Preparation of an anti-cotinine monoclonal antibody and its application in immunological detection / 浙江大学学报·医学版

OBJECTIVE@#To prepare monoclonal antibody against cotinine (COT) and to establish immunoassay for detecting COT in human urinary samples.@*METHODS@#BALB/c mice were immunized with synthesized cotinine-bovine serum albumin (COT-BSA) to screen monoclonal antibody with technique of cell fusion. The monoclonal antibody was used for the indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) and colloidal gold immunochromatographic strip assay for the detection of COT in human urine.@*RESULTS@#The monoclonal antibody against COT was identified by ic-ELISA with a 50%inhibitive concentration (IC@*CONCLUSIONS@#The ic-ELISA and colloidal gold immunochromatographic strip assay using the prepared monoclonal antibody against COT have been proved to be reliable for the rapid detection of COT in human urines, which may be used for monitoring of environmental tobacco smoke.

Socio-environmental risks associated with the green tobacco sickness in farmers: a case-control study / Riesgos socioambientales asociados a la enfermedad del tabaco verde en agricultores: un estudio caso-control / Riscos socioambientais associados à doença da folha verde do tabaco em agricultores: um estudo caso-controle

ABSTRACT Objective: to determine the presence of socio-environmental risk factors for the development of Green Tobacco Sickness in workers who grow Burley tobacco. Method: matched case-control study. The data collection took place in two moments: from December 2016 to January 2017 and December 2017, when the Burley tobacco was collected, through a household survey with interview application and urine collection for urinary cotinine. Results: the socio-environmental risk factors that remained associated with the disease were: bundling tobacco (p=0.047) and wearing socks (p=0.011); with protective effect were found sticking tobacco seeding of the day (p=0.006) and number of tobacco harvested per day (p=0.021). Conclusion: the steps in the Burley tobacco work process increase the exposure and risk of developing the disease. By identifying these factors, it is possible to address interdisciplinary control and prevention measures.

RESUMEN Objetivo: determinar la presencia de factores de riesgo socioambientales para el desarrollo de la Enfermedad del Tabaco Verde en trabajadores que cultivan el tabaco Burley. Método: estudio del tipo caso-control pareado. La recolección de datos ocurrió en dos momentos: de diciembre de 2016 a enero de 2017 y diciembre de 2017, período en que ocurrió la recolección del tabaco Burley, por medio de encuesta domiciliaria con aplicación de entrevista y recolección de orina para el examen de cotinina urinaria. Resultados: los factores de riesgo socioambientales que permanecieron asociados a la enfermedad fueron aferrar tabaco (p=0,047) y usar medias (p=0,011); con efecto protector fueron encontrados espetar los pies de tabaco del día (p=0,006) y el número de pies de tabaco cosechados por día (p=0,021). Conclusión: las etapas del proceso de trabajo con tabaco Burley aumentan la exposición y el riesgo de desarrollar la enfermedad. Al identificar estos factores, es posible dirigir, de forma interdisciplinaria, medidas de control y prevención.

RESUMO Objetivo: determinar a presença de fatores de riscos socioambientais para o desenvolvimento da Doença da Folha Verde do Tabaco em trabalhadores que cultivam o tabaco Burley. Método: estudo do tipo caso-controle pareado. A coleta de dados ocorreu em dois momentos: de dezembro de 2016 a janeiro de 2017 e dezembro de 2017, período em que ocorreu a colheita do tabaco Burley, por meio de inquérito domiciliar com aplicação de entrevista e coleta de urina para exame de cotinina urinária. Resultados: os fatores de riscos socioambientais que permaneceram associados à doença foram enfeixar tabaco (p=0,047) e usar meias (p=0,011); com efeito protetor foram encontrados espetar pés de tabaco do dia (p=0,006) e número de pés de tabaco colhido por dia (p=0,021). Conclusão: as etapas do processo de trabalho com tabaco Burley aumentam a exposição e o risco de desenvolver a doença. Ao identificar esses fatores, é possível direcionar, de forma interdisciplinar, medidas de controle e prevenção.

Uso de biomarcador cotinina em trabalhadores para detecção da doença da folha verde do tabaco / Use of cotinine biomarker in workers to detect green tobacco sickness / Uso de biomarcador cotinina en trabajadores para detectar la Enfermedad del Tabaco Verde

Objetivo verificar, por meio da tecnologia de biomarcador de cotinina urinária, a ocorrência da doença da folha verde do tabaco em trabalhadores que cultivam tabaco do tipo Burley. Método estudo caso-controle pareado, com base no status tabágico e na proporção 1:4, com participação de 20 trabalhadores-caso e 91 controles. Para a coleta de dados foi realizada entrevista por meio de inquérito domiciliar e coleta de urina para exame de cotinina. Foram utilizados os testes t de Student, Mann-Whitney, qui-quadrado de Pearson ou exato de Fisher. Resultados dos 23 casos suspeitos, 20 apresentaram níveis elevados de cotinina, sinais e sintomas de dor de cabeça, irritação de pele, náusea, enjoo e mal-estar geral, principalmente pela manhã. A maioria trabalhou com tabaco molhado decorrente do sereno e o clima estava quente. Conclusão verificam-se sinais sugestivos da doença da folha verde do tabaco nos trabalhadores do tabaco Burley. Faz-se necessária a atuação de profissionais de saúde no desenvolvimento de ações promotoras de saúde e preventivas sobre essa doença relacionada ao trabalho.

