Childhood sound disturbance and sleep problems in Alpine valleys with high levels of traffic exposures and greenspace.

Sound disturbance and sleep problems are regarded as the most common adverse effects of environmental noise but evidence of the role of air pollution and greenspace is scant. This is especially true for children who find themselves in a sensitive developmental period and experience their environment differently than adults. This study examined the joint effects of traffic exposures and residential greenspace on child sound disturbance and sleep problems via perceptions of neighborhood quality. We used cross-sectional data for 1251 schoolchildren (8-12 years) in the Tyrol region of Austria/Italy. Questionnaires provided information on sociodemographic and housing factors, perceived neighborhood quality, sound disturbance in different situations, and sleep problems. Modelled acoustic indicators included day-evening-night sound levels and the highest percentile level, and night-time sound level and a bespoke sleep disturbance index. Nitrogen dioxide served as a proxy for traffic-related air pollution. The normalized difference vegetation index was calculated as a measure of residential greenspace, and presence of a domestic garden was self-reported. Results showed that higher level of traffic-related exposures was positively associated with sound disturbance and sleep problems, while living in a greener area, especially in a house with a garden, was associated with lower sound disturbance and less sleep problems even in the presence of traffic. Traffic exposures contributed to more unfavorable, and greenspace to more positive perceptions in terms of traffic-related stressors, opportunities for outdoor recreation, and general satisfaction with the neighborhood. This indirect path seemed more important for greenspace than for traffic exposures. In conclusion, it seems advantageous to combine traffic-related mitigation with improving access to greenspace in interventions for supporting the acoustic comfort of children during day and nighttime. Even highly nature-dominated environments could still benefit from proximal green infrastructure, especially from domestic gardens.

Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity.

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.

Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities.

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Natural and built environments and blood pressure of Alpine schoolchildren.

BACKGROUND: Early life environments may influence children's blood pressure (BP), but evidence on the combined effects of natural and built environment exposures is scarce. The present study investigates the associations of natural and built environment indicators, traffic noise, and air pollution with BP in children living in Alpine valleys. METHODS: In 2004/2005, 1251 school children (8-12 years old) were sampled for a cross-sectional survey in several Austrian and Italian mountain valleys. Children's mothers completed a questionnaire. The outcomes of interest were systolic and diastolic BP measured with a calibrated oscillometric device. Indicators of land cover assigned to the residential and school coordinates within 100 and 1000 m included normalized difference vegetation index (NDVI), tree canopy cover, and a broader naturalness indicator titled distance to nature (D2N). The presence of a home garden was also measured via self-report. Imperviousness density served as a proxy for the built environment. Residential air pollution (NO2) and noise (Lden) from traffic were calculated using bespoke modeling. NO2, Lden, physical activity, and body mass index (BMI) were treated as mediating pathways. RESULTS: Higher NDVI and tree cover levels in residential and school surroundings and home gardens were consistently associated with lower BP. The built environment was associated with higher BP. Counterintuitive inverse associations between NO2 and Lden and BP were also found. Structural equation modeling showed that higher levels of greenspace and presence of a home garden were weakly associated with more outdoor play spaces, and in turn with lower BMI, and ultimately with lower BP. CONCLUSIONS: Exposure to natural environments may help maintain normal BP in children, while built environment may increase children's BP. Outdoor play and less adiposity in greener areas may mediate some of these associations. Evidence on air pollution and noise remains controversial and difficult to explain.

Ventricular activation patterns during intrinsic conduction and right ventricular pacing in cardiac resynchronization therapy patients.

BACKGROUND: Cardiac resynchronization therapy (CRT) involves stimulation of both right ventricle (RV) and left ventricle (LV). LV pacing from the sites of delayed electrical activation improves CRT response. The RV-LV conduction is typically measured in intrinsic rhythm. The differences in RV-LV conduction patterns and timing between intrinsic rhythm and during paced RV activation, these differences are not fully understood. METHODS: Enrolled patients were implanted with a de novo CRT device and quadripolar LV lead, with lead implant locations at the implanting physician's discretion. QRS duration and conduction delay between the RV lead and each of the four LV electrodes (D1, M2, M3, and P4) were measured during intrinsic conduction and RV pacing. RESULTS: Conduction measurements were collected from 275 patients across 14 international centers (68 ± 13 years of age, 73% male, 45% ischemic, 158 ± 22 ms QRS duration). Mean RV-LV conduction time was shorter during intrinsic conduction versus RV pacing by 59.6 ms (106.5 ± 36.5 versus 166.1 ± 32.1 ms, p < 0.001). The intra-LV activation delay between the latest and earliest activating LV electrode was also shorter during intrinsic conduction versus RV pacing by 6.6 ms (20.6 ± 13.1 vs. 27.2 ± 21.2 ms, p < 0.001). Intrinsic conduction and RV pacing resulted in a different activation order in 72.7% of patients, and the same LV activation order in 27.3%. CONCLUSIONS: Differences in RV-LV conduction time, intra-LV conduction time, and activation pattern were observed between intrinsic conduction and RV pacing. These findings highlight the importance of evaluating intrinsic versus paced ventricular activation to guide LV pacing site selection in CRT patients.

