Dimovska, Mirjana

Preferred name

Dimovska, Mirjana

Official Name

Dimovska, Mirjana

Main Affiliation

mirjana.dimovska@medf.ukim.edu.mk

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Примена на методите за проценка на ризик во услови на високо урбано аерозагадување во РМ
(2019-01)
Вовед: Урбаното загадување на воздухот е на пат да стане водечки ризик фактор од животната средина како причина за смрт ширум светот до 2050 година. Бројот на предвремени смртни случаи заради изложеност на загаден воздух со суспендирани (РМ) честички, се зголемил од 3.5 милиони во 1990 година на 4.2 милиони во 2015 година. Во европскиот регион на Светската здравствена организација, таа изложеност е причина за намалување на животниот век (Life expectancy) на секој човек во просек од речиси една година главно заради зголемениот ризик од кардиоваскуларни, респираторни заболувања и рак на бели дробови. Иако загадувањето на амбиентниот воздух со РМ-честички претставува сериозен јавно-здравствен проблем во градовите во Република Македонија, засега постојат недоволен број епидемиолошки студии кои го потврдуваат тоа. Цели: Главна цел на студијата е да се направи квантификација на здравствените ефекти и оптовареноста со болести од загадениот воздух во високо загадените градови во Република Македонија, со примена на различни методолошки пристапи и индикатори за проценка на ризик, како и проценка на придобивките по здравјето на населението од примена на целни политики и акции кои би ги намалиле концентрациите на загадувачките материи до пропишаните гранични нивоа на ЕУ или СЗО. Материјали и методи: Студијата претставува ретроспективна дескриптивноаналитичка студија која ја истражува врската помеѓу изложеноста на населението на тековното загадување на амбиентниот воздух и смртноста (општа и специфична). Просторно, студијата се спроведе на подрачјето на Скопскиот Регион и општина Тетово во периодот од 1 јануари 2012 до 31 декември 2016 година, анализирана е општата смртност (сите причини за смрт освен надворешни) и специфичната смртност (кардиореспираторни болести и рак на дишни патишта), кај лица на возраст над 25 години. За процена на оптоварувањето со болести се примени методот на проценка на влијанијата врз здравјето и проценка на влијанијата врз здравјето со употреба на индикаторот за години на изгубен живот (YLL). За проценка на придобивките по здравјето се поставија три хипотетички сценарија. Статистичката обработка на податоците се изврши со користење на SPSS Syntax софтвер. За тестирање на предиктивната вредност на селектираните загадувачки материи врз смртноста, се примени методот на униваријантна линеарна регресија. Резултати: Проценетото влијание на загадениот воздух со суспендирани честички врз смртноста е значително. РМ-честичките се добри предиктори на смртноста од сите причини (освен надворешни) и кардиопулмонарната смртност во Скопски Регион, како и во Тетово за кардиопулмонарната смртност. Во Скопскиот Регион 1205 животи годишно се губат заради изложеност на тековните нивоа на РМ2.5, додека во Тетово 265. Во Скопскиот Регион, 120 смртни случаи од рак на бели дробови се припишуваат на РМ2.5 честичките, што изнесува 39 % од вкупната смртност од овие малигни неоплазми, додека во Тетово 19 смртни случаи, што претставува 61 % од вкупната смртност од овие малигноми. Проценетото оптоварување со болести од сите причини е највисоко во Тетово каде годишно се губат 10,343 години на здрав живот (11,216/100,000), додека во Скопскиот Регион се проценети 30,256 YLL (4821/100,000). Доколку со целни интерсекторски политики и организирани акции се постигнат граничните вредности на ЕУ, 45 % од атрибутивната општа смртност во Скопски Регион и високи 75 % во Тетово може да се избегне, а доколку се постигнат граничните вредности на СЗО, намалувањето на атрибутивната смртност ќе изнесува 80 % и 91 %. Заклучно согледување: И покрај одредени ограничувањата, оваа студија и проценките обезбедуваат вреден придонес за националните и локалните политики во справување со овој најголем здравствено-еколошки проблем во државата. Клучни зборови: Загадување на воздух, суспендирани честички, проценка на ризик по здравје, смртност, проценка на оптоварување со болести.
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Losing Years of Human Life in Heavy Polluted Cities in Macedonia
(ID Design/Scientific Foundation SPIROSKI, 2019-02-06)
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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.</jats:p>
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Diabetes and arterial stiffness, our experiences
(Македонско лекарско друштво = Macedonian medical association, 2021)
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Cibrev, Dragan
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Angelovska, Makedonka
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Introduction. The incidence and prevalence of diabetes mellitus (DM) has increased worldwide but also in the Republic of Macedonia, Diabetes is a high-ranking a cause of death, primarily as a cause of cardiovascular death. In the United States, 42% of diabetic patients have diabetic nephropathy, with a 20-fold increased risk of cardiovascular mortality. Arterial rigidity is another independent risk factor for CV death, which is a degenerative process of remodeling the large arteries wall. There is increased arterial rigidity in both: diabetic patients and in patients with arterial hypertension, but studies that address these issues do not have consistency in the results, which was our motive for this study. Methods. This was a cross-sectional study that comprised 62 patients with diabetes mellitus type 2, aged over 38 years, followed at the University Clinic for Nephrology for diagnosis of, or already diagnosed hypertension. The control group consisted of 22 healthy subjects who had not been diagnosed with either DM type 2 or arterial hypertension. We examined pulse wave velocity, and analyzed hypertension with data obtained from 24-hour ambulatory blood pressure monitoring. The obtained data were statistically processed. Results. The results were displayed in tables. Conclusion. Arterial stiffness (measured by PWV) was higher in patients with DM compared to the control group of healthy subjects. In our study HgA1c had impact on PWV which can serve as a tool for assessing CV risk and arterial rigidity. Keywords: diabetes mellitus, arterial hypertension, arterial rigidity, pulse wave velocity
