Mirjana Dimovska

BACKGROUND: The postpartum period and early years of motherhood represent a transformative stage in a woman’s life, accompanied by significant physiological, psychological, and social changes. One of the most commonly reported challenges during this period is sleep disruption. Sleep disturbances are common among mothers of young children, yet limited data exist for this issue in the context of North Macedonia. This study explores the prevalence and correlates of poor sleep quality among mothers in the postpartum period. AIM: To assess the sleep patterns, duration, and quality among mothers with young children and identify key demographic, behavioral, and psychosocial factors associated with sleep disturbances. METHODS: A cross-sectional survey was conducted among 648 mothers of children aged 0–2 years in North Macedonia. A structured questionnaire was used to collect data on sleep duration, sleep quality (using the Pittsburgh Sleep Quality Index), and associated factors such as maternal age, number of children, employment status, co-sleeping, and perceived stress. RESULTS: Findings revealed that over 60% of participants reported poor sleep quality, with significant reductions in sleep duration compared to their pre-motherhood period. The most common issues were frequent night awakenings and difficulty falling back asleep. Poor sleep was significantly associated with lack of family support, chronic fatigue, and higher levels of self-reported stress. CONCLUSION: Maternal sleep quality in North Macedonia is substantially affected during early child-rearing years. Tailored interventions focusing on maternal mental health, family support, and sleep hygiene education are needed to improve sleep health in this vulnerable population.

BACKGROUND: Arsenic groundwater contamination is a challenging public health threat in many regions globally, it also poses a threat to sustainable agriculture and food production. Hyperpigmentation, hyperkeratosis and skin lesions on the palms and feet are the first symptoms of the long term exposure, both, trough drinking water and food. In terms of its carcinogenic effect, long term exposure to Arsenic is associated with cancer of the bladder, lungs, skin, kidneys, nasal passages, liver and prostate. AIM: The aim of the study was to analyze the effects of long-term exposure to low levels of arsenic in groundwater in two regions in the Republic of North Macedonia - Kumanovo municipality (Northeast Region) and Gevgelija municipality (Southeast Region), related to the cancer incidence rate and some other related diagnoses. METHODS: The relationship between arsenic concentration in groundwater and the death rate due to various causes of deaths was investigated using Poisson Regression. RESULTS: Our study despite the methodological limitations suggested important links between the chronic exposure to Arsenic in groundwater and adverse health outcomes such as diabetes mellitus, cancer of larynx, liver, bronchus and lung cancer, stomach cancer leukaemia, lymphoma and cancer of prostate, from total malignancies and malignancies of digestive organs. CONCLUSIONS: The policy and actions in the RN Macedonia supposed to be focus on awareness raising of the local population about the adverse effects of groundwater used for irrigation, crop cultivation or even drinking, replacing high content arsenic sources (wells) with some more safe alternatives, regular monitoring of the arsenic content in the groundwater, drinking water and food (crops) or eventually, ban of the use of arsenic-contaminated wells as a last resort.

BACKGROUND: Climate change (CC) threats to public health in Kosovo include changes in rainfall and extreme weather conditions (heat waves, rising average temperatures, floods, and droughts). Such changes can affect the physical, mental health, and well-being of the population, also potentially adversely affecting the functioning and physical infrastructure of the healthcare system. AIM: The aim of the study was to conduct a CC vulnerability assessment in selected healthcare facilities and workforce in Kosovo. METHODS: The World Health Organization standard checklist was used to assess weaknesses and level of preparedness in six healthcare facilities in the context of CC for three extreme situations of exposure (heat waves, floods, and droughts). RESULTS: During heat waves and floods the weak points identified are: The infrastructure, technology process, healthcare workforce preparedness, and process of waste treatment. In some regions (Mitrovica and Peja), the risk is even higher in the absence of sufficient health staff. The hospital in Gjilan shows the highest level of unpreparedness to cope some CC extremes. The western part of the country has a higher risk of frequent floods. The lack of an emergency plan to protect health workers from numerous biological and chemical risks increases the risk of negative effects of floods. CONCLUSIONS: The findings of this study confirm various types of vulnerabilities and weaknesses in the healthcare facilities in Kosovo for all areas of assessment (health workforce preparedness, level of adaptation of the current system, infrastructure, technologies, and sustainability). The health outcomes of CC jeopardize the provision of good quality healthcare services. A short list of priorities is recommended to minimize the various types of vulnerabilities.

