Biomarkers of passive smoking among Greek preschool children

Background Greece has the highest adult smoking prevalence in the European Union, affecting not only those who smoke but also threatening the health of those who are involuntarily exposed to passive smoke, especially young Greek children.Objective The aim of this study was to quantify passive smoking biomarkers (serum nicotine and cotinine levels) among preschool children in Crete in relation to parental smoking habits.Methods All children enrolled in kindergarten in western Crete (1,757 preschool children and 2,809 parents) were interviewed during the 2004–2005 Cretan health promotion programme out of which a sample of 81 children was randomly selected according to parental smoking status and blood samples for cotinine and nicotine assay were taken.Results The geometric means of serum nicotine values in children with both parents current smokers and in those with both parents non-smokers were 0.71 ng/ml (95%CI 0.62, 0.80) and 0.59 ng/ml (95%CI 0.49, 0.69), respectively, (p=0.073). Cotinine geometric mean values were found at 1.69 ng/ml (95%CI 0.93, 3.06) and 0.15 ng/ml (95%CI 0.09, 0.28), respectively, (p<0.001). Girls with smoker parents had also greater cotinine geometric mean values than boys (3.35 versus 0.85 ng/ml, respectively, p=0.018).Conclusion Our findings prove that Greek preschool children, especially young girls, are exposed to substantial levels of passive smoke which therefore stresses the need for immediate action so as to prevent the predisposition and early addiction of Greek preschool children to tobacco.     

Nicotine and cotinine concentrations in the milk of smoking mothers: influence of cigarette consumption and diurnal variation

The relationship between nicotine and cotinine concentrations in mother's milk (including 24 h profiles) and the number of cigarettes consumed was studied. A total of 206 milk samples were collected from 34 nursing, smoking mothers. The mothers were distributed into three groups: Group I (1–10 cigarettes/day), group II (11–20 cigarettes/day) and group III (21–40 cigarettes/day). Milk samples from all nursing periods of a 24 h interval were collected. Nicotine and cotinine concentrations were measured by specific gas chromatographic techniques.The average milk nicotine and cotinine concentrations over a 24 h interval in the three groups were as follows: group I, 18±16 and 76±33 ng/ml; group II, 28±21 and 125±60 ng/ml; group III, 48±25 and 230±62 ng/ml (means ± SD).Over a time interval of 24 h the nicotine concentrations varied greatly in the milk of smoking mothers, while the cotinine concentrations remained relatively constant. Because of the great intra- and inter-individual variations in the nicotine concentrations, the influence of the number of cigarettes smoked on the nicotine concentration in milk was most apparent if nicotine concentrations were measured repeatedly over a prolonged time interval. Our results indicate that the exposure of the nursed infant to nicotine and cotinine via milk depends on the daily cigarette consumption but also on individual smoking habits; the time of smoking, smoking frequency prior to nursing, and the time interval between nursing and the last cigarette.     

Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures

BACKGROUND: Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological studies, with children's exposure often assessed through parental estimates. The authors examined the relationship between parent-reported estimates of children's exposure to ETS and children's urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children. METHODS: A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children's respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children. RESULTS: According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low. CONCLUSION: To evaluate the level of ETS exposure of children, the parents' reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.     

Effects of information on smoking behaviour in families with preschool children

An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested. A total of 443 consecutive families with one or two smoking parents, attending mother and child health centres in Oslo, Norway, were randomly allocated to an intervention group ( n = 221) and a control group ( n = 222). Eighty families (18%) dropped out during the study period. For the intervention group, the communication between the health visitor and the family was prolonged at one well-child visit with a brief session on smoking, and the parents were given three brochures. The families in the control group received no information on smoking. Changes in practical measures to prevent passive smoking by the children (e.g. no smoking indoors) as well as changes in daily smoking and smoking quantity were assessed by parental reports. We found no significant differences between the groups with respect to change in smoking behaviour.     

