Is there an association between aircraft noise exposure and the incidence of hypertension? A meta-analysis of 16784 participants

To determine if aircraft noise exposure causes an increased incidence of hypertension among residents near airports. We conducted a meta-analysis of observational studies to evaluate the association between aircraft noise exposure and the incidence of hypertension. PubMed, Embase, Web of Science, the Cochrane Library, and the Chinese Biomedical Literature Database were searched without any restrictions. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted. The pooled ORs were calculated using both the fixed effects model and random effects model. All analyses were performed using STATA version 12.0 software (Stata Corporation, College Station, TX, USA). We examined five studies, comprising a total of 16,784 residents. The overall OR for hypertension in residents with aircraft noise exposure was 1.63 (95% CI, 1.14-2.33), and one of our included studies showed that there was no evidence that aircraft noise is a risk factor for hypertension in women. According to our subgroup analysis, the summary OR for the incidence was 1.31 (95% CI, 0.85-2.02) with I² of 80.7% in women and 1.36 (95% CI, 1.15-1.60) with moderate heterogeneity in men. The pooled OR for the incidence of hypertension in residents aged over 55 years and under 55 years was 1.66 (95% CI, 1.21-2.27) with no heterogeneity and 1.78 (95% CI, 1.33-2.39) with I² of 29.4%, respectively. The present meta-analysis suggests that aircraft noise could contribute to the prevalence of hypertension, but the evidence for a relationship between aircraft noise exposure and hypertension is still inconclusive because of limitations in study populations, exposure characterization, and adjustment for important confounders.     

Does exposure to aircraft noise increase the mortality from cardiovascular disease in the population living in the vicinity of airports? Results of an ecological study in France

The impact of aircraft noise on health is of growing concern. We investigated the relationship between this exposure and mortality from cardiovascular disease, coronary heart disease, myocardial infarction, and stroke. We performed an ecological study on 161 communes (commune being the smallest administrative unit in France) close to the following three major French airports: Paris-Charles de Gaulle, Lyon Saint-Exupéry, and Toulouse-Blagnac. The mortality data were provided by the French Center on Medical Causes of Death for the period 2007-2010. Based on the data provided by the French Civil Aviation Authority, a weighted average exposure to aircraft noise (L_den AEI) was computed at the commune level. A Poisson regression model with commune-specific random intercepts, adjusted for potential confounding factors including air pollution, was used to investigate the association between mortality rates and L_den AEI. Positive associations were observed between L_den AEI and mortality from cardiovascular disease [adjusted mortality rate ratio (MRR) per 10 dB(A) increase in L_den AEI = 1.18; 95% confidence interval (CI): 1.11-1.25], coronary heart disease [MRR = 1.24 (1.12-1.36)], and myocardial infarction [MRR = 1.28 (1.11-1.46]. Stroke mortality was more weakly associated with L_den AEI [MRR = 1.08 (0.97-1.21]. These significant associations were not attenuated after the adjustment for air pollution. The present ecological study supports the hypothesis of an association between aircraft noise exposure and mortality from cardiovascular disease, coronary heart disease, and myocardial infarction. However, the potential for ecological bias and the possibility that this association could be due to residual confounding cannot be excluded.     

Simultaneous effects of noise exposure and smoking on OAEs

Noise is one of the most pervasive hazardous factors in the workplace. Noise-induced hearing loss (NIHL) is the most common disorder related to noise exposure. Smoking is probably associated with hearing loss. The simultaneous effect of noise and smoking on hearing is a recent concern. In this study, we assessed the simultaneous effect of noise and smoking on standard pure tone audiometry (PTA) and distortion product otoacoustic emissions (DP-OAEs). This was an historical cohort study on 224 workers exposed to noise who were divided into two groups: Smokers and nonsmokers. DP-OAE response amplitudes were assessed. Data were analyzed by SPSS software (version 19) using Student''s t-test and Mann-Whitney U test. One hundred and five subjects were smokers (case group) and 119 individuals were nonsmokers (control group). All the subjects were exposed to 91.08 ± 2.29 dBA [time-weighted average (TWA) for an 8 h work shift]. Mean DP-OAE response amplitude at frequencies higher than 1,000 Hz was significantly higher in the smokers than the nonsmokers. This study showed that smoking can aggravate the effect of noise on hearing in DP-OAEs.     

