Noise annoyance and risk of prevalent and incident atrial fibrillation–A sex-specific analysis

BackgroundWhile chronic exposure to high levels of noise was demonstrated to increase the risk of various cardiovascular diseases, the association between noise annoyance and risk of cardiovascular disease remains still inconsistent. Recently, we showed that noise annoyance is associated with prevalent atrial fibrillation in the general population. However, the association between noise annoyance and risk of incident atrial fibrillation as well as potential sex-differences remain still elusive.Methods and results15,010 subjects from a German population-based cohort were examined at baseline (2007 to 2012) and follow-up five years later (2012 to 2017) to investigative the association between noise annoyance due to multiple sources and prevalent and incident atrial fibrillation. After multivariable adjustment, the results from logistic regression analyses revealed overall consistent and positive associations between noise annoyance and prevalent and incident atrial fibrillation in men, whereas this association was weaker in women, in particular with respect to incident atrial fibrillation. For instance, industrial noise annoyance was associated with 21% (95% confidence interval (CI) 9–34%) and 18% (8–29%) higher odds of prevalent atrial fibrillation in men and women, respectively. In prospective analysis, this association remained stable in men (odds ratio (OR) 1.25, 1.07–1.44), while in women no association was observed (OR 1.03, 0.89–1.18).ConclusionsThe findings suggest that noise annoyance can increase the risk of incident atrial fibrillation in a large population-based cohort and that men may be more sensitive to the adverse effects of noise annoyance with regard to the risk of atrial fibrillation

What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation Survey (i-CODE) – a mixed methods approach

Purpose: We conducted an international survey of bereaved relatives of cancer patients dying in hospitals in seven countries, with the aim to assess and improve the quality of care. The survey used the i-CODE (International Care Of the Dying Evaluation) questionnaire. Here we report findings from the free-text comments submitted with the questionnaires. We explored for topic areas which would potentially be important for improving the quality of care. Further, we examined who reported freetexts and in what way, to reduce bias without ignoring the function the free-texts may have for those contributing. Methods: We used a combined qualitative-quantitative approach: logistic regression analysis to study the effect of respondents’ socio-demographic characteristics on the probability of free-texts contributions, and thematic analysis to understand the free-text meaning. The primary survey outcomes, (1) how frequently the dying person was treated with dignity and respect, and (2) support for the relative, were related to free-text content. Results: In total, 914 questionnaires were submitted; 457/914 (50%) contained free-text comments. We found no socio-demographic differences between the respondents providing free-texts and those who did not. We discovered different types of free-texts (‘feedback’, ‘narrative’, ‘selfrevelation’) containing themes of which ‘continuity of care’, ‘the one person who can make a difference’, and ‘the importance of being a companion to the dying’ represent care dimensions supplementing the questionnaire items. A free-text type of grateful feedback was associated with well perceived support for the relative. Conclusion: Bereaved relatives used the free-texts to report details related to i-CODE items and to dimensions otherwise not represented. They highlighted the importance of the perceived support from human interaction between staff and the dying patient and themselves; and that more than professional competence alone, personal, meaningful interactions have profound importance

Impact of the temporary closure of a major bridge on local air quality in two large German cities: an accountability study

Despite recent achievements in reducing the contribution of road traffic to air pollution, agreed pollutant standards are exceeded frequently in large parts of Europe. Previous studies assessed the effectiveness of traffic interventions in improving local air quality. However, little research exists on the effect of closures of short road sections over longer periods. The multi-week maintenances on the Theodor Heuss Bridge, the main connection over the river Rhine between the German cities Mainz and Wiesbaden, offered the opportunity to investigate its effect on local air pollution. We measured ambient concentrations of major air pollutants and meteorological parameters at the Theodor Heuss Bridge before, during, and after its closure on 800 m in early 2020. We carried out time-series and closure-dependent evaluations of pollutant concentrations at the bridge accounting for wind direction. Furthermore, we performed regression analyses accounting for wind speed additionally. We compared the results with data from surrounding monitoring stations. We recorded higher concentrations at the Theodor Heuss Bridge compared to outside the closure, especially for particulate matter, nitric oxide, and black carbon. Only with wind from specific directions, we could detect reductions of concentrations during the closure for many pollutants as nitrogen dioxide (− 9.8%; 95% confidence interval: − 10.8– − 8.7%), but not for particulate matter. Since we found similar meteorology-dependent pollution reductions during the closure at both the bridge and the surrounding monitoring stations, we assume that regional meteorological factors overlaid a potential closure-related effect on local air quality. These factors must be accounted for in accountability studies on interventions focusing on short roads