Among risks, protection, and lessons learned: Perspectives of Brazilian rural families about work in adolescence.

Adolescents working in the Brazilian rural contexts were investigated through participant observation and interviews, aiming at understanding the role played by work in the nurturing of adolescent in these contexts. The qualitative and longitudinal survey involved six participants who were members of two different families, as follows: four female adolescents, one adult woman, and one adult man. It was found that adolescents and their families understood work as a context for nurturing moral values, learning skills, and meeting needs. Observation, however, found that work also involved exposure to risks. The study reviews the role of work in adolescence as a cultural component in some rural contexts and how this should be taken into account to avoid an ethnocentric and universalistic interpretation that divides adolescence between "normal" and "abnormal."

The Multidimension of Malnutrition among School Children in a Rural Area, South Africa: A Mixed Methods Approach.

To address childhood malnutrition, the use of multifaceted methodologies, such as mixed methods research, is required to inform effective and contextual interventions. However, this remains limited in studying malnutrition among school children in a South African context, notwithstanding its persistence. We adopted a convergent parallel mixed methods design to best understand the magnitude of malnutrition through multilevel influences in a rural area. A quantitative survey determined the magnitude of malnutrition and associated factors among school children and their mothers (n = 508), parallel to a qualitative study, which explored mothers' insights into the influences of child growth and nutrition in interviews using seven focus group discussions. Mixed methods integration was achieved through convergence of the quantitative constructs developed from measured variables for malnutrition and related factors with ten emergent qualitative themes using a joint display analysis to compare the findings and generate meta-inferences. Qualitative themes on food unavailability and affordability, poor feeding beliefs and practices, and decision to purchase foods were consistent with the quantified poor socio-demographic status of mothers. Furthermore, the qualitative data explained the high prevalence of undernutrition among children but did not corroborate the high estimated households' food security in the quantitative survey. The misperceptions of mothers on child growth agreed with limited food knowledge as well as lack of knowledge on child growth gathered during the survey. Moreover, mothers believed that their children were growing well despite the high presence of childhood undernutrition. Mothers further overrated the effectiveness of school feeding programmes in providing healthy food to children as compared to their household food. They reported high incidence of food allergies, diarrhea, and vomiting caused by food consumed at school which resulted in children not eating certain foods. This might have impacted on the nutritional status of children since mothers depended on the school feeding program to provide food for their children. The ambiguity of cultural influences in relation to child growth was evident and substantiated during qualitative interview. Mixed methods integration offered a better understanding of malnutrition from empirical findings on interrelated factors at child, maternal, household, and school levels. This study points to a need for multilevel, informed, and contextual multidimensional interventions to contribute towards addressing childhood malnutrition in South Africa.

Cognitive reserve over life course and 7-year trajectories of cognitive decline: results from China health and retirement longitudinal study.

BACKGROUND: Cognitive reserve (CR) could partly explain the individual heterogeneity in cognitive decline. No study measured CR from a life course perspective and investigated the association between CR and trajectories of cognitive decline in older Chinese adults. METHODS: Data of 6795 Chinese adults aged 60+ from China Health and Retirement Longitudinal Study were used. Global cognition score (0-32) was assessed in all four waves. A life-course CR score was constructed using markers of childhood circumstance, education, highest occupational class, and leisure activities in later life. Latent growth curve modelling (LGCM) was applied to assess the association between CR and trajectories of cognitive decline. RESULTS: For the life-course CR, factor loadings of markers in adulthood and later life were larger than that of markers in childhood. The life-course CR score (ranged between - 2.727 and 6.537, SD: 1.74) was higher in urban Chinese adults (0.75, SD: 1.90) than in rural Chinese adults (- 0.50, SD: 1.43). The unconditional LGCM results showed that urban older Chinese adults had better global cognition at baseline (intercept: 15.010, 95% CI: 14.783, 15.237) and a slower rate of cognitive decline per year (linear slope: -0.394, 95% CI: - 0.508, - 0.281) than their rural counterparts (intercept: 12.144, 95% CI: 11.960, 12.329; linear slope: -0.498, 95% CI: - 0.588, - 0.408). After controlling for all covariates, one-unit higher CR score was associated with 1.615 (95% CI: 1.521, 1.709) and 1.768 (95% CI: 1.659, 1.876) unit higher global cognition at baseline for urban and rural older Chinese adults, respectively. The slower rate of cognitive decline associated with higher CR was more evident in rural residents (slope: 0.083, 95% CI: 0.057, 0.108) than in their urban counterparts (0.054, 95% CI: 0.031, 0.077). CONCLUSIONS: CR was associated with better baseline cognition and slower cognitive decline in Chinese older adults. Although rural residents were disadvantaged in both CR and cognition, the protective effect of CR against cognitive decline was stronger for them than in those who live in urban area.

Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy.

OBJECTIVE: This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites. MATERIALS: The analysis focused on 145 10th-12th-century adults with at least one preserved maxillary sinus. METHODS: Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis. RESULTS: Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases. CONCLUSIONS: Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out. SIGNIFICANCE: This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations. LIMITATIONS: Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results. SUGGESTIONS FOR FURTHER RESEARCH: Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.

Corrigendum: Risks for Child Cognitive Development in Rural Contexts.

[This corrects the article DOI: 10.3389/fpsyg.2018.02735.].

Engaging Mothers on the Growth of School-Age Children in a Rural South African Health and Demographic Site: A Qualitative Insight.

A qualitative study was conducted to explore mothers' insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth.

Positive Adolescent Development: Effects of a Psychosocial Intervention Program in a Rural Setting.

The Positive Youth Development (PYD) approach identifies adolescents as resources to be empowered rather than problems to be solved. All adolescents have strengths and will fully develop when these strengths are integrated with healthy resources in the diverse environments where they live and interact. The objective of this study was twofold: (1) to present the Positive Development Program for Adolescents living in rural areas (DPAR Program) and (2) to pilot test the intervention program. The DPAR program was evaluated using a repeated-measures design before and after the intervention, with an intervention group and a control group. The sample consisted of 176 adolescents between 11 and 15 years old (M = 12.89, SD = 0.90) who belonged to two high schools with similar characteristics located in rural settings. A mixed-design analysis of variance was performed for each dependent variable. Results showed a significant increase in most of the study variables (self-esteem, self-efficacy, group identity, empathy, relational skills, assertiveness, and conflict resolution) and a significant decrease in alexithymia, as well as better academic performance. All this evidence indicates that the DPAR program is effective in promoting positive adolescent development and addresses the lack of programs based on the PYD approach in rural areas.

The Development of Context-Sensitive Attention in Urban and Rural Brazil.

Human perception differs profoundly between individuals from different cultures. In the present study, we investigated the development of context-sensitive attention (the relative focus on context elements of a visual scene) in a large sample (N = 297) of 5- to 15-year-olds and young adults from rural and urban Brazil, namely from agricultural villages in the Amazon region and the city of São Paulo. We applied several visual tasks which assess context-sensitive attention, including an optical illusion, a picture description, a picture recognition and a facial emotion judgment task. The results revealed that children and adults from the urban sample had a higher level of context-sensitive attention, when compared to children and adults from the rural sample. In particular, participants from São Paulo were more easily deceived by the context elements in an optical illusion task and remembered more context elements in a recognition task than participants from rural Amazon villages. In these two tasks, context-sensitivity increased with age. However, we did not find a cultural difference in the picture description and the facial emotion judgment task. These findings support the idea that visual information processing is highly dependent on the culture-specific learning environments from very early in development. Specifically, they are more consistent with accounts that emphasize the role of the visual environment, than with the social orientation account. However, they also highlight that further research is needed to disentangle the diverse factors that may influence the early development of visual attention, which underlie culture-specific developmental pathways.

The Impact of Community Size, Community Climate, and Victimization on the Physical and Mental Health of SGM Youth.

Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey (n = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health.