Objective using the urinary cotinine biomarker to verify the occurrence of green tobacco sickness in workers who cultivate Burley tobacco. Method paired case-control study, based on smoking status and on the 1:4 ratio, with participation of 20 case workers and 91 controls. Data collection included household surveys and urine collection for cotinine examination. Student's T-Test, the Mann-Whitney test, Pearson's chi-square or Fisher's exact tests were used. Results of the 23 suspected cases, 20 showed elevated levels of cotinine, signs and symptoms of headache, skin irritation, nausea, sickness and general malaise, especially in the morning. Most had worked with tobacco that was wet from the morning dew and when the weather was warm. Conclusion there are signs suggestive of green tobacco sickness in Burley tobacco workers. The action of health professionals is necessary for the development of health promotion and preventive actions addressing work-related illness.

Objetivo certificar, por medio de la tecnología de biomarcador de cotinina urinaria, la ocurrencia de la Enfermedad del Tabaco Verde en trabajadores que cultivan tabaco del tipo Burley. Método estudio caso-control pareado, con base en el status tabáquico y en la proporción 1:4, con la participación de 20 trabajadores-caso y 91 controles. Para la recopilación de datos se realizó una encuesta por medio de cuestionario domiciliar y de recolección de orina para análisis de cotinina. Se utilizaron las siguientes pruebas t de Student, Mann-Whitney, chi-cuadrado de Pearson o exacta de Fisher. Resultados de los 23 casos sospechosos, 20 presentaron niveles elevados de cotinina, señales y síntomas de dolor de cabeza, irritación de la piel, náusea, mareo y malestar general, principalmente por la mañana. La mayoría trabajó con tabaco mojado por el sereno y en un clima caluroso. Conclusión se certifican señales sugestivas de Enfermedad del Tabaco Verde en los trabajadores del tabaco Burley. Se hace necesaria la actuación de profesionales de la salud en el desarrollo de acciones promotoras de salud y preventivas de esta enfermedad relacionado con el trabajo.

Self-reported smoking status and urinary cotinine levels in patients with asthma / Tabagismo entre asmáticos: avaliação por autorrelato e dosagem de cotinina urinária

ABSTRACT Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.

RESUMO Objetivo: Descrever a frequência de tabagismo ativo entre pacientes com asma e indivíduos sem asma, usando questionários padronizados e dosagem da cotinina urinária. Métodos: Estudo transversal realizado em Salvador (BA), com 1.341 indivíduos, sendo 498 com asma grave, 417 com asma leve/moderada e 426 sem asma. O tabagismo foi identificado por meio de autorrelato utilizando questionários e por mensuração da cotinina urinária. Para a comparação das variáveis estudadas, utilizaram-se os testes do qui-quadrado e de Kruskal-Wallis. Resultados: Dos 55 participantes (4,1%) que se declararam tabagistas atuais, 5, 17 e 33 eram dos grupos asma grave, asma leve/moderada e sem asma, respectivamente. Desses 55, 32 (58,2%) eram tabagistas diários e 23 (41,8%) eram tabagistas ocasionais. Observaram-se níveis elevados de cotinina urinária entre não fumantes autodeclarados e tabagistas pregressos, especialmente no grupo asma grave, o que sugere omissão do hábito atual de fumar. A carga tabágica entre os fumantes e a proporção de ex-tabagistas foram maiores no grupo asma grave do que no grupo asma leve/moderada. Conclusões: O tabagismo pregresso esteve associado à asma grave. Tabagismo atual também foi observado em alguns pacientes com asma grave e detectou-se omissão em alguns casos. A investigação de tabagismo deve ser meticulosa em pacientes com asma grave e a entrevista desses deve ser complementada por uma avaliação objetiva.

Urinary cotinine in tobacco farmers in Southern Brazil

ABSTRACT OBJECTIVE To describe urinary cotinine levels in tobacco farmers. METHODS A cross-sectional study was conducted in 2,570 tobacco farmers. All participants that reported green tobacco sickness in the week prior to the interview plus a subsample of 492 pesticide applicators were included. We collected urinary samples and information about sociodemographic, behavioral, dietary, occupational characteristics, and pesticide poisoning during their lifetime. Stratification by sex and smoking was performed and the Wilcoxon and Kruskal-Wallis non-parametrical tests were used to analyze cotinine means. RESULTS This study included 582 individuals. There was no difference in urinary cotinine means between green tobacco sickness symptomatic and asymptomatic individuals. Among non-smokers, having picked tobacco in the previous week was associated with higher cotinine means in both genders. Cotinine levels were higher on the first day of symptoms and reduced exponentially with each day in female non-smokers. Male non-smokers had higher levels on the second day and a more gradual reduction. The cotinine level rose up to 15 cigarettes/day of consumption. CONCLUSIONS The urinary cotinine measures exposure to nicotine up to its saturation point; while green tobacco sickness, affected by tolerance, indicates nicotine poisoning. Strategies to reduce nicotine exposure in tobacco production are needed. Mechanization could be an alternative, as long as it overcame the challenge of irregular terrain and did not affect the quality of the leaf. More studies are needed to evaluate the chronic effect of nicotine exposure.

