Up-regulation of the immediate early gene product RhoB by the cytotoxic necrotizing factor 1 from Escherichia coli

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Social Inequalities in Exposure to Ambient Air Pollution: A Systematic Review in the WHO European Region

Ambient air pollution is a long-standing and significant public health issue. The aim of this review is to systematically examine the peer-reviewed evidence on social inequalities and ambient air pollution in the World Health Organization European Region. Articles published between 2010 and 2017 were analyzed in the review. In total 31 articles were included in the review. There is good evidence from ecological studies that higher deprivation indices and low economic position are usually linked with higher levels of pollutants such as particulate matter (particulate matter under 2.5 and 10 microns in diameter, PM2.5, PM10) and oxides of nitrogen (e.g., NO2, and NOx). There is also evidence that ethnic minorities experience a mixed exposure in comparison to the majority population being sometimes higher and sometimes lower depending on the ethnic minority under consideration. The studies using data at the individual level in this review are mainly focused on pregnant women or new mothers, in these studies deprivation and ethnicity are more likely to be linked to higher exposures of poor air quality. Therefore, there is evidence in this review that the burden of higher pollutants falls disproportionally on different social group

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Psychische Gesundheit im Kontext : Auswirkungen sozialer Strukturen und der gebauten Umwelt auf das psychische Wohlbefinden und auf psychische Belastungen

Introduction: Not only individual factors but also factors of the social and built environment influence mental distress and ill-health and mental wellbeing. This dissertation aimed to gain further insight into the relationship between individually attributed factors of the social and built environment and mental distress and mental wellbeing. The first objective was to investigate prevalences and variations in mental health by characteristics at the individual level. The second objective was to assess the relationship between social structures at the macro level (here the focused factor was on welfare regimes) and mental health. The third objective was to investigate the relationship between factors of the built environment at the meso level (here the focused factor was environmental noise) and mental health. Methods: The three objectives were addressed by four conceptually independent but topic wise interrelated studies: i) material, psychosocial and sociodemographic determinants of mental wellbeing in Europe, ii) socioeconomic determinants of mental distress and mental wellbeing in school children iii) association between gender, welfare regimes and mental wellbeing, and iv) noise and mental distress in school-aged children. Data from the third wave of the European Quality of Life Survey (2011-2012) and the Health Monitoring Units in Bavaria served as the basis for these studies. Odds ratios were calculated using multilevel and multivariate logistic regression analyses. Poisson regression analyses were used to calculate relative risks for the incidences. Results: In adults material, psychosocial and sociodemographic factors were independently associated with low levels of mental wellbeing. In children, the analyses showed that several indicators of familiesa social disadvantage were associated with mental distress, in contrast to mental wellbeing, where only a few factors were associated. At the macro level prevalence of good mental wellbeing was in most instances higher among men compared to women at welfare regime level, with the exception of the Former Soviet Union welfare regime, where women report slightly higher prevalence of good mental wellbeing. Gender inequalities in good mental wellbeing were identified independent of further individual sociodemographic variables and independent of the welfare regimes that people lived in. People in the Former Soviet Union and the Central and Eastern European Countries welfare regimes showed statistically significantly lower chances to report good mental wellbeing compared to the Scandinavian welfare regime. Gender inequalities in good mental wellbeing were not modified by welfare regimes. At the individual level of the built environment, exposure to road traffic noise at day or night was the main risk factor for incident mental health problems in children. Exposure to noise by neighbours day and night also appeared to be a risk factor for some subcategories of the strength and difficulties questionnaire. Both noise from construction work and aircraft noise during the day were not associated with incident mental health problems. Discussion: Findings of this dissertation highlight an association between individual factors, aspects of the social and built environment and mental wellbeing and mental distress. The study of mental wellbeing is relatively young, therefore, especially in this field further studies are needed to confirm and expand the findings of this dissertation. To plan effective prevention and health promotion interventions a thorough understanding of the underlying mechanisms and pathways is needed. Further studies are warranted to gain knowledge on the impact of (further aspects of) the social and built environment on mental wellbeing and mental distress in adults and in children to identify underlying mechanisms and to identify vulnerable groups for targeted preventions

Sitzendes Verhalten als Risikofaktor im Kindes- und Jugendalter

Bucksch J, Dreger S. Sitzendes Verhalten als Risikofaktor im Kindes- und Jugendalter. Prävention und Gesundheitsförderung. 2014;9(1):39-46

Material, psychosocial and sociodemographic determinants are associated with positive mental health in Europe: a cross-sectional study