Are the noise levels acceptable in a built environment like Hong Kong?

Governments all over the world have enacted environmental noise directives and noise control ordinances/acts to protect tranquility in residential areas. However, there is a lack of literature on the evaluation of whether the Acceptable Noise Levels (ANLs) stipulated in the directive/ordinance/act are actually achievable. The study aimed at measuring outdoor environmental noise levels in Hong Kong and identifying whether the measured noise levels are lower than the stipulated ANLs at 20 categories of residential areas. Data were gathered from a territory-wide noise survey. Outdoor noise measurements were conducted at 203 residential premises in urban areas, low-density residential areas, rural areas, and other areas. In total, 366 daytime hourly L_eq outdoor noise levels, 362 nighttime hourly L_eq outdoor noise levels, and 20 sets of daily, that is, 24 L_eq,1-h outdoor noise levels were recorded. The mean daytime L_eq,1-h values ranged 54.4-70.8 dBA, while the mean nighttime L_eq,1-h values ranged 52.6-67.9 dBA. When the measured noise levels were compared with the stipulated ANLs, only three out of the 20 categories of areas had outdoor noise levels below ANLs during daytime. All other areas (and all areas during nighttime) were found to have outdoor noise levels at or above ANLs.     

The effects of a hearing education program on recreational noise exposure,attitudes and beliefs toward noise,hearing loss,and hearing protector devices in young adults

Excessive recreational noise exposure in young adults might result in noise-induced hearing loss (NIHL) and tinnitus. Inducing behavioral change in young adults is one of the aims of a hearing conservation program (HCP). The goal of the current study was to evaluate the effect of a hearing education program after 6 months in young adults in relation to knowledge regarding their individual hearing status. The results of a questionnaire regarding the weekly equivalent recreational noise exposure, attitudes and beliefs toward noise, and hearing loss and hearing protector devices (HPDs) were compared between both sessions. Seventy-eight young adults completed the questionnaire concerning recreational noise exposure, youth attitude to noise scale (YANS), and beliefs about hearing protection and hearing loss (BAHPHL). Their hearing status was evaluated based on admittance measures, audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). The main analysis consisted of a mixed model analysis of variance with dependent variables of either the noise exposure or the scores on (subscales of) YANS and BAHPHL. The independent variables were hearing status and session one versus session two. There was a significant decrease in recreational noise exposure and several (sub) scales of YANS and BAHPHL between both the sessions. This behavioral change resulted in a more frequent use of HPDs in 12% of the participants. However, the behavioral change was not completely related to the knowledge of young adults’ individual hearing status. To prevent hearing damage in young people, investing in HCPs is necessary, apart from regulating sound levels and its compliance at various leisure-time activities. Also, the long-term effect of HCPs and their most cost-efficient repetition rates should be further investigated.     

Noise exposure and cognitive performance: A study on personnel on board Royal Norwegian Navy vessels

Prior research shows that work on board vessels of the Royal Norwegian Navy (RNoN) is associated with noise exposure levels above recommended standards. Further, noise exposure has been found to impair cognitive performance in environmental, occupational, and experimental settings, although prior research in naval and maritime settings is sparse. The aim of this study was to evaluate cognitive performance after exposure to noise among personnel working on board vessels in the RNoN. Altogether 87 Navy personnel (80 men, 7 women; 31 ± 9 years) from 24 RNoN vessels were included. Noise exposure was recorded by personal noise dosimeters at a minimum of 4 h prior to testing, and categorized into 4 groups for the analysis: <72.6 dB(A), 72.6-77.0 dB(A), 77.1-85.2 dB(A), and >85.2 dB(A). The participants performed a visual attention test based on the Posner cue-target paradigm. Multivariable general linear model (GLM) analyses were performed to analyze whether noise exposure was associated with response time (RT) when adjusting for the covariates age, alertness, workload, noise exposure in test location, sleep the night before testing, use of hearing protection device (HPD), and percentage of errors. When adjusting for covariates, RT was significantly increased among personnel exposed to >85.2 dB(A) and 77.1-85.2 dB(A) compared to personnel exposed to <72.6 dB(A).     

