xtreme heat episodes result in significant morbidity, especially in northern latitudes or areas influenced by more temperate climates. 1,2 A recent meta-analysis showed that both environmental factors, such as the absence of air conditioning, and population risk factors, such as having cardiovascular or psychiatric co-morbidities, increase the probability of heat-related deaths. 3 Following the European heat wave of 2003, 15,000 excess deaths were reported in 12 European countries during the first week of August and approximately 24,000 during the second week. 4,5 This event prompted many countries to initiate or reinforce heat health watch warning systems to avoid high levels of excess mortality. 6,7 To counter the effect of extreme heat, the Montreal public health department has developed a heat response plan in collaboration with the regional and local public health network and municipal partners. This plan has been in effect since 2004. Its development was prompted by the large increase in mortality following the 2003 heat wave in Europe. Although preventive measures following Environment Canada's heat warnings have been issued to the population since 1994 and a communication campaign was initiated in 2002, the Montreal health department heat plan was undertaken by public health authorities to describe actions under different alert levels with local partners. Indeed, although the heat response plan is addressed to the public health network, public health actions are coordinated with municipal and civil security partners. Health and weather surveillance is an important component of the plan, both for immediate intervention and for updating the plan. These indicators serve as a basis for determination of different levels of action during the summer period. The main objective of the Montreal heat response plan (MHRP) is to reduce heat-related mortality and morbidity. In order to attain this objective, the plan must clearly identify and coordinate actions to be undertaken under different alert levels by partners at the regional public health and municipal level. The MHRP also serves as a guide for the health and social services network (e.g., hospitals or health and social services centres) to develop their own local heat plan for the people they serve. The following paper presents a brief overview of the Montreal heat response plan and its implementation in Montreal during the July 2010 heat wave, which was the first time the Intervention level was
Noise exposure generated by air traffic has been linked with sleep disturbances. The purpose of this systematic review is to clarify whether there is a causal link between aircraft noise exposure and sleep disturbances. Only complete, peer-reviewed articles published in scientific journals were examined. Papers published until December 2010 were considered. To be included, articles had to focus on subjects aged 18 or over and include an objective evaluation of noise levels. Studies were classified according to quality. Given the paucity of studies with comparable outcome measures, we performed a narrative synthesis using a best-evidence synthesis approach. The primary study findings were tabulated. Similarities and differences between studies were investigated. Of the 12 studies surveyed that dealt with sleep disturbances, four were considered to be of high quality, five were considered to be of moderate quality and three were considered to be of low quality. All moderate- to high-quality studies showed a link between aircraft noise events and sleep disturbances such as awakenings, decreased slow wave sleep time or the use of sleep medication. This review suggests that there is a causal relation between exposure to aircraft noise and sleep disturbances. However, the evidence comes mostly from experimental studies focusing on healthy adults. Further studies are necessary to determine the impact of aircraft noise on sleep disturbance for individuals more than 65 years old and for those with chronic diseases.
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