Preliminarno praćenje povezanosti stambenih zelenih i vodenih površina s boljim mentalnim zdravljem u sveučilišnih studenata

Previous research has suggested that natural urban environment (green space and blue space) benefit mental health, but only a few longitudinal studies have explored the underlying mechanisms. In this pilot study we aimed to examine mechanisms/variables mediating associations between residential green/blue space and symptoms of anxiety/depression in 109 Bulgarian students from Plovdiv university. The students were followed from the beginning to the end of the school year (October 2017 to May 2018). Residential green space was defined as the mean of the normalised difference vegetation index (NDVI) in circular buffers of 100, 300, and 500 m around their residences. Blue space was assessed based on its presence in the same buffers. Levels of anxiety/depression were assessed using the 12-item General Health Questionnaire. The investigated mediator variables included residential noise (LAeq) and air pollution (NO2), environmental annoyance, perceived restorative quality of the neighbourhood, neighbourhood social cohesion, physical activity, and sleep disturbance. Cross-sectional data (obtained at baseline) showed that higher NDVI correlated with better mental health only indirectly through higher physical activity and restorative quality. Longitudinal (follow-up) data showed improved mental health but no significant effect of mediator variables. Similarly, blue space correlated with better mental health in all models, but physical activity and restorative quality were significant mediator variables only in the cross-sectional analysis. Our findings support that green space and blue space are psychologically restorative features in urban environment. Future research should replicate these findings in the general population and employ longitudinal modelling tailored to the specific mechanisms under study.Rezultati presječnih istraživanja upućuju na to da prirodni okoliš u gradovima (zelene i vodene površine) povoljno utječe na mentalno zdravlje, ali tek je nekoliko dugoročnih istraživanja pokušalo utvrditi mehanizme u pozadini tog učinka. Cilj ovoga preliminarnog (pilot) istraživanja bio je ispitati mehanizme/varijable koji posreduju između zelenih/vodenih površina u mjestu stanovanja i tjeskobe/depresije u 109 bugarskih studenata sa Sveučilišta u Plovdivu. Studenti su praćeni od početka do kraja akademske godine (od listopada 2017. do svibnja 2018.). Stambeno se zelenilo odredilo pomoću normaliziranog indeksa razlike u vegetaciji (engl. normalised difference vegetation index, krat. NDVI) u radijusu od 100, 300 i 500 m oko adrese stanovanja. Udio vodenih površina također je procijenjen u tim radijusima. Razine tjeskobe/depresije ocijenjene su pomoću 12 stavki iz Upitnika o općem zdravstvenom stanju (General Health Questionnaire, krat. GHQ-12). Od posredničkih (engl. mediator) varijabli istražili smo buku, onečišćenje zraka (NO2), uzrujanost okolišem, percepciju utjecaja susjedstva na oporavak (engl. restorative quality), društvenu povezanost u susjedstvu (engl. social cohesion), tjelesnu aktivnost i poremećaj spavanja. Podaci iz presječnoga istraživanja (dobiveni za početnog mjerenja) pokazali su da viši NDVI korelira s boljim mentalnim zdravljem tek neizravno kroz izrazitiju tjelesnu aktivnost i snažniji utjecaj na oporavak u susjedstvu. Dugoročno je pak istraživanje (praćenje) pokazalo istu tu korelaciju, ali bez značajnog sudjelovanja posredničkih varijabli. Slično je i s vodenim površinama. Njihov veći udio korelirao je s boljim mentalnim zdravljem u svim modelima, ali su tjelesna aktivnost i oporavak značajno posredovali samo u presječnom istraživanju (početnom mjerenju). Naši rezultati potvrđuju povoljan psihološki utjecaj gradskih zelenih i vodenih površina na psihu i njezin oporavak, ali će tek buduća istraživanja trebati to potvrditi i u općoj populaciji. U dugoročnim bi istraživanjima svakako trebalo prilagoditi modeliranje konkretnim mehanizmima koji se ispituju

Profesionalna izloženost buci i razina testosterona u serumu u muškaraca obuhvaćenih ispitivanjem National Health and Nutrition Examination Survey od 1999. do 2004.

