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WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition.

ABSTRACT: This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for other outcomes such as attention and executive function and for some noise sources such as road traffic noise and railway noise. The GRADE evaluation of low quality evidence across studies for some cognitive domains and for some noise sources does not necessarily mean that there are no effects: rather, that more robust and a greater number of studies are required.

SUBMITTER: Clark C

PROVIDER: S-EPMC5858354 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition.

Clark Charlotte C Paunovic Katarina K

International journal of environmental research and public health 20180207 2

This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 8 ...[more]

PMID: 29414890

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Project description:Background: This paper describes a systematic review and meta-analyses on effects of environmental noise on annoyance. The noise sources include aircraft, road, and rail transportation noise as well as wind turbines and noise source combinations. Objectives: Update knowledge about effects of environmental noise on people living in the vicinity of noise sources. Methods: Eligible were published studies (2000-2014) providing comparable acoustical and social survey data including exposure-response functions between standard indicators of noise exposure and standard annoyance responses. The systematic literature search in 20 data bases resulted in 62 studies, of which 57 were used for quantitative meta-analyses. By means of questionnaires sent to the study authors, additional study data were obtained. Risk of bias was assessed by means of study characteristics for individual studies and by funnel plots to assess the risk of publication bias. Main Results: Tentative exposure-response relations for percent highly annoyed residents (%HA) in relation to noise levels for aircraft, road, rail, wind turbine and noise source combinations are presented as well as meta-analyses of correlations between noise levels and annoyance raw scores, and the OR for increase of %HA with increasing noise levels. Quality of evidence was assessed using the GRADE terminology. The evidence of exposure-response relations between noise levels and %HA is moderate (aircraft and railway) or low (road traffic and wind turbines). The evidence of correlations between noise levels and annoyance raw scores is high (aircraft and railway) or moderate (road traffic and wind turbines). The evidence of ORs representing the %HA increase by a certain noise level increase is moderate (aircraft noise), moderate/high (road and railway traffic), and low (wind turbines). Strengths and Limitations: The strength of the evidence is seen in the large total sample size encompassing the included studies (e.g., 18,947 participants in aircraft noise studies). Main limitations are due to the variance in the definition of noise levels and %HA. Interpretation: The increase of %HA in newer studies of aircraft, road and railway noise at comparable Lden levels of earlier studies point to the necessity of adjusting noise limit recommendations. Funding: The review was funded by WHO Europe.

Project description:To evaluate the quality of available evidence on the effects of environmental noise exposure on sleep a systematic review was conducted. The databases PSYCINFO, PubMed, Science Direct, Scopus, Web of Science and the TNO Repository were searched for non-laboratory studies on the effects of environmental noise on sleep with measured or predicted noise levels and published in or after the year 2000. The quality of the evidence was assessed using GRADE criteria. Seventy four studies predominately conducted between 2000 and 2015 were included in the review. A meta-analysis of surveys linking road, rail, and aircraft noise exposure to self-reports of sleep disturbance was conducted. The odds ratio for the percent highly sleep disturbed for a 10 dB increase in Lnight was significant for aircraft (1.94; 95% CI 1.61-2.3), road (2.13; 95% CI 1.82-2.48), and rail (3.06; 95% CI 2.38-3.93) noise when the question referred to noise, but non-significant for aircraft (1.17; 95% CI 0.54-2.53), road (1.09; 95% CI 0.94-1.27), and rail (1.27; 95% CI 0.89-1.81) noise when the question did not refer to noise. A pooled analysis of polysomnographic studies on the acute effects of transportation noise on sleep was also conducted and the unadjusted odds ratio for the probability of awakening for a 10 dBA increase in the indoor Lmax was significant for aircraft (1.35; 95% CI 1.22-1.50), road (1.36; 95% CI 1.19-1.55), and rail (1.35; 95% CI 1.21-1.52) noise. Due to a limited number of studies and the use of different outcome measures, a narrative review only was conducted for motility, cardiac and blood pressure outcomes, and for children's sleep. The effect of wind turbine and hospital noise on sleep was also assessed. Based on the available evidence, transportation noise affects objectively measured sleep physiology and subjectively assessed sleep disturbance in adults. For other outcome measures and noise sources the examined evidence was conflicting or only emerging. According to GRADE criteria, the quality of the evidence was moderate for cortical awakenings and self-reported sleep disturbance (for questions that referred to noise) induced by traffic noise, low for motility measures of traffic noise induced sleep disturbance, and very low for all other noise sources and investigated sleep outcomes.