Attitudes toward noise,perceived hearing symptoms,and reported use of hearing protection among college students: Influence of youth culture

The purpose of this study was to assess the attitude toward noise, perceived hearing symptoms, noisy activities that were participated in, and factors associated with hearing protection use among college students. A 44-item online survey was completed by 2,151 college students (aged 17 years and above) to assess the attitudes toward noise, perceived hearing symptoms related to noise exposure, and use of hearing protection around noisy activities. Among the participants, 39.6% experienced at least one hearing symptom, with ear pain as the most frequently reported (22.5%). About 80% of the participants were involved in at least one noise activity, out of which 41% reported the use of hearing protection. A large majority of those with ear pain, hearing loss, permanent tinnitus, and noise sensitivity was involved in attending a sporting event, which was the most reported noisy activity. The highest reported hearing protection use was in the use of firearms, and the lowest in discos/ dances. The reported use of hearing protection is associated with having at least one hearing symptom but the relationship is stronger with tinnitus, hearing loss, and ear pain (χ² = 30.5-43.5, P < 0.01) as compared to noise sensitivity (χ² = 3.8, P = 0.03); it is also associated with anti-noise attitudes, particularly in youth social events. Universities and colleges have important roles in protecting young adults’ hearing by integrating hearing conservation topic in the college curriculum, promoting hearing health by student health services, involving student groups in noise-induced hearing loss (NIHL) awareness and prevention, and establishing noise level limitations for all on-campus events.     

Association between polymorphism of interleukin-6 in the region -174G/C and tinnitus in the elderly with a history of occupational noise exposure

Tinnitus is a symptom usually related to cochlear change that may arise from noise exposure and induces expression of proinflammatory cytokines including interleukin-6 (IL6). This study aimed to evaluate the association between the polymorphism of the IL6 gene in the region 174G/C and tinnitus in elderly with history of occupational noise exposure. Settings and Design: This was a cross-sectional study with a sample of 179 independent elderly individuals aged >60 years. Information on exposure to occupational noise was obtained by interviews. Audiological evaluation was performed using pure tone audiometry and genotyped through polymerase chain reaction by restriction fragment length polymorphism (PCR-RFLP). Data were analyzed using the chi-square test and the odds ratio (OR), with the significance level set at 5%. Among the study subjects, 24.6% were homozygous for the G allele, 39.7% were homozygous for the C allele, and 35.8% were heterozygous for IL6 (P > 0.05). Of these, 33.5% reported noise exposure history, with 42.5% having tinnitus. We found significant association between the genotype and allele frequencies of the IL6 −174 gene (rs1800795) and tinnitus among the elderly with history of exposure to occupational noise (P = 0.03). The elderly with the C allele were less likely to have tinnitus associated with history of exposure to occupational noise [OR = 0.167, confidence interval (CI) 95% 0.167-0.749; P = 0.004] when compared to those carrying the G allele. This study suggests that there is an association between polymorphisms in the IL6 gene at region – 174G/C and susceptibility to tinnitus.     

