THE HOME & HUMAN HEALTH
THE HOME & HUMAN HEALTH
Jerome A. Paulson, MD, FAAP
Jerome A Paulson MD FAAP
Medical Director for National and Global Affairs & Director of the Mid‐
Atlantic Center for Children’s Health and the Environment
Child H lth Ad
Child Health Advocacy Institute
I tit t
Children’s National Health System
Professor of Pediatrics and of Environmental & Occupational Health
George Washington University
1
Dr Paulson has NO conflicts of interest to declare. • This material was developed by the Mid‐Atlantic Center p
y
for Children’s Health & the Environment and funded under the cooperative agreement award number 1U61TS000118‐03 from the Agency for Toxic Substances and Disease Registry (ATSDR). d Di
R i
(ATSDR) • Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing funds to ATSDR under Inter‐Agency Agreement number DW‐75‐
9 30 30 0 e t e
92301301‐0. Neither EPA nor ATSDR endorse the o
S e do se t e
purchase of any commercial products or services mentioned in PEHSU publications. 2
Objectives
• Upon completion of this activity, the participant should be able to:
– Recognize the impact of the home environment on the health of children.
– Incorporate that information into patient evaluations.
– Integrate the information into care management plans for I
h i f
i i l f patients.. 3
Visions of Housing & Health
http://www.rurdev.usda.gov/images/content/sfhhouse.gif
4
Fields of Study Related to Housing & Health
5
Characteristics of a Healthy Building
•
•
•
•
•
•
•
•
•
•
•
•
Healthy Communication (business, multi‐family)
Dry
Ventilation and Filtration
Control of Biological Exposures
Control of Chemical Exposures
Cleanliness
Safety – injury prevention
Comfortable Temperature
Spacious
Quiet
Light
Maintenance of above
New Building ‐ Existing Building
• New
–
–
–
–
Siting issues
g
Building materials
Removal of waste
Design issues
• Existing
– Cleaning
– Maintenance
– Renovation
• Lighting
• Ventilation
7
Children & Homes
• Infants spend about 20 hrs/d at home
• Children spend about 15 hrs/d at home
8
Factors that Influence Environmental Quality in Homes
(houses & apartments) (and other buildings as well)
• Chemicals
– Naturally Occurring
• Radon
– In Consumer Products
• Cleaning supplies
• Cosmetics
• Dry cleaning
– Tobacco smoke
– Lead in paint
– Carbon Monoxide
• Other
– Heating, Ventilation & Air Conditioning
– Mold and moisture
– Pests
– Noise
N i
– Accessibility
– Injury risks
U.S. Environmental Protection Agency (EPA). Exposure Factors Handbook. United States Environmental Protection Agency Washington DC EPA/600/R 06/096F 2008
Environmental Protection Agency, Washington, DC, EPA/600/R‐06/096F,2008
9
Other Home Environmental Factors
•
•
•
•
Parental mental health
Food Insecurity
Domestic Violence
Guns in the home
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
10
INDOOR AIR QUALITY
11
Indoor air pollution
• Depending on building materials used, condition of building, chemicals used inside building, HVAC system, some pollutants may be at higher concentrations indoors than outdoors
• No legal regulation of IAQ except for laws pertaining to smoking
Warner A, et al.. Childhood asthma and exposure to indoor allergens: low mite levels are associated with sensitivity. Pediatr Allergy Immunol 2007;7(2):61–7.
12
Radon
13
Radon Case • Family with 4 children 10 yr. old male, 6 yr. old female, 4 year old M/F twins
y
y
• 10 year old has Crouzon syndrome with hydrocephalus, multiple shunt revisions
y
y
• Family has lived in home X 8 years
• Recent radon test result: 55 pCu/L3 in basement, 37 pCu/L3 on 2nd floor
14
How Radon Enters a House
http://geopanorama.rncan.gc.ca/whitehorse/radon_e.php?p=1
15
Radon as Health Hazard
•
•
•
•
•
•
•
Radon chemically inert and electrically uncharged
Radioactive
Decay produces radon progeny
Inhaled into the lungs attached to dust
Emit alpha radiation
Disrupts DNA of these lung cells
Exposure to alpha radiation may lead to development of cancer
16
Radon as Health Hazard
• Radon clearly associated with lung cancer in miners
• Exposed to much higher concentration of radon than in homes
• Many smokers, most males and exposed to dust and other hazards
17
Radon as Health Hazard
• Committee of National Academy of Sciences estimates 15,400 or 21,800 cases of lung cancer per year in the p y
United States can be attributed to radon among ever smokers and among ever‐smokers and never‐smokers together. • Most of the radon‐related lung‐cancers occur among ever‐smokers
http://books nap edu/openbook php?record id=5499&page=R1
http://books.nap.edu/openbook.php?record_id
5499&page R1
http://www.health.state.mn.us/divs/eh/indoorair/r
adon/images/rnadonehires.jpg
18
Radon & Homes
•
•
•
•
•
Issue varies in different parts of country
How to build to limit radon incursion?
