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Huang E, Albrecht L, O’Hearn K, Nicolas N, Armstrong J, Weinberg M, Menon K. Reporting of social determinants of health in randomized controlled trials conducted in the pediatric intensive care unit. Front Pediatr 2024; 12:1329648. [PMID: 38361997 PMCID: PMC10867174 DOI: 10.3389/fped.2024.1329648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The influence of social determinants of health (SDOH) on access to care and outcomes for critically ill children remains an understudied area with a paucity of high-quality data. Recent publications have highlighted the importance of incorporating SDOH considerations into research but the frequency with which this occurs in pediatric intensive care unit (PICU) research is unclear. Our objective was to determine the frequency and categories of SDOH variables reported and how these variables were defined in published PICU randomized controlled trials (RCTs). Methods We searched Medline, Embase, Lilacs, and Central from inception to Dec 2022. Inclusion criteria were randomized controlled trials of any intervention on children or their families in a PICU. Data related to study demographics and nine WHO SDOH categories were extracted, and descriptive statistics and qualitative data generated. Results 586 unique RCTs were included. Studies had a median sample size of 60 patients (IQR 40-106) with 73.0% of studies including ≤100 patients and 41.1% including ≤50 patients. A total of 181 (181/586, 30.9%) studies reported ≥1 SDOH variable of which 163 (163/586, 27.8%) reported them by randomization group. The most frequently reported categories were food insecurity (100/586, 17.1%) and social inclusion and non-discrimination (73/586, 12.5%). Twenty-five of 57 studies (43.9%) investigating feeding or nutrition and 11 of 82 (13.4%) assessing mechanical ventilation reported baseline nutritional assessments. Forty-one studies investigated interventions in children with asthma or bronchiolitis of which six reported on smoking in the home (6/41, 14.6%). Discussion Reporting of relevant SDOH variables occurs infrequently in PICU RCTs. In addition, when available, categorizations and definitions of SDOH vary considerably between studies. Standardization of SDOH variable collection along with consistent minimal reporting requirements for PICU RCT publications is needed.
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Affiliation(s)
- Emma Huang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Albrecht
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Katie O’Hearn
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Naisha Nicolas
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jennifer Armstrong
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Maya Weinberg
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Kusum Menon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
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Ingham T, Keall M, Jones B, Aldridge DRT, Dowell AC, Davies C, Crane J, Draper JB, Bailey LO, Viggers H, Stanley TV, Leadbitter P, Latimer M, Howden-Chapman P. Damp mouldy housing and early childhood hospital admissions for acute respiratory infection: a case control study. Thorax 2019; 74:849-857. [PMID: 31413146 PMCID: PMC6824607 DOI: 10.1136/thoraxjnl-2018-212979] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A gap exists in the literature regarding dose-response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children. METHODS A prospective, unmatched case-control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011-2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp-mould subscale. The main outcome was case-control status. Adjusted ORs (aORs) of the association of housing quality measures with case-control status were estimated, along with the population attributable risk of eliminating dampness-mould on hospitalisation for ARI among New Zealand children. RESULTS 188 cases and 454 controls were studied. Higher levels of RHI were associated with elevated odds of hospitalisation (OR 1.11/unit increase (95% CI 1.01 to 1.21)), which weakened after adjustment for season, housing tenure, socioeconomic status and crowding (aOR 1.04/unit increase (95% CI 0.94 to 1.15)). The damp-mould index had a significant, adjusted dose-response relationship with ARI admission (aOR 1.15/unit increase (95% CI 1.02 to 1.30)). By addressing these harmful housing exposures, the rate of admission for ARI would be reduced by 19% or 1700 fewer admissions annually. CONCLUSIONS A dose-response relationship exists between housing quality measures, particularly dampness-mould, and young children's ARI hospitalisation rates. Initiatives to improve housing quality and to reduce dampness-mould would have a large impact on ARI hospitalisation.
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Affiliation(s)
- Tristram Ingham
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Michael Keall
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Daniel R T Aldridge
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Anthony C Dowell
- Department of Obstetrics and Gynaecology, University of Otago Wellington, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma Trust, Lower Hutt, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Jessica Barbara Draper
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Tu Kotahi Māori Asthma Trust, Lower Hutt, New Zealand
| | | | - Helen Viggers
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Thorsten Villiers Stanley
- Department of Paediatrics, University of Otago Wellington, Wellington, New Zealand
- Department of Paediatrics, Capital and Coast District Health Board, Wellington, New Zealand
| | - Philip Leadbitter
- Department of Paediatrics, Hutt Valley District Health Board, Lower Hutt, New Zealand
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Cheemarla NR, Uche IK, McBride K, Naidu S, Guerrero-Plata A. In utero tobacco smoke exposure alters lung inflammation, viral clearance, and CD8+T-cell responses in neonatal mice infected with respiratory syncytial virus. Am J Physiol Lung Cell Mol Physiol 2019; 317:L212-L221. [DOI: 10.1152/ajplung.00338.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Maternal smoking during pregnancy and exposure of infants to cigarette smoke are strongly associated with adverse health effects in childhood including higher susceptibility to respiratory viral infections. Human respiratory syncytial virus (HRSV) is the most important cause of lower respiratory tract infection among young infants. Exacerbation of respiratory disease, including HRSV bronchiolitis and higher susceptibility to HRSV infection, is well correlated with previous smoke exposure. The mechanisms of recurrence and susceptibility to viral pathogens after passive smoke exposure are multifactorial and include alteration of the structural and immunologic host defenses. In this work, we used a well-established mouse model of in utero smoke exposure to investigate the effect of in utero smoke exposure in HRSV-induced pathogenesis. Sample analysis indicated that in utero exposure led to increased lung inflammation characterized by an increased influx of neutrophils to the airways of the infected mice and a delayed viral clearance. On the other hand, decreased HRSV-specific CD8+T-cell response was observed. These findings indicate that cigarette smoke exposure during pregnancy alters HRSV-induced disease as well as several aspects of the neonatal immune responses.
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Affiliation(s)
- Nagarjuna R. Cheemarla
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Ifeanyi K. Uche
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Kaitlin McBride
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Shan Naidu
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Antonieta Guerrero-Plata
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, Louisiana
- Center for Experimental Infectious Disease Research, Louisiana State University, Baton Rouge, Louisiana
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Cystathionine γ-lyase deficiency enhances airway reactivity and viral-induced disease in mice exposed to side-stream tobacco smoke. Pediatr Res 2019; 86:39-46. [PMID: 30986815 PMCID: PMC6594876 DOI: 10.1038/s41390-019-0396-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/04/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) is a known risk factor for severe respiratory syncytial virus (RSV) infections, yet the mechanisms of ETS/RSV comorbidity are largely unknown. Cystathionine γ-lyase regulates important physiological functions of the respiratory tract. METHODS We used mice genetically deficient in the cystathionine γ-lyase enzyme (CSE), the major H2S-generating enzyme in the lung to determine the contribution of H2S to airway disease in response to side-stream tobacco smoke (TS), and to TS/RSV co-exposure. RESULTS Following a 2-week period of exposure to TS, CSE-deficient mice (KO) showed a dramatic increase in airway hyperresponsiveness (AHR) to methacholine challenge, and greater airway cellular inflammation, compared with wild-type (WT) mice. TS-exposed CSE KO mice that were subsequently infected with RSV exhibited a more severe clinical disease, airway obstruction and AHR, enhanced viral replication, and lung inflammation, compared with TS-exposed RSV-infected WT mice. TS-exposed RSV-infected CSE KO mice had also a significant increase in the number of neutrophils in bronchoalveolar lavage fluid and increased levels of inflammatory cytokines and chemokines. CONCLUSION This study demonstrates the critical contribution of the H2S-generating pathway to airway reactivity and disease following exposure to ETS alone or in combination with RSV infection.
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Naja Z, Fayad D, Khafaja S, Chamseddine S, Dbaibo G, Hanna-Wakim R. Bronchiolitis Admissions in a Lebanese Tertiary Medical Center: A 10 Years' Experience. Front Pediatr 2019; 7:189. [PMID: 31157192 PMCID: PMC6533463 DOI: 10.3389/fped.2019.00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/24/2019] [Indexed: 12/27/2022] Open
Abstract
Bronchiolitis and more specifically respiratory syncytial virus (RSV) bronchiolitis is a leading cause of global childhood morbidity and mortality. Despite the previous identification of possible risk factors associated with the severity of bronchiolitis, the data from Lebanon remains limited. We described the burden of bronchiolitis hospitalizations in children under 5 years of age in a tertiary care center in Lebanon from October 2004 to October 2014 and identified the risk factors associated with severe bronchiolitis. This was a retrospective cohort study conducted at the American University of Beirut Medical Center. Records of children younger than 5 years of age admitted with a diagnosis of bronchiolitis were reviewed. More than half the patients were RSV positive. RSV bronchiolitis was found to be significantly associated with longer hospital stay compared to children with non-RSV bronchiolitis (P = 0.007). Children exposed to smoking had an increased risk for longer hospital stay (P = 0.002) and were more likely to require ICU admission (P < 0.001) and supplemental oxygen (P = 0.045). Congenital heart disease was found to be a significant risk factor for severe bronchiolitis (P < 0.005). Conclusion: Patients with RSV bronchiolitis had a longer hospital stay compared to patients with non-RSV bronchiolitis. Exposure to smoking was associated with a more severe and complicated RSV infection. Congenital heart disease was the only risk factor significantly associated with all markers of bronchiolitis disease severity.