Effects of noise and mental task performance upon changes in cerebral blood flow parameters

The objectives of this paper were to determine whether traffic noise influences the parameters of cerebral blood flow (CBF) measured by functional transcranial Doppler sonography (fTCD) during the performance of mental tasks, and to see whether impact of noise on CBF changes with age. The study comprised 36 healthy volunteers, 22 women and 14 men, aged 25-49 years. The fTCD was performed using a fixed 2-MHz probe, aiming for an evaluation of mean velocity (MFV) and the pulsatility index (PI) in the middle cerebral artery (MCA) on both sides. Subsequently, fTCD was monitored: At rest; during performance of the Paced Auditory Serial Addition Test (PASAT); during exposure to traffic noise; and during concomitant exposure to noise and PASAT performance. MFV and PI were compared for particular conditions and correlated with age. During exposure to noise, flow parameters did not change significantly. PASAT performance in silence increased MFV and decreased PI in MCA on both sides. During PASAT performance, on exposure to noise, MCV and PI changed significantly only in the left MCA. However, values of MFV were significantly lower during noise than in silence. Correlations with age were noted for velocities in the right MCA during PASAT performance in silence and for PI on both sides during PASAT performed in noise conditions. Noise impairs the CBF during mental tasks. A comparison of changes in CBF parameters correlated with age suggests that the involvement of the nondominant hemisphere in managing with noise effects increases with age.     

The effect of drill-generated noise in the contralateral healthy ear following mastoid surgery: The emphasis on hearing threshold recovery time

In mastoid surgeries, contralateral ear noise exposure is a known, identified factor leading to high-frequency hearing loss due to the wide variety of surgical devices that may be used during the surgery. However, the hearing threshold recovery time after this trauma was uncertain. The present study aimed to assess this time. In this prospective survival analysis study, 28 consecutive patients with chronic otitis media who were undergoing tympanomastoidectomy were assessed. Standard pure-tone audiometry (PTA) and distortion-product otoacoustic emission (DPOAE) were measured in all contralateral ears before and 6 h, 24 h, 48 h, 72 h, and 96 h after the surgery. Based on the PTA postoperative hearing loss, survival rates at frequencies of 3000 Hz, 4000 Hz, 6000 Hz, and 8000 Hz were 44.4%, 36.4%, 51.7%, and 47.4%, 24 h after surgery; 11.1%, 9.1%, 10.3%, and 13.2%, 48 h after surgery; and 0%, 0%, 3.4%, and 2.6%, 72 h after surgery, respectively. Based on the PTA and DPOAE, survival rates at all frequencies were 0%, 96 h after the surgery. According to the PTA, mean hearing recovery times were 61.98 ± 26.76 h (3000 Hz), 62.73 ± 26.50 h (4000 Hz), 67.08 ± 25.90 h (6000 Hz), 70.70 ± 24.13 h (8000 Hz), and with regard to DPOAE the recovery times were 58.58 ± 28.39 h (2000 Hz), 63.32 ± 28.83 h (4000 Hz), 65.22 ± 29.13 h (6000 Hz), and 75.14 ± 22.70 h (8000 Hz), respectively. To conclude, high-frequency hearing loss usually occurs following mastoid surgeries that is mainly temporary and reversible after 72 h.     

Hearing in young adults. Part I: The effects of attitudes and beliefs toward noise,hearing loss,and hearing protector devices

There is great concern regarding the development of noise-induced hearing loss (NIHL) in youth caused by high sound levels during various leisure activities. Health-orientated behavior of young adults might be linked to the beliefs and attitudes toward noise, hearing loss, and hearing protector devices (HPDs). The objective of the current study was to evaluate the effects of attitudes and beliefs toward noise, hearing loss, and HPDs on young adults’ hearing status. A questionnaire and an audiological test battery were completed by 163 subjects (aged 18-30 years). The questionnaire contained the Youth Attitude to Noise Scale (YANS) and Beliefs about Hearing Protection and Hearing Loss (BAHPHL). A more positive attitude or belief represented an attitude where noise or hearing loss is seen as unproblematic and attitudes and beliefs regarding HPDs is worse. Hearing was evaluated using (high frequency) pure tone audiometry (PTA), transient evoked and distortion product otoacoustic emissions. First, mean differences in hearing between the groups with different attitudes and beliefs were evaluated using one-way analysis of variance (ANOVA). Second, a χ² test was used to examine the usage of HPDs by the different groups with different attitudes and beliefs. Young adults with a positive attitude had significantly more deteriorated hearing and used HPDs less than the other subjects. Hearing conservation programs (HCPs) for young adults should provide information and knowledge regarding noise, hearing loss, and HPDs. Barriers wearing HPDs should especially be discussed. Further, those campaigns should focus on self-experienced hearing related symptoms that might serve as triggers for attitudinal and behavioral changes.     

