Stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States, with 88% of strokes originating from blood flow blockage known as ischemic strokes.¹ The majority of cortical ischemic strokes in humans originate from blockage in the middle cerebral artery (MCA). Currently, there are only two U.S. Food and Drug Administration-approved treatments: (1) an injectable drug [recombinant tissue plasminogen activator (rtPA)] and (2) a procedure known as stent retrieval thrombectomy. Despite the success of these treatments, there still remains a sizable proportion of patients for whom substantial reperfusion cannot be achieved.^{2 – 4} Therefore, in recent years, there has been an active search for alternative or complementary protection strategies to these treatments or as stand-alone treatments.

Exposome research has seen a recent increase. The conceptual framework of the Social Exposome extends initial concepts by considering the entirety of societal, social, built and natural environmental exposures which are assumed to holistically impact development and health across the lifecourse. The aim of this study is the identification and characterisation of exposome clusters. Additionally, their relevance for mental health is investigated. To this end 2,850 participants aged 11-12 of the Amsterdam Born Children and their Development (ABCD) Cohort Study were analysed. The exposome was characterized by 60 variables representing the societal, social, built and natural environment. Uniform manifold approximation and projection (UMAP) was applied for dimensionality reduction, and subsequently clustering was performed on the retrieved low-dimensional embedding. Mental health symptoms and behaviour related outcomes were assessed by the Strength and Difficulties Questionnaire (SDQ) as well as the Substance Use Risk Profile Scale (SURPS). The results suggest that exposome clusters are mainly driven by contextual socioeconomic and physical characteristics such as neighborhood income and deprivation rather than social characteristics at the individual level. Moreover, prevalence of children's mental health problems was more prominent within exposome clusters characterized at the contextual level by more deprived neighborhoods and at the individual level by higher prevalence of maternal mental health problems. This exploratory exposome cluster identification emphasized the relevance of socioeconomic neighborhood characteristics, thus structural inequalities.

Recently, attention has been drawn to the need to integrate sex/gender more comprehensively into environmental health research. Considering theoretical approaches, we define sex/gender as a multidimensional concept based on intersectionality. However, operationalizing sex/gender through multiple covariates requires the usage of statistical methods that are suitable for handling such complex data. We therefore applied two different decision tree approaches: classification and regression trees (CART) and conditional inference trees (CIT). We explored the relevance of multiple sex/gender covariates for the exposure to green spaces, measured both subjectively and objectively. Data from 3742 participants from the Cooperative Health Research in the Region of Augsburg (KORA) study were analyzed within the INGER (Integrating gender into environmental health research) project. We observed that the participants’ financial situation and discrimination experience was relevant for their access to high quality public green spaces, while the urban/rural context was most relevant for the general greenness in the residential environment. None of the covariates operationalizing the individual sex/gender self-concept were relevant for differences in exposure to green spaces. Results were largely consistent for both CART and CIT. Most importantly we showed that decision tree analyses are useful for exploring the relevance of multiple sex/gender dimensions and their interactions for environmental exposures. Further investigations in larger urban areas with less access to public green spaces and with a study population more heterogeneous with respect to age and social disparities may add more information about the relevance of multiple sex/gender dimensions for the exposure to green spaces.

Individuals’ perceived fairness or justice beliefs are related to health in numerous ways. However, environment justice research to date has given little attention to perceived fairness of environmental exposures as experienced by individuals. This study explored the feasibility of a bottom-up digital participatory (via mobile phones) approach using ecological momentary assessment (EMA) to capture individuals’ subjective experience of environmental exposures and the subjective evaluation of fairness by those affected in the context of Nepal. In total, 22 individuals participated in the study for 28 days. The results show high rates of study retention and adherence. Individuals’ justice perception was found to vary within and between individuals, but also substantially depending on the types of environmental exposures. Nevertheless, the study indicates that uncertainties are inevitable as study design and timing may conflict participants’ daily lives and priorities. The method allows us to consider multiple geographic contexts of individuals’ everyday lives beyond residential environment. This pilot study proved the possibility to assess perceptions of environmental justice issues and demonstrated the necessary steps to using digital participatory method for assessing subjective perception of fairness of individuals.

To date, PHMR has often relied on male/female stratification, but rarely considers the complex, intersecting social positions of men and women in describing the prevalence of health and disease. Stratification on an Intersectional Gender-Score (IG-Score), which is based on a variety of social covariables, would allow comparison of the prevalence of individuals who share the same complex intersectional profile (IG-Score). The cross-sectional case study was based on the German Socio-Economic Panel 2017 (n = 23,269 age 18+). After stratification, covariable-balance within the total sample and IG-Score-subgroups was assessed by standardized mean differences. Prevalence of self-rated health, mental distress, depression and hypertension was compared in men and women. In the IG-Score-subgroup with highest proportion of males and lowest probability of falling into the ‘woman’-category, most individuals were in full-time employment. The IG-Score-subgroup with highest proportion of women and highest probability of falling into the ‘woman’-category was characterized by part-time/occasional employment, housewife/-husband, and maternity/parental leave. Gender differences in prevalence of health indicators remained within the male-dominated IG-Score-subgroup, whereas the same prevalence of depression and self-rated health was observed for men and women constituting the female-dominated IG-Score-subgroup. These results might indicate that sex/gender differences of depression and self-rated health could be interpreted against the background of gender associated processes. In summary, the proposed procedure allows comparison of prevalence of health indicators conditional on men and women sharing the same complex intersectional profile.