The relationship between active/passive smoking and spontaneous preterm birth: Data from a multicenter study.

BACKGROUND: Prematurity is considered to be the leading cause of death in children under 5 years of age, with one child dying every 2 s. Smoking is known to be one of the factors associated with prematurity, with both immediate and late consequences. However, it is difficult to obtain concrete data on the relationship between smoking and spontaneous preterm birth. OBJECTIVE: The aim of this study was to evaluate the influence of active and passive smoking on spontaneous preterm birth. METHODS: This was a multicenter, cross-sectional complementary study that included data on preterm births in 20 maternity hospitals in Brazil between 2011 and 2012. The relationship between smoking category (people who smoke [PWS]; people who smoke indirectly [PWSI]; and people who do not smoke [PWDNS]) and sociodemographic characteristics, birth, and neonatal data was assessed. Statistical analysis was performed using frequencies, percentages, the χ2 test, and stepwise comparisons, with a significance level of 5%. RESULTS: The original study included 5295 pregnant participants and their preterm infants. There were 1491 spontaneous preterm births (SPBs); 1191 preterm rupture of membranes; 1468 therapeutic preterm births; and 1146 term births. The proportion of women who were PWS during pregnancy was 13.5%, and 31.6% were PWSI. Pregnant individuals who smoked and who smoked indirectly had a higher incidence of SPBs (61.2%) compared with PWDNS (48.4%; P < 0.0001); however, multivariate analysis did not confirm causality. CONCLUSIONS: This study did not confirm that smoking during pregnancy increases the risk of SPB. PWSI also did not have an increased incidence of spontaneous preterm birth or adverse neonatal outcomes.

Discriminative Accuracy of Chronic Obstructive Pulmonary Disease Screening Instruments in 3 Low- and Middle-Income Country Settings.

Importance: Most of the global morbidity and mortality in chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs), with significant economic effects. Objective: To assess the discriminative accuracy of 3 instruments using questionnaires and peak expiratory flow (PEF) to screen for COPD in 3 LMIC settings. Design, Setting, and Participants: A cross-sectional analysis of discriminative accuracy, conducted between January 2018 and March 2020 in semiurban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda, using a random age- and sex-stratified sample of the population 40 years or older. Exposures: Three screening tools, the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE; range, 0-6; high risk indicated by a score of 5 or more or score 2-5 with low PEF [<250 L/min for females and <350 L/min for males]), the COPD in LMICs Assessment questionnaire (COLA-6; range, 0-5; high risk indicated by a score of 4 or more), and the Lung Function Questionnaire (LFQ; range, 0-25; high risk indicated by a score of 18 or less) were assessed against a reference standard diagnosis of COPD using quality-assured postbronchodilator spirometry. CAPTURE and COLA-6 include a measure of PEF. Main Outcomes and Measures: The primary outcome was discriminative accuracy of the tools in identifying COPD as measured by area under receiver operating characteristic curves (AUCs) with 95% CIs. Secondary outcomes included sensitivity, specificity, positive predictive value, and negative predictive value. Results: Among 10 709 adults who consented to participate in the study (mean age, 56.3 years (SD, 11.7); 50% female), 35% had ever smoked, and 30% were currently exposed to biomass smoke. The unweighted prevalence of COPD at the 3 sites was 18.2% (642/3534 participants) in Nepal, 2.7% (97/3550) in Peru, and 7.4% (264/3580) in Uganda. Among 1000 COPD cases, 49.3% had clinically important disease (Global Initiative for Chronic Obstructive Lung Disease classification B-D), 16.4% had severe or very severe airflow obstruction (forced expiratory volume in 1 second <50% predicted), and 95.3% of cases were previously undiagnosed. The AUC for the screening instruments ranged from 0.717 (95% CI, 0.677-0.774) for LFQ in Peru to 0.791 (95% CI, 0.770-0.809) for COLA-6 in Nepal. The sensitivity ranged from 34.8% (95% CI, 25.3%-45.2%) for COLA-6 in Nepal to 64.2% (95% CI, 60.3%-67.9%) for CAPTURE in Nepal. The mean time to administer the instruments was 7.6 minutes (SD 1.11), and data completeness was 99.5%. Conclusions and Relevance: This study demonstrated that screening instruments for COPD were feasible to administer in 3 low- and middle-income settings. Further research is needed to assess instrument performance in other low- and middle-income settings and to determine whether implementation is associated with improved clinical outcomes.

Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study.

OBJECTIVES: To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7 years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH. STUDY DESIGN: Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1 hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170 mg/dL, fasting glucose <100 mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P < .05) in a multivariable logistic regression model. RESULTS: ICVH prevalence at mean ± SD age 4.7±0.6 years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese = 0.41 [0.23, 0.73]) and offspring sex (ORmale vs female = 2.14 [1.22, 3.65]). CONCLUSIONS: At age 4-7 years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.

Exposure to secondhand smoke among patients with asthma: a cross-sectional study.

OBJECTIVE: To estimate the frequency of secondhand smoke exposure among patients with asthma. METHODS: A cross-sectional study of asthma patients and non-asthmatic controls using questionnaires to identify secondhand smoke exposure at home, school, work, and public places. RESULTS: We studied 544 severe asthma patients, 452 mild/moderate asthma patients, and 454 non-asthmatic patients. Among severe patients, the mean age was 51.9 years, 444 (81.6%) were female, 74 (13.6%) were living with a smoker, 383 (71.9%) reported exposure in public spaces and, of the 242 (44.5%) who worked/ studied, 46 (19.1%) reported occupational exposure. Among those with mild/moderate asthma, the mean age was 36.8 years, 351 (77.7%) were female, 50 (11.1%) reported living with a smoker, 381 (84.9%) reported exposure in public settings and, of the 330 (73.0%) who worked/ studied, 58 (17.7%) reported occupational exposure. An association between secondhand smoke exposure and disease control was found among patients with mild/moderate asthma. Among those interviewed, 71% of severe asthma patients and 63% of mild/moderate asthma patients avoided certain places due to fear of secondhand smoke exposure. CONCLUSION: Secondhand smoke exposure is a situation frequently reported by a significant proportion of asthma patients. Individuals with asthma are exposed to this agent, which can hamper disease control, exacerbate symptoms and pose unacceptable limitations to their right to come and go in public settings.

The relationship between second-hand smoke and wheezing in infants from Córdoba, Argentina.

BACKGROUND: Wheezing constitutes a common respiratory symptom in children, and several risk factors have been associated with the prevalence of recurrent wheezing (RW) and its severity, especially viral respiratory infections and second-hand smoke (SHS) exposure. OBJECTIVE: To analyze the relationship between smoking patterns in the home and wheezing, in infants from the city of Córdoba, Argentina, during their first year of life. METHODS: Parents of infants were invited to complete a standardized questionnaire voluntarily and anonymously (WQ-P1-EISL). Wheezing in the first 12 months of life was classified as occasional wheezing (OW) when having one or two episodes during the first 12 months of life; recurrent wheezing (RW) if having three or more, and more frequent wheezing (MFW) ≥6 episodes. RESULTS: 409 infants (39.0%) had one or more episodes of wheezing in the first 12 months. Of these, 214 infants (52.3%) presented occasional wheezing (OW), 135 (33%) had recurrent wheezing (RW), and 60 (14.7%) more frequent wheezing (MFW). SHS was significantly related to MFW, especially if the mother smoked (OR=2.7; IC 95%: 1.4-5.18; p=0.0009) or if she smoked during pregnancy (OR=4; IC 95%: 1.8-8.5; p=0.0001). This group of MFW was also associated with SHS as well as having been to the emergency room for wheezing (40.87%, p=0.0056). CONCLUSION: The results indicate that second-hand tobacco smoke is a significant risk factor for the presence of wheezing in infants, and for its severity. Our findings have significant implications for public health, as smoking is a modifiable behavior.

