Passive smoking in babies: The BIBE study (Brief Intervention in babies. Effectiveness)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth. The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS). Methods/Design: Cluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia. The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care. Discussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health. The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS

Tabaquisme passiu en nadons: efectivitat d’una intervenció breu

Introducció: L’exposició al fum ambiental del tabac (FAT) és causa important de morbimortalitat. Particularment en el nadó, ja que la seva freqüència respiratòria és superior a la dels adults, el pulmó encara és immadur i ell per si sol no pot voluntàriament evitar l’exposició. L’exposició al FAT es relaciona amb un increment del risc de malalties pediàtriques com la síndrome de mort sobtada, malalties respiratòries agudes, empitjorament de l’asma, malalties agudes-cròniques de l’oïda mitjana i alentiment en el creixement pulmonar. No obstant, no es coneix l’eficàcia d’una intervenció en pares per reduir el FAT. Objectius: Valorar l’efecte d’una intervenció breu per evitar l’exposició al FAT adreçada als pares de nadons menors de 18 mesos, basades en les creences sobre tabaquisme passiu i les conductes dels cuidadors del nadó, realitzada per professionals de pediatria als 3 mesos de la intervenció. Material i mètodes: Assaig aleatoritzat, per conglomerats (grup control: GC i grup intervenció: GI), controlat, paral·lel, obert i multicèntric. La unitat d’aleatorització és l’Equip d’Atenció Primària (EAP), format per un pediatre/a i un infermer/a de pediatria, ambdós responsables d’una mateixa població infantil (aproximadament 2000 nens/es). Els criteris d’inclusió eren nadons de menys de 18 mesos, que el pare o mare fumessin, que es visitessin als EAP i donessin el consentiment per participar a l’estudi. Els criteris exclusió eren malalties greus dels pares o del nadó, malaltia psiquiàtrica dels pares, addicció dels pares a substàncies psicoactives, pares en procés de deshabituació tabac i previsió d’un canvi de domicili durant l’estudi. El GI rep una intervenció breu, basada en el consell personalitzat segons l’exposició i l’entrevista motivacional, de 10 minuts/sessió per 3 sessions en total, segons el model transteòric del canvi de Prochaska i Di Clemente i en l’estratègia de les 5’As (Ask, Advise, Assess, Assist, Arrange), per evitar l’exposició al FAT dels nadons i el GC fa les revisions habituals de pediatria. Es realitzen 3 controls (basal, 3 mesos i 6 mesos), tot i que en la present tesi només es valoraran la visita basal i el primer control als 3 mesos. En la visita basal es recullen, mitjançant un qüestionari de recollida de dades, variables clíniques del nadó, antecedents i característiques de l’exposició al FAT, i es recullen mostres de cabell del nadó només al primer i últim control als 6 mesos, per tal d’analitzar el nivell de nicotina en cabell, tot i que aquestes dades no formen part d’aquesta tesi. Les variables recollides dels progenitors són dades sociodemogràfiques, variables lligades al consum de tabac, dependència i estadi de canvi. En les visites de seguiment (als 3 i 6 mesos de la visita basal) es recullen dades d’exposició al FAT dels nadons. Resultats: Van participar a l’estudi 83 centres d’AP que van reclutar 937 nadons amb una edat mediana de 7,89 mesos (P25=4,17, P75=12,25). Als 3 mesos de la intervenció, el 35,7% de les famílies del GI i el 26,7% del GC (p=0,003) prenien mesures útils dins de casa, i el 58,6% del GI i el 50,9% del GC (p=0,018) les adoptaven dins del cotxe per evitar l’exposició al FAT. El 38,4% dels progenitors del GI i el 31,6% (p=0,029) del GC havien adoptat com a mínim un canvi de conducta per