 2017.

Training Manager Planning Manager Lessebo municipality Lessebo municipality
Information to guardians about the processing of samples and personal data We will store the blood samples in a biobank (Regional Biobank Register). Region Skåne and Södra Sjukvårdsregionen. Biobank Occupational and Environmental Medicine, AMMED-USIL) which is already located at the Division of Occupational and Environmental Medicine at Lund University Hospital. AMMED-USIL has a biobank license.
The samples will be stored coded. This means that they cannot be directly traced to your child as a person. The samples and the associated identification list (code key) will be stored securely and separately.
Patient data with results of the examinations (social security number, name, address, data from questionnaires and laboratory data) will be stored in a register at Occupational and Environmental Medicine. These will later be processed. Then the name and social security number will be replaced by a code. At the time of publication of the study, no individuals can be identified. The information is protected by confidentiality. No unauthorized person has access to the information.
The samples may only be used in the way you have given your consent (we will ask you to write a consent form, if your child is to participate in the study). You have the full right to request without further explanation that your child's samples be destroyed, in accordance with the Biobanks Act.
Since the intention is to follow the development over time, the information will be preserved for the foreseeable future. Region Skåne is responsible for the handling of personal data. This is regulated by the Personal Data Act (SFS 1998: 204). If you want to know more about this law, there is detailed information at www.skane.se. By sending a signed application, you can also request information about the processing of personal data through the Personal Data Ombudsman, Region Skåne, 291 89 Kristianstad. You may also have any incorrect information corrected.