Possible hazardous effects of laboratory work on the reproduction outcomes of female laboratory personnel in Sweden from 1990 to 1994 were investigated in a questionnaire-based study (n = 1052) by comparison with personnel in non-laboratory departments. The individual woman constituted the primary sampling unit, with her pregnancies defined as the unit of analysis. Allowance for dependence between different pregnancies of the same woman was considered by applying random effect models. With regard to spontaneous abortions, no elevated odds ratio was found for laboratory work in general, but an odds ratio of 2.3 and a 95% confidence interval of 0.9 to 5.9 (n = 856) was connected to working with chloroform. The odds ratio for large for gestational age infants in association with the mother's laboratory work was 1.9 (confidence interval, 0.7 to 5.2). The result with regard to spontaneous abortion partly supports previously reported increased risks of miscarriage related to laboratory work with solvents.
BACKGROUND: Psychosocial resources as well as lifestyle habits during pregnancy have been shown to effect the risk of having a small-for-gestational-age (SGA) child. Most previous studies are based on a single assessment of these exposures, which does not take into account the possibility of different effects during early and late stages of pregnancy. METHODS: The impact of psychosocial and lifestyle factors on the risk of giving birth to an SGA child (as measured by ultrasound) was examined among 747 nulliparous Swedish women who completed both a prenatal baseline, and a post-partum assessment. RESULTS: Those registering low social participation on both assessments showed increased risk of giving birth to an SGA infant (OR = 2.44 and 95% CI: 1.06-5.66), while at one assessment (OR = 1.70 and 95% CI: 0.74-3.91). Maternal smoking confirmed by both or one assessments yielded an OR = 2.72 and 95% CI: 1.37-5.39 and OR = 1.60 and 95% CI: 0.58-4.46, respectively. During early pregnancy, poor instrumental support, maternal smoking, or passive smoking yielded increased risks of SGA, adjusted for confounding (OR = 2.39 and 95% CI: 1.11-5.17; OR = 2.38 and 95% CI: 1.27-4.49; OR = 2.92 and 95% CI: 1.17-7.32, respectively). In late pregnancy, only maternal smoking yielded a significant association (OR = 2.34 and 95% CI: 1.24-4.41). CONCLUSION: Scheduling repeated assessments of psychosocial resources and lifestyle factors during pregnancy yielded additional information. The findings suggest that there can be differential effects of such exposures depending on gestational stage. This information is of importance when designing appropriate intervention strategies for maternal health services as well as for public health relevant policy formulation (e.g. regarding exposure to environmental tobacco during pregnancy).
OBJECTIVES: This study attempted to give a medical and social prognosis for patients with perceived "electrical sensitivity". METHODS: In 1980-1998, 350 patients with electrical sensitivity were registered at the University Hospital of Northern Sweden in Umeå, Sweden. Those with hypersensitivity to electricity had multiple symptoms evoked by exposure to different electric environments. Those with skin symptoms related to the use of visual display terminals (VDT) predominantly had facial skin symptoms evoked by a VDT, television screens, or fluorescent light tubes. A questionnaire on civil status, current health status, care, treatment and other measures taken, consequences of the problem, eliciting factors, and current employment was sent to all the patients. The response rate was 73%. Of the 50 respondents with hypersensitivity to electricity, 38% were men and 62% were women. Of the 200 patients with skin symptoms related to VDT use, 21.5% were men and 78.5% women. RESULTS: More women than men had turned to caregivers, including complementary therapies. A larger proportion of patients with hypersensitivity to electricity (38%) than those with skin symptoms related to VDT use (17%) was no longer gainfully employed. Both groups reported a higher symptom frequency than that reported by the the general population. Over time, the medical prognosis improved in the latter group but not in the former. CONCLUSIONS: Patients with hypersensitivity to electricity, particularly women, have extensive medical problems and a considerable number of them stop working. Many patients with skin symptoms related to VDT use have a favorable prognosis. Both groups need early and consistent management.
Pesticide exposure has been associated with various childhood cancers. However, most studies rely on questionnaires, with few using biologic measures of dose. This study was designed to measure herbicide exposure directly in children of farm applicators, and to compare these results with exposure imputed from questionnaire information.
Two consecutive 24-hour urine samples were collected from 92 children of Ontario farm applicators who used the herbicides 2,4-D (2,4-dichlorophenoxyacetic acid) or MCPA (4-chloro-2-methylphenoxyacetic acid) for the first time during 1996. The farm applicator completed questionnaires describing his pesticide-handling practices as well as the child's location during the various stages of handling these pesticides.