There is compelling evidence from animal experiments that noise exposure suppresses testosterone in males by affecting the hypothalamic-pituitary-testicular axis. Virtually nothing is known about its effect in humans. Therefore, the aim of this study was to explore the association between occupational noise exposure and serum testosterone in a representative sample of the general population. The sample has been taken from the National Health and Nutrition Examination Survey (NHANES) data for the period between 1999 and 2004 and is limited to employed men aged 16-85+ years at the time. The associations between noise exposure (either established according to the Occupational Information Network - O*NET categories or self-reported) and total and free testosterone (TT and FT, respectively) were analysed using linear regression models with increasing adjustments. In the fully adjusted model (n=414), the third quartile of the O*NET noise exposure was associated with lower TT and FT, which reached statistically significant decrease of -58.32 ng dL-1 (95 % CI: -111.22, -5.42) and -1.58 ng dL-1 (95 % CI: -2.98, -0.18), respectively. In stratified analyses, younger, lower income, normal weight, better hearing, and workers not using hearing protection at work experienced significantly more severe adverse effects than the rest. The odds for hypogonadism (TT<300 ng dL-1) did not significantly rise with one interquartile range increment in O*NET noise exposure (OR=1.24, 95 % CI: 0.64, 2.39). Self-reported loud noise exposure did not significantly decrease TT when all men were considered (n=214) and only in the men ≥37 years did it decrease TT significantly by -87.55 ng dL-1 (95 % CI: -158.35, -16.74). In conclusion, noise exposure was associated with lower TT and FT only in some population subgroups and these associations were non-linearIstraživanja na životinjama uvjerljivo upozoravaju na to da izloženost buci potiskuje lučenje testosterona u mužjaka djelujući na osovinu hipotalamus-hipofiza-testisi. Međutim, gotovo se ništa ne zna o takvom djelovanju buke na ljude. Stoga je cilj ovog istraživanja bio utvrditi postoji li povezanost između profesionalne izloženosti buci i razina testosterona u serumu u reprezentativnom uzorku opće populacije. Uzorak je preuzet iz ispitivanja National Health and Nutrition Examination Survey (NHANES) koje se provodilo od 1999. do 2004. i bilo ograničeno na tada zaposlene muškarce u dobi od 16 do 85+ godina. Povezanost između izloženosti buci (koja je utvrđena bilo na temelju baze podataka i kategorizacije Occupational Information Networka - tzv. O*NET, ili na temelju izjava sudionika o izloženosti buci) i razina ukupnoga (UT) i slobodnoga testosterona (ST) analizirana je linearnim regresijskim modelima. U modelu sa svim varijablama (n=414) ispitanici u trećem kvartilu izloženosti buci prema O*NET-u imali su statistički značajno niže vrijednosti UT-a i ST-a u odnosu na neizložene radnike: vrijednosti njihova UT-a bile su niže za 58,32 ng dL-1 (95 % CI: -111,22; -5,42), a vrijednosti ST-a za 1,58 ng dL-1 (95 % CI: -2,98; -0,18) u odnosu na neizložene. Stratificirana je analiza pokazala da su mlađi radnici, radnici s manjim primanjima, radnici normalne tjelesne mase, oni koji bolje čuju te radnici koji ne nose zaštitu od buke na poslu imali značajno štetnije posljedice od izloženosti od ostalih radnika. Izgledi za hipogonadizam (UT<300 ng dL-1) nisu se značajno povećali s porastom izloženosti prema klasifikaciji O*NET-a u vrijednosti od jednoga interkvartilnog raspona (OR=1,24, 95 % CI: 0,64; 2,39). Izloženost buci nije značajno utjecala na pad UT-a kad su analizom bili obuhvaćeni svi radnici koji su sami prijavili izloženost (n=214) nego samo u radnika ≥37 godina, koji su imali za 87,55 ng dL-1 (95 % CI: -158,35; -16,74) niže vrijednosti u odnosu na neizložene radnike. Ovo je istraživanje pokazalo povezanost između izloženosti buci i sniženih razina UT-a i ST-a samo u pojedinim populacijskim podskupinama, a ta povezanost nije bila linearna

Is there an association between urban greenness and air pollution annoyance?

