Smarter, greener, more inclusive? Indicators to support the Europe 2020 strategy - 2017 edition

The 2017 edition of "Smarter, greener, more inclusive? - Indicators to support the Europe 2020 strategy" continues the series of Eurostat flagship publications supporting the Europe 2020 strategy by monitoring progress towards the targets and goals defined under the three mutually reinforcing priorities of smart, sustainable and inclusive growth. The analysis is based on the Europe 2020 headline indicators chosen to monitor progress towards the strategy's targets. Other indicators focusing on specific subgroups of society or on related contextual issues are also used to deepen the analysis and present a broader picture. The data used mainly come from official statistics produced by the European Statistical System and disseminated by Eurostat. It covers the period from 2002 or 2008 up to the most recent year for which data are available (2015 or 2016)

MOLECULAR VIROLOGICAL ANALYSIS OF THE TRANSMISSION CLUSTERS AND RESISTANCE MUTATIONS OF HIV-1 SUBTYPE B IN BULGARIA (2012-2020)

HIV-1 infection in Bulgaria is known for its high level of genetic diversity. Previous studies have indicated that subtype B is the most common strain in Bulgaria, particularly among men who have sex with men, who are at a high risk of transmission. The primary objective of this study was to identify any transmission clusters and transmission resistance in individuals newly diagnosed with HIV-1 who have not yet received antiretroviral therapy (ART). To this end, we sequenced the HIV-1 pol gene in the samples from the study participants using either the Viroseq HIV-1 Genotyping Test (Abbott) and the Applied Biosystems 3130xl genetic analyzer or the TruGene DNA Sequencing System (Siemens Healthcare) and an OpenGene DNA sequencing system. We then subtyped the HIV-1 pol sequences, and further analyzed those that met the criteria for subtype B. The study included a total of 595 HIV-1 subtype B sequences. Our analysis revealed that the majority of those diagnosed with HIV-1 subtype B were male and lived in Sofia region. The most common transmission mode was through sexual intercourse among men who have sex with men, followed by heterosexual transmission. We also observed the presence of multiple transmission clusters , and a low percentage of transmitted drug resistance mutations (TDRMs). Overall, our study confirms that HIV-1 subtype B remains the most dominant strain in Bulgaria

Projecting the impact of air pollution on child stunting in India—synergies and trade-offs between climate change mitigation, ambient air quality control, and clean cooking access

Many children in India face the double burden of high exposure to ambient (AAP) and household air pollution, both of which can affect their linear growth. Although climate change mitigation is expected to decrease AAP, climate policies could increase the cost of clean cooking fuels. Here, we develop a static microsimulation model to project the air pollution-related burden of child stunting in India up to 2050 under four scenarios combining climate change mitigation (2 °C target) with national policies for AAP control and subsidised access to clean cooking. We link data from a nationally representative household survey, satellite-based estimates of fine particulate matter (PM2.5), a multi-dimensional demographic projection and PM2.5 and clean cooking access projections from an integrated assessment model. We find that the positive effects on child linear growth from reductions in AAP under the 2 °C Paris Agreement target could be fully offset by the negative effects of climate change mitigation through reduced clean cooking access. Targeted AAP control or subsidised access to clean cooking could shift this trade-off to result in net benefits of 2.8 (95% uncertainty interval [UI]: 1.4, 4.2) or 6.5 (UI: 6.3, 6.9) million cumulative prevented cases of child stunting between 2020–50 compared to business-as-usual. Implementation of integrated climate, air quality, and energy access interventions has a synergistic impact, reducing cumulative number of stunted children by 12.1 (UI: 10.7, 13.7) million compared to business-as-usual, with the largest health benefits experienced by the most disadvantaged children and geographic regions. Findings underscore the importance of complementing climate change mitigation efforts with targeted air quality and energy access policies to concurrently deliver on carbon mitigation, health and air pollution and energy poverty reduction goals in India

Defining pathways to healthy sustainable urban development.