Exposure to secondhand smoke among patients with asthma: a cross-sectional study / Exposição à fumaça secundária do cigarro entre pacientes com asma: estudo transversal

ABSTRACT Objective To estimate the frequency of secondhand smoke exposure among patients with asthma. Methods A cross-sectional study of asthma patients and non-asthmatic controls using questionnaires to identify secondhand smoke exposure at home, school, work, and public places. Results We studied 544 severe asthma patients, 452 mild/moderate asthma patients, and 454 non-asthmatic patients. Among severe patients, the mean age was 51.9 years, 444 (81.6%) were female, 74 (13.6%) were living with a smoker, 383 (71.9%) reported exposure in public spaces and, of the 242 (44.5%) who worked/ studied, 46 (19.1%) reported occupational exposure. Among those with mild/moderate asthma, the mean age was 36.8 years, 351 (77.7%) were female, 50 (11.1%) reported living with a smoker, 381 (84.9%) reported exposure in public settings and, of the 330 (73.0%) who worked/ studied, 58 (17.7%) reported occupational exposure. An association between secondhand smoke exposure and disease control was found among patients with mild/moderate asthma. Among those interviewed, 71% of severe asthma patients and 63% of mild/moderate asthma patients avoided certain places due to fear of secondhand smoke exposure. Conclusion Secondhand smoke exposure is a situation frequently reported by a significant proportion of asthma patients. Individuals with asthma are exposed to this agent, which can hamper disease control, exacerbate symptoms and pose unacceptable limitations to their right to come and go in public settings.

RESUMO Objetivo Estimar a frequência de exposição à fumaça secundária do cigarro entre pacientes com asma. Métodos Estudo transversal, que avaliou pacientes com asma e controles sem asma, por meio de questionários, para identificar a exposição secundária à fumaça do cigarro no ambiente domiciliar, escolar, no trabalho e em ambientes públicos. Resultados Estudamos 544 asmáticos graves, 452 com asma leve/moderada e 454 sem asma. Entre os asmáticos graves, a média de idade foi de 51,9 anos, 444 (81,6%) eram do sexo feminino, 74 (13,6%) tinham fumantes em sua residência, 383 (71,9%) relataram exposição em ambientes públicos e, dos 242 (44,5%) que trabalhavam e/ou estudavam, 46 (19,1%) admitiram exposição ocupacional. Entre asmáticos leves/moderados, a média de idade foi de 36,8 anos, 351 (77,7%) eram do sexo feminino, 50 (11,1%) afirmaram haver tabagistas em sua residência, 381(84,9%) relataram exposição em ambientes públicos e, dos 330 (73,0%) que trabalhavam e/ou estudavam, 58 (17,7%) referiram exposição ocupacional. Encontrou-se associação entre exposição à fumaça secundária do cigarro e controle da doença entre pacientes com asma leve/moderada. Entre os entrevistados, 71% dos pacientes asmáticos graves e 63% daqueles com asma leve/moderada relataram evitar frequentar certos ambientes pelo receio da exposição à fumaça secundária do cigarro − relato mais associado aos pacientes com asma grave. Conclusão A exposição secundária à fumaça do cigarro é uma situação frequente e relatada por uma proporção significativa de asmáticos. Indivíduos com asma encontram-se expostos a este agente, que pode dificultar o controle da doença, exacerbar sintomas e lhes impor limitação inaceitável ao direito de ir e vir em ambientes públicos.

Factores asociados con la exposición al humo de tabaco de segunda mano en lugares públicos y privados en México. Encodat 2016 / Correlates of secondhand smoke exposure in public and private settings in Mexico. Encodat 2016

Resumen: Objetivo: Determinar los factores asociados con la exposición al humo de tabaco de segunda mano (HTSM) en lugares públicos y privados. Material y métodos: Se analizó la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016. La exposición al HTSM se evaluó mediante modelos Poisson multinivel. La muestra del estudio incluye únicamente no fumadores. Resultados: La exposición al HTSM fue similar en los estados que tienen prohibición total para fumar en espacios cerrados en comparación con estados con prohibición parcial. Adultos jóvenes, hombres y personas con nivel educativo alto tienen mayor exposición al HTSM en bares y restaurantes. Los hombres tienen mayor exposición al HTSM en el trabajo, los adultos de mayor edad en el transporte público, mientras las mujeres y adolescentes en el hogar. Conclusiones: La exposición al HTSM continúa elevada y afecta diferencialmente a la población mexicana. Para reducirla, se requiere aplicar totalmente el artículo octavo del Convenio Marco para el Control del Tabaco.