The double burden of malnutrition in a rural health and demographic surveillance system site in South Africa: a study of primary schoolchildren and their mothers.

BACKGROUND: In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. METHODS: A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. RESULTS: Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01-2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01-2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07-0.46). CONCLUSION: A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be over-emphasized.

Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa.

BACKGROUND: Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa. METHODS: A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren. RESULTS: Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight. CONCLUSIONS: The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.

Serviço de Apoio Domiciliário como substituição ou complemento do cuidado familiar / Home Care as substitution or complementary of familiarly care / Servicio de Apoyo Domicilio como sustitución o complemento del cuidado familiar

Este estudo exploratório aborda o papel do Serviço de Apoio Domiciliário no quotidiano dos idosos e suas famílias, em função do contexto urbano e rural, e o percurso de vida dos utentes de dois SAD do norte de Portugal. Recorreu-se a uma metodologia qualitativa, com a aplicação de 11 entrevistas semiestruturadas. O SAD mantém uma função assistencialista/tradicional, tendo um papel de substituição em meio urbano e complementar em meio rural. Este estudo aponta para a necessidade de apostar numa lógica de prevenção, educação e reabilitação, em torno da criação de um plano de cuidados personalizado, baseado num sistema de classificação dos utentes.

This exploratory study deals with the role of the Domiciliary Support Service in the daily life of the elderly and their families, depending on the urban and rural context and the life course of the users of two SADs in the north of Portugal. A qualitative methodology was used, with the application of 11 semi-structured interviews. The SAD maintains a welfare / traditional function, having primarily a substitution role in an urban and complementary environment in rural areas. This study points to the need of betting on a logic of prevention, education and rehabilitation, around the creation of a personalized care plan, based on a classification system of the users.

Este estudio exploratorio aborda el papel de la atención domiciliaria de la vida cotidiana de las personas mayores y sus familias, de acuerdo con el contexto urbano y rural y el modo de vida de los usuarios del SAD dos norte de Portugal. Se recurrió a una metodología cualitativa, con la aplicación de 11 entrevistas semiestructuradas. El SAD mantiene una función asistencialista / tradicional, teniendo un papel de sustitución en medio urbano y complementario en medio rural. Este estudio apunta a la necesidad de apostar en una lógica de prevención, educación y rehabilitación, en torno a la creación de un plan de cuidados personalizado, basado en un sistema de clasificación de los usuarios.

Risks for Child Cognitive Development in Rural Contexts.

While poverty all over the world is more typical and extreme in rural contexts, interventions to improve cognition in low socioeconomic status (SES) children are for the most part based on studies conducted in urban populations. This paper investigate how poverty and rural or urban settings affect child cognitive performance. Executive functions and non-verbal intelligence performance, as well as individual and environmental information was obtained from 131 5-year-old children. For the same level of SES, children in rural settings performed consistently worse than children in urban settings. These differences could be accounted mostly by the months of past preschool attendance and the father's completed level of education. These results should inform policies and programs for children living in rural poverty worldwide, and specially in Latin America.

The Sierra Leone Ultrasound Rainbow4Africa Project (SLURP): an observational study of ultrasound effectiveness in developing countries.