Project description:Introduction: Three recent systematic reviews suggested a relationship between noise exposure and adverse birth outcomes. The aim of this review was to evaluate the evidence for the World Health Organization (WHO) noise guidelines and conduct an updated systematic review of environmental noise, specifically aircraft and road traffic noise and birth outcomes, such as preterm birth, low birth weight, being small for gestational age and congenital malformations. Materials and methods: We reviewed again all the papers on environmental noise and birth outcomes included in the previous three systematic reviews and conducted a systematic search on noise and birth outcomes to update previous reviews. Web of Science, PubMed and Embase electronic databases were searched for papers published between June 2014 (end date of previous systematic review) and December 2016 using a list of specific search terms. Studies were also screened in the reference list of relevant reviews/articles. Further inclusion and exclusion criteria for the studies provided by the WHO expert group were applied. Risk of bias was assessed according to criteria from the Newcastle-Ottawa quality assessment scale for case-control and cohort studies. Finally, we applied the GRADE principles to our systematic review in a reproducible and appropriate way for judgment about quality of evidence. Results: In total, 14 studies are included in this review, six studies on aircraft noise and birth outcomes, five studies (two with more or less the same population) on road traffic noise and birth outcomes and three related studies on total ambient noise that is likely to be mostly traffic noise that met the criteria. The number of studies on environmental noise and birth outcomes is small and the quality of evidence generally ranges from very low to low, particularly in case of the older studies. The quality is better for the more recent traffic noise and birth outcomes studies. As there were too few studies, we did not conduct meta-analyses. Discussion: This systematic review is supported by previous systematic reviews and meta-analyses that suggested that there may be some suggestive evidence for an association between environmental noise exposure and birth outcomes, although they pointed more generally to a stronger role of occupational noise exposure, which tends to be higher and last longer. Very strict criteria for inclusion and exclusion of studies, performance of quality assessment for risk of bias, and finally applying GRADE principles for judgment of quality of evidence are the strengths of this review. We found evidence of very low quality for associations between aircraft noise and preterm birth, low birth weight and congenital anomalies, and low quality evidence for an association between road traffic noise and low birth weight, preterm birth and small for gestational age. Further high quality studies are required to establish such associations. Future studies are recommended to apply robust exposure assessment methods (e.g., modeled or measured noise levels at bedroom façade), disentangle associations for different sources of noise as well as daytime and nighttime noise, evaluate the impacts of noise evens (that stand out of the noise background), and control the analyses for confounding factors, such as socioeconomic status, lifestyle factors and other environmental factors, especially air pollution.

Project description:Background: Hearing loss is defined as worsening of hearing acuity and is usually expressed as an increase in the hearing threshold. Tinnitus, defined as "ringing in the ear", is a common and often disturbing accompaniment of hearing loss. Hearing loss and environmental exposures to noise are increasingly recognized health problems. Objectives: The objective was to assess whether the exposure-response relationship can be established between exposures to non-occupational noise and permanent hearing outcomes such as permanent hearing loss and tinnitus. Methods: Information sources: Computer searches of all accessible medical and other databases (PubMed, Web of Science, Scopus) were performed and complemented with manual searches. The search was not limited to a particular time span, except for the effects of personal listening devices (PLDs). The latter was limited to the years 2008-June 2015, since previous knowledge was summarized by SCENIHR descriptive systematic review published in 2008. Study eligibility criteria: The inclusion criteria were as follows: the exposure to noise was measured in sound pressure levels (SPLs) and expressed in individual equivalent decibel values (LEX,8h), the studies included both exposed and reference groups, the outcome was a permanent health effect, i.e., permanent hearing loss assessed with pure-tone audiometry and/or permanent tinnitus assessed with a questionnaire. The eligibility criteria were evaluated by two independent reviewers. Study appraisal and synthesis methods: The risk of bias was assessed for all of the papers using a template for assessment of quality and the risk of bias. The GRADE (grading of recommendations assessment, development, and evaluation) approach was used to assess the overall quality of evidence. Meta-analysis was not possible due to methodological heterogeneity of included studies and the inadequacy of data. Results: Out of 220 references identified, five studies fulfilled the inclusion criteria. All of them were related to the use of PLDs and comprised in total of 1551 teenagers and young adults. Three studies used hearing loss as the outcome and three tinnitus. There was a positive correlation between noise level and hearing loss either at standard or extended high frequencies in all three of the studies on hearing loss. In one study, there was also a positive correlation between the duration of PLD use and hearing loss. There was no association between prolonged listening to loud music through PLDs and tinnitus or the results were contradictory. All of the evidence was of low quality. Limitations: The studies are cross-sectional. No study provides odds ratios of hearing loss by the level of exposure to noise. Conclusions: While using very strict inclusion criteria, there is low quality GRADE evidence that prolonged listening to loud music through PLDs increases the risk of hearing loss and results in worsening standard frequency audiometric thresholds. However, specific threshold analyses focused on stratifying risk according to clearly defined levels of exposure are missing. Future studies are needed to provide actionable guidance for PLDs users. No studies fulfilling the inclusion criteria related to other isolated or combined exposures to environmental noise were identified.

Project description:ObjectivesTo appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence (LoE), astrength of recommendations (SoR), and consideration of antibiotic stewardship.DesignSystematic review of the literature.Data sourcesThree-pronged search of (1) databases: Medline, Embase, Cochrane library, Guidelines International Network and Trip Medical Database; (2) websites of European national paediatric associations and (3) contact of European experts. Data were collected between January 2017 and February 2018.Eligibility criteriaNational guidelines of European countries for the clinical management of AOM in children aged <16 years.Data extraction and synthesisData were extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. LoE and SoR were compared. Guidelines were assessed for principles of antibiotic stewardship.ResultsAOM guidelines were obtained from 17 or the 32 countries in the European Union or European Free Trade Area. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based on similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15; 93%). The majority (15/17; 88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17; 82%). Recommended treatment duration varied from 5 to 10 days. Seven countries advocated high-dose (75-90 mg/kg/day) and five low-dose (30-60 mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data.ConclusionsGuidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and it often did not refer to country-specific antibiotic resistance patterns. Coordinating efforts to produce a core guideline which can then be adapted by each country may help improve overall quality and contribute to tackling antibiotic resistance.

Dataset Information

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition.

Publications

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition.

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