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Affiliation(s)
- Zeina Naja
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Danielle Fayad
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Sarah Khafaja
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Chamseddine
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
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Bottorff JL, Sarbit G, Oliffe JL, Caperchione CM, Wilson D, Huisken A. Strategies for Supporting Smoking Cessation Among Indigenous Fathers: A Qualitative Participatory Study. Am J Mens Health 2018; 13:1557988318806438. [PMID: 30324851 PMCID: PMC6771127 DOI: 10.1177/1557988318806438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a need for tailored smoking cessation programs specifically for Indigenous fathers who want to quit smoking.The aim of this study was to engage Indigenous men and key informants in guiding cultural adaptations to the Dads in Gear (DIG) cessation program. In Phase 1 of this qualitative participatory study, Indigenous men were engaged in group sessions and key informants in semistructured interviews to gather advice related to cultural adaptations to the DIG program. These data were used to guide the development of program prototypes. In Phase 2, the prototypes were evaluated with Indigenous fathers who were using tobacco (smoking or chewing) or were ex-users. Data were analyzed inductively. Recommendations for programming included ways to incorporate cultural values and practices to advance men’s cultural knowledge and the need for a flexible program design to enhance feasibility and acceptability among diverse Indigenous groups. Men also emphasized the importance of positive message framing, building trust by providing “honest information,” and including activities that enabled discussions about their aspirations as fathers as well as cultural expectations of current-day Indigenous men. That the Indigenous men’s level of involvement with their children was diverse but generally less prescriptive than contemporary “involved fathering” discourse was also a key consideration in terms of program content. Strategies were afforded by these insights for meeting the men where they are in terms of their fathering—as well as their smoking and physical activity. This research provides a model for developing evidence-based, gender-specific health promotion programs with Indigenous men.
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Affiliation(s)
- Joan L Bottorff
- 1 Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada
| | - Gayl Sarbit
- 1 Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada
| | - John L Oliffe
- 2 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Cristina M Caperchione
- 3 School of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | | | - Anne Huisken
- 1 Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada
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Nwosu BU, Kum-Nji P. Tobacco smoke exposure is an independent predictor of vitamin D deficiency in US children. PLoS One 2018; 13:e0205342. [PMID: 30296288 PMCID: PMC6175516 DOI: 10.1371/journal.pone.0205342] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE The role of tobacco-smoke exposure on serum vitamin D concentration in US pediatric population is not known. We hypothesized that tobacco smoke exposure would increase the prevalence of vitamin D deficiency in US children. METHODS Representative national data were accessed from the National Health and Nutrition Examination Survey (NHANES) 2009-2010 databank on 2,263 subjects of ages 3 to 17 years. Subjects were categorized into two groups based on their age: children, if <10 years; and youth if 10 to 17 years. Descriptive and multiple logistic regression analyses were conducted to determine the effect of serum cotinine-verified tobacco smoke exposure on vitamin D status after controlling for key sociodemographic confounders. Vitamin D deficiency was defined as 25(OH)D <20 ng/mL, insufficiency as 25(OH)D of 20-29.9 ng/mL, and sufficiency as 25(OH)D of ≥30 ng/mL. Tobacco smoke exposure status was defined by serum cotinine concentration as follows: unexposed and non-smoking (<0.05 ng/mL) and exposed (passive and active smokers combined) (≥0.05ng/mL). Specifically, passive and active smoking were defined as cotinine of 0.05-10 ng/mL, and ≥10ng/mL respectively. RESULTS The prevalence of second-hand smoke exposure was 42.0% (95%CI, 36.7%-47.5%); while the prevalence of active smoking among teenagers was 9.0% (95%CI, 6.2%-12.5%). Vitamin D deficiency occurred at a frequency of 15.1% in children unexposed to tobacco smoke, 20.9% in children exposed to passive tobacco smoke, and 18.0% among actively smoking youth (p<0.001). Tobacco smoke exposure independently predicted vitamin D deficiency after controlling for age, sex, race, BMI, maternal education, and family socio-economic status (OR:1.50; 95%CI, 1.14-1.85, p = 0.002). CONCLUSIONS This analysis of a nationwide database reports that tobacco smoke exposure is an independent predictor of vitamin D deficiency in US children.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Philip Kum-Nji
- Department of General Pediatrics, Children’s Hospital of Richmond, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
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Behrooz L, Balekian DS, Faridi MK, Espinola JA, Townley LP, Camargo CA. Prenatal and postnatal tobacco smoke exposure and risk of severe bronchiolitis during infancy. Respir Med 2018; 140:21-26. [PMID: 29957275 PMCID: PMC6056008 DOI: 10.1016/j.rmed.2018.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Maternal prenatal smoking has adverse effects on the growing fetus including those of respiratory nature. Although postnatal smoke exposure is a risk factor for respiratory infections, the effects of prenatal smoking independent of postnatal smoke exposure are less established. We hypothesized that both maternal prenatal smoking, and postnatal smoke exposure are risk factors for severe bronchiolitis during infancy. METHODS We performed a case-control study of 1353 children born between 1996 and 2011 at a single teaching hospital. Cases were admitted to the same hospital for bronchiolitis during infancy. Maternal prenatal smoking was collected from birth records. Postnatal smoke exposure was collected from review of electronic health records. Multivariable logistic regression was used to evaluate the independent associations of the two smoking variables with severe bronchiolitis. RESULTS 6% of cases were exposed to maternal prenatal smoking, compared with 4% of controls (P = 0.10). Postnatal smoke exposure was present in the households of 17% of cases compared with 3% of controls (P < 0.001). In a multivariable model with both smoking variables and adjustment for 10 covariates, maternal prenatal smoking was not a significant risk factor for severe bronchiolitis (adjusted OR = 1.02, 95%CI 0.56-1.84). By contrast, postnatal smoke exposure was associated with >300% increased odds (adjusted OR 4.19, 95%CI 2.51-6.98). CONCLUSIONS Although maternal prenatal smoking has many known adverse effects, it was not associated with increased odds of severe bronchiolitis in either unadjusted or multivariable analyses. Postnatal smoke exposure was a consistently strong risk factor. Our findings support ongoing efforts to decrease infant exposure to ambient smoke.
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Affiliation(s)
- Leili Behrooz
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | | | | | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Liam P Townley
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Strzelak A, Ratajczak A, Adamiec A, Feleszko W. Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1033. [PMID: 29883409 PMCID: PMC5982072 DOI: 10.3390/ijerph15051033] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023]
Abstract
Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor α ([TNF]-α). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages and neutrophils and disturbed lymphocyte balance towards Th2. The plethora of presented phenomena fully justifies a restrictive policy aiming at limiting the domestic and public exposure to ETS.
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Affiliation(s)
- Agnieszka Strzelak
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Aleksandra Ratajczak
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Aleksander Adamiec
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
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Perry DC, Thomson C, Pope D, Bruce CE, Platt MJ. A case control study to determine the association between Perthes' disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure. Bone Joint J 2017; 99-B:1102-1108. [PMID: 28768789 DOI: 10.1302/0301-620x.99b8.bjj-2016-1282.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/27/2017] [Indexed: 01/09/2023]
Abstract
AIMS It is well established that there is a strong association between Perthes' disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis. PATIENTS AND METHODS A hospital case-control study (n = 149/146) examined the association between tobacco smoke exposure and Perthes' disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure using the urinary cotinine-creatinine ratio, which is a widely used and validated measure of tobacco smoke exposure. RESULTS The odds of Perthes' disease significantly increased with reported in utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06, 95% confidence interval (CI) 1.17 to 3.63; paternal smoking OR 2.09, 95% CI 1.26 to 3.46). The cotinine-creatinine ratio was significantly greater in cases, OR 1.63 (95% CI 1.09 to 2.43), suggesting a greater 'dose' of current tobacco exposure. CONCLUSION An association exists between tobacco smoke exposure and Perthes' disease but we remain unable to disentangle the association with socioeconomic deprivation. Cite this article: Bone Joint J 2017;99-B:1102-8.
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Affiliation(s)
- D C Perry
- Alder Hey Children's Hospital, E Prescot Road, Liverpool, L14 5AB, UK
| | - C Thomson
- Mersey Deanery, Liverpool, Merseyside, UK
| | - D Pope
- University of Liverpool, Liverpool, L69 3GL, UK
| | - C E Bruce
- Alder Hey Children's Hospital , E Prescot Road, Liverpool, L14 5AB, UK
| | - M J Platt
- University of East Anglia, Norwich, Norfolk, UK
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Sloan C, Heaton M, Kang S, Berrett C, Wu P, Gebretsadik T, Sicignano N, Evans A, Lee R, Hartert T. The impact of temperature and relative humidity on spatiotemporal patterns of infant bronchiolitis epidemics in the contiguous United States. Health Place 2017; 45:46-54. [PMID: 28285184 PMCID: PMC5502811 DOI: 10.1016/j.healthplace.2017.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/09/2016] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
Infant bronchiolitis is primarily due to infection by respiratory syncytial virus (RSV), which is highly seasonal. The goal of the study is to understand how circulation of RSV is impacted by fluctuations in temperature and humidity in order to inform prevention efforts. Using data from the Military Health System (MHS) Data Repository (MDR), we calculated rates of infant bronchiolitis for the contiguous US from July 2004 to June 2013. Monthly temperature and relative humidity were extracted from the National Climate Data Center. Using a spatiotemporal generalized linear model for binomial data, we estimated bronchiolitis rates and the effects of temperature and relative humidity while allowing them to vary over location and time. Our results indicate a seasonal pattern that begins in the Southeast during November or December, then spreading in a Northwest direction. The relationships of temperature and humidity were spatially heterogeneous, and we find that climate can partially account for early onset or longer epidemic duration. Small changes in climate may be associated with larger fluctuations in epidemic duration.
