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BACKGROUND: Although plausible from a pathophysiological point of view, robust evidence for effects of transportation noise on mental health remains scarce. Meanwhile, psychiatric diseases are among the most prevalent noncommunicable diseases worldwide, and suicide as a mortality outcome highly connected to mental disorders presents a pressing public health issue. The aim of this study was to investigate the association between source-specific transportation noise, particulate matter (PM) air pollution, residential greenness, and suicide by means of a nationwide cohort study. METHODS: Road traffic, railway and aircraft noise exposure as well as exposure to air pollution [PM with aerodynamic diameter ≤2.5 μm (PM2.5)] and greenness [normalized difference vegetation index (NDVI)] were linked to 5.1 million adults (age 15 y and older) in the Swiss National Cohort, accounting for their address history. Mean noise exposure in 5-y periods was calculated. Individuals were followed for up to 15 y (2001-2015). Time-varying Cox regression models were applied to deaths by suicide (excluding assisted suicide). Models included all three noise sources, PM2.5, and NDVI plus individual and spatial covariates, including socioeconomic status. Effect modification by sex, age, socioeconomic indicators, and degree of urbanization was explored. RESULTS: During the follow-up, there were 11,265 suicide deaths (10.4% poisoning, 33.3% hanging, 28.7% firearms, 14.7% falls). Road traffic and railway noise were associated with total suicides [hazard ratios. 1.040; 95% confidence interval (CI): 1.015, 1.065; and 1.022 (95% CI: 1.004, 1.041) per 10 dB day-evening-night level (Lden)], whereas for aircraft noise, a risk increase starting from 50 dB was masked by an inverse association in the very low exposure range (30-40 dB). Associations were stronger for females than males. The results were robust to adjustment for residential greenness and air pollution. CONCLUSION: In this longitudinal, nationwide cohort study, we report a robust association between exposure to road traffic and railway noise and risk of death by suicide after adjusting for exposure to air pollution and greenness. These findings add to the growing body of evidence that mental health disorders may be related to chronic transportation noise exposure. [ABSTRACT FROM AUTHOR]

Objectives: To measure the tocolytic effect of the combination of the oxytocin receptor antagonist atosiban with the β-mimetic agent fenoterol on human myometrium of pregnant women. Methods: An in vitro study of contractility in human myometrium at the Laboratory of the Department of Obstetrics, University Hospital of Zürich, Switzerland, was performed. Thirty-six human myometrial biopsies were obtained during elective caesarean sections of singleton pregnancies at term. Tissue samples were exposed to atosiban, fenoterol and the combination of atosiban with fenoterol. Contractility was measured as area under the curve during 30 min of spontaneous contractions. The effect of treatment was expressed as the percentage of change from basal activity during 30 min of exposure. Differences were calculated using a paired Wilcoxon signed-rank test. An additive effect of dual tocolysis was assumed when no significant difference was detected between the observed and expected inhibition of dual tocolysis. When inhibition was greater or lower than expected, the dual combination was characterised as "synergistic" or "antagonistic", respectively. Results: Atosiban and fenoterol alone suppressed contractions by a median of 43.2% and 29.8%, respectively. The combination of atosiban plus fenoterol was measured at a level of 67.3% inhibition. There was no significant difference in the expected (63.2%) and observed inhibition effect of dual tocolysis (P=0.945). Conclusion: This study demonstrated an additive effect of dual tocolysis of atosiban and fenoterol on human myometrium in vitro, but no synergistic or antagonistic effect. [ABSTRACT FROM AUTHOR]

Introduction: The study aims were to analyze the experience of women and their physicians of nakedness when moving between changing room and examination chair and during pelvic examination itself, and to assess the protective benefit of a wrap skirt in alleviating the associated discomfort and vulnerability.Material and Methods: We offered 1000 women a wrap skirt for pelvic examination and asked them to complete a post-procedure questionnaire. Physicians were invited to complete a similar but separate questionnaire. Data were analyzed using chi-squared contingency tables.Results: A total of 425 women (43%, age 15-78 years) completed the questionnaire; 51% felt uncomfortable and embarrassed during the examination, Muslim women significantly more so (p < 0.001). Most women (n = 255; 58%) rated the wrap skirt a significant improvement; 69% requested it for future examinations, significantly more so if the physician was male rather than female (66% vs. 54%, p = 0.003). Even the one-third of women experiencing no discomfort reported improvement. Most examiners (n = 45; 56%) found the wrap skirt beneficial; 31 (38%) were unconvinced.Conclusions: Pelvic examination as practiced in many countries, on women naked from the waist down throughout, causes unnecessary embarrassment. A simple protective measure, such as a wrap skirt, significantly alleviates the discomfort and sense of vulnerability associated with nakedness. [ABSTRACT FROM AUTHOR]

