Exposure-response relationship for noise annoyance and sleep disturbance. An analysis of national data

Blootstelling-responsrelaties voor verkeersgeluid en hinder lijken schaalspecifiek te zijn: relaties opgesteld op internationaal niveau wijken soms af van relaties op nationaal niveau die op hun buurt weer afwijken van relaties op regionaal niveau. Voor beleid betekent dit dat bij toepassing van (inter-)nationale blootstelling-responsrelaties op lokale situaties terdege rekening dient te worden gehouden met de beperkingen en 'vertaalbaarheid' van de relatie naar de lokale situatie. Daarnaast blijkt dat ondanks het gebruik van standaardvragen voor hinder en slaapverstoring, vastgelegd in een ISO-norm, de wijze van operationaliseren van hinder en slaapverstoring van invloed is op de blootstelling-responsrelatie. Dit zijn de belangrijkste bevindingen uit een onderzoek naar de relatie tussen geluid van wegverkeer en hinder en slaapverstoring op basis van gegevens uit het EMPARA-geluidsmodel en de Hinderinventarisatie 2003. In Nederland en binnen de Europese Unie is de verstoring van de leefomgeving door geluid een belangrijk aandachtspunt van beleid, omdat blootstelling aan hoge geluidsniveaus kan leiden tot negatieve effecten op welbevinden en gezondheid, waaronder hinder en slaapverstoring. In het rapport is onderzocht of het mogelijk is om met bestaande Nederlandse onderzoeksgegevens relaties vast te stellen tussen blootstelling aan verkeersgeluid en het optreden van hinder en slaapverstoring. De resultaten zijn vergeleken met de voorstellen voor relaties die in Europees verband zijn gedaan en de uitkomsten van de Gezondheidskundige Evaluatie Schiphol. Hierbij traden belangrijke verschillen aan het licht. Een belangrijke kanttekening bij de resultaten is dat slechts een beperkt aantal deelnemers aan het onderzoek is blootgesteld aan hogere geluidbelastingniveaus waardoor de betrouwbaarheidsintervallen voor hoge blootstellingen groot zijn. Dit is het gevolg van de scheve (min of meer log-normale) verdeling van geluidblootstelling in de Nederlandse bevolking.Exposure-response relations for traffic sound and annoyance appear to be scale-specific: relationships established at international levels sometimes deviate from national relationships; in turn these relations can deviate from regional ones. For policy, this means that due consideration should be given to the limitations and transferability of (inter-) national exposure-response relationships used in local situations. The definition and operationalisation of the terms 'annoyance' and 'sleep disturbance' can have a profound impact on the results. Although survey questions on annoyance conform to the ISO standard, the different interpretations of annoyance found in the literature can result in differences between exposure-response relationships. These are the main findings from a study investigating the relation between traffic sound and annoyance and sleep disturbance on the basis of the EMPARA noise model and a periodic national Annoyance survey (2003). Disturbance of the living environment through noise exposure is of concern, both in the Netherlands and the European Union. Exposure to high levels of noise can have adverse effects (annoyance and sleep disturbance) on health and well-being. The study described used existing Dutch data for determining the relationship between exposure to transport noise, and annoyance and sleep disturbance. The results from the Annoyance survey and EMPARA were compared with the proposals of the EU Noise Expert Network and the outcome of the monitoring programme, Health Impact Assessment - Schiphol Airport. The comparison revealed significant differences. In the Annoyance survey only few respondents experienced relatively high exposure levels. This resulted in large confidence intervals at high exposures.MN

Welcoming low testosterone as a cardiovascular risk factor

Male hypogonadism now has a new spectrum of complications. They are mainly cardiometabolic in nature. Low serum testosterone levels are a risk factor for diabetes, metabolic syndrome, inflammation and dyslipidemia. These metabolic and inflammatory complications are not without consequences. Recent studies have shown low serum testosterone levels to be an independent risk factor of cardiovascular and all-cause mortality. It is time to welcome low serum testosterone levels as a cardiovascular risk factor

Relationship of menopausal status and climacteric symptoms to sleep in women undergoing chemotherapy

