Panayota Sourtzi

Hypertension and exposure to noise near airports: the HYENA study.

Background An increasing number of people are exposed to aircraft and road traffic noise. Hypertension is an important risk factor for cardiovascular disease, and even a small contribution in risk from environmental factors may have a major impact on public health. Objectives The HYENA (Hypertension and Exposure to Noise near Airports) study aimed to assess the relations between noise from aircraft or road traffic near airports and the risk of hypertension. Methods We measured blood pressure and collected data on health, socioeconomic, and lifestyle factors, including diet and physical activity, via questionnaire at home visits for 4,861 persons 45–70 years of age, who had lived at least 5 years near any of six major European airports. We assessed noise exposure using detailed models with a resolution of 1 dB (5 dB for United Kingdom road traffic noise), and a spatial resolution of 250 × 250 m for aircraft and 10 × 10 m for road traffic noise. Results We found significant exposure–response relationships between night-time aircraft as well as average daily road traffic noise exposure and risk of hypertension after adjustment for major confounders. For night-time aircraft noise, a 10-dB increase in exposure was associated with an odds ratio (OR) of 1.14 [95% confidence interval (CI), 1.01–1.29]. The exposure–response relationships were similar for road traffic noise and stronger for men with an OR of 1.54 (95% CI, 0.99–2.40) in the highest exposure category (> 65 dB; ptrend = 0.008). Conclusions Our results indicate excess risks of hypertension related to long-term noise exposure, primarily for night-time aircraft noise and daily average road traffic noise.

Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: A systematic review and meta-analysis

BACKGROUND Heart failure (HF) is a clinical condition with major socioeconomic burden. Scientists are trying to find effective solutions to eliminate the effects of the disease and the current innovations in research address the introduction of HF management programmes (HF-MPs). OBJECTIVES A meta-analysis was undertaken to estimate the effect of HF-MP with a nurse-driven pre-discharge phase on the outcomes of HF and all-cause re-admission. DATA SOURCES A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (reviews and clinical trials) was performed to locate randomised controlled trials (RCTs), published in English language, which implemented any HF-MP with discharge planning carried out by a nurse. Identified articles were further screened for additional studies. STUDY SELECTION Two reviewers independently screened relevant abstracts or titles using a standardised predefined check list. Pilot studies, studies additionally assessing other conditions and studies that evolved technology utilities or included medication management beyond optimisation of therapy, were excluded. DATA EXTRACTION Selected articles were thoroughly screened and data of interest (characteristics and outcomes) were obtained. Quality assessment was done by two reviewers separately. DATA SYNTHESIS Nineteen RCTs were selected for the meta-analysis. The overall pooled effect (relative risk, RR) of the intervention group compared with the control group was estimated by using a random effects analysis (95% confidence interval (CI)) for the outcomes of HF-related re-admission and all-cause re-admission. The overall RR of HF re-admissions was 0.68, 95% CI (0.53, 0.86), p<0.05 and of all-cause re-admission was 0.85, 95% CI (0.76, 0.94), p<0.05 favouring the intervention. Metaregression analysis was performed while trying to explain the observed heterogeneity but none of the factors (environment, duration of follow-up, origin and complexity) were significantly related with the RR. No significant publication bias was observed regarding both HF and all-cause re-admission. CONCLUSIONS The results of the current meta-analysis highlight the potential of HF-MPs with nurse-driven pre-discharge interventions to reduce hospital re-admissions. Essential characteristics or components of a successful HF-MP are still to be determined; thus more studies are required to solve this issue.

Noise annoyance--a modifier of the association between noise level and cardiovascular health?

OBJECTIVES The effect modifying impact of annoyance due to aircraft noise and road traffic noise on the relationships between the aircraft noise level and road traffic noise level on the prevalence of hypertension was investigated in 4861 subjects of the HYENA study (HYpertension and Exposure to Noise near Airports). METHODS Different models were investigated either including the noise level and noise annoyance variables separately, or simultaneously, or together with an interaction term referring to the same noise source for the noise level and the noise annoyance. RESULTS Significant effect modification was found with respect to the association between aircraft noise and hypertension. The association was stronger in more annoyed subjects. No clear interaction was found with respect to road traffic noise. The comparison of the magnitude of the main effects (per standard deviation or inter-quartile range) of noise level and noise annoyance variables revealed stronger associations with hypertension for the noise levels. CONCLUSION There is some indication that the noise level has a stronger predictive meaning for the relationship between noise exposure and hypertension than the reported noise annoyance (main effects). The results from the Hyena study support the hypothesis that noise annoyance acts as an effect modifier of the relationship between the noise level and hypertension.

Exposure modifiers of the relationships of transportation noise with high blood pressure and noise annoyance

In the cross-sectional hypertension and exposure to noise near airports study the relationship between road traffic noise, aircraft noise and hypertension and annoyance was investigated. The data collection comprised a variety of potentially exposure modifying factors, including type of housing, location of rooms, window opening habits, use of noise-reducing remedies, shielding due to obstacles, lengths of exposure. In the present paper the quantitative role of these factors on the relationship between road and aircraft noise exposure and outcomes was analyzed. Multiple logistic and linear regression models were calculated including these co-factors and related interaction terms with noise indicators, as well as stratified analyses. Type of housing, length of residence, location of rooms and the use of noise reducing remedies modified the relationship between noise and hypertension. However, the effects were not always in the direction of a stronger association in higher exposed subjects. Regarding annoyance, type of housing, location of rooms, noise barriers, window opening habits, noise insulation, the use of noise reducing remedies, hours spent at home during daytime were significant effect modifiers. The use of noise-reducing remedies turned out to be indicators of perceived noise disturbance rather than modifiers reducing the annoyance.