The effects of passive tobacco smoking on the microcirculation of the abdominal wall in rats

ABSTRACT PURPOSE: To analysis the effects of passive smoking on the microstructure of tissues of the abdominal wall regarding microcirculation, using histopathological study of the tobacco exposed rats. METHODS: Twenty four male Wistar rats were divided in Control Group (CG = 8 animals) and Exposition Groups (EG = 16 animals). EG was exposed to cigarette smoke 4x/day for 120 days, while CG was preserved from exposure. Food, water and housing were similar for both groups. After 120 days, urine samples were collected before necropsy to analyze cotinine levels (ng/mL) in urine and blinded histopathological analysis of the abdominal wall performed to count arteries and veins in dermal and muscular fascia layer. RESULTS: No difference in weight was observed between both groups (P>0.05). Cotinine concentration was significantly higher in EG (P<0.05). In dermal layer, the average of vessels per animal was 8.72 (IC95%: 8.31-9.13) for CG and 11,23 (IC95%: 10.09-12.38) for EG. In muscular fascia layer the average of vessels per animal was 17.97 (IC95%: 15.79-20.15) for CG, whereas the average for EG was of 14,85 (IC95%: 12.71-17.01) (P<0.05). CONCLUSION: Exposition to passive smoking may cause increase in the number of vessels in dermal layer, with the opposite effects at the muscular fascia layer.

Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth? / Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?

OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management ...

OBJETIVO: O tabagismo autodeclarado é usado frequentemente para estimar a prevalência dessa condição. As taxas de tabagismo podem ser subestimadas por esse método. O objetivo deste estudo foi avaliar a diferença entre o tabagismo autodeclarado e o tabagismo determinado pelo uso de medidas objetivas em um ambulatório de doenças respiratórias. MÉTODOS: Estudo transversal realizado em 144 indivíduos: 51 pacientes com asma, 53 pacientes com DPOC, 20 fumantes e 20 não fumantes. O tabagismo foi determinado por meio de autorrelato em entrevistas e medição de monóxido de carbono no ar exalado (COex) e de cotinina urinária. RESULTADOS: Todos os pacientes com asma e DPOC declararam não ser fumantes. Nos pacientes com DPOC e asma, a mediana de concentração de cotinina urinária foi de 167 ng/ml (variação, 2-5.348) e de 47 ng/ml (variação, 5-2.735 ppm), respectivamente (p < 0,0001), enquanto . a mediana de COex foi de 8 ppm (variação, 0-31) e 5,0 ppm (variação, 2-45 ppm), respectivamente (p < 0,05). Em 40 (38%) dos pacientes com asma ou DPOC (n = 104), houve discordâncias entre o tabagismo autodeclarado e a concentração de cotinina urinária (> 200 ng/mL). Em 48 (46%) desses 104 pacientes, o não tabagismo autodeclarado foi refutado por um nível de COex > 6 ppm, considerado indicativo de fumo atual. Em 30 (29%) dos pacientes com asma ou DPOC, a concentração de cotinina urinária e o nível de COex contradisseram o autorrelato desses como não fumantes. CONCLUSÕES: Nossos achados sugerem que altas proporções de pacientes fumantes com doenças respiratórias declaram ser não fumantes. A classificação correta do tabagismo é fundamental no tratamento dessas doenças. Medidas objetivas do tabagismo podem ser úteis na melhora do manejo clínico e no aconselhamento. .

Effectiveness of the Self-determination Theory based a Motivational Interviewing YOU-TURN Program for Smoking Cessation among Adolescents

PURPOSE: In this study, the effectiveness of a motivational interviewing smoking cessation YOU-TURN program for adolescents was examined. The program was based on the self-determination theory. METHODS: The study was carried out with a nonequivalent control group pretest-posttest design. Participants in the present study were 136 high school students living in D city. The students were assigned to the experimental group (n=52) who participated in the motivational interviewing smoking cessation YOU-TURN program based on self-determination theory, or to the control group (n=84) who participated in a general smoking cessation program. Data were collected from September 1, 2013 through April 30, 2014. Collected data were analyzed using SPSS PC+ 21.0 with Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test, Repeated Measures ANOVA, and MANOVA-Wilk's Lambda. RESULTS: The experimental group had a significant increase in basic psychological needs, and duration of quitting-smoking in comparison with the control group. The experimental group had a significant decrease in cigarettes smoked per day and cotinine in urine in comparison with the control group. CONCLUSION: The motivational interviewing YOU-TURN program, when delivered to adolescents who smoked, was effective in discouraging smoking, and can be utilized as an effective nursing intervention for adolescents who smoke.

