Noise sensitivity: Symptoms, health status, illness behavior and co-occurring environmental sensitivities

Validity of the Capacity to Work Index: Development of an Instrument to Measure Work Capacity in Relation to Depression and Anxiety in the General Working Population

PURPOSE

To develop an index to assess capacity to work in relation to common mental disorders (CMDs) in the general working population and field test its psychometric properties.

METHODS

Content analysis of three qualitative studies on people (n = 49) with their own experiences of working with CMD guided the items selected for the index. Face and content validity and test-retest reliability were performed. The index was field tested in two versions with 26 and 17 items, respectively, among health care professionals regarding internal reliability, component structure and concurrent validity.

RESULTS

The final version of the Capacity to Work Index (C2WI; 17 items) was normally distributed in the field test with high internal reliability (Cronbach's alpha, 0.84). Missing responses were randomly distributed and nonspecific. Principal component analysis showed one clear component with negatively framed items. Concurrent validity showed high correlation with the WHO-5 Well-Being Scale (Pearson's r, 0.68), but lower correlation for the general health question (r, - 0.44), one item of the Work Ability Index (r, - 0.33), and the Stress of Conscience constructs (r, 0.44).

CONCLUSION

The C2WI showed promising psychometric qualities. Low and negative correlation with the item from Work Ability Index suggests that the C2WI measures additional dimensions, but further testing in larger and more diverse samples is required.

Psychometric properties of an arabic translation of the short form of Weinstein noise sensitivity scale (NSS-SF) in a community sample of adolescents

BACKGROUND

The Weinstein Noise Sensitivity Scale (NSS) is widely recognized as a prominent unidimensional self-reported questionnaire to measure noise sensitivity, which is regarded as the foremost subjective factor moderating the impact of noise on perceived levels of annoyance. In this current study, we conducted an examination of the psychometric properties of a newly translated Arabic version of the short form of the scale (NSS-SF).

METHODS

A sample of 527 Lebanese adolescents participated in the study, completing the NSS-SF with measures of noise annoyance and insomnia. The total sample was randomly divided into two subsamples. Exploratory-to-Confirmatory Factor Analysis (EFA-CFA) was conducted. The normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 5 for χ²/df, and ≤ 0.08 for RMSEA, and 0.90 for CFI and TLI indicate good fit of the model to the data. Composite reliability in both subsamples was assessed using McDonald's ω and Cronbach's alpha.

RESULTS

EFA results on the first split-half subsample revealed that one item (item 2) was removed because of low communality (< 0.3); the other 4 items converged on one factor, which explained 67.85% of the common variance (ω = 0.84 and α = 0.84). CFA was conducted on the second half-split subsample in adults according to the model obtained on the first split-half subsample; the fit indices were acceptable as follows: χ2/df = 5.07/2 = 2.54, p < .001, RMSEA = 0.076 (90% CI 0.001, 0.160), SRMR = 0.021, CFI = 0.992, and TLI = 0.976 (ω = 0.84 and α = 0.84). Configural, metric, and scalar invariance was supported across gender in the total sample.

CONCLUSION

Our findings substantiate that the Arabic version of the NSS-SF is a reliable, psychometrically valid instrument for assessing noise sensitivity among Arab adolescents, thereby enhancing its overall utility and applicability within Arab countries.

Aircraft and road traffic noise, insulin resistance, and diabetes: The role of neighborhood socioeconomic status in San Diego County

Evidence linking traffic noise to insulin resistance and diabetes is limited and unanswered questions remain regarding the potential effect modification by neighborhood socioeconomic status (nSES). We aimed to assess socioeconomic inequalities in noise exposure, whether road and aircraft noise exposures were associated with insulin resistance or diabetes, and whether nSES modified these relationships. Among the Community of Mine Study in San Diego County, road and aircraft noise exposure at enrollment was calculated based on the static (participant's administrative boundary, and circular buffer around participant homes), and dynamic (mobility data by global positioning system, GPS) spatio-temporal aggregation methods. Associations of noise with insulin resistance (HOMA-IR) or type 2 diabetes (T2DM) were quantified using generalized estimating equation models adjusted for sex, age, ethnicity, individual income, and air pollution (nitrogen dioxide) exposure. Additive interaction between noise and nSES was assessed. Among 573 participants (mean age 58.7 y), participants living in low nSES were exposed to higher levels of aircraft and road noise using noise level at the census tract, circular buffer, or Kernel Density Estimation (KDE) of GPS data. Participants exposed to road noise greater or equal to the median (53 dB(A)) at the census tract and living in low nSES had an increased level of insulin resistance (β = 0.15, 95%CI: -0.04, 0.34) and higher odds of T2DM (Odds Ratio = 2.34, 95%CI: 1.12, 4.90). A positive additive interaction was found as participants living in low nSES had higher odds of T2DM. The impact of noise exposure on insulin resistance and T2DM differs substantially by nSES. Public health benefits of reducing exposure to road or aircraft noise would be larger in individuals living in low nSES.

Multiple Chemical Sensitivity: It's time to catch up to the science

Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

Associations between the urban exposome and type 2 diabetes: Results from penalised regression by least absolute shrinkage and selection operator and random forest models

BACKGROUND

Type 2 diabetes (T2D) is thought to be influenced by environmental stressors such as air pollution and noise. Although environmental factors are interrelated, studies considering the exposome are lacking. We simultaneously assessed a variety of exposures in their association with prevalent T2D by applying penalised regression Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest (RF), and Artificial Neural Networks (ANN) approaches. We contrasted the findings with single-exposure models including consistently associated risk factors reported by previous studies.

METHODS

Baseline data (n = 14,829) of the Occupational and Environmental Health Cohort study (AMIGO) were enriched with 85 exposome factors (air pollution, noise, built environment, neighbourhood socio-economic factors etc.) using the home addresses of participants. Questionnaires were used to identify participants with T2D (n = 676(4.6 %)). Models in all applied statistical approaches were adjusted for individual-level socio-demographic variables.

RESULTS

Lower average home values, higher share of non-Western immigrants and higher surface temperatures were related to higher risk of T2D in the multivariable models (LASSO, RF). Selected variables differed between the two multi-variable approaches, especially for weaker predictors. Some established risk factors (air pollutants) appeared in univariate analysis but were not among the most important factors in multivariable analysis. Other established factors (green space) did not appear in univariate, but appeared in multivariable analysis (RF). Average estimates of the prediction error (logLoss) from nested cross-validation showed that the LASSO outperformed both RF and ANN approaches.