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Assessing Health Impact of Air Pollution in Macedonian Cities
(Biomedical Research Network, LLC, 2018-10-15)
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Particulate matter measurements in Macedonia for health impact assessment
(Book of abstracts of the 22nd European Aerosol Conference, France Tours 2016, 2016)
Rumrich, Isabell Katharina
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Lappi, Sari
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Stefanovska, Aneta
Solid fuel combustion is a common heating source in Macedonia. Small scale combustion in combination with lacking legislation for other emissions lead to high air pollution levels in the Skopje valley. It is suspected that current air quality has significant impact on the population health. To investigate this topic further, risk assessment investigations have been introduced within the EU-funded Twinning project “Further strengthening the capacities for effective implementation of the acquis in the field of air pollution” (MoE 2016). Measured monthly mean concentration of particulate matter (PM) will be used in a pilot study on health impact assessment. The aim of the present work was to assess the correlations between the measured monthly particulate matter mass concentrations (PM2.5 and PM10) from different air quality monitoring stations, in order to evaluate their usability in the health impact assessment study. Method Monthly PM data were available from the national air quality monitoring network for the period of January 2012 to February 2016. PM2.5 was measured at two stations only (both within the city of Skopje) and PM10 at nine stations (4 Skopje city, 1 Skopje region, 4 outside Skopje region). Missing monthly values were imputed using the average PM2.5 or PM10 concentration calculated from measurements in the corresponding month of the other years at the same monitoring station. In addition, the average monthly ratios PM2.5:PM10 were calculated for the two stations in Skopje having parallel measurements of these two PM parameters with continuously acting instruments. Results The PM2.5:PM10 ratios at the two stations within Skopje city ranged between 0,61 in spring and 0,67 in autumn. Overall, the correlations in PM data between the different monitoring stations were high. The correlation in PM2.5 between the two stations in Skopje was excellent (R2>90%): The same applied to the PM10 stations within the city of Skopje, where only one monitoring station showed correlation lower than 90% with the others (Gazi Baba; R2>80%). all the Skopje region monitoring stations as well as the monitoring stations outside Skopje region showed generally intercorrelations higher than 70%. Only PM10 data from the station of Kavadarci, correlated poorly with the other stations. The rural background station of Lazaropole, located on a mountain, showed an inverse correlation with all the other monitoring stations. Conclusions. The limited size of the newly started national air quality monitoring programme in Macedonia poses challenges for air pollution exposure assessment. High PM2.5 and PM10 intercorrelations, however, suggest that the PM10 data can be used to improve spatial coverage of PM exposures. Most likely due to same sources, PM pollution levels have similar monthly profiles to those in Skopje city also at the three urban monitoring sites outside Skopje.
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How Good Is our Place-Implementation of the Place Standard Tool in North Macedonia
(MDPI AG, 2019)
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Morris, George
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Howie, John
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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.
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Methods and data needs to assess health impacts of chemicals in industrial contaminated sites
(2019-08)
Martin-Olmedo, Piedad
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Ranzi, Andrea
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Santoro, Michele
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Dack, Sarah
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de Hoogh, Kees
BACKGROUND: human exposure to mixtures of chemicals of toxicological interest, typically found in industrial contaminated sites (ICSs), has been associated with a broad range of different health outcomes. Deprived population groups endure most of the burden of disease and premature death associated to the exposure to those pollutants. Characterizing the impacts on health of an ICS is a challenging process. Currently the two main methodological approaches used are Human Health Risk Assessment (HHRA) and Environmental Epidemiological (EE) studies. OBJECTIVES: review existing guidance and scientific evidence for HHRA and EE studies applied to contaminated sites that orientate in selecting the most suitable methodological approach for characterizing health impacts in ICSs according to the site characteristics, and the availability of environmental, health and sociodemographic data. RESULTS: HHRA has evolved into a more holistic approach, placing more emphasis in planning, community involvement and adapting the dimension of the assessment to the problem formulation and to the availability of resources. Many different HHRA guidelines for contaminated sites has been published worldwide, and although they share a similar framework, the scientific evidence used for deriving reference values and the variet of policy options can result in a wide variability of health risk estimates. This paper condenses different options with the recommendations to use those tools, default values for environmental and exposure levels and toxicological reference values that most suit to the population and characteristics of the ICSs under evaluation. CONCLUSIONS: the suitability to use one or another approach to assess the impact of ICSs on health depends on the availability of data, cost-benefit aspects and the kind of problem that needs to be answered. Risk assessment based on toxicological data can be very rapid and cheap, providing direct information when the intervention to protect the health of population is urgent and no suitable dose-response functions are available from epidemiological studies. Conducting EE studies provide a deeper insight into the problem of the exposure to industrial pollutants that do not require extrapolation from data obtained from toxicological studies or other population, addressing the community concern’s more directly. Complementing the results obtained from different approaches, including those from public health surveillance systems, might provide an efficient and complete response to the impact of ICSs.
