RESUMO
OBJECTIVE: To investigate the relationship between secondhand tobacco smoke (SHS) exposure and neuromotor function in children. STUDY DESIGN: We studied 404 children aged 7-9 years who were exposed to SHS and other environmental neurotoxicants. Parents reported smoking habits, and serum cotinine levels were measured in children to determine SHS exposure. The Halstead-Reitan Finger Oscillation Test, Purdue Grooved Pegboard Test-Kiddie version, and Bruininks-Oseretsky Test of Motor Proficiency 2-Short Form were used to assess neuromotor function. Multivariable regression models that accounted for potential confounders were used to evaluate the associations. RESULTS: Approximately 50% of the children were exposed to SHS based on serum cotinine measures. Exposure to SHS was significantly associated with motor impairment in children, including diminished visuomotor coordination (P = .01), fine motor integration (P = .01), balance (P = .02), and strength (P = .04) after adjusting for exposures to lead and manganese, age, sex, body mass index, measures of parental cognitive abilities, parental education, and quality of home environment. CONCLUSION: SHS is a neurotoxicant that may be associated with impaired childhood neuromotor function.
Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Cotinina/sangue , Exposição Ambiental/análise , Destreza Motora/fisiologia , População Rural , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/análise , Criança , Feminino , Humanos , Masculino , PaisRESUMO
OBJECTIVE: To examine whether succimer, a mercaptan compound known to reduce blood lead concentration in children, reduces blood mercury concentration. STUDY DESIGN: We used samples from a randomized clinical trial of succimer chelation for lead-exposed children. We measured mercury levels in pre-treatment samples from 767 children. We also measured mercury levels in blood samples drawn 1 week after treatment began (n = 768) and in a 20% random sample of the children who received the maximum 3 courses of treatment (n = 67). A bootstrap-based isotonic regression method was used to compare the trend with time in the difference between the adjusted mean mercury concentrations in the succimer group and that in the placebo group. RESULTS: The adjusted mean organic mercury concentration in the succimer group relative to the placebo group fell from 99% at baseline to 82% after 3 courses of treatment (P for trend = .048), but this resulted from the prevention of the age-related increase in the succimer group. CONCLUSION: Succimer chelation for low level organic mercury exposure in children has limited efficacy.
Assuntos
Quelantes/uso terapêutico , Intoxicação por Mercúrio/tratamento farmacológico , Succímero/uso terapêutico , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Limite de Detecção , Modelos Lineares , Masculino , Mercúrio/sangue , Estados UnidosRESUMO
OBJECTIVE: To develop a statistical method for defining clusters of necrotizing enterocolitis (NEC) cases in the neonatal intensive care unit (NICU). STUDY DESIGN: The study group included 2782 infants weighing 401 to 1500 g at birth born between 1996 and 2004. NEC was defined as Bell stage II or III. Two statistical methods were used to define "disease clusters": a modified scan test and a comparison of observed and expected incidence density rates (IDRs) of NEC at each NICU. RESULTS: The proportion of infants with NEC was similar in the 2 NICUs (7.1% vs 7.7%; P = .6), as was the expected IDR of NEC (1.39/1000 patient-days vs 1.32/1000 patient-days; P = .72). Twelve temporal clusters of NEC were identified in the 2 NICUs, representing 18% of 203 total NEC cases during the study period. No seasonal/secular trends were noted for NEC rates or identified clusters. Potential NEC clusters of > or =3 cases at either NICU had a >75% likelihood of being a true NEC cluster. CONCLUSIONS: No operational definition of NEC cluster exists. This study introduces methods to use in prospective surveillance and to guide studies investigating etiologic relevance. Using the proposed methods, statistically significant clusters (ie, potential outbreaks) of NEC within NICUs can be identified early, providing an opportunity for early implementation of cluster investigation protocols.