CONCLUSIONS

Neighbourhood socio-economic and socio-demographic characteristics and surface temperature were consistently associated with the risk of T2D. For other physical-chemical factors associations differed per analytical approach.

The effect of traffic noise on cognitive performance with regard to personality traits: A laboratory experiment study

BACKGROUND: Exposure to traffic noise could play an important part in inducing psychological disorders which in turn can affect individuals’ cognitive and mental performance. OBJECTIVE: The aim of this study was to determine the effect of traffic noise exposure on the cognitive performance with regard to subjects’ personality traits. METHODS: Sixty students with normal hearing and vision took part in this experimental study. In order to simulate the traffic noise condition of Tehran, the noise from several busy streets was first carefully recorded. Later on, the subjects were exposed to this recorded noise in an anechoic chamber. Also, the NEO-five factor inventory questionnaire and the continuous performance test were used to assess personality traits and cognitive performance of participants respectively. RESULTS: The results showed that the cognitive features of the study, such as reaction time and the number of commission/omission errors in continuous performance testing increased significantly after exposure to the traffic noise (p < 0.05), and among the personality traits, only the neuroticism has a significant correlation with response time in the continuous performance tests (p < 0.05). CONCLUSIONS: Apart from the effect of traffic noise on cognitive function, the findings of this study confirmed that Neuroticism (one of the personality traits) also significantly affect the cognitive performance of individuals when they are exposed to traffic noise in laboratory conditions.

Machine learning approaches to characterize the obesogenic urban exposome

BACKGROUND

Characteristics of the urban environment may contain upstream drivers of obesity. However, research is lacking that considers the combination of environmental factors simultaneously.

OBJECTIVES

We aimed to explore what environmental factors of the urban exposome are related to body mass index (BMI), and evaluated the consistency of findings across multiple statistical approaches.

METHODS

A cross-sectional analysis was conducted using baseline data from 14,829 participants of the Occupational and Environmental Health Cohort study. BMI was obtained from self-reported height and weight. Geocoded exposures linked to individual home addresses (using 6-digit postcode) of 86 environmental factors were estimated, including air pollution, traffic noise, green-space, built environmental and neighborhood socio-demographic characteristics. Exposure-obesity associations were identified using the following approaches: sparse group Partial Least Squares, Bayesian Model Averaging, penalized regression using the Minimax Concave Penalty, Generalized Additive Model-based boosting Random Forest, Extreme Gradient Boosting, and Multiple Linear Regression, as the most conventional approach. The models were adjusted for individual socio-demographic variables. Environmental factors were ranked according to variable importance scores attributed by each approach and median ranks were calculated across these scores to identify the most consistent associations.

RESULTS

The most consistent environmental factors associated with BMI were the average neighborhood value of the homes, oxidative potential of particulate matter air pollution (OP), healthy food outlets in the neighborhood (5 km buffer), low-income neighborhoods, and one-person households in the neighborhood. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households and smaller amount of healthy food retailers. Higher BMI levels were observed in low-income neighborhoods, with lower average house values, lower share of one-person households, smaller amounts of healthy food retailers and higher OP levels. Across the approaches, we observed consistent patterns of results based on model's capacity to incorporate linear or nonlinear associations.

DISCUSSION

The pluralistic analysis on environmental obesogens strengthens the existing evidence on the role of neighborhood socioeconomic position, urbanicity and air pollution.

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study

A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, p = 0.001), symptom severity (60% vs. 27%, p < 0.001), and life impact subscales (53% vs. 20%, p < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.

Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms

OBJECTIVES

The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population.

DESIGN

This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9.

RESULTS

Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%.

CONCLUSIONS

The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.

Noise sensitivity associated with nonrestorative sleep in Chinese adults: a cross-sectional study

Background

Nonrestorative sleep is a common sleep disorder with a prevalence ranging from 1.4 to 35%, and is associated with various psychological and physical health issues. Noise exposure and noise sensitivity have been proposed to contribute to nonrestorative sleep. This study aimed to examine the relationships among noise, noise sensitivity, nonrestorative sleep, and physiological sleep parameters in Chinese adults.

Methods

A cross-sectional household survey was conducted with randomly selected Chinese adults based on a frame stratified by geographical districts and types of quarters in Hong Kong. We administered a battery of questionnaires, including the Nonrestorative Sleep Scale, the Weinstein Noise Sensitivity Scale, the ENRICHD Social Support Instrument, the Patient Health Questionnaire, and the Perceived Stress Scale to assess nonrestorative sleep, noise sensitivity, social support, somatic symptoms and stress, respectively. Anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale while sociodemographic and lifestyle characteristics were assessed with an investigator-developed sheet. Nocturnal noise level and physiological sleep parameters were measured during nighttime for a week by noise dosimetry and actigraphy, respectively. A structured multiphase linear regression was conducted to estimate associations.

Results

A total of 500 adults (66.4% female) with an average age of 39 years completed this study. Bivariate regressions showed that age, marital status, occupation, family income, season, exercise, cola and soda consumption, social support, somatic symptoms, stress, depression, noise sensitivity, total sleep time, and awakenings were associated with nonrestorative sleep. In the multivariable analysis, family income, season, exercise, social support, somatic symptoms, stress, and depression remained associated with nonrestorative sleep. Specifically, a one-unit increase of noise sensitivity was associated with 0.08 increase in nonrestorative sleep (95% confidence interval [CI]: 0.01, 0.15, p = 0.023). Nocturnal noise was negatively associated with time in bed (b = − 1.65, 95% CI: − 2.77, − 0.52, p = 0.004), total sleep time (b = − 1.61, 95% CI: − 2.59, − 0.62, p = 0.001), and awakenings (b = − 0.16, 95% CI: − 0.30, − 0.03, p = 0.018), but was not associated with nonrestorative sleep.

Conclusions

Nonrestorative sleep was predicted by noise sensitivity in addition to family income, season, exercise, social support, somatic symptoms, stress, and depression.

Road traffic noise, noise sensitivity, noise annoyance, psychological and physical health and mortality

BACKGROUND

Both physical and psychological health outcomes have been associated with exposure to environmental noise. Noise sensitivity could have the same moderating effect on physical and psychological health outcomes related to environmental noise exposure as on annoyance but this has been little tested.