Background Apart from its physical effects air pollution might exert psychological stress effect on health. Based on the limited evidence about the symbolic value of urban greenness in traffic perception and a small body of research indicating that greenness might abate the negative perception of noise pollution, we hypothesized that it could also reduce air pollution annoyance.Aim We aimed to test this hypothesis and determine whether greenness could buffer the annoyance reaction to air pollution.Material and methodsIn a sample of 508 residents of Plovdiv, Bulgaria we investigated the interplay between objective and perceived air pollution exposure, annoyance, and several indicators of urban greenness, using path models.Results Results showed that women living closer to a green space reported lower perceived air pollution exposure and through it - lower annoyance. This indirect path was driving the total effect and perceived air pollution acted as a full mediator. Among men there was no effect. With respect to perceived greenness, no effects on air pollution annoyance were found.ConclusionIn conclusion, urban green spaces might act as a buffer for the psychological stress effect of air pollution. Nonetheless, at this formative stage of research the evidence is tentative

Road traffic noise and annoyance: exposure-response relationship and burden of disease calculations in Bulgaria

Background: Noise annoyance (NA) contributes considerably to the cumulative burden of disease from environmental noise in Europe. Exposure-response functions are the basis for assessment of its socio-economic impact which is essential for environmental health policy. These functions have not been implemented in Bulgaria.Aim: In order to determine the socio-economic impact of road traffic NA in Plovdiv and Bulgaria several objectives were set: to establish a preliminary exposure-response relationship between road traffic noise and NA; to compare it to Miedema and Oudshoorn`s curve recommended by the World Health Organization (WHO); and to quantify the burden of high NA.Material and methods: Based on data collected during a survey on cardio-metabolic environmental risk factors in Plovdiv we generated an exposure-response function derived from a logistic model and compared it to Miedema and Oudshoorn`s polynomial. Employing the official WHO methodology we calculated the disability-adjusted life years (DALYs) lost in Plovdiv due to high NA and monetized the value of these DALYs. Then we extended the analyses to the total Bulgarian urban population.Results: The logistic function in our study bared close resemblance to Miedema and Oudshoorn`s polynomial (range 55-75 dB). Based on the latter,  an annual loss of 1 188.17 DALYs was estimated in Plovdiv which translated into € 14.26 million assuming € 12 000 per DALY. On a national scale the results were even more alarming (6 399.60 DALYs and € 76.80 million).Conclusion: Road traffic NA appears to have a considerable socio-economic impact in the country which calls for decisive actions by involved authorities. Future use of Miedema and Oudshoorn`s polynomial is substantiated

Przewlekła ekspozycja na hałas a niedobór testosteronu — metaanaliza i metaregresja wyników badań na gryzoniach

