| 1. |
- Azfar, Hossain Syed, et al.
(author)
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Cardiovascular Disease and Mental Distress Among Ethnic Groups in Kyrgyzstan
- 2021
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In: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 9
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Journal article (peer-reviewed)abstract
- The purpose of this study was to characterize different ethnic groups in Kyrgyzstan regarding cardiovascular disease (CVD) and mental distress, and to investigate the association between CVD and mental distress. The mental distress was measured in terms of sleep disturbance, burnout, and stress.Materials and Methods: A cross-sectional study was carried out among six ethnic groups in Kyrgyzstan, aged 18 years and above. The sample was stratified for age, education, family status, and income. We used the Karolinska Sleep Questionnaire to assess sleep disturbance, the physical and emotional subscale of the Shirom Melamed Burnout Questionnaire to assess burnout, and the 10-item Perceived Stress Scale to assess perceived stress.Results: The distribution of CVD differed significantly between the six ethnic groups, with higher prevalence among East Europeans, and Western Asians and lower among Other minorities and Central Asians. In all ethnic groups in Kyrgyzstan, individuals with CVD had increased odds of sleep disturbance and burnout. There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups.Conclusion: There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups. In addition to CVD prevention, mitigating sleep disturbance and preventing burnout in the general population should be aimed at in public health measures.
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| 2. |
- Dahal, Usha, et al.
(author)
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Green dreams, local realities: Complexities of the European Union's energy transition to ensure local health and well-being in a fossil fuel-based industrial region
- 2024
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In: Environmental impact assessment review. - : Elsevier. - 0195-9255 .- 1873-6432. ; 106
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Journal article (peer-reviewed)abstract
- European Union's Green Deal is a legal obligation to EU countries to shift towards environment-friendly energy systems from fossil-fuel-based systems. This transition will bring significant global health benefits by combating climate change, but it is crucial to understand the so far understudied impacts on local communities' lives and, thus, on their health and well-being. The study proposes a novel conceptual framework based on socio-technical systems theory and the production of space theory to identify the interacting points between energy systems and health and well-being systems in the energy transition context. This framework is tested in Estonia's transitioning fossil fuel oil-shale-based energy system based on four focus group discussions, ten expert interviews, and document analysis. We innovatively pinpoint pathways, including feedback loops, through a causal loop diagram (CLD) impacting inhabitants' health and well-being from the interplay between energy and health and well-being systems. The analysis indicates that protecting and promoting health and well-being has been a challenge not only due to disruption created by the energy transition process but also due to the accumulated problems regarding socioeconomic conditions, environmental health impacts, and well-being at the local level. The compound effects of multiple existing and emerging issues, including the divergent interpretations of health and the lack of holistic support mechanisms for inhabitants to navigate the changes in sociocultural and economic space, can harm locals' health and well-being. The developed conceptual framework provides an important theoretical background to study the impacts on the mental and physical health, including social health and well-being, of the inhabitants living in the fossil-fuel-based industrial area. The CLD developed using this framework demonstrates the interacting points to avoid unintended consequences of energy transition.
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| 3. |
- Dahal, Usha, et al.
(author)
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Perinatal Health Inequalities in the Industrial Region of Estonia: A Birth Registry-Based Study
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:18
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Journal article (peer-reviewed)abstract
- Despite the increasing number of studies on industrially contaminated sites (ICS) and their health effects, there are very few studies on perinatal health outcomes in ICSs. In the present study, we examined the perinatal health inequalities by comparing adverse birth outcomes (ABOs) in the oil shale industry region of Ida-Viru County in Estonia with national-level figures and investigated the effects of maternal environmental and sociodemographic factors. Based on the 208,313 birth records from 2004–2018, Ida-Viru ICS has a birth weight 124.5 g lower than the average of 3544 g in Estonia. A higher prevalence of preterm birth (4.3%) and low birth weight (4.8%) in Ida-Viru ICS is found compared to 3.3% on both indicators at the national level. Multiple logistic regression analysis shows the statistically significant association of ABOs with fine particle (PM2.5) air pollution, mother’s ethnicity, and education throughout Estonia. However, in Ida-Viru ICS, the ABOs odds are remarkably higher in these characteristics except for the mother’s ethnicity. Furthermore, the ABOs are associated with the residential proximity to ICS. Thus, the Ida-Viru ICS has unequally higher odds of adverse perinatal health across the environmental and sociodemographic factors. In addition to reducing the air pollutants, policy actions on social disparities are vital to address the country’s unjustly higher perinatal health inequalities, especially in the Ida-Viru ICS.
