ABSTRACT A listening test was conducted to investigate whether A- or C- weighed sound levels are ... more ABSTRACT A listening test was conducted to investigate whether A- or C- weighed sound levels are most suitable as indicator of annoyance due to wind turbine noise. The tests consisted of fifteen different wind turbine noises presented at eight sound levels together with pink noise signals as reference sounds. A total number of 31 persons performed the listening test divided into two subgroups. The first group comprising of 20 students conducted the test in a semi anechoic chamber, and the second group of 11 residents annoyed by wind turbine noise in their homes, conducted the test in their own homes. Results from both subgroups showed that A-weighed sound levels were a more accurate description of wind turbine noise annoyance than C-weighed sound levels. The residents found the same wind turbine noises more annoying than the students, indicating a higher sensitivity to wind turbine noise among persons a priori annoyed by this noise and exposed to this source in their residential settings.
Recent studies show associations between aircraft noise and cardiovascular outcomes such as hyper... more Recent studies show associations between aircraft noise and cardiovascular outcomes such as hypertension. However, the studies were mostly cross-sectional and there are uncertainties regarding potential gender differences as well as sensitive subgroups. In this study, we investigated the cumulative incidence of hypertension in relation to aircraft noise exposure among Swedish men and women living in Stockholm County. A total of 4721 subjects, aged 35-56 at baseline, were followed for 8-10 years. The population was selected according to family history of diabetes, which was present for half of the subjects. The exposure assessment was performed by geographical information systems and based on residential history during the period of follow-up. Blood pressure was measured at baseline and at the end of follow-up. Additional information regarding diagnosis and treatment of hypertension as well as various lifestyle factors was provided by questionnaires. In the overall population, no increased risk for hypertension was found among subjects exposed to aircraft noise (Lden ≥50 dB(A)); RR 1.02 (95% CI 0.90-1.16). When restricting the cohort to those not using tobacco at the blood pressure measurements, a significant risk increase per 5 dB(A) of aircraft noise exposure was found in men; RR 1.21 (1.05-1.39), but not in women; RR 0.97 (0.83-1.13). In both sexes combined, an increased risk of hypertension related to aircraft noise exposure was indicated primarily among those reporting annoyance to aircraft noise; RR 1.41 (1.09-1.83). No consistent effect modification was detected for any of the cardiovascular risk factors under investigation although a family history of diabetes appeared to modify the risk in women. In conclusion, the results suggest an increased risk of hypertension following long-term aircraft noise exposure in men and that subjects annoyed by aircraft noise may be particularly sensitive to noise related hypertension.
Objectives-To investigate whether there is a relation between residential exposure to aircraft no... more Objectives-To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. Methods-The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. Results-The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. Conclusions-Community exposure to aircraft noise may be associated with hypertension. (Occup Environ Med 2001;58:769-773)
Traffic noise, which is steadily increasing, is considered to be an important environmental healt... more Traffic noise, which is steadily increasing, is considered to be an important environmental health problem. The aim of this study was to estimate the degree of annoyance and sleep disturbance related to road traffic noise in residential settings in an urban community. The study is based on a questionnaire on environmentally related health effects distributed to a stratified random sample of 1000 individuals, 19-80 years old, in a municipality with heavy traffic in the county of Stockholm. The response rate was 76%. The individual noise exposure was estimated using evaluated noise dispersion models and local noise assessments. Frequent annoyance was reported by 13% of subjects exposed to Leq 24 hr >50 dBA compared to 2% among those exposed to <50 dBA, resulting in a difference of 11% (95% Confidence Interval (CI) 7%, 15%). Sometimes or frequently occurring sleep disturbance was reported by 23% at Leq 24 hr >50 dBA and by 13% at levels <50 dBA, a difference of 11% (95% CI ...
