Vocabulary Acquisition and Usage for Late Talkers: The Feasibility of a Caregiver-Implemented Telehealth Model.

PURPOSE: This feasibility study examined a caregiver-implemented telehealth model of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) protocol. We asked whether caregivers could reach fidelity on VAULT, if the protocol was socially and ecologically valid, and if late-talking toddlers could learn new words with this model. METHOD: Five late-talking monolingual and bilingual toddlers and four caregivers participated. The caregiver-related research questions involved measurements taken at multiple time points and replication across subjects but did not follow a specific research design. The toddler-related research questions included elements of a single-case design. Caregivers completed self-paced online training modules and then provided 8 weeks of VAULT to their children with remote coaching. Fidelity data were collected during coached sessions and through rating scales. Social and ecological validity data were collected via surveys and interviews. Children's word learning was measured before, during, and after treatment via production of targets and controls and via standardized vocabulary inventories. RESULTS: Caregivers demonstrated high fidelity to VAULT throughout treatment. They reported being comfortable with many aspects of VAULT. Feedback was mixed regarding the time required. Many reported their child was talking more as a result of the program. Visual analysis revealed that toddlers learned more target than control words, which was corroborated by Tau-U and d effect size analyses. CONCLUSION: A caregiver-implemented telehealth model of VAULT was feasible, was socially and ecologically valid, and benefited toddlers, making this a worthwhile model for future studies to examine. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21753872.

A Vocabulary Acquisition and Usage for Late Talkers Treatment Efficacy Study: The Effect of Input Utterance Length and Identification of Responder Profiles.

Purpose This study examined the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment in a version that manipulated the length of clinician utterance in which a target word was presented (dose length). The study also explored ways to characterize treatment responders versus nonresponders. Method Nineteen primarily English-speaking late-talking toddlers (aged 24-34 months at treatment onset) received VAULT and were quasirandomly assigned to have target words presented in grammatical utterances matching one of two lengths: brief (four words or fewer) or extended (five words or more). Children were measured on their pre- and posttreatment production of (a) target and control words specific to treatment and (b) words not specific to treatment. Classification and Regression Tree (CART) analysis was used to classify responders versus nonresponders. Results VAULT was successful as a whole (i.e., treatment effect sizes of greater than 0), with no difference between the brief and extended conditions. Despite the overall significant treatment effect, the treatment was not successful for all participants. CART results (using participants from the current study and a previous iteration of VAULT) provided a dual-node decision tree for classifying treatment responders versus nonresponders. Conclusions The input-based VAULT treatment protocol is efficacious and offers some flexibility in terms of utterance length. When VAULT works, it works well. The CART decision tree uses pretreatment vocabulary levels and performance in the first two treatment sessions to provide clinicians with promising guidelines for who is likely to be a nonresponder and thus might need a modified treatment plan. Supplemental Material https://doi.org/10.23641/asha.14226641.

Using AAC to unlock communicative potential in late-talking toddlers.

PURPOSE: The purpose of this study was to report on modifications we made to a standardized input-based word learning treatment for two late-talking toddlers. The modifications were the addition of an augmentative alternative communication (AAC) device and the requirement that the children use this device, or speech, to communicate. METHOD: We used a single-subject design to track late-talking toddlers' progress through an input-based word learning treatment, which was part of a larger study. Because the input-based treatment protocol was not effective for each toddler based on absent or clinically insignificant treatment effect sizes, we modified the protocol. The modifications were meant to address each child's potential over-reliance on nonverbal communication and the potential impact of speech sound delay. We then measured their linguistic output. RESULTS: Both toddlers showed no evidence of learning during the input-based treatment. Each child's linguistic output increased by over 600 % once we made the protocol modification and introduced the AAC device. They used both AAC and vocal speech to communicate. Both toddlers produced novel words, and one began to produce multiple word combinations. DISCUSSION: While input-based therapy has an evidence base and has been successful for some toddlers, it may require modifications for children who have not learned the pragmatic convention of using spoken language, and for children with difficulty with speech sound production.

