Dental Service Utilization, Dental Health Production and Equity in Dental Care: the Finnish Experience

This thesis is grounded on four articles. Article I generally examines the factors affecting dental service utilization. Article II studies the factors associated with sector-specific utilization among young adults entitled to age-based subsidized dental care. Article III explores the determinants of dental ill-health as measured by the occurrence of caries and the relationship between dental ill-health and dental care use. Article IV measures and explains income-related inequality in utilization. Data employed were from the 1996 Finnish Health Care Survey (I, II, IV) and the 1997 follow-up study included in the longitudinal study of the Northern Finland 1966 Birth Cohort (III). Utilization is considered as a multi-stage decision-making process and measured as the number of visits to the dentist. Modified count data models and concentration and horizontal equity indices were applied. Dentist s recall appeared very efficient at stimulating individuals to seek care. Dental pain, recall, and the low number of missing teeth positively affected utilization. Public subvention for dental care did not seem to statistically increase utilization. Among young adults, a perception of insufficient public service availability and recall were positively associated with the choice of a private dentist, whereas income and dentist density were positively associated with the number of visits to private dentists. Among cohort females, factors increasing caries were body mass index and intake of alcohol, sugar, and soft drinks and those reducing caries were birth weight and adolescent school achievement. Among cohort males, caries was positively related to the metropolitan residence and negatively related to healthy diet and education. Smoking increased caries, whereas regular teeth brushing, regular dental attendance and dental care use decreased caries. We found equity in young adults utilization but pro-rich inequity in the total number of visits to all dentists and in the probability of visiting a dentist for the whole sample. We observed inequity in the total number of visits to the dentist and in the probability of visiting a dentist, being pro-poor for public care but pro-rich for private care. The findings suggest that to enhance equal access to and use of dental care across population and income groups, attention should focus on supply factors and incentives to encourage people to contact dentists more often. Lowering co-payments and service fees and improving public availability would likely increase service use in both sectors. To attain favorable oral health, appropriate policies aimed at improving dental health education and reducing the detrimental effects of common risk factors on dental health should be strengthened. Providing equal access with respect to need for all people ought to take account of the segmentation of the service system, with its two parallel delivery systems and different supplier incentives to patients and dentists.

Obstetric and gynaecological aspects of HIV infection

The purpose of the present study was to examine the outcome of pregnancies among HIV-infected women in Helsinki, use of the levonorgestrel-releasing intrauterine system (LNG-IUS) among HIV-infected women and the prevalence and risk factors of cytological and histologically proven cervical lesions in this population. Between 1993 and 2003 a total of 45 HIV-infected women delivered 52 singleton infants. HIV infection was diagnosed during pregnancy in 40% of the mothers. Seventeen of the mothers received antiretroviral (ARV) medication prior to pregnancy and in 34 cases, the medication was started during pregnancy. A good virological response (i.e. HIV RNA load <1000/mL during the last trimester) to ARV medication was achieved in 36/40 (90%) of the patients in whom HI viral load measurements were performed. Of the infants, 92% were born at term, and their mean (±SD) birth weight was 3350±395 g. The Caesarean section rate was low, 25%. All newborns received ARV medication and none of the infants born to mothers with pre-delivery diagnosis of maternal HIV infection were infected. The safety and advantages of the LNG-IUS were studied prospectively (n=12) and retrospectively (n=6). The LNG-IUS was well tolerated and no cases of PID or pregnancy were noted. Menstrual bleeding was reduced significantly during use of the LNG-IUS; this was associated with a slight increase in haemoglobin levels. Serum oestradiol concentrations remained in the follicular range in all subjects. The key finding was that genital shedding of HIV RNA did not change after the insertion of the LNG-IUS. The mean annual prevalence of low-grade squamous intraepithelial lesions (SIL) was 15% and that of high-grade SIL was 5% among 108 systematically followed HIV-infected women during 1989 2003. A reduced CD4 lymphocyte count was associated with an increased prevalence of SIL, whereas duration of HIV infection, use of ARV medication and HI viral load were not. The cumulative risk of any type of SIL was 17% after one year and 48% after five years among patients with initially normal Pap smears. The risk of developing SIL was associated with young age and a high initial HI viral load. During the follow-up 51 subjects (n=153) displayed cervical intraepithelial neoplasia (CIN), (16% CIN1 and 18% CIN 2-3). Only one case of cancer of the uterine cervix was detected. Pap smears were reliable in screening for CIN. Both nulliparity (p<0.01) and bacterial vaginosis (p<0.04) emerged as significant risk factors of CIN. In conclusion, a combination of universal antenatal screening and multidisciplinary management allows individualized treatment and prevents vertical transmission of HIV. Use of the LNG-IUS is safe among HIV-infected women and cervicovaginal shedding of HIV RNA is not affected by use of the LNG-IUS. The risk of cervical pre-malignant lesions is high among HIV-infected women despite systematic follow-up.