童趣化游戏干预在学龄前儿童肺炎支原体肺炎中的应用效果

目的 探讨童趣化游戏干预在学龄前儿童肺炎支原体肺炎中的应用效果.方法 选取2017年2月至2019年5月扬州大学附属医院儿科收治的肺炎支原体肺炎学龄前儿童,按照入院时间先后顺序分为对照组44例和观察组45例.两组患儿均给予规范治疗和常规护理,观察组在对照组基础上加予童趣化游戏干预.比较两组患儿的临床表现(咳嗽、发热、气...     

Effects of passive smoking on common respiratory symptoms in young children

AIM: To observe the effects of fathers' smoking on respiratory symptoms in children between the ages of 6 mo and 5 y living in Tehran during the period January to December 2001. METHODS: The caregivers of 622 children attending resident-based clinics in two university hospitals were interviewed about the respiratory illnesses incurred by the child during the previous 12 mo and the smoking habits of those living with the child. Children who lived in households in which any person, other than the father, smoked were excluded. RESULTS: The analysis included 595 children, 40.6% of whom were living in homes where fathers smoked cigarettes. About 35% of smokers admitted to unrestricted smoking at home. In children not living with a smoker, 81.6% had experienced at least one episode of upper respiratory tract infection (URTI) during the previous year and the rate increased to 95.2% in passive smokers whose fathers were not restricted from smoking in front of the children, (p-value <0.01). A similar pattern was found for otitis media and asthma (p-value <0.05 and <0.01, respectively). The average number of URTI episodes during the previous year was significantly higher in children exposed to unrestricted smoking (p <0.01). CONCLUSION: The study outlines the detrimental effects of paternal smoking on the respiratory health of children from a part of world in which this problem has not been studied previously, and highlights the importance of educating fathers to alter their smoking habits so that even if they do not stop smoking altogether, they should discontinue smoking indoors.     

Massage decreases aggression in preschool children: a long-term study

AIM: To evaluate the effects of massage in 4- to 5-year-old children with aggression and deviant behaviour at day-care centres. METHOD: The children received daily massage in preschool at the midday rest (n = 60). The controls were listening to a story (n = 50). The Child Behaviour Checklist (CBCL) was used to rate the children's behaviour by parents and staff before the treatment started, and after 3 and 6 months. A long-term evaluation was also carried out. It included all massaged children still in daycare after 12 months (n = 34). RESULTS: Children with high scores of behaviour problems, receiving massage and/or extra attention showed significant decrease in aggression scores after 3 months, but after 6 months significantly lowered scores were only found in massage-treated deviant children. Parents of the children receiving massage rated a significant decrease of somatic problems of their children. Staff rated that the massaged children's social problems decreased, compared to the control children. Attention problems tended to decrease, especially at home. A continuous decrease in aggressive behaviour and somatic problems over a 12-month period was observed in the children receiving massage. CONCLUSION: Daily touching by massage lasting for 5-10 min could be an easy and inexpensive way to decrease aggression among preschool children.     

Six-year follow-up of an intervention to improve the management of preschool children with asthma

Aims:  In a randomized controlled study involving 60 preschool children with asthma, an intervention with extra information and support to parents in the form of group discussions was performed. An earlier follow-up after 18 months revealed an improved adherence and a reduction of exacerbation days. This is a 6-year follow-up.
Methods:  Fifty-four children performed clinical examinations, blood tests, measurements of exhaled nitric oxide, spirometry, bronchial provocation with dry air and skin prick tests. Data from the patients' records and questionnaires were obtained.
Results:  Twenty-nine per cent had no current signs of asthma, whereas 43% exhibited persistent and 28% intermittent asthma. The burden on the healthcare system was minimal. Intermittent inhaled corticosteroid (ICS) therapy was used by 81%. The intervention group (IG) had fewer contacts with nurses. Their parents had a better quality of life. Interviewing children separately contributed in identification of children needing treatment. More children in the IG had to restart ICS as they had signs of worse asthma control.
Conclusion:  Straightforward and timely support to parents of children with asthma can have long-term positive effects by strengthening the ability of parents to treat their children at home, although parents may also develop an underestimation of mild symptoms. It is important to directly ask children about their disease and to maintain regular follow-up visits.     