Sleep Disturbance in Nursing Personnel Working Shifts

OBJECTIVE The aim of the present study was to explore the factors that are associated with sleep disturbance in nursing personnel working irregular shifts. METHODS A cross-sectional survey was carried out. The Standard Shiftwork Index was used for data collection, which was completed by 365 nurses and nurse assistants working shifts including nights. RESULTS Female nurses and nurses with elevated levels of chronic fatigue were found with greater sleep disturbance between all shifts. Sleep disturbance between most shifts was greater in participants with more than 18 years of working experience and those having family members to look after. No differences were observed in family status, professional training, or circadian characteristics. CONCLUSION Our results suggest that demographics, working characteristics, and family structure are associated with sleep disturbance between shifts in nursing personnel. The modification of shift schedules according to individual needs and preferences is necessary for the reduction of sleeping problems.

Influence of shiftwork on greek nursing personnel.

Background The aim of this study was to investigate the burden experienced by nursing personnel working irregular shifts in Greece and to conduct the first test of a Greek version of the Standard Shiftwork Index (SSI). Methods A cross-sectional survey was carried out. The SSI was completed by 365 nurses and nursing assistants working shifts, including nights. Results Female nursing personnel and those suffering from a chronic disease were most affected by working rotating shifts as they had elevated scores on the majority of the SSI scales, such as sleep, chronic fatigue, digestive and cardiovascular problems, general health questionnaire, cognitive and somatic anxiety, shift time satisfaction, engagement and disengagement strategies, languidity, flexibility, and neurotisicm. Nurses with longer working experience and those with family responsibilities also scored higher on some of the SSI scales, such as the sleep, shift time satisfaction, social and domestic disruption, disengagement strategies, morningness, and languidity scales. Conclusion Shiftwork affects female nurses, those with chronic disease, older age, and domestic responsibilities more severely. Therefore management should take these factors into account when designing work schedules to alleviate the burden caused by shiftwork.

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

Cypriot nurses’ knowledge of heart failure self-management principles

Background: The nurse’s role as educator has become very crucial in heart failure management; thus, nurses must be adequately prepared to undertake this task. Aim: The main objective of the study was to estimate the level of Cypriot nurses’ knowledge on basic heart failure self-care principles. Methods: A questionnaire measuring knowledge on heart failure self-care principles was administered among cardiology nurses working in five public urban hospitals of Cyprus. Data were analysed by using descriptive statistics, t-test and analysis of variance for categorical variables (such as gender and working setting) and correlation tests (Pearson’s) plus simple linear regression for continuous variables (such as working experience). Results: Participants were 143 nurses. The mean heart failure self-care knowledge score was 13.57/20 (SD 2.33). Gender, hospital and cardiac clinical experience do not significantly affect scoring. Significant difference in the knowledge score was observed among critical care, cardiology and medical unit nurses (f=4.1, p=0.018). Post hoc analysis showed that this significant difference originated from the comparison of critical care nurses with cardiology unit nurses (14.1, SD 2.3 vs. 13.0, SD 2.1 respectively). Correlation and linear regression analyses yielded only weak negative correlation between correct scoring and duration of nursing practice (r=−0.262, p=0.002), with 6% of the total variation in scoring being explained by this relationship. Conclusions: Results are consistent with previous findings and it is thus under question whether cardiology nurses are properly educating their heart failure patients. Consequently, there is an urgent need for nurses to update their knowledge and enhance their educational skills.

Is aircraft noise exposure associated with cardiovascular disease and hypertension? Results from a cohort study in Athens, Greece

Background We followed up, in 2013, the subjects who lived near the Athens International Airport and had participated in the cross-sectional multicountry HYENA study in 2004–2006. Objective To evaluate the association of exposure to aircraft and road traffic noise with the incidence of hypertension and other cardiovascular outcomes. Methods From the 780 individuals who participated in the cross-sectional study, 537 were still living in the same area and 420 accepted to participate in the follow-up. Aircraft and road traffic noise exposure was based on the estimations conducted in 2004–2006, linking geocoded residential addresses of the participants to noise levels. We applied multiple logistic regression and Cox proportional hazards models, adjusting for potential confounders. Results The incidence of hypertension was significantly associated with higher aircraft noise exposure during the night. Specifically, the OR for hypertension per 10 dB increase in Lnight aircraft noise exposure was 2.63 (95% CI 1.21 to 5.71). Doctor-diagnosed cardiac arrhythmia was significantly associated with Lnight aircraft noise exposure, when prevalent and incident cases were considered with an OR of 2.09 (95% CI 1.07 to 4.08). Stroke risk was also increased with increasing noise exposure but the association was not significant. Twenty-four-hour road traffic noise associations with the outcomes considered were weaker and less consistent. Conclusions In conclusion, our cohort study suggests that long-term exposure to aircraft noise, particularly during the night, is associated with incident hypertension and possibly, also, cardiovascular effects.

Health Promotion Practices and Attitudes Among Nurses in Special Education Schools in Greece

Published research concerning health promotion in Greek schools is limited. The aim of the study was to evaluate special education school nurses’ involvement in health promotion activities, examine their attitudes toward it, and to explore the factors influencing their practices. A cross-sectional survey was carried out in 2005 by mailed questionnaires to all 45 Greek school nurses. Descriptive statistics and nonparametric tests were used. The results indicate that 37 (82%) school nurses have had moderate involvement in health promotion programs due to the existing health policies set mainly by the school personnel and the state services. Their attitude toward health promotion was positive and depended on personal health promotion practices and activities and on health policies. Pupils’ participation in health promotion programs changed according to their special health needs. The lack of legislated duties and absence of a specific health promotion programming prevented school nurses from being involved. Children’s special needs inhibited or promoted health promotion activities.