FM NOVEMBER 2018 ISSUE - digital edition

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health outcomes: cardiovascular and metabolic effects; annoyance; effects on sleep; cognitive impairment; hearing impairment and tinnitus; adverse birth outcomes; and quality of life, mental health and well-being. A separate systematic review of the evidence was conducted to assess the effectiveness of environmental noise interventions in reducing exposure and associated impacts on health. Once identified and synthesized, EIGHT SYSTEMATIC REVIEWS OF EVIDENCE WERE CONDUCTED TO ASSESS THE RELATIONSHIP BETWEEN ENVIRONMENTAL NOISE. the quality of the evidence of the systematic reviews was assessed by the Systematic Review Team. Subsequently, the Guideline Development Group (GDG) formulated recommendations, guided by the Systematic Review Team’s assessment and informed by of a number of additional contextual parameters. To facilitate the formulation of recommendations, WHO RECOMMENDATIONS ON ENVIRONMENTAL NOISE SOURCE ROAD TRAFFIC NOISE For average noise exposure, the GDG strongly recommends reducing noise levels produced by road traffic below 53 decibels (dB) L den , as road traffic noise above this level is associated with adverse health effects. For night noise exposure, the GDG strongly recommends reducing noise levels produced by road traffic during night time below 45 dB L night , as night-time road traffic noise above this level is associated with adverse effects on sleep. To reduce health effects, the GDG strongly recommends that policy-makers implement suitable measures to reduce noise exposure from road traffic in the population exposed to levels above the guideline values for average and night noise exposure. For specific interventions, the GDG recommends reducing noise both at the source and on the route between the source and the affected population by changes in infrastructure. Strong RAILWAY NOISE For average noise exposure, the GDG strongly recommends reducing noise levels produced by railway traffic below 54 dB L den , as railway noise above this level is associated with adverse health effects. For night noise exposure, the GDG strongly recommends reducing noise levels produced by railway traffic during night time below 44 dB L night , as night-time railway noise above this level is associated with adverse effects on sleep. To reduce health effects, the GDG strongly recommends that policy-makers implement suitable measures to reduce noise exposure from railways in the population exposed to levels above the guideline values for average and night noise exposure. There is, however, insufficient evidence to recommend one type of intervention over another. Strong AIRCRAFT NOISE For average noise exposure, the GDG strongly recommends reducing noise levels produced by aircraft below 45 dB L den ., as aircraft noise above this level is associated with adverse health effects. For night noise exposure, the GDG strongly recommends reducing noise levels produced by aircraft during night time below 40 dB L night ., as night-time aircraft noise above this level is associated with adverse effects on sleep. 72 / FUTURE MEDICINE / NOVEMBER 2018
BY SOURCE To reduce health effects, the GDG strongly recommends that policy-makers implement suitable measures to reduce noise exposure from aircraft in the population exposed to levels above the guideline values for average and night noise exposure. For specific interventions, the GDG recommends implementing suitable changes in infrastructure. WIND TURBINE NOISE For average noise exposure, the GDG conditionally recommends reducing noise levels produced by wind turbines below 45 dB L den , as wind turbine noise above this level is associated with adverse health effects. No recommendation is made for average night noise exposure Lnight of wind turbines. The quality of evidence of night-time exposure to wind turbine noise is too low to allow a recommendation. To reduce health effects, the GDG conditionally recommends that policy-makers implement suitable measures to reduce noise exposure from wind turbines in the population exposed to levels above the guideline values for average noise exposure. No evidence is available, however, to facilitate the recommendation of one particular type of intervention over another. LEISURE NOISE For average noise exposure, the GDG conditionally recommends reducing the yearly average from all leisure noise sources combined to 70 dB L Aeq,24h as leisure noise above this level is associated with adverse health effects. The equal energy principle can be used to derive exposure limits for other time averages, which might be more practical in regulatory processes. For single-event and impulse noise exposures, the GDG conditionally recommends following existing guidelines and legal regulations to limit the risk of increases in hearing impairment from leisure noise in both children and adults. Following a precautionary approach, to reduce possible health effects, the GDG strongly recommends that policy-makers take action to prevent exposure above the guideline values for average noise and singleevent and impulse noise exposures. This is particularly relevant as a large number of people may be exposed to and at risk of hearing impairment through the use of personal listening devices. There is insufficient evidence, however, to recommend one type of intervention over another. strong conditional the GDG first defined priority health outcomes and then selected the most relevant health outcome measures for the outcomes. Consecutively, a process was developed to identify the guideline exposure levels with the help of the exposure-response functions provided by the systematic reviews. To reflect the nature of the research (observational studies) underpinning the relationship between environmental noise and health, the GRADE procedures were adapted to the requirements of environmental exposure studies where needed. Noise indicators From a scientific point of view, the best noise indicator is the one that performs best in predicting the effect of interest. There are, however, a number of additional criteria that may influence the choice of indicator. For example, various indicators might be suitable for different health end-points. Some considerations of a more political nature can be found in the European Commission’s Position paper on EU NOVEMBER 2018 / FUTURE MEDICINE / 73
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₹ 250.00 VOL 5 | ISSUE 7 PAGES 10
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Vol 5 Issue 7 November 2018 ₹ 250
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REGULATORY DIAGNOSTICS HEAD & NECK
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