Plasma and serum micronutrient concentrations in preschool children

Abstract The plasma concentrations of vitamin A, vitamin E, β-carotene and serum concentrations of zinc, retinol-binding protein and prealbumin were examined for a random cluster sample, stratified by socioeconomic status, of 467 healthy preschool children. Children were aged 9–62 months; 44% were females. The mean plasma values were: vitamin A, 1.29 µmol 1^-1; vitamin E, 18.9 µmol 1^-1; and β-carotene, 0.30 µmol 1^-1. The mean serum values were: zinc, 13.9 µmol 1^-1; retinol-binding protein, 25.5mg 1^-1; and prealbumin, 186.2 mg 1^-1. The mean molar ratio of vitamin A to retinol-binding protein for the study group was 1.10. There were no differences in the mean values of any of the measured micronutrients between the genders. The results of this survey do not indicate that the prevalence of micronutrient deficiency in this preschool population is of public health significance.     

沙美特罗替卡松气雾剂吸入治疗学龄前哮喘的临床观察

目的 探讨吸入沙美特罗替卡松气雾剂治疗4～5岁学龄前哮喘患儿的临床疗效.方法 在哮喘门诊和呼吸科病房收集学龄前哮喘儿童74例,分为沙美特罗替卡松组(n=37)和丙酸氟替卡松组(n=37),分别进行吸入治疗,症状量化评分,并定期随访,观察比较两组1周、1个月、3个月的临床疗效.结果 两组间日间评分、夜间评分在基线期、第1周、第1个月差异无统计学意义(P＞0.05),在第3个月时沙美特罗替卡松组日间评分(0.16±0.09 vs 0.32±0.11,P＜0.05)及夜间评分(0.04±0.01 vs 0.14±0.00,P ＜0.05)均低于丙酸氟替卡组.沙美特罗替卡松组顺利进行降级治疗的患儿人数高于丙酸氟替卡松组(X2=4.57,P＜0.05).结论 哮喘急性期吸入沙美特罗替卡松气雾剂及丙酸氟替卡松气雾剂后均能较快得到缓解,其效果相似.吸入沙美特罗替卡松气雾剂较吸人丙酸氟替卡松气雾剂对于哮喘缓解期症状的控制效果可能更佳.     

学龄前儿童普通话平均句子长度和词汇广度研究

目的了解学龄前儿童普通话平均句子长度（MLU）和词汇广度随年龄增长的变化规律。方法选择上海市浦东新区2所幼儿园，按不同年龄组［（36±1）个月，（42±1）个月，（48±1）个月，（54±1）个月，（60±1）个月，（66±1）个月，（72±1）个月］各选取10名儿童（共70名）。计算每名儿童20 min语言样本中所有自然语言的MLU和词汇广度，观察学龄前儿童MLU和词汇广度随年龄增长的变化情况及MLU和词汇广度的相关性。结果 70名儿童均进入研究。直线回归分析示学龄前儿童普通话的MLU与年龄呈正相关(r = 0.563，P=0.000)。根据年龄预计儿童MLU值的方程为：MLU=（0.023×年龄）+2.966。2次曲线回归分析示学龄前儿童普通话的词汇广度与年龄呈正相关(r=0.373，P=0.006)。根据年龄预计儿童词汇广度（以D值表示）的方程为：D=（1.77×年龄）- 0.014×年龄2 + 15.02。MLU与D值呈正相关(r=0.303，P=0.011)，但控制年龄因素后，MLU和D值无相关性(P=0.115)。结论掌握学龄前儿童普通话MLU和词汇广度随年龄增长的规律，是对学龄前儿童语言发育研究的初探，同时为学龄前儿童语言发展的基础和临床研究提供参考资料。     