Abstract: Objective: To assess the correlates of secondhand smoke exposure (SHS) in public and private settings. Materials and methods: Data came from the 2016 National Survey of Drug, Alcohol and Tobacco use. Multilevel Poisson models were conducted to evaluate factors associated with SHS. Results: Having a higher education, being male and being a young adult were associated with higher SHS in bars and restaurants. Men had greater SHS at work, while women and adolescents had greater exposure at home. Adults older than 45 years had higher SHS on public transportation compared to adolescents between 12-17 years old. Conclusions: Exposure to SHS remains high and affects the population differentially. To reduce SHS, it is necessary to apply Article 8 of the Framework Convention on Tobacco Control.

[Correlates of secondhand smoke exposure in public and private settings in Mexico. Encodat 2016.] / Factores asociados con la exposición al humo de tabaco de segunda mano en lugares públicos y privados en México. Encodat 2016.

OBJECTIVE: To assess the correlates of secondhand smoke exposure (SHS) in public and private settings. MATERIALS AND METHODS: Data came from the 2016 National Survey of Drug, Alcohol and Tobacco use. Multilevel Poisson models were conducted to evaluate factors associated with SHS. RESULTS: Having a higher education, being male and being a young adult were associated with higher SHS in bars and restaurants. Men had greater SHS at work, while women and adolescents had greater exposure at home. Adults older than 45 years had higher SHS on public transportation compared to adolescents between 12-17 years old. CONCLUSIONS: Exposure to SHS remains high and affects the population differentially. To reduce SHS, it is necessary to apply Article 8 of the Framework Convention on Tobacco Control.

OBJETIVO: Determinar los factores asociados con la exposición al humo de tabaco de segunda mano (HTSM) en lugares públicos y privados. MATERIAL Y MÉTODOS: Se analizó la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016. La exposición al HTSM se evaluó mediante modelos Poisson multinivel. La muestra del estudio incluye únicamente no fumadores. RESULTADOS: La exposición al HTSM fue similar en los estados que tienen prohibición total para fumar en espacios cerrados en comparación con estados con prohibición parcial. Adultos jóvenes, hombres y personas con nivel educativo alto tienen mayor exposición al HTSM en bares y restaurantes. Los hombres tienen mayor exposición al HTSM en el trabajo, los adultos de mayor edad en el transporte público, mientras las mujeres y adolescentes en el hogar. CONCLUSIONES: La exposición al HTSM continúa elevada y afecta diferencialmente a la población mexicana. Para reducirla, se requiere aplicar totalmente el artículo octavo del Convenio Marco para el Control del Tabaco.

Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013.

BACKGROUND: Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013. METHODS: Data were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis. RESULTS: Prevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES. CONCLUSIONS: While overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.

Secondhand smoking, knowledge/attitudes and socioeconomic status among married Bangladeshi women: a cross-sectional study.

BACKGROUND: There is a paucity of research on knowledge/attitudes regarding the dangers of exposure to secondhand smoking (SHS) among women. The relationship between exposure to SHS, socioeconomic status (SES) and knowledge/attitudes regarding the risks of SHS has often been ignored. We therefore aimed to examine (1) whether SES and exposure to SHS were independently associated with knowledge/attitudes regarding the risks of SHS; and (2) whether women with low SES and exposure to SHS were uniquely disadvantaged in terms of deficient knowledge and more dismissive attitudes towards the risks of SHS. DESIGN AND SETTING: Cross-sectional study in the Rajshahi district, Bangladesh. METHODS: A total of 541 women were interviewed. Knowledge of and attitudes towards the risks of SHS were the outcomes of interest. RESULTS: A majority of the respondents were exposed to SHS at home (49.0%). Only 20.1% had higher levels of knowledge, and only 37.3% had non-dismissive attitudes towards the risks of SHS. Participants in the low SES group and those exposed to SHS had lower odds of higher knowledge and their attitudes towards the risks of SHS were more dismissive. Regarding deficient levels of knowledge and scores indicating more dismissive attitudes, women in the low SES group and who were exposed to SHS were not uniquely disadvantaged. CONCLUSIONS: Exposure to SHS and low SES were independently associated with deficient knowledge and scores indicating more dismissive attitudes. Regarding knowledge/attitudes, the negative effect of exposure to SHS extended across all socioeconomic backgrounds and was not limited to women in either the low or the high SES group.

Association of secondhand tobacco smoke exposure during childhood on adult cardiovascular disease risk among never-smokers.