BACKGROUND: Diagnostic tools available in low-income countries are often really basic even if patients can be as sick as those of the richer countries. Point-of-care ultrasound could be a solution for this problem. We studied the impact of ultrasound at the Holy Spirit Hospital, Makeni, Sierra Leone. METHODS: This is a prospective, observational study on outpatients presenting at the HSH. We enrolled continually for 1 month 105 patients asked for ultrasound examination by the caring physician that had to indicate the differential diagnosis hypothesized, the confidence degree about these on a 5-point Likert scale, and the therapy before and after the US. The primary outcome was to measure the difference in the number of differential diagnoses. Secondary outcomes were the rate of new diagnoses, the confidence changes of the visiting physician, and the changes in prescribed therapy or management. Categorical variables were compared using the Chi-square test, and continuous ones using two-tailed Student's test and Likert with the Wilcoxon rank-sum test. RESULTS: 194 differential diagnoses were formulated, with a mean of 1.85 (DS 0.87) diagnoses per patient. 89 (46%) were excluded on the basis of US, reducing the mean of differential diagnosis per patient to 1, 0 (p < 0.001). US also introduced 53 new diagnoses in 42 patients (mean 1.26; SD 0.54), raising the final differential diagnosis from 105 to 158 (+50.5%) that is 1.51 (DS 0.79) per patient. There is a statistically significant reduction (18.6%) in diagnoses per patient after having performed the ultrasound (p < 0.001). The certainty level increased (Wilcoxon rank-sum test: p < 0.001). We did not reach the statistical significance studying the changes in therapy and management because the subgroups for analysis were too small. Nonetheless, we saw interesting changes in drug prescription and referral rate before and after the US. CONCLUSION: Ultrasound is feasible in low-income countries; with it diagnostic hypotheses were reduced and new unexpected diagnoses were introduced. Further studies are needed to explore other strong outcomes like mortality, length of stay in hospital, and money saved with the use of ultrasound in developing countries.

Pobreza multidimensional e seus aspectos subjetivos em contextos rurais e urbanos nordestinos / Multidimensional poverty and its subjective aspects in rural and urban contexts in Northeast Brazil / Pobreza Multidimensional y sus aspectos subjetivos en contextos rurales y urbanos de Nordeste

Resumo Objetiva-se analisar a pobreza multidimensional e seus aspectos subjetivos em contextos rural e urbano em um Estado do Brasil. Os aspectos subjetivos da pobreza estão relacionados a uma autopercepção vinculada à privação financeira e à responsabilização individual. A amostra total constou de 417 participantes. Foi desenvolvido um Índice de Mensuração de Pobreza Multidimensional a partir das privações nas dimensões habitação, escolaridade, trabalho/renda, saúde e aspectos subjetivos da pobreza. Foram realizados testes de Análise de Regressão Múltipla e Análise Multivariada de Variância. Identificou-se que as privações nas dimensões escolaridade e habitação são mais intensas na zona rural. Já a dimensão subjetiva da pobreza é mais forte no contexto urbano. Em ambos os contextos, dimensão privação de trabalho/renda tem predição positiva com os aspectos subjetivos da pobreza. No contexto urbano, as dimensões saúde e habitação também são preditoras positivas da dimensão subjetiva da pobreza, enquanto a dimensão educação tem uma correlação negativa.

Abstract The objective is to analyze the multidimensional poverty and its subjective aspects in rural and urban contexts in a State of Brazil. The total sample consisted of 417 participants. It was set up the Measurement Index of the Multidimensional Poverty from deprivation in housing , education, work/income, health dimensions and subjective aspects of poverty. Multiple Regression Analysis and Multivariate Analysis of Variance were performed. It was found that the deprivations in the education and housing dimensions are more intense in the countryside. The subjective dimension of poverty is stronger in the urban context. In both contexts, deprivation of work/income dimension has positive prediction with the subjective aspects of poverty. In the urban context, health and housing dimensions are also positive predictors of subjective dimension of poverty, while the education is has a negative correlation.

Resumen El objetivo es analizar la pobreza multidimensional y sus aspectos subjetivos en contextos rurales y urbanos en un Estado del Brasil. El total de la muestra consistió en 417 participantes. Se ha creado un índice de medición de pobreza multidimensional por medio de las privaciones en las dimensiones de la vivienda, la educación, el trabajo/ingreso, la salud y los aspectos subjetivos de la pobreza. Las pruebas se realizaron en el Análisis de Regresión Múltiple y Análisis Multivariado de Varianza. Se constató que las variaciones en las dimensiones de la educación y la vivienda son más intensas en el campo. La dimensión subjetiva de la pobreza es más fuerte en el contexto urbano. En ambos contextos, la privación de la dimensión trabajo/ingreso cuenta con la predicción positiva con los aspectos subjetivos de la pobreza. En el contexto urbano, las dimensiones salud y vivienda son también predictores positivos de la dimensión subjetiva de la pobreza, mientras que la educación tiene una correlación negativa.