Passive smoking is associated with lower serum HDL‐C levels in school children

Background: In recent years, a number of studies have reported that exposure to environmental tobacco smoke (ETS) reduces high‐density lipoprotein cholesterol (HDL‐C) levels in children, as well as in adults. Further, a number of countries have indicated that passive smoking increases the risk of early arteriosclerosis onset. Here, to evaluate the effects of ETS exposure, we conducted a cross‐sectional epidemiological study on primary school children in Japan using answers from a questionnaire survey, as well as urine cotinine and lipid metabolism‐related variable measurements. Methods: A total of 121 sixth‐grade primary school children participated in this study by completing a questionnaire about their food intake, lifestyle and family smoking habits. Early in the morning, we also measured height, weight, blood pressure, serum levels of total cholesterol, triglyceride, HDL‐C, and blood sugar, as well as urine levels of cotinine and creatinine under unfed conditions. Results: From the questionnaire, 40 and 81 children reported being exposed and not exposed to ETS, respectively. Serum HDL‐C levels, which were adjusted for the degree of corpulence and exercise habits, were significantly lower in the passive smoker group than the non‐passive‐smoker group (65.3 and 72.1 mg/dL, respectively; P= 0.012). In addition, proportional differences in serum HDL‐C levels were also observed based on the amount of cigarettes smoked at home by family members of the child. Conclusions: Results suggest that ETS exposure at home is associated in a dose‐related manner with lower serum HDL‐C levels in primary school children. In addition, our results suggest that smoking in the presence of children who are not usually exposed to ETS increases the risk of arteriosclerosis. Given these findings, we strongly recommend the establishment of anti‐passive‐smoking measures.     

Sleep architecture in healthy 5-year-old preschool children: associations between sleep schedule and quality variables

Aim: Although disturbed sleep quality such as night awakenings and difficulties in falling asleep are common symptoms during sleep in preschool children, relationships between sleep quality and sleep schedule are mostly unknown. This study aimed to evaluate the relationships between sleep schedule and quality variables in preschool children. Methods: Sleep‐wake patterns of 48 healthy 5‐year‐old children were assessed over 7 consecutive days using actigraphy. Results: Children with longer sleep latency had a lower sleep quality, a later bedtime, a later sleep onset time, a shorter nocturnal sleep period and a longer daytime nap. Children with a longer nocturnal sleep period on weekends compared with weekdays had longer sleep latency and a later sleep onset time on weekdays, resulting in a lower sleep quality on weekends. An irregular bedtime on weekdays was associated with a later sleep onset time and a shorter sleep period on weekends. Conclusion: Sleep quality and schedule were linked with each other, whiche may explain why sleep problems tend to aggregate and form a wider syndrome of disturbed sleep even in young children. Strategies solely targeting the improvement of sleep quantity may not promote ideal sleep; simultaneous considerations for the sleep rhythm and quality may be required.     

Cotinine concentrations in amniotic fluid and urine of smoking,passive smoking and non-smoking pregnant women at term and in the urine of their neonates on 1st day of life

Cotinine was measured in the amniotic fluid and urine of 31 pregnant women and in the urine of their offspring. Amniotic fluid cotinine was 8 times higher in active and 2.5 times higher in passive smokers than in non-smokers. In general, amniotic fluid cotinine was considerably higher than urinary cotinine both in active and in passive smokers. Estimation of cotinine both in amniotic fluid immediately before delivery and in urine of the newborn on the 1st day of life aids in assessing the degree of prenatal exposure to tobacco smoke.     

Environmental exposures and exhaled nitric oxide in children with asthma

OBJECTIVE: To evaluate the relation of environmental factors with exhaled nitric oxide (FENO) concentrations among asthmatic children. STUDY DESIGN: Cross-sectional analysis of 170 tobacco smoke-exposed children, ages 6 to 12 years, who have doctor-diagnosed asthma using measures of FENO, medication use, and exposures to settled indoor allergens and tobacco smoke. RESULTS: In multivariable analysis, child's age, uncarpeted flooring, not owning a cat, higher income, dust mite exposure, and being sensitized to any allergens were associated with higher FENO concentrations. Children who were sensitized to indoor allergens had an adjusted geometric mean FENO of 15.4 ppb (95% CI, 13.1, 18.2) compared with 10 ppb (95% CI, 8.2, 12.2) for unsensitized children. There was no statistically significant association of serum cotinine, hair cotinine, or reported corticosteroid therapy with FENO. CONCLUSIONS: FENO is higher among children who are sensitized to indoor allergens and exposed to dust mites. The results hold promise for the use of FENO as a tool to manage childhood asthma by using both pharmacologic and environmental treatments.     