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Affiliation(s)
| | | | - Sorah Kang
- Brigham Young University, Provo, UT, USA
| | | | - Pingsheng Wu
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nicholas Sicignano
- Health ResearchTx, Trevose, PA, USA; Navy and Marine Corps Public Health Center, Portsmouth, VA, USA
| | - Amber Evans
- Navy and Marine Corps Public Health Center, Portsmouth, VA, USA
| | - Rees Lee
- Naval Medical Research Unit Dayton, Wright Patterson AFB, OH, USA
| | - Tina Hartert
- Vanderbilt University Medical Center, Nashville, TN, USA
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Yokus B, Mete N, Cakir U, Toprak G. Effects of Active and Passive Smoking on Antioxidant Enzymes and Antioxidant Micronutrients. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.1080/13102818.2005.10817238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ingram DG, Matthews CK, Plante DT. Seasonal trends in sleep-disordered breathing: evidence from Internet search engine query data. Sleep Breath 2014; 19:79-84. [DOI: 10.1007/s11325-014-0965-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/15/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022]
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14
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Nabi-Burza E, Winickoff JP, Finch S, Regan S. Triple tobacco screen: opportunity to help families become smokefree. Am J Prev Med 2013; 45:728-31. [PMID: 24237914 PMCID: PMC3860591 DOI: 10.1016/j.amepre.2013.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/04/2013] [Accepted: 07/29/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND American Academy of Pediatrics policy recommends that pediatricians document environmental tobacco smoke (ETS) exposure of a child at every visit. The extent to which pediatricians adhere to this policy, however, is unknown. PURPOSE The goal of the study was to examine the extent to which pediatricians screen parents for tobacco use and home- and car-related smoking rules. Further, the potential association between factors associated with pediatrician inquiry into parental tobacco use and rules is examined. METHODS Post-visit exit interviews were conducted in ten pediatric practices between June 2009 and March 2011 with parents whose children had been seen by a healthcare provider. Parents were considered to have been given the "triple tobacco screen" if they reported being asked by a pediatric healthcare provider about their smoking behavior, smokefree home rules, and smokefree car rules. Bivariate analysis and multivariable logistic regression was done to explore factors associated with parents being given any component of the triple tobacco screening. Data were analyzed between March 2012 and February 2013. RESULTS Of 9145 parents interviewed, 20% of the parents reported being asked at least one question from the triple tobacco screen, and only 9% reported being asked all three questions. Overall, 17% of parents reported being asked about their smoking status, 16% about smokefree home rules, and 11% about smokefree car rules. Few smoking parents (23%) and fewer nonsmoking parents (19%) were screened about their tobacco use and behavior. CONCLUSIONS Pediatricians infrequently addressed ETS exposure of children among parents who do and do not smoke. Substantial missed opportunities may exist to counsel smokers and reduce ETS exposure of children in the most common exposure locations-the home and car.
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Affiliation(s)
- Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts.
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15
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Bozaykut A, Paketci A, Sezer RG, Paketci C. Evaluation of risk factors for recurrent wheezing episodes. J Clin Med Res 2013; 5:395-400. [PMID: 23976913 PMCID: PMC3748665 DOI: 10.4021/jocmr1543w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to evaluate the risk factors for recurrent wheezing in patients diagnosed with acute bronchiolitis. Method From 2009 to 2011, 500 patients from the pediatric clinics, with first attack of acute bronchiolitis were included in this prospective study. Each patient’s age, gender, birth weight, duration of breastfeeding, family history of atopy and asthma, smoking exposure, source of heating in the house, the presence of pets, any history of chronic disease have been questioned. The patients were followed for a duration of 12 - 24 months. Results In this study, 39% (n = 195) of the cases were female and 61% (n = 305) were male, with a median age of 3 months old. Male gender, low birth weight (< 2,500 g), low gestational age (< 37 weeks), breastfeeding of less than 6 months, congenital heart disease, family history of atopy, asthma, smoking exposure, stove warming, was found as significant risk factors for recurrent wheezing, however, presence of pets at home was found to be a protective factor. Conclusions Informing parents about the risk factors such as exposure to cigarette smoke, heating mode, duration of breastfeeding can significantly decrease recurrent episodes of wheezing.
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Affiliation(s)
- Abdulkadir Bozaykut
- Zeynep Kamil Maternity and Childrens' Disease Training and Research Hospital, Department of Pediatrics, Uskudar 34668, Istanbul, Turkey
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16
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Bottorff JL, Oliffe JL, Kelly MT, Johnson JL, Chan A. Reconciling parenting and smoking in the context of child development. QUALITATIVE HEALTH RESEARCH 2013; 23:1042-1053. [PMID: 23774626 DOI: 10.1177/1049732313494118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this article we explore the micro-social context of parental tobacco use in the first years of a child's life and early childhood. We conducted individual interviews with 28 mothers and fathers during the 4 years following the birth of their child. Using grounded theory methods, we identified the predominant explanatory concept in parents' accounts as the need to reconcile being a parent and smoking. Desires to become smoke-free coexisted with five types of parent-child interactions: (a) protecting the defenseless child, (b) concealing smoking and cigarettes from the mimicking child, (c) reinforcing smoking as bad with the communicative child, (d) making guilt-driven promises to the fearful child, and (e) relinquishing personal responsibility to the autonomous child. We examine the agency of the child in influencing parents' smoking practices, the importance of children's observational learning in the early years, and the reciprocal nature of parent-child interactions related to parents' smoking behavior.
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Affiliation(s)
- Joan L Bottorff
- Institute of Healthy Living and Chronic Disease Prevention, University of British Columbia's Okanagan Campus, 3333 University Way, Kelowna, British Columbia, Canada.
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17
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Patria MF, Esposito S. Recurrent lower respiratory tract infections in children: a practical approach to diagnosis. Paediatr Respir Rev 2013; 14:53-60. [PMID: 23347661 DOI: 10.1016/j.prrv.2011.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/17/2011] [Accepted: 11/02/2011] [Indexed: 12/20/2022]
Abstract
Many children are affected by recurrent lower respiratory tract infections (LRTIs), but the majority of them do not suffer from serious lung or extrapulmonary disease. The challenge for clinicians is to distinguish the recurrent RTIs with self-limiting or minor problems from those with underlying disease. The aim of this review is to describe a practical approach to children with recurrent LRTIs that limits unnecessary, expensive and time-consuming investigations. The children can be divided into three groups on the basis of their personal and family history and clinical findings: 1) otherwise healthy children who do not need further investigations; 2) those with risk factors for respiratory infections for whom a wait-and-see approach can be recommended; and 3) those in whom further investigations are mandatory. However, regardless of the origin of the recurrent LRTIs, it is important to remember that prevention by means of vaccines against respiratory pathogens (i.e. type b Haemophilus influenzae, pertussis, pneumococcal and influenza vaccines) can play a key role.
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Affiliation(s)
- Maria Francesca Patria
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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18
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Wilson KM, Pier JC, Wesgate SC, Cohen JM, Blumkin AK. Secondhand tobacco smoke exposure and severity of influenza in hospitalized children. J Pediatr 2013; 162:16-21. [PMID: 22863259 DOI: 10.1016/j.jpeds.2012.06.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/16/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess whether children with influenza who are exposed to secondhand tobacco smoke (SHS) would have more severe illness than those not exposed. STUDY DESIGN We abstracted charts from pediatric inpatients with confirmed influenza from 2002-2009 for demographics, medical history, and smoke exposure. Severity indicators included intensive care, intubation, and length of stay (LOS) in the hospital; potential confounding factors included demographics and the presence of asthma or chronic conditions. All χ(2), t tests, and regression analyses were run using SPSS v. 18.0. RESULTS Of 117 children, 40% were exposed to SHS, who had increased need for intensive care (30% vs 10%, P < .01) and intubation (13% vs 1%, P < .05), and had longer LOS (4.0 vs 2.4 days, P < .01). Children with chronic conditions and SHS exposure required more intensive care (53% vs 18%, P < .05) and had longer LOS (10.0 vs 3.5 days, P < .01) than children not exposed to SHS with chronic conditions. In multivariate analyses controlling for potential confounding factors, children with SHS exposure were 4.7 times more likely to be admitted to intensive care (95% CI 1.4-18.5) and had a 70% longer LOS (95% CI 12%-230%). CONCLUSIONS Children with SHS exposure who are hospitalized with influenza have more severe illness. Efforts are needed to immunize this population against influenza, and eliminate children's exposure to SHS.
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Nabi-Burza E, Regan S, Drehmer J, Ossip D, Rigotti N, Hipple B, Dempsey J, Hall N, Friebely J, Weiley V, Winickoff JP. Parents smoking in their cars with children present. Pediatrics 2012; 130:e1471-8. [PMID: 23147972 PMCID: PMC3507249 DOI: 10.1542/peds.2012-0334] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine prevalence and factors associated with strictly enforced smoke-free car policies among smoking parents. METHODS As part of a cluster, randomized controlled trial addressing parental smoking, exit interviews were conducted with parents whose children were seen in 10 control pediatric practices. Parents who smoked were asked about smoking behaviors in their car and receipt of smoke-free car advice at the visit. Parents were considered to have a "strictly enforced smoke-free car policy" if they reported having a smoke-free car policy and nobody had smoked in their car within the past 3 months. RESULTS Of 981 smoking parents, 817 (83%) had a car; of these, 795 parents answered questions about their car smoking policy. Of these 795 parents, 29% reported having a smoke-free car policy, and 24% had a strictly enforced smoke-free car policy. Of the 562 parents without a smoke-free car policy, 48% reported that smoking occurred with children present. Few parents who smoke (12%) were advised to have a smoke-free car. Multivariable logistic regression controlling for parent age, gender, education, and race showed that having a younger child and smoking ≤10 cigarettes per day were associated with having a strictly enforced smoke-free car policy. CONCLUSIONS The majority of smoking parents exposed their children to tobacco smoke in cars. Coupled with the finding of low rates of pediatricians addressing smoking in cars, this study highlights the need for improved pediatric interventions, public health campaigns, and policies regarding smoke-free car laws to protect children from tobacco smoke.
