Environmental Noise Pollution in the United States: Developing an Effective Public Health Response (PDF)
Source: Environmental Health Perspectives
Tens of millions of Americans suffer from a range of adverse health outcomes due to noise exposure, including heart disease and hearing loss. Reducing environmental noise pollution is achievable and consistent with national prevention goals, yet there is no national plan to reduce environmental noise pollution.
We aimed to describe some of the most serious health effects associated with noise, summarize exposures from several highly prevalent noise sources based on published estimates as well as extrapolations made using these estimates, and lay out proven mechanisms and strategies to reduce noise by incorporating scientific insight and technological innovations into existing public health infrastructure.
We estimated that 104 million individuals had annual LEQ(24) levels > 70 dBA (equivalent to a continuous average exposure level of >70 dBA over 24 hr) in 2013 and were at risk of noise-induced hearing loss. Tens of millions more may be at risk of heart disease, and other noise-related health effects. Direct regulation, altering the informational environment, and altering the built environment are the least costly, most logistically feasible, and most effective noise reduction interventions.
Significant public health benefit can be achieved by integrating interventions that reduce environmental noise levels and exposures into the federal public health agenda.
Audit of VA’s Hearing Aid Services (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General
We conducted this audit to evaluate the effectiveness of VA’s administration of hearing aid order and repair services through VA’s audiology services. Tinnitus and hearing loss were the first and second most prevalent service-connected disabilities for veterans receiving compensation at the end of FY 2012. VA was not timely in issuing new hearing aids to veterans or in meeting its 5-day timeliness goal to complete repair services. During the 6-month period ending September 2012, the Veterans Health Administration issued 30 percent of its hearing aids to veterans more than 30 days from the estimated receipt date from their vendors. Medical facilities’ audiology staff attributed the delays to inadequate staffing to meet an increased workload. In addition, the Denver Acquisition and Logistics Center (DALC) took 17 to 24 days to complete hearing aid repair services, exceeding its 5-day timeliness goal. During this period, 5 of 21 repair technician positions were vacant. These vacancies, and an increased workload, adversely affected DALC’s ability to meet its timeliness goal for hearing aid repairs. We observed and estimated about 19,500 sealed packages of hearing aids were waiting for repair and staff to record the date received into DALC’s production system. According to management, staff did not record the date they received the packages because opening packages had the potential risk of losing small parts. Without a timely recording system, staff cannot adequately respond to veteran and medical facility inquiries. We recommended the Under Secretary for Health develop a plan to implement productivity standards and staffing plans for audiology clinics. Also, we recommended the Principal Executive Director of the Office of Acquisition, Logistics, and Construction ensure DALC determines the appropriate staffing levels for its repair lab and establish controls to timely track and monitor hearing aids for repair. The Under Secretary for Health and Principal Executive Director, Office of Acquisition, Logistics, and Construction, and the Office of Inspector General concurred with our recommendations.
Video Relay Service: Program Funding and Reform (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
The Federal Communications Commission (FCC) regulates a number of disability-related telecommunications services, including video relay service (VRS). VRS allows persons with hearing disabilities, using American Sign Language (ASL), to communicate with voice telephone users through video equipment, rather than through typed text. VRS has quickly become a very popular service, as it offers several features not available with the text-based telecommunications relay service (TRS).
In June 2010, the FCC began a comprehensive review of the rates, structure, and practices of the VRS program. The goal of the review is to reform the VRS program, which had long been burdened by waste, fraud, and abuse, and by compensation rates that had become inflated above actual cost. The FCC issued its updated VRS Program rules in June 2013. The new rules initiate fundamental restructuring of the program to support innovation and competition, drive down ratepayer and provider costs, eliminate incentives for waste, and further protect consumers…
Clinical Digest — Spotlight on a Modality: Omega-3 Fatty Acids
Source: National Center for Complementary and Alternative Medicine
Omega-3 fatty acids have been in the news lately, after a new study raises concern about the association of omega-3s and an increased risk of prostate cancer. Omega-3s are a popular supplement used by many Americans. In fact, according to the 2007 National Health Interview Survey, which included a comprehensive survey on the use of complementary health practices by Americans, fish oil/omega-3/DHA supplements are the natural product (excluding vitamins and minerals) most commonly taken by adults, and the second most commonly taken by children.