Pobreza multidimensional e seus aspectos subjetivos em contextos rurais e urbanos nordestinos / Multidimensional poverty and its subjective aspects in rural and urban contexts in Northeast Brazil / Pobreza Multidimensional y sus aspectos subjetivos en contextos rurales y urbanos de Nordeste

Objetiva-se analisar a pobreza multidimensional e seus aspectos subjetivos em contextos rural e urbano em um Estado do Brasil. Os aspectos subjetivos da pobreza estão relacionados a uma autopercepção vinculada à privação financeira e à responsabilização individual. A amostra total constou de 417 participantes. Foi desenvolvido um Índice de Mensuração de Pobreza Multidimensional a partir das privações nas dimensões habitação, escolaridade, trabalho/renda, saúde e aspectos subjetivos da pobreza. Foram realizados testes de Análise de Regressão Múltipla e Análise Multivariada de Variância. Identificou-se que as privações nas dimensões escolaridade e habitação são mais intensas na zona rural. Já a dimensão subjetiva da pobreza é mais forte no contexto urbano. Em ambos os contextos, dimensão privação de trabalho/renda tem predição positiva com os aspectos subjetivos da pobreza. No contexto urbano, as dimensões saúde e habitação também são preditoras positivas da dimensão subjetiva da pobreza, enquanto a dimensão educação tem uma correlação negativa.

The objective is to analyze the multidimensional poverty and its subjective aspects in rural and urban contexts in a State of Brazil. The total sample consisted of 417 participants. It was set up the Measurement Index of the Multidimensional Poverty from deprivation in housing , education, work/income, health dimensions and subjective aspects of poverty. Multiple Regression Analysis and Multivariate Analysis of Variance were performed. It was found that the deprivations in the education and housing dimensions are more intense in the countryside. The subjective dimension of poverty is stronger in the urban context. In both contexts, deprivation of work/income dimension has positive prediction with the subjective aspects of poverty. In the urban context, health and housing dimensions are also positive predictors of subjective dimension of poverty, while the education is has a negative correlation.

El objetivo es analizar la pobreza multidimensional y sus aspectos subjetivos en contextos rurales y urbanos en un Estado del Brasil. El total de la muestra consistió en 417 participantes. Se ha creado un índice de medición de pobreza multidimensional por medio de las privaciones en las dimensiones de la vivienda, la educación, el trabajo/ingreso, la salud y los aspectos subjetivos de la pobreza. Las pruebas se realizaron en el Análisis de Regresión Múltiple y Análisis Multivariado de Varianza. Se constató que las variaciones en las dimensiones de la educación y la vivienda son más intensas en el campo. La dimensión subjetiva de la pobreza es más fuerte en el contexto urbano. En ambos contextos, la privación de la dimensión trabajo/ingreso cuenta con la predicción positiva con los aspectos subjetivos de la pobreza. En el contexto urbano, las dimensiones salud y vivienda son también predictores positivos de la dimensión subjetiva de la pobreza, mientras que la educación tiene una correlación negativa.

Sex-specific differences in fetal growth in newborns exposed prenatally to traffic-related air pollution in the PELAGIE mother-child cohort (Brittany, France).

