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72 EFFECTS ON HEALTH 4.5.10 DOSE–RESPONSE CURVE: META-ANALYSIS For a quantitative risk assessment and the derivation of guidelines for public health noise policy a common dose–response curve is required. The risk estimates obtained from different noise studies can be summarized using the statistical approach of a meta-analysis. Based on the judgement criteria discussed in section 4.5.9.2, five analytic and two descriptive studies emerged that can be used to derive a common dose–response curve for the association between road traffic noise and the risk of myocardial infarction. Two separate meta-analyses were made by considering the analytic studies that were carried out in Caerphilly and Speedwell (cohort studies) and Berlin (case-control studies) on the one hand, and the descriptive studies that were carried out in Caerphilly and Speedwell (cross-sectional studies) on the other hand. It turned out, as a result of the evaluation, that all these studies referred to road traffic noise during the day (L day : 06.00–22.00) and the incidence or prevalence of myocardial infarction as the outcome. Study subjects were men. In all analytic studies the orientation of rooms was considered for the exposure assessment (facing the street or not). With respect to the Caerphilly and Speedwell studies, the six years of pooled follow-up data provided the respective information. In all descriptive studies the traffic noise level referred to the facades that were facing the street and did not consider the orientation of rooms/windows. All individual effect estimates were adjusted for the covariates considered in each of the studies. Different sets of covariates were considered in each study. However, this pragmatic approach accounts best for possible confounding in each study and provides the most reliable effect estimates derived from each study. The concept of meta-analysis was used to aggregate and summarize the findings of the different studies (Olkin, 1995; Blettner et al., 1999). The program “meta” was downloaded from the “STATA” web site for use in the statistical package STATA (version 8.0), and for calculating the pooled random effect estimates. Table 4.2 Single and pooled (meta-analysis) effect estimates (odds ratios and 95% confidence intervals) of descriptive and analytic studies on the relationship between road traffic noise level (L day ) and the incidence/prevalence of myocardial infarction Road traffic noise level - L day [dB(A)] Descriptive studies 51-55 56-60 61-65 66-70 N Caerphilly 1.00 1.00 (0.58-1.71),[13.29] 0.90 (0.56-1.44),[17.23] 1.22 (0.63-2.35),[ 8.98] 2512 Speedwell 1.00 1.02 (0.57-1.83),[11.19] 1.22 (0.70-2.21),[12.62] 1.07 (0.59-1.94),[10.94] 2348 Pooled 1.00 1.01 (0.68-1.50) 1.02 (072-1.47) 1.14 (0.73-1.76) Q-Test p=0.96 p=0.41 p=0.77 Analytic studies ≤ 60 61-65 66-70 71-75 76-80 N Caerphilly + Speedwell 1.00 0.65 (0.27-1.57),[ 4.95] 1.18 (0.74-1.89),[17.48] --- --- 3950 Berlin I 1.00 1.48 (0.57-3.85),[ 4.21] 1.19 (0.49-2.87),[ 4.94] 1.25 (0.41-3.81),[ 3.09] 1.76 (0.11-28.5),[0.50] 243 Berlin II 1.00 1.16 (0.82-1.65),[31.43] 0.94 (0.62-1.42),[22.76] 1.07 (0.68-1.68),[18.92] 1.46 (0.77-2.78),[9.27] 4035 Berlin III 1.00 1.01 (0.77-1.32),[54.42] 1.13 (0.86-1.49),[50.87] 1.27 (0.88-1.84),[28.24] --- 4115 Pooled 1.00 1.05 (0.86-1.29) 1.09 (0.90-1.34) 1.19 (0.90-1.57) 1.47 (0.79-2.76) Q-Test p=0.57 p=0.87 p=0.84 p=0.90 Table 4.2 shows individual and pooled effect estimates with confidence intervals (rounded brackets), statistical weights (square brackets) for the individual studies, and the Q-test of heterogeneity between studies. According to the Q-test, the nil hypothesis of non-heterogeneity was never discarded. Figs 4.6 and 4.7 show odds ratios of individual studies and the pooled estimates for the descriptive and analytic studies. NIGHT NOISE GUIDELINES FOR EUROPE
EFFECTS ON HEALTH 73 Fig. 4.6 and Fig. 4.7 Single and pooled effect estimates (odds ratios) for the descriptive and analytic studies of the association between road traffic noise level and the prevalence (left graph) and incidence (right graph), respectively, of myocardial infarction 1,8 1,8 1,6 1,6 Odds ratio 1,4 1,2 1 Caerphilly Speedwell Pooled Odds ratio 1,4 1,2 1 Caer+Speed Berlin I Berlin II Berlin III Pooled 0,8 0,8 0,6 51-55 56-60 Lday 61-65 [dB(A)] 66-70 0,6
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NIGHT NOISE GUIDELINES FOR EUROPE
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Keywords NOISE - ADVERSE EFFECTS -
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IV CONTENTS CHAPTER 3 EFFECTS OF NI
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VI ABSTRACT The WHO Regional Office
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VIII LIST OF CONTRIBUTORS Torbjörn
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X EXECUTIVE SUMMARY PROCESS OF DEVE
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XII EXECUTIVE SUMMARY An example of
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XIV EXECUTIVE SUMMARY Effect Indica
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XVI EXECUTIVE SUMMARY 50 100 Fig. 4
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XVIII EXECUTIVE SUMMARY For the pri
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2 METHODS AND CRITERIA impact on th
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4 METHODS AND CRITERIA ITALY: NETHE
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6 METHODS AND CRITERIA There are im
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8 METHODS AND CRITERIA use and heal
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10 METHODS AND CRITERIA L night = L
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12 METHODS AND CRITERIA 1.3.6 BACKG
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14 METHODS AND CRITERIA Fig. 1.8 sh
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16 SLEEP AND HEALTH • Stage 2 req
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18 SLEEP AND HEALTH Table 2.3 Mean
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20 SLEEP AND HEALTH vegetative, mot
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Page 120 and 121: 100 EFFECTS ON HEALTH Furthermore,
Page 122 and 123: 102 GUIDELINES AND RECOMMENDATIONS
Page 132 and 133: 112 Ancoli-Israel S, Roth T (1999).
Page 134 and 135: 114 Bistrup ML (2003). Prevention o
Page 136 and 137: 116 Cartwright J, Flindell I (2000)
Page 138 and 139: 118 der Streßforschung (Bonner Ver
Page 140 and 141: 120 Goto K, Kaneko T (2002). Distri
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122 Ishihara K (1999). The effect o
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124 Kogi K, Ohta T (1975). Incidenc
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126 Marth E et al. (1988). Fluglär
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128 Nieminen P et al. (2002). Growt
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130 Reyner et al. (1995). Patterns
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132 Suter AH (1992). Noise sources
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134 Weed DL (2000). Interpreting ep
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136 APPENDICES Term/acronym Definit
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138 APPENDICES APPENDIX 3. ANIMAL S
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140 APPENDICES cause a certain habi
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142 APPENDICES • Acute exposure t
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144 APPENDICES dence indicate that
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146 APPENDICES Fig.1 Effects of 12
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) 148 APPENDICES 50 40 Young rats O
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150 APPENDICES neuronal degeneratio
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152 Gesi M et al. (2002a). Morpholo
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154 APPENDIX 4. NOISE AND SLEEP IN
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156 APPENDICES during quiet sleep (
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158 APPENDICES (American Academy of
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160 APPENDICES cents, 12.2% of adol
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162 REFERENCES Abel SM (1990). The
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The WHO Regional Office for Europe
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