Long-term aircraft noise exposure may increase the risk of cardiovascular disease, but no study h... more Long-term aircraft noise exposure may increase the risk of cardiovascular disease, but no study has investigated chronic effects on the metabolic system. The aim of this study was to investigate effects of long-term aircraft noise exposure on body mass index (BMI), waist circumference, and type 2 diabetes. Furthermore, we explored the modifying effects of sleep disturbance. This prospective cohort study of residents of Stockholm County, Sweden, followed 5,156 participants with normal baseline oral glucose tolerance tests (OGTT) for up to 10 years. Exposure to aircraft noise was estimated based on residential history. Information on outcomes and confounders was obtained from baseline and follow-up surveys and examinations, and participants who developed prediabetes or type 2 diabetes were identified by self-reported physician diagnosis or OGTT at follow-up. Adjusted associations were assessed by linear, logistic, and random-effects models. The mean (± SD) increases in BMI and waist circumference during follow-up were 1.09 ± 1.97 kg/m2 and 4.39 ± 6.39 cm, respectively. The cumulative incidence of prediabetes and type 2 diabetes was 8% and 3%, respectively. Based on an ordinal noise variable, a 5-dB(A) increase in aircraft noise was associated with a greater increase in waist circumference of 1.51 cm (95% CI: 1.13, 1.89), fully adjusted. This association appeared particularly strong among those who did not change their home address during the study period, which may be a result of lower exposure misclassification. However, no clear associations were found for BMI or type 2 diabetes. Furthermore, sleep disturbances did not appear to modify the associations with aircraft noise. Long-term aircraft noise exposure may be linked to metabolic outcomes, in particular increased waist circumference.
Scandinavian Journal of Work, Environment & Health, 2013
The aim of this study was to assess the joint effect of job strain and both road-traffic and occu... more The aim of this study was to assess the joint effect of job strain and both road-traffic and occupational noise on myocardial infarction (MI). We conducted a population based case-control study on first time MI in Stockholm County during 1992-1994. Participants answered a questionnaire and underwent a physical examination. Residential road-traffic noise exposure was based on residential history combined with information on traffic intensity and distance to nearby roads. Occupational noise exposure was assessed by occupational history combined with a job-exposure matrix derived from measurements. Job strain was based on questions regarding psychological demands and decision latitude. A total of 3050 study participants (1252 cases and 1798 controls) were included in the study. An increased risk of MI was indicated among participants exposed to road-traffic noise [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.01-1.51], occupational noise (OR 1.17, 95% CI 0.98-1.41) and job strain (OR 1.39, 95% CI 1.17-1.65). Participants exposed to one, two, or three of these factors showed an increased risk (OR 1.16, 95% CI 0.97-1.40, OR 1.57, 95% CI 1.24-1.98, and OR 2.27, 95% CI 1.41-3.64, respectively). Exposure to two or three of these factors occurred among about 20% of the controls. Our results indicate that exposure to a combination of noise exposure and job strain increases the risk of MI substantially. Such exposures affect a considerable part of the population, which has relevance for prioritization of preventative measures.
Two types of pacing leads with different insulation material, polyurethane, and polyethylene, wer... more Two types of pacing leads with different insulation material, polyurethane, and polyethylene, were followed for 44 months with respect to their electrophysiological characteristics and complications. In 48 patients, 32 polyurethane leads (Lifeline 493-03) and 16 polyethylene leads (EMT 588 D) were implanted and connected in all cases to the same type of programmable ventricular inhibited (VVI) pulse generator (Programalith, Pacesetter). There was a significant fall during the follow-up in lead impedance with the polyurethane leads (495 +/- 62 to 444 +/- 58 ohms, P less than 0.01), whereas the corresponding measurements for the polyethylene leads were essentially unchanged (360 +/- 58 to 378 +/- 71 ohm, ns). The energy of the stimulation threshold tended to increase in the polyurethane group, whereas an opposite tendency was observed in the polyethylene group. Pacing and/or lead failures were not observed in any case. The observed fall in impedance with the polyurethane leads was seemingly of no clinical significance.