Approximately 30% of the children on farms using these herbicides had detectable concentrations in their urine, with maximum values of 100 microg/L for 2,4-D and 45 microg/L for MCPA. Children with higher levels were more likely to be boys and to have parents who also had higher mean urinary concentrations. The sensitivity and specificity of a simple indicator of use were 47% and 72%, respectively, for 2,4-D, and 91% and 30%, respectively, for MCPA, using the biomonitoring data as the gold standard.
Information on living on a farm, or on living on a farm where a specific pesticide is used, is not enough to classify children's exposures. Given this potential for misclassification, we urge incorporation of biomonitoring studies in subsets of children at least to estimate the extent of misclassification.
The objective of this study was to determine the prevalence of and risk factors for work-related musculoskeletal disorders (WRMDs) in female physiotherapists with more than 15 years of job experience. A self-administered postal questionnaire was sent to 203 female physiotherapists with more than 15 years of job experience. Unconditional logistic regression was used to study the association between job exposures and the risk for WRMDs. The questionnaire was returned by 131 physiotherapists (64.5%). Of 99 subjects who answered specific questions about WRMDs, 52 (53.5%) were affected by WRMDs in at least one body part. Regions most affected were the hand/wrist (n=31; 58.5%) and the lower back (n=30; 56.5%). For hand/wrist pain, associations were found with: orthopedic manual therapy techniques (adjusted odds ratio [OR]=3.90; 95% confidence interval [CI]=1.2-13.1); working in awkward or cramped positions (OR=4.96; 95% CI=1.3-18.7); and high psychological job demands (OR=4.34; 95% CI=1.2-15.0). For lower back pain, associations were found with: working in awkward or cramped positions (adjusted OR=6.37; 95% CI=1.6-24.7); and kneeling or squatting (adjusted OR=4.76; 95% CI=1.4-15.9). More than half of the respondents reported WRMDs. General physical and psychosocial work-related exposures, as well as specific therapy tasks, were strongly associated with WRMDs. Larger, longitudinal studies are needed to determine the direction of causality.
Pesticide use on urban lawns and gardens contributes to environmental contamination and human exposure. Municipal policies to restrict use and educate households on viable alternatives deserve study. We describe the development and implementation of a cosmetic/non-essential pesticide bylaw by a municipal health department in Toronto, Ontario, Canada and assess changes in resident practices associated with bylaw implementation.
Implementation indicators built on a logic model and were elaborated through key informant interviews. Bylaw impacts on awareness and practice changes were documented through telephone surveys administered seasonally pre, during and post implementation (2003-2008). Multivariable logistic regression models assessed associations of demographic variables and gardening season with respondent awareness and practices.
Implementation indicators documented multiple municipal health department activities and public involvement in complaints from commencement of the educational phase. During the enforcement phases only 40 warning letters and 7 convictions were needed. The number of lawn care companies increased. Among survey respondents, awareness of the bylaw and the Natural Lawn campaign reached 69% and 76% respectively by 2008. Substantial decreases in the proportion of households applying pesticides (25 to 11%) or hiring lawn care companies for application (15 to 5%) occurred. Parallel absolute increases in use of natural lawn care methods occurred among households themselves (21%) and companies they contracted (7%).
Bylaws or ordinances implemented through education and enforcement are a viable policy option for reducing urban cosmetic pesticide use.
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Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied.
The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used.
A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities.
The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk.
Adverse health effects of exposure to high levels of air pollutants from biodegradable wastes have been well-studied. However, few investigations have examined the potential effects of chronic exposure to low-to-moderate levels on non-specific health symptoms among residents. Besides, most studies have relied on distances to waste sites to assign exposure status, and have not investigated whether the exposure-symptoms associations are direct or mediated by odor annoyance. In this study, individual-level exposures to a proxy indicator of biodegradable waste pollution (ammonia, NH3) in non-urban residences (n=454) during 2005-2010 were characterized by data from emission-dispersion validated models. Logistic regression and mediating analyses were used to examine associations between exposures and questionnaire-based data on annoyance and non-specific symptoms, after adjusting by person-specific covariates. Strong dose-response associations were found between exposures and annoyance, and between annoyance and symptoms. Associations between exposures and symptoms (nausea, headache, dizziness, difficulty concentrating and unnatural fatigue) were indirect (annoyance-mediated). This study indicates that environmental exposures play an important role in the genesis of non-specific symptoms among residents exposed to low-to-moderate air pollution from biodegradable wastes, although the effects seem to be indirect, relayed through stress-related mechanisms.
