Consent for interventions during childbirth: A national population-based study.

OBJECTIVE: To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. METHODS: The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. RESULTS: Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). CONCLUSION: Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.

Effects of aircraft noise exposure on self-reported health through aircraft noise annoyance: Causal mediation analysis in the DEBATS longitudinal study in France.

BACKGROUND: Previous studies reported an association between transportation noise and self-reported health status (SRHS). They also suggested a mediating role of noise annoyance using conventional statistical methods. These methods are subject to bias in longitudinal studies with time-dependent exposure, mediator and confounding factors. This study aims to investigate the mediating role of aircraft noise annoyance in the effect of aircraft noise on SRHS using a causal inference approach to address time-dependent variables issues. METHODS: We used data from 881 participants in all three visits in the DEBATS longitudinal study conducted around three French airports. Participants over 18 years of age reported their self-perceived health status, aircraft noise annoyance, and noise sensitivity by completing a questionnaire at three visits in 2013, 2015 and 2017. Noise maps were used to estimate aircraft noise levels outside their homes. Marginal structural models with inverse probability weighting were used to estimate the total effect of aircraft noise levels on SRHS and its decomposition into direct and indirect effect through aircraft noise annoyance. RESULTS: This study showed a deleterious effect of aircraft noise on SRHS. The odds ratio (OR) corresponding to the total effect and comparing the highest aircraft noise category (≥60 dBA) to the reference category (<50 dBA) was significant (ORpoor/fair_SHRS = 1.25 (95%CI: 1.06 to 2.08)). It also showed no direct effect of aircraft noise levels on SRHS, but an indirect effect through annoyance. This indirect effect increased as aircraft noise levels increased, with a statistically significant OR when comparing the highest noise category (≥60 dBA) to the lowest (<50 dBA) (ORpoor/fair_SHRS = 1.16 (95%CI: 1.03 to 1.52)). Nearly 66% of aircraft noise's effect on SRHS was mediated by aircraft noise annoyance. CONCLUSION: This study supports the deleterious causal effect of aircraft noise on SRHS. The results highlight the important mediating role of aircraft noise annoyance in the causal pathway from exposure to aircraft noise to poor/fair SRHS.

Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units.

Objectives: We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time. Methods: We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019). Results: We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01). Conclusion: Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.

The Role of Noise Annoyance and Noise Sensitivity in the Effect of Aircraft Noise on Self-Reported Health: The Results of the DEBATS Longitudinal Study in France.

Background: Transportation noise seems to impair self-reported health status (SRHS). However, only a few studies have considered the role of noise annoyance and noise sensitivity in this deleterious effect. This study aims investigating mediator and moderator roles of noise annoyance and noise sensitivity. Methods: In 2013, the DEBATS longitudinal study included 1244 participants aged over 18 years and living around three French airports. These participants were followed up in 2015 and 2017. They self-reported their perceived health status, aircraft noise annoyance, and their noise sensitivity via a questionnaire during the three visits. Noise maps were used to estimate aircraft noise levels at the facade of participants' residence. Generalized linear mixed models with a random intercept at the participant level were used. Results: Aircraft noise levels were associated with severe annoyance. Severe annoyance tent to be associated with impaired SRHS. Aircraft noise levels were associated with impaired SRHS only in men (odds ratio [OR] = 1.47, 95% confidence interval [CI] = [1.02, 2.11], for a 10-dBA Lden increase in aircraft noise levels) with a weaker association adjusted for annoyance (OR = 1.36, 95% CI = [0.94, 1.98]). The association was stronger in men who reported high noise sensitivity (OR = 1.84, 95% CI = [0.92, 3.70], versus OR = 1.39, 95% CI = [0.90, 2.14], for men who were not highly sensitive to noise). Conclusion: From our results, the deleterious effect of aircraft noise on SRHS could be mediated by noise annoyance and moderated by noise sensitivity. Further studies using causal inference methods are needed for identifying causal effect of exposure, mediator, and moderator.

A natural experiment to assess how urban interventions in lower socioeconomic areas influence health behaviors: the UrbASanté study.

BACKGROUND: Mechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach. METHODS: The study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference-in-differences method). DISCUSSION: Relying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies. TRIAL REGISTRATION: This research was registered at the ClinicalTrial.gov (NCT05743257).

