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Several pregnancy-related complications resulting in maternal mortality in low-income countries may be due to inaccessible or under-utilized antenatal healthcare services. This study aims to assess the sociodemographic characteristics of Haitian women and how these may affect their access to and use of antenatal care services (ANC) during pregnancy. Multi-logistic regression was used to analyze sociodemographic factors associated with ANC access and use among a cross-section of Haitian women (N = 4890) from the Demographic and Health Survey Haiti (2016–2017). Approximately 18.2% of the women had no education, 40.2% had secondary education, and 4.0% had higher education. About 45.6% of women with no education, 95% with higher education, and 76% of urban dwellers made four or more ANC visits. Only 3% of those who used public sector ANC had a higher education, and over 64.2% of those who used private sector ANC lived in urban areas. Rich women (OR = 2.49, 95% CI = 2.02–3.08) vs. poor women and mature mothers (OR = 1.97, 95% CI = 1.42–2.73) vs. teenage mothers both had higher odds of using ANC services four or more times. Women with higher education (OR = 0.19, 95% CI = 0.12–0.30) and those who were rich (OR = 0.67, 95% CI = 0.5–0.89) had lower odds of using public sector ANC vs. private sector ANC. Wealth and education are protective of ANC access and use by Haitian women. As over half the population has home births, public health education interventions targeting traditional birth attendants are recommended. Interventions training traditional birth attendants to provide better ANC during pregnancy and at the time of birth and to access skilled help during emergency deliveries is recommended.

Digital media have become an integral part of the journalism industry and of audience habits – in 2021 our research registered 2873 active news websites in Spain. First, this paper explores trends facing online news; it sets out the criteria used to identify a news brand as digital-native or non-native; and it presents the results of our classification. This includes: data on the presence of news titles both on proprietary platforms (print, radio, TV or app) in addition to their websites, and on external platforms (Facebook, Twitter, Instagram, YouTube and Telegram); their geographic scope (hyperlocal, local/regional or national/global); their subject (general or specialized coverage); and on ownership and language used. Almost 70% of the media were regional or local, while 60% covered general news, and one in three were linked to a print product, almost as many as those with their own app for users. Social media uptake is so widespread that more than 95% of the sites are on Facebook, with a similar number on Twitter, while more than 60% can be found on YouTube, and similarly on Instagram. Among specialized sites, sport is the largest category, comprising twice as many digital-native sites (106) than sites with traditional roots (46). The entertainment focus expands in the digital environment, and online-originated culture, business and science and technology outlets also outnumber legacy publications.

Abstract Background Exposure to bisphenols may affect fetal growth and development. The trimester-specific effects of bisphenols on repeated measures of fetal growth remain unknown. Our objective was to assess the associations of maternal bisphenol urine concentrations with fetal growth measures and birth outcomes and identify potential critical exposure periods. Methods In a population-based prospective cohort study among 1379 pregnant women, we measured maternal bisphenol A, S and F urine concentrations in the first, second and third trimester. Fetal head circumference, length and weight were measured in the second and third trimester by ultrasound and at birth. Results An interquartile range increase in maternal pregnancy-averaged bisphenol S concentrations was associated with larger fetal head circumference (difference 0.18 (95% confidence interval (CI) 0.01 to 0.34) standard deviation scores (SDS), p-value

Digital-native news organizations have grown steadily in Spain since the mid-1990s and they have become established as a major force in the media market. Paradoxically, their biggest expansion coincided with the Great Recession (2008–2014). In fact, their numbers increased most during 2012–2013, when traditional media were cutting staff in response to the economic crisis, and unemployment rates in the media sector as a whole hit their peak. However, these digital-native news startups have yet to prove their sustainability and stability. This study uses our own database of 3,862 native and non-native digital news outlets in Spain and the Reuters Institute Digital News Report to analyze a number of characteristics of these media, such as the percentage that have gone inactive, the relative popularity of legacy brands vs. digital natives, multi-platform synergies, content subject matter, geographical location, ownership, and funding sources. Based on these quantitative parameters, this study reviews the structural strengths and weaknesses of digital-native media in the Spanish news market. Taking into account these findings, we conclude that the surge in digital-native news media observed in Spain during the Great Recession followed the pattern of creative destruction described by several economists.

