Compliance Surveillance of the Tobacco Control Legislation in a Spanish Region and Characterization of Passive Exposure to Tobacco Smoke and E-Cig in Children in Outdoor Spaces.

(1) Background: Exposure to environmental tobacco smoke has decreased in recent years in Spain, due to the implementation of tobacco control policies. However, there is no regulation that protects against second-hand smoke (SHS) in outdoor environments. Our goal is to describe the smoking prohibition signage in public spaces and to characterize tobacco consumption in outdoor environments describing the SHS exposure in children. (2) Methods: A cross-sectional study using direct observation was carried out with a convenience sample (n = 179) that included hospitality venues with terraces, schools and healthcare facilities in the municipality of Sant Cugat del Vallès (Barcelona, Spain). The observations were made without notifying the owners by one single field researcher between April and June 2018. The variables were evaluated by signage and signs of tobacco consumption (ashtrays, cigarette butts and presence of smokers). (3) Results: Smoke-free zone signage outside public spaces was present in 30.7% of all venues, with only 50.9% correctness. When analysing terraces of hospitality venues, in 35.8% of them there were children present with 66.7% of tobacco consumption. (4) Conclusions: Our results show a low prevalence of antismoking signage, without an impact on tobacco consumption regardless of the presence of children.

Incidence and Prevalence of Children's Diffuse Lung Disease in Spain.

BACKGROUND: Children's diffuse lung disease, also known as children's Interstitial Lung Diseases (chILD), are a heterogeneous group of rare diseases with relevant morbidity and mortality, which diagnosis and classification are very complex. Epidemiological data are scarce. The aim of this study was to analyse incidence and prevalence of chILD in Spain. METHODS: Multicentre observational prospective study in patients from 0 to 18 years of age with chILD to analyse its incidence and prevalence in Spain, based on data reported in 2018 and 2019. RESULTS: A total of 381 cases with chILD were notified from 51 paediatric pulmonology units all over Spain, covering the 91.7% of the paediatric population. The average incidence of chILD was 8.18 (CI 95% 6.28-10.48) new cases/million of children per year. The average prevalence of chILD was 46.53 (CI 95% 41.81-51.62) cases/million of children. The age group with the highest prevalence were children under 1 year of age. Different types of disorders were seen in children 2-18 years of age compared with children 0-2 years of age. Most frequent cases were: primary pulmonary interstitial glycogenosis in neonates (17/65), neuroendocrine cell hyperplasia of infancy in infants from 1 to 12 months (44/144), idiopathic pulmonary haemosiderosis in children from 1 to 5 years old (13/74), hypersensitivity pneumonitis in children from 5 to 10 years old (9/51), and scleroderma in older than 10 years old (8/47). CONCLUSIONS: We found a higher incidence and prevalence of chILD than previously described probably due to greater understanding and increased clinician awareness of these rare diseases.

Incidence and Prevalence of Children's Diffuse Lung Disease in Spain / Incidencia y prevalencia de las neumopatías intersticiales pediátricas en España

Background Children's diffuse lung disease, also known as children's Interstitial Lung Diseases (chILD), are a heterogeneous group of rare diseases with relevant morbidity and mortality, which diagnosis and classification are very complex. Epidemiological data are scarce. The aim of this study was to analyse incidence and prevalence of chILD in Spain. Methods Multicentre observational prospective study in patients from 0 to 18 years of age with chILD to analyse its incidence and prevalence in Spain, based on data reported in 2018 and 2019. Results A total of 381 cases with chILD were notified from 51 paediatric pulmonology units all over Spain, covering the 91.7% of the paediatric population. The average incidence of chILD was 8.18 (CI 95% 6.28–10.48) new cases/million of children per year. The average prevalence of chILD was 46.53 (CI 95% 41.81–51.62) cases/million of children. The age group with the highest prevalence were children under 1 year of age. Different types of disorders were seen in children 2–18 years of age compared with children 0–2 years of age. Most frequent cases were: primary pulmonary interstitial glycogenosis in neonates (17/65), neuroendocrine cell hyperplasia of infancy in infants from 1 to 12 months (44/144), idiopathic pulmonary haemosiderosis in children from 1 to 5 years old (13/74), hypersensitivity pneumonitis in children from 5 to 10 years old (9/51), and scleroderma in older than 10 years old (8/47). Conclusions We found a higher incidence and prevalence of chILD than previously described probably due to greater understanding and increased clinician awareness of these rare diseases.