METHODS

A cohort of 2398 men between 45 and 59 years, the longitudinal Caerphilly Collaborative Heart Disease study, was established in 1984/88 and followed into the mid-1990s. Road traffic noise maps were assessed at baseline. Psychological ill-health was measured in phase 2 in 1984/88, phase 3 (1989/93) and phase 4 (1993/7). Ischaemic heart disease was measured in clinic at baseline and through hospital records and records of deaths during follow up. We examined the longitudinal associations between road traffic noise and ischaemic heart disease morbidity and mortality using Cox Proportional Hazard Models and psychological ill-health using Logistic Regression; we also examined whether noise sensitivity and noise annoyance might moderate these associations. We also tested if noise sensitivity and noise annoyance were longitudinal predictors of ischaemic heart disease morbidity and mortality and psychological ill-health.

RESULTS

Road traffic noise was not associated with ischaemic heart disease morbidity or mortality. Neither noise sensitivity nor noise annoyance moderated the effects of road traffic noise on ischaemic heart disease morbidity or mortality. High noise sensitivity was associated with lower ischaemic heart disease mortality risk (HR = 0.74, 95%CI 0.57, 0.97). Road traffic noise was associated with Phase 4 psychological ill-health but only among those exposed to 56-60dBA (fully adjusted OR = 1.82 95%CI 1.07, 3.07). Noise sensitivity moderated the association of road traffic noise exposure with psychological ill-health. High noise sensitivity was associated longitudinally with psychological ill-health at phase 3 (OR = 1.85 95%CI 1.23, 2.78) and phase 4 (OR = 1.65 95%CI 1.09, 2.50). Noise annoyance predicted psychological ill-health at phase 4 (OR = 2.47 95%CI 1.00, 6.13).

CONCLUSIONS

Noise sensitivity is a specific predictor of psychological ill-health and may be part of a wider construct of environmental susceptibility. Noise sensitivity may increase the risk of psychological ill-health when exposed to road traffic noise. Noise annoyance may be a mediator of the effects of road traffic noise on psychological ill-health.

University Students' Self-Rated Health in Relation to Perceived Acoustic Environment during the COVID-19 Home Quarantine

BACKGROUND

Online education became mandatory for many students during the Coronavirus disease 2019 (COVID-19) pandemic and blurred the distinction between settings where processes of stress and restoration used to take place. The lockdown also likely changed perceptions of the indoor acoustic environment (i.e., soundscape) and raised its importance. In the present study, we seek to understand how indoor soundscape related to university students' self-rated health in Bulgaria around the time that the country was under a state of emergency declaration caused by the COVID-19 pandemic.

METHODS

Between 17 May and 10 June 2020, we conducted a cross-sectional online survey among 323 students (median age 21 years; 31% male) from two universities in the city of Plovdiv, Bulgaria. Self-rated health (SRH) was measured with a single-item. Participants were asked how frequently they heard different types of sounds while at home and how pleasant they considered each of those sounds to be. Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale) was measured with a single-item. A priori confounders and effect modifiers included sociodemographics, house-related characteristics, general sensitivity to environmental influences, and mental health. Our analysis strategy involved sequential exploratory factor analysis (EFA), multivariate linear and ordinal regressions, effect modification tests, and structural equation modeling (SEM).

RESULTS

EFA supported grouping perceived sounds into three distinct factors-mechanical, human, and nature sounds. Regression analyses revealed that greater exposure to mechanical sounds was consistently associated with worse SRH, whereas no significant associations were found for human and nature sounds. In SEM, exposure to mechanical sounds related to lower restorative quality of the home, and then to poorer SRH, whereas nature sounds correlated with higher restorative quality, and in turn with better SRH.

CONCLUSIONS

These findings suggest a role of positive indoor soundscape and restorative quality for promoting self-rated health in times of social distancing.

University Students' Self-Rated Health in Relation to Perceived Acoustic Environment during the COVID-19 Home Quarantine

BACKGROUND

Online education became mandatory for many students during the Coronavirus disease 2019 (COVID-19) pandemic and blurred the distinction between settings where processes of stress and restoration used to take place. The lockdown also likely changed perceptions of the indoor acoustic environment (i.e., soundscape) and raised its importance. In the present study, we seek to understand how indoor soundscape related to university students' self-rated health in Bulgaria around the time that the country was under a state of emergency declaration caused by the COVID-19 pandemic.

METHODS

Between 17 May and 10 June 2020, we conducted a cross-sectional online survey among 323 students (median age 21 years; 31% male) from two universities in the city of Plovdiv, Bulgaria. Self-rated health (SRH) was measured with a single-item. Participants were asked how frequently they heard different types of sounds while at home and how pleasant they considered each of those sounds to be. Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale) was measured with a single-item. A priori confounders and effect modifiers included sociodemographics, house-related characteristics, general sensitivity to environmental influences, and mental health. Our analysis strategy involved sequential exploratory factor analysis (EFA), multivariate linear and ordinal regressions, effect modification tests, and structural equation modeling (SEM).

RESULTS

EFA supported grouping perceived sounds into three distinct factors-mechanical, human, and nature sounds. Regression analyses revealed that greater exposure to mechanical sounds was consistently associated with worse SRH, whereas no significant associations were found for human and nature sounds. In SEM, exposure to mechanical sounds related to lower restorative quality of the home, and then to poorer SRH, whereas nature sounds correlated with higher restorative quality, and in turn with better SRH.

CONCLUSIONS

These findings suggest a role of positive indoor soundscape and restorative quality for promoting self-rated health in times of social distancing.

Tinnitus and associations with chronic pain: The population-based Tromsø Study (2015-2016)

Tinnitus and pain have many similarities. Both are subjective sensations that may turn chronic, they are often accompanied by hypersensitivity in their respective sensory system, and overlapping brain changes have been observed. Since no population study has examined the empirical association between chronic pain and tinnitus, the present study aimed to explore the relationship in a general adult population. We used data from the seventh survey of the Tromsø Study (2015–2016). Participants (aged ≥40) responded to questions about pain and tinnitus. Using multiple logistic regression, we analysed the adjusted relationship between chronic pain and tinnitus in the full sample (n = 19,039), using several tinnitus definitions ranging from tinnitus >5 minutes within the past 12 months (broadest definition) to at least weekly and highly bothersome tinnitus (strictest definition). We also analysed relationships between number of body regions with pain, pain intensity and bothering, and tinnitus >5 minutes, among participants with chronic pain (n = 11,589). We found an association between chronic pain and tinnitus that was present irrespective of tinnitus definition, but was stronger with more bothersome tinnitus. With chronic pain, the odds of tinnitus >5 minutes was 64% higher, while odds of at least weekly, highly bothersome tinnitus was 144% higher than without chronic pain. Among participants with chronic pain, the number of pain regions was the pain variable most strongly associated with tinnitus >5 minutes (OR = 1.17 (95% CI: 1.14–1.20) for an increase of one region), whereas the other pain variables (intensity and bothering) showed weaker associations. All chronic pain variables had significant interactions with age, with the strongest associations for the youngest individuals (40–54 years). Our findings support the existence of an association between chronic pain and tinnitus and emphasises the importance of examining for comorbid pain in tinnitus patients to provide a more comprehensive treatment of tinnitus.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use: results of a pooled-analysis from seven European countries