Elucidating the relationship between noise sensitivity and personality

Sensitivity to unwanted sounds is common in general and clinical populations. Noise sensitivity refers to physiological and psychological internal states of an individual that increase the degree of reactivity to noise in general. The current study investigated the relationship between the Big Five personality dimensions and noise sensitivity using the 240-item NEO Personality Inventory (NEO-PI) and 35-item The Noise-Sensitivity-Questionnaire (NoiSeQ) scales, respectively. Overall, the Big Five accounted for 33% of the variance in noise sensitivity, with the Introversion-Extroversion dimension explaining the most variability. Furthermore, the Big Five personality dimensions (neuroticism, extroversion, openness, agreeableness, and conscientiousness) had an independent effect on noise sensitivity, which were linear. However, additional analyses indicated that the influence of gender and age must be considered when examining the relationship between personality and noise sensitivity. The findings caution against pooling data across genders, not controlling for age, and using personality dimensions in isolation.     

Direct medical costs of type 2 diabetes and its complications in Switzerland

BACKGROUND: This paper analyses the direct medical costs of type 2 diabetes and its complications in Switzerland. METHODS: Individual healthcare resource consumption related to type 2 diabetes and its complications was determined retrospectively in 1479 non-incident and non-dying patients over 12 months (1998-1999). Literature-derived attributable risks were used to correct for non-diabetes related macrovascular disease. RESULTS: A total of 111 primary care physicians from 19 cantons throughout Switzerland participated. Their diabetic patients on average had 10.3 consultations per year related to this disease (95% CI: 10.0-10.7). Patients spent on average 2.7 days (95% CI: 2.2-3.3) per year in hospital due to diabetes and diabetes-related complications. Mean annual type 2 diabetes-related direct medical costs per patient amounted to CHF 3,508 / Euro 2,323 (95% CI: CHF 3,140-3,876 / Euro 2,080-2,567). They were particularly high in patients with insulin treatment or with complications. After application of attributable risks and a correction for the use of adjuvant materials, costs were CHF 3,324 / Euro 2,201. Assuming 250,000 patients with type 2 diabetes in Switzerland leads to an estimate of CHF 0.88 billion spent for this disease and its complications in 1998. This represents a share of about 2.2% of the country's total healthcare expenditures. CONCLUSION: These findings demonstrate the high economic importance of type 2 diabetes and its complications in Switzerland.     

Macronutrient Intakes and Development of Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies

Objective: To synthesize the best available evidence on the association between macronutrient intake and type 2 diabetes risk.

Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Library, ProQuest, Mednar, and the JBI Library of Systematic Reviews were searched up to July 2012 to identify published and unpublished studies. The review was restricted to human participants only but was not restricted by date or by language.

Study Eligibility: Studies were included in the review if they were a cohort study examining the relationship between dietary macronutrient intake and type 2 diabetes risk, included healthy participants with no history of type 2 diabetes at the baseline assessment, and reported risk estimates (odds ratios, hazards ratios, or relative risks [RRs]) and corresponding 95% confidence intervals for type 2 diabetes risk by comparison of the highest with the lowest level of macronutrient consumption.

Methods: Data extraction and risk of bias assessments were performed in duplicate by 2 reviewers. Random-effects meta-analyses were performed to pool RR estimates from individual studies to assess the relationship between dietary macronutrient (carbohydrate, fat, protein, and macronutrient subtypes) intake and type 2 diabetes risk. Statistical heterogeneity was assessed using the I² statistic. Sensitivity analyses were performed to assess robustness of results, and publication bias was evaluated by the visual inspection of funnel plots and was formally assessed using Egger's test.