BACKGROUND: Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. METHODS: A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476) (response rate 56%). Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. RESULTS: Three composite dimensions of perceived residential safety were identified: (I) structural indicators of social disorder; (II) contact with disorderly behavior; and (III) existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. CONCLUSION: We have identified environmental, socio-demographic, and personal correlates of safety-related concerns in contiguous neighbourhoods in a Swedish community. The results of this study suggest that residents' self-assessed area reputation is an important underlying mechanism of perceived safety. We also found a difference in crime rates and safety-related concerns between areas with blocks of flats compared with small-scale areas although the neighbourhoods were close geographically.
To explore the relationship between disability and physical dependence handicap, and the mediating effect of personal (demographic) and environmental factors as modeled by the International Classification of Impairments, Disability, and Handicaps.
Data on people with arthritis-associated disabilities were abstracted from a national population survey (n = 16,017). A hierarchical physical dependence variable was formulated. Nominal logistical regression was used to determine predictors of physical dependence related to specific disability, personal characteristics, and environmental adaptation variables.
The risk of physical dependence only increased substantially at age > or = 75 years. Specific types of physical disability differentially predicted different levels of physical dependence. The major predictor of physical dependence was disability alone and in conjunction with environmental factors.
There appears to be a specific and ordered relationship between the level of physical dependence and various types of physical disabilities. The findings could have implications for therapeutic intervention and health status measures.
BACKGROUND: Professional drivers are at an increased risk of myocardial infarction but the underlying causes for this increased risk are uncertain. METHODS: We identified all first events of myocardial infarction among men age 45-70 years in Stockholm County for 1992 and 1993. We selected controls randomly from the population. Response rates of 72% and 71% resulted in 1067 cases and 1482 controls, respectively. We obtained exposure information from questionnaires. We calculated odds ratios (ORs), with and without adjustment for socioeconomic status, tobacco smoking, alcohol drinking, physical inactivity at leisure time, overweight status, diabetes and hypertension. RESULTS: The crude OR among bus drivers was 2.14 (95% confidence interval = 1.34-3.41), among taxi drivers 1.88 (1.19-2.98) and among truck drivers 1.66 (1.22-2.26). Adjustment for potential confounders gave lower ORs: 1.49 (0.90-2.45), 1.34 (0.82-2.19) and 1.10 (0.79-1.53), respectively. Additional adjustment for job strain lowered the ORs only slightly. An exposure-response pattern (by duration of work) was found for bus and taxi drivers. CONCLUSIONS: The high risk among bus and taxi drivers was partly explained by unfavorable life-style factors and social factors. The work environment may contribute to their increased risk. Among truck drivers, individual risk factors seemed to explain most of the elevated risk.
The Norwegian Mother and Child Cohort Study (MoBa) started in 1999 to identify environmental factors that could be involved in mechanisms leading to disease. Questions have been raised about potential risks to the fetus from prenatal exposure to mercury from amalgam fillings in pregnant women. The aim of the present study was to identify factors potentially associated with amalgam fillings in pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa). An additional aim was to obtain information about dental treatment in the cohort.
Total of 67,355 pregnancies from the MoBa study were included in the present study. Information regarding age, education, smoking habits, alcohol consumption, weight, and height for the women was obtained from a questionnaire that was filled in at the 17th week of pregnancy. In another questionnaire, which was sent to all participants in the 30th week of pregnancy, the women reported types of dental treatment during pregnancy, total number of teeth, and number of teeth with amalgam fillings. The self-assessed number of teeth and number of teeth with amalgam fillings were validated in an external sample of 97 women of childbearing age.
Odds ratio for having more than 12 teeth with amalgam fillings increased considerably with age. Other significant risk factors for having high exposure to amalgam were low education, high body mass index (BMI), and smoking during pregnancy. Women with the lowest levels of education had a twofold increased odds ratio of having more than 12 teeth filled with amalgam compared with women who had more than 4 years of university studies. According to the results from the validation of self-assessed number of teeth with amalgam fillings, the information obtained was reliable.
Age, education, smoking habits, and BMI were associated with amalgam exposure.
Comment In: J Evid Based Dent Pract. 2011 Sep;11(3):162-321855822
To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that one's level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2-year follow-up.
Observational prospective cohort study and cross-sectional analyses.
Community and research center.
A total of 643 community-living ambulatory people aged 75 to 81 took part in face-to-face interviews and examinations at baseline and 314 at the 2-year follow-up.
Unmet physical activity need and its potential individual and environmental correlates were assessed at baseline. Development of unmet physical activity need was assessed over the 2-year follow-up period.