Introduction: Chronic psychological distress can cause suppression of the hypothalamic–pituitary–testicular axis and thus lead to male hypogonadism, which is associated with psycho-social dysfunction, chronic diseases, and as a result, considerable economic costs. Conversely, noise is a prototypal environmental stressor of growing importance, already linked to birth outcomes and diabetes. However, its effects on male testosterone levels have been paid little attention. Material and methods: This paper reports a systematic review and meta-analysis of experimental studies in rodents, which have examined the effect of chronic noise stress on serum testosterone levels. A systematic search in MEDLINE, EMBASE and the Internet yielded seven studies. A quality effects meta-analytical model was applied to compute pooled Hedges’s g. Quality effects meta-regression was carried out as well. Results: We found pooled Hedges’s g of –2.41 (95% CI: –3.28, –1.54), indicating a very large effect of noise exposure on testosterone. Metaregression confirmed that the overall duration of exposure explained a significant proportion of the variance across individual effect sizes (Q (1) = 3.95, p = 0.047). However, there was considerable inter-study heterogeneity (I2 = 82%) and publication bias (p = 0.016). After inputting two studies previously thought to be missing, the pooled effect dropped to g = –1.53 (95% CI: –3.01, –0.05). Conclusions: Chronic noise exposure of ≈ 100 dB leads to a significant reduction of serum testosterone in male rodents. Research on humans is highly warranted, especially given the steady trend in Western societies for increasing the burden of both male hypogonadism and noise pollution. Wstęp: Przewlekły stres może powodować stłumienie osi podwzgórze–przysadka–jądra, a przez to prowadzić do hipogonadyzmu u mężczyzn. Zaburzenie to wiąże się z kolei z występowaniem zaburzeń społeczno-psychologicznych, rozwojem chorób przewlekłych, a przez to generuje znaczne obciążenie ekonomiczne. Hałas jest prototypowym środowiskowym czynnikiem stresogennym, którego znaczenie jest coraz bardziej podnoszone i który został ostatnio powiązany z rozwojem cukrzycy i przebiegiem ciąży. Wpływ hałasu na stężenie testosteronu u mężczyzn nie był jednak dotychczas badany. Materiał i metody: Niniejsza publikacja zawiera systematyczny przegląd danych i metaanalizę wyników badań dotyczących wpływu przewlekłego stresu w związku z ekspozycją na hałas na stężenia testosteronu w surowicy gryzoni. Dokonano systematycznego przeglądu baz danych MEDLINE i EMBASE, uzyskując siedem publikacji. W oparciu o wyniki tych badań dokonano metaanalizy z obliczeneniem wskaźnika wielkości efektu (wskaźnik g Hedgesa) oraz metaregresji. Wyniki: Wartość wskaźnika g Hedgesa wyniosła –2,41 (95% CI: –3,28; –1,54), co wskazuje na bardzo silny wpływ ekspozycji na hałas na stężenie testosteronu. Metaregresja potwierdziła, że czas ekspozycji ma istotny wpływ na wariancję poszczególnych wyników badań (Q (1) = 3,95; p &lt; 0,047). Jednocześnie stwierdzono jednak znaczną zmienność wyników poszczególnych badań (I2 = 82%) i pewną stronniczość publikacji (p = 0,016). Po dodaniu wyników dwóch przypuszczalnie nieuwzględnionych badań wartość ogólnego wskaźnika g spadła do –1,53 (95% CI: –3,01; –0,05). Wnioski: Przewlekła ekspozycja na hałas o natężeniu ≈ 100 dB prowadzi do istotnego zmniejszenia stężeń testosteronu w surowicy gryzoni. Pożądane jest więc prowadzenie podobnych badań u ludzi. Może to mieć szczególne znaczenie w krajach zachodnich, gdzie obserwuje się rosnące obciążenie hałasem w środowisku, ale także stały trend w kierunku rozwoju hipogonadyzmu u mężczyzn

Odnos između izloženosti prometnoj buci i rizika od moždanog udara: sustavni pregled s metaanalizom