Ambient air pollution is the leading cause of environmental mortality and morbidity worldwide. However, the individual contributions to acute mortality of traffic-related air pollutants such as nitrogen dioxide (NO 2) and fine particulate matter (PM 2.5) are still debated. We conducted a time-stratified case-crossover study for a population located around Zurich airport in Switzerland, including 24,886 adult cardiovascular deaths from the Swiss National Cohort. We estimated the risk of cause-specific cardiovascular mortality associated with daily NO 2 and PM 2.5 concentrations at home using distributed lag models up to 7 days preceding death, adjusted for daily temperature, precipitation, acute night-time aircraft noise, firework celebrations, and holidays. Cardiovascular mortality was associated with NO 2 , whereas the association with PM 2.5 disappeared upon adjustment for NO 2. The strongest association was observed between NO 2 and ischemic stroke mortality (odds ratio = 1.55 per 10 μg/m3, 95% confidence intervals = 1.20–2.00). Cause-specific mortality analyses showed differences in terms of delayed effect: odds ratios were highest at 1–3 days after exposure for most outcomes but at lags of 3–5 days for heart failure. Individual vulnerabilities to NO 2 associated cardiovascular mortality also varied by cause of death, possibly highlighting the role of different behaviours and risk factors in the most susceptible groups. The risk of cardiovascular mortality was also increased on firework days and after public holidays, independent from NO 2 and PM 2.5 concentrations. This study confirms the association between ambient NO 2 , as a marker for primary emissions, and acute cardiovascular mortality in a specific setting around a major airport. Future research should clarify the role of additional air pollutants including ultra-fine particles on cardiovascular diseases to inform most efficient control measures. [Display omitted] • Cardiovascular mortality associated with NO 2 levels around a major airport. • Highest NO 2 risk observed for ischemic stroke mortality. • No association of PM 2.5 with cardiovascular mortality after adjustment for NO 2. • Increased cardiovascular mortality in relation to national firework days. [ABSTRACT FROM AUTHOR]

As aircraft noise affects large areas around airports, noise exposure calculations need to be highly accurate. In this study, we compare noise exposure measurements with calculations of several thousand single flights at Zurich and Geneva airports, Switzerland, of three aircraft noise calculation programs: sonAIR, a next-generation aircraft noise calculation program, and the two current best-practice programs FLULA2 and AEDT. For one part of the flights, we had access to flight data recorder (FDR) data, which contain flight configuration information that sonAIR can account for. For the other part, only radar data without flight configuration information were available. Overall, all three programs show good results, with mean differences between calculations and measurements smaller than ±0.5 dB in the close range of the airports. sonAIR performs clearly better than the two best-practice programs if FDR data are available. However, in situations without FDR data (reduced set of input data), sonAIR cannot exploit its full potential and performs similarly well as FLULA2 and AEDT. In conclusion, all three programs are well suited to determine averaged noise metrics resulting from complex scenarios consisting of many flights (e.g., yearly air operations), while sonAIR is additionally capable to highly accurately reproduce single flights in greater detail. [ABSTRACT FROM AUTHOR]

• Application of the case time series design in a natural experiment setting. • Fighter jet noise was associated with drug administrations in a psychiatric clinic. • Results support that noise can exacerbate symptoms in psychiatric patients. • The study design and setting ensure robustness and low risk for bias or confounding. Existing evidence suggests that psychiatric patients are highly noise sensitive, and that noise exposure increases the risk for adverse mental health outcomes, such as psychiatric hospitalizations and even suicide. To investigate acute effects of noise in this vulnerable population, we assessed short-term associations between fighter jet noise and on-demand sedative and analgesic drug administrations in a psychiatric clinic located close to a military airfield in Switzerland. We applied a case time series analysis with an hourly time resolution using distributed-lag models. Analysis was adjusted for long-term and seasonal trends, day of week, time of day, time-varying weather conditions and the week of stay. Noise exposure (hourly A-weighted equivalent continuous sound pressure levels (L Aeq)) was modelled using detailed flight plans and noise footprints for different fighter jet and route combinations. Outcome data were available from the clinic's records. During the study period (06/2016–12/2021), 23,486 flights occurred. 5,968 clinical stays with a median length of 41 days (IQR: 28d, 50d) were recorded. The odds ratio (OR) for medication administration over the lag period of 3 hours after exposure was 1.016 (95 %CI: 1.006, 1.026) per 10 dB LAeq for sedatives and 1.032 (95 %CI: 1.016, 1.048) per 10 dB for analgesics. Effects were larger in multimorbid patients. Case time series analysis is a novel method to investigate transient associations in observational data while minimizing risk of bias. Using an objectively recorded outcome measure, our results demonstrate that psychiatric patients are a vulnerable population, in which noise exposure can lead to symptom exacerbations and adverse events. [ABSTRACT FROM AUTHOR]