Exploring Input Parameters in an Expressive Vocabulary Treatment With Late Talkers.

Purpose The aims of this study were (a) to assess the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment and (b) to compare treatment outcomes for expressive vocabulary acquisition in late talkers in 2 conditions: 3 target words/90 doses per word per session versus 6 target words/45 doses per word per session. Method We ran the treatment protocol for 16 sessions with 24 primarily monolingual English-speaking late talkers. We calculated a d score for each child, compared treatment to control effect sizes, and assessed the number of words per week children acquired outside treatment. We compared treatment effect sizes of children in the condition of 3 target words/90 doses per word to those in the condition of 6 target words/45 doses per word. We used Bayesian repeated-measures analysis of variance and Bayesian t tests to answer our condition-level questions. Results With an average treatment effect size of almost 1.0, VAULT was effective relative to the no-treatment condition. There were no differences between the different dose conditions. Discussion The VAULT protocol was an efficacious treatment that has the potential to increase the spoken vocabulary of late-talking toddlers and provides clinicians some flexibility in terms of number of words targeted and dose number, keeping in mind the interconnectedness of treatment parameters. Supplemental Material https://doi.org/10.23641/asha.11593323.

[Tuberculosis in Peru: epidemiological situation, progress and challenges for its control]. / Tubersulosis en el Perú: situación epidemiológica, avances y desafíos para su control.

Tuberculosis (TB) is the first cause of death by an infectious agent in the world, the incidence in the population is declining very slowly and drug resistance is currently considered an international crisis. In Peru, the recent TB Prevention and Control Act in Peru (Law 30287) declares the fight against TB of national interest. In recent years, the Ministry of Health's (MINSA) National Health Strategy for the Prevention and Control of Tuberculosis (ESNPCT) has achieved significant progress in the control of this disease; however, challenges still remain to be addressed. This article reviews the epidemiological situation of TB in Peru, systematizes the progress achieved during the management of the ESNPCT >team between the years 2011 and 2015 from the biomedical approach, public management and social determinants of health, also posing challenges to achieving TB control under law 30287 and the "End of TB" strategy of the World Health Organization (WHO).

La tuberculosis (TB) es la primera causa de muerte por un agente infeccioso en el mundo, la incidencia en la población viene disminuyendo muy lentamente y la resistencia a los medicamentos es actualmente considerada como una crisis internacional. En el Perú, la reciente Ley de Prevención y Control de la TB en el Perú (Ley 30287), declara de interés nacional la lucha contra la TB. En los últimos años, la Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis (ESNPCT) del Ministerio de Salud (MINSA), ha obtenido avances significativos en el control de esta enfermedad; sin embargo, aún persisten desafíos que deben ser abordados. El presente artículo revisa la situación epidemiológica de la TB en el Perú, sistematiza los avances logrados durante la gestión del equipo de la ESNPCT entre los años 2011 y 2015 desde el abordaje biomédico, de gestión pública y en las determinantes sociales de la salud, además, plantea desafíos para lograr el control de la TB, en el marco de la Ley 30287 y la estrategia "Fin de la TB" de la Organización Mundial de la Salud (OMS).

Tubersulosis en el Perú: situación epidemiológica, avances y desafíos para su control / Tuberculosis in Peru: epidemiological situation, progress and challenges for its control

RESUMEN La tuberculosis (TB) es la primera causa de muerte por un agente infeccioso en el mundo, la incidencia en la población viene disminuyendo muy lentamente y la resistencia a los medicamentos es actualmente considerada como una crisis internacional. En el Perú, la reciente Ley de Prevención y Control de la TB en el Perú (Ley 30287), declara de interés nacional la lucha contra la TB. En los últimos años, la Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis (ESNPCT) del Ministerio de Salud (MINSA), ha obtenido avances significativos en el control de esta enfermedad; sin embargo, aún persisten desafíos que deben ser abordados. El presente artículo revisa la situación epidemiológica de la TB en el Perú, sistematiza los avances logrados durante la gestión del equipo de la ESNPCT entre los años 2011 y 2015 desde el abordaje biomédico, de gestión pública y en las determinantes sociales de la salud, además, plantea desafíos para lograr el control de la TB, en el marco de la Ley 30287 y la estrategia "Fin de la TB" de la Organización Mundial de la Salud (OMS).