Cotinina urinaria en embarazadas expuestas al humo ambiental del tabaco que concurren a controles prenatales en la ciudad de Gualeguaychú / Urinary cotinine values and exposure to environmental snuff in pregnant women who attend prenatal examinations in the city of Gualeguaychú

El tabaco es uno de los factores de riesgo prevenibles más importante de las enfermedades crónicas no trasmisibles (ECNT). Los efectos de fumar no están limitados a los fumadores activos, involucran además a los individuos que sufren los efectos de los tóxicos del humo del tabaco ambiental (HTA): los fumadores pasivos. Las mujeres embarazadas fumadoras activas o expuestas al HTA son una población muy sensible a los efectos tóxicos del tabaco, ya que los mismos repercuten también sobre el feto en formación. La cotinina es en la actualidad el marcador biológico más adecuado para medir exposición al HTA tanto activa como pasiva. Objetivo: determinar el nivel de cotinina en mujeres embarazadas que manifestaron ser fumadoras pasivas, relacionando los valores obtenidos con los días de exposición manifestados. Materiales y métodos: se trabajó con 443 embarazadas que concurrieron a centros de salud públicos y a un centro privado de Gualeguaychú para su control prenatal, solicitándoles a las que manifestaron estar expuestas al HTA una muestra de orina para el dosaje de cotinina. Se aplicó un diseño de tipo no experimental, retrospectivo y de corte transversal. El dosaje de cotinina se realizó en orina, empleando una metodología quimioluminiscente. Previamente se obtuvo un valor referencial de cotinina urinaria inferior a los 15,2 ng/ml para el 98 % de sujetos no fumadores no expuestos al HTA. Resultados: los análisis de los niveles de cotinina en las embarazadas fumadoras pasivas revelaron que, el 82 % en los centros públicos y el 42 % en el centro privado, presentaron un nivel de cotinina superior a 15,2 ng/ml. Teniendo en cuenta los días de exposición, el registro promedio de cotinina para las que manifestaron estar expuestas los últimos siete días fue de 52,3 ng/ml en el sector público y 64,1 ng/ml en el privado. Discusión y conclusiones: la medición de cotinina resulta de utilidad para tener datos fidedignos de la exposición pasiva al HTA. En los centros públicos el 82 % de las embarazadas que manifestaron estar expuestas tenían valores de cotinina urinaria que coincidían con lo expresado, mientras que en el centro privado el 42 % de las que manifestaron la misma situación presentaba valores del indicador que denotaban exposición al tabaco. Se observó un aumento progresivo del promedio del indicador biológico de acuerdo a los días de exposición en ambos sectores, superando los 50ng/ml cuando la exposición declarada fue durante los últimos 7 días, lo que es indicativo de una exposición al HTA severa. El interés y preocupación manifestados por las embarazadas que participaron en este estudio indica que la implementación de este tipo de diagnóstico puede contribuir a las campañas de prevención contra el consumo de tabaco y promover el derecho de quienes no fuman a vivir en ambientes saludables libres de los compuestos tóxicos del mismo.

Tobacco is one of the preventable risk factors, which is most important in the chronic non-communicable diseases (NCDs). The effects of smoking are not limited to active smokers; it also involves individuals who suffer the effects of environmental tobacco smoke (ETS): passive smokers. Pregnant women who are active smokers or exposed to ETS are a very sensitive population to the toxic effects of snuff, since they also affect the developing fetus. Cotinine is currently the most suitable biomarker for measuring ETS exposure both active and passive. Objective: To determine the level of cotinine in pregnant women who reported being passive smokers, relating the values obtained with the indicated days of exposure. Materials and methods: We worked with 443 pregnant women attending public health centers and a private centre in Gualeguaychú for prenatal care, asking to be exposed to ETS showed a urine sample for cotinine dosage. We performed a non-experimental, retrospective and cross-sectional design. The dosage of cotinine in urine was performed using a chemiluminescent method. Previously we obtained a reference value of urinary cotinine less than 15,2ng/ml for 98% of non smokers unexposed to ETS. Results: The analysis of cotinine levels in passive smoking pregnant women show tHTA in public centers, 82% has a cotinine level greater than 15,2ng/embaml, whereas in the private centre, 42% have the same range values. Considering the days of exposure, the average cotinine log for those who said were exposed for the past seven days, was 52.32 ng/ml in the public sector and 64.17 ng/ml in the private one. Discussion and conclusion: The measurement of cotinine is useful to have reliable data from passive exposure to ETS. In public centers, 82% of pregnant women who said were exposed had urinary cotinine levels consistent with the statement, while in the private centre the 42% who said had the same situation had indicator values denoting exposure to snuff. There was a progressive increase in average biological indicator according to the days of exposure in both sectors, exceeding 50ng/ml when the declared exposure was during the last 7 days, which is indicative of a severe ETS exposure. The interest and concern expressed by the pregnant women who participated in this study indicates HTA the implementation of this kind of diagnosis may contribute to prevention campaigns against snuff consumption and promote the right of nonsmokers to live in healthy environments free of the toxic compounds thereof.