Results: Twenty-two relevant cohort studies were eligible for inclusion in this review. High intake of total dietary carbohydrate was associated with an increased type 2 diabetes risk (relative risk [RR] = 1.11, 95% confidence interval [CI]: 1.01 to 1.22, p = 0.035); however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake was associated with a reduced type 2 diabetes risk in females (RR = 0.76, 95% CI: 0.68 to 0.85, p < 0.001). Other macronutrients were not significantly associated with type 2 diabetes risk.

Conclusions and Implications: The results of this systematic review and meta-analysis indicate that total carbohydrate is associated with an increased risk of type 2 diabetes; however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake may decrease type 2 diabetes risk in females. There is a need for further well-designed prospective cohort studies to examine the potential association between macronutrient intake and type 2 diabetes risk.     

Human amygdala activation by the sound produced during dental treatment: A fMRI study

During dental treatments, patients may experience negative emotions associated with the procedure. This study was conducted with the aim of using functional magnetic resonance imaging (fMRI) to visualize cerebral cortical stimulation among dental patients in response to auditory stimuli produced by ultrasonic scaling and power suction equipment. Subjects (n = 7) aged 23-35 years were recruited for this study. All were right-handed and underwent clinical pure-tone audiometry testing to reveal a normal hearing threshold below 20 dB hearing level (HL). As part of the study, subjects initially underwent a dental calculus removal treatment. During the treatment, subjects were exposed to ultrasonic auditory stimuli originating from the scaling handpiece and salivary suction instruments. After dental treatment, subjects were imaged with fMRI while being exposed to recordings of the noise from the same dental instrument so that cerebral cortical stimulation in response to aversive auditory stimulation could be observed. The independent sample confirmatory t-test was used. Subjects also showed stimulation in the amygdala and prefrontal cortex, indicating that the ultrasonic auditory stimuli elicited an unpleasant response in the subjects. Patients experienced unpleasant sensations caused by contact stimuli in the treatment procedure. In addition, this study has demonstrated that aversive auditory stimuli such as sounds from the ultrasonic scaling handpiece also cause aversive emotions. This study was indicated by observed stimulation of the auditory cortex as well as the amygdala, indicating that noise from the ultrasonic scaling handpiece was perceived as an aversive auditory stimulus by the subjects. Subjects can experience unpleasant sensations caused by the sounds from the ultrasonic scaling handpiece based on their auditory stimuli.     

2型糖尿病患者睡眠质量及其危险因素调查

目的探讨2型糖尿病(T2DM)患者的睡眠质量及其危险因素。方法采用多阶段整群抽样方法,抽取徐州市944例T2DM患者,使用统一调查表及匹兹堡睡眠质量指数量表(PSQI)、生存质量特异性量表(DSQL)、抑郁自评量表(SDS)等进行调查,采用多因素logistic回归分析睡眠异常的危险因素。结果 T2DM患者睡眠异常比例为33.6%,PSQI平均(6.87±3.84)分,异常组PSQI总分(11.19±2.80)高于良好组(4.59±1.59),DSQL各维度及总分也高于良好组,以上差异均有统计学意义(P值均0.01)。PSQI总分与DSQL总分呈正相关,相关系数为0.38。logistic回归分析显示,性别、婚姻、并发症、病程和抑郁与T2DM患者的睡眠异常有关,其OR值及95%CI分别为1.427(1.050~1.939)、1.801(1.234~2.628)、1.537(1.083~2.181)、1.391(1.164~1.662)、2.527(1.883~3.390)。结论 T2DM患者的睡眠质量与其生存质量相关。女性、未婚/离婚/丧偶、有并发症、病程长及合并抑郁可能是T2DM患者睡眠异常的危险因素。