How to monitor home over time as basement floors and walls change?
Cost‐effective amelioration methodologies?
DE Division of Public Health
f bl
lh
– www.dhss.delaware.gov/dhss/dph/in
dex.html exiting epa
– Phone: (302) 744‐4700 or 1‐888‐459‐
(3 ) 744 47
459
2943
– Email: dhssinfo@ state.de.us
http://www.epa.gov/radon/zonemap.html#more%20about%20the%20map
Zone 2 counties have a predicted average indoor radon screening level b
between 2 and 4 pCu/L (orange d
zones)
Zone 3 counties have a predicted average indoor radon screening level less than 2 pCi/L (yellow zones)
19
Damp Spaces – Mold 20
Damp Indoor Spaces and Health
• Institute of Medicine
• National Academy of Sciences
http://books.nap.edu/catalog.php?record_id=11011
21
What happens in damp buildings?
• May get increased growth of mold –
yg
g
fungus –
g
mildew
– Different terms meaning the same thing
– All indoor space has some mold
– Mold and products of mold
p
• May get increased bacterial growth
– Bacteria and products of bacteria
– All indoor space has some bacteria
• May get increased dust mites
– All indoor space, except the most dry or very cold, have some dust mites
• May get release of degradation products from break down of building materials
22
MOLD
23
Case ‐ Mold
• Mother & 9 yo boy, 6 yo boy and 4 yo girl in ground floor apartment
p
4y
g
• Note mold in apartment 4 years ago
• Rained a lot recently
• New mold
• 9 yo diagnosed with ADHD. 6 yo with “attention p
problems”
• Everyone congested while at home, better when at school or work. 24
Environmental Mold Exposure
Ceiling
ili
heavily
contaminated
with mold
Wall
Door
http://www.cdc.gov/nceh/publications/books/
p
g
p
housing/Graphics/chapter_05/Figure5.01.jp
g
25
Indoor factors supporting mold growth
• Nutrition ‐
Nutrition building materials • Moisture ‐ leaking roofs or pipes, condensation on or water intrusion through, walls or basements
g ,
• Inadequate and/or poorly maintained ventilation systems that y
– May not provide enough air for dilution and/or dehumidification
– May contain sources of mold and/or disperse mold spores f
into the occupants’ breathing zone
26
MOLD & DISEASE
27
Four ways that fungi can cause disease in humans (and animals)
• May be building related
– Allergic or hypersensitivity reactions
– Irritant reactions
– Toxic reactions • Not likely to be building related
– Infections
28
Allergic reactions most common
• About 10% of the population has allergic antibodies to fungal antigens, and 5% have clinical illness
– Allergic rhinitis (“hay fever”) or asthma
• Outdoor molds more abundant and important in airway allergic disease
29
Allergic Symptoms
• Nasal
–
–
–
–
Clear nasal discharge
g
Nasal congestion
Sneezing
Post‐nasal drip with sore throat
h
– Coughing
– Hoarseness
– Nasal obstruction
• Pulmonary
– Asthma attacks in sensitized individuals
– New onset of asthma
30
Molds & Volatile Organic Compounds
• Molds growth can →
Molds growth can volatile organic compounds (VOCs) ‐ alcohols, esters, aldehydes, and aromatic compounds
• VOC production varies with growth conditions
31
In higher concentrations, VOCs can be highly irritating
•
•
•
•
•
•
•
Eye irritation and conjunctivitis
Skin rashes
Runny nose
Laryngitis and hoarseness
Cough
Chest tightness
Headache and fatigue
32
Mycotoxins
• Produced by some, not all molds
• Toxigenic species do not always produce mycotoxin‐
depends on various conditions
p
• Mycotoxins ‐ large molecules
– Not significantly volatile; i.e., don’t “off gas”
g
y
; ,
g
– Don’t migrate through walls or floors
33
Exposure to Mycotoxins
• For inhalation must get fungal fragments or spores into air
y
g
• May cause skin irritation if contact fungi
• Can be toxic when ingested
34
Mold & Homes
• Issue varies in different parts of country
• How to build appropriately to control moisture?