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| 4. |
- Demuzere, M, et al.
(author)
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Mitigating and adapting to climate change : multi-functional and multi-scale assessment of green urban infrastructure
- 2014
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In: Journal of Environmental Management. - : Elsevier. - 0301-4797 .- 1095-8630. ; 146, s. 107-115
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Journal article (peer-reviewed)abstract
- In order to develop climate resilient urban areas and reduce emissions, several opportunities exist starting from conscious planning and design of green (and blue) spaces in these landscapes. Green urban infrastructure has been regarded as beneficial, e.g. by balancing water flows, providing thermal comfort. This article explores the existing evidence on the contribution of green spaces to climate change mitigation and adaptation services. We suggest a framework of ecosystem services for systematizing the evidence on the provision of bio-physical benefits (e.g. CO2 sequestration) as well as social and psychological benefits (e.g. improved health) that enable coping with (adaptation) or reducing the adverse effects (mitigation) of climate change. The multi-functional and multi-scale nature of green urban infrastructure complicates the categorization of services and benefits, since in reality the interactions between various benefits are manifold and appear on different scales. We will show the relevance of the benefits from green urban infrastructures on three spatial scales (i.e. city, neighborhood and site specific scales). We will further report on co-benefits and trade-offs between the various services indicating that a benefit could in turn be detrimental in relation to other functions. The manuscript identifies avenues for further research on the role of green urban infrastructure, in different types of cities, climates and social contexts. Our systematic understanding of the bio-physical and social processes defining various services allows targeting stressors that may hamper the provision of green urban infrastructure services in individual behavior as well as in wider planning and environmental management in urban areas.
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| 5. |
- Orru, Hans, et al.
(author)
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Exposures, Symptoms and Risk Perception among Office Workers in Relation to Nanoparticles in the Work Environment
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:10
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Journal article (peer-reviewed)abstract
- Submicroscopic nanoparticles (NPs) in air have received much attention due to their possible effects on health and wellbeing. Adverse health impacts of air pollution may not only be associated with level of exposure, but also mediated by the perception of the pollution and by beliefs of the exposure being hazardous. The aim of this study was to test a model that describes interrelations between NP pollution, perceived air quality, health risk perception, stress, and sick building syndrome. In the NanoOffice study, the level of NPs was measured and a survey on health risk perception was conducted among 260 employees in twelve office buildings in northern Sweden. Path analyses were performed to test the validity of the model. The data refute the model proposing that the NP exposure level significantly influences stress, chronic diseases, or SBS symptoms. Instead, the perceived exposure influences the perceived risk of NP, and the effect of perceived exposure on SBS and chronic disease is mediated by stress. There was little concern about nanoparticles, despite relatively high levels in some facilities. Perceived pollution and health risk perception may explain a large part of the environmentally induced symptoms and diseases, particularly in relatively low levels of pollution. The research results raise important questions on the physiologically or psychologically mediated health effects of air pollution.
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| 6. |
- Orru, Hans, et al.