Intervention during the Perinatal Period: Synthesis of the Clinical Practice Guidelines from the French National College of Midwives.

These clinical practice guidelines from the French National College of Midwives (CNSF) are intended to define the messages and the preventive interventions to be provided to women and co-parents by the different professionals providing care to women or their children during the perinatal period. These guidelines are divided into 10 sections, corresponding to 4 themes: 1/ the adaptation of maternal behaviors (physical activity, psychoactive agents); 2/ dietary behaviors; 3/ household exposure to toxic substances (household uses, cosmetics); 4/ promotion of child health (breastfeeding, attachment and bonding, screen use, sudden unexplained infant death, and shaken baby syndrome). We suggest a ranking to prioritize the different preventive messages for each period, to take into account professionals' time constraints.

Incident hypertension in relation to aircraft noise exposure: results of the DEBATS longitudinal study in France.

BACKGROUND: Although several cross-sectional studies have shown that aircraft noise exposure was associated with an increased risk of hypertension, a limited number of longitudinal studies have addressed this issue. This study is part of the DEBATS (Discussion on the health effect of aircraft noise) research programme and aimed to investigate the association between aircraft noise exposure and the incidence of hypertension. METHODS: In 2013, 1244 adults living near three major French airports were included in this longitudinal study. Systolic and diastolic blood pressure, as well as demographic and lifestyle factors, were collected at baseline and after 2 and 4 years of follow-up during face-to-face interviews. Exposure to aircraft noise was estimated for each participant's home address using noise maps. Statistical analyses were performed using mixed Poisson and linear regression models adjusted for potential confounding factors. RESULTS: A 10 dB(A) increase in aircraft noise levels in terms of Lden was associated with a higher incidence of hypertension (incidence rate ratio (IRR)=1.36, 95% CI 1.02 to 1.82). The association was also significant for Lday (IRR 1.41, 95% CI 1.07; to 1.85) and Lnight (IRR 1.31, 95% CI 1.01 to 1.71). Systolic and diastolic blood pressure increased with all noise indicators. CONCLUSION: These results strengthen those obtained from the cross-sectional analysis of the data collected at the time of inclusion in DEBATS, as well as those from previous studies conducted in other countries. Hence, they support the hypothesis that aircraft noise exposure may be considered as a risk factor for hypertension.

Pooling and Comparing Noise Annoyance Scores and "High Annoyance" (HA) Responses on the 5-Point and 11-Point Scales: Principles and Practical Advice.

The use of different noise annoyance scales across studies and socio-acoustic surveys, in particular the popular 5-point verbal and 11-point numerical scales, has made the evaluation, comparison, and pooling of noise annoyance responses among studies a taxing issue. This is particularly the case when "high annoyance" (HA) responses need to be compared and when the original studies used different scales; thus, there are different so-called cutoff points that define the part of the scale that indicates the HA status. This paper provides practical guidance on pooling and comparing the respective annoyance data in both the linear and logistic regression context in a statistically adequate manner. It caters to researchers who want to carry out pooled analyses on annoyance data that have been collected on different scales or need to compare exposure-HA relationships between the 5-point and 11-point scales. The necessary simulation of a cutoff point non-native to an original scale can be achieved with a random assignment approach, which is exemplified in the paper using original response data from a range of recent noise annoyance surveys. A code example in the R language is provided for easy implementation of the pertinent procedures with one's own survey data. Lastly, the not insignificant limitations of combining and/or comparing responses from different noise annoyance scales are discussed.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use: results of a pooled-analysis from seven European countries.