The effects of secondhand smoke on chronic obstructive pulmonary disease in nonsmoking Korean adults

BACKGROUND/AIMS: Smoking is widely acknowledged as the single most important risk factor for chronic obstructive pulmonary disease (COPD). However, the risk of COPD in nonsmokers exposed to secondhand smoke remains controversial. In this study, we investigated the association of secondhand smoke exposure with COPD prevalence in nonsmokers who reported never smoking. METHODS: This study was based on data obtained from the Korean National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2010. Using nationwide stratified random sampling, 8,596 participants aged > or = 40 years of age with available spirometry results were recruited. After selecting participants who never smoked, the duration of exposure to secondhand smoke was assessed based on the KNHANES questionnaire. RESULTS: The prevalence of COPD was 6.67% in participants who never smoked. We divided the participants who had never smoked into those with or without exposure to secondhand smoke. The group exposed to secondhand smoke was younger with less history of asthma and tuberculosis, higher income, and higher educational status. Multivariate logistic regression analysis determined that secondhand smoke did not increase the prevalence of COPD. CONCLUSIONS: There was no significant difference in the prevalence of COPD between participants who had never smoked with or without exposure to secondhand smoke in our study. Thus, secondhand smoke may not be an important risk factor for the development of COPD in patients who have never smoked.

Parental smoking patterns and their association with wheezing in children

OBJECTIVE: To investigate parental smoking patterns and their association with wheezing in children. METHODS: We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS: Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION: Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family. .

Aumento do estresse oxidativo em pré-escolares expostos ao tabagismo passivo / Increased oxidative stress in preschool children exposed to passive smoking

OBJETIVOS: Estudar o efeito do fumo passivo sobre o estado plasmático oxidativo e antioxidativo em pré-escolares fumantes passivos e compará-los com controles. MÉTODOS: Trinta e quatro pré-escolares fumantes passivos (cinco a 50 cigarros/dia) (grupo de estudo) e 32 controles que nunca estiveram expostos à fumaça de cigarro foram escolhidos aleatoriamente entre crianças de 4 a 6 anos. Foram determinados os níveis de cotinina urinária e de indicadores do estado oxidativo e antioxidativo, isto é, estado oxidante total (EOT), capacidade antioxidante total (CAT) e índice de estresse oxidativo (IEO). RESULTADOS: A média do consumo ambiental de cigarros foi de 22±13 cigarros por dia nas crianças fumantes passivas. Os níveis médios de cotinina urinária foram 77,6±41,4 ng/mL e 11,9±2,3 ng/mL nos grupos de estudo e controle, respectivamente (p < 0,001). Os níveis médios da CAT plasmática foram 0,95±0,13 mmol equivalente de Trolox/L e 1,01±0,09 mmol equivalente de Trolox/L, respectivamente (p = 0,039). Os níveis médios de EOT plasmático foram 28,6±7,9 µmol H2O2 equivalente/L e 18,5±6,3 µmol H2O2 equivalente/L, respectivamente (p < 0,001). Os níveis médios de IEO foram 3,08±0,98 unidade arbitrária e 1,84±0,64 unidade arbitrária, respectivamente (p < 0,001). Uma pequena quantidade de fumaça de cigarro (cinco a 10 cigarros/dia) causa estresse oxidativo considerável. Não houve correlações significativas entre o número de cigarros consumidos e os níveis de estado oxidante e de IEO. CONCLUSÕES: O tabagismo passivo é um potente oxidante em pré-escolares. Seus efeitos deletérios não se limitam apenas tabagismo passivo pesado, mas também ocorrem com a exposição a pequenas quantidades de fumaça.

OBJECTIVES: To study the effect of passive cigarette smoking on plasma oxidative and antioxidative status in passive smoking preschool children and to compare them with controls. METHODS: Thirty-four passive smoking (five to 50 cigarettes per day) preschool children (study group) and 32 controls who had never been exposed to cigarette smoke were randomly chosen from children aged from 4 to 6 years. Urinary cotinine and plasma indicators of oxidative and antioxidative status, i.e., total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI), were determined. RESULTS: Mean environmental cigarette consumption was 22±13 cigarettes per day in passive smoking children. Mean urinary cotinine levels were 77.6±41.4 ng/mL and 11.9±2.3 ng/mL in the study and control groups, respectively (p < 0.001). Mean plasma TAC levels were 0.95±0.13 mmol Trolox equivalent/L and 1.01±0.09 mmol Trolox equivalent/L, respectively (p = 0.039). Mean plasma TOS levels were 28.6±7.9 µmol H2O2 equivalent/L and 18.5±6.3 µmol H2O2 equivalent/L, respectively (p < 0.001). Mean OSI levels were 3.08±0.98 arbitrary units and 1.84±0.64 arbitrary units, respectively (p < 0.001). A small amount of cigarette smoke (five to 10 cigarettes per day) causes considerable oxidative stress. There were significant correlations between number of cigarettes consumed and oxidant status and OSI levels. CONCLUSIONS: Passive smoke is a potent oxidant in preschool children. Its deleterious effects are not limited just to heavy passive smoking, but also occur with exposure to small amounts of smoke.