ABSTRACT Tuberculosis (TB) is the first cause of death by an infectious agent in the world, the incidence in the population is declining very slowly and drug resistance is currently considered an international crisis. In Peru, the recent TB Prevention and Control Act in Peru (Law 30287) declares the fight against TB of national interest. In recent years, the Ministry of Health's (MINSA) National Health Strategy for the Prevention and Control of Tuberculosis (ESNPCT) has achieved significant progress in the control of this disease; however, challenges still remain to be addressed. This article reviews the epidemiological situation of TB in Peru, systematizes the progress achieved during the management of the ESNPCT >team between the years 2011 and 2015 from the biomedical approach, public management and social determinants of health, also posing challenges to achieving TB control under law 30287 and the "End of TB" strategy of the World Health Organization (WHO).

A new species of Ornithodoros (Acari: Argasidae) from desert areas of northern Chile.

Ornithodoros atacamensis n. sp. is described from larvae collected on the lizard Liolaemus bisignatus and from free-living adults collected in desert areas from the Pan de Azúcar and Llanos de Challe National Parks, in Northern Chile. Additionally, unengorged larvae were obtained from fertilized females, which laid eggs in the laboratory. Morphological and mitochondrial 16S rDNA sequence analyses were performed in order to compare this new soft tick species with other congeneric Neotropical representatives. Larvae of O. atacamensis are morphologically closely related to Ornithodoros talaje sensu stricto, Ornithodoros puertoricensis, Ornithodoros rioplatensis, Ornithodoros guaporensis and Ornithodoros hasei, all belonging to the O. talaje species group. The larval diagnostic characters for this species are a combination of a large pyriform dorsal plate with a length of approximately 300µm, 17 pairs of dorsal setae with five central pairs, hypostome with apex pointed and dental formula 2/2 in most rows, 3/3 apically, and capsule of the Haller's organ oval in shape without reticulations. Phylogenetic analyses inferred from the mitochondrial 16S rRNA gene and a Principal Component Analysis based on morphometric characters provide additional support to the description of O. atacamensis as an independent lineage within the genus clustering within the O. talaje species group.

Relación del uso de anticonvulsivantes y conductas suicidas en pacientes que consultan en el Hospital Nacional Psiquiátrico enero - agosto 2011 / Relationship of the use of anticonvulsants and suicidal behaviors in patients who consult at the National Psychiatric Hospital January - August 2011