BLUHM, G., ET AL.: Antibiotic prophylaxis in pacemaker surgery. A prospective trial with local or... more BLUHM, G., ET AL.: Antibiotic prophylaxis in pacemaker surgery. A prospective trial with local or systemic administration of antibiotics at generator replacements. To avaiuatv ihe effect of sbort-lerm antibiotic prophylaxis al pacemaker surgery, conseculivo pnlienfs scheduled for routine generator replacements were randomly assigned to a doubJe blind study. One group received systemic prophylactic (SP) antibiotics and one group was given local prophylactic (LP) antibiotics. One-hundred and eight patienfs entered the study, but three were subsequendy excluded. The SP group received fiucloxaciUin 2 gni intravenously 1 hour before surgery, then 1 gm orally every 8 hours for the following 5 days. In [he LP group. JO mi of a dextran emulsion ivith 5% cloxacillin was instilled in the generator pocket at the end of the operation. Infection developed in 0/53 in the SP group and 2/52 in the LP group. 7'issue fluid was drawn 24 hours postoperatively from the generator pocket for determination of pocket concentration of antibiotics and culture tests. The concentration o//lucloxacillin in tissue/luid/rom the pacemaker pocket 1 day posloperatively could be measured in 29 patients in the SP group with a median of 7.2 ng/mi. Median level of pocket fluid concentration of cloxaciliin was 58.5 /xg/ml in 31 patients in the LP group. Bacteriological cultures were positive in 1/32 patients in the SP group and in 1/33 in the LP group, but none of these patients developed infection. In conclusion, there was a low infection rate, both with systemic prophylaxis with /lucloxacillin for a short period of time and with local prophylaxis with cloxacillin perioperatively
Background: It has been suggested that noise exposure increases the risk of hypertension. Road tr... more Background: It has been suggested that noise exposure increases the risk of hypertension. Road traffic is the dominant source of community noise exposure. Objective: To study the association between exposure to residential road traffic noise and hypertension in an urban municipality. Methods: The study population comprised randomly selected subjects aged 19-80 years. A postal questionnaire provided information on individual characteristics, including diagnosis of hypertension. The response rate was 77%, resulting in a study population of 667 subjects. The outdoor equivalent traffic noise level (Leq 24 h) at the residence of each individual was determined using noise-dispersion models and manual noise assessments. The individual noise exposure was classified in units of 5 dB(A), from ,45 dB(A) to .65 dB(A). Results: The odds ratio (OR) for hypertension adjusted for age, smoking, occupational status and house type was 1.38 (95% confidence interval (CI) 1.06 to 1.80) per 5 dB(A) increase in noise exposure. The association seemed stronger among women (OR 1.71; 95% CI 1.17 to 2.50) and among those who had lived at the address for .10 years (OR 1.93; 95% CI 1.29 to 2.83). Analyses of categorical exposure variables suggested an exposure-response relationship. The strongest association between exposure to traffic noise and hypertension was found among those with the least expected misclassification of true individual exposure, as indicated by not having triple-glazed windows, living in an old house and having the bedroom window facing a street (OR 2.47; 95% CI 1.38 to 4.43). Conclusion: The results of our study suggest an association between exposure to residential road traffic noise and hypertension. 122 www.occenvmed.com
To investigate whether there is a relation between residential exposure to aircraft noise and hyp... more To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. Community exposure to aircraft noise may be associated with hypertension.
1 Devaney K, Goodman Z, Ishak KG. Post-infantile giant-cell transformation in hepatitis. Hepatolo... more 1 Devaney K, Goodman Z, Ishak KG. Post-infantile giant-cell transformation in hepatitis. Hepatology 1992; 16: 327-33. 2 Phillips MJ, Blendis LM, Poucell S, Patterson J, Petric M, Roberts E et al. Syncytial giant cell hepatitis. N Engl J Med 1991; 324: 455-60. 3 Lau JYN, Koukoulis G, Mieli-Vergani G, Portmann BC, Williams R. Syncytial giant-cell hepatitis -a specific disease entity? J Hepatol 1992; 15: 216-9. 4 Thijs JC, Bosma A, Henzen-Longmans SC, Meuwissen SGM. Postinfantile giant cell hepatitis in a patient with multiple autoimmune features. Am J Gastroenterol 1985; 80: 294-7. 5 Protzer U, Dienes HP, Bianchi L, Lohse AW, Helmreich-Becker I, Gerken G et al. Post-infantile giant cell hepatitis in patients with primary sclerosing cholangitis and autoimmune hepatitis. Liver 1996; 16: 274-82. 6 Gohlke F, Lohse AW, Dienes HP, Löhr H, Märker-Hermann E, Gerken G et al. Evidence for an overlap syndrome of autoimmune hepatitits and primary sclerosing cholangitis. J Hepatol 1996; 24: 699-705. 7 Rabinovitz M, Demetris AJ. Postinfantile giant cell hepatitis associated with anti-M2 mitochondrial antibodies.