Traffic noise is an established risk factor for some cardiovascular diseases such as hypertension and ischaemic heart disease, but the evidence regarding stroke is still limited. In this study we aimed to systematically review the related epidemiological data and make a meta-analysis of the risk of stroke morbidity associated with road and air traffic noise exposure. We searched articles in English, Spanish, and Russian indexed in MEDLINE, EMBASE, and Google Scholar on 24 November 2015. Qualitative synthesis was made for 13 studies, and 11 studies were included in quality effects meta-analyses. Overall, they were of high quality. Based on six studies (n≈8,790,671 participants) for road traffic noise, we found a pooled relative risk (RR) of stroke per 10 dB to be 1.03 (95 % CI: 0.87, 1.22). In the 70-75 dB noise range (versus <55 dB) RR increased to 1.29 (95 % CI: 0.74, 2.24). For air traffic noise we pooled five studies (n≈16,132,075 participants) and the RR per 10 dB was 1.05 (95 % CI: 1.00, 1.10). The air traffic group had low heterogeneity, whereas the road traffic group had high heterogeneity, but there was evidence of publication bias. In conclusion, we have established a small but elevated risk of stroke to be associated with both road and air traffic noise exposure, but the association was statistically significant only with the latter. The effect of road traffic noise followed a non-linear trend.Prometna je buka rizični čimbenik za nastanak bolesti krvožilja poput povišenoga krvnog tlaka i ishemijske bolesti srca, ali su saznanja vezana uz moždani udar još uvijek ograničena. Cilj je ovoga istraživanja bio napraviti sustavni pregled epidemioloških podataka i metaanalizu rizika od moždanog udara povezanoga s izloženošću buci cestovnog i zračnog prometa. Pretraživanje je provedeno 24. studenoga 2015., a obuhvatilo je članke na engleskom, španjolskom i ruskom jeziku koji su odgovarali kriterijima pretrage u bazama MEDLINE, EMBASE i Google Scholar. Kvalitativna sinteza obuhvatila je 13 istraživanja, od kojih je 11 obuhvaćeno metaanalizom kvalitativnih učinaka. U prosjeku su svi članci bili visokokvalitetni. Na temelju rezultata šest istraživanja (n≈8.790.671 sudionik) vezanih uz buku cestovnog prometa, utvrdili smo da ukupni relativni rizik (RR) od moždanog udara prilikom porasta buke od 10 dB iznosi 1,03 (95 % CI: 0,87, 1,22). U rasponu buke od 70 do 75 dB (prema <55 dB) RR se povećao na 1,29 (95 % CI: 0,74; 2,24). Prema objedinjenim podacima o buci zračnoga prometa iz pet istraživanja (n≈16.132.075 sudionika), RR za porast buke od 10 dB iznosio je 1,05 (95 % CI: 1,00; 1,10). Podaci iz istraživanja cestovne buke, za razliku od onih iz istraživanja zračne buke, bili su statistički izrazito heterogeni. Istraživanja cestovne buke iskazala su odstupanje podataka zbog pretežitog objavljivanja određenog tipa istraživanja (tzv. publication bias). Ovim smo istraživanjem utvrdili donekle povišeni rizik od moždanog udara zbog izloženosti buci cestovnog i zračnog prometa, ali je ta povezanost bila statistički značajna samo kod potonjega. Učinci cestovne buke slijedili su nelinearni trend

Adapting a gis version of the Irvine-Minnesota inventory (IMI) for Bulgarian settings

IntroductionVarious neighbourhood features such as safety, green spaces, aesthetics and maintenance of the build environment, etc. are correlates of health-related behaviours and outcomes. Assessment of neighbourhood quality by raters using audit tools is objective way to obtain reliable information about those features, and the Irvine-Minnesota Inventory (IMI) is one of the most widely used tools.AimThe aim of this study was to adapt IMI for Bulgarian settings by restructuring and modifying its dimensions, and to test the reliability of a desk-based (GIS) against a field audit version. Material and methodsIMI was adapted for Bulgarian settings (BVIMI). Then 180 street segments were selected from the city of Plovdiv based on their characteristics, and 25% were sampled to be audited. Three raters carried out the neighbourhood audits using a field version (in-person audits) and a GIS version of BVIMI. The inter- and intra-rater agreement, as well as the agreement between the GIS and field audits was tested with Krippendorff`s alpha and the Intraclass correlation coefficient.ResultsBVIMI has 86 items organized in six domains - `Safety`, `Traffic`, `Maintenance`, `Nature and Landscape`, `Attractiveness of the Build Environment` and `Types of Buildings and Land use`. It is temporally stable and has high inter- and intra-rater agreement, except for some items necessitating subjective judgments (i.e. about features and attitudes) or assessing unstable features (i.e. stray dogs).ConclusionsBVIMI is a reliable GIS-based neighbourhood auditing tool adapted for Bulgarian urban settings. It might be routinely utilized by environmental hygienists, social epidemiologists and other public health experts to study the associations between various neighbourhood features and health behaviours/outcomes