Determinar la relación existente entre el uso de los anticonvulsivantes y conductas suicidas en pacientes que padecen de Epilepsia Tónico Clónico Generalizada tratados con fármacos antiepilépticos que consultan en el hospital Nacional Psiquiátrico entre las edades de 15 a 45 años, durante el periodo comprendido de Enero hasta Agosto 2011. Se realizó el estudio partiendo del informe de la FDA acerca de los anticonvulsivantes y el riesgo suicida. El estudio de investigación es de tipo Descriptivo-transversal-Retrospectivo. De una muestra total de 150 pacientes que padecen de Epilepsia tónico clónico generalizada a través de un proceso sistemático Probabilístico-aleatorio simple. Se recopiló los datos atreves de una ficha de captura de datos por medio de la revisión de expedientes clínicos y la escala de riesgo suicida de Putchik. En base a los resultados obtenidos del 100% de la población; el 57% es tratado con Fenitoína, 7% con ácido valproico, un 45% con carbamazepina y un 51% fenobarbital. Entre las conductas suicidas documentadas en los expedientes clínicos corresponde un 2% que presento pensamiento suicida y un 2% intento suicida, y con la escala de Putchik un 11% presento pensamiento suicida e intento un 9%. Con la escala de Putchik 9% sostuvieron pensamiento suicida con el uso de carbamazepina y 11% presentaron intento suicida utilizando ácido valproico, Fenitoína y carbamazepina. Que en base a ello 15% corresponde a uso de carbamazepina, 3% Fenitoína y 2% ácido valproico; Haciendo un total del 20% que presentaron conducta suicida pero que sin embargo en los expedientes solo se registraron un 4%, ya que el resto se obtuvo a partir de la escala de Putchik. Conclusiones: No existe relación entre el uso de antiepilépticos y conductas suicidas en pacientes tratados con anticonvulsivantes que padecen de Epilepsia tónico clónico generalizada; ya que la mayoría de la población de estudio no presento conductas suicidas con el uso de anticonvulsivantes

Factors that influence fast mapping in children exposed to Spanish and English.

PURPOSE: The purpose of this study was to determine whether children exposed to 2 languages would benefit from the phonotactic probability cues of a single language in the same way as monolingual peers and to determine whether crosslinguistic influence would be present in a fast-mapping task. METHOD: Two groups of typically developing children (monolingual English and bilingual Spanish-English) took part in a computer-based fast-mapping task that manipulated phonotactic probability. Children were preschool-aged (N = 50) or school-aged (N = 34). Fast mapping was assessed through name-identification and naming tasks. Data were analyzed using mixed analyses of variance with post hoc testing and simple regression. RESULTS: Bilingual and monolingual preschoolers showed sensitivity to English phonotactic cues in both tasks, but bilingual preschoolers were less accurate than monolingual peers in the naming task. School-aged bilingual children had nearly identical performance to monolingual peers. CONCLUSION: Knowing that children exposed to two languages can benefit from the statistical cues of a single language can help inform ideas about instruction and assessment for bilingual learners.

Using norm-referenced tests to determine severity of language impairment in children: disconnect between U.S. policy makers and test developers.

PURPOSE: The purpose of this study was to identify various U.S. state education departments' criteria for determining the severity of language impairment in children, with particular focus on the use of norm-referenced tests. A secondary objective was to determine if norm-referenced tests of child language were developed for the purpose of identifying the severity of children's language impairment. METHOD: Published procedures for severity determinations were obtained from U.S. state education departments. In addition, manuals for 45 norm-referenced tests of child language were reviewed to determine if each test was designed to identify the degree of a child's language impairment. Consistency was evaluated among state criteria, test developers' intentions, and test characteristics. RESULTS: At the time of this study, 8 states published guidelines for determining the severity of language impairment, and each specified the use of norm-referenced tests for this purpose. The degree of use and cutoff-point criteria for severity determination varied across states. No cutoff-point criteria aligned with the severity cutoff points described within the test manuals. Furthermore, tests that included severity information lacked empirical data on how the severity categories were derived. CONCLUSION: Researchers and clinicians should be cautious in determining the severity of children's language impairment using norm-referenced test performance given the inconsistency in guidelines and lack of empirical data within test manuals to support this use.

Exposición prenatal y posnatal al tabaco y síntomas respiratorios y alérgicos en los primeros años de vida / Perinatal Exposure to Tobacco and Respiratory and Allergy Symptoms in First Years of Life