The pharmacokinetics of flucloxacillin in plasma and tissue fluid after i.v. infusion of I g was ... more The pharmacokinetics of flucloxacillin in plasma and tissue fluid after i.v. infusion of I g was analyzed according to an open two-compartment model in 19 patients with bradyarrhythmias (mean age 70.8 years) admitted for implantation or replacement of a permanent pacemaker system. After the first infusion of flucloxacillin (5 rain), the distribution phase was rapid (t,~ = 0.13 h). The plasma halflife of elimination (t,/~/~) was 1.51 h, which is almost twice as long as reported in healthy volunteers. Total plasma clearance (93.1 ml/min) was also lower than is usually found in healthy individuals, due to low renal clearance of flucloxacillin (60.2 ml/min). The total apparent volume of distribution during the /% phase (Vdar~a) was 0.172 l/kg and distribution in the central compartment (Vc) 0.0641/kg. In each patient plasma protein binding and drug distribution to plasma water, proteins and blood cells in whole "blood were determined. Binding in plasma to proteins was 91.0% and distribution to blood cells in whole blood t3.8%. The mean distribution volume of free flucloxacillin during the fl-phase (Vd, free) was 2.181/kg, which exceeds total body water, suggesting possible intracellular distribution and substantial tissue binding. Plasma concentrations of flucloxacillin after the fourth dose (1 g t.i.d.) were very similar to those obtained after the first infusion and those predicted from the single dose kinetics. The concentration of flucloxacillin in fluid from the pacemaker pockets in 5 patients averaged 12.1 lxg/ml and 9.5 lxg/ml at I and 5 h, respectively, which was more than ten times the MIC-values for Staphylococcus aureus and S. epidermidis. The average concentration ratio (tissue fluid/plasma) was 0.57. Thus the pharmacokinetics of flucloxacillin in these elderly patients exhibited marked differences from what has been found in healthy volunteers. Despite the high degree of plasma protein binding, flucloxacillin appears to distribute rapidly and efficiently to extravascular compartments, such as a pacemaker pocket.
The role of noise as an environmental pollutant and its impact on health are being increasingly r... more The role of noise as an environmental pollutant and its impact on health are being increasingly recognized. Beyond its effects on the auditory system, noise causes annoyance and disturbs sleep, and it impairs cognitive performance. Furthermore, evidence from epidemiologic studies demonstrates that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, and stroke. Both observational and experimental studies indicate that in particular night-time noise can cause disruptions of sleep structure, vegetative arousals (e.g. increases of blood pressure and heart rate) and increases in stress hormone levels and oxidative stress, which in turn may result in endothelial dysfunction and arterial hypertension. This review focuses on the cardiovascular consequences of environmental noise exposure and stresses the importance of noise mitigation strategies for public health.
Background: An association has been reported between long-term exposure to road traffic noise and... more Background: An association has been reported between long-term exposure to road traffic noise and the risk of myocardial infarction (MI), but the evidence is limited and inconclusive. No previous study has simultaneously analyzed the role of exposure to noise and air pollution from road traffic in the risk of MI. Methods: A population-based case-control study on MI was conducted 1992-1994 in Stockholm County. Participants answered a questionnaire and underwent a physical examination. Residential exposure to noise and air pollution from road traffic between 1970 and 1992-1994 was assessed for 3666 participants (1571 cases of MI and 2095 controls), based on residential history combined with information on traffic intensity and distance to nearby roads. Information was also obtained on factors potentially affecting the relationship between noise exposure and MI, such as noise annoyance. Results: The correlation between long-term individual exposure to noise and air pollution from traffic was high (r ϭ 0.6). The adjusted odds ratio for MI associated with long-term road traffic noise exposure of 50 dBA or higher was 1.12 (95% confidence interval ϭ 0.95-1.33). In a subsample, defined by excluding persons with hearing loss or exposure to noise from other sources, the corresponding odds ratio was 1.38 (1.11-1.71), with a positive exposure-response trend. No strong effect modification was apparent by sex or cardiovascular risk factors, including air pollution from road traffic.