Moderate evidence has emerged about the health benefits of consuming seafood, but the health benefits of omega-3s in supplement form are less clear. For example, the findings of individual studies on omega-3 supplements and heart disease have been inconsistent, and in 2012, two combined analyses of the results of these studies did not find convincing evidence that omega-3s protect against heart disease.
There is some evidence that omega-3s are modestly helpful in relieving symptoms in rheumatoid arthritis. Omega-3s may also be helpful for age-related macular degeneration (AMD; an eye disease that can cause loss of vision in older people). For most other conditions for which omega-3s are being studied, definitive conclusions cannot yet be reached. This issue of the digest provides information on what the science says about omega-3’s effectiveness and safety for several conditions for which there is the most evidence, including heart disease, rheumatoid arthritis, infant development, and diseases of the eye and brain.
Elevated Frequency of Cataracts in Birds from Chernobyl
Source: PLoS ONE
Radiation cataracts develop as a consequence of the effects of ionizing radiation on the development of the lens of the eye with an opaque lens reducing or eliminating the ability to see. Therefore, we would expect cataracts to be associated with reduced fitness in free-living animals.
We investigated the incidence of lens opacities typical of cataracts in more than 1100 free-living birds in the Chernobyl region in relation to background radiation. The incidence of cataracts increased with level of background radiation both in analyses based on a dichotomous score and in analyses of continuous scores of intensity of cataracts. The odds ratio per unit change in the regressor was 0.722 (95% CI 0.648, 0.804), which was less than odds ratios from investigations of radiation cataracts in humans. The relatively small odds ratio may be due to increased mortality in birds with cataracts. We found a stronger negative relationship between bird abundance and background radiation when the frequency of cataracts was higher, but also a direct effect of radiation on abundance, suggesting that radiation indirectly affects abundance negatively through an increase in the frequency of cataracts in bird populations, but also through direct effects of radiation on other diseases, food abundance and interactions with other species. There was no increase in incidence of cataracts with increasing age, suggesting that yearlings and older individuals were similarly affected as is typical of radiation cataract.
These findings suggest that cataracts are an under-estimated cause of morbidity in free-living birds and, by inference, other vertebrates in areas contaminated with radioactive materials.
Mechanisms of Hearing Loss after Blast Injury to the Ear
Source: PLoS ONE
Given the frequent use of improvised explosive devices (IEDs) around the world, the study of traumatic blast injuries is of increasing interest. The ear is the most common organ affected by blast injury because it is the body’s most sensitive pressure transducer. We fabricated a blast chamber to re-create blast profiles similar to that of IEDs and used it to develop a reproducible mouse model to study blast-induced hearing loss. The tympanic membrane was perforated in all mice after blast exposure and found to heal spontaneously. Micro-computed tomography demonstrated no evidence for middle ear or otic capsule injuries; however, the healed tympanic membrane was thickened. Auditory brainstem response and distortion product otoacoustic emission threshold shifts were found to be correlated with blast intensity. As well, these threshold shifts were larger than those found in control mice that underwent surgical perforation of their tympanic membranes, indicating cochlear trauma. Histological studies one week and three months after the blast demonstrated no disruption or damage to the intra-cochlear membranes. However, there was loss of outer hair cells (OHCs) within the basal turn of the cochlea and decreased spiral ganglion neurons (SGNs) and afferent nerve synapses. Using our mouse model that recapitulates human IED exposure, our results identify that the mechanisms underlying blast-induced hearing loss does not include gross membranous rupture as is commonly believed. Instead, there is both OHC and SGN loss that produce auditory dysfunction.
Source: World Health Organization
- 360 million people worldwide have disabling hearing loss1.
- Hearing loss may be inherited, caused by maternal rubella or complications at birth, certain infectious diseases such as meningitis, chronic ear infections, use of ototoxic drugs, exposure to excessive noise and ageing.
- Half of all cases of hearing loss are avoidable through primary prevention.
- People with hearing loss can benefit from devices such as hearing aids, assistive devices and cochlear implants, and from captioning, sign language training, educational and social support.
- Current production of hearing aids meets less than 10% of global need.
- WHO is assisting countries in developing programmes for primary ear and hearing care that are integrated into the primary health-care system of the country.
Hearing problems is one of the top ten public health disorders in the general population and there is a well-established relationship between stress and hearing problems. The aim of the present study was to explore if an acute stress will increase auditory sensitivity (hyperacusis) in individuals with high levels of emotional exhaustion (EE).