PURPOSE: Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD. METHODS: In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers. RESULTS: Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD. CONCLUSIONS: We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.

Secondhand smoking, knowledge/attitudes and socioeconomic status among married Bangladeshi women: a cross-sectional study

ABSTRACT BACKGROUND: There is a paucity of research on knowledge/attitudes regarding the dangers of exposure to secondhand smoking (SHS) among women. The relationship between exposure to SHS, socioeconomic status (SES) and knowledge/attitudes regarding the risks of SHS has often been ignored. We therefore aimed to examine (1) whether SES and exposure to SHS were independently associated with knowledge/attitudes regarding the risks of SHS; and (2) whether women with low SES and exposure to SHS were uniquely disadvantaged in terms of deficient knowledge and more dismissive attitudes towards the risks of SHS. DESIGN AND SETTING: Cross-sectional study in the Rajshahi district, Bangladesh. METHODS: A total of 541 women were interviewed. Knowledge of and attitudes towards the risks of SHS were the outcomes of interest. RESULTS: A majority of the respondents were exposed to SHS at home (49.0%). Only 20.1% had higher levels of knowledge, and only 37.3% had non-dismissive attitudes towards the risks of SHS. Participants in the low SES group and those exposed to SHS had lower odds of higher knowledge and their attitudes towards the risks of SHS were more dismissive. Regarding deficient levels of knowledge and scores indicating more dismissive attitudes, women in the low SES group and who were exposed to SHS were not uniquely disadvantaged. CONCLUSIONS: Exposure to SHS and low SES were independently associated with deficient knowledge and scores indicating more dismissive attitudes. Regarding knowledge/attitudes, the negative effect of exposure to SHS extended across all socioeconomic backgrounds and was not limited to women in either the low or the high SES group.

Magnitude and Chronicity of Environmental Smoke Exposure Across Infancy and Early Childhood in a Sample of Low-Income Children.

INTRODUCTION: Infants and young children may be at an increased risk for second- and thirdhand exposure to tobacco smoke because of increased respiration rate and exposure to surface residue. However, relatively fewer studies have examined biomarkers of exposure (cotinine) in children under age 4 years. This study examines the magnitude and chronicity of exposure across early childhood among children from low-income families in order to better characterize contextual risk factors associated with exposure. METHODS: A total of 1292 families were recruited in six nonurban counties of Pennsylvania and North Carolina. Cotinine was assayed from infant saliva at 6, 15, 24, and 48 months of age (N = 1218), and categorized as low (≤0.45 ng/mL), moderate (0.46-12 ng/mL), or high (≥12 ng/mL) at each time point. Categories were highly correlated across time. Latent class analysis was used to summarize patterns of exposure categories across time. RESULTS: Magnitude of exposure in this sample was high, with approximately 12% of infants registering cotinine values at least 12 ng/mL, consistent with active smoking in adults. Greater exposure was associated with lower income, less education, more residential instability, and more instability in adult occupants in the home, whereas time spent in center-based day care was associated with lower exposure. CONCLUSIONS: Young children from low-income, nonurban communities appear to bear a higher burden of secondhand smoke exposure than previous studies have reported. Results contribute to understanding populations at greater risk, as well as specific, potentially malleable, environmental factors that may be examined as direct contributors to exposure. IMPLICATIONS: Results suggest that infants from low-income, nonurban families have higher risk for environmental smoke exposure than data from nationally representative samples. Predictors of exposure offer insights into specific factors that may be targeted for risk reduction efforts, specifically conditions of children's physical space. In addition to considering the increases in risk when an adult smoker lives in a child's home, families should also attend to the possible risk embedded within the home itself, such as residual smoke from previous occupants. For high-risk children, day care appears to mitigate the magnitude of exposure by providing extended time in a smoke-free environment.

Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis

Abstract Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ±21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n =8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Prevalence of invehicle smoking and secondhand smoke exposure in Uruguay.