ABSTRACT A listening test was conducted to investigate whether A- or C- weighed sound levels are ... more ABSTRACT A listening test was conducted to investigate whether A- or C- weighed sound levels are most suitable as indicator of annoyance due to wind turbine noise. The tests consisted of fifteen different wind turbine noises presented at eight sound levels together with pink noise signals as reference sounds. A total number of 31 persons performed the listening test divided into two subgroups. The first group comprising of 20 students conducted the test in a semi anechoic chamber, and the second group of 11 residents annoyed by wind turbine noise in their homes, conducted the test in their own homes. Results from both subgroups showed that A-weighed sound levels were a more accurate description of wind turbine noise annoyance than C-weighed sound levels. The residents found the same wind turbine noises more annoying than the students, indicating a higher sensitivity to wind turbine noise among persons a priori annoyed by this noise and exposed to this source in their residential settings.
Recent studies show associations between aircraft noise and cardiovascular outcomes such as hyper... more Recent studies show associations between aircraft noise and cardiovascular outcomes such as hypertension. However, the studies were mostly cross-sectional and there are uncertainties regarding potential gender differences as well as sensitive subgroups. In this study, we investigated the cumulative incidence of hypertension in relation to aircraft noise exposure among Swedish men and women living in Stockholm County. A total of 4721 subjects, aged 35-56 at baseline, were followed for 8-10 years. The population was selected according to family history of diabetes, which was present for half of the subjects. The exposure assessment was performed by geographical information systems and based on residential history during the period of follow-up. Blood pressure was measured at baseline and at the end of follow-up. Additional information regarding diagnosis and treatment of hypertension as well as various lifestyle factors was provided by questionnaires. In the overall population, no increased risk for hypertension was found among subjects exposed to aircraft noise (Lden ≥50 dB(A)); RR 1.02 (95% CI 0.90-1.16). When restricting the cohort to those not using tobacco at the blood pressure measurements, a significant risk increase per 5 dB(A) of aircraft noise exposure was found in men; RR 1.21 (1.05-1.39), but not in women; RR 0.97 (0.83-1.13). In both sexes combined, an increased risk of hypertension related to aircraft noise exposure was indicated primarily among those reporting annoyance to aircraft noise; RR 1.41 (1.09-1.83). No consistent effect modification was detected for any of the cardiovascular risk factors under investigation although a family history of diabetes appeared to modify the risk in women. In conclusion, the results suggest an increased risk of hypertension following long-term aircraft noise exposure in men and that subjects annoyed by aircraft noise may be particularly sensitive to noise related hypertension.
Objectives-To investigate whether there is a relation between residential exposure to aircraft no... more Objectives-To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. Methods-The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. Results-The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. Conclusions-Community exposure to aircraft noise may be associated with hypertension. (Occup Environ Med 2001;58:769-773)
Traffic noise, which is steadily increasing, is considered to be an important environmental healt... more Traffic noise, which is steadily increasing, is considered to be an important environmental health problem. The aim of this study was to estimate the degree of annoyance and sleep disturbance related to road traffic noise in residential settings in an urban community. The study is based on a questionnaire on environmentally related health effects distributed to a stratified random sample of 1000 individuals, 19-80 years old, in a municipality with heavy traffic in the county of Stockholm. The response rate was 76%. The individual noise exposure was estimated using evaluated noise dispersion models and local noise assessments. Frequent annoyance was reported by 13% of subjects exposed to Leq 24 hr >50 dBA compared to 2% among those exposed to <50 dBA, resulting in a difference of 11% (95% Confidence Interval (CI) 7%, 15%). Sometimes or frequently occurring sleep disturbance was reported by 23% at Leq 24 hr >50 dBA and by 13% at levels <50 dBA, a difference of 11% (95% CI ...