BACKGROUND: Numerous studies have linked prenatal traffic-related air pollution exposure to fetal growth. Recently, several studies have suggested exploring this association independently among boys and girls because of potential sex-specific biological vulnerability to air pollution. Residence-based factors can also influence fetal growth by enhancing susceptibility to the toxic effects of air pollution and must also be considered in these relations. OBJECTIVE: We examined sex-specific associations between prenatal air pollution exposure and fetal growth and explored whether they differed by the urban-rural status of maternal residence. METHODS: This study relied on the PELAGIE mother-child cohort (2521 women, Brittany, France, 2002-2006). Fetal growth was assessed through birth weight, head circumference and small weight (SGA) and small head circumference (SHC) for gestational age. Nitrogen dioxide (NO2) concentrations at mothers' homes were estimated by using a land use regression model taking into account temporal variation during pregnancy. Associations between estimated NO2 concentrations and fetal growth were assessed with linear regression or logistic regression models, depending on the outcome investigated. RESULTS: An interquartile range (8.8 µg m(-3)) increase in NO2 exposure estimates was associated with a 27.4 g (95% CI 0.8 to 55.6) increase in birth weight and a 0.09 cm (95% CI 0.00-0.17) significant increase in head circumference, among newborn boys only. Their risks of SGA and SHC were reduced (OR 0.70, 95% CI 0.53-0.92, OR 0.76, 95% CI 0.56-1.03, respectively, for an increase of 8.8 µg m(-3)). No statistically significant trends were observed among girls. Urban-rural status modified the effect of air pollution only for SHC and again only for newborn boys. CONCLUSION: Findings from this study confirm the need to consider sex-specific associations between air pollution and fetal growth and to investigate possible mechanisms by which traffic-related air pollution may increase anthropometric parameters at birth.

Socioeconomic Disparities in Adverse Birth Outcomes in Urban and Rural Contexts: a French Mother-Child Cohort.

BACKGROUND: Although adverse birth outcomes have been associated with neighbourhood deprivation in urban areas, few studies have addressed this issue in rural zones. This study examines whether associations between neighbourhood deprivation and adverse birth outcomes differ in urban and rural contexts, while taking individual characteristics and spatial accessibility of prenatal care (SAPC) into account. METHODS: Pregnant women from a French mother-child cohort were recruited from 2002 to 2006 in Brittany. Their residential addresses were geocoded into their census blocks (the finest geographical resolution available). Deprivation was assessed at the same neighbourhood level. Models to assess the associations of deprivation, stratified by urban/rural status, with preterm delivery (PTD), with small for gestational age birth weight (SGA) and with small for gestational age head circumference at birth (SHC), estimated odds ratios (ORs), adjusted for maternal socioeconomic characteristics and SAPC. RESULTS: This study considered 2929 liveborn singleton pregnancies from 780 census blocks. Neighbourhood deprivation was associated with increased risks of SGA and SHC (P trend < 0.01 and 0.03 respectively), only among mothers residing in rural areas. Neighbourhood deprivation had statistically significantly heterogeneous effects on SGA and SHC according to the urban/rural status of maternal residence. CONCLUSION: These findings suggest that neighbourhood deprivation affects fetal growth differentially in urban and rural areas and that SAPC does not seem to be responsible for this difference. Comparison of these findings with the literature requires caution in the conceptualisation of urban and rural settings.

Association between prenatal exposure to traffic-related air pollution and preterm birth in the PELAGIE mother-child cohort, Brittany, France. Does the urban-rural context matter?

INTRODUCTION: Evidence has accumulated that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) in urban settings. Conversely, this relation has barely been investigated in rural areas where individual characteristics (demographic, socioeconomic, and psychosocial factors) and environmental co-exposures may differ. OBJECTIVE: We examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother-child cohort (Brittany, France, 2002-2006) living in urban (n=1550) and rural (n=959) settings. METHODS: Women's residences were classified as either urban or rural according to the French census bureau rural-urban definitions. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models as a marker of traffic-related pollution. Associations between NO2 concentrations and PTB were assessed with logistic regression models. RESULTS: Prevalence of PTB was similar among women living in urban (3.2%) and in rural (3.5%) settings. More positive socioeconomic characteristics and health behaviors but more single-parent families were observed among urban women. NO2 exposure averaged 20.8±6.6 µg m(-3) for women residing in urban areas and 18.8±5.6 µg m(-3) for their rural counterparts. A statistically significant increased risk of PTB was observed among women exposed to NO2 concentrations ≥16.4 µg m(-3) and residing in urban areas but not among their rural counterparts. DISCUSSION: The results of this study, conducted in a region with interspersed urban-rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar suggests that environmental mixtures and psychosocial inequalities might play a role in this heterogeneity.