INTRODUCTION: Protection from secondhand smoke (SHS) is one of the fundamental principles of the WHO Framework Convention for Tobacco Control. Objective data on SHS exposure in vehicles in South America is scarce. This study aimed to estimate prevalence of smoking inside vehicles. METHODS: The point prevalence of smoking in vehicles was observed, and a method for estimating smoking prevalence was piloted. RESULTS: We observed 10 011 vehicles. In 219 (2.2%; 95% CI 1.91 to 2.49) of them, smoking was observed, and in 29.2% of these, another person was exposed to SHS. According to the 'expansion factor' we constructed, direct observation detected one of six to one to nine vehicles in which smoking occurred. The observed prevalence of smoking in vehicles (2.2%) could reflect a real prevalence between 12% and 19%. In 29.2% (95% CI 23.6 to 35.5) and 4.6% (95% CI 2.2 to 8.3) of vehicles in which smoking was observed, another adult or a child, respectively, was exposed to SHS. CONCLUSIONS: Smoking was estimated to occur in 12%-19% of vehicles, with involuntary exposure in one of three of vehicles observed. These data underscore a need for new public policies to eliminate SHS in vehicles to protect public health.

Tabaquismo pasivo y su efecto en la salud infantil: ¿Qué cambió en 11 años?: Hospital Zubizarreta / Passive smoking and its effect on children's health: What changes in 11 years?: Zubizarreta Hospital

Investigación que sigue los hallazgos de un estudio previo realizado entre junio de 2005 y junio de 2006, sobre el humo ambiental de tabaco y sus efectos en las madres y sus hijos, donde se encuestaron 100 madres de niños que se atendieron en el Hospital Zubizarreta. de la Ciudad de Buenos Aires. La presente investigación tuvo como objetivo determinar cuál es la situación actual de las familias que asisten al mismo hospital, en relación a la exposición al tabaco y si hay algún cambio en la distribución de fumadores en los hogares de los pacientes, o si se expone menos a los niños fumando fuera de las viviendas en las familias de fumadores. Se realizó un estudio epidemiológico descriptivo transversal para el que se confeccionó una encuesta semiestructurada anónima que se les realizó a las madres de niños/as entre 4 meses y 12 años de edad que concurrieron al hospital. La misma fue administrada por médicos del Consultorio Externo de Pediatría y una voluntaria que concurrió por 1 mes para efectuarla. El estudio se llevó a cabo entre julio de 2016 y julio de 2017, y se trabajó sobre las variables socio demográficas incluidas en el Índice de Graffar modificado, como tipo de vivienda, trabajo, escolaridad entre otros. A su vez se incluyen datos de salud, sobre antecedentes obstétricos de la madre y de procesos de enfermedad de los/as hijos/as y del consumo o no de tabaco, entre otras variables

Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review.

OBJECTIVE: Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients. METHODS: A cross-sectional study of SLE patients was performed to investigate the possible association between smoking exposure (ever [previous or current, active or secondhand smokers] or never) and cumulative chronic damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). A systematic review of the literature was conducted by cross-searching Medline for the terms lupus and smoking. RESULTS: We enrolled 105 patients with SLE (96% female), with a mean ± SD age of 40.7 ± 11.4 years and a mean followup time of 8.98 years. Of the 105 patients, 74 had an SDI score of 1-10, and 31 had an SDI score of 0. The difference between smoking exposure and no smoking exposure was significant (P = 0.02 by chi-square test in contingency table analysis), and SLE patients who were never exposed to smoking had 0.78 times the risk of progressing toward a cumulative damage status (SDI score of > 0) (95% confidence interval 0.16-0.98) throughout the followup period compared to those who were ever exposed. In the systematic review of the literature, we found only a small number of articles that addressed some aspects of the relationship between smoking exposure and cumulative damage in SLE patients. CONCLUSION: Our findings indicate that smoking exposure is associated with cumulative chronic damage, as determined by the SDI score, in patients with SLE. Smoking exposure may have deleterious effects on lupus morbidity, and more detailed studies of this association are needed.

Smoke-free politics--lessons to learn for Romania.

Very recently ASH -Global Action for everyone's health 2014 published two lesson on the progress of smoke free regulations in two countries France and Uruguay with all the explanations and comments referring to the results, limits and benefits of different strategies. I am trying to see in comparison with this two examples what we have done and what is necessary to learn in the future for also having in Romania a strong free regulation for smoke free environment.