Allergic symptoms in association with naturalness, greenness, and greyness: A cross-sectional study in schoolchildren in the Alps.

BACKGROUND: Greenness may protect from or contribute to allergy risk by influencing air pollution and human-microbe interactions. However, existing research on the issue is heterogeneous and produced conflicting results. Less in known about the effects of greyness. This study investigated the association between different characteristics of residential and school environment and allergic symptoms in schoolchildren. METHODS: The present cross-sectional survey was undertaken in 2004/2005 among 1251 schoolchildren (8-12 years old) in several alpine valleys in Austria and Italy. Children's mothers completed a questionnaire that asked about allergic symptoms (International Study of Asthma and Allergies in Childhood questionnaire), sociodemographic information, lifestyle, perinatal data, and housing conditions. We constructed four aggregate outcome variables: current asthma symptoms, ever asthma symptoms, ever allergic rhinitis (AR) symptoms, and ever eczema symptoms. We employed well-known greenness and greyness exposure indicators (Normalized Difference Vegetation Index, tree canopy cover, agricultural cover, imperviousness cover, and industrial cover), as well as an alternative naturalness index (Distance to Nature, D2N). Adjusted logistic regressions were used to explore associations between each exposure-outcome pair. Air pollution (NO2), traffic noise and time spent outdoors were tested as potential mediators in causal mediation analysis. RESULTS: Decrease in naturalness in a 500-m buffer around the home was associated with higher prevalence of AR symptoms. Associations with asthma symptoms were in the same direction but marginally significant. Residential NDVI and tree cover were marginally associated with lower prevalence of asthma and AR symptoms. Having a domestic garden was associated with lower prevalence of asthma symptoms. School greenness in a 100-m buffer was associated with lower prevalence of AR symptoms. Residential greyness was associated with higher prevalence of AR and asthma symptoms. We observed stronger associations for greenness and greyness in non-movers and in children without a family history of allergies. Mediation by NO2 and time spent outdoors was present in some of the exposure-outcome pairs. CONCLUSIONS: Schoolchildren residing in places with lower naturalness and higher greyness may be more likely to have allergic rhinitis and possibly asthma. Considering more comprehensive indicators than greenness and greyness and conducting research in children without a family history of allergic diseases may be key to better understanding who can profit from natural landscapes.

Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine?

BACKGROUND: The COVID-19 pandemic has profoundly changed people's ability to recreate in public green spaces, which is likely to exacerbate the psychological impacts of the pandemic. In the current study, we seek to understand whether greenery can support mental health even with insufficient outdoor exposure in times of physical isolation from the outdoor environment. METHODS: Between 17 May and 10 June, 2020, we conducted an online survey among 323 students (21.99 ± 3.10 years; 31% male) in health-related programs from two universities in the city of Plovdiv, Bulgaria. Severities of depressive and anxiety symptoms over the past two weeks were measured with the Patient Health Questionnaire 9-item and the Generalized Anxiety Disorder 7-item scale. We employed two self-reported measures of greenery experienced indoors (number of houseplants in the home and proportion of exterior greenery visible from inside the home) and two measures of greenery experienced outdoors (presence/absence of a domestic garden and availability of neighborhood greenery). Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale; PRS) and the neighborhood (the "being away" and "fascination" dimensions of the PRS), engagement with outdoor greenery (frequency of different types of interaction) and perceived social support were treated as mediators. Associations between greenery and mental health were tested using generalized linear regression and logistic regression. Structural equation modelling (SEM) techniques were used to test the theoretically-indicated relations among the variables. RESULTS: Clinically-meaningful symptoms of moderate depression and anxiety were reported by approximately 33% and 20% of the students, respectively. The relative abundance of greenery visible from the home or in the neighborhood was associated with reduced depressive/anxiety symptoms and lower depression/anxiety rates. Having more houseplants or a garden was also associated with some of these markers of mental health. As hypothesized, the mental health-supportive effects of indoor greenery were largely explained by increased feelings of being away while at home. Neighborhood greenery contributed to neighborhood restorative quality, which in turn facilitated social support and more frequent engagement with greenery, and that led to better mental health. CONCLUSIONS: Students who spent most of their time at home during the COVID-19 epidemic experienced better mental health when exposed to more greenery. Our findings support the idea that exposure to greenery may be a valuable resource during social isolation in the home. However, causal interpretation of these associations is not straightforward.

Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature.

BACKGROUND: Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses. METHODS: We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics. RESULTS: We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing. CONCLUSIONS: We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.

Propafenone shows class Ic and class II antiarrhythmic effects.

AIMS: Propafenone is a well-known Class Ic antiarrhythmic agent. It has the typical chemical structure of a beta-blocker, but human studies on its beta-blocking effects revealed conflicting results. METHODS AND RESULTS: Twelve healthy males received single oral doses of 600 mg propafenone and placebo according to a randomized, double-blind, placebo-controlled, cross-over protocol. Four hours following drug intake, heart rate and blood pressure were measured, and plasma concentrations of propafenone were determined at rest, during exercise and after recovery. At exercise, propafenone significantly decreased heart rate (-6%, P < 0.05), systolic blood pressure (-6%, P < 0.05), and the rate-pressure product (-11%, P < 0.05). Plasma concentrations of propafenone increased during exercise (+23%, P < 0.05) and decreased during recovery (-33%, P < 0.05). CONCLUSION: Both effects on heart rate and blood pressure as well as the changes of plasma concentrations of propafenone during exercise represent two particular features of beta-blockers. Therefore, we conclude that propafenone is both a Class Ic and a Class II antiarrhythmic agent, and 600 mg propafenone, i.e. the dose recommended in current guidelines for cardioversion of paroxysmal atrial fibrillation, cause clinically significant beta-blockade. Thus, single oral doses of 600 mg propafenone appear also suitable for cardioversion of paroxysmal atrial fibrillation in patients with structural heart disease since beta-blockers are explicitly indicated in the treatment of both coronary artery disease and heart failure.

The ecological context of soundscapes for children's blood pressure.

Although the majority of studies on community noise levels and children's physiological stress responses are positive, effect sizes vary considerably, and some studies do not confirm these effects. Employing a contextual perspective congruent with soundscapes, a carefully constructed sample of children (N = 115, M = 10.1 yr) living in households in relatively high (>60 dBA) or low (<50 dBA) noise areas created by proximity to major traffic arterials in Austria was reanalyzed. Several personal and environmental factors known to affect resting cardiovascular parameters measured under well-controlled, clinical conditions were incorporated into the analyses. Children with premature births and elevated chronic stress (i.e., overnight cortisol) were more susceptible to adverse blood pressure responses to road traffic noise. Residence in a multi-dwelling unit as well as standardized assessments of perceived quietness of the area did not modify the traffic noise impacts but each had its own, independent effect on resting blood pressure. A primary air pollutant associated with traffic volume (NO2) had no influence on any of these results. The scope of environmental noise assessment and management would benefit from incorporation of a more contextualized approach as suggested by the soundscape perspective.

Association and moderation of self-reported hypotension with traffic noise exposure: a neglected relationship.

In a short-term experimental study about one-third of subjects exposed to noise shows both increases and decreases in blood pressure. While the association of noise with hypertension is established it is not yet known whether hypotension is associated with noise in field studies. In a cross-sectional study the association of self-reported hypotension and low blood pressure readings with traffic noise was examined in adults (age 25-65, N = 1989, participation = 62%). Noise exposure was based on both, short and long-term day/night recordings and standard noise mapping. Questionnaire data on socio-demographics, housing, life-style, noise and weather sensitivity, health status, mental and physical symptoms were available to adjust for potential confounding and testing for moderation. Non-linear multiple regression was applied to estimate the association between the two outcomes and overall noise exposure. We did not observe a stable relation between noise and low blood pressure readings since the number of subjects based on the recommended cut-off points (5 th percentile or 110 (100)/60 mmHg) was too small. However, self-reported hypotension was non-linearly associated with noise exposure ( P = 0.044) in the presence of a strong sex × age effect modification ( P < 0.0001). Another significant moderation by noise were observed with reported symptoms of exhaustion ( P = 0.03). Weather sensitivity showed a significant interaction with noise sensitivity ( P = 0.02) and also a non-linear interaction with age ( P = 0.02). The results remained stable after adjustment for variables known to be associated with constitutional hypotension. The exposure-effect curve ascends around sound levels of 55 dBA. The results suggest a novel moderated association of noise with self-reported hypotension, predominantly in weather sensitive women with symptoms of exhaustion. Further and larger studies are needed to replicate the potential moderating effect of noise on persons with constitutional hypotension.