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Affiliation(s)
- Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and
| | - Susan Regan
- General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Deborah Ossip
- University of Rochester Medical Center, Rochester, New York
| | - Nancy Rigotti
- Tobacco Research and Treatment Center, and,General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Bethany Hipple
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and
| | - Janelle Dempsey
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and
| | - Nicole Hall
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and
| | - Joan Friebely
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and
| | | | - Jonathan P. Winickoff
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, Massachusetts;,Tobacco Research and Treatment Center, and,AAP Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Illinois; and
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20
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Kum-Nji P, Meloy LD, Keyser-Marcus L. The prevalence and effects of environmental tobacco smoke exposure among inner-city children: lessons for pediatric residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:1772-1778. [PMID: 23095931 DOI: 10.1097/acm.0b013e318272f5e7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To determine the prevalence of environmental tobacco smoke (ETS) exposure, to explore the relationship between ETS exposure and the use of health services, and to examine the degree to which pediatric residents document ETS exposure status and counsel parents. METHOD In 2006, the authors recruited dyads of children (0-12 years old) and their mothers from an inner-city pediatric group practice clinic. Mothers completed a survey, and the authors searched the children's medical charts. The authors compared ETS-exposed children with nonexposed children using chi-square, t test, and ANOVA analyses. They also ran logistic regression analyses to examine the relationship between the use of health services and selected child and maternal variables. RESULTS More than 60% (142/232) of children were exposed to ETS, and more than 69% (99/142) of those children had a mother who smoked. ETS exposure significantly predicted the overall number of sick visits, even after controlling for sociodemographic confounders (odds ratio = 7.44; 95% confidence internal = 1.21-44.55). About 80% (187/232) of mothers reported that their child's pediatrician had counseled them on the dangers of ETS exposure. Less than half (105/232) of the children's charts included their ETS exposure status. CONCLUSIONS Although pediatric residents often counsel parents on the dangers of ETS exposure, educators should teach residents to regard ETS exposure status as a fifth vital sign. By screening for and documenting ETS exposure status, residents can identify at-risk children and parents, who could benefit from counseling.
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Affiliation(s)
- Phillip Kum-Nji
- Children's Hospital of Richmond, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
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21
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DiFranza JR, Masaquel A, Barrett AM, Colosia AD, Mahadevia PJ. Systematic literature review assessing tobacco smoke exposure as a risk factor for serious respiratory syncytial virus disease among infants and young children. BMC Pediatr 2012; 12:81. [PMID: 22721493 PMCID: PMC3411420 DOI: 10.1186/1471-2431-12-81] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 06/21/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The role of environmental tobacco smoke (ETS) exposure as a risk factor for serious respiratory syncytial virus (RSV) disease among infants and young children has not been clearly established. This systematic review was conducted to explore the association between ETS exposure and serious RSV disease in children younger than 5 years, including infants and young children with elevated risk for serious RSV disease. METHODS A systematic review of English-language studies using the PubMed and EMBASE databases (1990-2009) was performed to retrieve studies that evaluated ETS as a potential risk factor for serious RSV illness. Studies assessing risk factors associated with hospitalization, emergency department visit, or physician visit due to RSV (based on laboratory confirmation of RSV or clinical diagnosis of RSV) in children under the age of 5 years were included. RESULTS The literature search identified 30 relevant articles, categorized by laboratory confirmation of RSV infection (n = 14), clinical diagnosis of RSV disease (n = 8), and assessment of RSV disease severity (n = 8). Across these three categories of studies, at least 1 type of ETS exposure was associated with statistically significant increases in risk in multivariate or bivariate analysis, as follows: 12 of 14 studies on risk of hospitalization or ED visit for laboratory-confirmed RSV infection; 6 of 8 studies of RSV disease based on clinical diagnosis; and 5 of the 8 studies assessing severity of RSV as shown by hospitalization rates or degree of hypoxia. Also, 7 of the 30 studies focused on populations of premature infants, and the majority (5 studies) found a significant association between ETS exposure and RSV risk in the multivariate or bivariate analyses. CONCLUSION We found ample evidence that ETS exposure places infants and young children at increased risk of hospitalization for RSV-attributable lower respiratory tract infection and increases the severity of illness among hospitalized children. Additional evidence is needed regarding the association of ETS exposure and outpatient RSV lower respiratory tract illness. Challenges and potential pitfalls of assessing ETS exposure in children are discussed.
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Affiliation(s)
- Joseph R DiFranza
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Anthony Masaquel
- MedImmune, Health Outcomes & Pharmacoeconomics, One MedImmune Way, Gaithersburg, MD, 20878, USA
| | - Amy M Barrett
- RTI Health Solutions, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Ann D Colosia
- RTI Health Solutions, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Parthiv J Mahadevia
- MedImmune, Health Outcomes & Pharmacoeconomics, One MedImmune Way, Gaithersburg, MD, 20878, USA
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22
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Zacharasiewicz A, Horak F, Fazekas T, Riedler J. Tabakrauchexposition von Kindern und Jugendlichen. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-011-2572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Hwang SH, Hwang JH, Moon JS, Lee DH. Environmental tobacco smoke and children's health. KOREAN JOURNAL OF PEDIATRICS 2012; 55:35-41. [PMID: 22375147 PMCID: PMC3286760 DOI: 10.3345/kjp.2012.55.2.35] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 01/12/2012] [Indexed: 01/10/2023]
Abstract
Passive exposure to tobacco smoke significantly contributes to morbidity and mortality in children. Children, in particular, seem to be the most susceptible population to the harmful effects of environmental tobacco smoke (ETS). Paternal smoking inside the home leads to significant maternal and fetal exposure to ETS and may subsequently affect fetal health. ETS has been associated with adverse effects on pediatric health, including preterm birth, intrauterine growth retardation, perinatal mortality, respiratory illness, neurobehavioral problems, and decreased performance in school. A valid estimation of the risks associated with tobacco exposure depends on accurate measurement. Nicotine and its major metabolite, cotinine, are commonly used as smoking biomarkers, and their levels can be determined in various biological specimens such as blood, saliva, and urine. Recently, hair analysis was found to be a convenient, noninvasive technique for detecting the presence of nicotine exposure. Because nicotine/cotinine accumulates in hair during hair growth, it is a unique measure of long-term, cumulative exposure to tobacco smoke. Although smoking ban policies result in considerable reductions in ETS exposure, children are still exposed significantly to tobacco smoke not only in their homes but also in schools, restaurants, child-care settings, cars, buses, and other public places. Therefore, more effective strategies and public policies to protect preschool children from ETS should be consolidated.
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Affiliation(s)
- Sang-Hyun Hwang
- Department of Laboratory Medicine, Center for Diagnostic Oncology, National Cancer Center, Goyang, Korea
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24
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Abstract
BACKGROUND Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. However, relatively little is known about the current use, compliance, and outcomes associated with this medication. METHODS A prospective, observational, registry based on 27 sites, with monthly follow-up of infants at high risk for RSV who received at least 1 dose of palivizumab during the 2005-2009 RSV seasons. RESULTS A total of 5286 children were enrolled (56.6% male; 71.7% white; average gestational age, 32.1 ± 5.5 weeks). Of them, 3741 patients (70.8%) were prophylaxed for prematurity only, 449 (8.5%) for bronchopulmonary dysplasia/chronic lung disease, 508 (9.6%) for congenital heart disease, and 588 (11.1%) for other reasons. Overall, 19,485 doses were given. On average, infants received 86.0% ± 28.4% of their expected number of injections; 71.2% of infants received their injections in the recommended time periods. Of the 5286 participants enrolled, 308 patients were hospitalized for respiratory tract illness (hospitalization rate, 5.8%). The RSV-hospitalization rate was calculated as 1.38%. Having siblings increased likelihood of hospitalization (66.9% vs. 55.7%, P < 0.005), and was significantly correlated with time to hospitalization in this cohort (P = 0.050). CONCLUSIONS The overall RSV-hospitalization rate in our study was within the range found in previous reports (1.3%-5.3%), although it did not mimic the declining rates of the US Palivizumab Outcomes Registry. This could be due to increased testing for RSV when hospitalized and increasing rates of prophylaxis of infants with underlying medical disorders.
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25
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Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res 2011; 12:5. [PMID: 21219618 PMCID: PMC3022703 DOI: 10.1186/1465-9921-12-5] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive smoke exposure increases the risk of lower respiratory infection (LRI) in infants, but the extensive literature on this association has not been systematically reviewed for nearly ten years. The aim of this paper is to provide an updated systematic review and meta-analysis of studies of the association between passive smoking and LRI, and with diagnostic subcategories including bronchiolitis, in infants aged two years and under. METHODS We searched MEDLINE and EMBASE (to November 2010), reference lists from publications and abstracts from major conference proceedings to identify all relevant publications. Random effect pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated. RESULTS We identified 60 studies suitable for inclusion in the meta-analysis. Smoking by either parent or other household members significantly increased the risk of LRI; odds ratios (OR) were 1.22 (95% CI 1.10 to 1.35) for paternal smoking, 1.62 (95% CI 1.38 to 1.89) if both parents smoked, and 1.54 (95% CI 1.40 to 1.69) for any household member smoking. Pre-natal maternal smoking (OR 1.24, 95% CI 1.11 to 1.38) had a weaker effect than post-natal smoking (OR 1.58, 95% CI 1.45 to 1.73). The strongest effect was on bronchiolitis, where the risk of any household smoking was increased by an OR of 2.51 (95% CI 1.96 to 3.21). CONCLUSIONS Passive smoking in the family home is a major influence on the risk of LRI in infants, and especially on bronchiolitis. Risk is particularly strong in relation to post-natal maternal smoking. Strategies to prevent passive smoke exposure in young children are an urgent public and child health priority.
