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.

Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality-A multicenter observational study.

BACKGROUND: Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries. METHODS: We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome. RESULTS: A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25-58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70-79 years age group, while this was observed in the 20-29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]). CONCLUSION: Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.

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.

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.

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.

The impact of aircraft noise exposure on objective parameters of sleep quality: results of the DEBATS study in France.

BACKGROUND: Noise in the vicinity of airports is a public health issue. Exposure to aircraft noise has been shown to have adverse effects on health and particularly on sleep. Many studies support the hypothesis that noise at night can affect subjective sleep quality. Fewer studies, however, have performed objective measurements of sleep. OBJECTIVES: This study aimed to investigate by actigraphy the relationship between aircraft noise exposure and objective parameters of sleep quality in the population living near two French airports. METHODS: This study includes 112 participants living in the vicinity of Paris-Charles de Gaulle and Toulouse-Blagnac airports. Wrist actigraphy measurements were performed during eight nights to evaluate objective parameters of sleep quality such as sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TB) and sleep efficiency (SE). Acoustic measurements were made simultaneously both inside the participants' bedrooms and outside (at the exterior frontage) to estimate aircraft noise levels. Energy indicators related to the sound energetic average for a given period of time, as well as indicators related to noise events (eg, the number of events that exceed a given threshold), were estimated. Logistic and linear regression models were used, taking into account potential confounders: age; gender; marital status; education; and body mass index (BMI). RESULTS: Energy indicators, in particular, indicators related to noise events were significantly associated with objective parameters of sleep quality. Increased levels of aircraft noise and increased numbers of aircraft noise events increased the time required for sleep onset (SOL) and the total wake time after sleep onset (WASO) and decreased sleep efficiency (SE). An association was also observed between aircraft noise exposure and an increase in total sleep time (TST) and time in bed (TB). CONCLUSION: The findings of the present study contribute to the overall evidence suggesting that nocturnal aircraft noise exposure may decrease the objective quality of sleep. Aircraft noise exposure affects objective parameters of sleep quality, not only regarding noise levels but also regarding the number of events. Mechanisms for adapting to sleep deprivation could be observed.

Aircraft Noise and Psychological Ill-Health: The Results of a Cross-Sectional Study in France.

Background: The effects of aircraft noise on psychological ill-health have not been largely investigated and remain to be discussed. No study has been performed in France on the health effects of aircraft noise. Objectives: The present study aimed to investigate the relationship between aircraft noise in dB and in terms of annoyance and psychological ill-health in populations living near airports in France. Methods: A total of 1244 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 about their personal medical history and socioeconomic and lifestyle factors was collected by means of a face-to-face questionnaire performed at their place of residence by an interviewer. Psychological ill-health was evaluated with the 12-item version of the General Heath Questionnaire (GHQ-12). For each participant, outdoor aircraft noise exposure in dB was estimated by linking their home address to noise maps. Objective noise exposure in dB was considered to be the primary exposure of interest. Four noise indicators referring to three different periods of the day were derived and used for the statistical analyses: Lden, LAeq,24hr, LAeq,6hr⁻22hr, and Lnight. Noise annoyance and noise sensitivity were the secondary risk factors of interest. Logistic regression models were used with adjustment for potential confounders. Results: The participation rate in the study was 30%. Approximately 22% of the participants were considered to have psychological ill-health according to the GHQ-12. No direct association was found between exposure to aircraft noise in dB and psychological ill-health. However, annoyance due to aircraft noise and noise sensitivity were both significantly associated with psychological ill-health. Moreover, a gradient was evidenced between annoyance and psychological ill-health, with increasing ORs from 1.79 (95% CI 1.06⁻3.03) for people who were not all annoyed to 4.00 (95% CI 1.67⁻9.55) for extremely annoyed people.Conclusions: These findings confirm the results of previous studies, suggesting there is no direct association between aircraft noise exposure in dB and psychological ill-health, but there is a significant relationship between noise sensitivity or annoyance due to aircraft noise and psychological ill-health. This supports the hypothesis that psychological aspects, such as noise annoyance and noise sensitivity, play important roles in the association between environmental noise and adverse effects on health. However, further studies are necessary in order to better understand the links between these variables.

Cannabis, alcohol and fatal road accidents.