Long-term aircraft noise exposure may increase the risk of cardiovascular disease, but no study h... more Long-term aircraft noise exposure may increase the risk of cardiovascular disease, but no study has investigated chronic effects on the metabolic system. The aim of this study was to investigate effects of long-term aircraft noise exposure on body mass index (BMI), waist circumference, and type 2 diabetes. Furthermore, we explored the modifying effects of sleep disturbance. This prospective cohort study of residents of Stockholm County, Sweden, followed 5,156 participants with normal baseline oral glucose tolerance tests (OGTT) for up to 10 years. Exposure to aircraft noise was estimated based on residential history. Information on outcomes and confounders was obtained from baseline and follow-up surveys and examinations, and participants who developed prediabetes or type 2 diabetes were identified by self-reported physician diagnosis or OGTT at follow-up. Adjusted associations were assessed by linear, logistic, and random-effects models. The mean (± SD) increases in BMI and waist circumference during follow-up were 1.09 ± 1.97 kg/m2 and 4.39 ± 6.39 cm, respectively. The cumulative incidence of prediabetes and type 2 diabetes was 8% and 3%, respectively. Based on an ordinal noise variable, a 5-dB(A) increase in aircraft noise was associated with a greater increase in waist circumference of 1.51 cm (95% CI: 1.13, 1.89), fully adjusted. This association appeared particularly strong among those who did not change their home address during the study period, which may be a result of lower exposure misclassification. However, no clear associations were found for BMI or type 2 diabetes. Furthermore, sleep disturbances did not appear to modify the associations with aircraft noise. Long-term aircraft noise exposure may be linked to metabolic outcomes, in particular increased waist circumference.
Scandinavian Journal of Work, Environment & Health, 2013
The aim of this study was to assess the joint effect of job strain and both road-traffic and occu... more The aim of this study was to assess the joint effect of job strain and both road-traffic and occupational noise on myocardial infarction (MI). We conducted a population based case-control study on first time MI in Stockholm County during 1992-1994. Participants answered a questionnaire and underwent a physical examination. Residential road-traffic noise exposure was based on residential history combined with information on traffic intensity and distance to nearby roads. Occupational noise exposure was assessed by occupational history combined with a job-exposure matrix derived from measurements. Job strain was based on questions regarding psychological demands and decision latitude. A total of 3050 study participants (1252 cases and 1798 controls) were included in the study. An increased risk of MI was indicated among participants exposed to road-traffic noise [odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.01-1.51], occupational noise (OR 1.17, 95% CI 0.98-1.41) and job strain (OR 1.39, 95% CI 1.17-1.65). Participants exposed to one, two, or three of these factors showed an increased risk (OR 1.16, 95% CI 0.97-1.40, OR 1.57, 95% CI 1.24-1.98, and OR 2.27, 95% CI 1.41-3.64, respectively). Exposure to two or three of these factors occurred among about 20% of the controls. Our results indicate that exposure to a combination of noise exposure and job strain increases the risk of MI substantially. Such exposures affect a considerable part of the population, which has relevance for prioritization of preventative measures.
Two types of pacing leads with different insulation material, polyurethane, and polyethylene, wer... more Two types of pacing leads with different insulation material, polyurethane, and polyethylene, were followed for 44 months with respect to their electrophysiological characteristics and complications. In 48 patients, 32 polyurethane leads (Lifeline 493-03) and 16 polyethylene leads (EMT 588 D) were implanted and connected in all cases to the same type of programmable ventricular inhibited (VVI) pulse generator (Programalith, Pacesetter). There was a significant fall during the follow-up in lead impedance with the polyurethane leads (495 +/- 62 to 444 +/- 58 ohms, P less than 0.01), whereas the corresponding measurements for the polyethylene leads were essentially unchanged (360 +/- 58 to 378 +/- 71 ohm, ns). The energy of the stimulation threshold tended to increase in the polyurethane group, whereas an opposite tendency was observed in the polyethylene group. Pacing and/or lead failures were not observed in any case. The observed fall in impedance with the polyurethane leads was seemingly of no clinical significance.