A massive "infodemic" developed in parallel with the global COVID-19 pandemic and contributed to public misinformation at a time when access to quality information was crucial. This research aimed to analyze the science and health-related hoaxes that were spread during the pandemic with the objectives of (1) identifying the characteristics of the form and content of such false information, and the platforms used to spread them, and (2) formulating a typology that can be used to classify the different types of hoaxes according to their connection with scientific information. The study was conducted by analyzing the content of hoaxes which were debunked by the three main fact-checking organizations in Spain in the three months following WHO's announcement of the pandemic (N = 533). The results indicated that science and health content played a prominent role in shaping the spread of these hoaxes during the pandemic. The most common hoaxes on science and health involved information on scientific research or health management, used text, were based on deception, used real sources, were international in scope, and were spread through social networks. Based on the analysis, we proposed a system for classifying science and health-related hoaxes, and identified four types according to their connection to scientific knowledge: "hasty" science, decontextualized science, badly interpreted science, and falsehood without a scientific basis. The rampant propagation and widespread availability of disinformation point to the need to foster media and scientific caution and literacy among the public and increase awareness of the importance of timing and substantiation of scientific research. The results can be useful in improving media literacy to face disinformation, and the typology we formulate can help develop future systems for automated detection of health and science-related hoaxes.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants. Urinary concentrations of mono-hydroxylated metabolites of PAHs (OH-PAHs) have been used as biomarkers of these chemicals’ exposure in humans. Little is known, however, with regard to intra- and inter-individual variability in OH-PAH concentrations and their association with oxidative stress. We conducted a longitudinal study of measurement of urinary concentrations of 15 OH-PAHs and 7 oxidative stress biomarkers (OSBs) of DNA damage [8-hydroxy-2′-deoxyguanosine (8-OHdG)], lipid [malondialdehyde (MDA) and F2-isoprostanes (PGF2α)] and protein [o,o′-dityrosine (diY)] peroxidation in 19 individuals for 44 consecutive days. Metabolites of naphthalene (OHNap), fluorene (OHFlu), phenanthrene (OHPhe), and pyrene (OHPyr) were found in >70% of 515 urine samples analyzed, at sum concentrations (∑OH-PAH) measured in the range of 0.46–60 ng/mL. After adjusting for creatinine, OHNap and ∑OH-PAH concentrations exhibited moderate predictability, with intra-class correlation coefficients (ICCs) ranging from 0.359 to 0.760. However, ICC values were low (0.001–0.494) for OHFlu, OHPhe, and OHPyr, which suggested poor predictability for these PAH metabolites. Linear mixed-effects analysis revealed that an unit increase in ∑OH-PAH concentration corresponded to 4.5%, 5.3%, 20%, and 21% increase in respective urinary 8-OHdG, MDA, PGF2α, and diY concentrations, suggesting an association with oxidative damage to DNA, lipids, and proteins. The daily intakes of PAHs, calculated from urinary concentrations of OH-PAHs, were 10- to 100-fold below the current reference doses. This study provides valuable information to design sampling strategies in biomonitoring studies and in assigning exposure classifications of PAHs in epidemiologic studies.