At baseline, all participants were able to walk at least 500 m outdoors, but 14% perceived unmet physical activity need. Unmet physical activity need was more prevalent in those with musculoskeletal diseases, depressive symptoms, and mobility limitations. Hills in the nearby environment, lack of resting places, and dangerous crossroads correlated with unmet physical activity need at baseline; the association was especially strong in those with walking difficulties. Significant baseline predictors for incident unmet physical activity need (15%) included fear of moving outdoors, hills in the nearby environment, and noisy traffic.
Unmet physical activity need is common in ambulatory community-living older people who have health and mobility problems and report negative environmental features in their neighborhood. Solutions to overcome barriers to physical activity need to be developed to promote equal opportunities for physical activity participation.
Pesticides have been implicated as likely environmental risk factors for Parkinson disease (PD), but assessment of past exposure to pesticides can be difficult. No prior studies of pesticide exposure and PD used biomarkers of exposure collected before the onset of PD. Our investigation examined the association between prospective serum biomarkers of organochlorine pesticides and PD.
We conducted a nested case-control study within the Finnish Mobile Clinic Health Examination Survey, with serum samples collected during 1968-1972, and analyzed in 2005-2007 for organochlorine pesticides. Incident PD cases were identified through the Social Insurance Institution's nationwide registry and were confirmed by review of medical records (n = 101). Controls (n = 349) were matched for age, sex, municipality, and vital status. Adjusted odds ratios (ORs) of PD were estimated using logistic regression.
Little association emerged with a summary score of the 5 organochlorine pesticides found at high levels, and only increasing dieldrin concentrations trended toward a higher risk of PD (OR per interquartile range [IQR] 1.28, 95% confidence interval [CI] 0.97-1.69, p = 0.08). Because of possible strong confounding by cigarette smoking among smokers, we ran additional analyses restricted to never smokers (n = 68 cases, 183 controls). In these analyses, increasing dieldrin concentrations were associated with increased odds of PD (OR per IQR 1.95, 95% CI 1.26-3.02, p = 0.003). None of the other organochlorine pesticides were associated with PD in these analyses.
These results provide some support for an increased risk of Parkinson disease with exposure to dieldrin, but chance or exposure correlation with other less persistent pesticides could contribute to our findings.
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Alaska Native children experience high rates of respiratory infections and conditions. Household crowding, indoor smoke, lack of piped water, and poverty have been associated with respiratory infections. We describe the baseline household characteristics of children with severe or chronic lung disease participating in a 2012-2015 indoor air study. We monitored indoor PM2.5, CO2 , relative humidity %, temperature, and VOCs and interviewed caregivers about children's respiratory symptoms. We evaluated the association between reported children's respiratory symptoms and indoor air quality indicators using multiple logistic regression analysis. Compared with general US households, study households were more likely overcrowded 73% (62%-82%) vs 3.2% (3.1%-3.3%); had higher woodstove use as primary heat source 16% (9%-25%) vs 2.1% (2.0%-2.2%); and higher proportion of children in a household with a smoker 49% (38%-60%) vs 26.2% (25.5%-26.8%). Median PM2.5 was 33 µg/m3 . Median CO2 was 1401 ppm. VOCs were detectable in all homes. VOCs, smoker, primary wood heat, and PM2.5>25 µg/m3 were associated with higher risk for cough between colds; VOCs were associated with higher risk for wheeze between colds and asthma diagnosis. High indoor air pollutant levels were associated with respiratory symptoms in household children, likely related to overcrowding, poor ventilation, woodstove use, and tobacco smoke.
Marginal structural model to evaluate the joint effect of socioeconomic exposures on the risk of developing end-stage renal disease in patients with type 1 diabetes: a longitudinal study based on data from the Swedish Childhood Diabetes Study Group.
Diabetic nephropathy is a severe complication of type 1 diabetes (T1D) that may lead to renal failure and end-stage renal disease (ESRD) demanding dialysis and transplantation. The etiology of diabetic nephropathy is multifactorial and both genes and environmental and life style-related factors are involved. In this study, we investigate the effect of the socioeconomic exposures, unemployment and receiving income support, on the development of ESRD in T1D patients, using a marginal structural model (MSM) in comparison with standard logistic regression models.
The study is based on the Swedish Childhood Diabetes Register which in 1977 started to register patients developing T1D before 15 years of age. In the analyses, we include patients born between 1965 and 1979, developing diabetes between 1977 and 1994, and followed until 2013 (n = 4034). A MSM was fitted to adjust for both baseline and time-varying confounders.