BLUHM, G., ET AL.: Antibiotic prophylaxis in pacemaker surgery. A prospective trial with local or... more BLUHM, G., ET AL.: Antibiotic prophylaxis in pacemaker surgery. A prospective trial with local or systemic administration of antibiotics at generator replacements. To avaiuatv ihe effect of sbort-lerm antibiotic prophylaxis al pacemaker surgery, conseculivo pnlienfs scheduled for routine generator replacements were randomly assigned to a doubJe blind study. One group received systemic prophylactic (SP) antibiotics and one group was given local prophylactic (LP) antibiotics. One-hundred and eight patienfs entered the study, but three were subsequendy excluded. The SP group received fiucloxaciUin 2 gni intravenously 1 hour before surgery, then 1 gm orally every 8 hours for the following 5 days. In [he LP group. JO mi of a dextran emulsion ivith 5% cloxacillin was instilled in the generator pocket at the end of the operation. Infection developed in 0/53 in the SP group and 2/52 in the LP group. 7'issue fluid was drawn 24 hours postoperatively from the generator pocket for determination of pocket concentration of antibiotics and culture tests. The concentration o//lucloxacillin in tissue/luid/rom the pacemaker pocket 1 day posloperatively could be measured in 29 patients in the SP group with a median of 7.2 ng/mi. Median level of pocket fluid concentration of cloxaciliin was 58.5 /xg/ml in 31 patients in the LP group. Bacteriological cultures were positive in 1/32 patients in the SP group and in 1/33 in the LP group, but none of these patients developed infection. In conclusion, there was a low infection rate, both with systemic prophylaxis with /lucloxacillin for a short period of time and with local prophylaxis with cloxacillin perioperatively
Background: It has been suggested that noise exposure increases the risk of hypertension. Road tr... more Background: It has been suggested that noise exposure increases the risk of hypertension. Road traffic is the dominant source of community noise exposure. Objective: To study the association between exposure to residential road traffic noise and hypertension in an urban municipality. Methods: The study population comprised randomly selected subjects aged 19-80 years. A postal questionnaire provided information on individual characteristics, including diagnosis of hypertension. The response rate was 77%, resulting in a study population of 667 subjects. The outdoor equivalent traffic noise level (Leq 24 h) at the residence of each individual was determined using noise-dispersion models and manual noise assessments. The individual noise exposure was classified in units of 5 dB(A), from ,45 dB(A) to .65 dB(A). Results: The odds ratio (OR) for hypertension adjusted for age, smoking, occupational status and house type was 1.38 (95% confidence interval (CI) 1.06 to 1.80) per 5 dB(A) increase in noise exposure. The association seemed stronger among women (OR 1.71; 95% CI 1.17 to 2.50) and among those who had lived at the address for .10 years (OR 1.93; 95% CI 1.29 to 2.83). Analyses of categorical exposure variables suggested an exposure-response relationship. The strongest association between exposure to traffic noise and hypertension was found among those with the least expected misclassification of true individual exposure, as indicated by not having triple-glazed windows, living in an old house and having the bedroom window facing a street (OR 2.47; 95% CI 1.38 to 4.43). Conclusion: The results of our study suggest an association between exposure to residential road traffic noise and hypertension. 122 www.occenvmed.com
To investigate whether there is a relation between residential exposure to aircraft noise and hyp... more To investigate whether there is a relation between residential exposure to aircraft noise and hypertension. The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension. The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability. Community exposure to aircraft noise may be associated with hypertension.
1 Devaney K, Goodman Z, Ishak KG. Post-infantile giant-cell transformation in hepatitis. Hepatolo... more 1 Devaney K, Goodman Z, Ishak KG. Post-infantile giant-cell transformation in hepatitis. Hepatology 1992; 16: 327-33. 2 Phillips MJ, Blendis LM, Poucell S, Patterson J, Petric M, Roberts E et al. Syncytial giant cell hepatitis. N Engl J Med 1991; 324: 455-60. 3 Lau JYN, Koukoulis G, Mieli-Vergani G, Portmann BC, Williams R. Syncytial giant-cell hepatitis -a specific disease entity? J Hepatol 1992; 15: 216-9. 4 Thijs JC, Bosma A, Henzen-Longmans SC, Meuwissen SGM. Postinfantile giant cell hepatitis in a patient with multiple autoimmune features. Am J Gastroenterol 1985; 80: 294-7. 5 Protzer U, Dienes HP, Bianchi L, Lohse AW, Helmreich-Becker I, Gerken G et al. Post-infantile giant cell hepatitis in patients with primary sclerosing cholangitis and autoimmune hepatitis. Liver 1996; 16: 274-82. 6 Gohlke F, Lohse AW, Dienes HP, Löhr H, Märker-Hermann E, Gerken G et al. Evidence for an overlap syndrome of autoimmune hepatitits and primary sclerosing cholangitis. J Hepatol 1996; 24: 699-705. 7 Rabinovitz M, Demetris AJ. Postinfantile giant cell hepatitis associated with anti-M2 mitochondrial antibodies.