Co-liposomes of redox-active alkyl-ferrocene modified low MW branched PEI and DOPE for efficacious gene delivery in serum

Herein, we present six new lipopolymers based on low molecular weight, branched polyethylenimine (BPEI 800 Da) which are hydrophobically modified using ferrocene terminated alkyl tails of variable lengths. The effects of degree of grafting, spacer length and the redox state of ferrocene in the lipopolymers on the self assembly properties were investigated in detail by TEM, AFM, DLS and zeta potential measurements. The assemblies displayed an oxidation induced increase in the size of the aggregates. The co-liposomes comprising the lipopolymer and a helper lipid, 1,2-dioleoyl phosphatidyl ethanolamine (DOPE), showed excellent gene (pDNA) delivery capability in a serum containing environment in two cancer cell lines (HeLa and U251 cells). Optimized formulations showed remarkably higher transfection activity than BPEI (25 kDa) and were also significantly better than a commercial transfection reagent, Lipofectamine 2000 as evidenced from both the luciferase activity and GFP expression analysis. Oxidation of ferrocene in the lipopolymers led to drastically reduced levels of gene transfection which was substantiated by reduced cellular internalization of fluorescently labelled pDNA as detected using confocal microscopy and flow cytometry. Moreover, the transfection inactive oxidized lipopolyplexes could be turned transfection active by exposure to ascorbic acid (AA) in cell culture medium during transfection. Endocytosis inhibition experiments showed that gene expression mediated by reduced formulations involved both clathrin and caveolae mediated pathways while the oxidized formulations were routed via the caveolae. Cytotoxicity assays revealed no obvious toxicity for the lipopolyplexes in the range of optimized transfection levels in both the cell lines studied. Overall, we have exploited the redox activity of ferrocene in branched PEI-based efficient polymeric gene carriers whose differential transfection activities could be harnessed for spatial or temporal cellular transfections.

Depressão pós-parto e estado nutricional infantil no segundo mês de vida

INTRODUÇÃO: As chances de adoecer e de mortalidade são maiores, em crianças com estado nutricional (EN) inadequado nos primeiros meses de vida. Fatores de risco para o EN inadequado, incluem os aspectos psicossociais maternos, como a ansiedade, a depressão pós-parto (DPP), a ausência de suporte social. No entanto, são poucos os estudos sobre o papel destes fatores na determinação do EN infantil e seus resultados controversos. OBJETIVO: Investigar a relação entre depressão no pós-parto e o estado nutricional infantil inadequado no segundo mês de vida. MÉTODOS: Trata-se de um estudo seccional com 466 crianças aos dois meses de vida (média= 65 dias; DP=0,5) oriundas de unidades básicas de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. Para compor o desfecho, médias de peso-para-idade foram expressas em escores z e comparadas às informações da nova curva de referência WHO (2006) para menores de cinco anos. Foram classificadas como estado nutricional inadequado, crianças com escore z abaixo de -2, baixo peso-para-idade, e crianças com escore z acima de +2, excesso de peso-para- idade. Informações referentes à DPP foram obtidas por meio da aplicação da versão em português do instrumento EPDS (Edinburgh Postnatal Depression Scale). As análises das associações entre a DPP e os desfechos foram verificadas via modelos de regressão logística multinomial, mediante estimativas de razões de chances (OR) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95). RESULTADOS: A amostra revelou escores z médios de -0,22 para peso-para-idade, 4,51%(n=21) apresentaram baixo peso-para- idade e 1,72% (n=8) de excesso de peso-para-idade. A prevalência de depressão foi de 27,6%. Nas análises brutas, filhos de mães deprimidas apresentavam 2,45 mais chance (OR=2,45; I.C. 95%=1,01-5,93;p-valor=0,050) de baixo peso-para-idade e 0,38 chance de excesso de peso-para-idade (OR=0,38;I.C. 95%=0,04-3,17;p-valor=0,38), do que os filhos de mães não deprimidas, porém esta associação apresentou nível de significância maior que 5%. Após ajuste pelo peso ao nascer, condições ambientais, posse de utensílios, prematuridade, idade materna e escolaridade materna a associação entre depressão e estado nutricional infantil não apresentou significância estatística (OR=2,39;I.C. 95%=0,74-7,71;p- valor>0,05).CONCLUSÃO: A DPP não foi associada ao estado nutricional infantil.