• How to monitor home over time as the building envelope changes?
• How to repair home once moisture incursion has occurred?
35
Mold & Homes ‐ Interventions
• Write letters to landlords
– Dear ____________:
• XQRNP JWMLZ is a __ year old child who is seen in my pediatric practice. Her/his mother has recently brought to my attention an issue with mold contamination in their home. For some children, mold itself can present medical problems. Even when it does not, mold is indicative of a serious problem with excess moisture than needs to be attended to. Option A. Option B. • I believe that the mold or moisture in the home is unhealthy for XQRNP JWMLZ. Thi bl h ld b This problem should be remediated immediately
di d i
di l
• Sincerely, – Option A. This child has asthma (and/or allergies) and the moisture and mold are making the child’s symptoms worse. – Option B. Mold can irritate the eyes, nose and through in some individuals. As a result it can cause discomfort in the eyes, runny nose, sore throat and cough. • Collaborate with your medical
Collaborate with your medical‐legal partnership or local legal aid legal partnership or local legal aid group
36
LEAD
37
Scope of the Problem
• Pre
Pre‐1978, and especially pre‐1951, housing
1978, and especially pre 1951, housing
• At least 4 million households have children living in them that are being exposed to lead
g p
• About 500,000 children with blood lead levels over 5 µg
µg/dL
• Have the potential to eliminate childhood lead poisoning
38
How Do Children Get Lead Poisoned Today?
• Old paint
• Lead on the ground
–
–
–
–
From paint
From past use of leaded gasoline
Industrial sources – smelters
Solder
• As lead paint becomes less common, “Other” becomes proportionately more important
39
“Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention
Call of Primary Prevention”
• Most recent CDC document –
Most recent CDC document June 2012
• “Elimination of the use of the term “blood lead level of concern” based on the compelling evidence that p
g
low BLLs are associated with IQ deficits, attention‐
related behaviors, and poor academic achievement.”
• The absence of an identified BLL without deleterious effects, combined with the evidence that these effects appear to be irreversible, underscores h
ff
b
bl
d
the critical importance of primary prevention.
40
Neurobehavioral Effects of “Low” Lead Levels
• Lowers IQ
• Individual impact small ‐ about 4 IQ points for blood lead levels of 2.4‐10 mcg/dL 4
g/
• Population impact very significant
• Quadruple risk of IQ < 80: 16% vs. 4%
• 5% of low leads with IQ > 125, O% of high leads.
41
Neurobehavioral Effects of “Low” Lead Levels
• Lowers IQ
– Individual impact small ‐ about 4 IQ points for blood lead levels of 2.4‐10 mcg/dL – Population impact very significant
• Quadruple risk of IQ < 80: 16% vs. 4%
• 5% of low leads with IQ > 125, O% of high leads.
5% of low leads with IQ > 125 O% of high leads
42
Small Individual Effects Can Have Large Population Effects
57% increase in in
“Intellectually Impaired “Population
43
PEHSUs’ Recommendations for Operationalizing the New CDC Recommendations
• BLL < 5 mcg/dL
5 g
– Review lab results with family. For reference, the geometric mean blood lead level for children 1‐5 years old is less than 2 mcg/dL .
– Repeat the blood lead level in 6‐12 months if the child is at high risk or risk p
g
changes during the timeframe. Ensure levels are done at 1 and 2 years of age.
– For children screened at age < 12 months, consider retesting in 3‐6 months as lead exposure may increase as mobility increases.
– Perform routine health maintenance including assessment of nutrition, physical and mental development, as well as iron deficiency risk factors.
– Provide anticipatory guidance on common sources of environmental lead exposure: paint in homes built prior to 1978, soil near roadways or other sources of lead, take‐home exposures related to adult occupations, imported spices, cosmetics, folk remedies, and cookware.
44
PEHSUs’ Recommendations for Operationalizing the New CDC Recommendations
• BLL 5‐14 mcg/dL
5
g
– Perform steps as described above for levels < 5 mcg/dL.
