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.

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.

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.

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.

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

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.