BACKGROUND: Few studies have considered aircraft noise annoyance and noise sensitivity in analyses of the health effects of aircraft noise, especially in relation to medication use. This study aims to investigate the moderating and mediating role of these two factors in the relationship between aircraft noise levels and medication use among 5860 residents of ten European airports included in the HYENA and DEBATS studies. METHODS: Information on aircraft noise annoyance, noise sensitivity, medication use, and demographic, socio-economic and lifestyle factors was collected during a face-to-face interview at home. Medication was coded according to the Anatomical Therapeutic Chemical (ATC) classification. Outdoor aircraft noise exposure was estimated by linking the participant's home address to noise contours using Geographical Information Systems (GIS) methods. Logistic regressions with adjustment for potential confounding factors were used. In addition, Baron and Kenny's recommendations were followed to investigate the moderating and mediating effects of aircraft noise annoyance and noise sensitivity. RESULTS: A significant association was found between aircraft noise levels at night and antihypertensive medication only in the UK (OR = 1.43, 95%CI 1.19-1.73 for a 10 dB(A)-increase in Lnight). No association was found with other medications. Aircraft noise annoyance was significantly associated with the use of antihypertensive medication (OR = 1.33, 95%CI 1.14-1.56), anxiolytics (OR = 1.48, 95%CI 1.08-2.05), hypnotics and sedatives (OR = 1.60, 95%CI 1.07-2.39), and antasthmatics (OR = 1.44, 95%CI 1.07-1.96), with no difference between countries. Noise sensitivity was significantly associated with almost all medications, with the exception of the use of antasthmatics, showing an increase in ORs with the level of noise sensitivity, with differences in ORs among countries only for the use of antihypertensive medication. The results also suggested a mediating role of aircraft noise annoyance and a modifying role of both aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and medication use. CONCLUSIONS: The present study is consistent with the results of the small number of studies available to date suggesting that both aircraft noise annoyance and noise sensitivity should be taken into account in analyses of the health effects of exposure to aircraft noise.

Self-rated health status in relation to aircraft noise exposure, noise annoyance or noise sensitivity: the results of a cross-sectional study in France.

BACKGROUND: Noise is a major public health issue because of its negative impacts on health, including annoyance, sleep disturbance, cardiovascular diseases and altered cognitive performance among children. Self-rated health status (SRHS) can be considered as a reliable indicator of quality of life, morbidity and mortality but few studies have considered SRHS in relation to aircraft noise exposure. The present study aims to investigate the association between this exposure and SRHS of people living near airports in France, and to consider the mediating or moderating role of aircraft noise annoyance and noise sensitivity in this association. METHODS: This cross-sectional study included 1242 participants older than 18 and living near three major French airports. Information on their SRHS, aircraft noise annoyance, noise sensitivity and demographic, socioeconomic and lifestyle factors was collected during a face-to-face interview performed at home. Outdoor aircraft noise levels were estimated for each participant's home address using noise maps. Logistic regressions with adjustment for potential confounders were used. The moderating and mediating effects of aircraft noise annoyance and noise sensitivity were investigated following Baron and Kenny's recommendations. RESULTS: A significant association was shown between aircraft noise levels and a fair/poor SRHS, only in men (OR=1.55, 95%CI 1.01-2.39, for a 10 dB(A)-increase in Lden). This relationship was higher in men highly sensitive to noise (OR=3.26, 95%CI 1.19-8.88, for a 10 dB(A)-increase in Lden). Noise sensitivity was associated with a fair/poor SRHS significantly in women (OR=1.74, 95%CI 1.12-2.68) and at the borderline of significance in men (OR=1.68, 95% CI 0.94-3.00), whereas aircraft noise annoyance was associated with a fair/poor SRHS only in men (OR=1.81, 95%CI 1.00-3.27). CONCLUSION: The present study confirms findings in the small number of available studies to date suggesting a positive association between aircraft noise levels and a fair/poor SRHS. These results also support the hypothesis that noise sensitivity would moderate this association. However, a mediating effect of annoyance cannot be excluded.

Quantification of Sound Exposure from Wind Turbines in France.

The WHO guidelines on environmental noise highlight that evidence on the health effects of wind turbine sound levels is either non-existent or of poor quality. In this context, a feasibility study was conducted in France in 2017. The objective was to suggest a methodology for calculating wind turbine sound levels in order to quantify the number of windfarms' residents exposed to this sound. Based on a literature review, the Harmonoise model was selected for sound exposure calculation. It was validated by quantifying its uncertainties, and finally used to estimate the population exposed to wind turbine sound in metropolitan France. Compared to other environmental noise sources (e.g., transportation), sound exposure is very moderate, with more than 80% of the exposed people exposed to sound levels below 40 dBA. The total number of people exposed to more than 30 dBA is about 686,000 and 722,000 people for typical daytime and night-time meteorological conditions respectively, i.e., about 1% of the French population in 2017. These results represent the first ever assessment of sound exposure from wind turbines at the scale of the entire metropolitan France.

Health disturbances and exposure to radiofrequency electromagnetic fields from mobile-phone base stations in French urban areas.