健康学龄前儿童入幼儿园前后鼻咽部病原学变化的队列研究

目的 了解入托儿童第1次上呼吸道感染(AURTIs)咽拭子标本病原学演变。方法 以幼儿园为队列研究现场,以首次入托的学龄前儿童为研究对象,以入幼儿园生活作为暴露因素,于入托前体检时、入托48 h后第1次发生AURTIs时、1个学期结束时(未发生AURTIs的学龄前儿童),用咽拭子采集鼻咽部分泌物,行细菌培养和呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A型(Iva)、B型(Ivb)、副流感病毒Ⅰ型(PIV Ⅰ)、Ⅱ型(PIV Ⅱ)、Ⅲ型(PIV Ⅲ)病毒、肺炎支原体和衣原体检测。结果 115例学龄前入托儿童进入本文分析,平均 3.4岁。入托前体检时培养出细菌114例,共培养出9种细菌,平均每例(3.3±0.8)种,检出支原体阳性1例(1.1%)。91例(79.1%)在学期期间第1次AURTIs,共培养出12种细菌。第1次AURTIs较入托时肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌细菌数量鉴定≥3+的例数有所增加。检出支原体和病毒25例(27.5%),其中支原体14例,Iva 5例,PIV Ⅰ、Ivb、ADV各2例。学期结束时24例学龄前儿童未发生AURTIs,共培养出9种细菌,平均每例(3.6±0.5)种;学期结束时较入托时仅化脓性链球菌细菌数量鉴定≥3+增加了1例,均未检出支原体、衣原体和病毒。115例学龄前健康儿童入托时和24例在学期期间未发生AURTIs的定植菌包括奈瑟菌属、草绿色链球菌、微球菌、革兰阳性杆菌、凝固酶阴性葡萄球菌、肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、阴沟肠杆菌和化脓性链球菌。结论 79.1%健康学龄前儿童入托后发生AURTIs,以细菌(肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌)、支原体和病毒(Iva、PIV Ⅰ、Ivb、ADV)感染为主。     

健康学龄前儿童入幼儿园前后鼻咽部病原学变化的队列研究

目的 了解入托儿童第1次上呼吸道感染(AURTIs)咽拭子标本病原学演变。方法 以幼儿园为队列研究现场,以首次入托的学龄前儿童为研究对象,以入幼儿园生活作为暴露因素,于入托前体检时、入托48 h后第1次发生AURTIs时、1个学期结束时(未发生AURTIs的学龄前儿童),用咽拭子采集鼻咽部分泌物,行细菌培养和呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A型(Iva)、B型(Ivb)、副流感病毒Ⅰ型(PIV Ⅰ)、Ⅱ型(PIV Ⅱ)、Ⅲ型(PIV Ⅲ)病毒、肺炎支原体和衣原体检测。结果 115例学龄前入托儿童进入本文分析,平均 3.4岁。入托前体检时培养出细菌114例,共培养出9种细菌,平均每例(3.3±0.8)种,检出支原体阳性1例(1.1%)。91例(79.1%)在学期期间第1次AURTIs,共培养出12种细菌。第1次AURTIs较入托时肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌细菌数量鉴定≥3+的例数有所增加。检出支原体和病毒25例(27.5%),其中支原体14例,Iva 5例,PIV Ⅰ、Ivb、ADV各2例。学期结束时24例学龄前儿童未发生AURTIs,共培养出9种细菌,平均每例(3.6±0.5)种;学期结束时较入托时仅化脓性链球菌细菌数量鉴定≥3+增加了1例,均未检出支原体、衣原体和病毒。115例学龄前健康儿童入托时和24例在学期期间未发生AURTIs的定植菌包括奈瑟菌属、草绿色链球菌、微球菌、革兰阳性杆菌、凝固酶阴性葡萄球菌、肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、阴沟肠杆菌和化脓性链球菌。结论 79.1%健康学龄前儿童入托后发生AURTIs,以细菌(肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌)、支原体和病毒(Iva、PIV Ⅰ、Ivb、ADV)感染为主。