Home gardens and distances to nature associated with behavior problems in alpine schoolchildren: Role of secondhand smoke exposure and biomarkers.

BACKGROUND: Behavior problems in children are shaped by a complex intertwining of environmental, social, and biological factors. This study investigated whether more nature exposure was associated with less behavior problems and whether these associations were mediated by differences in secondhand smoke in the home, sleep problems, adiposity, and inflammation. METHODS: We used cross-sectional data collected from 1251 schoolchildren (8-12 years old) in the Tyrol region of Austria and Italy. Information on sociodemographics, lifestyle, perinatal data, and housing conditions was obtained by questionnaire. Behavior problems in the past school year were rated by teachers using the Needleman questionnaire for classroom performance. We estimated nature exposure using a comprehensive naturalness index called "distance to nature" (D2N). This was calculated in several buffer sizes around the child's home and school. Presence of a home garden was assessed by self-report. Data on potential mediators including parental smoking in the home, child's urinary cotinine concentrations, sleep problems, body mass index, and urinary neopterin concentrations were also collected. Structural equation modeling was used to examine the multiple pathways between nature exposure and behavior problems. RESULTS: Children who lived in a home with a garden and those whose school was closer to nature exhibited less school behavior problems. The effect of proximity to nature from the school was directly associated with less behavior problems, and the effect of a home garden on behavior problems acted indirectly through a lower likelihood of secondhand smoke exposure. Associations were in unexpected directions between behavior problems and residential proximity to nature and depended on the outcome and context. CONCLUSIONS: Natural environments in school and home surroundings might be beneficial for school conduct and performance. Lower secondhand smoke exposure at home might be a pathway between home gardens and children's behavioral problems. Associations with residential proximity to nature in this study were in unexpected directions and warrant further investigation. These findings serve as a point of departure for investigating how proximal nature might activate health supportive pathways in children and simultaneously confer childhood health benefits via positive behavioral changes in their parents.

Early environmental quality and life-course mental health effects: The Equal-Life project.

BACKGROUND: There is increasing evidence that a complex interplay of factors within environments in which children grows up, contributes to children's suboptimal mental health and cognitive development. The concept of the life-course exposome helps to study the impact of the physical and social environment, including social inequities, on cognitive development and mental health over time. METHODS: Equal-Life develops and tests combined exposures and their effects on children's mental health and cognitive development. Data from eight birth-cohorts and three school studies (N = 240.000) linked to exposure data, will provide insights and policy guidance into aspects of physical and social exposures hitherto untapped, at different scale levels and timeframes, while accounting for social inequities. Reasoning from the outcome point of view, relevant stakeholders participate in the formulation and validation of research questions, and in the formulation of environmental hazards. Exposure assessment combines GIS-based environmental indicators with omics approaches and new data sources, forming the early-life exposome. Statistical tools integrate data at different spatial and temporal granularity and combine exploratory machine learning models with hypothesis-driven causal modeling. CONCLUSIONS: Equal-Life contributes to the development and utilization of the exposome concept by (1) integrating the internal, physical and social exposomes, (2) studying a distinct set of life-course effects on a child's development and mental health (3) characterizing the child's environment at different developmental stages and in different activity spaces, (4) looking at supportive environments for child development, rather than merely pollutants, and (5) combining physical, social indicators with novel effect markers and using new data sources describing child activity patterns and environments.

Cardiovascular effects of environmental noise: research in Austria.

