Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity.

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.

Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities.

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Energy, macronutrients and dietary fibre intake among adults in North Macedonia.

OBJECTIVE: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. METHODS: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. RESULTS: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, ß = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, ß = -2.077) and among highly educated participants (p = 0.018, ß = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, ß = 4.213). CONCLUSION: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

Environmental noise and sleep disturbance: research in Central, Eastern and South-Eastern Europe and Newly Independent States.

Countries from South-East Europe (SEE), Central and Eastern Europe (CEE) and Newly Independent States (NIS) are in the process of harmonization with European environmental noise legislation. However, research work on noise and health was performed in some countries independently of harmonization process of adoption and implementation of legislation for environmental noise. Aim of this review is to summarize available evidence for noise induced sleep disturbance in population of CEE, SEE and NIS countries and to give directions for further research work in this field. After a systematic search through accessible electronic databases, conference proceedings, PhD thesis, national reports and scientific journals in English and non-English language, we decided to include six papers and one PhD thesis in this review: One paper from former Yugoslavia, one paper from Slovakia, one paper from Lithuania, two papers from Serbia and one paper, as also one PhD thesis from The Former Yugoslav Republic of Macedonia. Noise exposure assessment focused on road traffic noise was mainly performed with objective noise measurements, but also with noise mapping in case of Lithuanian study. Sleep disturbance was assessed with the questionnaire based surveys and was assumed from dose-effect relationship between night-time noise indicator (Lnight ) for road traffic noise and sleep disturbance (for Lithuanian study). Although research evidence on noise and sleep disturbance show to be sufficient for establishing dose response curves for sleep disturbance in countries where studies were performed, further research is needed with particular attention to vulnerable groups, other noise sources, development of laboratory research work and common methodology in assessment of burden of diseases from environmental noise.

Community response to noise: research in Central, Eastern and South-Eastern Europe and Newly Independent States.

The systems of public complaints on environmental noise were reviewed in seven countries of Central and Eastern Europe (CEE), South-East Europe (SEE), and Newly Independent States (NIS). Public complaints remain an important issue due to differences in public sensitivity to noise and due to several cases where a measurement of noise intensity does not give a satisfying solution to the problem. The unresolved problem remaining in the residential neighborhoods is the noise from pubs and restaurants that are open until late in the night. In our review, we compiled information on the institutions responsible for the implementation of environmental noise legislation and organizations that are responsible for dealing with public complaints. Information on activities for increasing public awareness on hazards rising from environmental noise and the role of civil initiative was explored. In seven countries, and among them, Slovenia, Lithuania, Latvia, Slovakia, The Former Yugoslav Republic of Macedonia, Serbia, and Poland, the responsibilities and duties are shared among different institutions at national and regional levels, depending on the noise source. The problem of gathering information on complaints and using it for improving the wellbeing and health of citizens remains often difficult and unsolved.

Preventive Measures and Hygiene Habits of Apple Producers in the Prespa Region.

Background: Agriculture is one of the most dangerous industries, both for the employees in that sector and for their families and the environment. The use of personal protective preventive measures and the maintenance of good hygienic practices are the basis for healthy production and healthy workers. The safety and hygiene of food products should be present during all stages of production. Objectives: The study aimed to assess the use of personal protective equipment (PPE) by apple growers during agricultural procedures as well as the hygiene habits of agricultural workers. Subjects and Methods: A cross-sectional study was conducted including 101 farmers from the Prespa region in the Republic of North Macedonia by using a questionnaire with 34 questions. The questions were formulated in order to give us an insight into the protective preventive measures undertaken at work by apple producers and their hygiene. Results: The study included 101 apple growers from the Prespa region. Wearing a completely tidy special PPE when using pesticides was registered in 78.2% of farmers, and when lawn mowing in 42.5%. 16% of the surveyed farmers during agricultural activities did not always wash their hands after going to the toilet, and almost 30% of them did not use soap when washing their hands. Conclusion: There is inadequate hygiene practice/personal hygiene during agricultural activities. In addition, the proper use of PPE is not at a satisfactory level and poses a risk to the health of apple growers.

Early environmental quality and life-course mental health effects: The Equal-Life project.

BACKGROUND: There is increasing evidence that a complex interplay of factors within environments in which children grows up, contributes to children's suboptimal mental health and cognitive development. The concept of the life-course exposome helps to study the impact of the physical and social environment, including social inequities, on cognitive development and mental health over time. METHODS: Equal-Life develops and tests combined exposures and their effects on children's mental health and cognitive development. Data from eight birth-cohorts and three school studies (N = 240.000) linked to exposure data, will provide insights and policy guidance into aspects of physical and social exposures hitherto untapped, at different scale levels and timeframes, while accounting for social inequities. Reasoning from the outcome point of view, relevant stakeholders participate in the formulation and validation of research questions, and in the formulation of environmental hazards. Exposure assessment combines GIS-based environmental indicators with omics approaches and new data sources, forming the early-life exposome. Statistical tools integrate data at different spatial and temporal granularity and combine exploratory machine learning models with hypothesis-driven causal modeling. CONCLUSIONS: Equal-Life contributes to the development and utilization of the exposome concept by (1) integrating the internal, physical and social exposomes, (2) studying a distinct set of life-course effects on a child's development and mental health (3) characterizing the child's environment at different developmental stages and in different activity spaces, (4) looking at supportive environments for child development, rather than merely pollutants, and (5) combining physical, social indicators with novel effect markers and using new data sources describing child activity patterns and environments.