Antecedentes Las neumopatías intersticiales pediátricas, también conocidas con el acrónimo chILD (del inglés children's Interstitial Lung Diseases), es un grupo heterogéneo de enfermedades raras con morbimortalidad relevante, cuyo diagnóstico y clasificación son complejos. Los estudios epidemiológicos son escasos. El objetivo de este trabajo fue analizar la incidencia y la prevalencia de chILD en España. Métodos Estudio prospectivo observacional multicéntrico en pacientes de 0 a 18 años afectos de chILD para analizar la incidencia y la prevalencia en España, a partir de datos recogidos en 2018 y 2019. Resultados Se recogieron 381 casos de chILD entre 51 unidades de neumología pediátrica de toda España, que cubrían el 91,7% de la población pediátrica. La incidencia promedio fue 8,18 (IC 95%: 6,28-10,48) casos nuevos/millón de niños por año. La prevalencia promedio fue de 46,53 (IC 95%: 41,81-51,62) casos/millón de niños. El grupo de edad con mayor prevalencia fue el de niños menores de un año. Se observaron diferentes entidades en niños de 2 a 18 años en comparación con niños de 0 a 2 años. Los diagnósticos más frecuentes fueron: glucogenosis intersticial pulmonar primaria en neonatos (17/65), hiperplasia de células neuroendocrinas en lactantes de uno a 12 meses (44/144), hemosiderosis pulmonar idiopática en niños de uno a 5 años (13/74), neumonía por hipersensibilidad en niños de 5 a 10 años (9/51) y esclerodermia en mayores de 10 años (8/47). Conclusiones Encontramos una mayor incidencia y prevalencia de chILD que las descritas previamente, probablemente debido a un mayor conocimiento y detección de estas enfermedades raras.

Smartphone and Tablet Usage during COVID-19 Pandemic Confinement in Children under 48 Months in Barcelona (Spain).

BACKGROUND: Total lockdown due to COVID-19 pandemic might have potentially increased screen time in children. This study aims to describe the smartphone and tablets usage in children under 48 months living in Barcelona during the COVID-19 confinement. METHODS: Cross-sectional study using a non-probabilistic sample of parents with children under 48 months living in Barcelona (Spain) during COVID-19 confinement (n = 313). We calculated percentages of exposure to smartphones and tablets. Moreover, for those children were exposed, we calculated unadjusted and adjusted Geometric Mean Ratios (GMR) of daily smartphones and tablets usage and their 95% confidence intervals (95% CI) trough Generalized Linear Models with Gamma family and link log. Associations were adjusted for potential confounders. RESULTS: During COVID-19 confinement, 67.5% of children under 48 months were daily exposed to smartphones and tablets. Further, those children who were exposed during meals, as well as before going to bed, spend longer durations using them, aGMR = 2.38 (95% CI 1.73, 3.34) and aGMR = 1.95 (95% CI 1.34, 2.91) respectively. CONCLUSION: Two out of three children under 48 months living in Barcelona were daily exposed to smartphones and tablets during total lockdown due to COVID-19. Taking this findings into account cohort studies are needed to assess any change in the screen time patterns due to total confinement in order to allow the Government help families, particularly those more vulnerable, in a possible pandemic resurgence.

How do infants and toddlers sleep in Spain? A cross-sectional study.