– Re‐test venous blood lead level within 1‐3 months and then if stable or decreasing, in 3 months. Refer patient to local health authorities if such resources g, 3
p
are available. Contact the CDC at 800‐CDC‐INFO (800‐232‐4636) or the National Lead Information Center at 800‐424‐LEAD (5323) for resources.
– Take a careful environmental history. Take care to consider other children who may be exposed.
b d
– Provide nutritional counseling related to calcium and iron.
– Ensure iron sufficiency with adequate laboratory testing (CBC, Ferritin, CRP) and treatment per AAP guidelines. Consider starting a multivitamin with iron.
– Perform structured developmental screening evaluations at child health maintenance visits, as lead’s effect on development may manifest over years
i
i i
l d ff
d l
f
45
PESTICIDE EXPOSURE
46
Pesticide Case
• Get a call from a community activist. • She found out that the local housing authority contracts for monthly pesticide applications in all yp
pp
low‐income, county‐owned housing. • She wants to know the health effects on the kids. 47
Pesticides and Use
• Pesticide classification
– By use: insecticides, fungicides, herbicides, and rodenticides, etc.
– By chemical class: organophosphates, N‐methyl carbamates, pyrethroids, triazines, and superwarfarins.
• 82% of US households report using pesticides
8 % f US h
h ld t i ti id
– 3‐4 different pesticides/home
48
Neurocognitive Impacts of Low‐level Pesticide Exposure
• Growing body of evidence that low level, prenatal and early postnatal exposures to pesticides lead to adverse neurocognitive outcomes
– Children not acutely toxic, no overt symptoms
– At greater risk for development of learning disabilities, l f IQ d tt ti bl
loss of IQ and attention problems
• Based on studies in Salinas Valley, CA (agricultural/outdoor use) and NY City (home/indoor use)
49
Neurocognitive Impacts of Low‐level Pesticide Exposure
• Mothers chlorpyrifos
py
metabolites in their urine and low activity of the enzyme paraoxonase (PON1), gave birth to infants with significantly reduced head circumferences compared with mothers with higher activity of PON1
• Children who have high chlorpyrifos exposure prenatally
– Increased risk of motor and cognitive development delay. – Significantly higher number of children manifested symptoms of inattention at age 3 years. – Decrease in FS IQ and working memory @ age 7
ec ease
S Qa d o
g e o y @ age 7
50
Neurocognitive Impacts of Low‐level Pesticide Exposure
• In utero exposure to DDE significantly associated p
g
y
with lower scores on the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development (BSID II) at 6 months and not at 12 Development (BSID‐II) at 6 months and not at 12 and 24 months
• Increase in maternal serum DDT level associated BSID‐II MDI at 12 and 24 months, respectively
• Significant inverse association between maternal serum DDT and the psychomotor development scores on the BSID‐II at 6 and 12 months but not at 24 months
51
Other Concerns about Adverse Outcomes R l t d t P ti id E
Related to Pesticide Exposure
• Ecologic and case
Ecologic and case‐control studies associated control studies associated parental exposures or pesticide use in home with childhood brain tumors, leukemias and lymphomas, and a number of other tumor types
• Birth defects studies have linked parental occupational pesticide exposure: cryptorchidism, orofacial clefts, limb reduction defects, and heart defects in their children
52
Integrated Pest Management
• Reduces pests
• Likely to expose residents to fewer hazards
• IPM Principles
– Remove food sources through proper food storage and cleaning
– Repair structural defects to prevent access – Apply low‐toxicity pesticides as needed
– Monitor
– Educate residents.
53
SUMMARY
54
SUMMARY
• Housing influences health
g
• Somewhat different issues for new vs. existing housing
• Housing professionals & health care professionals have many areas where they can work together to improve individual and public health
• Need a holistic approach when dealing with housing issues in older homes
55
WHERE DO YOU TURN WITH QUESTIONS ABOUT CHILDREN’S ENVIRONMENTAL HEALTH?
56
Turn to a PEHSU
• A resource for pediatricians, public health officials, esou ce o ped at c a s, pub c ea t o c a s,
school personnel, parents and others to get questions answered about children’s health and the environment
– Provide education
– Provide consultation
• Pediatricians with expertise in environmental health
• Occupational and environmental health specialty physicians
• Medical toxicologists, pulmonologists, etc.
