[Threats, challenges and opportunities for paediatric environmental health in Europe, Latin America and the Caribbean]. / Amenazas, desafíos y oportunidades para la salud medioambiental pediátrica en Europa, América Latina y el Caribe.

In a world that is increasingly technological and interconnected, but also more violent, overexploited and polluted, Paediatric Environmental Health (PEH) is one of the best contributions to improve global health. Few areas of the planet have a high affinity with common values and interests, such as the European Union (EU), Latin America and the Caribbean (LAC). The investments and actions of the PEH in pre- and postnatal periods during the first two decades of life will generate countless benefits in the health and well-being during the human life span. Detecting, reducing, or eliminating physical, chemical, biological and social pollutants is one of the main missions and actions of the PEH. In this special article, an update review is presented on the threats, challenges and cooperation opportunities in PEH among bio-health professionals and other social sectors involved, from the EU and LAC. New professional profiles, knowledge structures and architectures for engagement emerge. Courageous leaderships, new substantial resources, broad social changes, and the necessary collaboration between the two regions will be required to improve the health of present and future generations.

Seguimiento a largo plazo de un programa de prevención y cesación tabáquica en pacientes con fibrosis quística / Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients

Este estudio evalúa el impacto en el tiempo de una intervención telefónica de prevención y cesación tabáquica dirigida a pacientes con fibrosis quística (FQ) en la Región de Murcia, España. Estudio prospectivo experimental en una cohorte de pacientes con FQ utilizando un programa integrativo de cesación tabáquica, entre 2008 y 2013. La población diana incluye a pacientes y familiares de la unidad regional de FQ. El estudio incluyó un cuestionario inicial de exposición al tabaco, medición de la función pulmonar, niveles de cotinina en orina, medidas antropomórficas y la intervención realizada en intervalos de tiempo. De los 88 pacientes seguidos, la tasa de fumadores activos se redujo de 10,23% a 4,55% (p = 0,06). La exposición al humo ambiental de tabaco se redujo en los pacientes no fumadores de 62,03% a 36,90% (p < 0,01) durante los cinco años de seguimiento. Se observaron reducciones significativas en la exposición al humo ambiental de tabaco en los hogares, de 31,65% (n = 25/79) a 19,05% (n = 16/84) en 2013 (p = <0,01). La cotinina se correlacionó significativamente con la exposición al tabaco activa y pasiva (p < 0,01) con una reducción significativa de los niveles de cotinina de 63,13 (28,58-97,69) a 20,56 (0,86-40,27) ng/ml (p < 0,01). La intervención para aumentar significativamente la probabilidad de abandono familiar (hogar libre de humo) fue de 1,26 (1,05-1,54). La intervención telefónica mantenida en el tiempo es una herramienta útil para la prevención y cesación tabáquica. Profesionales entrenados en este modelo de intervención con enfoque en salud medioambiental son necesarios para mejorar el tratamiento de FQ

This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p =<0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF

Tiempo para quedar en embarazo: Evaluación de su reproducibilidad en una cohorte retrospectiva / Time to pregnancy: reproducibility assessment in a retrospective cohort study

Introducción: El tiempo para quedar en embarazo (TPE) es una medida clínica de la fecundidad útil en la evaluación de efectos reproductivos relacionados con exposiciones ambientales u ocupacionales. Estudios con mujeres europeas evidencian que su uso tiene una adecuada recordación y reproducibilidad; sin embargo, estas propiedades no han sido evaluadas en Latinoamérica. Objetivos: Evaluar la reproducibilidad de la medida TPE en una población de mujeres colombianas como una aproximación clínica de la fecundidad. Metodología: Estudio de reproducibilidad prueba-reprueba de un cuestionario para determinar el tiempo al primer embarazo en una sub-muestra de 27 mujeres, anidado en una cohorte retrospectiva de evaluación de los efectos reproductivos de la exposición al mercurio metálico en la minería artesanal de oro. El cuestionario fue administrado de forma repetida por un evaluador entrenado, en el primer momento en una entrevista presencial y 12 meses después en una entrevista telefónica. La reproducibilidad del cuestionario fue evaluada usando el coeficiente de correlación intraclase (CCI). Resultados: La mediana de tiempo al embarazo fue de 4 meses (rango intercuartil 1-12). El rango de tiempo transcurrido desde el primer embarazo estuvo entre 1 y 15 años. El CCI (2,k) fue 0.726 (IC 95% 0.39, 0.88), demostrando una buena reproducibilidad de la variable después de un año de separación entre la primera y segunda entrevista. Conclusiones: El TPE para el primer embarazo mostró ser una medida clínica de fecundidad sencilla y reproducible, con un tiempo de recordación de hasta 15 años y en evaluación presencial o telefónica en una población de mujeres colombianas.

Introduction: Time to pregnancy (TTP) is a clinical measurement of fecundity that has been used in occupational and environmental epidemiological research. Previous studies conducted in European women have shown an adequate reliability and reproducibility. However, these characteristics have not been yet evaluated in Latin American women. Objective: To assess the reproducibility of TTP for the first pregnancy as clinical measurement of couple's fecundity in a population of Colombian women. Methods: A test-retest study of TTP in 27 Colombian women was nested in a retrospective cohort study assessing the effect of mercury exposure on reproductive effects. The questionnaire was applied twice by the same trained interviewer (by person at baseline and by phone 12 months later). The TTP's reproducibility was evaluated using the intraclass correlation coefficient (ICC 2,k). Results: The median TTP was 4 months (Interquartile range 1-12). The range of time from the first pregnancy to the first interview was between 1 and 15 years. The ICC (2,k) was 0.726, (CI 95% 0.39 - 0.88), indicating good reproducibility between both measures. Conclusions: Our results suggest that TTP is a useful and reproducible measurement, with a remembrance time up to 15 years. Results were similar when assessed by phone and face-to face interview in a population of Colombian women.

Violence against women and gastroschisis: a case-control study.

BACKGROUND: Gastroschisis, a birth defect characterized by herniated fetal abdominal wall, occurs more commonly in infants born to teenage and young mothers. Ischemia of the vascular vitelline vessels is the likely mechanism of pathogenesis. Given that chronic stress and violence against women are risk factors for cardiovascular disease we explored whether these may represent risk factors for gastroschisis, when they occur during pregnancy. A case-control study was conducted, with 15 incident cases of children born with gastroschisis in the Region of Murcia, Spain, from December 2007 to June 2013. Forty concurrent controls were recruited at gestation weeks 20-24 or post-partum. All mothers of cases and controls completed a comprehensive, in-person, 'green sheet' questionnaire on environmental exposures. RESULTS: Mothers of children with gastroschisis were younger, smoked more cigarettes per week relative to controls, were exposed to higher amounts of illegal drugs, and suffered from domestic violence more frequently than the controls. Multivariable logistic regression analysis highlights periconceptional 'gender-related violence' (OR: 16.6, 95% CI 2.7 to 101.7) and younger maternal age (OR 1.1, 95% CI 1.0-1.3). CONCLUSIONS: Violence against pregnant women is associated with birth defects, and should be studied in more depth as a cause-effect teratogenic. Psychosocial risk factors, including gender-based violence, are important for insuring the health and safety of the pregnant mother and the fetus.