Uso e exposição à fumaça do tabaco no Brasil: resultados da pesquisa nacional de saúde 2013 / Use of tobacco and exposure to tobacco smoke in Brazil: results from the national health survey 2013 / Uso y exposición al humo de tabaco en Brasil: resultados de la encuesta nacional de salud 2013

OBJETIVO: Descrever indicadores relacionados ao uso e exposição à fumaça do tabaco no Brasil. MÉTODOS: estudo descritivo com dados da Pesquisa Nacional de Saúde 2013. RESULTADOS: a prevalência do uso atual do tabaco foi de 15,0 por cento (IC95 por cento 14,4 por cento-15,5 por cento), sendo a maior parte fumado (14,7 por cento; IC95 por cento 14,2 por cento-15,2 por cento); nos 12 meses anteriores à entrevista, 51 por cento (IC95 por cento 49,3 por cento-52,9 por cento) dos fumantes atuais haviam tentado parar de fumar; a prevalência de ex-fumantes foi de 17,5 por cento (IC95 por cento 16,9 por cento-18,0 por cento), de 19,2 por cento (IC95 por cento 18,3 por cento-20,1 por cento) em homens e de 11,2 por cento (IC95 por cento 10,6 por cento-11,8 por cento) em mulheres; a prevalência da exposição à fumaça do tabaco em casa foi de 10,7 por cento (IC95 por cento 10,2 por cento-11,3 por cento) e em locais fechados de trabalho foi de 13,5 por cento (IC95 por cento 12,6 por cento-14,4 por cento). CONCLUSÃO: na comparação com outros países, a prevalência do consumo do tabaco no Brasil foi baixa, assim como a exposição à fumaça do tabaco; todavia, cerca de um sexto da população consumia algum produto do tabaco.

OBJETIVO: Describir indicadores relacionados al uso y exposición al humo de tabaco en Brasil. MÉTODOS: estudio descriptivo de la Encuesta Nacional de Salud 2013. RESULTADOS: la prevalencia puntual de consumo de tabaco fue 15,0 por ciento (IC95 por ciento; 14,4 por ciento-15,5 por ciento), siendo la mayor parte del consumo (14,7 por ciento; IC95 por ciento 14,2 por ciento-15,2 por ciento); en los 12 meses anteriores a la encuesta, 51 por ciento (IC95 por ciento 49,3 por ciento-52,9 por ciento) de los fumadores había intentado dejar de fumar; la prevalencia de ex-fumadores fue de 17,5 por ciento (IC95 por ciento 16,9 por ciento-18,0 por ciento), 19,2 por ciento (IC95 por ciento 18,3 por ciento-20,1 por ciento) eran hombres y 11,2 por ciento (IC95 por ciento 10,6 por ciento-11,8 por ciento) mujeres; la exposición al humo de tabaco en casa fue de 10,7 por ciento (IC95 por ciento 10,2 por ciento-11,3 por ciento) y 13,5 por ciento (IC95 por ciento 12,6 por iento-14,4 por ciento) en lugares de trabajo cerrados. CONCLUSIÓN: comparado con otros países, el consumo y exposición al humo de tabaco fueron bajas; una sexta parte de la población consume productos de tabaco.

OBJECTIVE: To describe indicators related to tobacco use and exposure to tobacco smoke in Brazil. METHODS : this was a descriptive study using National Health Survey 2013 data. RESULTS: prevalence of current tobacco use was 15.0 per cent (95 per cent CI 14.4 per cent-15.5 per cent), mainly via smoking (14.7 per cent; 95 per cent CI 14.2 per cent-15.2 per cent); in the 12 months preceding the interview, 51 per cent (95 per cent CI 49.3 per cent - 52.9 per cent) of current smokers had tried to quit smoking; the prevalence of former smokers was 17.5 per cent (95 per cent CI 16.9 per cent -18.0 per cent), 19.2 per cent (95 per cent CI 18.3 per cent-20.1 per cent) in males and 11.2 per cent (95 per cent CI 10.6 per cent -11.8 per cent) in females; prevalence of exposure to tobacco smoke at home was 10.7 per cent (95 per cent CI 10.2 per cent -11.3 per cent) whilst in enclosed work places it was 13.5 per cent (95 per cent CI 12.6 per cent -14.4 per cent). CONCLUSION: in comparison with other countries, the prevalence of tobacco consumption in Brazil was low, as was exposure to tobacco smoke; nevertheless, around one-sixth of the population consumed some kind of tobacco product.