• National and international network of collaborators
57
PEHSU Regions
10 PEHSUs in the US
58
The Pediatric Environmental Health Specialty Unit (PEHSU) Program is funded by:
&
The Association of Occupational and Environmental Clinic is responsible for programmatic and financial management.
59
PEHSUs
Evaluation and Management of
•
•
•
•
•
•
Lead toxicity
Pesticide exposures
Sick building problems
Water pollution
Air pollution
Job related exposures in adolescents
• Volatile Organic Compounds
• Exposure to hazardous waste sites
y
• Environmentally related asthma
g
p
• Agricultural pollutants
• Solvents
• Carbon monoxide
• Arsenic
• Mercury
60
MACCHE
• Director
– Jerome A. Paulson, MD, FAAP
• Toxicologist
g
– Maryann Amirshahi, PharmD, MD, MPH • Coordinator
– Veronica Tinney, MPH
• Fellow
– Abby L. Nerlinger, MD
61
MACCHE
• Region 3
• Pennsylvania, Delaware, Maryland, Virginia, West Virginia, & the District of Columbia
g ,
• 1‐866‐622‐2431 43
• 202‐476‐4829
47 4 9
• www.childrensnational.org/MACCHE
62
QUESTIONS?
E‐mail: [email protected]
Phone: 202‐471‐4829
T ll f
Toll free:
866 6
866‐622‐2431
63
2009 Surgeon General’s Call to Action to Promote Healthy Homes
• "The Call to Action says, A healthy home is sited, The Call to Action says, A healthy home is sited, designed, built, renovated, and maintained in ways that support the health of residents.” Office of the Surgeon General (US). The Surgeon General's Call to Action to Promote Healthy Homes Rockville MD: Office of the Surgeon General 2009
Promote Healthy Homes. Rockville, MD: Office of the Surgeon General, 2009.
64
Carbon Monoxide
65
Case
• A family of 4 move into a 25 year old single‐family y 4
5y
g
y
home in July. The home has natural gas for cooking, heating and hot water. • On several days in October, all family members O
ld
O b
ll f
l
b
complain of health ache and “feeling funny” upon arising. No medical care is sought. • In mid‐November, the father wakes with a severe headache. He can barely awaken his wife who is disoriented. The two children cannot be awakened and EMS is summoned. 66
Carbon monoxide
• Colorless, odorless
• Children and infants have higher metabolic and respiratory rates are more susceptible to CO toxicity.
p
y
p
y
• Maternal smoking leads to in utero exposure
• More than half of the states in the US have statutes that require CO detectors in residential buildings (family homes, child care centers, group child care homes, and schools )
67
Sources of Exposure
• Faulty furnaces
• Inadequate ventilation of heating sources
• Exposure to engine exhaust
– Automobile
– Gasoline or diesel powered generators indoors or near p
g
windows
Symptoms
• Mild exposures
–
–
–
–
Headache
y g
Myalgia
Dizziness
Neuropsychological i
impairment
i
• Severe exposures – Confusion
– Loss of consciousness
– Death
Chronic Exposure
• Symptoms
–
–
–
–
–
–
–
–
–
–
–
–
–
Chronic fatigue, Affective changes
Emotional distress
M
Memory deficits
d fi i
Difficulty working or doing school work
Sleep disturbances
Vertigo
Neuropathy,
Paresthesias
Recurrent infections
Polycythemia
Abdominal pain
Diarrhea
Sequelae
• Acute exposure without hyperbaric O2
– 46% cognitive sequelae
q
– 49% affective sequelae
– Other
•
•
•
•
•
•
Gait and motor disturbance
P i h l Peripheral neuropathy
th
Hearing loss
Vestibular abnormalities
Dementia
Psychosis
Treatment of Acute Poisoning
• Normobaric O2
• Hyperbaric O2 – Controversial – Single study with excellent RCT design
• Cognitive sequelae lower with 3 session of hyperbaric O2
• Cognitive sequelae also lower at 12 months
– A C
A Cochrane review of six trials, including two published h
i f i i l i l di bli h d only in abstract form, did not support the use of O2
Tobacco Smoke
73
Case
• AQK is a 7 yr. old girl who lives in a 5 story apartment 7y
g
5
y p
building. She is well controlled on inhaled steroids. She needs a rescue inhaler < 1/month when exposed to secondhand smoke to secondhand smoke. • For 3 weeks, she has been coughing on a daily basis when she returns from school and has needed her rescue inhaler at least once on each of the past 2 Saturdays or Sundays. • What might be going on and what community resources could you call on?
