• Journal of Preventive Medicine and Public Health
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• v.30 no.4 s.59
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• pp.741-751
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• 1997

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

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.3 no.2
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• pp.141-151
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• 1993

Blood samples obtained from 200 adults who had visited the "S" general hospital were analyzed to compare the zinc protoporphyrin (ZPP) levels quantified by high performance liquid chromatograph (HPLC) and by hematofluorometer (HF) to investigate the methodological difference if any and the relationship between the levels of blood lead and ZPP among no-lead exposed adults. Also investigated were the distribution of ZPP and protoporphyrin IX (PPIX) concentrations, the establishment of normal levels of blood ZPP and blood lead, and the contribution of age and sex factors to these values. These subjects had no previous occupational exposure to lead. The results obtained were as follows : 1. The mean values of blood lead for male and female subjects were $9.46{\pm}2.44{\mu}g/dl$ and $8.09{\pm}2.17{\mu}g/dl$, respectively. The difference observed in the mean concentrations between male and female subjects was statistically very significant. 2. The mean values of blood ZPP by HPLC for male and female subjects were $15.94{\pm}4.55{\mu}g/dl$ and $22.26{\pm}6.61{\mu}g/dl$, respectively. The difference observed in the mean concentrations between male and female subjects was statistically not significant. The mean values of blood PPIX by HPLC for male and female subjects were $2.51{\pm}1.78{\mu}g/dl$ and $2.81{\pm}1.56{\mu}g/dl$, respectively. The difference observed in the mean concentrations between male and female subjects was statistically not significant. 3. The mean values of blood ZPP by HF for male and female subjects were $28.44{\pm}7.11{\mu}g/dl$ and $37.77{\pm}8.04{\mu}g/dl$, respectively. The difference observed in the mean concentrations between male and female subjects was statistically very significant. 4. No statistically significant correlation was found between the levels of blood ZPP and blood lead. 5. The ratio of ZPP and protoporphyrin IX (PPIX) concentration to erythrocyte protoporphyrin (EP, EP=ZPP+PPIX) concentration was 87.4% and 12.6%, respectively. 6. A statistically very significant correlation was found between the ZPP concentrations determined by HPLC and the values by HF (r=0.7565). The ZPP concentraitons quantified by HF were 1.75 times as high as the values obtained by HPLC. 7. The blood ZPP concentrations quantified by HPLC, HF, and spectrofluorometer (SF) from the blood samples obtained from 14 lead-exposed workers and from 16 no-lead exposed adults showed wide variations. The ZPP concentrations by HF were the highest followed by the levels obtained by SF and by HPLC. In the exposed group, no statistically significant difference was found among three methods of quantifying blood ZPP levels. In the no-lead exposed group, however, statistically significant difference was observed among these methods. The ZPP concentrations by HF were about twice as high as those of by HPLC or by SF. Among three methods of quantifying blood ZPP (HPLC, SF and HF), the results revealed significant difference. Therefore it is suggested that objective methods of quantifying blood ZPP and a system of correcting different ZPP levels be developed by the ministry of Labor.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.6 no.1
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• pp.88-96
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• 1996

This study was conducted to establish model between lead and ZPP concentration in blood of workers exposed to lead. Workers employed in secondary smelting manufacturing industry showed $85.1{\mu}g/dl$ of blood lead level, exceeding $60{\mu}g/dl$, the Criteria for Removal defined by Occupational Safety and Health Act of Korea. Average blood lead level of workers in the battery manufacturing industry was $51.3{\mu}g/dl$, locating between $40{\mu}g/dl$ and $60{\mu}g/dl$, the Criteria for Requiring Medical Removal. Blood lead level of in the litharge and radiator manufacturing industry was below $40{\mu}g/dl$, the Criteria Requiring Temporary Medical Removal. Blood lead levels of workers by industry were Significantly different(p<0.05). 50(21 %) showed blood lead levels above $60{\mu}g/dl$, the Criteria for Removal and 66(27.7 %) showed blood lead levels between the Criteria for Requiring Medical Removal, $40-60{\mu}g/dl$. Thus, approximately 50 percent of workers indicated blood lead levels above $40{\mu}g/dl$, the Criteria Requiring Temporary Medical Removal and should receive medical examination and consultation including biological monitoring. Average ZPP level of workers employed in the secondary smelting industry was $186.2{\mu}g/dl$, exceeding above $150{\mu}g/dl$, the Criteria for Removal. Seventy seven of all workers(32.3 %) showed ZPP level above $100-150{\mu}g/dl$, the Criteria for Requiring Medical Removal. The most appropriate model for predicting ZPP in blood was log-linear regression model. Log linear regression models between lead and ZPP concentrations in blood was Log ZPP(${\mu}g/dl$) = -0.2340 + 1.2270 Log Pb-B(${\mu}g/dl$)(standard error of estimate: 0,089, ${\gamma}^2=0.4456$, n=238, P=0.0001), Blood-in-lead explained 44.56 % of the variance in log(ZPP in blood).