IntroducciónEl objetivo del estudio ha sido analizar la relación de la exposición prenatal y posnatal al tabaco con la aparición de síntomas respiratorios y alérgicos en los primeros 4 años de vida.Pacientes y métodosEstudio de cohortes prospectivo y multicéntrico que incluye a sujetos del estudio AMICS (Asthma Multicentric Infant Cohort Study) en Ashford (Reino Unido), Barcelona y Menorca (España). Se incluyó a 1.611 niños que fueron seguidos desde el embarazo hasta el cuarto año de vida mediante cuestionarios anuales para obtener información sobre tabaquismo de los padres y síntomas respiratorios y alérgicos de los niños. En la cohorte de Barcelona (n=487) se procedió al análisis de un biomarcador de exposición al tabaco (cotinina) en distintas matrices.ResultadosLa exposición prenatal exclusiva al tabaco se relaciona con mayor riesgo de hospitalización por infección respiratoria, especialmente en el segundo año de vida, mientras que la exposición posnatal se asocia con la aparición de sibilancias tardías y aumenta la probabilidad del diagnóstico de asma a los 4 años. Los niños expuestos pre y posnatalmente presentan más sibilancias y roncus persistentes, tos nocturna, episodios de resfriados al año y diagnósticos de asma. El riesgo de presentar sibilancias es mayor cuanto más altos son los valores de cotinina. No existe asociación entre exposición al tabaco y síntomas atópicos.ConclusionesLa exposición pasiva al humo del tabaco durante el embarazo y la infancia tiene efectos clínicos respiratorios bien diferenciados en niños, por lo que la interrupción del hábito tabáquico en mujeres en edad fértil tiene que ser una prioridad en medicina preventiva(AU)

Background and objectivesTo analyse the relationship between prenatal and postnatal tobacco exposure and the development of respiratory and allergy symptoms during the first 4 years of life.Patients and methodsProspective and multicentred cohort study that included the subjects belonging to AMICS (Asthma Multicentred Infant Cohort Study) located in Ashford (England), Barcelona and Minorca (Spain). We recruited 1611 children, followed from the pregnancy to the 4th year of life, whose parents annually answered a questionnaire on their tobacco consumption and their children's respiratory and allergy health. In the Barcelona cohort (n=487) a tobacco exposure biomarker (cotinine) was analysed on several matrices.ResultsPrenatal tobacco exposure is associated with a greater risk of hospitalisation due to respiratory infection, particularly in the second year of life, whereas postnatal tobacco exposure is associated more strongly with the presence of late wheezing presence and increases in the chance of being diagnosed with asthma at 4 years of age. The children prenatally and postnatally exposed had more persistent wheezing, persistent rhoncus, early cough, a higher number of upper respiratory infections per year and a greater number were diagnosed with asthma. The higher the levels of cotinine measured, the higher was the risk for wheezing. No relationship was seen between tobacco exposure and atopic symptoms.ConclusionsPassive smoke exposure during pregnancy and childhood has very distinct clinical respiratory effects in children. Therefore, smoking cessation of childbearing age women must be a priority of preventive medicine(AU)

[Perinatal exposure to tobacco and respiratory and allergy symptoms in first years of life]. / Exposición prenatal y posnatal al tabaco y síntomas respiratorios y alérgicos en los primeros años de vida.

BACKGROUND AND OBJECTIVES: To analyse the relationship between prenatal and postnatal tobacco exposure and the development of respiratory and allergy symptoms during the first 4 years of life. PATIENTS AND METHODS: Prospective and multicentred cohort study that included the subjects belonging to AMICS (Asthma Multicentred Infant Cohort Study) located in Ashford (England), Barcelona and Minorca (Spain). We recruited 1611 children, followed from the pregnancy to the 4th year of life, whose parents annually answered a questionnaire on their tobacco consumption and their children's respiratory and allergy health. In the Barcelona cohort (n=487) a tobacco exposure biomarker (cotinine) was analysed on several matrices. RESULTS: Prenatal tobacco exposure is associated with a greater risk of hospitalisation due to respiratory infection, particularly in the second year of life, whereas postnatal tobacco exposure is associated more strongly with the presence of late wheezing presence and increases in the chance of being diagnosed with asthma at 4 years of age. The children prenatally and postnatally exposed had more persistent wheezing, persistent rhoncus, early cough, a higher number of upper respiratory infections per year and a greater number were diagnosed with asthma. The higher the levels of cotinine measured, the higher was the risk for wheezing. No relationship was seen between tobacco exposure and atopic symptoms. CONCLUSIONS: Passive smoke exposure during pregnancy and childhood has very distinct clinical respiratory effects in children. Therefore, smoking cessation of childbearing age women must be a priority of preventive medicine.