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development

Climate change and health in India : impacts and co-benefits

El primer estudio de esta tesis doctoral demostró que tanto las temperaturas ambientales altas como las bajas y las olas de calor son factores de riesgo de mortalidad por todas las causas en la India, y el riesgo de mortalidad aumenta de manera más pronunciada a temperaturas más altas. El segundo y tercer estudio evaluaron algunos de los beneficios colaterales para la salud relacionados con la contaminación del aire y las compensaciones de la mitigación del cambio climático en la India. Los hallazgos sugirieron que la reducción proyectada de la contaminación del aire ambiental bajo los objetivos del Acuerdo de París puede alargar la esperanza de vida al nacer, reducir la mortalidad prematura y el número de niños con retraso en el crecimiento en la India para 2050 en comparación con los negocios habituales. Sin embargo, los costos de combustible más altos en virtud de los objetivos del Acuerdo de París pueden conducir a una mayor contaminación del aire en los hogares, compensando así por completo los beneficios para el crecimiento lineal infantil de una mejor calidad del aire ambiental. Complementar las medidas de mitigación con el control de la calidad del aire al final de la tubería y las políticas para respaldar el acceso a una cocina limpia puede maximizar los beneficios colaterales para la salud y reducir las compensaciones de mitigación, especialmente entre los más desfavorecidos.The first study in this PhD thesis demonstrated that both high and low ambient temperatures and heatwaves are risk factors for all-cause mortality in India, with mortality risk increasing more steeply at higher temperatures. The second and third study assessed some of the air pollution related health co-benefits and trade-offs from climate change mitigation in India. Findings suggested that projected reduction of ambient air pollution under the Paris Agreement targets can lengthen life expectancy at birth, reduce premature mortality and the number of stunted children in India by 2050 compared to the business-as-usual. However, higher fuel costs under Paris Agreement targets can lead to higher household air pollution, thus completely offsetting the benefits for child linear growth from improved ambient air quality. Complementing mitigation measures with end-of-pipe air quality control and policies to support access to clean cooking can maximise health co-benefits and reduce mitigation trade-offs, especially among the most disadvantaged

Association between ambient temperature and heat waves with mortality in South Asia: Systematic review and meta-analysis

Background: South Asia is highly vulnerable to climate change and is projected to experience some of the highest increases in average annual temperatures throughout the century. Although the adverse impacts of ambient temperature on human health have been extensively documented in the literature, only a limited number of studies have focused on populations in this region. Objectives: Our aim was to systematically review the current state and quality of available evidence on the direct relationship between ambient temperature and heat waves and all-cause mortality in South Asia. Methods: The databases Pubmed, Web of Science, Scopus and Embase were searched from 1990 to 2020 for relevant observational quantitative studies. We applied the Navigation Guide methodology to assess the strength of the evidence and performed a meta-analysis based on a novel approach that allows for combining nonlinear exposure-response associations without access to data from individual studies. Results: From the 6,759 screened papers, 27 were included in the qualitative synthesis and five in a meta-analysis. Studies reported an association of all-cause mortality with heat wave episodes and both high and low daily temperatures. The meta-analysis showed a U-shaped pattern, with increasing mortality for both high and low temperatures, but a statistically significant association was found only at higher temperatures - above 31° C for lag 0-1 days and above 34° C for lag 0-13 days. Effects were found to vary with cause of death, age, sex, location (urban vs. rural), level of education and socio-economic status, but the profile of vulnerabilities was somewhat inconsistent and based on a limited number of studies. Overall, the strength of the evidence for ambient temperature as a risk factor for all-cause mortality was judged as limited and for heat wave episodes as inadequate. Conclusions: The evidence base on temperature impacts on mortality in South Asia is limited due to the small number of studies, their skewed geographical distribution and methodological weaknesses. Understanding the main determinants of the temperature-mortality association as well as how these may evolve in the future in a dynamic region such as South Asia will be an important area for future research. Studies on viable adaptation options to high temperatures for a region that is a hotspot for climate vulnerability, urbanisation and population growth are also needed.VI gratefully acknowledges funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 730,004 (project PUCS). JB gratefully acknowledges funding from the European Union’s Horizon 2020 research and innovation programme under grant agreements No 865,564 (European Research Council Consolidator Grant EARLY-ADAPT), 727,852 (project Blue-Action) and 730,004 (project PUCS). CT was funded through a Ramón y Cajal fellowship (RYC-2015–17402) awarded by the Spanish Ministry of Economy and Competitiveness

Defining pathways to healthy sustainable urban development

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development

HCV transmission in high-risk communities in Bulgaria.