There is limited information on sleep patterns among infants and toddlers in Spain. The aim of this study was to assess sleep patterns in children three to 36 months of age in Spain. A cross-sectional study was conducted between February 2017 and February 2018. Sociodemographic data and sleep variables were collected using an expanded version of the validated Spanish version of the brief infant sleep questionnaire. A total of 1,404 parental reports on children (725 males; 679 females) with a mean age of 18.8 ± 9.5 months were collected. Parents who perceived their child's sleep as problematic (39% of our sample) reported fewer sleep hours (median 9 versus 10 h), more night awakenings (median 2 versus 1), and longer periods of nocturnal awakenings (median 0.5 versus 0.08 min) (p < 0.001). Parental presence at the time of sleep onset and later and irregular bedtime routines were significantly associated with a reduction in total sleep time, longer sleep latency, and disruptive night awakenings (p < 0.001). These findings highlight the need for further studies to assess how to improve sleep patterns as a relevant modifiable lifestyle factor.Conclusion: A substantial percentage of the population perceived that their children slept poorly, which was evident in a variety of sleep patterns, including sleep duration and sleep quality. What is known: • Previous research has established that sleep difficulties among pediatric population affect up to 30% of all children and up to 20-30% of infants and toddlers. • A positive relationship between less parental bedtime involvement and sleep consolidation in infants and toddlers has been established. What is new: • More than a third of Spanish parents perceived their infants and toddlers sleep as problematic and their children reportedly have shorter night sleep hours, more night awakenings, and longer periods of nocturnal awakenings. • Later and irregular parental bedtime routines were associated with worst infants and toddlers sleep.

Immunofluorescence Analysis as a Diagnostic Tool in a Spanish Cohort of Patients with Suspected Primary Ciliary Dyskinesia.

Primary ciliary dyskinesia (PCD) is an autosomal recessive rare disease caused by an alteration of ciliary structure. Immunofluorescence, consisting in the detection of the presence and distribution of cilia proteins in human respiratory cells by fluorescence, has been recently proposed as a technique to improve understanding of disease-causing genes and diagnosis rate in PCD. The objective of this study is to determine the accuracy of a panel of four fluorescently labeled antibodies (DNAH5, DNALI1, GAS8 and RSPH4A or RSPH9) as a PCD diagnostic tool in the absence of transmission electron microscopy analysis. The panel was tested in nasal brushing samples of 74 patients with clinical suspicion of PCD. Sixty-eight (91.9%) patients were evaluable for all tested antibodies. Thirty-three cases (44.6%) presented an absence or mislocation of protein in the ciliary axoneme (15 absent and 3 proximal distribution of DNAH5 in the ciliary axoneme, 3 absent DNAH5 and DNALI1, 7 absent DNALI1 and cytoplasmatic localization of GAS8, 1 absent GAS8, 3 absent RSPH9 and 1 absent RSPH4A). Fifteen patients had confirmed or highly likely PCD but normal immunofluorescence results (68.8% sensitivity and 100% specificity). In conclusion, immunofluorescence analysis is a quick, available, low-cost and reliable diagnostic test for PCD, although it cannot be used as a standalone test.

Humo de tercera mano y otros retos del control del tabaquismo en población pediátrica / Thirdhand smoke and other challenges of tobacco control in the pediatric population

No disponible

Síndrome de muerte súbita del lactante: ¿siguen las familias las recomendaciones? / Sudden infant death syndrome: Do the parents follow the recommendations?

INTRODUCCIÓN: La postura en decúbito prono al dormir es el principal factor de riesgo modificable conocido para el síndrome de muerte súbita del lactante (SMSL). Existen otras recomendaciones respecto al SMSL con menor impacto. El objetivo de este estudio es conocer la prevalencia del decúbito prono durante el sueño así como de otros factores de riesgo asociados a SMSL en una muestra de lactantes españoles. MATERIAL Y MÉTODOS: Estudio transversal realizado en 640 familias con niños de 0 meses a 11 meses. Además de la postura, se analizó la adherencia a otras cuatro recomendaciones respecto al SMSL: lugar donde duerme el lactante, lactancia materna, succión no nutritiva y tabaquismo materno. RESULTADOS: El 41,3% de los menores de 6 meses y el 59,7% de los lactantes de 6 a 11 meses dormían en una postura no recomendada. Solo el 6,4% de las familias seguían las cinco recomendaciones analizadas. DISCUSIÓN: Existe una elevada prevalencia de factores de riesgo modificables de SMSL en la población estudiada. Parece necesario reimpulsar la educación personalizada y otras campañas de concienciación y prevención del SMSL