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Affiliation(s)
- Laura L Jones
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
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Kabir Z, Alpert HR, Goodman PG, Haw S, Behm I, Connolly GN, Gupta PC, Clancy L. Effect of smoke-free home and workplace policies on second-hand smoke exposure levels in children: an evidence summary. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/phe.10.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Second-hand smoke (SHS) is a major avoidable cause of developmental and respiratory disease and premature death among children worldwide. SHS is a ‘Class A’ carcinogen, and there is no safe level of SHS exposure. Almost 700 million children worldwide are exposed daily to SHS at home. This article reviews and summarizes evidence based on available studies that report on ‘voluntary’ home smoking restrictions and their effects on SHS exposure levels in children aged 0–17 years. All potentially relevant publications within a 10-year period (January 2000–April 2010) were identified (n = 19 full-text articles) through comprehensive database searches. In general, voluntary household smoking restrictions reported a significant reduction in childhood SHS exposure ranging between 20–50% reductions, using both self-reported and biological measures. Mandated comprehensive workplace and enclosed public smoke-free policies also suggested an apparent benefit in some specific pediatric health encounters, namely, decreased preterm birth risks and reduced emergency hospital visits owing to asthma.
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Affiliation(s)
| | - Hillel R Alpert
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Patrick G Goodman
- TobaccoFree Research Institute (RIFTFS), The Digital Depot, Thomas Street, Dublin 8, Ireland
- Dublin Institute of Technology, Dublin, Ireland
| | - Sally Haw
- Scottish Collaboration for Public Health Research & Policy, Edinburgh & NHS Health Scotland, Edinburgh, UK
| | - Ilan Behm
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Gregory N Connolly
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Luke Clancy
- TobaccoFree Research Institute (RIFTFS), The Digital Depot, Thomas Street, Dublin 8, Ireland
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Halterman JS, Conn KM, Hernandez T, Tanski SE. Parent knowledge, attitudes, and household practices regarding SHS exposure: a case-control study of urban children with and without asthma. Clin Pediatr (Phila) 2010; 49:782-9. [PMID: 20522612 DOI: 10.1177/0009922810368290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impoverished children suffer disproportionately from asthma and are more likely than other children to be exposed to secondhand smoke (SHS). We conducted a case-control study to describe and compare knowledge, attitudes, and household practices regarding SHS exposure among parents of young urban children with and without asthma (response rate, 76%). Overall, 39% of children lived with > or =1 smoker (cases, 36%; controls, 43%). The majority of parents (78%) felt that cigarette smoking is very dangerous and agreed that smoke harms the health of children (97%). Cases were more likely than controls to report that smoking in a car affects children's health (54% vs 42%) and that smoking in front of children is never allowed in their home (88% vs 79%). Additionally, more cases reported a home smoking ban (81% vs 70%). Our findings suggest that parents of children with asthma have somewhat better knowledge, attitudes, and practices regarding SHS; however, gaps remain, and many urban children continue to be exposed.
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Affiliation(s)
- Jill S Halterman
- University of Rochester School of Medicine, Golisano Children's Hospital at Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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28
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Khuri-Bulos N, Williams JV, Shehabi AA, Faouri S, Al Jundi E, Abushariah O, Chen Q, Ali SA, Vermund S, Halasa NB. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. ACTA ACUST UNITED AC 2010; 42:368-74. [PMID: 20100116 DOI: 10.3109/00365540903496544] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute respiratory infections (ARI) play a major role in hospitalizations in the Middle East, but the specific viral causes are unknown. We conducted prospective viral surveillance in children <5 y of age admitted with ARI and/or fever at 2 dissimilar hospitals in Amman, Jordan during peak respiratory syncytial virus (RSV) season. We collected prospective clinical and demographic data and obtained nose/throat swabs for testing for RSV by real-time polymerase chain reaction (RT-PCR). We obtained clinical and laboratory data for 728/743 (98%) subjects enrolled. The children's median age was 4.3 months, 58.4% were males, 87% were breastfed, 4% attended day care, 67% were exposed to smokers, 7% were admitted to the intensive care unit, and 0.7% died (n = 5). Out of 728 subjects, 467 (64%) tested positive by RT-PCR for RSV. Comparing RSV-positive with RSV-negative subjects, the RSV-positive subjects had lower median age (3.6 vs 6.4 months, p < 0.001) and fewer males (55% vs 64%, p = 0.02). RSV-positive children had higher rates of oxygen use (72% vs 42%, p < 0.001), a longer hospital stay (5 vs 4 days, p = 0.001), and higher hospital charges (US$538 vs US$431, p < 0.001) than RSV-negative children. In young hospitalized Jordanian infants, the medical and financial burden of RSV was found to be high. Effective preventive measures, such as an RSV vaccine, would have a significant beneficial impact.
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Affiliation(s)
- Najwa Khuri-Bulos
- Department of Paediatrics and Pathology-Microbiology, Jordan University, Amman, Jordan
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Abstract
PURPOSE OF REVIEW Bronchiolitis is a complex disease that exhibits tremendous heterogeneity with respect to cause, clinical presentation, outcome and susceptibility of afflicted patients. Although respiratory syncytial virus (RSV) is widely considered to be the most important cause of bronchiolitis in children, little is known about the mechanisms of susceptibility to severe infection. RECENT FINDINGS Over the last several years, there have been important advances in our understanding of RSV bronchiolitis, ranging from large-scale epidemiologic observations to novel in-vitro discoveries, including those related to environmental and host risk factors. In addition, new investigative techniques have been developed, which may enhance our understanding about the interaction between RSV and the pediatric airway. SUMMARY RSV remains the most frequently encountered cause of bronchiolitis and contributes to significant morbidity and mortality worldwide. The investigations highlighted in this review may serve as foundations for future mechanistic studies, the implementation of new preventive strategies and the discovery of novel treatments.
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Kristjánsson S, Skúladóttir HE, Sturludóttir M, Wennergren G. Increased prevalence of otitis media following respiratory syncytial virus infection. Acta Paediatr 2010; 99:867-70. [PMID: 20002623 DOI: 10.1111/j.1651-2227.2009.01637.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to analyse whether, during the 18 months following a respiratory syncytial virus (RSV) infection in infants, there were differences in the prevalence of common infections such as acute otitis media (AOM), compared with controls. We also wanted to see whether passive smoking could be a contributory factor. METHODS In a longitudinal study, 33 children who attended the emergency room with an RSV infection (age < or = 7 months) were compared with 37 age-matched controls recruited from routine infant check-ups. The 18-month follow-up consisted of a questionnaire focusing on environmental factors and the child's health during the last 12 months. An allergy skin prick test (SPT) was performed and venous blood was obtained. RESULTS The prevalence of AOM and the use of antibiotics were higher in the RSV group than in the controls (p = 0.009 and p = 0.027 respectively). The number of AOMs and the use of antibiotics correlated, r = 0.8. In the RSV group, one or both parents smoked in 52% compared with 14% in the controls (p < 0.001). There were no differences in allergy SPT results. CONCLUSION The infants with RSV infection had AOM and were prescribed antibiotics more frequently during the follow-up period. Furthermore, smoking was far more common among the parents of the RSV group. We speculate that passive smoking could be a contributory factor to the infections noted here.
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Affiliation(s)
- S Kristjánsson
- Children's Hospital, Landspítali University Hospital, Reykjavík, Iceland.
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31
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Modestou MA, Manzel LJ, El-Mahdy S, Look DC. Inhibition of IFN-gamma-dependent antiviral airway epithelial defense by cigarette smoke. Respir Res 2010; 11:64. [PMID: 20504369 PMCID: PMC2890646 DOI: 10.1186/1465-9921-11-64] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 05/26/2010] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although individuals exposed to cigarette smoke are more susceptible to respiratory infection, the effects of cigarette smoke on lung defense are incompletely understood. Because airway epithelial cell responses to type II interferon (IFN) are critical in regulation of defense against many respiratory viral infections, we hypothesized that cigarette smoke has inhibitory effects on IFN-gamma-dependent antiviral mechanisms in epithelial cells in the airway. METHODS Primary human tracheobronchial epithelial cells were first treated with cigarette smoke extract (CSE) followed by exposure to both CSE and IFN-gamma. Epithelial cell cytotoxicity and IFN-gamma-induced signaling, gene expression, and antiviral effects against respiratory syncytial virus (RSV) were tested without and with CSE exposure. RESULTS CSE inhibited IFN-gamma-dependent gene expression in airway epithelial cells, and these effects were not due to cell loss or cytotoxicity. CSE markedly inhibited IFN-gamma-induced Stat1 phosphorylation, indicating that CSE altered type II interferon signal transduction and providing a mechanism for CSE effects. A period of CSE exposure combined with an interval of epithelial cell exposure to both CSE and IFN-gamma was required to inhibit IFN-gamma-induced cell signaling. CSE also decreased the inhibitory effect of IFN-gamma on RSV mRNA and protein expression, confirming effects on viral infection. CSE effects on IFN-gamma-induced Stat1 activation, antiviral protein expression, and inhibition of RSV infection were decreased by glutathione augmentation of epithelial cells using N-acetylcysteine or glutathione monoethyl ester, providing one strategy to alter cigarette smoke effects. CONCLUSIONS The results indicate that CSE inhibits the antiviral effects of IFN-gamma, thereby presenting one explanation for increased susceptibility to respiratory viral infection in individuals exposed to cigarette smoke.