The pharmacokinetics of flucloxacillin in plasma and tissue fluid after i.v. infusion of I g was ... more The pharmacokinetics of flucloxacillin in plasma and tissue fluid after i.v. infusion of I g was analyzed according to an open two-compartment model in 19 patients with bradyarrhythmias (mean age 70.8 years) admitted for implantation or replacement of a permanent pacemaker system. After the first infusion of flucloxacillin (5 rain), the distribution phase was rapid (t,~ = 0.13 h). The plasma halflife of elimination (t,/~/~) was 1.51 h, which is almost twice as long as reported in healthy volunteers. Total plasma clearance (93.1 ml/min) was also lower than is usually found in healthy individuals, due to low renal clearance of flucloxacillin (60.2 ml/min). The total apparent volume of distribution during the /% phase (Vdar~a) was 0.172 l/kg and distribution in the central compartment (Vc) 0.0641/kg. In each patient plasma protein binding and drug distribution to plasma water, proteins and blood cells in whole "blood were determined. Binding in plasma to proteins was 91.0% and distribution to blood cells in whole blood t3.8%. The mean distribution volume of free flucloxacillin during the fl-phase (Vd, free) was 2.181/kg, which exceeds total body water, suggesting possible intracellular distribution and substantial tissue binding. Plasma concentrations of flucloxacillin after the fourth dose (1 g t.i.d.) were very similar to those obtained after the first infusion and those predicted from the single dose kinetics. The concentration of flucloxacillin in fluid from the pacemaker pockets in 5 patients averaged 12.1 lxg/ml and 9.5 lxg/ml at I and 5 h, respectively, which was more than ten times the MIC-values for Staphylococcus aureus and S. epidermidis. The average concentration ratio (tissue fluid/plasma) was 0.57. Thus the pharmacokinetics of flucloxacillin in these elderly patients exhibited marked differences from what has been found in healthy volunteers. Despite the high degree of plasma protein binding, flucloxacillin appears to distribute rapidly and efficiently to extravascular compartments, such as a pacemaker pocket.
The role of noise as an environmental pollutant and its impact on health are being increasingly r... more The role of noise as an environmental pollutant and its impact on health are being increasingly recognized. Beyond its effects on the auditory system, noise causes annoyance and disturbs sleep, and it impairs cognitive performance. Furthermore, evidence from epidemiologic studies demonstrates that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, and stroke. Both observational and experimental studies indicate that in particular night-time noise can cause disruptions of sleep structure, vegetative arousals (e.g. increases of blood pressure and heart rate) and increases in stress hormone levels and oxidative stress, which in turn may result in endothelial dysfunction and arterial hypertension. This review focuses on the cardiovascular consequences of environmental noise exposure and stresses the importance of noise mitigation strategies for public health.
Background: An association has been reported between long-term exposure to road traffic noise and... more Background: An association has been reported between long-term exposure to road traffic noise and the risk of myocardial infarction (MI), but the evidence is limited and inconclusive. No previous study has simultaneously analyzed the role of exposure to noise and air pollution from road traffic in the risk of MI. Methods: A population-based case-control study on MI was conducted 1992-1994 in Stockholm County. Participants answered a questionnaire and underwent a physical examination. Residential exposure to noise and air pollution from road traffic between 1970 and 1992-1994 was assessed for 3666 participants (1571 cases of MI and 2095 controls), based on residential history combined with information on traffic intensity and distance to nearby roads. Information was also obtained on factors potentially affecting the relationship between noise exposure and MI, such as noise annoyance. Results: The correlation between long-term individual exposure to noise and air pollution from traffic was high (r ϭ 0.6). The adjusted odds ratio for MI associated with long-term road traffic noise exposure of 50 dBA or higher was 1.12 (95% confidence interval ϭ 0.95-1.33). In a subsample, defined by excluding persons with hearing loss or exposure to noise from other sources, the corresponding odds ratio was 1.38 (1.11-1.71), with a positive exposure-response trend. No strong effect modification was apparent by sex or cardiovascular risk factors, including air pollution from road traffic.
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