Cardiovascular effects of noise rank second in terms of disability-adjusted life year (DALYs) after annoyance. Although research during the past decade has consolidated the available data base, the most recent meta-analysis still shows wide confidence intervals - indicating imprecise information for public health risk assessment. The alpine area of Tyrol in the Austrian part of the Alps has experienced a massive increase in car and heavy goods traffic (road and rail) during the last 35 years. Over the past 25 years small-, middle-, and large-sized epidemiological health surveys have been conducted - mostly within the framework of environmental health impact assessments. By design, these studies have emphasized a contextually driven environmental stress perspective, where the adverse health effects on account of noise are studied in a broader framework of environmental health, susceptibility, and coping. Furthermore, innovative exposure assessment strategies have been implemented. This article reviews the existing knowledge from these studies over time, and presents the exposure-response curves, with and without interaction assessment, based on standardized re-analyses and discusses it in the light of past and current cardiovascular noise effects research. The findings support relevant moderation by age, gender, and family history in nearly all studies and suggest a strong need for consideration of non-linearity in the exposure-response analyses. On the other hand, air pollution has not played a relevant role as a moderator in the noise-hypertension or the noise-angina pectoris relationship. Finally, different noise modeling procedures can introduce variations in the exposure response curves, with substantive consequences for public health risk assessment of noise exposure.

University Students' Self-Rated Health in Relation to Perceived Acoustic Environment during the COVID-19 Home Quarantine.

BACKGROUND: Online education became mandatory for many students during the Coronavirus disease 2019 (COVID-19) pandemic and blurred the distinction between settings where processes of stress and restoration used to take place. The lockdown also likely changed perceptions of the indoor acoustic environment (i.e., soundscape) and raised its importance. In the present study, we seek to understand how indoor soundscape related to university students' self-rated health in Bulgaria around the time that the country was under a state of emergency declaration caused by the COVID-19 pandemic. METHODS: Between 17 May and 10 June 2020, we conducted a cross-sectional online survey among 323 students (median age 21 years; 31% male) from two universities in the city of Plovdiv, Bulgaria. Self-rated health (SRH) was measured with a single-item. Participants were asked how frequently they heard different types of sounds while at home and how pleasant they considered each of those sounds to be. Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale) was measured with a single-item. A priori confounders and effect modifiers included sociodemographics, house-related characteristics, general sensitivity to environmental influences, and mental health. Our analysis strategy involved sequential exploratory factor analysis (EFA), multivariate linear and ordinal regressions, effect modification tests, and structural equation modeling (SEM). RESULTS: EFA supported grouping perceived sounds into three distinct factors-mechanical, human, and nature sounds. Regression analyses revealed that greater exposure to mechanical sounds was consistently associated with worse SRH, whereas no significant associations were found for human and nature sounds. In SEM, exposure to mechanical sounds related to lower restorative quality of the home, and then to poorer SRH, whereas nature sounds correlated with higher restorative quality, and in turn with better SRH. CONCLUSIONS: These findings suggest a role of positive indoor soundscape and restorative quality for promoting self-rated health in times of social distancing.

No antiarrhythmic effect of direct oral anticoagulants versus vitamin K antagonists in paroxysmal atrial fibrillation patients undergoing catheter ablation.

INTRODUCTION: Direct oral anticoagulants (DOACs) are superior to vitamin K antagonists (VKAs) for the prevention of stroke in atrial fibrillation (AF) patients with elevated stroke risk. Possible antiarrhythmic effects of DOACs have been discussed. We analyzed impact of DOAC treatment on recurrence-free survival after AF catheter ablation. METHODS: Two-hundred and thirty-nine consecutive patients (median age 57 [IQR 48-64] years, 26.4% female) undergoing ablation for paroxysmal AF were included into this study. 68.6% of them received DOACs (DOAC group), 31.4% VKA (VKA group). The primary outcome was arrhythmia-free one-year survival. RESULTS: DOAC patients had lower BMI, shorter history of AF, less arterial hypertension, less vascular disease, less use of antiarrhythmics and consequently lower CHA2DS2-VASc and HAS-BLED Scores. There was no difference in arrhythmia-free survival between DOAC and VKA groups (DOAC: 86.6%, VKA: 76.7%, p = 0.286). CONCLUSIONS: Despite baseline characteristics favouring a better outcome of DOAC patients, arrhythmia-free survival was similar in both groups. Consequently, DOAC treatment did not have clinically relevant antiarrhythmic properties in these patients.

A Taxonomy Proposal for the Assessment of the Changes in Soundscape Resulting from the COVID-19 Lockdown.