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The Effects of COVID-19 Lockdown on Air Quality in Macedonia
(Scientific Foundation SPIROSKI, 2020-10)
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BACKGROUND: Faced with the novel coronavirus outbreak (2019-nCoV), various urgent and coordinated actions have been taken worldwide to reduce spread of the disease. Slowing down economic activities, transportation, restrictions of the human public gatherings, and interaction resulted with a tremendous decline in air pollutant concentration especially in nitrogen dioxide, registered by National Aeronautics and Space Administration and European Space Agency satellites. AIM: The aim of the study was to assess the impact of COVID-19 lockdown conditions on the air quality in selected cities in Macedonia. METHODS: Daily mean concentration of the particulate matter (PM10 and PM2.5), nitrogen dioxide, ozone, and carbon monoxide measured in the national air quality monitoring network, was analyzed separately comparing following periods: past week of February 2020 to the end of May 2020 with the same period in 2017–2019. Depending on the data distribution, parametric independent-samples t-test or nonparametric Mann–Whitney U-test was run to determine if there were differences in the pollutants concentration during the COVID-19 and non-COVID-19 period. RESULTS: Implementation of strict restrictions of the movement along with reduced economic activities and vehicular transport, led to notable decrement of air pollutant concentrations. We have found an evident decrease in the concentration levels of all pollutants measured during COVID-19 period in 2020, compared to those from 2017 to 2019 with exceptions for PM2.5 in Kumanovo and carbon monoxide in Skopje (7% and 3% higher concentration). The most notable decrement was for NO2, with a concentration 5–31% lower during COVID-19 period. CONCLUSIONS: Although beneficial to human health, there is a need to assess economic implications of the lockdown that could have a negative impact on the health as well.
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Assessing environmental and health risks from chemicals in Republic of Macedonia
(Istituto Superiore di Sanità, Italy, 2016)
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The paper presents the current status of the contaminated sites in Republic Macedonia including policy aspects. Special emphasize has been put on the most dangerous site of the ex chemical plant near the capital city of Skopje. The Republic of Macedonia faces similar problems in the environmental sector to those of many other former command economies in Central and Eastern Europe. In particular, inadequate solid waste management and numerous industrial hotspots (including historical industrial pollution sites) have in some cases led to threatened public health with environmental implications. The lack of suitable infrastructure hampers adequate waste disposal in general and disposal of hazardous waste in particular. There is only one licensed (though not acquiscompliant) landfill in the country compared to around a thousand illegal dumps; there are no incineration (except for medical waste), no composting and few recycling facilities. Hazardous waste is exported in accordance with the Basel Convention. A register and maps for pollutants and polluting substances for solid and hazardous waste and waste waters were completed in September 2005. Decades of industrialization and extensive exploitation of natural resources have left certain number of areas heavily polluted in the country. Since independence no significant concrete investments in this regard have taken place for the protection of the environment. As a result many uncontrolled municipal, as well as industrial landfills and wild dumps proliferated. With regard to economic activities contributing to soil contamination expressed in percentage, the highest share belongs to mining and metallurgy with 31.25%, followed by organic chemical industry with 12.5% and oil refining and leather manufacturing industry with 6.25% (2). There are many barriers in the management of the hot spots such are: no official National Strategy for remediation of contaminated sites; no specific law on soil protection; lack of technical guidelines for investigation of contamination, human health and/or environmental risk assessment and prioritizing the need of actions and management of contaminated sites; insufficient institutional capacity for contaminated site management; no permanent intergovernmental or inter-institutional coordination bodies established for the coordination of contaminated sites management, with the consequence of improper inspection on site
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Some Aspects of Women’s Health in Republic of Macedonia
(Scientific Foundation SPIROSKI, 2022-10-12)
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INTRODUCTION: Sex and gender “matters” in terms of the health status as well as a result of both biological and gender-related differences. Thus, sex must be considered in all aspects and all levels of biomedical research.AIM: This study aims to analyze sex- and gender-based differences in Republic of 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 computer-assisted personal interview composed on different topics including women’s health for the period of 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 Republic of 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 groups 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 Republic of Macedonia through the mortality and 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.

Dimovska, Mirjana

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