evitar l’exposició al FAT, als 3 mesos de la intervenció. Conclusions: La intervenció breu dirigida als progenitors és efectiva per disminuir-ne l’exposició al fum ambiental del tabac als seus fills a dins de casa i al cotxe.Background: Second Hand Smoke (SHS) from tobacco is clearly associated to an increased risk or morbidity and mortality. Particularly in the newborn, who has a higher respiratory frequency compared to adults, their lungs are still immature and voluntarily cannot avoid SHS exposition. Exposition to SHS is related to an increased risk to suffer some pediatric illnesses such as syndrome of sudden death, acute respiratory illnesses, worsening of asthma, eacute- chronic illnesses- of the middle ear and average hearing and slow pulmonary growth. However, no Known effective intervention for parents to reduce SHS. Objectives: To value the effect of a brief intervention to avoid SHS exposition in newborns and child aged <18 months. The intervention was undertaken by pediatrics professionals and was addressed to child’s parents on the beliefs and behaviors of the carers of the newborn at three months post intervention. Methods: Community based open, parallel, multicentric and conglomerate based randomized trial. The unit of randomization was the primary care team composed by a pediatrician and a pediatric nurse, both responsible of the same pediatric population (around 2000 children). A total of 937 children aged 18 months or younger with at least one of their parents being a current smoker and who are attended in any of the participating primary care center of Catalunya (North east of Spain) were included in the study. All parents signed the informed consent. The inclusion criteria were babies under 18 months of age whose parents smoke and who give their informed consent to participate in the study. The exclusion criteria was any pathology or parents or baby’s illness, Known addiction in the parents to other substances, parent in smoking cessation process or foreseeable change in residency. Intervention group received a brief intervention based on counseling, cognitive theory and motivational interviewing (5’As intervention: Ask, Advise, Assess, Assist, Arrange), to avoid SHS exposition in the children and control group received habitual care. Three controls were made, although for the present dissertation we included results for basal timeline and at three month post intervention. Basal information on children’s clinical data, past and recent SHS exposition and parent’s sociodemographic data and variables related to tobacco consumption (including dependency and state of change) was gathered with a face to face interview with the parent. At three and six months post intervention we gathered information on SHS exposure. Besides, at the beginning of the study and at six months post intervention children’s hair samples were collected to analyze nicotine levels, but this information is not offered in the present dissertation. Results: Eighty-three primary care centers participated in the study. The study included 937 children (median age: 7.89 months, P25=4,17, P75=12,25). At three months post intervention we observed an improvement on the measures to avoid SHS exposition among the intervention group compared to the control group: inside the house and in the car the percentage of families that undertook improvements were 35.7% 8 (vs. 26.7%, p=0.003) and 58.6% (vs. 50.9%, p=0.018). Globally, 38.4% of the parents of the intervention group (compared to the 31.6% of the control group, p=0.029) has adopted at least one behavior change to avoid SHS exposition at three months post-intervention. Conclusions: The present brief intervention addressed to parents who smoke to avoid SHS in their children is effective to reduce exposition inside the house and the car