The effects of radiofrequency exposure on the health of people living near mobile-phone base stations (MPBSs) have been the subject of several studies since the mid-2000s, with contradictory results. We aimed to investigate the association between measured exposure to radiofrequency electromagnetic fields (RF-EMF) from MPBSs and the presence of self-reported non-specific and insomnia-like symptoms. A cross-sectional survey conducted between 2015 and 2017 in five large cities in France involved 354 people living in buildings located at a distance of 250 m or less from an MPBS and in the main transmit beam of the antennas. Information on environmental concerns, anxiety, and non-specific and insomnia-like symptoms was collected with a questionnaire administrated by telephone. A complete broadband field-meter measurement [100 kHz - 6 GHz] was then made at five points of each dwelling, followed by a spectral analysis at the point of highest exposure, detailing the contribution of each service, including MPBS. The median exposure from MPBS was 0.27 V/m (0.44 V/m for global field), ranging from 0.03 V/m to 3.58 V/m, MPBSs being the main source of exposure for 64% of the dwellings. In this study population, the measured exposure from MPBSs was not associated with self-reported non-specific or insomnia-like symptoms. However, for insomnia-like symptoms, a significant interaction was found between RF-EMF exposure from MPBSs and environmental concerns. These findings do not support the hypothesis of an effect of RF-EMF from MPBSs on non-specific or insomnia-like symptoms in the overall population. Studies are needed to further investigate the positive association observed between exposure from MPBSs and insomnia-like symptoms among people reporting environmental concerns.

Radiofrequency exposure of people living near mobile-phone base stations in France.

In response to the demand from a growing number of people concerned about the possible impact of RF-EMF on health, the French National Frequency Agency (ANFR) has published a standardized protocol for in-situ measurements of radiofrequency electromagnetic fields (RF-EMF). This protocol was based on the search for the point of highest field strength and the use of spot measurement. In the framework of an epidemiological study, such spot measurements were implemented in the homes of 354 participants located in urban areas within 250 m of a mobile-phone base station (MPBS) and in the main beam direction of the antenna. Among the participants, more than half accepted to be enrolled in a longer-term study, among whom 152 were equipped with a personal exposure meter (PEM) for 48 h and 40 for seven continuous days. Both spot and PEM measurements quantified downlink field strengths, i.e. FM, TV3-4-5, TETRA I-II-III, 2 GHz-5GHz Wi-Fi, WiMax, GSM900, GSM1800, UMTS900, UMTS 2100, LTE800, LTE1800, and LTE2600. Spot measurements showed a mean/median field strength of 0.58/0.44 V/m for total RF-EMF and 0.43/0.27 V/m from the MPBS. RF-EMF from the MPBS was the dominant source of exposure in 64% of households. Exposure to RF-EMF was influenced by the position of the windows with respect to the MPBS, in particular line-of-site visibility, the distance of the antenna and the floor of the apartment. The PEM surveys showed the measured exposure to be higher during outings than at home and during the day than at night, but there was no difference between the weekends and working days. There was a strong correlation between exposure quantified by both spot and PEM measurements, although spot measures were approximately three times higher than those by PEMs. This study is the first to assess exposure to RF-EMF of people living near a MPBS in urban areas in France. These preliminary results suggest the value of using spot measurements to estimate the impact of the evolution of the mobile-phone network and technology on the exposure of populations to RF-EMF. The low levels of RF-RMF expressed as mean values do not necessarily rule out possible health effects of this exposure.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and hypertension risk: Results of a pooled analysis from seven European countries.