[Display omitted] • Long-term road traffic and railway noise are associated with most CVD causes of death. • Risk increases often start well below the WHO Environmental Noise guideline levels. • Associations are independent of air pollution. • Higher levels of noise intermittency are independently associated with each outcome. • Relative and absolute risk are higher in males compared to females. Death from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source. Road traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM 2.5 , adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group. During a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024–1.034), 1.013 (1.010–1.017), and 1.003 (0.996–1.010) per 10 dB L den , respectively. Associations for MI mortality were a respective 1.043 (1.029–1.058), 1.020 (1.010–1.030) and 1.040 (1.020–1.060) per 10 dB L den. Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40 dB L den for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females. Independent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits. [ABSTRACT FROM AUTHOR]

Current best practice aircraft noise calculations primarily focus on strategic noise mapping to assess compliance with legal noise limits. To date, the effects of shielding by buildings or reflections from buildings, forests or cliffs have not been considered in noise mapping, despite their potential impact on results, particularly in mountainous and/or densely built urban areas. In this study, the effects of shielding by buildings and reflections from buildings, forests and cliffs on aircraft noise results were assessed. Calculations were performed with the sonAIR simulation tool for a residential area close to the runway of a military airfield in a mountain valley in Switzerland. The calculations revealed that shielding and reflections may locally strongly affect the results. While this may yield valuable insights for special investigations, calculations without accounting for these effects are still recommended for large-scale noise mapping, to obtain a better overview of the noise exposure and legal compliance. • Analysis of shielding from buildings, reflections from buildings, cliffs and forest. • Barrier effects are more important for large-scale noise exposure than reflections. • In acoustical shadows zones, reflections play a significant role. • For aircraft noise mapping, accounting for these effects is not recommended. • The studied effects may be of interest for special and/or local investigations. [ABSTRACT FROM AUTHOR]

Environmental noise exposure has been shown to affect children's cognition, but the concept of cognition is multifaceted, and studies on associations with noise are still inconclusive and fragmented. We studied cognitive change within one year in 882 adolescents aged 10–17 years in response to road traffic noise exposure. Participants filled in a comprehensive questionnaire and underwent cognitive testing twice at an interval of one year. Figural and verbal memory was measured with the Intelligenz-Struktur-Test (IST), and concentration accuracy and constancy were measured with FAKT-II and d2 test. Exposure to noise and other environmental stressors were modelled for school and home location at baseline. Missing data was addressed with multiple imputation. Cross-sectional multilevel analyses and longitudinal change score analyses were performed. In cross-sectional analyses, figural memory was significantly reduced by −0.27 (95%CI -0.49,-0.04) units per 10 dB road traffic noise increase at home (L den). Longitudinal analyses showed a significant reduction of concentration constancy Z-scores between baseline and follow-up by −0.13 (95%CI -0.25, 0.00) per 10 dB road traffic noise at home (L den). Our study indicates that road traffic noise at home reduces cognitive performance in adolescents. Larger cohorts with longer follow-up time are needed to confirm these results. • Decreased figural memory is associated with road noise in cross-sectional analyses. • Change in concentration constancy within one year is associated with noise. • Associations were more pronounced if the bedroom is facing the loudest street. [ABSTRACT FROM AUTHOR]

The findings of environmental noise exposure and behavioural disorders in children and adolescents are inconclusive, and longitudinal studies are scarce. We studied the response of behaviour and behavioural change within one year in a cohort of 886 adolescents in Switzerland aged 10–17 years in response to road traffic noise exposure. Participants filled in a comprehensive questionnaire at baseline and follow-up. It included the Strengths and Difficulties Questionnaire (SDQ), which measures self-rated positive and negative behaviours in five scales. We modelled road traffic noise for participants' most exposed facade at home and school addresses in various metrics (L den , L night , L day , Intermittency Ratio and Number of events). We addressed missing data with multiple imputation and performed mixed linear cross-sectional analyses and longitudinal change score analyses. In cross-sectional analyses, peer relationship problems increased by 0.15 units (95%CI: 0.02, 0.27; scale range: 0–10) per 10 dB road traffic noise increase. In longitudinal analyses, increases in SDQ scales between baseline and follow-up were not related to noise exposure. This study suggests subtle associations between road traffic noise exposure and behaviour problems in adolescents, but longer follow-up times may be needed to observe longitudinal changes. • Noise is significantly associated with peer problems in cross-sectional analyses. • Change in behaviour over one year is not associated with noise exposure. • Children with a bedroom facing a main street show higher hyperactivity/inattention. • Number of noise events shows no associations with behaviour problems. [ABSTRACT FROM AUTHOR]