Tabaquisme passiu en nadons : efectivitat d'una intervenció breu /

Introducció: L'exposició al fum ambiental del tabac (FAT) és causa important de morbimortalitat. Particularment en el nadó, ja que la seva freqüència respiratòria és superior a la dels adults, el pulmó encara és immadur i ell per si sol no pot voluntàriament evitar l'exposició. L'exposició al FAT es relaciona amb un increment del risc de malalties pediàtriques com la síndrome de mort sobtada, malalties respiratòries agudes, empitjorament de l'asma, malalties agudes-cròniques de l'oïda mitjana i alentiment en el creixement pulmonar. No obstant, no es coneix l'eficàcia d'una intervenció en pares per reduir el FAT. Objectius: Valorar l'efecte d'una intervenció breu per evitar l'exposició al FAT adreçada als pares de nadons menors de 18 mesos, basades en les creences sobre tabaquisme passiu i les conductes dels cuidadors del nadó, realitzada per professionals de pediatria als 3 mesos de la intervenció. Material i mètodes: Assaig aleatoritzat, per conglomerats (grup control: GC i grup intervenció: GI), controlat, paral·lel, obert i multicèntric. La unitat d'aleatorització és l'Equip d'Atenció Primària (EAP), format per un pediatre/a i un infermer/a de pediatria, ambdós responsables d'una mateixa població infantil (aproximadament 2000 nens/es). Els criteris d'inclusió eren nadons de menys de 18 mesos, que el pare o mare fumessin, que es visitessin als EAP i donessin el consentiment per participar a l'estudi. Els criteris exclusió eren malalties greus dels pares o del nadó, malaltia psiquiàtrica dels pares, addicció dels pares a substàncies psicoactives, pares en procés de deshabituació tabac i previsió d'un canvi de domicili durant l'estudi. El GI rep una intervenció breu, basada en el consell personalitzat segons l'exposició i l'entrevista motivacional, de 10 minuts/sessió per 3 sessions en total, segons el model transteòric del canvi de Prochaska i Di Clemente i en l'estratègia de les 5'As (Ask, Advise, Assess, Assist, Arrange), per evitar l'exposició al FAT dels nadons i el GC fa les revisions habituals de pediatria. Es realitzen 3 controls (basal, 3 mesos i 6 mesos), tot i que en la present tesi només es valoraran la visita basal i el primer control als 3 mesos. En la visita basal es recullen, mitjançant un qüestionari de recollida de dades, variables clíniques del nadó, antecedents i característiques de l'exposició al FAT, i es recullen mostres de cabell del nadó només al primer i últim control als 6 mesos, per tal d'analitzar el nivell de nicotina en cabell, tot i que aquestes dades no formen part d'aquesta tesi. Les variables recollides dels progenitors són dades sociodemogràfiques, variables lligades al consum de tabac, dependència i estadi de canvi. En les visites de seguiment (als 3 i 6 mesos de la visita basal) es recullen dades d'exposició al FAT dels nadons. Resultats: Van participar a l'estudi 83 centres d'AP que van reclutar 937 nadons amb una edat mediana de 7,89 mesos (P25=4,17, P75=12,25). Als 3 mesos de la intervenció, el 35,7% de les famílies del GI i el 26,7% del GC (p=0,003) prenien mesures útils dins de casa, i el 58,6% del GI i el 50,9% del GC (p=0,018) les adoptaven dins del cotxe per evitar l'exposició al FAT. El 38,4% dels progenitors del GI i el 31,6% (p=0,029) del GC havien adoptat com a mínim un canvi de conducta per evitar l'exposició al FAT, als 3 mesos de la intervenció. Conclusions: La intervenció breu dirigida als progenitors és efectiva per disminuir-ne l'exposició al fum ambiental del tabac als seus fills a dins de casa i al cotxeBackground: Second Hand Smoke (SHS) from tobacco is clearly associated to an increased risk or morbidity and mortality. Particularly in the newborn, who has a higher respiratory frequency compared to adults, their lungs are still immature and voluntarily cannot avoid SHS exposition. Exposition to SHS is related to an increased risk to suffer some pediatric illnesses such as syndrome of sudden death, acute respiratory illnesses, worsening of asthma, eacute- chronic illnesses- of the middle ear and average hearing and slow pulmonary growth. However, no Known effective intervention for parents to reduce SHS. Objectives: To value the effect of a brief intervention to avoid SHS exposition in newborns and child aged 18 months. The intervention was undertaken by pediatrics professionals and was addressed to child's parents on the beliefs and behaviors of the carers of the newborn at three months post intervention. Methods: Community based open, parallel, multicentric and conglomerate based randomized trial. The unit of randomization was the primary care team composed by a pediatrician and a pediatric nurse, both responsible of the same pediatric population (around 2000 children). A total of 937 children aged 18 months or younger with at least one of their parents being a current smoker and who are attended in any of the participating primary care center of Catalunya (North east of Spain) were included in the study. All parents signed the informed consent. The inclusion criteria were babies under 18 months of age whose parents smoke and who give their informed consent to participate in the study. The exclusion criteria was any pathology or parents or baby's illness, Known addiction in the parents to other substances, parent in smoking cessation process or foreseeable change in residency. Intervention group received a brief intervention based on counseling, cognitive theory and motivational interviewing (5'As intervention: Ask, Advise, Assess, Assist, Arrange), to avoid SHS exposition in the children and control group received habitual care. Three controls were made, although for the present dissertation we included results for basal timeline and at three month post intervention. Basal information on children's clinical data, past and recent SHS exposition and parent's sociodemographic data and variables related to tobacco consumption (including dependency and state of change) was gathered with a face to face interview with the parent. At three and six months post intervention we gathered information on SHS exposure. Besides, at the beginning of the study and at six months post intervention children's hair samples were collected to analyze nicotine levels, but this information is not offered in the present dissertation. Results: Eighty-three primary care centers participated in the study. The study included 937 children (median age: 7.89 months, P25=4,17, P75=12,25). At three months post intervention we observed an improvement on the measures to avoid SHS exposition among the intervention group compared to the control group: inside the house and in the car the percentage of families that undertook improvements were 35.7% 8 (vs. 26.7%, p=0.003) and 58.6% (vs. 50.9%, p=0.018). Globally, 38.4% of the parents of the intervention group (compared to the 31.6% of the control group, p=0.029) has adopted at least one behavior change to avoid SHS exposition at three months post-intervention. Conclusions: The present brief intervention addressed to parents who smoke to avoid SHS in their children is effective to reduce exposition inside the house and the car