INTRODUCTION: Many studies, including the HYENA and the DEBATS studies, showed a significant association between aircraft noise exposure and the risk of hypertension. Few studies have considered aircraft noise annoyance and noise sensitivity as factors of interest, especially in relation to hypertension risk, or as mediating or modifying factors. The present study aims 1) to investigate the risk of hypertension in relation to aircraft noise annoyance or noise sensitivity; and 2) to examine the role of modifier or mediator of these two factors in the association between aircraft noise levels and the risk of hypertension. METHODS: This study included 6,105 residents of ten European airports from the HYENA and DEBATS studies. Information on aircraft noise annoyance, noise sensitivity, and demographic, socioeconomic and lifestyle factors was collected during an interview performed at home. Participants were classified as hypertensive if they had either blood pressure levels above the WHO cut-off points or physician-diagnosed hypertension in conjunction with the use of antihypertensive medication. Outdoor aircraft noise exposure was estimated for each participant's home address. Poisson regression models with adjustment for potential confounders were used. Interactions between noise exposure and country were tested to consider possible differences between countries. RESULTS: An increase in aircraft noise levels at night was weekly but significantly associated with an increased risk of hypertension (RR = 1.03, 95% CI 1.01-1.06 for a 10-dB(A) increase in Lnight). A significant association was found between aircraft noise annoyance and hypertension risk (RR = 1.06, 95%CI 1.00-1.13 for highly annoyed people compared to those who were not highly annoyed). The risk of hypertension was slightly higher for people highly sensitive to noise compared to people with low sensitivity in the UK (RR = 1.29, 95%CI 1.05-1.59) and in France (RR = 1.11, 95%CI 0.68-1.82), but not in the other countries. The association between aircraft noise levels and the risk of hypertension was higher among highly sensitive participants (RR = 1.00, 95%CI 0.96-1.04; RR = 1.03, 95%CI 0.90-1.11; RR = 1.12, 95%CI 1.01-1.24, with a 10-dB(A) increase in Lnight for low, medium, and high sensitive people respectively) or, to a lesser extent, among highly annoyed participants (RR = 1.06, 95%CI 0.95-1.18 for a 10-dB(A) increase in Lnight among highly annoyed participants, and RR = 1.02, 95%CI 0.99-1.06 among those not highly annoyed). CONCLUSIONS: The present study confirms findings in the small number of available studies to date suggesting adverse health effects associated with aircraft noise annoyance and noise sensitivity. The findings also indicate possible modifier effects of aircraft noise annoyance and noise sensitivity in the relationship between aircraft noise levels and the risk of hypertension. However, further investigations are needed to better understand this role using specific methodology and tools related to mediation analysis and causal inference.

Understanding the relationship between air traffic noise exposure and annoyance in populations living near airports in France.

Since the 2000s, increased aircraft noise annoyance has been observed in the populations living near airports. The DEBATS-study compared the exposure-response relationship estimated among airports' residents in France with old and new EU standard curves. It also examines whether non-acoustical factors may explain this annoyance. For 1244 adults living near three French airports, information about demographic and socio-economic factors as well as aircraft noise annoyance, situational, personal and attitudinal factors was collected with a face-to-face questionnaire. Outdoor aircraft noise exposure was estimated by linking home address to noise exposure maps. Logistic regression models were used to investigate the association between annoyance and a broad range of other variables in addition to the Lden. Severe noise annoyance was associated not only with increased aircraft noise levels, but also with non-acoustical factors. Annoyance was higher than predicted by the old EU standard curve when estimated with the model including non-acoustical factors in addition to the Lden. It was even higher when only noise exposure was considered. However, annoyance was lower in DEBATS than predicted by the new EU standard curve provided by WHO. The increase of noise annoyance does not seem to be explained by the factors already mentioned in the literature as possible explanations. However, it cannot be ruled out that methodological differences in the HA assessment may be the reason for changes in annoyance over the years. For this reason, we argue for a definition of HA derived substantially as recommended by ICBEN. The findings of the DEBATS study also confirm that taking into account non-acoustical factors such as situational, personal and attitudinal factors would improve annoyance predictions.

Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries.