The Republic of Kosovo is a small country in the Balkans. The capital city of Pristina hosts most of its population and is situated in a mountain basin with poor air exchange, especially during winter. Domestic heating, road transport, industry and coal-fired power plants contribute to high levels of air pollution. We performed a time-series analysis on effects of particulate air pollution (PM2.5) on respiratory health of children and adolescents, using hospital admission and ambulatory visit numbers from the pediatric university clinic. From 2018 until 2020, daily mean concentrations of PM2.5 ranged between 2.41 and 161.03 µg/m³. On average, there were 6.7 ambulatory visits per day with lower numbers on weekends and during the first COVID-19 wave in 2020. An increase in PM2.5 led to an immediate increase in visit numbers that lasted over several days. Averaged over a full week, this amounted to about a 1% increase per 10 µg/m³. There were, on average, 1.7 hospital admissions per day. Two and three days after a rise in air pollution, there was also a rise in admission numbers, followed by a decline during the consecutive days. This might indicate that the wards were overstressed because of high admission numbers and restricted additional admissions.

Exposure to different chemicals is an inevitable part of our everyday lives. Within HBM4EU, focus group discussions were conducted to gather data on citizens’ perceptions of chemical exposure and human biomonitoring. These discussions were hosted in Cyprus, Denmark, Hungary, Israel, Latvia, the Netherlands, and North Macedonia following a protocol developed in the first round of discussions. Results indicate the very high concern of European citizens regarding food safety and the environment. Focus group participants were well aware of potential uptake of chemicals through food consumption (e.g., preservatives, flavor enhancers, coloring agents, pesticides, fertilizers, metals), drinking water, or from polluted air and water. One of the positive aspects identified here, is the high interest of citizens in awareness and education on personal measures to control exposure. The promotion of personal behavioral changes requires active involvement of society (e.g., commuting habits, energy choices, waste disposal, dietary habits). Activities should focus on raising awareness of the general public, implementation of policy measures, and mainstreaming of related topics into the education system. Raising awareness of the general public may promote engagement of citizens, which in turn may empower them to put pressure on politicians to take effective actions. There is also a need for further research which might focus on the impact of country-specific situations and of the COVID-19 pandemic on the exposure of citizens to chemicals.

INTRODUCTION: Sex and gender "matters" in terms of the health status as well as a result of both biological and gender-related differences. AIM: To analyze sex and gender-based differences in North Macedonia through analysis of some aspects of mortality, the knowledge and attitudes related to women’s health. METHODS: Analysis of the general and age-standardized mortality patterns and CAPI (Computer-assisted personal interview) composed on different topics including women's health for the period 2017-2020 were used. RESULTS: Age-standardized mortality rates (all-causes of death, circulatory and respiratory diseases and neoplasms) are prevalent and higher in the male population in North Macedonia. A significantly higher all-cause mortality trend for both sexes was found in 2020 making this year hardly comparable with the previous years. A decreasing trend of malignant neoplasms rate of female genital organs and an increasing trend of breast cancer mortality is observed. The majority of the respondents (50.6%) rated their current health status as excellent with a statistically significant difference between the age and ethnical groups. One-third of the respondents reported regular physical activity, mostly on a daily basis. The majority (39.3%) are overweight and 27.5% belongs to the obesity class I without a significant difference in terms of ethnicity. Respondents (27%), reported that have high blood pressure, 20.2% vaginal infections, 19.9% allergies, heart issues 15.1%, anemia 11.7%, while diabetes and cancer 8.5% and 2.5% respectively. The youngest and oldest age group of Albanian women are the least informed about the early detection procedures of malignant compared to Macedonian women and other ethnic groups. CONCLUSIONS: Analyzing some aspects of women's health in North Macedonia through the mortality, knowledge and attitudes of Macedonian women, we provide some further evidence for the development and implementation of targeted interventions and policies aimed to reduce the sex and gender-based health inequalities in the country.