Goals of workThe goal of this study was to examine the relationship between menopausal symptoms, sleep quality, and mood as measured by actigraphy and self-report prior to treatment and at the end of four cycles of chemotherapy in women with breast cancer.Patients and methodsData on sleep quality (measured using actigraphy and self-report) and mood were collected prior to treatment and 12 weeks later at the end of four cycles of chemotherapy in 69 women with newly diagnosed breast cancer. In addition, each filled out the Greene Climacteric Scale. Based on reported occurrence of menses, participants were categorized post hoc into three menopausal status groups: pre-menopausal before and after chemotherapy (Pre-Pre), pre-menopausal or peri-menopausal before and peri-menopausal after chemotherapy (Pre/Peri-Peri), and post-menopausal before and after chemotherapy (Post-Post).Main resultsResults suggested that women within the Pre-Pre group evidenced more fragmented sleep with less total sleep time (TST) after chemotherapy compared to baseline. Compared to the other groups, the Pre-Pre group also experienced less TST and more awakenings before and after chemotherapy. Although the Pre/Peri-Peri group evidenced a greater increase in vasomotor symptoms after chemotherapy, there was no relationship with sleep. All groups evidenced more depressive symptoms after chemotherapy, but depression was not related to measures of sleep.ConclusionsContrary to the study hypothesis, these results suggest that women who are pre-menopausal or having regular menses before and after four cycles of chemotherapy have worse sleep following chemotherapy. Those women who maintain or become peri-menopausal (irregular menses) experience an increase in climacteric symptoms but do not experience an associated worsening of sleep. These results are preliminary and more research is necessary to further explain these findings

Ablation of the androgen receptor from vascular smooth muscle cells demonstrates a role for testosterone in vascular calcification

Vascular calcification powerfully predicts mortality and morbidity from cardiovascular disease. Men have a greater risk of cardiovascular disease, compared to women of a similar age. These gender disparities suggest an influence of sex hormones. Testosterone is the primary and most well-recognised androgen in men. Therefore, we addressed the hypothesis that exogenous androgen treatment induces vascular calcification. Immunohistochemical analysis revealed expression of androgen receptor (AR) in the calcified media of human femoral artery tissue and calcified human valves. Furthermore, in vitro studies revealed increased phosphate (Pi)-induced mouse vascular smooth muscle cell (VSMC) calcification following either testosterone or dihydrotestosterone (DHT) treatment for 9 days. Testosterone and DHT treatment increased tissue non-specific alkaline phosphatase (Alpl) mRNA expression. Testosterone-induced calcification was blunted in VSMC-specific AR-ablated (SM-ARKO) VSMCs compared to WT. Consistent with these data, SM-ARKO VSMCs showed a reduction in Osterix mRNA expression. However, intriguingly, a counter-intuitive increase in Alpl was observed. These novel data demonstrate that androgens play a role in inducing vascular calcification through the AR. Androgen signalling may represent a novel potential therapeutic target for clinical intervention

Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testim Registry in the US (TRiUS)

<p>Abstract</p> <p>Background</p> <p>Recent evidence suggests that there may be a bidirectional, physiological link between hypogonadism and metabolic syndrome (MetS), and testosterone replacement therapy (TRT) has been shown to improve some symptoms of MetS in small patient populations. We examined the effect of 12 months of TRT on MetS components in a large cohort of hypogonadal men.</p> <p>Methods</p> <p>Data were obtained from TRiUS (Testim^®Registry in the United States), a 12-month, multicenter, prospective observational registry (N = 849) of hypogonadal men prescribed Testim 1% testosterone gel (5-10 g/day). Data analyzed included age, total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and MetS components: waist circumference, blood pressure, fasting blood glucose, plasma triglycerides, and HDL cholesterol.</p> <p>Results</p> <p>Of evaluable patients (581/849) at baseline, 37% were MetS+ (n = 213) and 63% were MetS- (n = 368). MetS+ patients had significantly lower TT (p < 0.0001) and SHBG (p = 0.01) levels. Patients with the lowest quartile TT levels (<206 ng/dL [<7.1 nmol/L]) had a significantly increased risk of MetS+ classification vs those with highest quartile TT levels (≥331 ng/dL [≥11.5 nmol/L]) (odds ratio 2.66; 95% CI, 1.60 to 4.43). After 12 months of TRT, TT levels significantly increased in all patients (p < 0.005). Despite having similar TT levels after TRT, only MetS+ patients demonstrated significant decreases in waist circumference, fasting blood glucose levels, and blood pressure; lowest TT quartile patients demonstrated significant decreases in waist circumference and fasting blood glucose. Neither HDL cholesterol nor triglyceride levels changed significantly in either patient population.</p> <p>Conclusion</p> <p>Hypogonadal MetS+ patients were more likely than their MetS- counterparts to have lower baseline TT levels and present with more comorbid conditions. MetS+ patients and those in the lowest TT quartile showed improvement in some metabolic syndrome components after 12 months of TRT. While it is currently unclear if further cardiometabolic benefit can be seen with longer TRT use in this population, testing for low testosterone may be warranted in MetS+ men with hypogonadal symptoms.</p