• Journal of Yeungnam Medical Science
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• v.15 no.2
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• pp.224-236
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• 1998

A study was conducted to investigate the blood lead and zinc protoporphyrin(ZPP) concentrations of the underground parking lot workers who exposed to vehicular exhaust aerosols which contained lead. The blood samples were collected from 25 study subjects of underground parking lot and from 33 controls in Taegu, from July to October, 1997. And also the related factors to the blood lead and ZPP concentrations were investigated. Blood lead concentration and ZPP concentration were measured by flameless furnace atomic absorption spectrophotometer (1L.551) and hemetofluorometer, respectively. The mean blood lead concentrations of study subjects and controls were $23.10{\pm}20.77{\mu}g/dl$ and $12.99{\pm}12.71{\mu}g/dl$, respectively(p<0.05), and the mean blood ZPP concentrations of study subjects and controls were $40.72{\pm}9.46{\mu}g/dl$ and $38.21{\pm}10.97{\mu}g/dl$, respectively. No significant correlations were observed between the blood lead concentration of the study subjects and their job duration and between blood ZPP concentration of the study subjects and their job duration. There were no statistically significant differences in the blood lead concentration and the blood ZPP concentration of smokers and nonsmokers. In multiple regression analysis on blood lead concentration of the study subjects and controls, occupation was a only significant dependent variable. In case of bood ZPP concentration, age was a only significant dependent variable in the study subjects and controls.

• Journal of Preventive Medicine and Public Health
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• v.24 no.2 s.34
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• pp.181-194
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• 1991

This study intended to obtain an useful information on the prevalence of subjective symptoms, and to clarify the interrelationships between blood lead and lead related symptoms in low level lead exposure. The 93 male workers exposed to lead and 56 male nonexposed workers were examined for their blood lead(PBB), Zinc-protoporphy(ZPP), hemoglobin(HB) and personnal history, and completed 15 questionnaires related to symptoms of lead absorption : also measured lead concentration in air (PBA) in the workplace. The results obtained were as follows ; 1. The means of blood lead (PBB), blood ZPP and hemoglobin (HB) among workers exposed to lead were $26.1{\pm}8.8{\mu}g/dl,\;28.3{\pm}26.0{\mu}g/dl$ and $16.2{\pm}1.2g/dl$ : whereas those of nonexposed workers were $18.7{\pm}5.1{\mu}g/dl,\;20.6{\pm}8.7{\mu}g/dl$ and $17.3{\pm}1.1g/dl$. The means of above three indicies between two groups showed significant difference statistically (p<0.05). 2. The means of blood lead (PBB), blood ZPP and hemoglobin of workers exposed .to different lead concentration in air were as follows : When it was below $25{\mu}g/m^3$, the indices were $24.7{\pm}79,\;26.1{\pm}26.8{\mu}g/dl\;and\;16.4{\pm}1.1g/dl$ respectively : These indices were $27.1{\pm}8.5,\;23.9{\pm}10.92{\mu}g/dl\;and\;16.2{\pm}1.3g/dl$ when the lead concentration in air was $25{\sim}50{\mu}g/m^3$ : and they were $3.4{\pm}9.3,\;42.3{\pm}31.3{\mu}g/dl\;and\;15.5{\pm}1.2g/dl$ when the concentration of lead was above $50{\mu}g/m^3$. Although there were statistical difference in blood lead and hemoglobin among three different lead concentration in air, there was no statistical difference of blood ZPP among the three groups with different exposure levels (p>0.05). 3. The most frequent by complained symptom was 'Generalized weakness and fatigue', and fewest symptom was 'Intermittent pains in abdomen' 4. Only two symptoms out of fifteen symptoms checked by themselves revealed significant difference between exposed and nonexposed groups. These were 'Intermittent pains of abdomen' and 'Joint pain or arthralgia' (p<0.05), No positive correlation was found between the levels of blood lead and symptom groups categorized as gastrointestinal, neuromuscular and constitutional symptoms, 5. Blood lead (r=0.3995) and ZPP (r=0.2837) showed statistically significant correlation with mean lead concentration in air, whereas correlations were not demonstrated between blood lead and lead related symptoms or blood ZPP and lead related symptoms. 6. Blood lead (PBB) and ZPP showed association (r=0.2466) and the equation PBB=23.75+0.0842 ZPP was derived. 7. On stepwise multiple regression, using blood lead level as a dependent variable and ZPP, hemoglobin (HB), age, work duration (WD) and symptom prevalence as a independent variables, only ZPP significantly contributed a lot to blood lead level. 8. While the ZPP measurement was found to be a good indicator in evaluating health effect of lead absorption in low level lead exposure, lead related symptoms were not sensitive enough to evaluate of lead absorption in low level exposure.

• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.708-718
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• 1998

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

• Journal of Nutrition and Health
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• v.25 no.7
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• pp.608-616
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• 1992

Using the hematofluiorometer normal values of the erythrocyte zinc protoporphyrin(ZPP) and ZPP/Heme ratio were measured in 312 males and 163 females aged from 6 month to 73 years old and compared with those of anemic persons. The mean$\pm$SD values of ZPP of normal Koreans were 28.5$\pm$6.4($\mu\textrm{g}$/dl) in males and 3.18$\pm$7.7 in females. the mean$\pm$SD of ZPP/Heme ratio were 49.5$\pm$12.3($\mu$mol/mol heme) in males and 62.0$\pm$15.8 in females. The difference in the mean ZPP and ZPP/Heme ratio values between male and female subjects were statistically signficant(p<0.0001) In male subjects the mean ZPP and ZPP/Heme ratio of the age groups less than 15 years old were higher than adult groups and the difference between age groups was significant(p<0.005 and p<0.0001 respecti-vely) The normal upper limit of the mean$\pm$2SD in normal male and female subjects were 41.3 and 47.2 for ZPP and 74.1 and 93.6 for ZPP/Heme ratio respectively. The mean values of ZPP and ZPP/Heme ratio measured in the anemic persons were higher than those of normal subjects and did not show any significant difference by the sex and age groups except in 6-14 years male groups. The test specificity(positivity) analyzed in the anemic persons by the cut-off values calculated from the normal data were 50.6% for ZPP and 73.0% for ZPP/Heme ratio. The correlation analysis between blood hemoglobin and erythrocyte ZPP or ZPP/Heme ratio in the total 801 normal and anemic subjects showed that there are very high logarithmic correlation between the hemoglobin levels and ZPP/Heme ratio (r=-0.8339) and high correla-tion between the hemoglobin levels and ZPP concentrations(r=-0.6372) These results suggested that the measurement of the erythrocyte ZPP and ZPP/Heme ratio with the hematofluorometer can be a usuful screening method for iron deficiency anermin because they provide a reliable immediate results with a small amount of sample and are relatively simple and inexpensive.

• 산업보건소식
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• no.46
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• pp.3-13
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• 1987

For the purpose of investigating the effect of occupational health service in terms of environmental control and health provision of workers on the improvement of worker's health, authors analysed the data of environmental measurement and health check-up of one lead using industry who started his investment to environmental improvement from 1980. Six hundred million won was invested for environmental improvement from 1980 to 1986. This investment brought about apparent improvement of working conditions of all of the workplaces from mean concentration of lead in air over 0.15mg/$m^3$ 1981 to mean concentration of lead in air less than 0.15mg/$m^3$. Environmental control reduced mean blood lead level from 51.2 $\pm$ 11.5ug/이 in 1983 to 39.2 $\pm$ 16.0ug/dl in 1986, and delta-aminolevulinic acid concentration 3.15 $\pm$ 2.1mg/l in 1982 to 1.96 $\pm$ 1. 7mg/l in 1986, respectively. Blood ZPP levels were decreased from 76.1 $\pm$ 58.9ug/dl in 1983 to 42.23 $\pm$ 30.3ug/dl in 1986. If 150ug/dl of blood ZPP is considered as unacceptable limit of lead intoxication, more than 10 percent of workers belonged to this category in 1983, but only 0.5 of workers showed their blood ZPP level over the 150ug/dl in 1986 It was observed that no workers whose work duration were less than one year showed their blood ZPP level over 100ug/dl, but there were high percentages of lead workers with high blood ZPP (over 150 ug/dl) who were working in uncontrolled had working condition and whose work duration were less than one year.