INTRODUCTION: Prone sleeping position is the main known modifiable risk factor for sudden infant death syndrome (SIDS). There are other SIDS recommendations although with less impact. The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. METHODS: Cross-sectional study carried out on 640 families with children from 0 months to 11 months. In addition to the sleep position, the adherence to four other recommendations regarding SIDS was analysed: place where infant sleeps, breastfeeding, use of non-nutritive suction, and maternal smoking. RESULTS: A total of 41.3% of infants under 6 months and 59.7% of infants aged 6 to 11 months slept in a non-recommended position. Only 6.4% of families analysed followed all five recommendations. DISCUSSION: There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS

[Sudden infant death syndrome: Do the parents follow the recommendations?] / Síndrome de muerte súbita del lactante: ¿siguen las familias las recomendaciones?

INTRODUCTION: Prone sleeping position is the main known modifiable risk factor for sudden infant death syndrome (SIDS). There are other SIDS recommendations although with less impact. The objective of this study is to describe the prevalence of prone position during sleep as well as other risk factors associated with SIDS in a sample of Spanish babies and infants. METHODS: Cross-sectional study carried out on 640 families with children from 0 months to 11 months. In addition to the sleep position, the adherence to four other recommendations regarding SIDS was analysed: place where infant sleeps, breastfeeding, use of non-nutritive suction, and maternal smoking. RESULTS: A total of 41.3% of infants under 6 months and 59.7% of infants aged 6 to 11 months slept in a non-recommended position. Only 6.4% of families analysed followed all five recommendations. DISCUSSION: There is a high prevalence of modifiable risk factors for SIDS among the studied population. Personalized education should be promoted, along with other campaigns to raise awareness and prevent SIDS.

[Prevalence of smoke-free homes and passive exposure to tobacco in pediatric population (children from 3 to 36 months)]. / Prevalencia de hogares libres de humo y exposición pasiva al tabaco en población pediátrica (niños de 3 a 36 meses).

OBJECTIVE: Pediatric population is the most vulnerable to secondhand smoke (SHS), exposure being households the main source of exposure in children. The objective of this study is to describe smoke-free households and the prevalence of SHS in the pediatric population (from 3 to 36 months) in Spain. METHODS: Cross-sectional study with 1,368 parents, mothers or guardians with children from 3 to 36 months carried out in Spain from March to November of 2017 through an online questionnaire as part of the EPISON study. Information was collected on the voluntary adoption of tobacco use regulations at home and SHS exposure at home and other environments. We calculated prevalences and Odds Ratio adjusted (ORa) for sex, age, level of education, and smoking status. RESULTS: 87.6% of respondents claimed to have a smoke-free home. 12.4% of respondents had partial regulation or did not have regulation at home, increasing up to 26.0% when the parent was a smoker or to 21.8% when the parent had primary or lower education. 5.4% of parents reported SHS exposure in their children at their homes, rising to 14.5% when it occurs in other environments, increasing with statistically significant differences between smoking parents and parents with lower educational level. CONCLUSIONS: The smoke-free homes are the majority; but SHS exposure to tobacco at home persists in children under 3 years of age, especially in families with a lower educational level. Therefore, awareness-raising campaigns on the effects of passive exposure on minors among families with.