INTRODUCTION: This research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates), and to compare the results to a similar study carried out in France between 2001 and 2003. METHODOLOGY: Police procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general. RESULTS: The proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4-2.8) and under the influence of cannabis at 3.4% (2.9%-3.9%). Drivers under the influence of alcohol are 17.8 times (12.1-26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%). Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16-2.34), and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%). An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed. CONCLUSION: Almost a decade separates the present study from a similar one previously conducted in France, and there have been numerous developments in the intervening years. Even so, the prevalence of drivers responsible for causing fatal accidents under the influence of alcohol or narcotics has stayed remarkably stable, as have the proportion of fatal accidents which could in theory be prevented if no drivers ever exceeded the legal limits. The overall number of deaths from traffic accidents has dropped sharply during this period, and the number of victims attributable to alcohol and/or cannabis declined proportionally. Alcohol remains the main problem in France. It is just as important to note that one in two drivers considered to be under the influence of cannabis was also under the influence of alcohol. With risks cumulating between the two, it is particularly important to point out the danger of consuming them together.

Effects of aircraft noise exposure on saliva cortisol near airports in France.

BACKGROUND: Saliva cortisol is a possible marker of noise-induced stress and could then mediate the relation observed between exposure to aircraft or road traffic noise and cardiovascular diseases. However, the association between transportation noise and cortisol levels is still unclear. The objective of the study was to investigate the variability of saliva cortisol concentration as an indicator of disturbed hypothalamus-pituitary-adrenal (HPA) axis regulation in relation to long-term aircraft noise exposure. METHODS: Saliva samples were taken when awakening and before going to bed for 1244 participants older than 18 years of age. Information about health, socioeconomic and lifestyle factors was also collected by means of a face-to-face questionnaire performed at home by an interviewer. Aircraft noise exposure was assessed for each participant's home address using noise maps. Linear regression models were used to evaluate the effects of aircraft noise exposure on the morning and evening cortisol levels and on the daily variation of cortisol per hour. RESULTS: This study suggests a modification of the cortisol circadian rhythm in relation to aircraft noise exposure. This exposure was associated with a smaller variation of cortisol levels over the day, with unchanged morning cortisol levels, but higher cortisol levels in the evening. CONCLUSIONS: These findings provide some support for a psychological stress induced by aircraft noise exposure, resulting in HPA dysregulation and a flattened cortisol rhythm, thus contributing to cardiovascular diseases.

Gender effect on driving cessation in pre-dementia and dementia phases: results of the 3C population-based study.

OBJECTIVES: Aging entails deterioration in sensory, physical, and cognitive functions, raising doubt in the driving capacity of older drivers, especially when the deficits are severe, as in dementia. Many older drivers, especially women, adapt their driving habits in order to compensate for these deficits and eventually stop driving. The present prospective study assessed driving cessation in men and women throughout the dementia process, including a 2-year pre-dementia phase. METHODS: The study was based on a three-city cohort of subjects who were aged 65 years and older in 2000 and followed for more than 10 years. Active dementia detection was conducted at each follow-up. The probability of driving cessation was assessed in men and women during the 2-year pre-dementia phase and until 5 years after diagnosis. RESULTS: In the 2-year pre-dementia phase, both men and women ceased driving earlier than drivers with no central nervous system pathology (p < 0,001), and women ceased driving earlier than men. A total of 45% of men and 74% of women had already ceased driving at dementia diagnosis. In contrast, the probability of cessation within 3 years after diagnosis was similar between men and women. CONCLUSION: The study showed that, in this French urban population, few demented drivers, especially women, were still driving after diagnosis. Those who continued to drive 3 years after the diagnosis all had Alzheimer-type dementia. There is certainly a need for physicians to help these drivers to adapt their driving activity to their deficits and to prepare them to stop driving. Copyright © 2016 John Wiley & Sons, Ltd.

Does aircraft noise exposure increase the risk of hypertension in the population living near airports in France?

OBJECTIVES: The largest study until now around 6 major European airports, the HYENA (HYpertension and Exposure to Noise near Airports) study, reported an excess risk of hypertension related to long-term aircraft noise exposure. The DEBATS (Discussion on the health effects of aircraft noise) study investigated the relationship between this exposure and the risk of hypertension in men and in women near French airports. METHODS: Blood pressure of 1244 participants older than 18 years of age was measured. Information about health, socioeconomic and lifestyle factors was collected by means of a face-to-face questionnaire performed at home by an interviewer. Aircraft noise exposure was assessed for each participant's home address using noise maps. They were calculated with the Integrated Noise Model with a 1 dB(A)-resolution. The major potential confounders being risk factors for hypertension were included in the logistic regression models: age, occupational activity, body mass index, physical activity and alcohol consumption. RESULTS: After adjustment for the main potential confounders, an exposure-response relationship was evidenced between the risk of hypertension and aircraft noise exposure at night for men only. A 10-dB(A) increase in Lnight was associated with an OR of 1.34 (95% CI 1.00 to 1.97). CONCLUSIONS: These findings contribute to the overall evidence suggesting that aircraft noise exposure at night-time may increase the risk of hypertension in men. Hypertension is a well-known and established risk factor for cardiovascular disease. The association reported in the present study between aircraft noise and hypertension implies that aircraft noise might be a risk factor also for cardiovascular disease.