OBJECTIVES: To investigate the association between psychosocial, sociodemographic and material determinants of positive mental health in Europe. DESIGN: Cross-sectional analysis of survey data. SETTING: 34 European countries. PARTICIPANTS: Representative Europe-wide sample consisting of 21 066 men and 22 569 women aged 18 years and over, from 34 European countries participating in the third wave of the European Quality of Life Survey (2011–2012). OUTCOME: Positive mental health as measured by the WHO-5—Mental Well-being Index, while the lowest 25% centile indicated poor positive mental health. RESULTS: The prevalence of poor positive mental health was 30% in women and 24% in men. Material, as well as psychosocial, and sociodemographic factors were independently associated with poor positive mental health in a Europe-wide sample from 34 European countries. When studying all factors together, the highest OR for poor positive mental health was reported for social exclusion (men: OR=1.73, 95% CI 1.59 to 1.90; women: OR=1.69, 95% CI 1.57 to 1.81) among the psychosocial factors. Among the material factors, material deprivation had the highest impact (men: OR=1.96, 95% CI 1.78 to 2.15; women: OR=1.93, 95% CI 1.79 to 2.08). CONCLUSIONS: This study gives the first overview on determinants of positive mental health at a European level and could be used as the basis for preventive policies in the field of positive mental health in Europe

Gender inequalities in mental wellbeing in 26 European countries: do welfare regimes matter?

Dreger S, Gerlinger T, Bolte G. Gender inequalities in mental wellbeing in 26 European countries: do welfare regimes matter? EUROPEAN JOURNAL OF PUBLIC HEALTH. 2016;26(5):872-876.Background: Nature and extent of welfare regimes and social policies are important determinants of health and health inequalities. This study examines the association of gender and mental wellbeing in European countries and investigates whether type of welfare regime plays a role in this association. Method: Data of 19 366 women and 14 338 men of the third round of the European Quality of Life Survey (2011-12) was used to analyse mental wellbeing, assessed by the World Health Organization 5-Mental Wellbeing Index. Multilevel logistic regression analyses were performed to analyse the association between gender and good mental wellbeing first at country-level, and secondly the between country variation was analysed and welfare regimes were included as explanatory variables. Results: We observed cross-national variation in good mental wellbeing. At country levels gender inequalities in good mental wellbeing were observed in 7 out of 26 countries. In analyses considering all countries together gender inequalities in good mental wellbeing were identified independent of further individual socio-demographic variables and independent of the welfare regimes that people lived in [women vs. men: OR = 0.76; (95% CI = 0.71-0.81)]. Gender inequalities in good mental wellbeing were not modified by welfare regimes. Conclusion: There are cross-national differences in good mental wellbeing between European countries. Gender inequalities with a lower prevalence of good mental wellbeing among women are common in European countries. This study suggests that welfare regimes do not modify these gender inequalities in mental wellbeing

Relations between Objective and Perceived Built Environments and the Modifying Role of Individual Socioeconomic Position. A Cross-Sectional Study on Traffic Noise and Urban Green Space in a Large German City

Perceived annoyance due to traffic noise and lack of urban green space is mostly determined using data from self-administered questionnaires. However, there is still no clear evidence to what extent such perceived measures are related to objectively assessed environmental data and whether socioeconomic dimensions modify such relationships. In a cross-sectional study in Dortmund, Germany, georeferenced home addresses from parents with preschool aged children were used to analyse relations between exposures to objectively measured green space and traffic noise and subjective annoyance due to noise and lack of green space with the additional consideration of socioeconomic characteristics as effect modifiers. Higher perceived annoyance correlated with higher objectively measured traffic noise and lower objectively measured green, respectively. Stratified logistic regression models indicated a modifying role of socioeconomic characteristics. The strengths of associations between objectively measured environmental exposures and perceived annoyance differed by socioeconomic strata. Especially for noise, odds ratios were higher in low socioeconomic strata than in high socioeconomic strata. Therefore, using objective measures of the built environment as a proxy for individual perception should be made with caution as negative relations between objectively assessed built environments and health could be underestimated when considering individual socioeconomic position only as a confounder

Social Inequalities in Environmental Resources of Green and Blue Spaces: A Review of Evidence in the WHO European Region

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental inequalities, focusing on availability and accessibility measures of green and blue spaces. Studies in the World Health Organisation (WHO) European Region published between 2010 and 2017 were considered for the review. In total, 14 studies were identified, where most of them (n = 12) analysed inequalities of green spaces. The majority had an ecological study design that mostly applied deprivation indices on the small area level, whereas cross-sectional studies on the individual level mostly applied single social measures. Ecological studies consistently showed that deprived areas had lower green space availability than more affluent areas, whereas mixed associations were found for single social dimensions in cross-sectional studies on the individual level. In order to gain more insights into how various social dimensions are linked to the distribution of environmental resources within the WHO European Region, more studies are needed that apply comparable methods and study designs for analysing social inequalities in environmental resources