OBJETIVO: La población pediátrica es la más vulnerable a la exposición pasiva al humo ambiental del tabaco (HAT), siendo los hogares la fuente principal de exposición en niños. El objetivo de este estudio fue describir los hogares libres de humo y la prevalencia de exposición pasiva al HAT en la población pediátrica (de 3 a 36 meses) en España. METODOS: Estudio transversal con 1.368 padres, madres o tutores con hijos de 3 a 36 meses realizado en España de marzo a noviembre de 2017 mediante cuestionario online como parte del estudio EPISON. Se recogió información sobre la adopción voluntaria de normas de consumo de tabaco en el hogar y exposición al HAT en casa y otros ambientes. Se calcularon las prevalencias y las Odds Ratio ajustadas (ORa) por sexo, edad, nivel educativo y consumo de tabaco. RESULTADOS: El 87,6% de los encuestados afirmó tener un hogar libre de humo. El 12,4% de los encuestados tenían regulación parcial o no tenían ninguna regulación en el hogar, incrementándose hasta el 26% cuando el progenitor era fumador o al 21,8% cuando tenía estudios primarios o inferiores. El 5,4% de los padres refirió exposición pasiva al tabaco en niños en sus hogares, elevándose hasta el 14,5% cuando la exposición se produjo en otros ambientes, incrementándose de forma estadísticamente significativa la diferencia entre los padres fumadores y con menor nivel educativo. CONCLUSIONES: Los hogares libres de humo son mayoritarios, pero persiste la exposición pasiva al tabaco en el hogar con niños menores de 3 años, especialmente en familias con menor nivel educativo. Por ello, se deberían incentivar campañas de sensibilización sobre los efectos de la exposición pasiva en menores, especialmente en familias con menos recursos.

Prevalencia de hogares libres de humo y exposición pasiva al tabaco en población pediátrica (niños de 3 a 36 meses) / Prevalence of smoke-free homes and passive exposure to tobacco in pediatric population (children from 3 to 36 months)

OBJETIVO: La población pediátrica es la más vulnerable a la exposición pasiva al humo ambiental del tabaco (HAT), siendo los hogares la fuente principal de exposición en niños. El objetivo de este estudio fue describir los hogares libres de humo y la prevalencia de exposición pasiva al HAT en la población pediátrica (de 3 a 36 meses) en España. MÉTODOS: Estudio transversal con 1.368 padres, madres o tutores con hijos de 3 a 36 meses realizado en España de marzo a noviembre de 2017 mediante cuestionario online como parte del estudio EPISON. Se recogió información sobre la adopción voluntaria de normas de consumo de tabaco en el hogar y exposición al HAT en casa y otros ambientes. Se calcularon las prevalencias y las Odds Ratio ajustadas (ORa) por sexo, edad, nivel educativo y consumo de tabaco. RESULTADOS: El 87,6% de los encuestados afirmó tener un hogar libre de humo. El 12,4% de los encuestados tenían regulación parcial o no tenían ninguna regulación en el hogar, incrementándose hasta el 26% cuando el progenitor era fumador o al 21,8% cuando tenía estudios primarios o inferiores. El 5,4% de los padres refirió exposición pasiva al tabaco en niños en sus hogares, elevándose hasta el 14,5% cuando la exposición se produjo en otros ambientes, incrementándose de forma estadísticamente significativa la diferencia entre los padres fumadores y con menor nivel educativo. CONCLUSIONES: Los hogares libres de humo son mayoritarios, pero persiste la exposición pasiva al tabaco en el hogar con niños menores de 3 años, especialmente en familias con menor nivel educativo. Por ello, se deberían incentivar campañas de sensibilización sobre los efectos de la exposición pasiva en menores, especialmente en familias con menos recursos

OBJECTIVE: Pediatric population is the most vulnerable to secondhand smoke (SHS), exposure being households the main source of exposure in children. The objective of this study is to describe smoke-free households and the prevalence of SHS in the pediatric population (from 3 to 36 months) in Spain. METHODS: Cross-sectional study with 1,368 parents, mothers or guardians with children from 3 to 36 months carried out in Spain from March to November of 2017 through an online questionnaire as part of the EPISON study. Information was collected on the voluntary adoption of tobacco use regulations at home and SHS exposure at home and other environments. We calculated prevalences and Odds Ratio adjusted (ORa) for sex, age, level of education, and smoking status. RESULTS: 87.6% of respondents claimed to have a smoke-free home. 12.4% of respondents had partial regulation or did not have regulation at home, increasing up to 26.0% when the parent was a smoker or to 21.8% when the parent had primary or lower education. 5.4% of parents reported SHS exposure in their children at their homes, rising to 14.5% when it occurs in other environments, increasing with statistically significant differences between smoking parents and parents with lower educational level. CONCLUSIONS: The smoke-free homes are the majority; but SHS exposure to tobacco at home persists in children under 3 years of age, especially in families with a lower educational level. Therefore, awareness-raising campaigns on the effects of passive exposure on minors among families with

