Nurses' and preschool teachers' experiences of taking part in a participatory intervention project in communication-intense working environments.

BACKGROUND: Noise is a common workplace problem that can affect health and performance. High sound levels have been found in sectors that largely has been overlooked in noise research such as health care and education. In these communication-intense environments the work requires speech communication, thus making it difficult to wear hearing protection. OBJECTIVE: To explore nurses' and preschool teachers' experiences of taking part in a participatory intervention project aiming to improve the sound environment and the psychosocial work environment. METHODS: One preschool and one obstetrics ward took part in the study, and a qualitative design was used to evaluate the experience of the participatory intervention approach. RESULTS: Five main themes were found in the analysis: Awareness; Taking control of the sound environment; Influence of the building and interior design; Circumstances influencing the intervention process; and Motivation to maintain change. CONCLUSIONS: Despite demanding working situations and lack of financial resources, preschool and obstetrics staff described being creative in planning and implementing several different solutions to improve the sound environment at their workplaces, while interventions specifically improving the psychosocial work environment were fewer. Hence, our study suggest that a participatory intervention approach may facilitate participation and motivation, but resources and support are needed for a comprehensive and effective implementation.

Exploring Perception of Vibrations from Rail: An Interview Study.

Rail transport is an environmentally responsible approach and traffic is expected to increase in the coming decades. Little is known about the implications for quality of life of populations living close to railways. This study explores the way in which vibrations from rail are perceived and described by these populations. The study took place in the Västra Götaland and Värmland regions of Sweden. A qualitative study approach was undertaken using semi-structured interviews within a framework of predetermined questions in participants' homes. A 26.3% response rate was achieved and 17 participants were interviewed. The experience of vibrations was described in tangible terms through different senses. Important emerging themes included habituation to and acceptance of vibrations, worry about property damage, worry about family members and general safety. Participants did not reflect on health effects, however, chronic exposure to vibrations through multimodal senses in individual living environments may reduce the possibility for restoration in the home. Lack of empowerment to reduce exposure to vibrations was important. This may alter individual coping strategies, as taking actions to avoid the stressor is not possible. The adoption of other strategies, such as avoidance, may negatively affect an individual's ability to cope with the stressor and their health.

The effect of occupational noise exposure on tinnitus and sound-induced auditory fatigue among obstetrics personnel: a cross-sectional study.

OBJECTIVE: There is a lack of research on effects of occupational noise exposure in traditionally female-dominated workplaces. Therefore, the aim of this study was to assess risk of noise-induced hearing-related symptoms among obstetrics personnel. DESIGN: A cross-sectional study was performed at an obstetric ward in Sweden including a questionnaire among all employees and sound level measurements in 61 work shifts at the same ward. PARTICIPANTS: 115 female employees responded to a questionnaire (72% of all 160 employees invited). MAIN OUTCOME MEASURES: Self-reported hearing-related symptoms in relation to calculated occupational noise exposure dose and measured sound levels. RESULTS: Sound levels exceeded the 80 dB LAeq limit for protection of hearing in 46% of the measured work shifts. One or more hearing-related symptoms were reported by 55% of the personnel. In logistic regression models, a significant association was found between occupational noise exposure dose and tinnitus (OR=1.04, 95% CI 1.00 to 1.09) and sound-induced auditory fatigue (OR=1.04, 95% CI 1.00 to 1.07). Work-related stress and noise annoyance at work were reported by almost half of the personnel. Sound-induced auditory fatigue was associated with work-related stress and noise annoyance at work, although stress slightly missed significance in a multivariable model. No significant interactions were found. CONCLUSIONS: This study presents new results showing that obstetrics personnel are at risk of noise-induced hearing-related symptoms. Current exposure levels at the workplace are high and occupational noise exposure dose has significant effects on tinnitus and sound-induced auditory fatigue among the personnel. These results indicate that preventative action regarding noise exposure is required in obstetrics care and that risk assessments may be needed in previously unstudied non-industrial communication-intense sound environments.