BACKGROUND

Few studies have considered aircraft noise annoyance and noise sensitivity in analyses of the health effects of aircraft noise, especially in relation to medication use. This study aims to investigate the moderating and mediating role of these two factors in the relationship between aircraft noise levels and medication use among 5860 residents of ten European airports included in the HYENA and DEBATS studies.

METHODS

Information on aircraft noise annoyance, noise sensitivity, medication use, and demographic, socio-economic and lifestyle factors was collected during a face-to-face interview at home. Medication was coded according to the Anatomical Therapeutic Chemical (ATC) classification. Outdoor aircraft noise exposure was estimated by linking the participant's home address to noise contours using Geographical Information Systems (GIS) methods. Logistic regressions with adjustment for potential confounding factors were used. In addition, Baron and Kenny's recommendations were followed to investigate the moderating and mediating effects of aircraft noise annoyance and noise sensitivity.

RESULTS

A significant association was found between aircraft noise levels at night and antihypertensive medication only in the UK (OR = 1.43, 95%CI 1.19-1.73 for a 10 dB(A)-increase in L_night). No association was found with other medications. Aircraft noise annoyance was significantly associated with the use of antihypertensive medication (OR = 1.33, 95%CI 1.14-1.56), anxiolytics (OR = 1.48, 95%CI 1.08-2.05), hypnotics and sedatives (OR = 1.60, 95%CI 1.07-2.39), and antasthmatics (OR = 1.44, 95%CI 1.07-1.96), with no difference between countries. Noise sensitivity was significantly associated with almost all medications, with the exception of the use of antasthmatics, showing an increase in ORs with the level of noise sensitivity, with differences in ORs among countries only for the use of antihypertensive medication. The results also suggested a mediating role of aircraft noise annoyance and a modifying role of both aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use.

CONCLUSIONS

The present study is consistent with the results of the small number of studies available to date suggesting that both aircraft noise annoyance and noise sensitivity should be taken into account in analyses of the health effects of exposure to aircraft noise.

Self-rated health status in relation to aircraft noise exposure, noise annoyance or noise sensitivity: the results of a cross-sectional study in France

BACKGROUND

Noise is a major public health issue because of its negative impacts on health, including annoyance, sleep disturbance, cardiovascular diseases and altered cognitive performance among children. Self-rated health status (SRHS) can be considered as a reliable indicator of quality of life, morbidity and mortality but few studies have considered SRHS in relation to aircraft noise exposure. The present study aims to investigate the association between this exposure and SRHS of people living near airports in France, and to consider the mediating or moderating role of aircraft noise annoyance and noise sensitivity in this association.

METHODS

This cross-sectional study included 1242 participants older than 18 and living near three major French airports. Information on their SRHS, aircraft noise annoyance, noise sensitivity and demographic, socioeconomic and lifestyle factors was collected during a face-to-face interview performed at home. Outdoor aircraft noise levels were estimated for each participant's home address using noise maps. Logistic regressions with adjustment for potential confounders were used. The moderating and mediating effects of aircraft noise annoyance and noise sensitivity were investigated following Baron and Kenny's recommendations.

RESULTS

A significant association was shown between aircraft noise levels and a fair/poor SRHS, only in men (OR=1.55, 95%CI 1.01-2.39, for a 10 dB(A)-increase in L_den). This relationship was higher in men highly sensitive to noise (OR=3.26, 95%CI 1.19-8.88, for a 10 dB(A)-increase in L_den). Noise sensitivity was associated with a fair/poor SRHS significantly in women (OR=1.74, 95%CI 1.12-2.68) and at the borderline of significance in men (OR=1.68, 95% CI 0.94-3.00), whereas aircraft noise annoyance was associated with a fair/poor SRHS only in men (OR=1.81, 95%CI 1.00-3.27).

CONCLUSION

The present study confirms findings in the small number of available studies to date suggesting a positive association between aircraft noise levels and a fair/poor SRHS. These results also support the hypothesis that noise sensitivity would moderate this association. However, a mediating effect of annoyance cannot be excluded.

Associations between road traffic noise exposure at home and school and ADHD in school-aged children: the TRAILS study

Environmental noise may play a role in the manifestation and severity of attention deficit/hyperactivity disorder (ADHD) symptoms, but evidence is limited. We investigated the cross-sectional associations between residential and school road traffic noise exposure and ADHD symptoms and diagnosis. The sample included n = 1710, 10-12-year-old children from the TRAILS study in The Netherlands. ADHD symptoms were measured using a DSM-IV based subscale from the Child Behavior Checklist. Children with diagnosed ADHD originated from the clinic-referred cohort. Road traffic noise (L_den) was estimated at the residence and school level, by model calculation. Risk ratios for ADHD symptoms and ADHD diagnoses, and regression coefficients for symptom severity were estimated separately and simultaneously for residential and school road traffic noise. Adjusted multinomial models with residential road traffic noise showed that residential noise was not associated with ADHD symptoms, but was associated with lower risks for ADHD diagnosis (RR = 0.93; 95% CI 0.89, 0.97). Similar associations were observed for models including school road traffic noise and models including both exposures. No clear exposure response relationship was observed for associations between residential or school noise and ADHD symptom severity. We found no evidence for a harmful association between road traffic noise and ADHD. Associations between noise and lower risks for ADHD were observed only in referred cases with a confirmed ADHD diagnosis and may be due to residual confounding or selection bias. Future studies should focus on residential and school noise exposure, and study associations with ADHD symptoms and diagnosis over time.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and hypertension risk: Results of a pooled analysis from seven European countries

INTRODUCTION

Many studies, including the HYENA and the DEBATS studies, showed a significant association between aircraft noise exposure and the risk of hypertension. Few studies have considered aircraft noise annoyance and noise sensitivity as factors of interest, especially in relation to hypertension risk, or as mediating or modifying factors. The present study aims 1) to investigate the risk of hypertension in relation to aircraft noise annoyance or noise sensitivity; and 2) to examine the role of modifier or mediator of these two factors in the association between aircraft noise levels and the risk of hypertension.