Disfunções endócrinas no modelo de programação pela exposição à fumaça de cigarro na lactação

Eventos ou estímulos no início da vida podem afetar o desenvolvimento do indivíduo; dentre esses o tabagismo materno. A exposição materna isolada à nicotina, principal componente do cigarro, causa na prole alterações metabólicas, em curto e longo prazo, como aumento da adiposidade, resistência à leptina, e disfunção tireoideana e adrenal. Entretanto é sabido que na fumaça de cigarro estão presentes outros componentes com potenciais efeitos tóxicos. Assim propomos comparar o efeito de duas formas de exposição neonatal à fumaça do cigarro sobre o perfil endócrino-metabólico da prole em curto e longo prazo. Para isso, no 3 dia após o nascimento, ratos lactentes foram submetidos a dois modelos: Modelo I (exposição pelo leite materno), ninhadas separadas em: exposição à fumaça (EF; n=8) lactantes expostas à fumaça de cigarros 2R1F (1,7 mg de nicotina/cigarro por 1h, 4 vezes ao dia), separadas de suas proles e grupo controle (C; n=8), onde as mães foram separadas de suas proles e expostas ao ar filtrado; Modelo II (exposição direta à fumaça), ninhadas separadas em: exposição à fumaça (EF; n=8) mães e proles expostas à fumaça de cigarros 2R1F e controle (C; n=8) mães e proles expostas ao ar filtrado. A exposição ao tabaco ocorreu até o desmame. Mães sacrificadas aos desmame e proles aos desmame e aos 180 dias de idade. As mães lactantes expostas à fumaça (EF) apresentaram hipoleptinemia (-46%), hiperprolactinemia (+50%), hipoinsulinemia (-40%) e diminuição de triglicérides (-53%). Quanto a composição bioquímica do leite, as lactantes EF mostraram aumento de lactose (+52%) e triglicérides (+78%). No modelo I, as proles EF apresentaram ao desmame: diminuição da gordura corporal total (-24%), aumento de proteína corporal total (+17%), diminuição da glicemia (-11%), hiperinsulinemia (+28%), hipocorticosteronemia (-40%) e aumento de triglicérides (+34%). Quando adultas, as proles EF apresentaram somente alteração da função adrenal onde observou-se menor conteúdo de catecolaminas (-50%) e da expressão de tirosina hidroxilase na medula adrenal (-56%). No modelo II, as proles EF aos 21 dias exibiram diminuição da MC (-7%), do comprimento nasoanal (-5%), da gordura retroperitoneal (-59%), da área dos adipócitos viscerais (-60%) com maior área dos adipócitos subcutâneos (+95%), aumento do T4 (+59), da corticosterona (+60%), do conteúdo adrenal de catecolaminas (+58%) e hipoinsulinemia (-29%). Aos 180 dias, as proles EF apresentaram aumento da ingestão alimentar (+10%), dos depósitos de gordura visceral (~60%) e conteúdo de gordura corporal total (+50%), menor área dos adipócitos subcutâneos (-24%), aumento da leptina (+85%), glicemia (+11%), adiponectina (+1.4x), T3 (+71%), T4 (+57%) e TSH (+36,5%) com menor corticosterona (-41%) e catecolaminas adrenais (-57%) e aumento dos triglicerídeos (+65%). Somados nossos dados evidenciam o impacto negativo que a exposição à fumaça do cigarro tem sobre o desenvolvimento do neonato com o surgimento de desordens endócrinas futuras, que ocorrem pelo menos em parte devido às alterações observadas nas mães. Portanto, independente da forma de exposição, seja via aleitamento materno ou por inalação direta, é de grande importância alertar a sociedade sobre as possíveis complicações metabólicas em longo prazo decorrente da exposição involuntária do neonato ao tabagismo.