Development and Evaluation of a Web-based Education Program to Prevent Secondary Stroke

PURPOSE: This study was conducted to develop and evaluate a web-based education program for secondary stroke prevention. METHODS: A web-based secondary stroke prevention education program was developed using the system's life cycle methods and evaluated by comparing the effects of education among three groups, a web group, a booklet group and a control group. RESULTS: Knowledge level of both patients and family, as well as some health behavior compliance in the web-based and booklet education groups were significantly higher than those of the control group. Family support in the web-based and booklet education groups was significantly higher than that of the control group after 12 weeks. The urine cotinine level in the web-based education group was significantly lower than that of the control group after 12 weeks. Medication adherence, blood pressure and perceived health status were not statistically different among the three groups at any time. CONCLUSION: Web-based and booklet education programs were equally effective regarding the level of knowledge of patients and their families, family support, health behavior compliance, and urine cotinine level. These results demonstrate the potential use of a web-based education program for secondary stroke prevention.

Single gas chromatography method with nitrogen phosphorus detector for urinary cotinine determination in passive and active smokers

Nicotine is a major addictive compound in cigarettes and is rapidly and extensively metabolized to several metabolites in humans, including urinary cotinine, considered a biomarker due to its high concentration compared to other metabolites. The aim of this study was to develop a single method for determination of urinary cotinine, in active and passive smokers, by gas chromatography with a nitrogen phosphorus detector (GC-NPD). Urine (5.0 mL) was extracted with 1.0 mL of sodium hydroxide 5 mol L-1, 5.0 mL of chloroform, and lidocaine used as the internal standard. Injection volume was 1 ìL in GC-NPD. Limit of quantification was 10 ng mL-1. Linearity was evaluated in the ranges 10-1000 ng mL-1 and 500-6000 ng mL-1, with determination coefficients of 0.9986 and 0.9952, respectively. Intra- and inter-assay standard relative deviations were lower than 14.2 %, while inaccuracy (bias) was less than +11.9%. The efficiency of extraction was greater than 88.5%. Ruggedness was verified, according to Youden's test. Means of cotinine concentrations observed were 2,980 ng mL-1 for active smokers and 132 ng mL-1, for passive smokers. The results revealed that satisfactory chromatographic separation between the analyte and interferents was obtained with a ZB-1 column. This method is reliable, precise, linear and presented ruggedness in the range evaluated. The results suggest that it can be applied in routine analysis for passive and active smokers, since it is able to quantify a wide range of cotinine concentrations in urine.

A nicotina é uma substância presente no cigarro capaz de causar dependência, sendo biotransformada em vários metabólitos nos seres humanos, dentre eles a cotinina urinária, que é considerada um indicador biológico de exposição à nicotina, devido a suas altas concentrações, comparado a outras matrizes. Assim, o objetivo deste estudo foi desenvolver um único método para determinação de cotinina urinária, em amostras de urina de fumantes ativos e passivos, através de cromatografia em fase gasosa com detector de nitrogênio- fósforo (CG-DNF). Para o preparo de amostras foram utilizados 5 mL de urina, 1 mL de hidróxido de sódio 5 mol L-1, 5 mL de clorofórmio, tendo como padrão interno a lidocaína. Na faixa de concentrações de 10-1000 ng mL-1 e 500- 6000 ng mL-1, o coeficiente de determinação foi 0,9986 e 0,9952, respectivamente e, o limite de quantificação foi 10 ng mL-1. A precisão intra- e interensaio apresentou desvio padrão relativo (%) menor que 14,2% e a inexatidão foi menor que +11,9%, com uma eficiência de extração de 88,5%. O método apresentou robustez, de acordo com o teste de Youden. As concentrações médias de cotinina observadas foram 2980 ng mL-1, para fumantes ativos e 132 ng mL-1, para fumantes passivos. Os resultados sugerem que o método é confiável, preciso, linear e apresentou robustez, na faixa avaliada, podendo ser aplicado na rotina para análises de amostras de fumantes ativos e passivos, pois é capaz de quantificar uma ampla faixa de concentrações de cotinina urinária.

Avaliação da concentração de monóxido de carbono no ar exalado em tabagistas com DPOC / Evaluation of the exhaled carbon monoxide levels in smokers with COPD