Prenatal diagnosis and tridimensional ultrasound features of bilateral femoral hypoplasia--unusual facies syndrome.

The femoral hypoplasia - unusual facies syndrome is a rare disorder, which was described first three decades ago. It is characterised by the occurrence of short femurs with certain associated alterations mainly affecting the face, of which micrognathia is the most frequently found. Although the etiology of this condition is unknown, clear relationship with maternal insulin-dependent diabetes has often been reported, which suggests some sort of inherited component. Nevertheless, most cases occur sporadically. This entity is usually diagnosed after birth because prenatal ultrasound detection is rather difficult. Here, we report a case of prospective detection. So far, such cases have been seldom described in the literature.

A longitudinal study of environmental tobacco smoke exposure in children: parental self reports versus age dependent biomarkers.

BACKGROUND: Awareness of the negative effects of smoking on children's health prompted a decrease in the self-reporting of parental tobacco use in periodic surveys from most industrialized countries. Our aim is to assess changes between ETS exposure at the end of pregnancy and at 4 years of age determined by the parents' self-report and measurement of cotinine in age related biological matrices. METHODS: The prospective birth cohort included 487 infants from Barcelona city (Spain). Mothers were asked about maternal and household smoking habit. Cord serum and children's urinary cotinine were analyzed in duplicate using a double antibody radioimmunoassay. RESULTS: At 4 years of age, the median urinary cotinine level in children increased 1.4 or 3.5 times when father or mother smoked, respectively. Cotinine levels in children's urine statistically differentiated children from smoking mothers (Geometric Mean (GM) 19.7 ng/ml; 95% CI 16.83-23.01) and exposed homes (GM 7.1 ng/ml; 95% CI 5.61-8.99) compared with non-exposed homes (GM 4.5 ng/ml; 95% CI 3.71-5.48). Maternal self-reported ETS exposure in homes declined in the four year span between the two time periods from 42.2% to 31.0% (p < 0.01). Nevertheless, most of the children considered non-exposed by their mothers had detectable levels of cotinine above 1 ng/mL in their urine. CONCLUSION: We concluded that cotinine levels determined in cord blood and urine, respectively, were useful for categorizing the children exposed to smoking and showed that a certain increase in ETS exposure during the 4-year follow-up period occurred.

Early-life domestic aeroallergen exposure and IgE sensitization at age 4 years.

BACKGROUND: Although it is widely assumed that childhood sensitization to common aeroallergens is directly related to allergen exposure in early life, few longitudinal studies have investigated this issue, and available data are scarce and mainly limited to high-risk groups. OBJECTIVE: We sought to assess the role of early exposure to 2 major household aeroallergens (Der p 1 and Fel d 1) in sensitization at the age of 4 years. METHODS: Pregnant women and their children were recruited for the Asthma Multicenter Infant Cohort Study. Three cohorts (Ashford in the United Kingdom and Menorca and Barcelona in Spain) followed the same research protocol. A total of 1611 newborn children were initially included in the cohort, from whose homes we collected dust samples at 3 months of age for 1474; Der p 1 and Fel d 1 levels were measured. Of these children, we obtained blood for specific IgE determination in 1019. RESULTS: The risk of Fel d 1 sensitization increased with exposure in a nonlinear manner. No association was found between specific IgE to Der p 1 and aeroallergen levels of exposure at early life in 2 centers, but a positive association was observed in the third. CONCLUSIONS: The dose-response relationships between allergen exposure and sensitization differ between allergens and might vary between different locales. The hypothesis that sensitization to house dust mite is directly related to levels of allergen exposure might not apply to the general population or to different ranges of exposure. CLINICAL IMPLICATIONS: Aeroallergen avoidance might not have any important effect on the incidence of sensitization.