Effects of train noise and vibration on human heart rate during sleep: an experimental study.

OBJECTIVES: Transportation of goods on railways is increasing and the majority of the increased numbers of freight trains run during the night. Transportation noise has adverse effects on sleep structure, affects the heart rate (HR) during sleep and may be linked to cardiovascular disease. Freight trains also generate vibration and little is known regarding the impact of vibration on human sleep. A laboratory study was conducted to examine how a realistic nocturnal railway traffic scenario influences HR during sleep. DESIGN: Case-control. SETTING: Healthy participants. PARTICIPANTS: 24 healthy volunteers (11 men, 13 women, 19-28 years) spent six consecutive nights in the sleep laboratory. INTERVENTIONS: All participants slept during one habituation night, one control and four experimental nights in which train noise and vibration were reproduced. In the experimental nights, 20 or 36 trains with low-vibration or high-vibration characteristics were presented. PRIMARY AND SECONDARY OUTCOME MEASURES: Polysomnographical data and ECG were recorded. RESULTS: The train exposure led to a significant change of HR within 1 min of exposure onset (p=0.002), characterised by an initial and a delayed increase of HR. The high-vibration condition provoked an average increase of at least 3 bpm per train in 79% of the participants. Cardiac responses were in general higher in the high-vibration condition than in the low-vibration condition (p=0.006). No significant effect of noise sensitivity and gender was revealed, although there was a tendency for men to exhibit stronger HR acceleration than women. CONCLUSIONS: Freight trains provoke HR accelerations during sleep, and the vibration characteristics of the trains are of special importance. In the long term, this may affect cardiovascular functioning of persons living close to railways.

The sound environment in an ICU patient room--a content analysis of sound levels and patient experiences.

This study had two aims: first to describe, using both descriptive statistics and quantitative content analysis, the noise environment in an ICU patient room over one day, a patient's physical status during the same day and early signs of ICU delirium; second, to describe, using qualitative content analysis, patients' recall of the noise environment in the ICU patient room. The final study group comprised 13 patients. General patient health status data, ICU delirium observations and sound-level data were collected for each patient over a 24-hour period. Finally, interviews were conducted following discharge from the ICU. The sound levels in the patient room were higher than desirable and the LAF max levels exceed 55dB 70-90% of the time. Most patients remembered some sounds from their stay in the ICU and whilst many were aware of the sounds they were not disturbing to them. However, some also experienced feelings of fear related to sounds emanating from treatments and investigations of the patient beside them. In this small sample, no statistical connection between early signs of ICU delirium and high sound levels was seen, but more research will be needed to clarify whether or not a correlation does exist between these two factors.

Influence of a wearer's voice on noise dosimeter measurements.

In recent years, interest in personal noise exposure has expanded beyond a workplace safety measure to become an effective means of investigating physiological effects of the acoustic environment on an individual. This work investigates the effects of the wearer's voice as a possible dominant sound source on body-mounted noise dosimeters and develops methods to improve the application of dosimeter measurements in medium-level noise environments. Subjects experienced a controlled set of acoustic conditions while wearing a dosimeter. In each condition, sound pressure levels were recorded with and without the subject speaking controlled phrases. Three experimental variables were considered-room type, noise type, and noise level. All three variables had a statistically significant effect upon the contribution of speech to a dosimeter measurement; for example, noise level was shown to cause a change in speech contribution by as much as 5.5 dB between sequential levels. Based upon the analysis, a method of predicting the decibel contribution of a wearer's voice was developed. The results of this study can be used to estimate the effect of a wearer's voice on dosimeter measurements in medium-level noise environments.

Observations of the relationship between noise exposure and preschool teacher voice usage in day-care center environments.

