Electromagnetic hypersensitivity (EHS) in occupational and primary health care: A nation-wide survey among general practitioners,occupational physicians and hygienists in the Netherlands

Subjects who attribute health complaints to every day levels of non-ionizing electromagnetic fields (EMF) have been referred to as electrohypersensitive (EHS). Previous surveys in Europe showed that 68–75% of general practitioners had ever been consulted on EHS. Given the lack of data on EHS in the Netherlands in the general population and on EHS in occupational settings, we performed a national survey among three professional groups that are likely in the first line of being consulted by EHS individuals. Results show that about one third of occupational hygienists, occupational physicians and general practitioners had ever been consulted by one or more EHS subjects. Many of these professionals considered a causal relationship between EMF and health complaints to some degree plausible, and their approach often included exposure reduction advice. Given the lack of scientific evidence for EHS and how low level EMF exposure could cause reported health complaints and given the finding that the majority of these professionals felt insufficiently informed about EMF and health, targeted information campaigns might assist them in their evidence based dealing with subjects who attribute symptoms to EMF.     

Subjective non-specific symptoms related with electromagnetic fields: description of 2 cases

In Italy, as in other countries, an apparently increasing number of subjects is reporting a variety of subjective symptoms that the subjects themselves refer to the exposure to electric, magnetic or electromagnetic fields (EMF) from nearby electric appliances, cellular phones, antennas, etc. Terms like electricity hypersensitivity (EHS), EMF hypersensitivity, or other similar, are frequently adopted to describe such symptoms; nevertheless, up to now, these terms are not entered the medical terminology. No accepted diagnostic criteria or procedures for the diagnosis of EHS are currently available. Furthermore, apart from the subject's self-attribution of the symptoms to EMFs, no direct cause-effect relationship between EHS symptoms and electromagnetic fields has been proved; additionally, evidence of a possible pathogenetic mechanism is lacking. In this paper, two cases developing symptoms of EHS ascribed to overhead power line in the proximity of their house are discussed. Nervous system (asthenia, depression, paraesthesias etc.), cardiovascular system (cardiac palpitations) and the skin (tingling, itching, etc.), are mostly (but not exclusively) involved. Based on available scientific knowledge, the rationale for an approach to subjects claiming for EHS is discussed. The establishment of a National archive for the collection of cases is communicated.     

Systematic review on the health effects of exposure to radiofrequency electromagnetic fields from mobile phone base stations

Objective

To review and evaluate the recent literature on the health effects of exposure to mobile phone base station (MPBS) radiation.

Methods

We performed a systematic review of randomized human trials conducted in laboratory settings and of epidemiological studies that investigated the health effects of MPBS radiation in the everyday environment.

Findings

We included in the analysis 17 articles that met our basic quality criteria: 5 randomized human laboratory trials and 12 epidemiological studies. The majority of the papers (14) examined self-reported non-specific symptoms of ill-health. Most of the randomized trials did not detect any association between MPBS radiation and the development of acute symptoms during or shortly after exposure. The sporadically observed associations did not show a consistent pattern with regard to symptoms or types of exposure. We also found that the more sophisticated the exposure assessment, the less likely it was that an effect would be reported. Studies on health effects other than non-specific symptoms and studies on MPBS exposure in children were scarce.

Conclusion

The evidence for a missing relationship between MPBS exposure up to 10 volts per metre and acute symptom development can be considered strong because it is based on randomized, blinded human laboratory trials. At present, there is insufficient data to draw firm conclusions about health effects from long-term low-level exposure typically occurring in the everyday environment.     

Instruments to assess and measure personal and environmental radiofrequency-electromagnetic field exposures

Radiofrequency-electromagnetic field (RF-EMF) exposure of human populations is increasing due to the widespread use of mobile phones and other telecommunication and broadcasting technologies. There are ongoing concerns about potential short- and long-term public health consequences from RF-EMF exposures. To elucidate the RF-EMF exposure-effect relationships, an objective evaluation of the exposures with robust assessment tools is necessary. This review discusses and compares currently available RF-EMF exposure assessment instruments, which can be used in human epidemiological studies. Quantitative assessment instruments are either mobile phone-based (apps/software-modified and hardware-modified) or exposimeters. Each of these tool has its usefulness and limitations. Our review suggests that assessment of RF-EMF exposures can be improved by using these tools compared to the proxy measures of exposure (e.g. questionnaires and billing records). This in turn, could be used to help increase knowledge about RF-EMF exposure induced health effects in human populations.     

Towards 5G communication systems: Are there health implications?