Lifetime dog guardianship and hypertension prevalence in Plovdiv

BackgroundDog guardianship (DG) is a novel behavioral preventive intervention against arterial hypertension (AH) based on increased opportunities for physical activity, positive neuroendocrine response to stress and improved social capital. Current biomedical mindset in Bulgaria, however, is mostly focused on treatment rather than prevention through such unconventional approaches.AimThis study aimed to determine whether DG was associated with lower odds of prevalent AH.Material and methodsA secondary analysis of a cross-sectional study among 513 residents of Plovdiv, Bulgaria was conducted. Data on self-reported doctor-diagnosis with AH, duration of lifetime dog guardianship (LDG) and confounding individual and environmental factors were available. A multivariate logistic regression model was set up to explore the odds of AH due to LDG; it was followed by sensitivity analyses to detect possible effect modification by individual differences.ResultsWe found 28.8% (95% CI: 2.6%, 47.9%) lower odds of AH per 8 years of LDG. This beneficial effect was more pronounced in males, people without family history of AH, who had never smoked, with lower socio-economic status, not obese and aged < 55 years.ConclusionLonger DG during one`s lifetime was associated with significantly lower odds of prevalent AH. Bulgarian public health exerts should explore it as an alternative preventive intervention for AH and contribute to fostering social acceptance of companion animals as means to enhance people`s health

Attention deficit in children with attention deficit hyperactivity disorder at primary school age measured with the attention network test (ANT) : a protocol for a systematic review and meta-analysis

Background: Attentional deficits are among the most bothersome symptoms of attention deficit hyperactivity disorder (ADHD). To date, the neurological basis of attentional deficits has not been fully described according to the diagnostic criteria. ADHD may result from deficits in various attributes of attention. There is no specialist neuropsychological diagnostic method that allows reliable distinction between primary attention disorders in the etiology of ADHD and secondary problems that may arise due to co-morbidities. This protocol aims to systematically review the literature to evaluate patterns of attention common to school-age children either diagnosed with ADHD or at high risk of ADHD, as measured by the neuropsychological attention network test (ANT). Methods: Our search strategy will consist of electronic databases (PubMed, PsychInfo, Web of Science, EMBASE, and Cochrane Library) and hand searching. Both prospective cohort studies and prospective studies of intervention effects will be included, provided they used the ANT. The primary output variable will be attention deficits. Screening and eligibility will be done independently by two reviewers based on pre-specified eligibility criteria. Data extraction will be based on a pre-pilot data extraction form and conducted by two authors independently. The risk of bias will be assessed by two authors independently. The rating of the certainty of the entire body of evidence will be evaluated using the GRADE approach. Any discrepancies identified at any stage of the review will be resolved by discussion or/and consultation with another reviewer. We plan a narrative synthesis of findings and a quantitative meta-analysis if the data allow. Discussion: The research will identify patterns of neuropsychological ANT results characteristic of both school-age children diagnosed with ADHD and those at high risk of having ADHD. Our results could be used to check whether the pattern of a child’s performance in the ANT corresponds to the characteristic pattern of the results of children with ADHD. At present, the ANT is used only in research; the results of this review will serve as a useful benchmark. Hopefully, in the future, it will be possible to use the ANT in the wider diagnosis of ADHD