The effect of aircraft and road traffic noise on the cognitive performance, annoyance and blood pressure of primary school children

De leesprestatie van basisschoolkinderen rondom drie Europese vliegvelden blijkt gemiddeld lager te zijn bij hogere geluidniveaus van vliegverkeer. Het percentage ernstige hinder hangt samen met het geluidniveau van vliegverkeer. De relatie tussen geluid van vliegverkeer en bloeddruk is niet geheel eenduidig.Dit blijkt uit het tot dusver grootste onderzoek naar de effecten van geluid van vlieg- en wegverkeer op cognitieve functies, de bloeddruk en de hinderbeleving bij kinderen. Het onderzoek is uitgevoerd onder 2.844 kinderen in de omgeving van drie Europese luchthavens. De onderzoeksresultaten tonen dat de bevindingen in recente buitenlandse studies over effecten van geluid van vliegtuiggeluid op cognitie ook van toepassing zijn op de situatie rondom Schiphol. Voorheen was dit onzeker.De resultaten wijzen verder op een ongunstig effect van blootstelling aan geluid van vliegverkeer op het lange termijn geheugen. Ook blijken kinderen bij hogere geluidniveaus van vliegverkeer meer fouten te maken op de wisselende aandachtstest. Naar schatting zijn er in de omgeving van Schiphol 50 tot 3.000 (0,1 - 2,5%) bovenbouwleerlingen extra met een relatief lage score op een leestest. Normaliter heeft 9% een relatief lage score.Circa 3.400 (2,9%) bovenbouwleerlingen zijn ernstig gehinderd door het geluid van vliegverkeer op school.In Nederland is de bloeddruk hoger bij hogere geluidniveaus van vliegverkeer; in Engeland is dat niet zo. Ook de wetenschappelijke literatuur geeft geen duidelijkheid. Daarom kunnen aan deze resultaten geen eenduidige conclusies worden verbonden.In het rapport wordt tevens op de effecten van geluid afkomstig van wegverkeer ingegaan.Aircraft noise is related to a decrease in reading comprehension levels among primary schoolchildren around three European airports. The percentage of severe annoyance increases with the aircraft noise level. The relation between aircraft noise and blood pressure is not quite consistent.These are the main results of the largest study of its kind, carried out among primary schoolchildren to investigate the effect of aircraft and road traffic noise on children's cognition, annoyance and blood pressure. The results indicate that the findings of recent studies of the effects of aircraft noise on cognition are applicable for the situation around Schiphol Airport. Effects of aircraft noise are also observed on memory: a decrease in recognition memory is found. Aircraft noise exposure is related to an increase in mistakes on a switching attention test. It is estimated that 50-3000 (0.1 - 2.5%) additional pupils in the last 4 classes of primary schools around Schiphol Airport have a relatively low test result for reading comprehension due to aircraft noise exposure. Normally, 9% have a relatively low score.An estimated 3400 (2.9%) pupils in the last 4 classes of the primary schools in the Schiphol area are severely annoyed at school due to aircraft noise.In the Dutch sample aircraft noise exposure is related to increased blood pressure; this was not the case in the British sample, and evidence in the literature is inconsistent. Therefore no unequivocal conclusions can be drawn with regard to the effect of noise on the blood pressure in children.VROMV en WVW