Many countries around the world have chosen lockdown and restrictions on people's mobility as the main strategies to combat the COVID-19 pandemic. These actions have significantly affected environmental noise and modified urban soundscapes, opening up an unprecedented opportunity for research in the field. In order to enable these investigations to be carried out in a more harmonized and consistent manner, this paper makes a proposal for a set of indicators that will enable to address the challenge from a number of different approaches. It proposes a minimum set of basic energetic indicators, and the taxonomy that will allow their communication and reporting. In addition, an extended set of descriptors is outlined which better enables the application of more novel approaches to the evaluation of the effect of this new soundscape on people's subjective perception.

Recommendations on the utilization of telemedicine in cardiology.

The enormous progress made in recent years in the field of information and communication technology and also in sensor and computer technology has affected numerous fields of medicine and is capable of inducing even radical changes in diagnostic and therapeutic processes. This is particularly true for cardiology, where, for example, telemetric monitoring of cardiac and circulatory functions has been in use for many years. Nevertheless, broad application of newer telemedical processes has not yet been achieved to the extent one would expect from the encouraging results of numerous clinical studies in this field and the state of the art of the underlying technology. In the present paper, the Working Group on Rhythmology of the Austrian Cardiological Society aims to provoke a critical discussion of the digital change in cardiology and to make recommendations for the implementation of those telemedical processes that have been shown to exert positive effects on a wide variety of medical and economic parameters. The greatest benefit of telecardiological applications is certainly to be found in the long-term care of patients with chronic cardiovascular diseases. Accordingly, follow-up care of patients with cardiological rhythm implants, management of chronic heart failure and secondary prevention following an acute cardiac event during rehabilitation are currently the most important fields of application. Telemedicine is intended to enable high-quality and cost-efficient care for an increasing number of patients, whose care poses one of the greatest challenges to our healthcare system. Not least of all, telemedicine should make a decisive contribution to improving the quality of life of this segment of the population by favorably influencing mortality, morbidity and hospitalization as well as the patient's contribution to treatment.

A model for the perception of environmental sound based on notice-events.

An approach is proposed to shed light on the mechanisms underlying human perception of environmental sound that intrudes in everyday living. Most research on exposure-effect relationships aims at relating overall effects to overall exposure indicators in an epidemiological fashion, without including available knowledge on the possible underlying mechanisms. Here, it is proposed to start from available knowledge on audition and perception to construct a computational framework for the effect of environmental sound on individuals. Obviously, at the individual level additional mechanisms (inter-sensory, attentional, cognitive, emotional) play a role in the perception of environmental sound. As a first step, current knowledge is made explicit by building a model mimicking some aspects of human auditory perception. This model is grounded in the hypothesis that long-term perception of environmental sound is determined primarily by short notice-events. The applicability of the notice-event model is illustrated by simulating a synthetic population exposed to typical Flemish environmental noise. From these simulation results, it is demonstrated that the notice-event model is able to mimic the differences between the annoyance caused by road traffic noise exposure and railway traffic noise exposure that are also observed empirically in other studies and thus could provide an explanation for these differences.

Road Traffic Noise Exposure and Depression/Anxiety: An Updated Systematic Review and Meta-Analysis.

Unlike other World Health Organization evidence reviews, the systematic review on mental disorders could not provide a quantitative estimate of the effect of environmental noise. With that in mind, we aimed to update it with additional studies published through to 18 August 2019 in order to allow for a formal meta-analysis of the association of residential road traffic noise with anxiety and depression. The quality effects and random effects estimators were used for meta-analysis and the robustness of findings was tested in several sensitivity analyses. Ten studies were included in the qualitative synthesis, from which we extracted 15 estimates for depression (n = 1,201,168) and five for anxiety (n = 372,079). Almost all studies were cross-sectional and the risk of bias in them was generally high. We found 4% (95% CI: -3%, 11%) higher odds of depression and 12% (95% CI: -4%, 30%) of anxiety associated with a 10 dB(A) increase in day-evening-night noise level (Lden). Both models suffered from moderate heterogeneity (55% and 54%), but there was evidence of publication bias only in the depression model. These findings were robust with no evidence of study-level moderators. A sensitivity analysis on an alternative set of categorically-reported estimates supported a linear relationship between Lden and depression. Taking into account an overall quality assessment for the included studies, we conclude that there is evidence of "very low" quality that increasing exposure to road traffic noise may be associated with depression and anxiety.