Although the relationship between noise exposure and vocal behavior (the Lombard effect) is well established, actual vocal behavior in the workplace is still relatively unexamined. The first purpose of this study was to investigate correlations between noise level and both voice level and voice average fundamental frequency (F0) for a population of preschool teachers in their normal workplace. The second purpose was to study the vocal behavior of each teacher to investigate whether individual vocal behaviors or certain patterns could be identified. Voice and noise data were obtained for female preschool teachers (n=13) in their workplace, using wearable measurement equipment. Correlations between noise level and voice level, and between voice level and F0, were calculated for each participant and ranged from 0.07 to 0.87 for voice level and from 0.11 to 0.78 for F0. The large spread of the correlation coefficients indicates that the teachers react individually to the noise exposure. For example, some teachers increase their voice-to-noise level ratio when the noise is reduced, whereas others do not.

Mean F0 values obtained through standard phrase pronunciation compared with values obtained from the normal work environment: a study on teacher and child voices performed in a preschool environment.

Mean fundamental frequency (F(0)) values are often used in research on vocal load. In this study, we examine how the mean F(0) differs when evaluated through pronouncing a standard phrase as compared to the mean F(0) obtained in a real work/play environment. We also examine how the F(0) values change throughout the day. The study was performed in a preschool, nine adult female preschool teachers and 11 children participated. The participants wore a digital recorder equipped with an accelerometer, which was attached to the neck. In the study, the participant first pronounced a standard phrase in a controlled environment; thereafter, the voice was recorded in the environment where both children and adults normally reside throughout the day, denoted by the work/play environment. For each participant, the procedure was repeated four times throughout the day. Analyses showed that the F(0) values of the children's and adult's voices were significantly higher when recorded in the work/play environment as compared to the controlled environment. The average difference was 36 Hz for adults and 24 Hz for children. Previous studies have shown an increase of F(0) over the day for teachers. In this study, an increase between morning and afternoon values was found amounting to 8 Hz for adults and 24 Hz for children. For the child population, this increase was statistically significant. However, the total changes over the day revealed a somewhat more complex scheme, with an increase of F(0) in the morning, a decrease during lunch, and finally an increase in the afternoon. This pattern was verified statistically for the joint child-adult population.

Comparison of two methods of voice activity detection in field studies.

PURPOSE: To evaluate and compare the performance of 2 methods of voice activity detection (neck-attached accelerometer vs. binaural recordings) in field studies in environments where voice activity normally occurs. METHOD: A group of 11 healthy adults wore recording equipment during their lunch break. We used binary classification to analyze the results from the 2 methods. The output was compared to a gold standard, obtained through listening tests, and the probability for sensitivity (Ps) and false positive (Pf) was rated. The binary classifiers were set for consistent sensitivity of 99%; thus, the lower false positive rate would indicate the method with the better performance. RESULTS: The neck-attached accelerometer (Pf = 0.5%) performed significantly (p < .001) better than the binaural method (Pf = 7%). CONCLUSION: The neck-attached accelerometer is more suitable than the binaural method for voice assessments in environments where people are speaking in close proximity to each other and where the signal-to-noise ratio is moderate to low.

Characterizing noise and perceived work environment in a neurological intensive care unit.

The hospital sound environment is complex. Alarms, medical equipment, activities, and ventilation generate noise that may present occupational problems as well as hinder recovery among patients. In this study, sound measurements and occupant evaluations were conducted in a neurological intensive care unit. Staff completed questionnaires regarding psychological and physiological reactions to the sound environment. A-weighted equivalent, minimum, and maximum (L(Aeq),L(AFMin),L(AFMax)) and C-weighted peak (L(CPeak)) sound pressure levels were measured over five days at patient and staff locations. Acoustical descriptors that may be explored further were investigated, including level distributions, restorative periods, and spectral content. Measurements near the patients showed average L(Aeq) values of 53-58 dB. The mean length of restorative periods (L(Aeq) below 50 dB for more than 5 min) was 9 and 13 min for day and night, respectively. Ninety percent of the time, the L(AFMax) levels exceeded 50 dB and L(CPeak) exceeded 70 dB. Dosimeters worn by the staff revealed higher noise levels. Personnel perceived the noise as contributing to stress symptoms. Compared to the majority of previous studies, this study provides a more thorough description of intensive care noise and aids in understanding how the sound environment may be disruptive to occupants.