Effects of pressure and molecular weight on the miscibility of polystyrene and cyclohexane

With the aid of Sanchez-Lacombe lattice fluid theory (SLLFT), the phase diagrams were calculated for the system cyclohexane (CH)/polystyrene (PS) with different molecular weights at different pressures. The experimental data is in reasonable agreement with SLLFT calculations. The total Gibbs interaction energy, g*(12) for different molecular weights PS at different pressures was expressed, by means of a universal relationship, as g(12)* =f(12)* + (P - P-0) nu*(12) demixing curves were then calculated at fixed (near critical) compositions of CH and PS systems for different molecular weights. The pressures of optimum miscibility obtained from the Gibbs interaction energy are close to those measured by Wolf and coworkers. Furthermore, a reasonable explanation was given for the earlier observation of Saeki et al., i.e., the phase separation temperatures of the present system increase with the increase of pressure for the low molecular weight of the polymer whereas they decrease for the higher molecular weight polymers. The effects of molecular weight, pressure, temperature and composition on the Flory Huggins interaction parameter can be described by a general equation resulting from fitting the interaction parameters by means of Sanchez-Lacombe lattice fluid theory.

MOLECULAR-WEIGHT DEPENDENCE OF THE GLASS-TRANSITION OF CYCLIC POLYSTYRENE

The glass transition temperature (T(g)) of cyclic polystyrene was measured by differential scanning calorimetry. There was a marked difference in the glass transition behaviour between cyclic and linear polystyrene. In the low molecular weight region (M(n) < 5 x 10(3)), the T(g) of the cyclic polystyrene increased with decreasing M(n), contrary to that of linear polystyrene. With M(n) higher than 5 x 10(3), the T(g) of cyclic polystyrene increased with increasing M(n). The T(g) of cyclic and linear polystyrene approached the same constant value when the M(n) was high enough (M(n) > 10(5)). Combining the results of specific volume, it is believed that the variation of T(g) with molecular weight does not depend only on free volume effects but that configurational entropy is also an important factor.

In vivo growth-inhibition of S 180 tumor by mixture of 5-Fu and low molecular lambda-carrageenan from Chondrus ocellatus

POLYSACCHARIDES; ANTICOAGULANT; SURVIVAL

Antioxidant activity of different molecular weight sulfated polysaccharides from Ulva pertusa Kjellm (Chlorophyta)

Polysaccharides extracted from Ulva pertusa Kjellm ( Chlorophyta) are a group of sulfated heteropolysaccharides, the ulvans. In this study, different molecular weight ulvans were prepared by H2O2 degradation and their antioxidant activities investigated including superoxide and hydroxyl radical scavenging activity, reducing power and metal chelating ability. The molecular weights of natural and degraded ulvans were 151.7, 64.5, 58.0, and 28.2 kDa, respectively, as determined by high performance gel permeation chromatography. Among the four samples, U-3 ( the lowest molecular weight sample) showed significant inhibitory effects on superoxide and hydroxyl radicals with IC50 values of 22.1 mu g mL(-1) and 2.8 mg mL(-1); its reducing power and metal chelating ability were also the strongest among the four samples. All the other samples also demonstrated strong activity against superoxide radicals. The results indicated that molecular weight had a significant effect on the antioxidant activity of ulvan with low molecular weight ulvan having stronger antioxidant activity.

Relevance of molecular weight of chitosan and its derivatives and their antioxidant activities in vitro

The antioxidant potency of different molecular weight (DMW) chitosan and sulfated chitosan derivatives was investigated employing various established in vitro systems, such as superoxide (O-2(.-))/hydroxyl ((OH)-O-.) radicals scavenging, reducing power, iron ion chelating. As expected, we obtained several satisfying results, as follows: Firstly, low molecular weight chitosan had stronger scavenging effect on O-2(.-) and (OH)-O-. than high molecular weight chitosan. For example the O-2(.-) scavenging activity of low molecular weight chitosan (9 kDa) and high molecular weight chitosan (760 kDa) were 85.86 % and 35.50 % at 1.6 mg/mL, respectively. Secondly, comparing with DMW chitosan, DMW sulfated chitosans had the stronger inhibition effect on 0(2)(.-). At 0.05 mg/mL, the scavenging activity on O-2(.-) reached 86.26 %, for low molecular weight chitosan sulfate (9 kDa), but that of low molecular weight chitosan (9 kDa) was 85.86 % at 1.6 mg/mL. As concerning chitosan and sulfated chitosan of the same molecular weight, scavenging activities of sulfated chitosan on superoxide and hydroxyl radicals were more pronounced than that of chitosan. Thirdly, low molecular weight chitosan sulfate had more effective scavenging activity on 02 and (OH)-O-. than that of high molecular weight chitosan sulfate. Fourthly, DMW chitosans and sulfated chitosans were efficient in the reducing power, especially LCTS. Their orders were found to be LCTS > CTS4 > HCTS > CTS3 > CTS2 > CTS1 > CTS. Fifthly, CTS4 showed more considerable ferrous ion-chelating potency than others. Finally, the scavenging rate and reducing power of DMW chitosan and sulfated derivatives increased with their increasing concentration. Moreover, change of DMW sulfated chitosans was the most pronounced within the experimental concentration. However, chelating effect of DMW chitosans were not concentration dependent except for CTS4 and CTS1. (C) 2004 Elsevier Ltd. All rights reserved.