This study describes the implementation, in North Macedonia, of a “tool”, initially devised in Scotland, to generate community and stakeholder discussion about the places in which they live and notably a place’s capacity to generate health wellbeing and greater equity among citizens. In this study, the “place standard tool” (PST) is viewed from the perspective of creating places which can deliver a triple win of health and wellbeing, equity, and environmental sustainability. Skopje, North Macedonia’s capital, inevitably differs economically, culturally, and politically from Scotland, thus providing an opportunity to augment existing knowledge on adaptability of the tool in shaping agendas for policy and action. Тhe PST was tested through seminars with selected focus groups and an online questionnaire. Over 350 respondents were included. Information on priorities enabled the distillation of suggestions for improvement and was shared with the Mayor and municipal administration. Skopje citizens valued an approach which solicited their views in a meaningful way. Specific concerns were expressed relating to heavy traffic and related air and noise pollution, and care and maintenance of places and care services. Responses varied by geographic location. Application of the PST increased knowledge and confidence levels among citizens and enthusiasm for active involvement in decision making. Effective implementation relies heavily on: good governance and top-level support; excellent organization and good timing; careful training of interviewers and focus group moderators; and on prior knowledge of the participants/respondents.

INTRODUCTION: The urban air pollution will deteriorate globally, by 2050 outdoor particulate air pollution and ground-level ozone is projected to become the top cause of environmentally related deaths worldwide. AIM: To assess the burden of diseases due to particulate air pollution and health benefits form the pollution reduction policies. METHODS: Environmental burden of disease methodology has been applied. Environmental data for population exposure, total years of life lost from all causes, and relevant concentration-response functions have been used in estimation. RESULTS: The estimated disease burden from all causes (excl. external) is 30,256 YLL (19,436-40,625 95% CI) in Skopje Region, and 10,343 YLL (6,224-14,785 95% CI) in Tetovo. In terms of cardiopulmonary mortality, the estimated disease burden is 9,282/100,000 in Tetovo, in the Skopje Region 3,784/100,000 respectively. Annually in Tetovo 1,645 years of healthy life are lost, while in the Skopje Region 3,936 due to lung cancer premature mortality. The estimated health gain is significant, for the three selected health outcomes if EU limit values are reached, 41-42% of the estimated burden in Skopje Region will be eliminated, and 74-77% in Tetovo. CONCLUSION: the estimated impact of particulate air pollution on mortality is significant and not negligible. The same applies to the health and well-being of the population if the EU or WHO limit levels are reached.

Biodiesel is a renewable and clean energy source to reduce carbon dioxide and greenhouse gas emissions.

Background Republic of Macedonia has committed itself to prepare an Action Plan (CEHAPE) to reduce and control the environmental risks which are responsible for 25–35% of the global burden of disease of school children. Objectives To assess the level of awareness of school children about environmental health risks and readiness of schools to achieve CEHAPE priority goals related among others to injury prevention and control. Material and Methods Cross-sectional study was conducted applying two survey questionnaires on a national representative sample of 1359 students (12–18 years) in the country. Results Students are more concerned about air pollution from road traffic as an environmental health risk than road traffic injuries. Student awareness of injuries and violence is very low despite the high rate of injuries (30%) and bulling (10%). Student transport to school is mostly organised by public transport, taxi or private cars. Education for safe cycling is provided in 6 of 10 schools, without having ‘safe routs for walking and cycling’, neither places for keeping bicycles or separate entrance for cyclists. School plan for travelling is reported in 7 schools out of 13. Significance Since safety schools are among the priorities in the national children's environmental and health policy, active involvement of children and young people should be the fundament of this process.