(author)
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Health impacts of particulate matter in five major Estonian towns : main sources of exposure and local differences
- 2011
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In: Air quality, atmosphere and health. - : Springer. - 1873-9318 .- 1873-9326. ; 4:3-4, s. 247-258
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Journal article (peer-reviewed)abstract
- Particulate matter (PM) is the major air pollution problem with health impacts in Estonia. The prevailing sources of particles are traffic and local heating. In this study, we quantified the health effects of PM in neighbourhoods of five main cities with a health impact assessment (HIA) approach that uses information on exposure, baseline mortality/morbidity and exposure–response relationships from previous epidemiological studies. The exposure was defined as modelled PM2.5 annual levels and daily averages of PM10 (monitoring data in Tallinn and Kohtla-Järve and modelled levels in Tartu, Narva and Pärnu). The modelled results were validated with data from monitoring stations and additional measuring programmes. The annual average concentration of PM2.5 in the neighbourhoods studied varied from 7.6 to 23.6 μg m−3. The analysis indicated that the exposure above natural background corresponds to 462 [95% confidence interval (CI) 120–815] premature deaths, resulting in 6,034 (95% CI 1,583–10,309) years of life lost per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.63 (95% CI 0.16–1.08) years. In the polluted city centres, this average decrease may reach >1 year and in Pärnu, it may reach 0.95 year. However, in the least polluted neighbourhood, the decrease of life expectancy was only 0.17 years. In addition, 231 (95% CI 145–306) respiratory and 338 (95% CI 205–454) cardiovascular hospitalisations per year could be expected. The majority of the external costs are related to the long-term effects on mortality and amount to €270 (95% CI 190–350) million annually. In comparison, the costs of hospitalisations contribute just €1.1 (95% CI 0.6–1.6) million. The main differences in health impacts were mostly driven by differences in the pollution sources, the magnitude of such sources and distribution patterns in the atmosphere. The smallest health effects, with the exception of the green residential areas, were observed in the industrial cities Kohtla-Järve and Narva (due to the small share contributed by local residential heating and relatively little car traffic). However, it is questionable whether the mass of fine particles is the best indicator of air pollution risk in such areas.
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| 7. |
- Orru, Hans, et al.
(author)
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Residents' Self-Reported Health Effects and Annoyance in Relation to Air Pollution Exposure in an Industrial Area in Eastern-Estonia
- 2018
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 15:2
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Journal article (peer-reviewed)abstract
- Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The "Study of the health impact of the oil shale sector-SOHOS" was aimed at identifying the impacts on residents' health and annoyance due to the industrial processing. First, a population-wide survey about health effects and annoyance was carried out. Second, the total and oil shale sectors' emitted concentrations of benzene, phenol, and PM2.5 were modelled. Third, the differences between groups were tested and relationships between health effects and environmental pollution studied using multiple regression analysis. Compared to the control groups from non-industrial areas in Tartu or Laane-Viru, residents of Ida-Viru more frequently (p < 0.05) reported wheezing, chest tightness, shortness of breath, asthma attacks, a long-term cough, hypertension, heart diseases, myocardial infarction, stroke, and diabetes. All health effects except asthma were reported more frequently among non-Estonians. People living in regions with higher levels of PM2.5, had significantly higher odds (p < 0.05) of experiencing chest tightness (OR = 1.13, 95% CI 1.02-1.26), shortness of breath (1.16, 1.03-1.31) or an asthma attack (1.22, 1.04-1.42) during the previous year. People living in regions with higher levels of benzene had higher odds of experiencing myocardial infarction (1.98, 1.11-3.53) and with higher levels of phenol chest tightness (1.44, 1.03-2.00), long-term cough (1.48, 1.06-2.07) and myocardial infarction (2.17, 1.23-3.83). The prevalence of adverse health effects was also higher among those who had been working in the oil shale sector. Next to direct health effects, up to a quarter of the residents of Ida-Viru County were highly annoyed about air pollution. Perceived health risk from air pollution increased the odds of being annoyed. Annoyed people in Ida-Viru had significantly higher odds of experiencing respiratory symptoms during the last 12 months, e.g., wheezing (2.30, 1.31-4.04), chest tightness (2.88, 1.91-4.33 or attack of coughing (1.99, 1.34-2.95).
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| 8. |
- Orru, Kati, et al.