Antihyperlipidemic effects of different molecular weight sulfated polysaccharides from Ulva pertusa (Chlorophyta)

Ulvan, a sulfated polysaccharide from Ulva pertusa, was degraded to yield two low molecular weight fractions U1 and U2. The molecular weights of ulvan and its fractions were determined and varied from 151.6 to 28.2 kDa. They were fed to rats on a hypercholesterolemic diet for 21 days to evaluate and compare the antihyperlipidemic actions. Ulvan-based diet significantly lowered the levels of serum total cholesterol (-45.2%, P < 0.05) and low density lipoprotein cholesterol (LDL-cholesterol, -54.1%, P < 0.05). While U1- and U2-based diets significantly elevated the levels of serum high density lipoprotein cholesterol (HDL-cholesterol, +22.0% for U1, not significant; +61.0% for U2; P < 0.05) and reduced triglyceride (TG, -82.4% for U1, -77.7% for U2; P < 0.05) in rats as compared to control diet. In addition, consumptions of various ulvans significantly increased fecal bile acid excrement. The results indicated that ulvans with different molecular weights exhibited diverse effects on lipid metabolism. The high molecular weight ulvan was effective in serum total and LDL-cholesterol, whereas low molecular weight fractions were in TG and HDL-cholesterol. The fractions were considered to be more beneficial to hyperlipidemia associated with diabetes over ulvan. (C) 2003 Elsevier Ltd. All rights reserved.

The influence of molecular weight of quaternized chitosan on antifungal activity

Quaternized chitosan derivatives with different molecular weights were synthesized in the laboratory. Subsequent experiments were conducted to test their antifungal activities against Botrytis cinerea Pers. (B. cinerea pers.) and Colletotrichum lagenarium (Pass) Ell.et halst (C. lagenarium (Pass) EII.et halst). Our results indicate that quaternized chitosan derivatives have stronger antifungal activities than chitosan. Furthermore, quaternized chitosan derivatives with high molecular weight are shown to have even stronger antifungal activities than those with low molecular weight. (c) 2007 Published by Elsevier Ltd.

Relevance of molecular weight of chitosan-N-2-hydroxypropyl trimethyl ammonium chloride and their antioxidant activities

The antioxidant potency of high/low molecular weight quatemary chitosan derivatives was investigated employing various established systems in vitro, such as superoxide (O-2(center dot-)) and hydroxyl (center dot OH) radicals scavenging, reducing power and iron ion chelating. As expected, we obtained several satisfying results, as follow: firstly, low molecular weight quaternary chitosan had stronger scavenging effect on O-2(center dot-) and center dot OH than high molecular weight quaternary chitosan. Secondly, the reducing power of low molecular weight quaternary chitosan was more pronounced than that of high molecular weight quaternary chitosan. Thirdly, ferrous ion chelating potency were showed to increase first and decrease afterwards with increasing concentration for two kinds of quaternary chitosans, namely, they have not concentration-dependence. However, the scavenging rate and reducing power of high and low molecular weight quaternary chitosans increased with their increasing conc centrations, and hence were concentration-dependent. (c) 2007 Elsevier Masson SAS. All rights reserved.

Monitoring behaviours and experiences before, during and after pregnancy in Ireland