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Affiliation(s)
- Modestos A Modestou
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242-1081, USA
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32
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Urrego F, Scuri M, Auais A, Mohtasham L, Piedimonte G. Combined effects of chronic nicotine and acute virus exposure on neurotrophin expression in rat lung. Pediatr Pulmonol 2009; 44:1075-84. [PMID: 19824047 PMCID: PMC3632456 DOI: 10.1002/ppul.21099] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Strong epidemiologic evidence indicates that tobacco smoke influences frequency and severity of respiratory infections. Previously, we have shown that infection with respiratory syncytial virus upregulates expression of neurotrophic factors and receptors in the lungs, but the effect of tobacco exposure on neurotrophins is unknown. Therefore, we first sought to determine the expression of neurotrophic pathways in lungs of rats chronically exposed to nicotine, and then we studied the interactions between pollution and infection by inoculating virus after nicotine exposure. Expression of the neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor, of their high-affinity tyrosine kinase receptors (trkA and trkB, respectively), and of the low-affinity receptor p75(NTR) was measured in the lungs of nicotine-exposed rats both at the mRNA level by reverse-transcription polymerase chain reaction and at the protein level by enzyme-linked immunoassay. Nicotine increased NGF expression both at the mRNA and protein level and also created a receptor imbalance deriving from increased expression of the pro-inflammatory p75(NTR) receptor without any concomitant change in the high-affinity trkA receptor. Viral infection after chronic nicotine exposure exerted an additive effect on NGF expression, and resulted in exaggerated neurogenic airway inflammation that was abolished by selective inhibition. In conclusion, nicotine levels comparable to those found in smokers are per se able to upregulate the expression of critical neurotrophic molecules in the respiratory tract, and combination of an acute infection following chronic nicotine exposure produces more severe neurotrophic dysregulation and neurogenic-mediated inflammation compared to either infection or nicotine alone.
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Affiliation(s)
- Fernando Urrego
- Ochsner Children's Health Center, New Orleans, Louisiana, USA
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33
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Kum-Nji P, Mangrem CL, Wells PJ, Herrod HG. Is environmental tobacco smoke exposure a risk factor for acute gastroenteritis in young children? Clin Pediatr (Phila) 2009; 48:756-62. [PMID: 19411611 DOI: 10.1177/0009922809332591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because passive smoke exposure has not been previously linked to diarrhea diseases in children, it was hypothesized that very young children exposed to environmental tobacco smoke (ETS) exposure at home would also be more likely to develop infectious gastroenteritis (GE) than their unexposed counterparts. During 1-year period, 260 children 36 months and younger were prospectively followed up in a private pediatric practice in a southern community in the United States. Multiple logistic regression analysis showed that ETS was strongly predictive of acute GE in the univariate analysis (P = .003). Even after controlling for the various confounders, ETS exposure was still significantly associated with acute GE (relative risk = 2.55; 95% CI = 1.26-5.18). It is speculated that, similar to acute respiratory infections, the same mechanisms may explain why ETS may also be associated with acute infectious GE.
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Affiliation(s)
- Philip Kum-Nji
- Children's Medical Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA.
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34
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Environmental tobacco smoke (ETS) and respiratory health in children. Eur J Pediatr 2009; 168:897-905. [PMID: 19301035 DOI: 10.1007/s00431-009-0967-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 02/26/2009] [Indexed: 10/21/2022]
Abstract
Environmental tobacco smoke (ETS) is a major risk factor for poor lung health in children. Although parental smoking is the commonest source of ETS exposure to children, they are also exposed to ETS in schools, restaurants, public places and public transport vehicles. Apart from containing thousands of chemicals, the particle size in the ETS is much smaller than the main stream smoke, and therefore has a greater penetrability in the airways of children. Exposure to ETS has been shown to be associated with increased prevalence of upper respiratory tract infections, wheeze, asthma and lower respiratory tract infections. Even developing fetuses are exposed to ETS via the umbilical cord blood if the mother is exposed to tobacco smoke. The placenta also does not offer any barrier to the penetration of ETS into the fetus. The immune system in these babies is more deviated toward the allergic and asthmatic inflammatory phenotype and therefore makes them more prone to develop asthma later in life. An increased awareness of the harmful effects of ETS on children's health is warranted.
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35
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Groskreutz DJ, Monick MM, Babor EC, Nyunoya T, Varga SM, Look DC, Hunninghake GW. Cigarette smoke alters respiratory syncytial virus-induced apoptosis and replication. Am J Respir Cell Mol Biol 2009; 41:189-98. [PMID: 19131644 DOI: 10.1165/rcmb.2008-0131oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals exposed to cigarette smoke have a greater number and severity of viral infections, including respiratory syncytial virus (RSV) infections, than do nonsmokers, but the cellular mechanism is unknown. Our objective was to determine the mechanism by which cigarette smoke augments viral infection. We hypothesize that cigarette smoke causes necrosis and prevents virus-induced cellular apoptosis, and that this is associated with increased inflammation and viral replication. Primary airway epithelial cells were exposed to cigarette smoke extract for 2 days, followed by 1 day of RSV exposure. Western blot detection of cleaved caspases 3 and 7 showed less apoptosis when cells were treated with cigarette smoke before viral infection. This finding was confirmed with ELISA and TUNEL detection of apoptosis. Measures of cell viability, including propidium iodide staining, ATP assay, and cell counts, indicated that cigarette smoke causes necrosis rather than virus-induced apoptosis. Using plaque assay and fluorescently-labeled RSV, we showed that although there were less live cells in the cigarette smoke-pretreated group, viral load was increased. The effect was inhibited by pretreatment of cells with N-acetylcysteine and aldehyde dehydrogenase, suggesting that the effect was primarily mediated by reactive aldehydes. Cigarette smoke causes necrosis rather than apoptosis in viral infection, resulting in increased inflammation and enhanced viral replication.
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Affiliation(s)
- Dayna J Groskreutz
- Division of Pulmonary, Critical Care, and Occupational Medicine, 100 EMRB, Iowa City, IA 52242, USA.
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36
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Castro SM, Kolli D, Guerrero-Plata A, Garofalo RP, Casola A. Cigarette smoke condensate enhances respiratory syncytial virus-induced chemokine release by modulating NF-kappa B and interferon regulatory factor activation. Toxicol Sci 2008; 106:509-18. [PMID: 18723827 PMCID: PMC2721674 DOI: 10.1093/toxsci/kfn175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 08/18/2008] [Indexed: 12/31/2022] Open
Abstract
Exposure to cigarette smoke is a risk factor contributing to the severity of respiratory tract infections associated with respiratory syncytial virus (RSV). Stimulation of airway epithelial cells by either RSV or cigarette smoke condensate (CSC) has been shown to induce secretion of the proinflammatory chemokines. However, the effect of coexposure of airway epithelial cells to CSC and RSV on inducible chemokine production has not been previously investigated. The results of this study indicate that CSC costimulation significantly increased RSV-induced interleukin-8 (IL-8) and monocyte chemoattactant protein-1 gene and protein expression when compared with each stimulus alone. Promoter deletion studies identified the interferon stimulatory response element (ISRE) of the IL-8 promoter as a critical region responsible for the synergistic increase of IL-8 gene transcription during mixed exposure. CSC costimulation enhanced RSV-induced activation of interferon regulatory factor (IRF)-1 and IRF-7, which bind to the ISRE site. CSC also furthered RSV-induced activation of the transcription factor nuclear factor kappa B (NF-kappaB), as shown by increased NF-kappaB DNA binding to its specific site of the IL-8 promoter and increased NF-kappaB-driven gene transcription. Therefore, our data demonstrate that a combined exposure to CSC and RSV synergistically increases chemokine expression in airway epithelial cells, suggesting that CSC contributes to an exuberant immune response to RSV by stimulating overlapping signal transduction pathways.
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Affiliation(s)
| | | | | | - Roberto P. Garofalo
- Department of Pharmacology and Toxicology
- Department of Pediatrics, Microbiology
- Immunology
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas 77555
| | - Antonella Casola
- Department of Pediatrics, Microbiology
- Immunology
- Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, Texas 77555
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38
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Kott KS, Salt BH, McDonald RJ, Jhawar S, Bric JM, Joad JP. Effect of secondhand cigarette smoke, RSV bronchiolitis and parental asthma on urinary cysteinyl LTE4. Pediatr Pulmonol 2008; 43:760-6. [PMID: 18615667 DOI: 10.1002/ppul.20853] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cysteinyl leukotrienes promote airway inflammation, bronchoconstriction and mucus hypersecretion. Cigarette smoking and respiratory syncytial virus (RSV) bronchiolitis are known to increase urinary cysteinyl leukotriene E4 (uLTE4), the end product of the cysteinyl leukotriene biosynthetic pathway. We tested the following hypotheses: (1) Secondhand smoke (SHS) exposure increases uLTE4 in well infants and in those hospitalized for RSV bronchiolitis; (2) Length of hospital stay for those with RSV bronchiolitis correlates with uLTE4; and (3) Infants with parent(s) with asthma will have higher uLTE4. Parental asthma for infants hospitalized with RSV bronchiolitis (n = 79) and Well babies (n = 31) was determined by questionnaire. Urine was analyzed for LTE4, cotinine, and creatinine. SHS exposure was determined by cotinine to creatinine ratio. Chi square, or t-tests were used to determine significant differences between two groups. A three-way analysis of variance compared the effects of SHS exposure and parental asthma on uLTE4 in Well versus RSV babies. Independent variables predicting length of hospital stay were determined by stepwise multiple regression. High SHS exposure and RSV significantly increased uLTE4. The SHS induced increase in uLTE4 was seen in infants with no parental asthma but not in those with parental asthma. Length of hospital stay positively correlated with uLTE4. We concluded that SHS exposure may increase the severity of bronchiolitis in RSV-infected infants by enhancing production of cysLTs in infants with no parental asthma.
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Affiliation(s)
- Kayleen S Kott
- Department of Pediatrics, University of California, Davis, California 95616, USA.