A prospective study of Fel d1 and Der p1 exposure in infancy and childhood wheezing.

The impact of domestic exposure to cat allergen (Fel d1) and house dust mite (Der p1) on wheezing from birth to the age of 4 years was investigated in a multicenter prospective birth cohort; 1,611 mothers were recruited before delivery in Ashford, England, and Barcelona and Menorca, Spain. Exposures were gathered via dust sample collection at children's home in their first year of life. Families provided complete outcome data (wheezing status in all 4 years) for 1,289 children. Domestic allergen levels varied substantially between centers. Six hundred three (47%) children never wheezed during their first 4 years of life. Der p1 did not correlate with any type of wheezing outcome. Fel d1 significantly increased the risk of wheezing in 3- and 4-year-olds in comparison to 1-year-olds. Distinct risk profiles were found for wheezing at different ages. Multivariate analysis revealed an interaction between Fel d1 and maternal asthma among children who wheeze in Year 4 (relative risk = 2.77; 95% confidence interval = 1.19-6.46). Our data support the idea that several patterns of wheezing with different risk profiles exist among young children. The effect of Fel d1 exposure varied according to age and maternal asthma.

Sources and concentrations of indoor nitrogen dioxide in Barcelona, Spain.

Sources and concentrations of indoor nitrogen dioxide (NO2) were examined in Barcelona, Spain, during 1996-1999. A total of 340 dwellings of infants participating in a hospital-based cohort study were selected from different areas of the city. Passive filter badges were used for indoor NO2 measurement over 7-30 days. Dwelling inhabitants completed a questionnaire on housing characteristics and smoking habits. Data on outdoor NO2 concentrations were available for the entire period of the study in the areas of the city where indoor concentrations were determined. Bivariate analysis was performed to investigate relationships between indoor NO2 concentrations on one hand and outdoor NO2 concentrations, housing, and occupant characteristics on the other. Stepwise multiple linear regression was performed with variables that were found to have a significant bivariate relationship. Indoor NO2 mean values ranged between 23.57 ppb in 1996 and 27.02 ppb in 1999, with the highest yearly value of 27.82 ppb in 1997. In the same time period, mean outdoor NO2 concentration ranged between 25.26 and 25.78 ppb with a peak of 30.5 ppb in 1998. Multiple regression analysis showed that principal sources of indoor NO2 concentrations were the use of a gas cooker, the absence of an extractor fan when cooking, and cigarette smoking. The absence of central heating was also associated with higher NO2 concentrations. Finally, each ppb increase in outdoor NO2 was associated with a 1% increase in indoor concentrations.

Assessment of chronic exposure to cigarette smoke and its change during pregnancy by segmental analysis of maternal hair nicotine.

This study aimed to investigate the association between biomarkers of fetal exposure to smoking during the whole pregnancy, nicotine in maternal and newborns hair samples, and quantitative measurement of smoking intake and exposure evaluated by maternal self-reported questionnaire. Study subjects were 150 mothers and their newborns from a hospital in Barcelona. A questionnaire including smoking habits was completed in the third trimester of pregnancy and on the day of delivery. Nicotine content was measured in two subsequent segments of maternal hair accounting for the first and last months of pregnancy, and in fetal hair. The geometric mean of nicotine concentration in maternal hair discriminated between nonexposition (3.84 and 2.80 ng/mg in distal and proximal hair segment, respectively) and exposition to cigarette smoke during pregnancy (6.06 and 4.30 ng/mg in distal and proximal hair segment, respectively) (P<0.05), and between these two classes and active smoking (14.40 and 11.08 ng/mg in distal and proximal hair segment, respectively). Maternal hair nicotine was able to differentiate levels of exposure to tobacco smoke and levels of intake. Nicotine concentration in hair from newborns did not differentiate between exposure and nonexposure to environmental tobacco smoke (ETS) in nonsmoking mothers. Finally, chronic exposure to cigarette smoke during pregnancy, assessed by maternal hair nicotine, correlated negatively with anthropometric parameters of newborns.