Passive smoking in babies: the BIBE study (Brief Intervention in babies. Effectiveness)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth.The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS). Methods/design: Cluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia.The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care. Discussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health.The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS

Passive smoking in babies: the BIBE study (brief intervention in babies : effectiveness)

There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth. The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS

Passive smoking in babies: The BIBE Study (Brief Intervention in babies. Effectiveness)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth./n/nThe objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS)./nMethods/Design/n/nCluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia./n/nThe measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care./nDiscussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health. The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS

Prevalencia de consumo de tabaco en trabajadores hospitalarios: metaanálisis en 45 hospitales catalanes = Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals

El 'Grupo de coordinadores de los Hospitales de la Red' está compuesto por: Sandra Bigordà Palau, Jaume González, Maite Elvira, Francesc Abella, Montserrat Pie, Lourdes Rofes, Tere Catalán, Joaquim Guasch, Joana Carrasco, Dolors Benito, Upe González, Peio Solà, Rosa Sunyer, Rosa Carreras, Sílvia Molina, Beatriu Castells, Ma Antònia Raich, Francesc Fibla, Merce Palau, Consol Serra, David de la Rosa, Francesc Macià, Andrea Burón, Ruth Ripoll, Marta Solé, José María Sánchez, M. Antònia Pajin, Mercè Santos Asensio, Cristina Pinet, Jordi Bugés, Claudia Guevara, Jaume Prat, Marga Cano, Pilar Pena, ˜ Gemma Mayor, Joana Guerrero, Manel Roda, Fernando Pommier, Montserrat Contel, Albert Tresserras Puyuelo, Francesc Soler, Miquel Vilardell, Jorge Sanz, Catalina Serra Carbonell y Manel SantinàObjective: To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. Method: A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. Results: The overall prevalence of smoking was 28.1% (95%. CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). Conclusion: The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groupsObjetivo: Estimar la prevalencia de consumo de tabaco en trabajadores/as de los hospitales miembros de la Red Catalana de Hospitales sin Humo según sus características sociodemográficas y tipo de hospital al que pertenecen, en el período 2009-2012. Método: Metaanálisis de encuestas de prevalencia en muestras representativas de trabajadores/as de 45 hospitales (2009-2012). La prevalencia conjunta se calculó mediante un modelo de regresión con efectos aleatorios ponderado por el tamaño muestral. Resultados: La prevalencia global de consumo de tabaco es del 28,1% (intervalo de confianza del 95% [IC95%]: 26,1-30,0%), con valores máximos y mínimos del 40,3% y el 19,1%. Los grupos con menor prevalencia son el colectivo médico (16,4%; IC95%: 12,9-19,9%) y el colectivo de enfermería (25,4%; IC95%: 21,6-29,2%). Conclusión: La prevalencia de consumo de tabaco en trabajadores/as hospitalarios/as es menor que en la población general en edad laboral, siendo el colectivo médico el menos fumador. Es necesario implementar acciones que faciliten el abandono del tabaco en el resto de los colectivo