Background: On-going surveillance of behaviours during pregnancy is an important but overlooked population health activity that is particularly lacking in Ireland. Few, if any, nationally representative estimates of most maternal behaviours and experiences are available. While on-going surveillance of maternal behaviours has not been a priority thus far in European countries including Ireland, on-going surveillance was identified as a key priority in the United States (US) during the 1980’s when the Pregnancy Risk Assessment Monitoring System (PRAMS), was established. Today, PRAMS is the only surveillance programme of maternal behaviours and experiences world-wide. Although on-going prevalence estimates are required in Ireland, studies which examine the offspring health effects of maternal behaviours are also required, since various questions regarding maternal exposures and their offspring health effects remain unanswered. Gestational alcohol consumption is one such important maternal exposure which is common in pregnancy, though its offspring health effects are unclear, particularly at lower or moderate levels. Thus, guidelines internationally have not reached consensus on safe alcohol recommendations for pregnant women. The aims of this thesis are to implement the PRAMS in Ireland (PRAMS Ireland), to describe the prevalence of health behaviours around the time of pregnancy in Ireland and to examine the effect of health behaviours on pregnancy and child outcomes (specifically the relationship between alcohol use during pregnancy and infant and child growth). Structure: In Chapter 1, a brief background and rationale for the work, as well as the thesis aims and objective is provided. A detailed description of the design and implementation of PRAMS Ireland is described in Chapter 2. Chapter 3 and Chapter 4 describe the methodological results of the implementation of the PRAMS Ireland pilot study and PRAMS Ireland main study. In Chapter 5, a comparison of alcohol prevalence in two Irish studies (PRAMS Ireland and Growing up in Ireland (GUI)) and one multi-centre prospective cohort study, Screening for Pregnancy Endpoints (SCOPE) Study is detailed. Chapter 6 describes findings on adherence to National Clinical Guidelines on health behaviours and nutrition around the time of pregnancy in PRAMS Ireland. Findings on exposure to alcohol use in pregnancy and infant growth outcomes are described in Chapter 7 and Chapter 8. The results of analysis conducted to examine the impact of gestational alcohol use on offspring growth trajectories to age ten are described in Chapter 9. Finally, a discussion of the findings, strengths and limitations of the thesis, direction for future research, policy, practice and public health implications are discussed in Chapter 10.Results: Implementation of PRAMS: PRAMS may be an effective system for the surveillance of health behaviours around the time of pregnancy in the Irish context. PRAMS Ireland had high response rates (67% and 61% response rates in the pilot and main study respectively), high item completion rates and valid prevalence estimates for many health behaviours. Examining prevalence of health behaviours: We found high levels of alcohol consumption before and during pregnancy, poor adherence to healthy diets and high levels of smoking before and during pregnancy among women in Ireland. Socially disadvantaged women had higher rates of deleterious health behaviours before pregnancy, although women with the most deleterious behaviour profiles before pregnancy appeared to experience the greatest gain in protective health behaviours during pregnancy. The impact of alcohol use on infant and offspring growth: We found that low and moderate levels of alcohol use did not impact on birth outcomes or offspring growth whereas heavy alcohol consumption resulted in reduced birth length and birth weight; however, this finding was not consistently observed across all studies. Selection, reporting and confounding biases which are common in observational research could be masking harmful effects. Conclusion: PRAMS is a valid and feasible method of surveillance of health behaviours around the time of pregnancy in Ireland. A surveillance program of maternal behaviours and experiences is immediately warranted due to high levels of deleterious health behaviours around the time of pregnancy in Ireland. Although our results do not indicate any evidence of harm, given the quality of evidence available, abstinence and advice of abstinence from alcohol may be the most prudent choice for patients and healthcare professionals respectively. Further studies of the effects of gestational alcohol use are required; particularly those which can reduce selection bias, reporting bias and confounding.

Cellular immune responses of preterm infants after vaccination with whole-cell or acellular pertussis vaccines.

Based on studies reporting specific antibody titers, it is recommended to vaccinate preterm infants against Bordetella pertussis according to their chronological age. However, as specific T-cell responses also are involved in the protection against B. pertussis, we have determined whether highly preterm infants (<31 weeks) are able to mount these immune responses during vaccination. Forty-eight premature infants were vaccinated at 2, 3, and 4 months of their chronological age with an acellular (Pa; n = 24) or a whole-cell (Pw; n = 24) tetravalent diphtheria-tetanus-pertussis-polio vaccine, and blood samples were collected at 2, 3, and 6 months of age. Most of the Pa- and Pw-vaccinated infants developed at 3 or 6 months of age a gamma interferon (IFN-gamma) response to the B. pertussis antigens, accompanied by an interleukin-5 (IL-5) and IL-13 secretion for the Pa-vaccinated infants. No association was found between a very low infant birth weight, the occurrence of severe infections, and corticosteroid treatment or the administration of gammaglobulins with a low level of antigen-induced IFN-gamma secretion. We conclude that like full-term infants, most preterm infants are able to mount a specific cellular immune response to the administration of the first doses of an acellular or a whole-cell pertussis vaccine.