BACKGROUND:The rate of HIV infection in Bulgaria is low. However, the rate of HCV-HIV-coinfection and HCV infection is high, especially among high-risk communities. The molecular epidemiology of those infections has not been studied before. METHODS:Consensus Sanger sequences of HVR1 and NS5B from 125 cases of HIV/HCV coinfections, collected during 2010-2014 in 15 different Bulgarian cities, were used for preliminary phylogenetic evaluation. Next-generation sequencing (NGS) data of the hypervariable region 1 (HVR1) analyzed via the Global Hepatitis Outbreak and Surveillance Technology (GHOST) were used to evaluate genetic heterogeneity and possible transmission linkages. Links between pairs that were below and above the established genetic distance threshold, indicative of transmission, were further examined by generating k-step networks. RESULTS:Preliminary genetic analyses showed predominance of HCV genotype 1a (54%), followed by 1b (20.8%), 2a (1.4%), 3a (22.3%) and 4a (1.4%), indicating ongoing transmission of many HCV strains of different genotypes. NGS of HVR1 from 72 cases showed significant genetic heterogeneity of intra-host HCV populations, with 5 cases being infected with 2 different genotypes or subtypes and 6 cases being infected with 2 strains of same subtype. GHOST revealed 8 transmission clusters involving 30 cases (41.7%), indicating a high rate of transmission. Four transmission clusters were found in Sofia, three in Plovdiv, and one in Peshtera. The main risk factor for the clusters was injection drug use. Close genetic proximity among HCV strains from the 3 Sofia clusters, and between HCV strains from Peshtera and one of the two Plovdiv clusters confirms a long and extensive transmission history of these strains in Bulgaria. CONCLUSIONS:Identification of several HCV genotypes and many HCV strains suggests a frequent introduction of HCV to the studied high-risk communities. GHOST detected a broad transmission network, which sustains circulation of several HCV strains since their early introduction in the 3 cities. This is the first report on the molecular epidemiology of HIV/HCV coinfections in Bulgaria

Identifying predictors of personal exposure to air temperature in peri-urban India

Characterizing personal exposure to air temperature is critical to understanding exposure measurement error in epidemiologic studies using fixed-site exposure data and to identify strategies to protect public health. To date, no study evaluating personal air temperature in the general population has been conducted in a low-and-middle income country. We used data from the CHAI study consisting of 50 adults monitored in up to six non-consecutive 24 h sessions in peri-urban south India. We quantified the agreement and association between fixed-site ambient and personal air temperature, and identified predictors of personal air temperature based on housing assessment, self-reported, GPS, remote sensing, and wearable camera data. Mean (SD) daytime (6 am-10 pm) average personal air temperature was 31.2 (2.6) °C and mean nighttime (10 pm-6 am) average temperature was 28.8 (2.8) °C. Agreement between average personal air and fixed-site ambient temperatures was limited, especially at night when personal air temperatures were underestimated by fixed-site temperatures (MBE = -5.6 °C). The proportion of average personal nighttime temperature variability explained by ambient fixed-site temperatures was moderate (R2mar = 0.39); daytime associations were stronger for women (R2mar = 0.51) than for men (R2mar = 0.3). Other predictors of average nighttime personal air temperature included residential altitude, ceiling height, and household income. Predictors of average daytime personal air temperature included roof materials, GPS-tracked altitude, time working in agriculture (for women), and time travelling (for men). No biomass cooking, urban heat island, or greenspace effects were identified. R2mar between ambient fixed-site and personal air temperature indicate that ambient fixed-site temperature is only a moderately useful proxy of personal air temperature in the context of peri-urban India. Our findings suggest that people living in houses at lower altitude, with lower ceiling height and asbestos roofing sheets might be more vulnerable to heat. We also identified households with higher income, women working in agriculture and men with long commutes as disproportionately exposed to high temperatures.This research was funded by the European Research Council under ERC Grant Agreement number 336167 for the CHAI Project. Cathryn Tonne was funded through a Ramón y Cajal fellowship (RYC-2015-17402) awarded by the Spanish Ministry of Economy and Competitiveness. None of the funding sources had a role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication