A Data-informed Public Health Policy-Makers Platform

Hearing loss is a disease exhibiting a growing trend due to the number of factors, including but not limited to the mundane exposure to the noise and ever-increasing amount of older population. In the framework of a public health policymaking process, modeling of the hearing loss disease based on data is a key factor in alleviating the issues related to the disease issuing effective public health policies. First, the paper describes the steps of the data-driven policymaking process. Afterward, a scenario along with the part of the proposed platform, responsible for supporting policymaking are presented. With the aim of demonstrating the capabilities and usability of the platform for the policy-makers, some initial results of preliminary analytics are presented in a framework of a policy-making process. Ultimately, the utility of the approach is validated throughout the results of the survey which was presented to the health system policy-makers professionals involved in the policy development process in Croatia

Vibroacoustic disease – a review of the literature

W artykule dokonano przeglądu piśmiennictwa dotyczącego nowej jednostki chorobowej – choroby wibroakustycznej. Choroba wibroakustyczna to ogólnoustrojowa choroba wywołana nadmierną ekspozycją na infradźwięki i hałas niskoczęstotliwościowy (0 ÷ 500 Hz). Wiąże się ona z nieprawidłowym rozrostem substancji międzykomórkowej (kolagenu i elastyny) przy nieobecności stanów za-palnych. Zgrubienia osierdzia przy nieobecności procesów zapalnych i braku zaburzeń diastolicznych to specyficzne oznaki tej choroby. U pacjentów z rozpoznaną chorobą wibroakustyczną standardowe testy diagnostyczne (ekg., eeg. i testy biochemiczne krwi) dają poprawne wyniki. Diagnostyka choroby wibroakustycznej wymaga stosowania metod umożliwiających identyfikację takich zmian strukturalnych, jak: echokardiografia, rezonans magnetyczny mózgu i badania histologiczne. Choroba wibroakustyczna była rozpoznawana głównie wśród osób eksponowanych na hałas niskoczęstoliwościowy: pracowników technicznych lotnictwa, pilotów i pozostałych członków załóg samolotów, obsługi statków, pracowników restauracji i dyskdżokejów. Przypadki tej choroby stwierdzano również wśród osób eksponowanych na hałas niskoczęstotliwościowy w miejscu zamieszkania. Nie określono jednak zależności dawka-skutek i nie przeprowadzono na dużą skalę badań epidemiologicznych. Choroba wibroakustyczna (vibroacoustic disease, VAD) jest nową jednostką chorobową wiązaną z nadmierną ekspozycją na infradźwięki (0 ÷ 20 Hz) i hałas niskoczęstotliwościowy (20 ÷ 500 Hz*). Pojęcie to wprowadzili w 1999 r. naukowcy portugalscy. Badania dotyczące skutków działania infradźwięków i hałasu niskoczęstotliwościowego są prowadzone od wielu lat w Portugalii przez zespół badaczy pod kierunkiem Nuno A. A. Castelo Branco i Mariany Alves-Pereira. Badania te rozpoczęto na początku lat 80. ubiegłego stulecia, kiedy to zauważono wśród personelu technicznego lotniczych zakła-dów produkcyjno-naprawczych Portugalskich Sił Powietrznych (Oficias Gerais de Ma-terial Aeronautico, OGMA) znacznie częstsze w stosunku do (portugalskiej) populacji generalnej występowanie padaczki (10% kontra 0,2%). Spostrzeżenie to zainicjowało badania neurofizjologiczne wśród pracowników eksponowanych na hałas niskoczęstotliwościowy (Alves-Pereira, Castelo Branco 2007). W 1983 r. zmarł pierwszy pacjent z badanej grupy pracowniczej, ale niemożliwe było wówczas przeprowadzenie sekcji zwłok. Sposobność taka pojawiła się cztery lata później, gdy inny poważnie chory pracownik OGMA wyraził życzenie przeprowadzania po jego śmierci autopsji. U 58-letniego mężczyzny, zmarłego z powodu tamponady serca wywołanej za-wałem mięśnia sercowego, z rozpoznaną wcześniej padaczką, stwierdzono zgrubienia w obrębie struktur serca (naczyń krwionośnych i osierdzia), zmiany nowotworowe mózgu i nerek oraz zwłóknienia w płucach (Castelo Branco, Alves-Pereira 2004a). Późniejsze wyniki badań mikroskopowych wykazały, że zgrubienia w obrębie struktur serca były spowodowane nienormalnym rozrostem włókien kolagenowych. Wyniki wspomnianej autopsji zainicjowały wykonywanie rutynowo badań echokardiograficznych wśród personelu technicznego OGMA. Rozpoczęto również badania histopatologiczne próbek osierdzia pobieranych przy okazji operacji chirurgicznych. Próbki takie pobrano m.in. od trzech pracowników technicznych, czterech pilotów samolotów, czterech pilotów helikopterów i jednego kierowcy ciężarówki (Leigthon 2007). Na podstawie wyników badań echokardiograficznych wykazano u wszystkich badanych techników lotniczych pogrubienie osierdzia, a u części – również zgrubienia zastawek serca (Marciniak i in. 1999). Wyniki te potwierdziły późniejsze badania z za-stosowaniem mikroskopu optycznego i elektronowego (Castelo Branco i in. 1999a; 2001; 2003a; b). Zgrubienia w obrębie struktur serca obserwowano także u zwierząt doświadczalnych (szczurów) eksponowanych na hałas niskoczęstotliwościowy (Castelo Branco i in. 2003c). Doświadczenia z udziałem zwierząt rozpoczęto w 1992 r., a jednym z powodów podjęcia tych badań był fakt, iż u wielu pacjentów stwierdzono występowanie wysięku opłucnowego o atypowej etiologii (Alves-Pereira, Castelo Branco 2007). Zgrubienia osierdzia przy braku procesów zapalnych i zaburzeń diastolicznych u osób eksponowanych na hałas niskoczęstotliwościowy są uznawane za specyficzne oznaki choroby wibroakustycznej (Holt 2000).A review of literature data concerning the vibroacoustic disease (VAD) is presented. VAD is a whole-body pathology that develops in individuals excessively exposed to infrasound and low-frequency noise (0 500 Hz). It is associated with an abnormal growth of extra-cellular ma-tricses (collagen and elastin), in the absence of an inflamantory process. Pericardial thickening with no diastolic dysfunction, and in the absence of an inflamantory process is a specific sign of this disease. Common medical diagnostic tests (ECG, EEG, blood chemistry analyses) in VAD patients present normal values. VAD diagnosis requires methods giving the possibility of identifying structural changes, such as echocardiography, brain MRI or histological tests. VAD has been mainly diagnosed in professionals exposed to low-frequency noise, such as air-craft technicians, commercial and military pilots and cabin crew, ship machinists, restaurant workers and DJs. It has also been observed in people exposed to low-frequency noise in the living environment. However, a valid dose-response has not been yet established and there are still no large-scale epidemiological studies

Effects of Ultrasonic Noise on the Human Body - A Bibliographic Review

Industrial noise in the working environment has adverse effects on human hearing; literature and private studies confirm that. It has been determined that significant changes in the hearing threshold level occur in the high frequency audiometry, i.e., in the 8-20 kHz frequency range. Therefore, it is important to determine the effect of ultrasonic noise (10-40 kHz) on the human body in the working environment. This review describes hearing and nonhearing effects (thermal effects, subjective symptoms and functional changes ) of the exposure to noise emitted by ultrasound devices. Many countries have standard health exposure limits to prevent effects of the exposure to ultrasonic noise in the working environment

A study of the annoyance of low-frequency noise in rooms for office and conceptual work

W artykule przedstawiono wyniki badań analizy uciążliwości hałasu niskoczęstotliwościowego występującego na stanowiskach pracy zlokalizowanych w pomieszczeniach biurowych. W ramach badań przeprowadzono pomiary wielkości akustycznych charakteryzujących ten rodzaj hałasu oraz ankietę wśród osób zatrudnionych na tych stanowiskach.This article presents the results of tests of the annoyance of low-frequency noise that occurs at office workstations. The tests covered measurement of acoustic parameters specific for this type of noise and survey at the work environment

Theoretical Predictions and Actual Hearing Threshold Levels in Workers Exposed to Ultrasonic Noise of Impulsive Character—A Pilot Study

Results of standard pure-tone audiom etry (PTA) were collected from 25 workers, mainly females, aged 23–58 years, exposed for 2–13 years to ultrasonic noise emitted by ultrasonic welders. Hearing tests were completed by evaluation of exposure to ultrasonic noise. The subjects’ actual audiometric hearing threshold levels (HTLs) were compared with theoretical predictions calculated according to ISO 1999:1990. In 60% of cases sound pressure levels in the 10–40 kHz 1/3-octave bands at workstands exceeded Polish exposure limits for ultrasonic noise. Our comparison of predicted and measured HTLs suggests that the ISO 1999:1990 method, intended for audible noise, might also make it possible to predict reliably permanent hearing loss (in the 2 000–6 000 Hz frequency range) after exposure to ultrasonic noise. No significant progress of hearing impairment (assessed using PTA) in the operators of ultrasonic welders was noted. Nevertheless, further studies on the hearing status of workers exposed to ultrasonic noise are needed

Hearing Ability in Orchestral Musicians

Pure-tone audiometry (PTA) and transient-evoked otoacoustic emissions (TEOAEs) were determined in 57 classical orchestral musicians along with a questionnaire inquiry using a modified Amsterdam Inventory for Auditory Disability and Handicap ((m)AIADH). Data on musicians’ working experience and sound pressure levels produced by various groups of instruments were also collected. Measured hearing threshold levels (HTLs) were compared with the theoretical predictions calculated according to ISO 1999:1990. High frequency notched audiograms typical for noise-induced hearing loss were found in 28% of the subjects. PTA and TEOAE consistently showed a tendency toward better hearing in females vs. males, younger vs. older subjects, and lower- vs. higher-exposed to orchestral noise subjects. Audiometric HTLs were better than theoretical predictions in the frequency range of 2000–4000 Hz. The (m)AIADH scores indicated some hearing difficulties in relation to intelligibility in noisy environment in 26% of the players. Our results indicated a need to implement a hearing conservation program for this professional group