Adaptación y estudio de propiedades métricas de un cuestionario de valoración del sueño para lactantes y preescolares / Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children

INTRODUCCIÓN: Aunque las alteraciones del sueño en lactantes y preescolares son comunes, no se dispone de un instrumento en español adecuadamente validado para su estudio. El Brief Infant Sleep Questionnaire (BISQ) es un cuestionario multidimensional bien establecido con este fin en el ámbito internacional. OBJETIVOS: Adaptar el BISQ al español y analizar su fiabilidad y validez. Explorar su viabilidad en el contexto asistencial y de investigación. Participantes y métodos: Se incluyeron niños de 3 a 30 meses de edad. La adaptación al español (BISQ-E) se efectuó mediante técnica bilingüe de retrotraducción y consenso, siguiendo las recomendaciones internacionales. Se evaluó la fiabilidad mediante análisis de los resultados del test-retest del BISQ-E y de la concordancia de las respuestas a 2formas de administración (autoadministración y entrevista clínica). La validez de constructo se estableció analizando su correlación con un diario de sueño. RESULTADOS: Participaron un total de 87 familias/niños. La correlación global test-retest en 60 sujetos fue de r = 0,848 (p < 0,001). El índice de kappa entre las 2 formas de administración fue de 0,939 (IC 95%: 0,858-1,00; p < 0,001).La correlación BISQ-E-diario de sueño se analizó en 27 familias/niños y fue estadísticamente significativa para las variables estudiadas: hora de acostarse (r = 0,731), horas de sueño nocturno (r = 0,726), horas de sueño diurno r = 0,867) y número de despertares nocturnos (r = 0,888) (p < 0,001). CONCLUSIONES: La adaptación española del BISQ presenta unas características de validez y fiabilidad adecuadas para la evaluación del sueño en lactantes y preescolares. Su utilización como instrumento clínico o para estudios de investigación clínico-epidemiológica resulta factible

INTRODUCTION: Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally. OBJECTIVES: To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research. METHODS: Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2 forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary. RESULTS: A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r = 0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r = 0.731), hours of night sleep (r = 0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r = 0.888) (P < 0.001). CONCLUSIONS: The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible

Knowledge and attitudes toward thirdhand smoke among parents with children under 3 years in Spain.

INTRODUCTION: The knowledge and beliefs about what is thirdhand smoke (THS) are limited. Our objective is to characterize the knowledge and beliefs about THS in parents of children under 3 years old in Spain. METHODS: A cross-sectional study (n = 1406 parents) was conducted online in 2017. We collected information about the knowledge of THS given later, written information with the definition of THS, and asking about beliefs of the effects of THS on children's health. RESULTS: A total of 27% of the respondents had heard about THS. We only found significant differences among smoking status, being the smokers who declare higher knowledge about THS. A total of 86% of the respondents believed that THS is harmful to their children with statistically significant differences according to educational level, higher among parents with a university degree (ORa = 2.6), and according to the previous knowledge on THS (ORa = 2.1). CONCLUSIONS: This is the first study in Europe to describe the knowledge and belief of THS. Around 3 out of 10 parents have heard about THS and more than 8 out of 10 parents believed that THS is harmful to their children. Currently, they were not aware of THS but after providing brief information about it, most of them agreed that THS exposure is harmful to their children.

Update on thirdhand smoke: A comprehensive systematic review.