The spread of radiofrequency electromagnetic fields (RF-EMF) is rising and health effects are still under investigation. RF-EMF promote oxidative stress, a condition involved in cancer onset, in several acute and chronic diseases and in vascular homeostasis. Although some evidences are still controversial, the WHO IARC classified RF-EMF as “possible carcinogenic to humans”, and more recent studies suggested reproductive, metabolic and neurologic effects of RF-EMF, which are also able to alter bacterial antibiotic resistance. In this evolving scenario, although the biological effects of 5G communication systems are very scarcely investigated, an international action plan for the development of 5G networks has started, with a forthcoming increment in devices and density of small cells, and with the future use of millimeter waves (MMW). Preliminary observations showed that MMW increase skin temperature, alter gene expression, promote cellular proliferation and synthesis of proteins linked with oxidative stress, inflammatory and metabolic processes, could generate ocular damages, affect neuro-muscular dynamics. Further studies are needed to better and independently explore the health effects of RF-EMF in general and of MMW in particular. However, available findings seem sufficient to demonstrate the existence of biomedical effects, to invoke the precautionary principle, to define exposed subjects as potentially vulnerable and to revise existing limits. An adequate knowledge of pathophysiological mechanisms linking RF-EMF exposure to health risk should also be useful in the current clinical practice, in particular in consideration of evidences pointing to extrinsic factors as heavy contributors to cancer risk and to the progressive epidemiological growth of noncommunicable diseases.     

Comparison of personal radio frequency electromagnetic field exposure in different urban areas across Europe

Background

Only limited data are available on personal radio frequency electromagnetic field (RF-EMF) exposure in everyday life. Several European countries performed measurement studies in this area of research. However, a comparison between countries regarding typical exposure levels is lacking.

Objectives

To compare for the first time mean exposure levels and contributions of different sources in specific environments between different European countries.

Methods

In five countries (Belgium, Switzerland, Slovenia, Hungary, and the Netherlands), measurement studies were performed using the same personal exposure meters. The pooled data were analyzed using the robust regression on order statistics (ROS) method in order to allow for data below the detection limit. Mean exposure levels were compared between different microenvironments such as homes, public transports, or outdoor.

Results

Exposure levels were of the same order of magnitude in all countries and well below the international exposure limits. In all countries except for the Netherlands, the highest total exposure was measured in transport vehicles (trains, car, and busses), mainly due to radiation from mobile phone handsets (up to 97%). Exposure levels were in general lower in private houses or flats than in offices and outdoors. At home, contributions from various sources were quite different between countries.

Conclusions

Highest total personal RF-EMF exposure was measured inside transport vehicles and was well below international exposure limits. This is mainly due to mobile phone handsets. Mobile telecommunication can be considered to be the main contribution to total RF-EMF exposure in all microenvironments.     

Temporal and spatial variability of personal exposure to radio frequency electromagnetic fields

Background

Little is known about the population's exposure to radio frequency electromagnetic fields (RF-EMF) in industrialized countries.

Objectives

To examine levels of exposure and the importance of different RF-EMF sources and settings in a sample of volunteers living in a Swiss city.

Methods

RF-EMF exposure of 166 volunteers from Basel, Switzerland, was measured with personal exposure meters (exposimeters). Participants carried an exposimeter for 1 week (two separate weeks in 32 participants) and completed an activity diary. Mean values were calculated using the robust regression on order statistics (ROS) method.

Results

Mean weekly exposure to all RF-EMF sources was 0.13 mW/m² (0.22 V/m) (range of individual means 0.014-0.881 mW/m²). Exposure was mainly due to mobile phone base stations (32.0%), mobile phone handsets (29.1%) and digital enhanced cordless telecommunications (DECT) phones (22.7%). Persons owning a DECT phone (total mean 0.15 mW/m²) or mobile phone (0.14 mW/m²) were exposed more than those not owning a DECT or mobile phone (0.10 mW/m²). Mean values were highest in trains (1.16 mW/m²), airports (0.74 mW/m²) and tramways or buses (0.36 mW/m²), and higher during daytime (0.16 mW/m²) than nighttime (0.08 mW/m²). The Spearman correlation coefficient between mean exposure in the first and second week was 0.61.

Conclusions

Exposure to RF-EMF varied considerably between persons and locations but was fairly consistent within persons. Mobile phone handsets, mobile phone base stations and cordless phones were important sources of exposure in urban Switzerland.     

Conduct of a personal radiofrequency electromagnetic field measurement study: proposed study protocol

Background  

The development of new wireless communication technologies that emit radio frequency electromagnetic fields (RF-EMF) is ongoing, but little is known about the RF-EMF exposure distribution in the general population. Previous attempts to measure personal exposure to RF-EMF have used different measurement protocols and analysis methods making comparisons between exposure situations across different study populations very difficult. As a result, observed differences in exposure levels between study populations may not reflect real exposure differences but may be in part, or wholly due to methodological differences.     

