Trends in and predictors of second‐hand smoke exposure indexed by cotinine in children in England from 1996 to 2006

Aims To explore trends in and predictors of second‐hand smoke (SHS) exposure in children. To identify whether inequalities in SHS exposure are changing over time. Design Repeated cross‐sectional study with data from eight annual surveys conducted over an 11‐year period from 1996 to 2006. Setting England. Participants Nationally representative samples of children aged 4–15 years living in private households. Measurements Saliva cotinine (4–15‐year‐olds), current smoking status (8–15‐year‐olds), smoking status of parents and carers, smoking in the home, socio‐demographic variables. Findings The most important predictors of SHS exposure were modifiable factors—whether people smoke in the house on most days, whether the parents smoke and whether the children are looked after by carers who smoke. Children from more deprived households were more exposed and this remained the case even after parental smoking status has been controlled for. Exposure over time has fallen markedly among children (59% decline over 11 years in geometric mean cotinine), with the most marked decline observed in the period immediately preceding smoke‐free legislation. Declines in exposure have generally been greater in children most exposed at the outset. For example, in children whose parents both smoke, median cotinine declined annually by 0.115 ng/ml compared with 0.019 ng/ml where neither parent smokes (P < 0.05). Conclusions In the 11 years leading up to smoke‐free legislation in England, the overall level of SHS exposure in children as well as absolute inequalities in exposure have been declining. Further efforts to encourage parents and carers to quit and to avoid smoking in the home would benefit child health.     

Mandibular distraction osteogenesis in a neonate.

Children with craniofacial anomalies are predisposed to airway obstruction and frequently require airway intervention. Tracheotomy is performed when the airway obstruction is severe and refractory to other less invasive interventions. Tracheotomy is associated with significant morbidity, and there is a trend noted in the literature toward achieving earlier decannulation by the institution of definitive structural changes to the mandible. Mandibular distraction osteogenesis has been shown to alleviate airway obstruction in the pediatric population. We report a case in which mandibular distraction osteogenesis was successfully carried out in a neonate with acute airway obstruction at birth as a result of combined Pierre Robin sequence and Klippel-Feil syndrome. After 1 year, the patient still had an adequate airway with tolerable scarring and no neurologic sequelae.     

The progesterone metabolite allopregnanolone potentiates GABA(A) receptor-mediated inhibition of 5-HT neuronal activity.

The dorsal raphe nucleus (DRN) is the origin of much of the 5-HT innervation of the forebrain. The activity of DRN 5-HT neurons is regulated by a number of receptors including GABA(A) and 5-HT(1A) inhibitory receptors and by excitatory alpha(1)-adrenoceptors. Using in vitro electrophysiological recording we investigated the action of progesterone and its metabolite, allopregnanolone on receptor-mediated responses of DRN 5-HT neurons. Neither allopregnanolone nor progesterone affected the alpha(1)-adrenoceptor agonist-induced firing. Allopregnanolone also had no effect on the inhibitory response to 5-HT. However, allopregnanolone significantly potentiated the inhibitory responses to GABA(A) receptor agonists. Progesterone did not enhance GABA(A) receptor-meditated inhibitory responses. Thus, the neuroactive metabolite of progesterone, allopregnanolone, has the ability to cause potentiation of GABA(A)-mediated inhibition of DRN 5-HT neurons. This effect on 5-HT neurotransmission may have relevance for mood disorders commonly associated with reproductive hormone events, such as premenstrual dysphoric disorder and postpartum depression.     

Design of the sex hormones and physical exercise (SHAPE) study

Background  

Physical activity has been associated with a decreased risk for breast cancer. The biological mechanismn(s) underlying the association between physical activity and breast cancer is not clear. Most prominent hypothesis is that physical activity may protect against breast cancer through reduced lifetime exposure to endogenous hormones either direct, or indirect by preventing overweight and abdominal adiposity. In order to get more insight in the causal pathway between physical activity and breast cancer risk, we designed the Sex Hormones and Physical Exercise (SHAPE) study. Purpose of SHAPE study is to examine the effects of a 1-year moderate-to-vigorous intensity exercise programme on endogenous hormone levels associated with breast cancer among sedentary postmenopausal women and whether the amount of total body fat or abdominal fat mediates the effects.     

Smoking. Baccy to front

The government is making 60m pounds available to develop smoking cessation services over three years. This year's funding is concentrated on health action zones where progress has been slow. The cost of nicotine replacement patches is significantly more than many smokers spend on cigarettes.     

Congenital Syphilis and Perinatal Mortality

About 6% of perinatal mortality in Addis Ababa, Ethiopia, is associated with congenital syphilis. We report on 65 autopsies and the accompanying maternal examinations and interviews. Congenital syphilis was most common in unwanted pregnancies, in women with previous stillborns, in those who had multiple sexual partners, and in those who did not seek antenatal medical care. Congenital syphilis causes enlargement of liver, spleen, and placenta; premature labor; and increased perinatal mortality. It is recognizable even in severely macerated stillborns.     

Discontinuation symptoms: comparison of brief interruption in fluoxetine and paroxetine treatment

Abrupt interruption or cessation of selective serotonin reuptake inhibitor (SSRI) treatment may result in discontinuation or treatment interruption symptoms. Recent reports suggested these symptoms occur more frequently with shorter half-life SSRIs. Previous studies indicated a 5-8-day treatment interruption resulted in fewer discontinuation-emergent adverse events in fluoxetine-treated patients than in paroxetine-treated patients. This study examines the effects of shorter treatment interruption (3-5 days), as would occur if patients miss just a few doses of medication. Patients successfully treated for depression with fluoxetine or paroxetine underwent treatment interruption in a double-blind fashion. Treatment interruption-emergent symptoms were assessed using the Discontinuation-Emergent Signs and Symptoms checklist. Other assessments included the Montgomery-Asberg Depression Rating Scale, Clinical Global Impressions-Severity scale and a social functioning questionnaire. Of 150 patients enrolled, 141 completed the study. Following treatment interruption, fluoxetine-treated patients experienced fewer treatment interruption-emergent events than did paroxetine-treated patients. The paroxetine treatment group also experienced significant increases in depressive symptoms, clinical global severity scores and difficulty in social functioning; the fluoxetine treatment group did not. These results are consistent with reports suggesting abrupt interruption of treatment with paroxetine is more often associated with somatic and psychological symptoms than is abrupt interruption of fluoxetine. Patients treated with fluoxetine appeared to be protected by its longer half-life.     

Developmental Recovery and Deficit in Children Adopted from Eastern European Orphanages

This research examined the degree of developmental recovery during the 1^st year of placement in a sample of 124 children adopted from Eastern European orphanages. At the time of adoption, substantial growth and developmental delays were identified, with about half below the 5^th percentile on weight and on height. Results indicated that there was considerable catch-up in all areas at postadoption. However, older, later placed children exhibited more developmental delays compared with earlier adopted children. Regression analysis revealed that the degree of developmental delay at the time of adoption, along with the duration of time spent in the adoptive home and age at adoption placement, predicted significant amounts of variance associated with developmental catch-up. In contrast, weight and height at time of adoption were not related to children's development postadoption.