¿Es el hábito tabáquico un factor determinante en la lactancia materna? / Is the smoking habit a determining factor in breastfeeding?

En España, las tasas de lactancia son bajas respecto a lo recomendado por la OMS. La relación entre tabaquismo y lactancia sigue siendo incierta, pero parece dificultarla. El objetivo de este estudio es clarificar el estado actual de la evidencia sobre la influencia del tabaquismo en la lactancia materna. Material y métodos. Revisión bibliográfica en Cochrane Library en español, PubMed, Cuiden y SCielo de publicaciones previas al año 2000. Resultados. Fumar se asocia con menores tasas de inicio de la lactancia y con una menor duración de la misma. La nicotina influye negativamente en la producción de leche, pero los factores sociales parecen ser los más influyentes en el éxito de la lactancia. La lactancia en mujeres fumadoras es más segura que combinar tabaquismo con fórmula artificial. La intervención educativa para modificar las actitudes maternas parece favorecer la lactancia en mujeres fumadoras. Conclusiones. Se necesitan más investigaciones sobre los efectos de la lactancia cuando la madre es fumadora. La lactancia materna es la opción más beneficiosa incluso en mujeres fumadoras (AU)

Lactation rates in Spain are lower than WHO recommendation. The relationship between smoking and breastfeeding is still uncertain but it looks to make it difficult. The aim of this study is to clarify the evidence state about the smoking influence on breastfeeding. Methods. Evidence review was conducted in Cochrane Library, PubMed, Cuiden and SCielo databases. Publications from year 2000 were considered. Results. Smoking is associated with lower rates in breastfeeding initiation and duration. Nicotine has a negative effect on milk production, but social factors seem to be the most important in breastfeeding success. Lactation in smoking women is safer than the smoke exposition combined with formula. Educative interventions to modify maternal attitude seems to facilitate breastfeeding in smoking women. Conclusions. Further investigation about breastfeeding in smoking women is needed. Breastfeeding is the best option even in smoking mothers (AU)

[Prevalence of tuberculosis infection in Maghrebian immigrants]. / Prevalencia de infección tuberculosa entre los inmigrantes magrebíes.

BACKGROUND: Maghrebian immigrants are a high-risk group for tuberculosis. The special features of this group (non-familial grouping [nFG], communication difficulties, illegal status) may have a negative influence on tuberculosis. SUBJECTS AND METHODS: A descriptive crossover study. Maghrebian immigrants older than 14 years attended at Centro de Salud Collado-Villalba, Madrid, Spain (n = 520). SELECTION: a random, proportional, age and sex-stratified sample (n = 142). Individuals completed a questionnaire in arabic and were subjected to tuberculosis screening tests till they were assigned one of the definitive diagnostic classes of the American Thoracic Society. Data are shown for three cut points of Mantoux: 5, 10 and 15 mm. The univariate and multivariate analysis were based on logistic regression. RESULTS: 80 individuals were tested. Sex ratio 4:1. The prevalence of tuberculosis infection was: Mantoux > or = 5 mm = 76.3%, Mantoux > or = 10 mm = 72.5%, Mantoux > or = 15 mm = 66.3%. Three tuberculosis cases were diagnosed (annual incidence 1.9%). Whatever the cut point considered for Mantoux: masculine sex, age, nFG, years as immigrant living in nFG and, amongst married people, living without their partners in Spain, were identified as risk factors. The number of years as immigrant living in a familiar grouping and the number of family members per house were identified as protective factors. In the sex-adjusted multivariate analysis, age and living in nFG were associated to a higher incidence of infection, whereas the number of people per house was a protective factor. CONCLUSIONS: The prevalence of tuberculosis infection in Maghrebian immigrants residents in Spain is very high. The particular living conditions of this group may have a negative influence.

[The results of an active screening program for tuberculosis in immigrants from the Maghreb: acceptability and adherence]. / Resultados de un programa de búsqueda activa de tuberculosis en inmigrantes magrebíes: aceptabilidad y adhesión.

OBJECTIVE: To assess acceptability and adherence to a tuberculosis screening programme (TSP) in Maghrebi immigrants (MI). DESIGN: A descriptive crossover study. SETTING: Primary health care service. INDIVIDUALS: MI residing in a periurban health district. All people who attended clinic for consultation at a primary care center were systematically recommended to be screened for tuberculosis. INTERVENTION: Individuals accomplished a questionnaire in arabic (with interpreter assistance) and were subjected to tuberculosis infection/illness screening tests till they were assigned one of the definitive diagnostic classes of the American Thoracic Society. RESULTS: 219 individuals were offered the TSP (sex ratio 6.2:1). 166 individuals (76.1%) accepted the test and kept their first appointment: 147 males (78.2%) versus 19 females (63.3%); difference in acceptance by gender was not significant (chi 2 = 3.14; p = 0.07). Fourteen individuals did not complete the study (8.6%): one did not attend clinic for Mantoux reading, four did not have the chest X-ray, three did not present themselves on their Mantoux reading, nor did they have the chest X-ray and, six did not deliver sputum samples (11.1% of the required samples). Six cases of TB were diagnosed. CONCLUSIONS: Given the special features of the MI (communication difficulties, illegal status, no fixed abode ...) acceptance and adherence to TSP are considered to be high. The diagnostic effectiveness, though considerable, was affected by the high number of individuals which did not deliver sputum samples. TSP directed to MI must have a specific design in order to facilitate acceptance and adherence.