[Neonatal effects of smoking habit during pregnancy and sociodemographic determinants in Barcelona, Spain]. / Efectos neonatales del hábito tabáquico durante el embarazo y determinantes sociodemográficos en Barcelona.

BACKGROUND: Smoking during pregnancy poses a health risk for the fetus which may later extend to the child and adult, with higher probability of respiratory problems. The aim of this study was the to investigate the correlation between smoking during pregnancy and the neonatal characteristics and sociodemographic determinants of smoking habit during pregnancy. PATIENTS AND METHODS: Study subjects were 419 mothers and their newborns in Barcelona, Spain. Data on smoking habits were collected using a structured questionnaire. We measured cotinine in umbilical cord blood as a biomarker of exposition to tobacco smoke. Concentrations of cotinine were determined using a radioimmunoassay. RESULTS: 29% interviewed mothers declared daily cigarette consumption during the third trimester of pregnancy, while the biomarker test showed that 34% mothers were smoking at the end of pregnancy. Smoking habit during pregnancy, assessed by means of either the questionnaire or the biomarker, correlated negatively with anthropometric parameters (weight, length and head circumference) of the newborn. The smoking habit was not associated with social class and age, although it was lower in primigravid mothers. CONCLUSIONS: Unlike other European countries, there is a widespread smoking consumption during pregnancy in Spain, regardless of the social class and maternal age. Reduction of both active smoking and exposition to environmental tobacco smoke represent key elements in the prevention of newborns' morbidity and mortality.

Efectos neonatales del hábito tabáquico durante el embarazo y determinantes sociodemográficos en Barcelona / Neonatal effects of smoking habit during pregnancy and sociodemographic determinants in Barcelona, Spain

FUNDAMENTO: El consumo de tabaco durante el embarazo representa un riesgo para la salud del feto y posteriormente para la del niño y el adulto, con una mayor probabilidad de presentar problemas respiratorios. El objetivo de este trabajo fue conocer la posible correlación entre el consumo de tabaco durante el embarazo y las características neonatales y los determinantes sociodemográficos del hábito tabáquico de las mujeres durante la gestación. SUJETOS Y MÉTODO: Los sujetos del estudio fueron 419 madres y sus recién nacidos, participantes en un estudio de cohortes en Barcelona. Los datos sobre el hábito tabáquico se recogieron empleando un cuestionario estructurado. Para valorar estos datos, y como biomarcador de exposición al tabaco, se determinó la concentración de cotinina (principal metabolito de la nicotina) en sangre del cordón umbilical mediante radioinmunoanálisis. RESULTADOS: Un 29 por ciento de todas las madres entrevistadas declararon el consumo diario de tabaco durante el último trimestre del embarazo, a la vez que el biomarcador demostró que el 34 por ciento de ellas fumaban al final de la gestación. El hábito tabáquico durante el embarazo, ya fuera medido con el cuestionario o con el biomarcador, se asoció significativamente de forma negativa con las medidas somatométricas (peso, talla y perímetro craneal) del recién nacido. En cambio, no se asoció con la clase social o la edad, si bien fue menor en las primíparas. CONCLUSIONES: A diferencia de otros países europeos, en España existe un consumo de tabaco muy extendido durante el embarazo, independientemente de la clase social y la edad de las madres. La reducción de la exposición al tabaco y de su consumo constituye un elemento clave en la prevención de la morbilidad y la mortalidad asociadas, entre otras, a la reducción de las medidas somatométricas del recién nacido (AU)