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39
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Hansbro NG, Horvat JC, Wark PA, Hansbro PM. Understanding the mechanisms of viral induced asthma: new therapeutic directions. Pharmacol Ther 2008; 117:313-53. [PMID: 18234348 PMCID: PMC7112677 DOI: 10.1016/j.pharmthera.2007.11.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 11/19/2007] [Indexed: 12/12/2022]
Abstract
Asthma is a common and debilitating disease that has substantially increased in prevalence in Western Societies in the last 2 decades. Respiratory tract infections by respiratory syncytial virus (RSV) and rhinovirus (RV) are widely implicated as common causes of the induction and exacerbation of asthma. These infections in early life are associated with the induction of wheeze that may progress to the development of asthma. Infections may also promote airway inflammation and enhance T helper type 2 lymphocyte (Th2 cell) responses that result in exacerbations of established asthma. The mechanisms of how RSV and RV induce and exacerbate asthma are currently being elucidated by clinical studies, in vitro work with human cells and animal models of disease. This research has led to many potential therapeutic strategies and, although none are yet part of clinical practise, they show much promise for the prevention and treatment of viral disease and subsequent asthma.
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Affiliation(s)
- Nicole G Hansbro
- Priority Research Centre for Asthma and Respiratory Disease, Faculty of Health, The University of Newcastle, New South Wales 2308, Australia
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40
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Ségala C, Poizeau D, Mesbah M, Willems S, Maidenberg M. Winter air pollution and infant bronchiolitis in Paris. ENVIRONMENTAL RESEARCH 2008; 106:96-100. [PMID: 17585899 DOI: 10.1016/j.envres.2007.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/05/2007] [Accepted: 05/18/2007] [Indexed: 05/15/2023]
Abstract
Respiratory syncytial virus (RSV) is one of the most common respiratory pathogens in infants and young children. It is not known why some previously healthy infants, when in contact with RSV, develop bronchiolitis whereas others have only mild symptoms. Our study aimed to evaluate the possible association between emergency hospital visits for bronchiolitis and air pollution in the Paris region during four winter seasons. We included children under the age of 3 years who attended emergency room services for bronchiolitis (following standardized definition) during the period 1997-2001. Two series of data from 34 hospitals, the daily number of emergency hospital consultations (n=50857) and the daily number of hospitalizations (n=16588) for bronchiolitis, were analyzed using alternative statistical methods; these were the generalized additive model (GAM) and case-crossover models. After adjustments for public holidays, holidays and meteorological variables the case-crossover model showed that PM10, BS, SO2 and NO2 were positively associated with both consultations and hospitalizations. GAM models, adjusting for long-term trend, seasonality, holiday, public holiday, weekday and meteorological variables, gave similar results for SO2 and PM10. This study shows that air pollution may act as a trigger for the occurrence of acute severe bronchiolitis cases.
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Affiliation(s)
- Claire Ségala
- SEPIA-Santé, 18bis rue du Calvaire, 56310 Melrand, France.
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41
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Hobson L, Everard ML. Persistent of respiratory syncytial virus in human dendritic cells and influence of nitric oxide. Clin Exp Immunol 2007; 151:359-66. [PMID: 18062796 DOI: 10.1111/j.1365-2249.2007.03560.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The annual epidemics of respiratory syncytial virus (RSV) infection are probably explained by poor herd immunity and the existence of a dormant reservoir of virus that is activated by an unknown trigger. The virus causes particular problems in infants, the elderly and patients with chronic obstructive airways disease (COPD). During two consecutive winters, human monocyte-derived dendritic cells (DCs) were exposed on a single occasion to one of two forms of RSV labelled with a fluorescent expresser genes (rgRSV or rrRSV) during the epidemic season. The cultures were maintained for many months, with fresh DCs being added at monthly intervals. The cultures were variously exposed to 600 parts per billion (ppb) nitric oxide for 15 min, nitric oxide (NO) donors and NO inhibitors outside the RSV epidemic season. The pattern of productive infection of DCs in vitro appeared to parallel the natural epidemics, in that DCs exhibited evidence of viral replication and productive infection only as manifested by intracellular fluorescence and infection of HeLa cells during the RSV epidemic season. When the long-term cultures were exposed to the above agents outside the RSV epidemic season there was again evidence of vigorous replication and productive infection, as shown by the reappearance of fluorescence and productive infection of HeLa cells. The results indicate that RSV may remain dormant in dendritic cells for prolonged periods and that replication appears to be activated by suppression of endogenous NO production. These observations may be key to our understanding of the mechanisms contributing to the annual epidemics of RSV infection.
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Affiliation(s)
- L Hobson
- Department of Respiratory Medicine, Sheffield Children's Hospital, Academic Department of Child Health, Sheffield University, Sheffield, UK
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42
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Jacobs-van der Bruggen MAM, Wijga AH, Brunekreef B, de Jongste JC, Baan CA, Kerkhof M, Smit HA. Do parents who smoke underutilize health care services for their children? A cross sectional study within the longitudinal PIAMA study. BMC Health Serv Res 2007; 7:83. [PMID: 17565678 PMCID: PMC1899488 DOI: 10.1186/1472-6963-7-83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 06/12/2007] [Indexed: 11/20/2022] Open
Abstract
Background A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected. From previous studies however, it appears that parents who smoke may underutilize health services for their children, especially with respect to respiratory care. This study explores the validity and generalizability of the previous assumption. Methods Data were obtained from a Dutch birth-cohort study; the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) project. Information regarding parental smoking, the child's respiratory symptoms and health care use and potential confounders were obtained by postal questionnaires. Multivariate logistic models were used to relate parental smoking to the child's respiratory symptoms and health care use. Results The study comprised 3,564, 4-year old children. In the crude analysis, respiratory symptoms were more frequent among children with a parent who smoked, while health care utilization for respiratory symptoms was not significantly different between children with or without a parent who smoked. In the multivariate analyses, maternal smoking had a larger impact on the child's respiratory symptoms and health care use as compared to paternal smoking. Maternal smoking was positively associated with mild respiratory symptoms of the child, adjusted odds ratio [AOR] 1.50 (1.19–1.91), but not with severe respiratory symptoms AOR 1.03 (0.75–1.40). Among children with mild respiratory symptoms, children with a mother who smoked were less likely to be taken to the general practitioner (GP) for respiratory symptoms, than children with mothers who did not smoke, AOR 0.58 (0.33–1.01). This finding was less pronounced among children with severe respiratory symptoms AOR 0.86 (0.49–1.52). Neither GP visits for non-respiratory symptoms nor specialized care for respiratory disease were significantly associated with parental smoking. Conclusion Mothers who smoke appear to underutilize health care for their children with mild respiratory symptoms. Health care workers should be informed about this phenomenon. Inquiring after the respiratory health of the children during regular visits to healthy baby clinics may help to track potential underutilization of care.
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Affiliation(s)
| | - Alet H Wijga
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Caroline A Baan
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marjan Kerkhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Henriette A Smit
- National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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43
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Marco Tejero A, Pérez Trullén A, Córdoba García R, García Sánchez N, Cabañas Bravo MJ. [Exposure to environmental tobacco smoke at home increases the need for medical attention for respiratory diseases in childhood]. An Pediatr (Barc) 2007; 66:475-80. [PMID: 17517202 DOI: 10.1157/13102512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Children are highly vulnerable to damage from passive smoking as they are unable to avoid environmental tobacco, if present. Some reports have suggested that domestic exposure to environmental tobacco smoke can increase respiratory diseases in children. The aim of this study was to assess whether domestic passive smoking is associated with new respiratory events. METHODS A descriptive, retrospective study was performed of 410 children aged less than 14 years old. The variables studied were: a) smokers in the household, b) the number of cigarettes smoked per day, c) school attendance, d) the number of siblings, e) previous respiratory diseases among parents and siblings, f) maternal smoking in pregnancy, and g) the number of respiratory events recorded in the previous year. Univariate, bivariate and multivariate analyses were performed. RESULTS A total of 50.2 % of the children cohabited with smokers at home. The mean number of upper respiratory tract events per child living in environments free of tobacco smoke was 2.53 versus 3.52 when one of the household members smoked. For respiratory disease as a whole, an inverse association with age was found [OR = 0.83; (95 % CI: 0.76-0.90)] and a direct association was found with maternal smoking [OR = 4.56 (95 % CI; 1.84-11.34)]. With upper respiratory tract disease, the OR was 1.4 if the mother smoked 11-20 cigarettes/day, and was 1.9 if the number of cigarettes was > 20. With lower respiratory diseases, the odds ratio was 3.48 (95 % CI; 2.07-6.06) if the mother smoked. CONCLUSIONS Fifty percent of the children studied were exposed to environmental tobacco smoke in the home. Younger children were at higher risk. The major risk factor for respiratory disease was maternal smoking and the risk increased with the number of cigarettes smoked. Health education is essential to protect children from tobacco smoke exposure.