Prevalence of Phonological Articulation Disorders in Preschool Children in the City of Skopje.

INTRODUCTION: Speech communication is a complex process based on the function of the central nervous system, and also on the speech mechanisms conditioned and controlled by auditory perception, verbal memory, intellectual activity and peripheral speech apparatus.The aim of this study was to determine the prevalence of the most common phonological articulation disorders in preschool children, from 4-6 years old. MATERIALS AND METHODS: A cross-sectional study was conducted during 2018, on a representative sample of 550 preschool children aged 4 - 6 years, who attend preschool institutions-kindergartens in the city of Skopje. The study used standardized articulation tests: The Global Articulation Test (GAT) and the Triple Test (vocals, plasia, affricative, fricative, nasal, and lateral), and a questionnaire filled out by a social worker at the kindergarten about the socioeconomic status and the child's health condition. RESULTS: Using GAT, we found that 260 (47.3%) children didn't manifest any phonological articulation disorders, but 290 (52.7%) had disorders. The analysis of gender-based data showed a higher percentage of speech disorders in 57% of boys and 46.9% of girls. The highest percentage of speech disorder is sigmatism with 24.5% in boys and 20.4% in girls, rhotacismus was found in 17.8% in boys and 16.5% in girls. Lambdacism with 8.3% was found in boys and 4.2% in girls. A mixed form (sigmatism, rotacism, and lambdacism) was also found in 2.4% of boys and 3.5% of girls. CONCLUSIONS: The calculated prevalence of phonological articulation disorders in preschool children aged 4-6 years is 52.7%, (57.9% in boys and 46.9% in girls), or every second child in kindergarten has some form of speech disorder. These findings indicate that the treatment of speech disorders should begin in the appropriate services as soon as possible, because the early detection and treatment of speech disorders enable child's normal intellectual development. The treatment should be started in the preschool period, to allow the start of the educational process without any speech problems.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Adverse Birth Outcomes.

Introduction: Three recent systematic reviews suggested a relationship between noise exposure and adverse birth outcomes. The aim of this review was to evaluate the evidence for the World Health Organization (WHO) noise guidelines and conduct an updated systematic review of environmental noise, specifically aircraft and road traffic noise and birth outcomes, such as preterm birth, low birth weight, being small for gestational age and congenital malformations. Materials and methods: We reviewed again all the papers on environmental noise and birth outcomes included in the previous three systematic reviews and conducted a systematic search on noise and birth outcomes to update previous reviews. Web of Science, PubMed and Embase electronic databases were searched for papers published between June 2014 (end date of previous systematic review) and December 2016 using a list of specific search terms. Studies were also screened in the reference list of relevant reviews/articles. Further inclusion and exclusion criteria for the studies provided by the WHO expert group were applied. Risk of bias was assessed according to criteria from the Newcastle-Ottawa quality assessment scale for case-control and cohort studies. Finally, we applied the GRADE principles to our systematic review in a reproducible and appropriate way for judgment about quality of evidence. Results: In total, 14 studies are included in this review, six studies on aircraft noise and birth outcomes, five studies (two with more or less the same population) on road traffic noise and birth outcomes and three related studies on total ambient noise that is likely to be mostly traffic noise that met the criteria. The number of studies on environmental noise and birth outcomes is small and the quality of evidence generally ranges from very low to low, particularly in case of the older studies. The quality is better for the more recent traffic noise and birth outcomes studies. As there were too few studies, we did not conduct meta-analyses. Discussion: This systematic review is supported by previous systematic reviews and meta-analyses that suggested that there may be some suggestive evidence for an association between environmental noise exposure and birth outcomes, although they pointed more generally to a stronger role of occupational noise exposure, which tends to be higher and last longer. Very strict criteria for inclusion and exclusion of studies, performance of quality assessment for risk of bias, and finally applying GRADE principles for judgment of quality of evidence are the strengths of this review. CONCLUSIONS: We found evidence of very low quality for associations between aircraft noise and preterm birth, low birth weight and congenital anomalies, and low quality evidence for an association between road traffic noise and low birth weight, preterm birth and small for gestational age. Further high quality studies are required to establish such associations. Future studies are recommended to apply robust exposure assessment methods (e.g., modeled or measured noise levels at bedroom façade), disentangle associations for different sources of noise as well as daytime and nighttime noise, evaluate the impacts of noise evens (that stand out of the noise background), and control the analyses for confounding factors, such as socioeconomic status, lifestyle factors and other environmental factors, especially air pollution.