Noise-Induced Hearing Loss in Professional Orchestral Musicians

The overall purpose of this study was to assess hearing status in professional orchestral musicians. Standard pure-tone audiometry (PTA) and transient-evoked otoacoustic emissions (TEOAEs) were per- formed in 126 orchestral musicians. Occupational and non-occupational risk factors for noise-induced hearing loss (NIHL) were identified in questionnaire inquiry. Data on sound pressure levels produced by various groups of instruments were also collected and analyzed. Measured hearing threshold levels (HTLs) were compared with the theoretical predictions calculated according to ISO 1999 (1990). Musicians were exposed to excessive sound at weekly noise exposure levels of for 81-100 dB (mean: 86.6±4.0 dB) for 5-48 years (mean: 24.0±10.7 years). Most of them (95%) had hearing corresponds to grade 0 of hearing impairment (mean hearing threshold level at 500, 1000, 2000 and 4000 Hz lower than 25 dB). However, high frequency notched audiograms typical for noise-induced hearing loss were found in 35% of cases. Simultaneously, about 35% of audiograms showed typical for NIHL high frequency notches (mainly occurring at 6000 Hz). When analyzing the impact of age, gender and noise exposure on hearing test results both PTA and TEOAE consistently showed better hearing in females vs. males, younger vs. older musicians. But higher exposure to orchestral noise was not associated with poorer hearing tests results. The musician’s audiometric hearing threshold levels were poorer than equivalent non-noise-exposed population and better (at 3000 and 4000 Hz) than expected for noise-exposed population according to ISO 1999 (1990). Thus, music impairs hearing of orchestral musicians, but less than expected from noise exposure

Self-Assessment of Hearing Status and Risk of Noise-Induced Hearing Loss in Workers in a Rolling Stock Plant

Noise measurements and questionnaire inquiries were carried out for 124 workers of a rolling stock plant to develop a hearing conservation program. On the basis of that data, the risk of noise-induced hearing loss (NIHL) was evaluated. Additionally, the workers’ hearing ability was assessed with the (modified) Amsterdam inventory for auditory disability and handicap, (m)AIADH. The workers had been exposed to noise at A-weighted daily noise exposure levels of 74–110 dB for 1-40 years. Almost one third of the workers complained of hearing impairment and the (m)AIADH results showed some hearing difficulties in over half of them. The estimated risk of hearing loss over 25 dB in the frequency range of 3-6 kHz was 41–50% when the standard method of predicting NIHL specified in Standard No. ISO 1999:1990 was used. This risk increased to 50-67% when noise impulsiveness, coexposure to organic solvents, elevated blood pressure and smoking were included in calculations

Evaluation of Sound Exposure and Risk of Hearing Impairment in Orchestral Musicians

This study aimed to assess exposure to sound and the risk of noise-induced hearing loss (NIHL) in orchestral musicians. Sound pressure level was measured in 1 opera and 3 symphony orchestras; questionnaires were filled in. On the basis of that data, the risk of NIHL was assessed according to Standard No. ISO 1999:1990. Classical orchestral musicians are usually exposed to sound at equivalent continuous A-weighted sound pressure levels of 81−90 dB (10th−90th percentiles), for 20−45 h (10th−90th percentiles) per week. Occupational exposure to such sound levels over 40 years of employment might cause hearing loss (expressed as a mean hearing threshold level at 2, 3, 4 kHz exceeding 35 dB) of up to 26%. Playing the horn, trumpet, tuba and percussion carries the highest risk (over 20%)

The Influence of Selected Risk Factors on the Hearing Threshold Level of Noise Exposed Employees

The aim of the study was to evaluate the combined effect of noise exposure and additional risk factors on permanent hearing threshold shift. Three additional risk factors were: exposure to organic solvents, smoking and elevated blood pressure. The data on exposure and health status of employees were collected in 24 factories. The study group comprised of 3741 noise male exposed workers of: mean age 39§8 years, mean tenure 16§7 years and LEX;8h = 86 § 5 dB. For each subject, hearing level was measured with pure tone audiometry, blood pressure and noise exposure were assessed from the records of local occupational health care and obligatory noise measurements performed by employers. Smoking and solvent exposure were assessed with questionnaire. The study group was divided into subgroups with respect to the considered risk factors. In the analysis, the distribution of hearing level of each subgroup was compared to the predicted one which the standard calculation method described in ISO 1999:1990. For each of the considered risk factors, the difference between measured and calculated hearing level distribution was used to establish, by the least square method, a noise dose related correction square function for the standard method. The considered risk factors: solvent exposure, smoking and elevated blood pressure combined with noise exposure, may increase degree of hearing loss