METHODS

This study included 6,105 residents of ten European airports from the HYENA and DEBATS studies. Information on aircraft noise annoyance, noise sensitivity, and demographic, socioeconomic and lifestyle factors was collected during an interview performed at home. Participants were classified as hypertensive if they had either blood pressure levels above the WHO cut-off points or physician-diagnosed hypertension in conjunction with the use of antihypertensive medication. Outdoor aircraft noise exposure was estimated for each participant's home address. Poisson regression models with adjustment for potential confounders were used. Interactions between noise exposure and country were tested to consider possible differences between countries.

RESULTS

An increase in aircraft noise levels at night was weekly but significantly associated with an increased risk of hypertension (RR = 1.03, 95% CI 1.01-1.06 for a 10-dB(A) increase in L_night). A significant association was found between aircraft noise annoyance and hypertension risk (RR = 1.06, 95%CI 1.00-1.13 for highly annoyed people compared to those who were not highly annoyed). The risk of hypertension was slightly higher for people highly sensitive to noise compared to people with low sensitivity in the UK (RR = 1.29, 95%CI 1.05-1.59) and in France (RR = 1.11, 95%CI 0.68-1.82), but not in the other countries. The association between aircraft noise levels and the risk of hypertension was higher among highly sensitive participants (RR = 1.00, 95%CI 0.96-1.04; RR = 1.03, 95%CI 0.90-1.11; RR = 1.12, 95%CI 1.01-1.24, with a 10-dB(A) increase in L_night for low, medium, and high sensitive people respectively) or, to a lesser extent, among highly annoyed participants (RR = 1.06, 95%CI 0.95-1.18 for a 10-dB(A) increase in L_night among highly annoyed participants, and RR = 1.02, 95%CI 0.99-1.06 among those not highly annoyed).

CONCLUSIONS

The present study confirms findings in the small number of available studies to date suggesting adverse health effects associated with aircraft noise annoyance and noise sensitivity. The findings also indicate possible modifier effects of aircraft noise annoyance and noise sensitivity in the relationship between aircraft noise levels and the risk of hypertension. However, further investigations are needed to better understand this role using specific methodology and tools related to mediation analysis and causal inference.

Subjective sensitivity to noise and non-auditory health effects among adults in Niš, Serbia

OBJECTIVE

The aim of this study was to examine subjective sensitivity to noise of the citizens of Niš and its impact on their non-auditory health effects.

METHODS

This study was designed as a cross-sectional questionnaire survey among 908 adult residents of Niš, Serbia, of whom 387 were men (42.6%) and 521 women (57.4%). Streets with day L_eq ≥ 55 dB(A) and night L_eq ≥ 45 dB(A) were regarded as noisy and those with day L_eq ≤ 55 dB(A) and night L_eq ≤ 45 dB(A) were regarded as quiet, in accordance with WHO recommendations. Noise sensitivity was measured with the Weinstein's Noise Sensitivity Scale. Logistic regression analysis was used to assess the impact of noise sensitivity on non-auditory health effects.

RESULTS

The study showed that the values of the Weinstein's Noise Sensitivity Scale were significantly higher for those surveyed in the noisy zone. Multiple regression analysis revealed a significant impact of noise sensitivity on night-sleep duration (p = 0.04), subjective assessment of sleep quality (p < 0.01) and daily rest disruption (p < 0.001).

CONCLUSION

Based on the study results, it can be confirmed that noise sensitivity has an important role in causing non-auditory health effects among adults.

Multisensory environmental sensitivity in patients with chronic tinnitus

OBJECTIVE

The study aimed at investigating the sensitivity to noise and chemosensory environmental stressors as well as the relation to perceived stress, depression and anxiety in subjects with chronic tinnitus as compared to subjects without tinnitus.

METHODS

We included 75 subjects with chronic tinnitus and 75 age and sex-matched subjects without tinnitus. Standardized questionnaires assessing the level of distress and impairment of quality of life caused by tinnitus, perceived level of stress, anxiety and depression, environmental noise and chemosensory sensitivity were used. A subgroup of 27 subjects with chronic tinnitus and 20 age-matched subjects without tinnitus underwent testing of olfactory function with the Sniffin' Sticks test and testing of intranasal trigeminal function using CO2 thresholds.

RESULTS

Our data confirmed the increased environmental noise sensitivity (NSS) in patients with tinnitus. Furthermore, we observed an increased environmental chemosensory sensitivity (CSS), but no difference in measured chemosensory function. Subjects with tinnitus showed also significant higher levels of perceived stress, anxiety and depression and those symptoms partially correlated to CSS and NSS. Predictors of both NSS and CSS results were the presence / absence of tinnitus and high anxiety levels while neither stress nor depression were found as predicting variables.

CONCLUSIONS

The results suggest that chronic tinnitus is related to a multisensory environmental hypersensitivity. Anxiety seems to be a predictor of this environmental vulnerability.

Assessment of noise pollution and associated subjective health complaints and psychological symptoms: analysis through structure equation model

Road traffic noise is affecting the exposed population through its detrimental effects. This study was conducted in urban zones of Peshawar, Khyber Pakhtunkhwa, Pakistan, to analyze causal relationship between noise and subjective health complaints with a special focus on psychological symptoms. A 12-h (LAeq) noise survey conducted at different locations (n = 57) indicated a noise range of 46.3-86.3 dB (A). A questionnaire survey was conducted from local residents (n = 500), students (n = 500), policemen (n = 500), shopkeepers (n = 500), and drivers (n = 500) exposed to road traffic noise and analyzed through structure equation modeling (SEM). Different models were prepared and a modified model obtained the acceptable model fit, i.e., chi-square 0.093, χ²/df 1.286, comparative fit index 0.986, goodness of fit index 0.966, normed fit index 0.943, Tucker-Lewis index 0.977, and root mean square error of approximation 0.034. The modified model gives not only the information about direct but also indirect effects of noise on the exposed population. Adding on, the model clearly indicates that sensitivity to noise has strong relationship with subjective health complaints (headache, exhaustion, and psychological symptoms such as annoyance, difficulty concentrating, ill temper, and anxiety) than profession, age, location, and gender. Duration of exposure to road traffic noise has an important role in increasing the frequency of subjective health issues. The model is important in depicting that sensitivity to noise may produce subjective health complaints (standardized parameter estimates of 0.12 and 0.29) but the mediator has much stronger positive path estimates (0.59). The modified model sought to discover and explicate the underlying mechanism of an observed relationship existing between the selected dependent and an independent variable through the identification of the mediator variables.