Reproductive outcomes associated with noise exposure - a systematic review of the literature.

INTRODUCTION: High noise exposure during critical periods in gestation is a potential stressor that may result in increased risk of implantation failure, dysregulation of placentation or decrease of uterine blood flow. This paper systematically reviews published evidence on associations between reproductive outcomes and occupational and environmental noise exposure. METHODS: The Web of Science, PubMed and Embase electronic databases were searched for papers published between 1970 to June 2014 and via colleagues. We included 14 epidemiological studies related to occupational noise exposure and nine epidemiological studies related to environmental noise exposure. There was some evidence for associations between occupational noise exposure and low birthweight, preterm birth and small for gestational age, either independently or together with other occupational risk factors. Five of six epidemiologic studies, including the two largest studies, found significant associations between lower birthweight and higher noise exposure. There were few studies on other outcomes and study design issues may have led to bias in assessments in some studies. CONCLUSIONS: There is evidence for associations between noise exposure and adverse reproductive outcomes from animal studies. Few studies in have been conducted in humans but there is some suggestive evidence of adverse associations with environmental noise from both occupational and epidemiological studies, especially for low birthweight.

Environmental noise and annoyance in adult population of Skopje: a cross-sectional study.

The aim of this study was to identify noise exposure indicators during day and night in the city of Skopje and to see if there is an association between these noise exposure indicators and annoyance. We have performed noise measurements and interviewed 510 adult subjects, using a questionnaire, prepared according to the ISO/TS-15666 standard. Average noise level over the day (Lday) was (62+/-6.45) dB(A) and over night (Lnight) (56+/-6.52) dB(A). Thirteen percent of subjects reported a high level, and 33.5% moderate level of annoyance. The most annoying noise sources were construction activities (34% of the subjects), road traffic (24%), and leisure/entertainment activities (18%). We found a significant association between exposure to Lday in the range 61 dB(A) to 65 dB(A) and annoyance in the exposed population (chi-square = 86.14; p<0.001; Spearman's R=0.45; p<0.05). During the night time annoyance was reported with exposure to Lnight above 46 dB(A). Levels of annoyance in Macedonia are similar to levels in developed European countries. Differences are in the source of noise. This study has shown that environmental noise is a significant hazard in urban environments, and assessment of annoyance may prove a useful tool for town planners and public health policy makers.

Psychosocial effects of community noise: cross sectional study of school children in urban center of Skopje, Macedonia.

AIM: To assess noise exposure in school children in urban center in different residential areas and to examine psychosocial effects of chronic noise exposure in school children, taking into account their socioeconomic status. METHODS: We measured community noise on specific measurement points in residential-administrative-market area and suburban residential area. We determined the average energy-equivalent sound level for 8 hours (LAeq, 8 h) or 16 hours (LAeq, 16 h) and compared measured noise levels with World Health Organization (WHO) guidelines. Psychological effects were examined in two groups of children: children exposed to noise level LAeq, 8 h >55 dBA (n=266) and children exposed to noise level LAeq, 8 h <55 dBA (n=263). The examinees were schoolchildren of 10-11 years of age. We used a self-reported questionnaire for each child - Anxiety test (General Anxiety Scale) and Attention Deficit Disorder Questionnaire intended for teachers to rate children's behavior. We used Mann Whitney U test and multiple regression for identifying the significance of differences between the two study groups. RESULTS: School children who lived and studied in the residential-administrative-market area were exposed to noise levels above WHO guidelines (55 dBA), and school children who lived and studied in the suburban residential area were exposed to noise levels below WHO guidelines. Children exposed to LAeq, 8 h >55 dBA had significantly decreased attention (Z=-2.16; p=0.031), decreased social adaptability (Z =-2.16; p=0.029), and increased opposing behavior in their relations to other people (Z=-3; p=0.001). We did not find any correlation between socioeconomic characteristics and development of psychosocial effects. CONCLUSION: School children exposed to elevated noise level had significantly decreased attention, and social adaptability, and increased opposing behavior in comparison with school children who were not exposed to elevated noise levels. Chronic noise exposure is associated with psychosocial effects in school children and should be taken as an important factor in assessing the psychological welfare of the children.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: the former Yugoslav Republic of Macedonia country assessment

We have reviewed the health system challenges and opportunities in the former Yugoslav Republic of Macedonia for improving core services for the prevention, early diagnosis and management of noncommunicable diseases(NCDs). The outcomes of most of these diseases have been improving, while mortality from diabetes has been increasing, and there are significant regional differences in the rates of premature mortality. The success achieved is partly due to progress in core population interventions (e.g. tobacco control) and individual services, although these could be further strengthened. It is recommended that, to further strengthen the health system response to NCDs, the Government should consider the following areas: strengthening governance and coordination mechanisms; investing in strengthening the evidence base and using evidence-based actions; empowering the population and patients; and optimizing models of care, aligning incentives and establishing mechanisms for continuous quality improvement.