Does exposure to aircraft noise increase the mortality from cardiovascular disease in the population living in the vicinity of airports? Results of an ecological study in France.

The impact of aircraft noise on health is of growing concern. We investigated the relationship between this exposure and mortality from cardiovascular disease, coronary heart disease, myocardial infarction, and stroke. We performed an ecological study on 161 communes (commune being the smallest administrative unit in France) close to the following three major French airports: Paris-Charles de Gaulle, Lyon Saint-Exupéry, and Toulouse-Blagnac. The mortality data were provided by the French Center on Medical Causes of Death for the period 2007-2010. Based on the data provided by the French Civil Aviation Authority, a weighted average exposure to aircraft noise (L den AEI) was computed at the commune level. A Poisson regression model with commune-specific random intercepts, adjusted for potential confounding factors including air pollution, was used to investigate the association between mortality rates and L den AEI. Positive associations were observed between L den AEI and mortality from cardiovascular disease [adjusted mortality rate ratio (MRR) per 10 dB(A) increase in L den AEI = 1.18; 95% confidence interval (CI): 1.11-1.25], coronary heart disease [MRR = 1.24 (1.12-1.36)], and myocardial infarction [MRR = 1.28 (1.11-1.46]. Stroke mortality was more weakly associated with L den AEI [MRR = 1.08 (0.97-1.21]. These significant associations were not attenuated after the adjustment for air pollution. The present ecological study supports the hypothesis of an association between aircraft noise exposure and mortality from cardiovascular disease, coronary heart disease, and myocardial infarction. However, the potential for ecological bias and the possibility that this association could be due to residual confounding cannot be excluded.

Complaints of Poor Sleep and Risk of Traffic Accidents: A Population-Based Case-Control Study.

INTRODUCTION: This study aimed to determine the sleepiness-related factors associated with road traffic accidents. METHODS: A population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents. RESULTS: As expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57-63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30-8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00-2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03-3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14-9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents. CONCLUSION: Physicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers.

Automobile driving in older adults: factors affecting driving restriction in men and women.

OBJECTIVES: To identify factors associated with driving restriction in elderly men and women. DESIGN: Prospective cohort study of French drivers from 2003 to 2009. SETTING: The Three-City Cohort of Bordeaux, a prospective study of 2,104 people aged 65 and older. PARTICIPANTS: Five hundred twenty-three drivers with a mean age of 76 (273 male, 250 female). MEASUREMENTS: Sociodemographic characteristics, driving habits, health variables, cognitive evaluation and dementia diagnosis. Predementia was defined as no dementia at one follow-up and dementia at the next follow-up. RESULTS: Over the 6-year period, 54% of men and 63% of women stopped driving or reduced the distance they drove. Predementia, Parkinson's disease, older age, and a high number of kilometers previously driven were common restriction factors in both sexes. Prevalent dementia, depressive symptomatology, a decline in one or more instrumental activities of daily living, and poor visual working memory were specific factors in men. In women, low income, fear of falling, slow processing speed, and severe decline in global cognitive performance all affected driving restriction. CONCLUSION: Older women restricted their driving activity more than older men, regardless of the number of kilometers previously driven, physical health, and cognitive status. Factors affecting driving restriction differed according to sex, and women were more likely to stop driving than men in the period preceding a dementia diagnosis.

Long-term chronic diseases and crash responsibility: a record linkage study.

OBJECTIVE: To assess the population impact of chronic conditions on the risk of road traffic crashes. METHODS: Data from three French national databases were extracted and matched: the national health care insurance database, police reports and the national police database of injurious crashes. Exposure to chronic conditions were compared between responsible and nonresponsible drivers. Analysis was performed using the Lasso (least absolute shrinkage and selection operator) method. RESULTS: 69,630 drivers involved in an injurious crash in France between 2005 and 2008, were included. 6210 (8.9%) were suffering from at least one long-term disease. When adjusted for prescription of medicines, blood alcohol, demographic driver characteristics and crash characteristics, increased risk of being responsible for a crash was found in drivers registered in the French healthcare database with the following long-term diseases: epilepsy (odds ratio [OR]=2.53 [1.53-4.20]), type 1 diabetes (OR=1.47) [1.12-1.92], alcoholic liver disease (OR=3.37 [1.40-8.13]), asthma (OR=1.72 [1.13-2.60]) and specific personality disorders (OR=1.35 [1.05-1.74]). No association was found for cardiovascular diseases or Alzheimer's disease. CONCLUSION: The results update the list of medical conditions that may impair driving skills. However, results should be considered cautiously with regards to potential regulatory driving judgments that could have a negative impact on patients' social life.