• Journal of Environmental Health Sciences
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• v.17 no.1
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• pp.95-103
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• 1991

For the purpose of estimating the working environment and the relationship between the airborne lead concentration and the ZPP level in the whole blood of the workers, the airborne lead concentrations and the ZPP level were measured at the 26 plants which deal with lead, from October 5 to November 5 in 1988. Analysis of the airborne lead concentration was performed by NIOSH Method 7082, and the ZPP level was measured by a hematofluorometer. The following results are concluded. 1. The average airborne lead concentration of the lead battery manufactures is 0.025mg/m$^{3}$ and that of the secondary lead smelters is 0.023mg/m$^{3}$. There were no significant differences between industry (p>0.1) 2. At the lead battery manufacture, the process of lead powder production showed the highest concentration of 0.034mg/m$^{3}$ but there were no significant differences among the processes (p>0.1). At the secondary lead smelter, the process of dismantling waste batteries showed the highest concentration 0.141mg/m$^{3}$, and there were very significant differences among the processes (p<0.005). 3. The ZPP level in the whole blood showed significant differences between industry (p<0.10). The average ZPP level of the lead battery manufactures is 133.0 + 106.3 $\mu$g/100ml and that of the secondary lead smelters is 149.6 + 110.9 $\mu$g/100ml. 4. The correlation coefficients between the airborne lead concantration and ZPP level were 0. 426 (p<0.001) for the lead battery manufactures and 0.484 (p<0.001) for the secondary lead smelters. The correlation coefficients between the work duration (in months) and the ZPP level were 0.238 (p<0.001) for the lead battery mannfactures and 0.075 (p>0.10) for the secondary lead smelters. 5. The linear regression equation, with the airborne lead concentration as an independent variable and the ZPP level as a dependent variable, is Y=96.84+1300.34X (r=0.448, p<0.001) for the 26 plants which deal with lead. The linear regression equation, with the work duration(in months) as an independent variable and the ZPP level as a dependent variable, is Y=127.28 +0.49X (r=0.162, p<0.05). 6. The correlation coefficients between the amount of inhaled lead and ZPP level were 0.349 (p < 0.001) for the lead battery manufactures and 0.318(p<0.001) for the secondary lead smeltes. The linear regression equation for the 26 plants surveyed, with the amount of inhaled lead as an independent variable and ZPP level as a dependent variable, is Y=123.63+18.82X (r=0. 335, p<0.001).

• Journal of Preventive Medicine and Public Health
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• v.31 no.1 s.60
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• pp.112-126
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• 1998

To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin (ZPP) concentrations of 131 workers (100 exposed subjects and 31 controls) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Ai. lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was $16.45{\pm}4.83{\mu}g/d\ell$ at the preemployment examination and slightly increased to $17.77{\pm}5.59{\mu}g/d\ell$ after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was $17.36{\pm}5.20{\mu}g/d\ell$ on employment and it was increased to $23.00{\pm}13.06{\mu}g/d\ell$ after 3 months. The blood ZPP concentration was increased to $27.25{\pm}6.40{\mu}g/d\ell$ on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between $25.48{\mu}g/d\ell$ and $26.61{\mu}g/d\ell$ in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was $14.34{\pm}6.10{\mu}g/d\ell$ on employment and it was increased to $28.97{\pm}7.14{\mu}g/d\ell$ (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between $26.96{\mu}g/d\ell$and $27.96{\mu}g/d\ell$. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was$21.34{\pm}5.25{\mu}g/d\ell$ on employment and it was gradually increased to $23.37{\pm}3.86{\mu}g/d\ell$ (p<0.01) after 3 months, $23.93{\pm}3.64{\mu}g/d\ell$ after 6 months, $25.50{\pm}3.01{\mu}g/d\ell$ after 9 months, and $25.50{\pm}3.10{\mu}g/d\ell$ after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were $0.365mg/m^3$, and after the intervention the levels were decreased to $0.216mg/m^3$ and$0.208mg/m^3$ in follow-up test. The Pb-A of part II which was resulted in lowe. value than part I was decreased from $0.232mg/m^3$ to $0.148mg/m^3$, and $0.120mg/m^3$ after the intervention. The Pb-A of part III was tested after the intervention and resulted in $0.124mg/m^3$ in January 1988 and $0.181mg/m^3$ in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in $0.110mg/m^3$ in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.