Background Stroke is a leading cause of morbidity and mortality worldwide, particularly in later life. While prior research suggests that proximity to green spaces may reduce stroke incidence and support post-stroke recovery, the relationship between the natural outdoor environment and stroke incidence remains underexplored. We investigated the associations between the residential natural outdoor environment and stroke incidence among older adults. Methods Utilizing Register RELOC-AGE data, a cohort study was conducted among 259,769 older adults aged 60+ residing in the Scania region, Southern Sweden. Data from Swedish population registers in 2008, and area-aggregated Perceived Sensory Dimension Score (PSD-score) derived from the Scania outdoor environment database (ScOut) were categorised into tertiles (high, intermediate and low) reflecting the natural outdoor environment close to residence. Incident strokes per 100,000 person-years were assessed between 2009 and 2019. Cox proportional hazard (multi-) exposure models adjusted for socioeconomic; demographic and health were used to examine associations between the PSD-score and stroke incidence. Results During the 10-year follow-up, 23,509 individuals experienced a stroke. Stroke incidence was the lowest among those with a high PSD-score (overall incidence rate of 668/100,000) compared with those with a low and intermediate PSD-score (incidence of 733/100,000 and 720/100,000, respectively). High PSD-score was associated with a lower hazard of stroke (adjusted HR 0.92, 95% CI 0.89-0.95), also when additionally adjusted for multiple exposures (adjusted HR 0.95, 95% CI 0.92-0.98). Conclusion The findings suggest that living in more favourable residential natural outdoor environment are protective against stroke, consistent across sexes. Although there was an indication for a protective effect for those living in high PSD-score areas in urban municipalities, interaction analyses indicated statistical uncertainty. These results highlight the potential relevance of natural outdoor environments for age-friendly and public health planning. Future research should investigate the mechanisms underlying these associations and the role of the natural outdoor environment in post-stroke recovery, while also considering stroke severity.
Research on the association between temperature and congenital heart disease (CHD) is relatively limited. This study aims to evaluate the effects of extreme temperature events on CHD morbidity, utilizing apparent temperature data. We conducted a 1:1 matched case-control study in Tianjin, China, including 1540 mother-infant pairs with CHD and their corresponding controls. We calculated maternal exposure to apparent temperature and Normalized Difference Vegetation Index (NDVI) exposures during weeks 3 to 8 of gestation. Conditional logistic regression was used to evaluate the association between extreme temperature events and CHD, and to assess their additive interactive effects with NDVI. Maternal exposure to extreme cold events during pregnancy significantly increased the risk of CHD in offspring (moderate extreme cold event: OR = 3.11). Pregnant women exposed to low NDVI levels (≤0.25) exhibited consistently higher CHD risks. Notably, the risk of CHD increased sharply during exposure to extreme cold events (OR up to 7.32), and a suggestive positive interactive trend was observed between severe extreme heat and low NDVI (RERI = 1.60), though it did not reach statistical significance. Furthermore, pregnant women whose last menstrual period (LMP) occurred during the cold season exhibited greater susceptibility to extreme cold, whereas those with an LMP in the warm season were more vulnerable to the adverse effects of extreme heat. Maternal exposure to extreme temperature events during weeks 3 to 8 of gestation significantly increases the risk of CHD in offspring.
Antimicrobial resistance genes (ARGs), mobile genetic elements (MGEs), and clinically relevant bacterial taxa are environmental-health concerns in wastewater-impacted ecosystems. However, the capacity of lagoon systems to attenuate these AMR-related signals before effluent discharge or reuse remains insufficiently characterized in semi-arid regions. Shotgun metagenomics was applied to 34 influent and treated-effluent samples collected approximately weekly during January–March 2025 from two Moroccan lagoon systems: Settat (urban, n = 18) and Ouled Said (rural, n = 16). TPM-normalized taxonomic, resistome, and mobilome profiles were analyzed using diversity metrics, PERMANOVA, differential-abundance testing, and correlation networks. Lagoon treatment produced site-dependent microbial restructuring, with a marked shift in Ouled Said (Aitchison PERMANOVA, R2 = 0.376, p = 0.002) but a weaker, non-significant shift in Settat (R2 = 0.125, p = 0.054). ESKAPE-associated bacteria declined from approximately 38% to 32% of CARD-annotated taxa but remained detectable in effluents. The resistome was broadly attenuated, but last-resort antibiotic resistance genes (LR-ARGs) responded unevenly: most mcr variants decreased by 82.4–89.9%, with significant reductions for several variants, whereas blaVIM-1 and tet(X) showed limited or non-significant reductions. The mobilome declined, although transposases and insertion sequences remained prominent. Network analysis indicated denser residual statistical ARG–MGE–taxa co-occurrence after treatment, without implying increased genetic mobility or HGT. Overall, the systems acted as selective, context-dependent barriers, reducing AMR-related burdens while retaining clinically relevant residual signals. The contrasting site responses indicate that treatment performance should not be assumed to be uniform across lagoon systems and support targeted effluent surveillance for safer discharge and reuse.