BACKGROUND: Many studies have demonstrated adverse effects of exposure to aircraft noise on health. Possible biological pathways for these effects include hormonal disturbances. Few studies deal with aircraft noise effects on saliva cortisol in adults, and results are inconsistent. OBJECTIVE: We aimed to assess the effects of aircraft noise exposure on saliva cortisol levels and its variation in people living near airports. METHODS: This study focused on the 1300 residents included in the HYENA and DEBATS cross-sectional studies, with complete information on cortisol sampling. All the participants followed a similar procedure aiming to collect both a morning and an evening saliva cortisol samples. Socioeconomic and lifestyle information were obtained during a face-to-face interview. Outdoor aircraft noise exposure was estimated for each participant's home address. Associations between aircraft noise exposure and cortisol outcomes were investigated a priori for male and female separately, using linear regression models adjusted for relevant confounders. Different approaches were used to characterize cortisol levels, such as morning and evening cortisol concentrations and the absolute and relative variations between morning and evening levels. RESULTS: Statistically significant increases of evening cortisol levels were shown in women with a 10-dB(A) increase in aircraft noise exposure in terms of LAeq, 16h (exp(ß) = 1.08; CI95% = 1.00-1.16), Lden (exp(ß) = 1.09; CI95% = 1.01-1.18), Lnight (exp(ß) = 1.11; CI95% = 1.02-1.20). A statistically significant association was also found in women between a 10-dB(A) increase in terms of Lnight and the absolute variation per hour (exp(ß) = 0.90; CI95% = 0.80-1.00). Statistically significant decreases in relative variation per hour were also evidenced in women, with stronger effects with the Lnight (exp(ß) = 0.89; CI95% = 0.83-0.96) than with other noise indicators. The morning cortisol levels were unchanged whatever noise exposure indicator considered. There was no statistically significant association between aircraft noise exposure and cortisol outcomes in men. CONCLUSIONS: The results of the present study show statistically significant associations between aircraft noise exposure and evening cortisol levels and related flattening in the (absolute and relative) variations per hour in women. Further biological research is needed to deepen knowledge of the pathway between noise exposure and disturbed hormonal regulation, and specially the difference in effects between genders.

Effects of Aircraft Noise Exposure on Heart Rate during Sleep in the Population Living Near Airports.

Background Noise in the vicinity of airports is a public health problem. Many laboratory studies have shown that heart rate is altered during sleep after exposure to road or railway noise. Fewer studies have looked at the effects of exposure to aircraft noise on heart rate during sleep in populations living near airports. Objective The aim of this study was to investigate the relationship between the sound pressure level (SPL) of aircraft noise and heart rate during sleep in populations living near airports in France. Methods In total, 92 people living near the Paris-Charles de Gaulle and Toulouse-Blagnac airports participated in this study. Heart rate was recorded every 15 s during one night, using an Actiheart monitor, with simultaneous measurements of SPL of aircraft noise inside the participants' bedrooms. Energy and event-related indicators were then estimated. Mixed linear regression models were applied, taking into account potential confounding factors, to investigate the relationship between energy indicators and heart rate during sleep measured every 15 s. Event-related analyses were also carried out in order to study the effects of an acoustic event associated with aircraft noise on heart rate during sleep. Results The more the SPL from all sources (LAeq,15s) and the SPL exceeded for 90% of the measurement period (LA90,15s) increased, the more heart rate also increased. No significant associations were observed between the maximum 1-s equivalent SPL associated with aircraft overflight (LAmax,1s) and differences between the heart rate recorded during or 15 or 30 s after an aircraft noise event and that recorded before the event. On the other hand, a positive and significant association was found between LAmax,1s and the heart rate amplitude calculated during an aircraft noise event. Results were unchanged when analyses were limited to participants who had lived more than five years in their present dwelling. Conclusion Our study shows that exposure to the maximum SPL linked to aircraft overflight affect the heart rate during sleep of residents near airports. However, further studies on a larger number of participants over several nights are needed to confirm these results.

Aircraft Noise Exposure and Subjective Sleep Quality: The Results of the DEBATS Study in France.

Background: Exposure to aircraft noise has been shown to have adverse effects on health, particularly on sleep. Exposure to nighttime aircraft noise clearly affects sleep architecture, as well as subjective sleep quality. Objectives: This study aimed to investigate the relationship between aircraft noise exposure and subjective sleep quality in the population living near airports in France. Methods: A total of 1,244 individuals older than 18 and living near three French airports (Paris-Charles de Gaulle, Lyon-Saint-Exupéry, and Toulouse-Blagnac) were randomly selected to participate in the study. Information on sleep as well as health, socioeconomic, and lifestyle factors was collected by means of a face-to-face questionnaire performed at their place of residence by an interviewer. For each participant, aircraft noise exposure was estimated at home using noise maps. Logistic regression models were used with adjustment for potential confounders. Results: Aircraft noise exposure was significantly associated with a short total sleep time (TST; ≤ 6 h) and with the feeling of tiredness while awakening in the morning. An increase of 10 dB(A) in aircraft noise level at night was associated with an OR of 1.63 (95% CI: 1.15-2.32) for a short TST and an OR of 1.23 (95% CI: 1.00-1.54) for the feeling of tiredness while awakening in the morning. Conclusions: These findings contribute to the overall evidence suggesting that aircraft noise exposure at nighttime may decrease the subjective amount and quality of sleep.