Perception and annoyance due to wind turbine noise--a dose-response relationship.

Installed global wind power increased by 26% during 2003, with U.S and Europe accounting for 90% of the cumulative capacity. Little is known about wind turbines' impact on people living in their vicinity. The aims of this study were to evaluate the prevalence of annoyance due to wind turbine noise and to study dose-response relationships. Interrelationships between noise annoyance and sound characteristics, as well as the influence of subjective variables such as attitude and noise sensitivity, were also assessed. A cross-sectional study was performed in Sweden in 2000. Responses were obtained through questionnaires (n = 351; response rate 68.4%), and doses were calculated as A-weighted sound pressure levels for each respondent. A statistically significant dose-response relationship was found, showing higher proportion of people reporting perception and annoyance than expected from the present dose-response relationships for transportation noise. The unexpected high proportion of annoyance could be due to visual interference, influencing noise annoyance, as well as the presence of intrusive sound characteristics. The respondents' attitude to the visual impact of wind turbines on the landscape scenery was found to influence noise annoyance.

Effects of nighttime low frequency noise on the cortisol response to awakening and subjective sleep quality.

The effects of night-time exposure to traffic noise (TN) or low frequency noise (LFN) on the cortisol awakening response and subjective sleep quality were determined. Twelve male subjects slept for five consecutive nights in a noise-sleep laboratory. After one night of acclimatisation and one reference night, subjects were exposed to either TN (35dB L(Aeq), 50dB L(Amax)) or LFN (40dB L(Aeq)) on alternating nights (with an additional reference night in between). Salivary free cortisol concentration was determined in saliva samples taken immediately at awakening and at three 15-minute intervals after awakening. The subjects completed questionnaires on mood and sleep quality. The awakening cortisol response on the reference nights showed a normal cortisol pattern. A significant interaction between night time exposure and time was found for the cortisol response upon awakening. The awakening cortisol response following exposure to LFN was attenuated at 30 minutes after awakening. Subjects took longer to fall asleep during exposure to LFN. Exposure to TN induced greater irritation. Cortisol levels at 30 minutes after awakening were related to "activity" and "pleasantness" in the morning after exposure to LFN. Cortisol levels 30 minutes after awakening were related to sleep quality after exposure to TN. This study thus showed that night time exposure to LFN may affect the cortisol response upon wake up and that lower cortisol levels after awakening were associated with subjective reports of lower sleep quality and mood.

Low frequency noise enhances cortisol among noise sensitive subjects during work performance.

Salivary free cortisol concentration, rated stress and annoyance were determined in 32 subjects before, during and after carrying out a battery of performance tasks for 2 hours during exposure to ventilation noise, with dominant low frequencies (low frequency noise) or a flat frequency spectrum (reference noise). Both noises had a level of 40 dBA. All subjects were studied on two occasions and were exposed to both noises in strict rotation. Subjects were categorised as high- or low-sensitive to noise in general and low frequency noise in particular on the basis of questionnaires. Cortisol concentrations during the task were not significantly modulated by the noises or related to noise sensitivity alone. The normal circadian decline in cortisol concentration was however significantly attenuated in subjects high-sensitive to noise in general, when they were exposed to the low frequency noise. This noise was rated as more annoying and more disruptive to working capacity than the reference noise. The study showed physiological evidence of increased stress related to noise sensitivity and noise exposure during work. This is the first study to demonstrate an effect of moderate levels of noise on neuroendocrine activity. The impact of long-term exposure to moderate noise levels, and particularly low frequency noise, in the workplace deserves further investigation.