Hyperacusis was assessed using uncomfortable loudness levels (ULL) in 348 individuals (140 men; 208 women; age 23–71 years). Multivariate analyses (ordered logistic regression), were used to calculate odds ratios, including interacting or confounding effects of age, gender, ear wax and hearing loss (PTA). Two-way ANCOVAs were used to assess possible differences in mean ULLs between EE groups pre- and post-acute stress task (a combination of cold pressor, emotional Stroop and Social stress/video recording).
There were no baseline differences in mean ULLs between the three EE groups (one-way ANOVA). However, after the acute stress exposure there were significant differences in ULL means between the EE-groups in women. Post-hoc analyses showed that the differences in mean ULLs were between those with high vs. low EE (range 5.5–6.5 dB). Similar results were found for frequencies 0.5 and 1 kHz. The results demonstrate that women with high EE-levels display hyperacusis after an acute stress task. The odds of having hyperacusis were 2.5 (2 kHz, right ear; left ns) and 2.2 (4 kHz, right ear; left ns) times higher among those with high EE compared to those with low levels. All these results are adjusted for age, hearing loss and ear wax.
Women with high levels of emotional exhaustion become more sensitive to sound after an acute stress task. This novel finding highlights the importance of including emotional exhaustion in the diagnosis and treatment of hearing problems.
See: Stress Makes Exhausted Women Over-Sensitive to Sounds (Science Daily)
WHY WE DID THIS STUDYWet age-related macular degeneration (AMD), a leading cause of vision loss in people aged 60 and older, affects millions of Americans. Lucentis is a Medicare Part B-covered drug approved by the Food and Drug Administration (FDA) for the treatment of wet AMD. Avastin is a Part B-covered drug approved by FDA for the treatment of various forms of cancer, but smaller doses of the drug are being used off-label to treat wet AMD. A dose of Avastin used to treat wet AMD costs a small fraction of the cost of a dose of Lucentis. CMS established a national Medicare payment amount for Lucentis; however, there is no national Medicare payment amount for Avastin when used to treat wet AMD in a physician’s-office setting. In 2010, combined Part B expenditures for Lucentis and Avastin totaled nearly $2 billion.HOW WE DID THIS STUDYUsing Medicare claims data, we selected 2 stratified random samples: 1 sample of 160 physicians who received Medicare payment for Lucentis and 1 sample of 160 physicians who received Medicare payment for Avastin. We sent electronic surveys asking physicians to provide the total dollar amount and quantity purchased of Lucentis and Avastin in the first quarter of 2010. We also asked physicians to describe the factors that they consider when choosing Avastin instead of Lucentis for the treatment of wet AMD. We compared physician acquisition costs to Medicare payment amounts obtained from CMS and Medicare contractors. Additionally, we analyzed Medicare contractor payment policies and the reasons physicians reported for administering Avastin instead of Lucentis.WHAT WE FOUNDIn the first quarter of 2010, physician acquisition costs for Lucentis and Avastin were 5 and 53 percent below the Medicare payment amount, respectively. Medicare contractors’ payment amounts for Avastin when used to treat wet AMD differed by as much as 28 percent, although payment policies were similar. Additionally, we found that the majority of physicians who administered Avastin to treat wet AMD reported the substantial cost difference compared to Lucentis as a primary factor in their decision.WHAT WE RECOMMENDWe recommend that CMS:
(1) Establish a national payment code for Avastin when used for the treatment of wet AMD and(2) Educate providers about the clinical and payment issues related to Lucentis and Avastin.
CMS did not concur with our first recommendation at this time but did concur with our second recommendation.
Treatment for Glaucoma: Comparative Effectiveness (PDF)
Source: Agency for Healthcare Research and Quality
Objectives. Glaucoma is a leading cause of visual impairment and blindness worldwide. Treatment focuses on the reduction of intraocular pressure (IOP), which secondarily prevents worsening of visual field loss; in this way, available treatments may prevent visual impairment and blindness. The objective of this Comparative Effectiveness Review is to summarize the evidence regarding the safety and effectiveness of medical, laser, and other surgical treatments for open-angle glaucoma in adults.
Data Sources. We searched MEDLINE®, Embase, LILACS, and CENTRAL through October 6, 2011 to identify clinical trials. We searched MEDLINE and CENTRAL (from 2009 to March 2, 2011) and screened an existing database to identify relevant systematic reviews.