Human exposure to phthalates is ubiquitous and has received considerable attention due to their association with adverse health outcomes, including type 2 diabetes mellitus (T2DM). Nevertheless, earlier studies that link phthalate exposure to T2DM yielded ambiguous results. Furthermore, studies that associate phthalate exposure with oxidative stress and then with T2DM are scant. In this diabetic case-control study, urine samples collected from 101 individuals aged 28–68 years from Jeddah, Saudi Arabia, were analyzed to determine 20 phthalate metabolites (PhMs) and seven oxidative stress biomarkers (OSBs). Unconditional logistic regression was used to estimate odds ratios for the association between diabetes and urinary PhMs and OSBs in participants, stratified by age, gender, nationality, smoking status, occupation, and urinary creatinine. Twelve PhMs and five OSBs were found at detection rates above 50%, with geometric mean concentrations of 0.61–100 and 0.35–10.7 ng/mL (1.04–171 and 0.61–18.6 μg/g creatinine), respectively. Almost all exposures were significantly higher in diabetic cases than in controls. The 12 PhMs were positively associated with higher urinary concentrations of 8-hydroxy-2′-deoxyguanosine (8-OHdG) and 8-iso-prostaglandin F2α (8-PGF2α). Individuals in the 3rd and/or 4th quartile(s) for urinary concentrations of PhMs and OSBs showed 3.7- and 7.3-fold increase, respectively, in the odds of having diabetes compared with those in the 1st quartile. The rank order of association of PhMs/OSBs with diabetes followed the order of: mEP ≈ mBP > mEHP > mCPP > mECPP ≈ mEOHP ≈ mEHHP ≈ mIBP ≈ mMP > mCMHP ≈ mBzP and 8-OHdG > 8-PGF2α ≈ 15-PGF2α. The relationship between phthalate exposure and risk of developing T2DM was mediated in part by phthalate-induced oxidative stress, especially 8-OHdG. Our study suggests that human exposure to phthalates is associated with increased oxidative stress which mediates the development of T2DM. Keywords: Diabetes, Phthalate metabolites, Oxidative stress, Biomonitoring, Urine

Importance: Exposure to phthalates may affect fetal growth, but previous studies are inconsistent and have not explored the trimester-specific effects of phthalates on repeated measures of fetal growth. Objective: To assess the associations of maternal phthalate metabolites urine concentrations with fetal growth measures and birth outcomes and identify potential windows of vulnerability to exposure. Design: Population-based prospective cohort study, the Generation R Study (2002–2006). Data analysis was performed from November 2019 to June 2020. Setting: Rotterdam, the Netherlands. Participants: 1379 pregnant women. Exposures: Maternal phthalate metabolites urine concentrations in first, second and third trimester. Main outcomes and measures: Fetal head circumference, length and weight measured in the second and third trimester by ultrasound and at birth and preterm birth and small size for gestational age at birth. Results: Higher pregnancy-averaged phthalic acid, low molecular weight phthalate (LMWP), high molecular weight phthalate (HMWP) and di-2-ethylhexylphthalate (DEHP) concentrations tended to be associated with lower fetal weight SDS across gestation. The associations of phthalic acid and LMWP with fetal weight became stronger as pregnancy progressed (differences −0.08 (95% CI −0.14 to −0.02) SDS and −0.09 (95% CI −0.16 to −0.02) SDS at 40 weeks per interquartile range increase in phthalic acid and LMWP, respectively). Higher concentrations of specific LMWP, HMWP and DEHP metabolites were also associated with smaller head circumference and lower length SDS at birth and an increased risk of preterm birth and small size for gestational age at birth (p-values

Background and aims: Fetal exposure to endocrine disruptors such as phthalates and bisphenols may lead to developmental metabolic adaptations. We examined associations of maternal phthalate and bisphenol urine concentrations during pregnancy with lipids, insulin, and glucose concentrations at school age. Methods: In a population-based, prospective cohort study among 757 mother–child pairs, we measured maternal phthalate and bisphenol urine concentrations in first, second and third trimester of pregnancy. We measured non-fasting lipids, glucose and insulin blood concentrations of their children at a mean age of 9.7 (standard deviation 0.2) years. Analyses were performed for boys and girls separately. Results: An interquartile range (IQR) higher natural log transformed third trimester maternal urine phthalic acid concentration was associated with a 0.20 (95% confidence interval (CI) 0.07–0.34) standard deviation score (SDS) higher triglycerides concentration among boys. Maternal bisphenol urine concentrations were not associated with non-fasting lipid concentrations during childhood. An IQR higher natural log transformed second trimester maternal high molecular weight phthalates (HMWP) and di-2-ethylhexylphthalate (DEHP) urine concentration were associated with a 0.19 (95% CI 0.31–0.07) respectively 0.18 (95% CI 0.31–0.06) SDS lower glucose concentration among boys. An IQR higher natural log transformed third trimester maternal bisphenol F urine concentration was associated with a 0.22 (95% CI 0.35–0.09) SDS lower non-fasting insulin concentration among boys. Conclusions: Our results suggest potential persisting sex specific effects of fetal exposure to phthalates and bisphenols on childhood lipid concentrations and glucose metabolism. Future studies are needed for replication and exploring underlying mechanisms.