The main results of the analysis indicate that being unemployed for more than 1 year and receiving income support are risk factors for the development of ESRD. Multiple exposures over time to these risk factors increase the risk associated with the disease.
Using a MSM is an advanced method well suited to investigate the effect of exposures on the risk of complications of a chronic disease with longitudinal data. The results show that socioeconomic disadvantage increases the risk of developing ESRD in patients with T1D.
Studies have shown associations between higher income and better health, but income has not been studied in relation to neck pain. The aims of this cohort study were to assess the sex-specific role of disposable income for onset and prognosis of neck pain in the general population and if economic stress influences such potential associations.
Two subcohorts were identified in the Stockholm Public Health Cohort with data from 2002. Cohort I (risk cohort) included persons without neck pain (n=8348). Cohort II (prognostic cohort) included persons with occasional neck pain during the previous 6 months (n=10?523). Both cohorts were assessed for long duration troublesome neck pain (LDNP) in 2007. Individual income was defined as aggregated annual family income in 2002 with each family member assigned a weighted consumption share, based on salary, pensions and social benefits. LDNP in 2007 was defined as having had troublesome neck pain lasting for three or more consecutive months the previous 5 years. Association between income and LDNP, considering potential confounding, was investigated by multivariable logistic regression. Economic stress was tested as effect modifier between income and LDNP.
In both cohorts, associations were found between lower income and a higher risk for LDNP. The results were similar between the sexes. Economic stress modified the associations in both cohorts.
Low income may be a risk as well as prognostic factor for developing LDNP. Furthermore, the results indicate that economic stress may be an underlying factor to consider when studying associations between income and neck pain.
In a Swedish population-based case-control study (1571 cases, 3371 controls), subjects with different body mass indices (BMIs) were compared regarding multiple sclerosis (MS) risk, by calculating odds ratios (OR) with 95% confidence intervals (95% CI). Subjects whose BMI exceeded 27 kg/m(2) at age 20 had a two-fold increased risk of developing MS compared with normal weight subjects. Speculatively, the obesity epidemic may explain part of the increasing MS incidence as recorded in some countries. Measures taken against adolescent obesity may thus be a preventive strategy against MS.
Previous studies have suggested that the presence of the vascular component of hand-arm vibration syndrome (HAVS) in the hands increases the risk of cold-induced vasospasm in the feet.
To determine if objectively measured cold-induced vasospasm in the hands is a risk factor for objectively measured cold-induced vasospasm in the feet in workers being assessed for HAVS.
The subjects were 191 male construction workers who had a standardized assessment for HAVS including cold provocation digital photocell plethysmography of the hands and feet to measure cold-induced vasospasm. Bivariate analysis and multinomial logistic regression were used to examine the association between plethysmographic findings in the feet and predictor variables including years worked in construction, occupation, current smoking, cold intolerance in the feet, the Stockholm vascular stage and plethysmographic findings in the hands.
Sixty-one (32%) subjects had non-severe vasospasm and 59 (31%) had severe vasospasm in the right foot with the corresponding values being 57(30%) and 62 (32%) in the left foot. Multinomial logistic regression indicated that the only statistically significant predictor of severe vasospasm in the feet was the presence of severe vasospasm in the hands (OR: 4.11, 95% CI: 1.60-10.6, P
The aim of this study was to investigate the association of noise sensitivity with self-reported hearing disability and hearing levels, with consideration of the role of self-reported history of noise exposure and use of hearing protectors. The study is based on the Finnish Twin Cohort. In 1988, a noise questionnaire was sent to 1005 twin pairs, 1495 individuals (688 men, 807 women) replied. The age range was 31-88 years. Information on some potential confounders was obtained from the questionnaire in 1981 for the same individuals. A subsample of thirty-eight elderly women with noise sensitivity response from 1988 had audiometry data from 2000 to 2001. Noise sensitivity was associated with self-reported hearing disability among all subjects [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.14-2.12] and among women (OR 1.90, 95% CI 1.19-3.04), but no-more significantly among men (OR 1.31, 95% CI 0.86-1.98). The association was primarily seen among younger subjects (50 years or less). The difference between noise sensitive and non-noise sensitive elderly women in the average of thresholds at frequencies of 0.5-4 kHz in the better ear was not significant (Pr = 0.18). Noise sensitivity did not modify the association of hearing disability with the self-reported history of occupational noise exposure. Noise sensitivity was associated with the use of hearing protectors at work. The study shows the importance of recognizing the noise sensitive in noise effect studies, since sensitivity in annoyance has implications in most of the effect categories.