Review Methods. Two reviewers independently assessed citations for eligibility. One reviewer assessed the risk of bias and extracted descriptions of the study. A second reviewer verified the data. Two reviewers also screened the results for systematic reviews. Details about the eligible systematic reviews were abstracted, including elements related to the methodological rigor.
Results. We identified 23 systematic reviews. Twelve reviews addressed medical treatments, 9 addressed surgical treatment, and 1 compared medical versus surgical treatments. One review addressed different surgical treatments as well as medical versus surgical treatments. We identified 73 RCTs and 13 observational studies addressing adverse effects. We identified no studies that evaluated treatments with regard to their impact on visual impairment. We also found insufficient evidence comparing treatment versus no treatment on patient-reported outcomes. No studies addressed the possible link between intermediate outcomes (IOP, optic nerve structure, or visual field) and visual impairment or patient-reported outcomes. There is moderate evidence that medical and surgical treatments can lower IOP and reduce the risk of progression by both visual field and optic nerve criteria. Among medical treatments, the prostaglandin agents are superior to other classes with regard to lowering IOP. While laser trabeculoplasty decreases IOP, the technology used does not make a difference in pressure lowering. With regard to incisional surgeries, trabeculectomy provides more pressure lowering than the class of nonpenetrating procedures. As expected, incisional surgeries produce more significant side effects than do medical treatments.
Conclusions. We did not find evidence addressing direct or indirect links between glaucoma treatment and visual impairment or patient-reported outcomes. This should be an area of focus in future trials of adequate size and duration to detect differences between treatment groups. However, we did find that a number of medical and surgical treatments clearly lower IOP and can prevent visual field loss and optic nerve damage. While we found direct comparisons between some treatments, there are significant gaps in our knowledge of comparative effectiveness.
Quieter Cars and the Safety of Blind Pedestrians, Phase 2: Development of Potential Specifications for Vehicle Countermeasure Sounds — Final Report
Quieter Cars and the Safety of Blind Pedestrians, Phase 2: Development of Potential Specifications for Vehicle Countermeasure Sounds — Final Report (PDF)
Source: National Highway Traffic Safety Administration
This project performed research to support the development of potential specifications for vehicle sounds, (i.e., audible countermeasures) to be used in vehicles while operating in electric mode in specific low speed conditions. The purpose of the synthetic vehicle sound is to alert pedestrians, including blind pedestrians, of vehicle presence and operation. The project developed various options and approaches to specify vehicle sounds that could be used to provide information at least equivalent to the cues provided by ICE vehicles, including speed change. Acoustic data from a sample of ICE vehicles was used to determine the sound levels at which synthetic vehicle sounds, developed as countermeasures, could be set. Psychoacoustic models and human-subject testing were used to explore issues of detectability, masking, and recognition of ICE-like and alternative sound countermeasures. Data were used to develop potential options that could be pursued to develop specifications for synthetic vehicle sounds. Project results indicate that vehicle detectability could potentially be met through various options including: recording(s) of actual ICE sounds; synthesized ICE-equivalent sounds; alternative, non-ICE-like sounds designed for detectability; and a hybrid of the options listed above.
Genomics and the Eye
Source: New England Journal of Medicine
The eye has had a pivotal role in the evolution of human genomics. At least 90% of the genes in the human genome are expressed in one or more of the eye’s many tissues and cell types at some point during a person’s life. Consistent with this impressive genomic footprint is the observation that about a third of entries in the Online Mendelian Inheritance in Man database for which a clinical synopsis is provided include a term that refers to the structure or function of the eye. Moreover, the phenotypic effects of even small genetic variations are made readily apparent by the many layers of amplification in the human visual system. For example, a single-nucleotide change in PAX6 can cause an anatomic abnormality of the macula less than a millimeter in diameter that results in noticeably reduced visual acuity and nystagmus.
The heritable inability to correctly perceive the color green, known as Daltonism (after the English chemist John Dalton, who himself was affected), was the first human trait mapped to the X chromosome. The Coppock cataract was the first human trait mapped to an autosome, and Leber’s hereditary optic neuropathy was the first human disease shown to be caused by a mutation in mitochondrial DNA. More recently, age-related macular degeneration (AMD) and glaucoma — two common causes of human blindness — have been shown to be largely genetic, as has Fuchs’ endothelial dystrophy,8 the most common cause of corneal transplantation in developed countries. Here, we review discoveries in mendelian and complex ophthalmic disorders and their implications for genetic testing and therapeutic intervention.