74
Tobacco
• Seco
Secondhand Smoke –
d a d S o e aalso ETS
so S
• > 4000 chemicals – >250 toxicants or carcinogens
• Alters fetal blood flow, protein metabolism and concentration of certain chemical in mother and fetus
– Chronic fetal hypoxemia
– Nicotine effects neurotransmitters leading to changes in neuronal pathways (animal models) p
y (
)
• Sudden Infant Death Syndrome (SIDS)
• Preterm birth & Low birth weight
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
l
b d d l lh
75
Tobacco
• Secondhand Smoke – also ETS
• Both pre‐ and post‐natal maternal smoking associated with increased respiratory disease
–
–
–
–
Asthma
A
th
Otitis media
Upper Respiratory Infection
Decreased respiratory function
• Both pre‐ and post‐natal maternal smoking associated with behavior problems ‐ hyperactivity, oppositional hyperactivity oppositional defiant disorder, delinquency, and internalizing and externalizing behaviors, decreased IQ W i
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
l 2013 C P b P d Ad l Hl h C
43 187
76
Tobacco
• Thirdhand smoke smoke ‐ residual particulate matter from tobacco smoke that remains on surfaces and in dust.
– Toxic to fetus in utero of nonsmoker
– In dust, therefore children more likely to be exposed
– Causes airway inflammation – increase in asthma exacerbation
b i
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
77
Tobacco
• Multifamily dwelling
– People in non‐smoking units exposed to SHS and THS
• Consider legislation limiting smoking in multifamily g
g
g
y
units
• Write letters to landlords
• Collaborate with your medical‐legal partnership or local legal aid group
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
78
NOISE
79
“Noise is an unwanted or objectionable sound”
80
Source of noise near home or school
• Airport, train, highway
• Impact on processing and language comprehension
Effect reading attention problem solving and • Effect reading, attention, problem solving, and memory Effect long term memory
• Effect long‐term memory
• Increase stress as reflected by catecholamine levels
Weitzman, et al., 2013, Curr Prob Ped Adol Hlth Care, 43: 187
81
MAGNIITUDE AND EFFECTS OF SOUND
COMMON EXAMPLE
dBA
Breathing 0‐10
EFFECT
Hearing threshold
Conversation at home 50
Quiet
Freeway traffic (15 m), vacuum cleaner, noisy F
t ffi ( ) l
i party
70
Annoying, interferes with A
i i t f
ith telephone use
Average factory, train (at 15 m) 80
Possible hearing damage
Jet take‐off (at 305 m) motorcycle
Jet take‐off (at 305 m), motorcycle
100
Damage if over 1 minute
Thunderclap, textile loom, chain saw, siren, rock concert
120
Human pain threshold
Toy cap pistol Jet takeoff (at 25 m) firecracker
Toy cap pistol, Jet takeoff (at 25 m), firecracker
150
Eardrum rupture
http://www.who.int/ceh/capacity/noise.pdf?ua=1
82
ADVERSE EFFECTS FROM EXCESS NOISE EXPOSURE
• Direct ear damage
– Noise induced hearing loss
– Noise induced threshold shift
• Indirect adverse effects
– Physiological effects
– Psychological effects
• Impaired cognition
• Characteristics of the sound can modify effect
http://www.who.int/ceh/capacity/noise.pdf?ua=1
83
NOIISE IINDUCED THRESHOLD SHIIFT (NIITS)
• Initially Initially ‐ a temporary condition
– Decrease in sensitivity to noise
– Tinnitus
• Caused by exposure to loud noises
y
• May be reversible or irreversible
– Severity and duration of exposure
– Continuous and recurrent exposure
http://www.who.int/ceh/capacity/noise.pdf?ua=1
p
p y
p
84
INDIRECT ADVERSE EFFECTS
• Stress‐related somatic effects
– Stress hormone
– Blood pressure
– Muscle spasm
• Psychological effects
– Annoyance / Isolation
– Sleep disturbance
– Mental health
• Cognitive effects
– Reading, concentration, memory, attention
http://www.who.int/ceh/capacity/noise.pdf?ua=1
85