Oxidative stress in humans is affected by the health and nutritional status as well as exposure to external environmental factors. To evaluate the effects of external factors, an assessment of baseline levels as well as diurnal variations in oxidative stress status of healthy individuals is needed. In this study, we examined intra- and inter-individual variability of oxidative stress biomarkers (OSBs) of lipids (malondialdehyde [MDA] and four F2-isoprostane isomers, namely, 8-isoprostaglandinF2α [8-PGF2α], 11β-prostaglandinF2α [11-PGF2α], 15(R)-prostaglandinF2α [15-PGF2α], and 8-iso,15(R)-prostaglandinF2α [8,15-PGF2α]); proteins (o,o′-dityrosine [diY]); and DNA (8-hydroxy-2′-deoxyguanosine [8-OHdG]) in urine from healthy individuals. The significance of creatinine correction, which is typically used to account for urinary dilution, on OSB concentrations was evaluated. Analysis of 515 urine samples, collected longitudinally from 19 healthy individuals daily for over a month, showed inter-individual coefficient of variation (CV) in concentrations from 112% for MDA to 272% for 15-PGF2α. Intra-individual CV in concentrations ranged from 29% for 8-OHdG to 149% for 15-PGF2α. MDA was the most abundant OSB found in urine. The intra- and inter-individual variability in F2-isoprostane concentrations were higher than the values calculated for diY, 8-OHdG, and MDA. All seven OSB concentrations were significantly correlated with each other and with creatinine. Creatinine normalization of OSB concentrations improved predictability in OSB concentrations over time. Our results suggest that 8-OHdG, showing the highest ICC (0.96), yielded more reproducible measurements with a low CV, and is the most suitable biomarker of OSB in spot urine samples. The measured concentrations and diurnal variability in urinary OSB levels in healthy individuals reported in this study are useful as a benchmark for future toxicological and epidemiological studies. Keywords: Biomarker, Oxidative stress, Urine, Variability, 8-hydroxy-2′-deoxyguanosine, Isoprostane, ICC

Objectives: Fetal exposure to phthalates and bisphenols may lead to vascular developmental adaptations, which program later cardiovascular disease. We examined the associations of fetal exposure to phthalates and bisphenols with childhood blood pressure. Methods: In a population-based, prospective cohort study among 1,064 mother-child pairs, we measured maternal urine phthalate and bisphenol concentrations in first, second and third trimester of pregnancy. We measured childhood blood pressure at the mean age of 9.7 years (standard deviation 0.2 years) old. Analyses were performed for the total group, and for boys and girls separately. Results: Maternal urine phthalate concentrations were not associated with childhood blood pressure among boys. Higher third trimester maternal urine concentrations of high molecular weight phthalates (HMWP), di-2-ehtylhexylphthalate (DEHP) and di-n-octylphthalate (DNOP) were associated with lower systolic and diastolic blood pressure among girls (p-values