OBJECTIVE: The objective of this study is to perform a comprehensive review of the literature about thirdhand smoke (THS). METHODS: Systematic review of all aspects of THS. Standard methodological procedures were used to search the following databases through April 2018: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (WOS) in Indo-European languages. To identify published grey literature, the first 200 hits from Google Scholar™ were evaluated. Clinical trial databases, conference proceedings, and reference lists from the identified articles were also searched. Two unblinded review authors independently assessed trials for inclusion in the review. These same reviewers also extracted study data in accordance with PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42018083619). RESULTS: Sixty-eight articles were included in this systematic review. Of these, 28 analyzed the concentration of nicotine as a component of THS (the most commonly-used method to measure THS in those studies was chromatography, followed by the mass spectrometry), 21 evaluated the exposure and impact of THS on health (11 studies analyzed the effect of THS in cells [human and animal], 4 in animals, 1 in adults, and 5 in children), 16 investigated the beliefs, behaviours, and policies related to THS, and 3 evaluated other aspects such as THS in e-cigarettes or hookahs. In these 68 studies, THS was determined by measuring the following components: nicotine (30 studies), nitrosamines (17 studies) and cotinine (15 studies). The findings from most of these studies suggest a potential health impact of THS exposure (i.e.: cytotoxicity, metabolic alterations in metabolism, in glycemia; or cell structure; alterations in liver, lung, skin and behaviour in mice), and low awareness about the risks of THS among the general population. CONCLUSIONS: Numerous specific biomarkers of THS were evaluated, with the most common being nicotine, nitrosamines, and cotinine. The most common method of preparing THS dust samples were cotton wipes, while chromatography, used alone or coupled with mass spectrometry, was the most common analytical technique. We have tried to establish common bases after reviewing all the current literature of the THS although, there is great heterogeneity between the studies and we have not always succeeded. The studies in this review demonstrate the harmful effects of THS on health in cells, in animal models, and in people including children. However, in people, the long-term effects remain unknown and more research is needed. These studies show that knowledge about THS and its potential harmful effects are poorly understood among the general population. For this reason, THS should receive greater emphasis in education and awareness policies.

[Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children]. / Adaptación y estudio de propiedades métricas de un cuestionario de valoración del sueño para lactantes y preescolares.

INTRODUCTION: Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally. OBJECTIVES: To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research. METHODS: Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary. RESULTS: A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r = 0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r = 0.731), hours of night sleep (r = 0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r = 0.888) (P < 0.001). CONCLUSIONS: The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible.

Correlation between tobacco control policies and preterm births and low birth weight in Europe.

OBJECTIVE: To assess the correlation between tobacco control policies- particularly smoking bans in work and public places-and the prevalence of preterm births and low birth weight in the European countries. METHODS: This is an ecological study and the unit of analysis set at the country level. Tobacco control data in Europe were obtained for the years 2010 and 2013 as measured by the Tobacco Control Scale (TCS), which reflects the level of implementation of tobacco control policies. Prevalence data for preterm births and low birth weight were obtained from two sources: the European Perinatal Health Report (EPHR), which provides data for 2010, and the Eurostat data, which includes the years 2013 and 2014. We analyzed the correlation between the TCS score and the prevalence of preterm birth and low birth weight in the European countries by means of Spearman (rsp) rank-correlation coefficients and their 95% confidence intervals (95%CI). RESULTS: The 2010 TCS was negatively correlated with the prevalence of preterm births before week 37 (rsp = -0.51; 95% CI: -0.77, -0.15; p = 0.006) and week 32 (rsp = -0.42; 95%CI: -0.73, -0.01; p = 0.030) and with the prevalence of the low birth weight (< 2500g, (rsp = -0.42; 95% CI: -0.66, -0.09; p = 0.028) in European countries in 2010. We found a statistically significant inverse correlation between the level of restrictions on smoking in public places and the prevalence of low birth weight (< 2500g rsp: -0.54; 95%CI: -0.72, -0.10; p = 0.017). CONCLUSION: The level of smoke-free legislation in European countries correlates with lower preterm birth prevalence rates at the ecological level. Given the important negative effects of premature births for the public health system, these data support greater implementation of smoke-free policies and tend to support the implementation of tobacco control policies, but more research is needed.