Severe Hearing Impairment Among Military Veterans — United States, 2010
Source: Morbidity and Mortality Weekly Report (CDC)
A substantial proportion of hearing loss in the United States is attributable to employment-related exposure to noise (1). Among military veterans, the most common service-connected disabilities are hearing impairments (2), suggesting that occupational noise exposure during military service might cause more veterans to have hearing loss than nonveterans. However, a recent analysis of data from the 1993–1995 Epidemiology of Hearing Loss Study did not find significant differences between the two groups (3). To further investigate hearing loss among veterans, specifically the prevalence of severe hearing impairment (SHI), data from the 2010 Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) were analyzed. This report describes the results of those analyses, which indicated that the prevalence of SHI among veterans was significantly greater than among nonveterans. Veterans were 30% more likely to have SHI than nonveterans after adjusting for age and current occupation, and veterans who served in the United States or overseas during September 2001–March 2010, the era of overseas contingency operations (including Operations Enduring Freedom and Iraqi Freedom), were four times more likely than nonveterans to have SHI. These findings suggest a need for increased emphasis on improving military hearing conservation programs (HCPs) and on hearing loss surveillance in military and veterans’ health systems.
Smoking and Visual Impairment Among Older Adults With Age-Related Eye Diseases
Source: Preventing Chronic Disease (CDC)
Smoking is linked to self-reported visual impairment among older adults with age-related eye diseases, particularly cataract and age-related macular degeneration. Longitudinal evaluation is needed to assess smoking cessation’s effect on vision preservation.
Ocular Toxocariasis — United States, 2009–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Ocular toxocariasis (OT) is caused by the zoonotic parasites Toxocara canis and Toxocara cati, roundworms of dogs and cats. Persons become infected with Toxocara when they unintentionally ingest embryonated eggs that have been shed in the feces of infected animals. Although OT is uncommon, it most often affects young children and can cause debilitating ophthalmologic disease, including blindness. Previous studies of OT in the United States have been conducted in single institutions (1–4). This report describes the results of a web-based survey distributed to uveitis, retinal, and pediatric ophthalmology specialists nationwide to collect epidemiologic, demographic, and clinical information on patients with OT. A total of 68 patients were newly diagnosed with OT from September 2009 through September 2010. Among the 44 patients for whom demographic information was available, the median patient age was 8.5 years (range: 1–60 years), and 25 patients (57%) lived in the South at the time of diagnosis. Among 30 patients with reported clinical data, the most common symptom was vision loss, reported by 25 (83%) patients; of these, 17 (68%) suffered permanent vision loss. The results of this first national level survey demonstrate that OT transmission continues to occur in the United States, frequently affecting children and causing permanent vision loss in the majority of reported patients. Good hygiene practices, timely disposal of pet feces, and routine deworming of pets are strategies necessary to reduce OT in humans.
Reasons for Not Seeking Eye Care Among Adults Aged ≥40 Years with Moderate-to-Severe Visual Impairment — 21 States, 2006–2009
Reasons for Not Seeking Eye Care Among Adults Aged ≥40 Years with Moderate-to-Severe Visual Impairment — 21 States, 2006–2009
Source: Morbidity and Mortality Weekly Report (CDC)
In 2000, an estimated 3.4 million U.S. residents aged ≥40 years were blind or visually impaired (1). Vision problems place a substantial burden on individuals, caregivers, health-care payers, and the U.S. economy, with the total cost estimated at $51.4 billion annually (2). Although regular comprehensive eye examinations are essential for timely treatment of eye disease to maintain vision health, a previous study has shown that substantial percentages of persons do not seek eye care, despite having visual impairment (3). To ascertain why adults aged ≥40 years with moderate-to-severe visual impairment did not seek eye care in the preceding year, CDC analyzed data for 21 states from 2006–2009 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes the results of that analysis, which found that eye-care cost or lack of insurance (39.8%) and perception of no need (34.6%) were the most common reasons given for not seeking eye care. Among those aged 40–64 years, cost or lack of health insurance was the most common reason (42.8%); among those aged ≥65 years, the most common reason was no need (43.8%). Identifying the reasons for unmet eye-care needs might enable development of targeted interventions to improve vision health among those with moderate-to-severe visual impairment.