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44
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Rees VW, Connolly GN. Measuring air quality to protect children from secondhand smoke in cars. Am J Prev Med 2006; 31:363-8. [PMID: 17046406 DOI: 10.1016/j.amepre.2006.07.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 05/17/2006] [Accepted: 07/07/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Secondhand tobacco smoke (SHS) is a major, preventable contributor to acute and chronic adverse health outcomes that affect children disproportionately. The predominant source of SHS among children is domestic exposure, and while up to two thirds of U.S. households have car smoking bans, an unacceptable number of children remain vulnerable. To help promote more effective protection through legislation, health communication strategies, or behavioral interventions, data demonstrating the adverse effect of SHS on air quality in cars are needed. METHODS Secondhand tobacco smoke in a motor vehicle under actual driving conditions was monitored by measuring respirable suspended particles (RSPs) of less than 2.5 microns in diameter, and carbon monoxide. Forty-five driving trials were conducted, using teams of volunteer drivers and smokers recruited from the general community. Three smoking conditions (nonsmoking baseline, active smoking, and immediate post-smoking period, each 5 minutes) were crossed with two ventilation conditions (windows open, closed) in a 3 x 2 within-sessions factorial design. RESULTS The highest mean observed RSP level was 271 mug/m(3), which is unsafe, particularly for children. Peak RSP levels were considerably higher. RSPs and carbon monoxide increased significantly from baseline after smoking, and these increases were greatest during the closed ventilation condition, compared with open ventilation. CONCLUSIONS Private passenger cars are a domestic environment with the potential to yield unsafe levels of SHS contaminants. These data may assist policymakers and health advocates to promote protective strategies to ensure smoke-free domestic environments for children.
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Affiliation(s)
- Vaughan W Rees
- Harvard School of Public Health, Division of Public Health Practice, Boston, Massachusetts 02115, USA.
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45
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Singh AM, Moore PE, Gern JE, Lemanske RF, Hartert TV. Bronchiolitis to asthma: a review and call for studies of gene-virus interactions in asthma causation. Am J Respir Crit Care Med 2006; 175:108-19. [PMID: 17053206 DOI: 10.1164/rccm.200603-435pp] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Viral infections are important causes of asthma exacerbations in children, and lower respiratory tract infections (LRTIs), caused by viruses such as respiratory syncytial virus (RSV) and rhinovirus (RV), are a leading cause of bronchiolitis in infants. Infants hospitalized with bronchiolitis are at significantly increased risk for both recurrent wheezing and childhood asthma. To date, studies addressing the incidence of asthma after bronchiolitis severe enough to warrant hospitalization have focused almost exclusively on RSV, but a number of recent studies suggest that other respiratory pathogens, including RV, may contribute as well. It is not known whether viral bronchiolitis directly contributes to asthma causation or simply identifies infants at risk for subsequent wheezing, as from an atopic predisposition or preexisting abnormal lung function. Alternatively, the properties of the infecting virus may be important. Thus, many possible determinants exist that may contribute to the severity of bronchiolitis and the subsequent development of asthma. One such determinant is the potential involvement of genetic susceptibility loci to asthma after viral bronchiolitis, a critical area that is just beginning to be evaluated. By clarifying the roles of both host- (genetic) and virus- (environment) specific factors that contribute to the frequency and severity of viral LRTI, it may be possible to determine if severe LRTIs cause asthma, or if asthma susceptibility predisposes patients to severe LRTI in response to viral infection. Characterizing these relationships offers the potential of identifying at-risk hosts in whom preventing or delaying infection could alter the phenotypic expression of asthma.
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Affiliation(s)
- Anne Marie Singh
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Somech R, Tal G, Gilad E, Mandelberg A, Tal A, Dalal I. Epidemiologic, socioeconomic, and clinical factors associated with severity of respiratory syncytial virus infection in previously healthy infants. Clin Pediatr (Phila) 2006; 45:621-7. [PMID: 16928839 DOI: 10.1177/0009922806291012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We prospectively quantified disease severity associated with epidemiologic and socioeconomic parameters as well as the clinical factors in 195 previously healthy infants with confirmed respiratory syncytial virus (RSV) infection. Infants were enrolled into three subgroups according to disease severity: outpatients (82 patients), inpatients (100 patients), and intensive care unit patients (13 patients). Epidemiologic parameters such as gestational age, birth weight, chronologic age at presentation, and gender as well as socioeconomic factors such as ethnic origin, family history of asthma, exposure to cigarette smoke, number of family members, presence of pets at home, breast-feeding, and day-care attendance were not found to predict the severity of RSV illness in previously healthy infants. Our results emphasize the complexity of predicting disease severity in previously healthy infants with RSV infection and suggest that other parameters such as host genetic background might explain the clinical variability.
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Affiliation(s)
- Raz Somech
- Department of Pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Boyaci H, Etiler N, Duman C, Basyigit I, Pala A. Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures. Pediatr Int 2006; 48:382-9. [PMID: 16911083 DOI: 10.1111/j.1442-200x.2006.02225.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Hasim Boyaci
- Department of Chest Diseases, Kocaeli University School of Medicine, Kocaeli, Turkey.
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Walsh P, Rothenberg SJ, O'Doherty S, Hoey H, Healy R. A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis. Eur J Emerg Med 2005; 11:265-72. [PMID: 15359199 DOI: 10.1097/00063110-200410000-00005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop and validate a logistic regression model to predict need for admission and length of hospital stay in children presenting to the Emergency Department with bronchiolitis. SETTING Two children's hospitals in Dublin, Ireland. METHODS We reviewed 118 episodes of bronchiolitis in 99 children admitted from the Emergency Department. Those discharged within 24 h by a consultant/attending paediatrician were retrospectively categorized as suitable for discharge. We then validated the model using a cohort of 182 affected infants from another paediatric Emergency Department in a bronchiolitis season 2 years later. In the validation phase actual admission, failed discharge, and age less than 2 months defined the need for admission. RESULTS The model predicted admission with 91% sensitivity and 83% specificity in the validation cohort. Age [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.76-0.97], dehydration (OR 2.54, 95% CI 1.34-4.82), increased work of breathing (OR 3.39, 95% CI 1.29-8.92) and initial heart rate above the 97th centile (OR 3.78, 95% CI 1.05-13.57) predicted the need for admission and a longer hospital stay. CONCLUSION We derived and validated a severity of illness model for bronchiolitis. This can be used for outcome prediction in decision support tools or severity of illness stratification in research/audit.
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Affiliation(s)
- Paul Walsh
- Department of Emergency Medicine, Kern Medical Centre, Bakersfield, CA, USA.
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Bhatt JM, Everard ML. Do environmental pollutants influence the onset of respiratory syncytial virus epidemics or disease severity? Paediatr Respir Rev 2004; 5:333-8. [PMID: 15531259 DOI: 10.1016/j.prrv.2004.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The trigger for annual epidemics of respiratory syncytial virus (RSV) infections and the factors contributing to the disappearance of RSV infections in late winter remain obscure. Similarly, there is no adequate explanation for the higher morbidity and admission rates in industrialised as compared with rural areas. It has been suggested that a variety of environmental factors such as temperature, daylight and humidity may influence the onset and waning of the epidemics. However, the few studies assessing these variables fail to support such a link. In many tropical countries the annual epidemic occurs in the summer or autumn, arguing against temperature having a direct influence. A number of studies have suggested that indoor pollutants, including cigarette smoke, are associated with an increased likelihood of being admitted to hospital with severe lower respiratory tract disease. One study exploring the potential role of outdoor pollutants on the pattern of RSV related illness in infancy was unable to identify a clear link between a variety of pollutants and the timing of the epidemic. Nitric oxide levels were higher in winter than during the summer and much higher winter peaks of NO were observe in industrialised areas as compared with urban and rural areas. Whether this or other environmental pollutants contribute to the higher incidence of severe disease in industrialised areas is unclear. Further work is required to explore the possible influence of NO and other environmental pollutants on both the timing and severity of epidemics.
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Affiliation(s)
- Jayesh M Bhatt
- Pediatric Respiratory Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK
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Gleeson M, Clancy RL, Cox AJ, Gulliver SA, Hall ST, Cooper DM. Mucosal immune responses to infections in infants with acute life threatening events classified as 'near-miss' sudden infant death syndrome. ACTA ACUST UNITED AC 2004; 42:105-18. [PMID: 15325403 DOI: 10.1016/j.femsim.2004.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/14/2004] [Indexed: 11/20/2022]
Abstract
This study examined the hypothesis that dysregulation of mucosal immune responses to respiratory infections is a critical event, which could be causal in respiratory arrest of some previously healthy infants. To examine this hypothesis, a prospective study was undertaken of infants presenting to the emergency department of a major teaching hospital with acute life threatening events (ALTE) of unknown cause and classified as "near-miss" SIDS. Salivary immunoglobulin concentrations were measured on admission and again after 14 days. The salivary immunoglobulins were compared with three control groups: infants with a mild upper respiratory tract infection (URTI); bronchiolitis; and healthy age-matched infants. The salivary IgA and IgM concentrations in the ALTE infants at presentation to hospital indicated a significant mucosal immune response had already occurred, with nearly 60% of the IgA concentrations significantly above the population-based reference ranges. The hyper-immune response was most evident in the ALTE infants with pathology evidence of an infection; 87% of these infants had salivary IgA concentrations on average 10 times higher that the age-related median concentration. The most prevalent pathogen identified in the ALTE infants was respiratory syncytial virus (RSV) (64%). RSV was also identified in all subjects with bronchiolitis. Risk factors for SIDS were assessed in each group. The data indicated that the ALTE infants diagnosed as 'near-miss' SIDS were a relatively homogeneous group, and most likely these ALTE infants and SIDS represent associated clinical outcomes. The study identified exposure to cigarette smoke and elevated salivary IgA concentrations as predictors of an ALTE. The study findings support the hypothesis of mucosal immune dysregulation in response to a respiratory infection in some infants with an ALTE. They provide a plausible explanation for certain SIDS risk factors. The underlying patho-physiological mechanism of proinflammatory responses to infections during a critical developmental period might be a critical factor in infants who have life-threatening apnoea or succumb to SIDS. The study raises the possibility of using salivary IgA to test infants who present with mild respiratory infections to identify a substantial number of infants at risk of developing an ALTE or SIDS, thus enabling intervention management to prevent such outcomes.
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Affiliation(s)
- Maree Gleeson
- Immunology Unit, Hunter Area Pathology Service, John Hunter Hospital, Locked Bag #1, Hunter Region Mail Centre, NSW 2310, Australia.
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