Factory employment exposure and human health: Evidence from rural China

Quantitating the health effects of employment history in factories, especially polluting ones, is essential for understanding the benefits or losses of industrialization in rural areas. Using a traced subset of nationwide panel data from 2005 covering five provinces, 101 villages, and 2026 households (collected recently in 2016) and the econometric models, this study estimated the effect of factory employment history on workers' health. The results showed that: the absolute number of factory workers increased from 1998 to 2015, and the proportion of factory workers was 7.68% in 2015; the absolute number and the proportion of farmers decreased from 63.84% in 1998 to 29.06% in 2015. Given that all the respondents live in rural areas, the HlthPlace (the first place the individual went to for their last illness in 2015) was selected as the main dependent variable of interest, and Hlthexp (Healthcare expenditure per person at last illness in 2015) and self-reported health were used as auxiliary dependent variables. The findings revealed that, after controlling the characteristics of individual, household, hospital and area, a one year increase of factory employment history corresponded to a 0.035 level increase in the probability of people choosing high-level hospital (p < 0.01) and a 237.61 yuan increase in healthcare expenditure (p < 0.1). The results also showed the adverse effect of self-reported health on factory employment history (p < 0.01). In addition, the relationship between the farming history and health was evaluated, and the econometric results showed that compared with factory employment history, farming history had opposite impacts on health (p < 0.01). Finally, the robustness check showed that the empirical results were reliable and that the initial results were robust. Generally, this study revealed the effect of overall factory employment on health, which is a useful research supplement to the studies on the health effects of specific pollution exposure.

"Symptoms associated with environmental factors" (SAEF) - Towards a paradigm shift regarding "idiopathic environmental intolerance" and related phenomena

Health conditions characterized by symptoms associated with chemical, physical and biological environmental factors unrelated to objectifiable pathophysiological mechanisms are often labelled by the general term "idiopathic environmental intolerances". More specific, exposure-related terms are also used, e.g. "multiple chemical sensitivities", "electromagnetic hypersensitivity" and "candidiasis hypersensitivity". The prevalence of the conditions varies from a few up to more than 50%, depending on definitions and populations. Based on evolving knowledge within this field, we provide arguments for a paradigm shift from terms focusing on exposure and intolerance/(hyper-)sensitivity towards a term more in line with the perceptual elements that seem to underlie these phenomena. Symptoms caused by established pathophysiologic mechanisms should not be included, e.g. allergic or toxicological conditions, lactose intolerance or infections. We discuss different alternatives for a new term/concept and end up proposing an open and descriptive term, "symptoms associated with environmental factors" (SAEF), including a definition. "Symptoms associated with environmental factors" both is in line with the current knowledge and acknowledge the experiences of the afflicted persons. Thus, the proposed concept is likely to facilitate therapy and communication between health professionals and afflicted persons, and to provide a base for better understanding of such phenomena in healthcare, society and science.

Assessment of noise pollution and its effects on human health in industrial hub of Pakistan

Faisalabad is one of the major industrial cities of Pakistan, which may cause noise pollution to the local residents due to the development of robust industrial and transport systems. This study aimed at (i) mapping the noise pollution levels at various locations of Faisalabad city; (ii) comparing noise pollution levels in the morning, the afternoon, and the evening for each source; and (iii) assessing nonauditory effects of noise on human health. Two industries and 43 famous/busy locations of Faisalabad Sadar were selected to study noise pollution by using the sound level meter for the period of 24 h. A questionnaire-based survey was carried out near the sampling points to get a public perception about the health impacts of noise pollution. The measured equivalent sound pressure levels (SPLeq) were higher than the permissible limits at all the sampling locations during morning, afternoon, and evening hours. The maximum sound pressure level (SPL_max) was 102 dB inside the production unit in the afternoon at Mian Muhammad Siddiq Textile Loom industry. The average SPL was found at State Bank road (102 dB), Children's Hospital (101 dB), Jhang Bazar (100 dB) in the afternoon and at Punjab Medical College in the evening (97 dB). Based on the survey, 94% of respondents reported headache, 76% sleeplessness, 74% hypertension, 74% physiological stress, 64% elevated blood pressure levels, and 60% dizziness due to noise. Noise pollution is higher than the standard limits and causes auditory as well as nonauditory effects on humans. The vehicles and industrial machinery should be maintained, and sound proofing and protection equipment should be provided to the workforce in order to protect them from extreme noise levels.

Negative impact of noise and noise sensitivity on mental health in childhood

Introduction:

Noise and noise sensitivity have negative effects on mental health and are not well-studied in children and adolescents. In this study, we investigated these effects in the aforementioned population with respect to sociodemographic variables and environmental factors.

Materials and Methods:

In this population-based study conducted in two large cities in South Korea, 918 elementary and middle-school students were included. After direct measurements at the selected sites, a noise map was created using an interpolation method. The road traffic noise of the participants’ residential areas was calculated based on this noise map. Noise sensitivity was assessed on an 11-point Likert scale. Using multivariate logistic regression, we investigated the relationship among noise, noise sensitivity, and the Child Behavior Checklist. Further analyses were performed subdividing the data according to household income levels.

Results:

Noise sensitivity was significantly associated with internalizing, externalizing, and total behavioral problems. Noise was positively associated with total behavioral problems. In the low-income group, the degree of association with problem behaviors was higher, whereas the relationship between noise sensitivity and externalization problems disappeared in the high-income group.

Conclusion:

Noise and noise sensitivity are negatively associated with the mental health of children and adolescents, particularly in low-income groups. The findings of this study suggest that noise sensitivity and socioeconomic status should be considered in coping with negative effects of noise in children and adolescents.

A profile of noise sensitivity on the health-related quality of life among young motorcyclists

Introduction:

Motorcycle riders with noise sensitivity (NS) may suffer from degraded health-related quality of life (HRQOL) because they are exposed to acute noise levels on a daily basis.