(author)
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Making Administrative Systems Adaptive to Emerging Climate Change-Related Health Effects : Case of Estonia
- 2018
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In: Atmosphere. - : MDPI AG. - 2073-4433 .- 2073-4433. ; 9:6
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Journal article (peer-reviewed)abstract
- To facilitate resilience to a changing climate, it is necessary to go beyond quantitative studies and take an in-depth look at the functioning of health systems and the variety of drivers shaping its effectiveness. We clarify the factors determining the effectiveness of the Estonian health system in assessing and managing the health risks of climate change. Document analyses, expert interviews with key informants from health systems whose responsibilities are relevant to climate change, and analysis of a population-based survey conducted in 2015, indicate that the health effects of climate change have not been mainstreamed into policy. Therefore, many of the potential synergistic effects of combining information on health systems, environment, and vulnerable populations remain unexploited. The limited uptake of the issue of climate change-related health risks may be attributed to the lack of experience with managing extreme weather events; limited understanding of how to incorporate projections of longer-term health risks into policies and plans; unclear divisions of responsibility; and market liberal state approaches. Minority groups and urban dwellers are placing strong pressure on the health system to address climate change-related risks, likely due to their lower levels of perceived control over their physical wellbeing. The results have implications for national, community, and individual resilience in upper-middle income countries in Eastern Europe.
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| 9. |
- Orru, Kati, et al.
(author)
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Perception of Risks from Wood Combustion and Traffic Induced Air Pollution : Evidence from Northern Europe
- 2022
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In: Sustainability. - : MDPI. - 2071-1050. ; 14:15
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Journal article (peer-reviewed)abstract
- The health effects of particulate matter, increasing emissions from transportation and requisites for making use of biofuels brings up the need to understand how individuals interpret air-pollution-related risks from wood burning and traffic. We aim to clarify the extent to which perceived risks from road-traffic and wood-smoke can be explained by the individual psychological, social status-related and socio-institutional factors in the case of two Northern European countries, Finland and Estonia. This approach elucidates which of the closely intertwined factors shape the perception of risks from air pollution in different socio-institutional contexts and for different air pollution sources. The study uses data from cross-sectional population surveys conducted among 1112 Finnish and 1000 Estonian residents about environmental health risk perception and coping. Binary logistic regression analysis demonstrated that in both countries’ cases, the perceived personal and general risk from traffic exhaust and wood-smoke can be explained by the perception of exposure to pollution and, also, by the level of knowledge of, the worry about and the possible symptoms from environmental health factors. The perceived vulnerability due to poor health further sensitises individuals towards risks from air pollution. Higher trust towards state institutions in guaranteeing a healthy living environment and greater perceived openness about the risks may attenuate the feelings of vulnerability to air pollution risks in Finland compared to Estonia. The ingrained appeal for wood burning may explain the higher acceptance of exhausts from wood-burning compared to traffic. This may lead to scant support for measures to reduce emissions from wood combustion.
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| 10. |
- Orru, Kati, et al.
(author)
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The role of perceived air pollution and health risk perception in health symptoms and disease : a population-based study combined with modelled levels of PM10
- 2018
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In: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 91:5, s. 581-589
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Journal article (peer-reviewed)abstract
- Purpose: Adverse health impact of air pollution on health may not only be associated with the level of exposure, but rather mediated by perception of the pollution and by top-down processing (e.g. beliefs of the exposure being hazardous), especially in areas with relatively low levels of pollutants. The aim of this study was to test a model that describes interrelations between air pollution (particles < 10 μ m, PM10), perceived pollution, health risk perception, health symptoms and diseases.Methods: A population-based questionnaire study was conducted among 1000 Estonian residents (sample was stratified by age, sex, and geographical location) about health risk perception and coping. The PM10 levels were modelled in 1 × 1 km grids using a Eulerian air quality dispersion model. Respondents were ascribed their annual mean PM10 exposure according to their home address. Path analysis was performed to test the validity of the model.Results: The data refute the model proposing that exposure level significantly influences symptoms and disease. Instead, the perceived exposure influences symptoms and the effect of perceived exposure on disease is mediated by health risk perception. This relationship is more pronounced in large cities compared to smaller towns or rural areas.Conclusions: Perceived pollution and health risk perception, in particular in large cities, play important roles in understanding and predicting environmentally induced symptoms and diseases at relatively low levels of air pollution.
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