Human exposure to neonicotinoid insecticides (hereafter “neonics”) is a concern. Spot urine samples have been widely used in the assessment of exposure to neonics. Urinary concentrations, however, can vary greatly over time due to variable exposure, potentially leading to exposure misclassification. In this study, within- and between-individual variability of urinary concentrations of 13 neonics and their metabolites collected consecutively for up to 44 days from 19 individuals were examined. We also measured seven oxidative stress biomarkers (OSBs) in repeated urine samples to elucidate their relationship with neonic exposure by mixed regression models. Intraclass correlation coefficients (ICCs, a ratio of between-individual variance to total variance) were used to assess the reproducibility of neonic/metabolite concentrations. Sensitivity and specificity were used to evaluate how well spot urine samples determined an individual’s average exposure over 44 days. A fair to good reproducibility was observed for N-desmethyl-acetamiprid (ICC = 0.42), whereas thiamethoxam, imidacloprid, clothianidin, imidaclothiz, 6-chloronicotinic acid, and sulfoxaflor showed poor reproducibility (ICC = 0.02–0.37). Use of single-spot urine samples to classify high (top 33%) exposure showed higher specificities (0.68–0.92) than sensitivities (0.32–0.88). The minimum number of specimens (k) required to estimate participant-specific mean for neonic exposures within 20% of the “true” values ranged from 16 to 172. Significant positive correlations were found between some of neonic and OSB concentrations. The high variability found in the urinary concentrations of most neonics/metabolites suggests that a single measurement can result in exposure misclassification. Keywords: Exposure, Neonicotinoid, Insecticide, Urine, Oxidative stress, ICC

Exposure of humans to pesticides is widespread. Measurement of urinary levels of pesticides and their metabolites is often used in the assessment of body burdens and exposure doses to these chemicals. An understanding of temporal variability in urinary levels of pesticides within individuals is critical for accurate exposure assessment. We examined within- and between-individual variability in concentrations of nine organophosphate and pyrethroid insecticides as well as two phenoxy herbicides in urine collected consecutively for up to 44 days from 19 individuals. Seven oxidative stress biomarkers also were measured in urine samples to elucidate their relationship with pesticide exposure. Intraclass correlation coefficients (ICCs) were calculated to assess reproducibility in urinary pesticide concentrations from repeated measures. Sensitivity and specificity analyses were performed to evaluate the suitability of spot urine to characterize average exposures. Data analysis was further limited to seven pesticides and their metabolites, which had a detection frequency of >60%. Poor reproducibility was found for the seven pesticides and their metabolites in both spot (ICCs ≤0.24) and first-morning-void (FMV) samples (ICCs

# Background The World Health Organisation (WHO) recommends skin-to-skin contact at birth as part of the essential newborn care processes that can help improve breastfeeding behaviours in new mothers. In 2019 Nigeria had the highest number of infant mortalities (270,000 infant deaths), second only to India (522,000 infant deaths). Consequently, the possible benefits of skin-to-skin contact and healthy breastfeeding behaviours to both mother and child cannot be overemphasised. This study seeks to understand the rate of skin-to-skin contact post-birth and how this affects early breastfeeding initiation, breastfeeding duration, and exclusive breastfeeding among Nigerian women. It also seeks to understand if the place of delivery or internet access affects the associations between skin-to-skin contact and breastfeeding behaviours. # Methods Data from the Demographic and Health Survey (2018) on Nigerian women were analyzed, and 19,328 women were included in this study. The association between skin-to-skin contact post-birth (independent variable) and breastfeeding initiation, exclusive breastfeeding, and breastfeeding duration (dependent variables) were analyzed with multivariable logistic regression models adjusted for known confounders. The modifying effects of place of delivery and internet use were also assessed. # Results Nearly 13% of Nigerian women experienced skin-to-skin contact post-birth. The odds of exclusive breastfeeding were higher for women who experienced skin-to-skin contact with their newborns, compared to those that did not (odds ratio, OR=1.24, 95% confidence interval, CI=1.13-1.36). Conversely, the odds of initiating breastfeeding within the first hour of birth (OR=0.87, 95% CI=0.79-0.96) were lower in women who experienced skin-to-skin contact post-birth. There was no association between skin-to-skin contact and breastfeeding duration. Delivering their baby in private hospitals modified the association between skin-to-skin contact and early breastfeeding initiation (OR=3.27, 95% CI=2.33-4.60, P