Materials and Methods:

This study was aimed to identify the relationship between NS and HRQOL among young motorcycle riders (undergraduate university students) aged between 19 and 25 years (n = 301) through a cross-sectional questionnaire-based study, that is, Weinstein noise sensitivity scale and the World Health Organization Quality of Life. The effects of NS on HRQOL were assessed based on gender, the years of motorcycle driving experience, and noise sensitive among groups using one-way analysis of variances with an alpha value of 0.05.

Results:

The results showed no significant difference in NS between males and females. On the other hand, motorcycle driving experience for <4 years displayed a higher tendency toward NS. Moreover, a significantly (P = 0.004) decreasing trend among low, moderate, and high NS with their respective HRQOL was observed, while a high NS showed significantly (P = 0.015) lower scores on the social domain of the quality of life.

Conclusion:

The overall premise of the study has statistical significance and shows that individuals with high NS tend to have degraded HRQOL compared to individuals with low NS. Furthermore, in-depth studies are required from the other demographical background of participants to investigate the motorcyclist’s NS and HRQOL as an integral requirement for the rider’s safety and health.

In ovo Sound Stimulation Mediated Regulation of BDNF in the Auditory Cortex and Hippocampus of Neonatal Chicks

Brain-derived neurotrophic factor (BDNF) is known to mediate activity-dependent changes in the developing auditory system. Its expression in the brainstem auditory nuclei, auditory cortex and hippocampus of neonatal chicks (Gallus gallus domesticus) in response to in ovo high intensity sound exposure at 110 dB (arrhythmic sound: recorded traffic noise, 30-3000 Hz with peak at 2700 Hz, rhythmic sound: sitar music, 100-4000 Hz) was examined to understand the previously reported altered volume and neuronal number in these regions. In the brainstem auditory nuclei, no mature BDNF, but proBDNF at the protein level was detected, and no change in its levels was observed after in ovo sound stimulation (music and noise). Increased ProBDNF protein levels were found in the auditory cortex in response to arrhythmic sound, along with decreased levels of one of the BDNF mRNA transcripts, in response to both rhythmic and arrhythmic sound stimulation. In the hippocampus, increased levels of mature BDNF were found in response to music. Expression microarray analysis was performed to understand changes in gene expression in the hippocampus in response to music and noise, followed by gene ontology analysis showing enrichment of probable signaling pathways. Differentially expressed genes like CAMK1 and STAT1 were found to be involved in downstream signaling on comparing music versus noise-exposed chicks. In conclusion, we report that BDNF is differentially regulated in the auditory cortex at the transcriptional and post-translational level, and in the hippocampus at the post-translational level in response to in ovo sound stimulation.

Modeled and perceived RF-EMF, noise and air pollution and symptoms in a population cohort. Is perception key in predicting symptoms?

BACKGROUND

Psychosocial research has shown that perceived exposure can influence symptom reporting, regardless of actual exposure. The impact of this phenomenon on the interpretation of results from epidemiological research on environmental determinants of symptoms is unclear.

OBJECTIVE

Our aim was to compare associations between modeled exposures, the perceived level of these exposures and reported symptoms (non-specific symptoms, sleep disturbances, and respiratory symptoms) for three different environmental exposures (radiofrequency electromagnetic fields (RF-EMF), noise, and air pollution). These environmental exposures vary in the degree to which they can be sensorially observed.

METHODS

Participant characteristics, perceived exposures, and self-reported health were assessed with a baseline (n = 14,829, 2011/2012) and follow-up (n = 7905, 2015) questionnaire in the Dutch population-based Occupational and Environmental Health Cohort (AMIGO). Environmental exposures were estimated at the home address using spatial models. Cross-sectional and longitudinal regression models were used to examine the associations between modeled and perceived exposures, and reported symptoms.

RESULTS

The extent to which exposure sources could be observed by participants likely influenced correlations between modeled and perceived exposure as correlations were moderate for air pollution (r_Sp = 0.34) and noise (r_Sp = 0.40), but less so for RF-EMF (r_Sp = 0.11). Perceived exposures were consistently associated with increased symptom scores (respiratory, sleep, non-specific). Modeled exposures, except RF-EMF, were associated with increased symptom scores, but these associations disappeared or strongly diminished when accounted for perceived exposure in the analyses.

DISCUSSION

Perceived exposure has an important role in symptom reporting. When environmental determinants of symptoms are studied without acknowledging the potential role of both modeled and perceived exposures, there is a risk of bias in health risk assessment. However, the etiological role of exposure perceptions in relation to symptom reporting requires further research.

Assessment of short-term exposure to an ultrasonic rodent repellent device

The objectives of the present study were to investigate the acoustical properties of the very high frequencies and/or ultrasound signals produced by a repellent device and to investigate potential adverse factors as a result of short-term exposure to these signals. Potential adverse effects were evaluated perceptually with 25 young and 25 middle-aged persons, all with normal hearing thresholds, in a quiet room using different outcome measures, including a 15-item survey presented before and immediately after each condition. Spectral analyses showed that, besides emitting frequency modulated sounds in the expected frequency ranges, a faint but audible sound in the 4-5 kHz range was present. On average, a relatively short exposure to the sound produced by a repellent device did not lead to significant adverse effects. Yet, when the signal was perceived, as it was frequently for the younger population at the two lower frequencies settings (12-14 kHz, 25-25 kHz) and with 2 sources emitting, it was considered to be disturbing by several participants. Given the increasing usage of ultrasonic devices as well as the much longer exposure of high frequency and ultrasound in domestic usage, careful consideration and better guidelines are required, especially for those who are most sensitive to sound.

Perspectives on multisensory perception disruption in idiopathic environmental intolerance: a systematic review

PURPOSE

Multiple chemical sensitivity (MCS) also known as idiopathic environmental intolerance/illness (IEI) encompasses a cohort of subjective symptoms characterized by susceptibility to a wide spectrum of environmental compounds, causing symptoms involving various organs and a decrease in quality of life. The aim of this systematic review is to summarize evidence about MCS, with focus on indexed studies analyzing sensory pathway-related disorders.

METHODS

Medical databases were searched for English language articles related to the topic, published between 1965 and 2017 in academic, peer-reviewed journals. Particular focus was concentrated on articles depicting disturbances involving sensory organs. References of the relevant articles were examined to identify additional significant documents.

RESULTS

Fifty-eight studies were eligible for full text review. Of these, 34 studies met the selection criteria and were included in this analysis. Many variables, such as different diagnostic criteria, lack of homogeneous symptom questionnaires and the general incidence of personality traits in control subjects, biased studies as confounding factors. However, moderate evidences show that sensory pathways are somewhat altered, especially with respect to information processing in the limbic system and related cortical areas. Recent studies suggested the presence, in MCS cohorts, of attention bias, sensitization and limbic kindling, as well as recently revealed subclinical organic alterations along sensory pathways.