OBJETIVO: Medir os níveis de monóxido de carbono no ar exalado (COex) em tabagistas com e sem DPOC. MÉTODOS: Tabagistas frequentadores dos ambulatórios do Hospital São Lucas em Porto Alegre (RS) entre setembro de 2007 e março de 2009 foram convidados a participar do estudo. Os participantes responderam a um questionário com características demográficas e epidemiológicas e realizaram espirometria, medição de cotinina urinária e de COex. Os participantes foram agrupados conforme a presença de DPOC. RESULTADOS: Foram incluídos 294 tabagistas, 174 (59,18 por cento) diagnosticados com DPOC. Todos os participantes apresentavam níveis de cotinina urinária > 50 ng/mL. Os fumantes com DPOC apresentaram medianas significativamente superiores as do grupo sem DPOC para as variáveis idade e maços-ano (p < 0,001 e p = 0,026, respectivamente). Não houve diferença significativa nas demais variáveis. Quando ajustados para sexo, início do tabagismo, cigarros/dia e cotinina urinária, os valores médios de COex foram mais altos no grupo DPOC que no grupo sem DPOC, mas sem significância estatística (17,8 ± 0,6 ppm e 16,6 ± 0,7 ppm, respectivamente; p = 0,200). As diferenças permaneceram não significativas quando o método de base logarítmica foi usado. Uma ampla dispersão dos valores de COex foi encontrada quando os participantes foram classificados conforme os valores de VEF1 (r = -0,06; p = 0,53) ou o sistema de classificação de Global Initiative for Chronic Obstructive Lung Disease (r = 0,08; p = 0,34). As proporções de resultados falso-negativos para tabagismo foram de 18,4 por cento e 6,7 por cento, respectivamente, nos grupos com e sem DPOC (p = 0,007). CONCLUÕES: Esse estudo mostrou que os valores de COex não apresentaram diferenças significativas em fumantes com ou sem DPOC. Desse modo, parece não haver nenhuma restrição relevante para a sua aplicabilidade em fumantes com DPOC.

OBJECTIVE: To measure exhaled carbon monoxide (COex) levels in smokers with and without COPD. METHODS: Smokers treated at outpatient clinics of São Lucas Hospital in the city of Porto Alegre, Brazil, between September of 2007 and March of 2009 were invited to participate in this study. The participants completed a questionnaire regarding demographic and epidemiologic characteristics and were submitted to spirometry, as well as to determination of COex and urinary cotinine levels. The participants were divided into two groups: those with COPD and those without COPD. RESULTS: The study involved 294 smokers, of whom 174 (59.18 percent) had been diagnosed with COPD. All of the participants presented with urinary cotinine levels > 50 ng/mL. Smokers with COPD presented significantly higher median values for age and pack-years than did those without COPD (p < 0.001 and p = 0.026, respectively). No other statistically significant differences were found. When adjusted for gender, age at smoking onset, number of cigarettes/day and urinary cotinine level, the mean values of COex were higher, but not statistically so, in the COPD group than in the non-COPD group (17.8 ± 0.6 ppm and 16.6 ± 0.7 ppm, respectively; p = 0.200). The differences remained nonsignificant when plotted logarithmically. A wide dispersion of COex values was found when the participants were classified by FEV1 level (r = -0.06; p = 0.53) or by Global Initiative for Chronic Obstructive Lung Disease classification (r = 0.08; p = 0.34). The proportions of false-negative results for smoking were 18.4 percent and 6.7 percent, respectively, in the COPD and non-COPD groups (p = 0.007). CONCLUSIONS: Since COex values did not differ significantly between smokers with COPD and those without, there seem to be no major contraindications to their use in smokers with COPD.

Self-reported Smoking and Urinary Cotinine Levels among Pregnant Women in Korea and Factors Associated with Smoking during Pregnancy

This study examined urinary cotinine levels and self-reported smoking among pregnant women in Korea and the factors associated with smoking during pregnancy. The subjects were selected from pregnant women who visited 30 randomly sampled obstetric clinics and prenatal care hospitals in Korea in 2006. Smoking status was determined by self-reporting and urinary cotinine measurement. A total of 1,090 self-administered questionnaires and 1,057 urine samples were analyzed. The percentage of smoking revealed by self-reporting was 0.55% (95% confidence interval [CI], 0.11-0.99) and that revealed by urinary cotinine measurement (>100 ng/mL) was 3.03% (95% CI, 1.99-4.06). The kappa coefficient of agreement between self-reported smoking status and urinary cotinine measurement was 0.20 (95% CI, 0.03-0.37). Multiple logistic regression analysis revealed that early gestational period, low educational level, and being married to a smoker were significant risk factors for smoking during pregnancy. Smoking among pregnant women in Korea is not negligible, and those who are concerned to maternal and child health should be aware of this possibility among pregnant women in countries with similar cultural background.

Aspectos analíticos da determinação de cotinina em matrizes biológicas / Analytical aspects of the continine'sdetermination in biological matrices

Several biomarkers have been proposed to estimate of the significant tobacco smoke exposure, among them, the measure of carboxyhemoglobin in blood, carbon monoxide in expired air, urinary thiocyanate, nicotine in saliva, plasma or urine and cotinine, which can be determined in urine, plasma, saliva and hair. However, some of these biomarkers, such as carbon monoxide and thiocyanate, can be influenced by others environmental sources, in addition to tobacco smoke. The presence of cotinine in biological fluids is attributed only to nicotine and it is thus considered a specific biomarker. Several methods for determination of cotinine in biological fluids have been published in the recent years, with the purpose of exposure assessment to tobacco smoke and also to validate nicotine replacement therapies. Chromatographic methods are preferably employed to other techniques therefore they present sensitivity, specificity and ability to determinate simultaneously several analites. Thus, the aim of this paper is to present the analytical aspects of the determination of cotinine in biological matrices, since this is considered an important tool for the prevention of toxic effects from exposure to tobacco smoke.

Diversos biomarcadores foram propostos para estimar a exposição à fumaça do cigarro, ativa ou passiva, dentre eles, a determinação de carboxiemoglobina no sangue, de monóxido de carbono no ar expirado, de tiocianato na urina, nicotina na saliva, plasma ou urina e de cotinina, que pode ser determinada na urina, plasma, saliva e cabelo. Entretanto, alguns desses biomarcadores, tais como monóxido de carbono e tiocianato, podem ser influenciados por outras fontes ambientais, além da fumaça do cigarro. A presença de cotinina em fluidos biológicos é atribuída apenas à exposição à nicotina, uma vez que esse produto é formado especificamente na biotransformação do alcalóide, sendo assim considerado um biomarcador específico. Muitos métodos para determinação de cotinina, em fluidos biológicos, foram publicados nos últimos anos, com o propósito de estimar exposição à fumaça do cigarro e também para validar terapias de reposição de nicotina. As técnicas cromatográficas são preferencialmente empregadas, visto que apresentam detectabilidade, seletividade e possibilitam a análise de vários analitos simultaneamente. Assim, o objetivo deste trabalho é apresentar os aspectos analíticos da determinação de cotinina em matrizes biológicas, uma vez que esse é considerado uma importante ferramenta para a prevenção dos efeitos tóxicos decorrentes da exposição à fumaça do tabaco.

Infant exposure to environmental tobacco smoke: Jordan University hospital-based study

To study exposure to environmental tobacco smoke during the first year of life, 220 infants attending the outpatient paediatric clinic of the University of Jordan for routine visits with their mothers were recruited to the study. Mothers completed a questionnaire about smoking habits of household members, and urine samples were obtained from infants for analysis of cotinine levels. A total of 60.0% of infants were reported to be exposed to passive smoking at home and 36.4% had detectable levels of urine cotinine [mean 7.1 ng/mL, range 0.27-41 ng/mL]. Detectable saliva cotinine levels in 8/20 mothers of neonates [1-2 days old] suggested in utero exposure. Recommendations are made to protect this vulnerable population from tobacco smoke exposure

Validity of Self-reported Smoking Using Urinary Cotinine among Vocational High School Students / 예방의학회지

OBJECTIVES: This study was conducted to validate self-reported smoking among high school students using urinary cotinine. METHODS: A self report of smoking behavior was collected together with urine sample for cotinine analysis from 130 male and female students in two vocational high school students in November, 2007. Validity and agreement between self-reported smoking and urinary cotinine was analyzed with STATA 9.0 for different definitions of current smokers, and frequent and daily smokers. Urinary cotinine concentration was measured by the DRI Cotinine Assay for urine (Microgenics Corp., Fremont, CA) on Toshiba 200FR. The cut-off point of urinary cotinine was 50 ng/dl. RESULTS: The concentrations of urinary cotinine were significantly different according to the frequency and amount of smoking. Sensitivity and specificity was 90.9% and 91.8% respectively, and the Cohen's kappa value was 0.787 among the current smokers who smoked at least one day during one month preceding the survey. The comparable high sensitivity, specificity, and kappa value were shown also among the other definitions of current smokers, that is, subjective smokers, and weekly smokers. CONCLUSIONS: The results showed the high validity of self-reported smoking among high school students. However, due to the small sample size and limitation of the participants, it is cautious to generalize the results to overall high school students.

Concentrations of Blood Vitamin A, C, E, Coenzyme Q10 and Urine Cotinine Related to Cigarette Smoking Exposure / 대한진단검사의학회지

BACKGROUND: In smokers, smoking causes many disease entities including cancers, chronic pulmonary diseases and cardiovascular diseases. Passive smoking is also accepted as a carcinogen and its adverse health effects are emphasized. We measured blood vitamin A, C, E (alpha-, beta- and gamma-tocopherol), coenzyme Q10 and urine cotinine concentrations in nonsmokers and smokers. METHODS: Twenty-one healthy nonsmokers and 24 healthy smokers were included in this study. Smoking status was assessed with a self-reported questionnaire. Plasma was analyzed for coenzyme Q10 and serum for vitamin A, C, E using HPLC (Agilent Technologies Inc., USA) and random urine for cotinine using LC/tandem mass spectrometry (Applied Biosystems Inc., Canada). RESULTS: Smokers had significantly lower serum concentrations of vitamin C than nonsmokers (P=0.0005). No significant differences in concentrations of serum vitamin A, E, and plasma coenzyme Q10 were observed. Smokers had highly elevated urine cotinine levels (1,454+/-903 ng/mL). In 16 (76.2%) of 21 nonsmokers, urine cotinine was detected (3.25+/-4.08 ng/mL). The correlations between urine cotinine and blood antioxidants levels were not found. Neither, the correlation between smoking status and blood antioxidants & urine cotinine was found. CONCLUSIONS: This study shows that smokers had significantly lower vitamin C levels among nonenzymatic antioxidants, namely, vitamin A, C, E and coenzyme Q10. High detection rate of urine cotinine in nonsmokers show the seriousness of passive smoking exposure, therefore more social efforts should be directed to reduce passive smoking exposure.