CONCLUSIONS

Evidences are consistent with MCS/IEI to be the result of a neural altered processing of sensorial ascending pathways, which combined with peculiar personality traits constitutes the underpinning of a multisensory condition needing multidisciplinary clinical approach.

Insights from the third international conference on hyperacusis: causes, evaluation, diagnosis, and treatment

BACKGROUND

Hyperacusis is intolerance of certain everyday sounds that causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities.

OBJECTIVE

The aim of this report is to summarize the key findings and conclusions from the Third International Conference on Hyperacusis.

TOPICS COVERED

The main topics discussed comprise (1) diagnosis of hyperacusis and audiological evaluations, (2) neurobiological aspect of hyperacusis, (3) misophonia, (4) hyperacusis in autism spectrum disorder, (5) noise sensitivity, (6) hyperacusis-related distress and comorbid psychiatric illness, and (7) audiologist-delivered cognitive behavioral therapy for hyperacusis.

CONCLUSIONS

Implications for research and clinical practice are summarised.

Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse

BACKGROUND

Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems.

OBJECTIVE

In this paper, we discuss whether data that are recorded routinely as part of the health care process in primary care are actually fit to use for other purposes such as research and quality of health care indicators, how the original purpose may affect the extent to which the data are fit for another purpose, and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the use and reuse of these type of data.

METHODS

This paper is based on the authors' experience as users of electronic health records data, as general practitioners, health informatics experts, and health services researchers. It is a product of the discussions they had during the Translational Research and Patient Safety in Europe (TRANSFoRm) project, which was funded by the European Commission and sought to develop, pilot, and evaluate a core information architecture for the learning health system in Europe, based on primary care electronic health records.

RESULTS

We first describe the different stages in the processing of electronic health record data, as well as the different purposes for which these data are used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step that can generate biased outcomes. We identified 13 possible sources of bias. Four of them are related to the organization of a health care system, whereas some are of a more technical nature.

CONCLUSIONS

There are a substantial number of possible sources of bias; very little is known about the size and direction of their impact. However, anyone that uses or reuses data that were recorded as part of the health care process (such as researchers and clinicians) should be aware of the associated data collection process and environmental influences that can affect the quality of the data. Our stepwise, actor- and purpose-oriented approach may help to identify these possible sources of bias. Unless data quality issues are better understood and unless adequate controls are embedded throughout the data lifecycle, data-driven health care will not live up to its expectations. We need a data quality research agenda to devise the appropriate instruments needed to assess the magnitude of each of the possible sources of bias, and then start measuring their impact. The possible sources of bias described in this paper serve as a starting point for this research agenda.

Prevalence of various environmental intolerances in a Swedish and Finnish general population

OBJECTIVE

To determine the prevalence of various environmental intolerances (EIs), using several criteria in a Swedish and a Finnish general population. Ill-health attributed to low-level environmental exposures is a commonly encountered challenge in occupational and environmental medicine.

METHODS

In population-based questionnaire surveys, the Västerbotten Environmental Health Study (Sweden) and the Österbotten Environmental Health Study (Finland), EI was inquired by one-item questions on symptom attribution to chemicals, certain buildings, or electromagnetic fields (EMFs), and difficulties tolerating sounds. The respondents were asked whether they react with central nervous system (CNS) symptoms or have a physician-diagnosed EI attributed to the corresponding exposures. Prevalence rates were determined for different age and sex groups and the Swedish and Finnish samples in general.

RESULTS

In the Swedish sample (n = 3406), 12.2% had self-reported intolerance to chemicals, 4.8% to certain buildings, 2.7% to EMFs, and 9.2% to sounds. The prevalence rates for the Finnish sample (n = 1535) were 15.2%, 7.2%, 1.6%, and 5.4%, respectively, differing statistically significantly from the Swedish. EI to chemicals and certain buildings was more prevalent in Finland, while EI to EMFs and sounds more prevalent in Sweden. The prevalence rates for EI with CNS-symptoms were lower and physician-diagnosed EIs considerably lower than self-reported EIs. Women reported EI more often than men and the young (18-39 years) to a lesser degree than middle-aged and elderly.

CONCLUSIONS

The findings reflect the heterogeneous nature of EI. The differences in EI prevalence between the countries might reflect disparities concerning which exposures people perceive harmful and focus their attention to.

A window into the brain mechanisms associated with noise sensitivity

Noise sensitive individuals are more likely to experience negative emotions from unwanted sounds and they show greater susceptibility to adverse effects of noise on health. Noise sensitivity does not originate from dysfunctions of the peripheral auditory system, and it is thus far unknown whether and how it relates to abnormalities of auditory processing in the central nervous system. We conducted a combined electroencephalography and magnetoencephalography (M/EEG) study to measure neural sound feature processing in the central auditory system in relation to the individual noise sensitivity. Our results show that high noise sensitivity is associated with altered sound feature encoding and attenuated discrimination of sound noisiness in the auditory cortex. This finding makes a step towards objective measures of noise sensitivity instead of self-evaluation questionnaires and the development of strategies to prevent negative effects of noise on the susceptible population.

The Role of Soundscape in Nature-Based Rehabilitation: A Patient Perspective

Nature-based rehabilitation (NBR) has convincing support in research, yet the underlying mechanisms are not fully understood. The present study sought to increase understanding of the role of soundscapes in NBR, an aspect paid little attention thus far. Transcribed interviews with 59 patients suffering from stress-related mental disorders and undergoing a 12-week therapy programme in the rehabilitation garden in Alnarp, Sweden, were analysed using Interpretative Phenomenology Analysis (IPA). Described sounds were categorised as natural, technological or human. The results showed that patients frequently referred to natural sounds as being part of a pleasant and “quiet” experience that supported recovery and induced “soft fascination”. Technological sounds were experienced as disturbing, while perception of human sounds varied depending on loudness and the social context. The study further uncovered how sound influenced patients’ behaviour and experiences in the garden, through examination of three cross-theme dimensions that materialised in the study; sound in relation to overall perception, sound in relation to garden usage, and increased susceptibility to sound. The findings are discussed in relation to NBR; the need for a more nuanced understanding of susceptibility to sound among people suffering from mental fatigue was identified and design considerations for future rehabilitation gardens were formulated.