Radiofrequency electromagnetic fields,screen time,and emotional and behavioural problems in 5-year-old children

Background

Little is known about the exposure of young children to radiofrequency electromagnetic fields (RF-EMF) and potentially associated health effects. We assessed the relationship of RF-EMF exposure from different sources and screen time exposure with emotional and behavioural problems in 5-year-old children.

Vitamin D, glucose, insulin, and insulin sensitivity

This review examines available evidence of links between abnormalities of glucose and insulin metabolism and vitamin D deficiency. Possible mechanisms of action of vitamin D include stimulation of insulin secretion and effects on insulin sensitivity. Sun exposure usually implies greater outdoor physical activity, which in itself may have beneficial effects on insulin sensitivity, unrelated to serum 25-hydroxyvitamin D concentrations. The observed associations in humans among vitamin D, insulin, and glucose metabolism have not yet been confirmed by intervention studies and, hence, a causal association has not been established. Clinical trials are needed to determine whether vitamin D treatment of vitamin D-deficient individuals is able to prevent or treat diabetes mellitus.     

The role of cats and dogs in asthma and allergy – a systematic review

Studies have reported contradictory effects of cat and dog exposure on allergy, resulting in inconsistent recommendations on animal avoidance. We conducted a systematic review of observational studies published in English from 2000 to January 2009. It shows in this review that the reported exposure-response relationships are contradictory. A total of 17 and 13 birth cohort studies on cat and dog exposure, respectively, are included in the review. Most of the birth cohort studies found that cat or dog exposure in early life had no effect on the development of asthma or wheezing symptoms and dog exposure during infancy was found to protect children from developing sensitization against aeroallergens. A total of 7 and 6 prospective studies in school-age children or adults on cat and dog exposure, respectively, are included in this review and most of these studies suggested an inverse association between cat exposure and asthma and wheezing symptoms. As for cross-sectional studies, 26 and 21 studies on cat and dog exposure, respectively, are included in this review, which cover a broad range of age groups and geographical areas, and reported inconsistent results. The evidence summarised in this systematic review needs to be interpreted with caution, the inconsistent study results may be due to study design, exposure assessment, and avoidance measure. The exposure-response relationships may also alter in geographical areas where the community prevalence of cats and dogs are significantly different. However, as the evidence of the effects of pet keeping on subsequent development of asthma or allergic diseases presented in this review are not overwhelmingly strong, the decision of whether to keep a cat or a dog in the family should be based on arguments other than the concern of developing asthma and allergy.     

Enrollment in early head start and oral health-related quality of life

Purpose

Dental problems in young children are widespread and can negatively impact quality of life. We examined the effect of enrollment in North Carolina Early Head Start (EHS)—a federally funded early education program for children under three years of age and their families—on oral health-related quality of life (OHRQoL).

Methods

In this quasi-experimental study, we interviewed 479 EHS and 699 Medicaid matched parent–child dyads at baseline (children’s average age 10 months) and 24 months later. Parents reported OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS), a 0–52 point scale with higher scores representing more negative impacts. We used a marginalized semicontinuous two-part model to estimate: (1) the effect of EHS on the probability of reporting any follow-up impacts (ECOHIS ≥ 1), and (2) the difference in overall mean ECOHIS follow-up scores. We controlled for baseline ECOHIS, language, and EHS and non-EHS group imbalances using a propensity score.

Results

At follow-up, negative OHRQoL impacts were more often reported by parents of non-EHS than EHS children (45 versus 37%, P < .01). In the adjusted model, EHS parents reported a lower odds of negative OHRQoL impacts (OR 0.70; 95% CI 0.52, 0.94). Mean adjusted ECOHIS scores were not significantly different (EHS: 1.59 ± 3.34 versus non-EHS: 2.11 ± 3.85, P > 0.05).

Conclusions

This study is the first to demonstrate that families of young children enrolled in EHS report improved OHRQoL compared to their non-enrolled peers. These results highlight the potential effectiveness of improving the quality of life of low-resource families through early childhood education.

     

Nutrition and Dementia: Evidence for Preventive Approaches?

In recent years, the possibility of favorably influencing the cognitive trajectory through promotion of lifestyle modifications has been increasingly investigated. In particular, the relationship between nutritional habits and cognitive health has attracted special attention. The present review is designed to retrieve and discuss recent evidence (published over the last 3 years) coming from randomized controlled trials (RCTs) investigating the efficacy of nutritional interventions aimed at improving cognitive functioning and/or preventing cognitive decline in non-demented older individuals. A systematic review of literature was conducted, leading to the identification of 11 studies of interest. Overall, most of the nutritional interventions tested by the selected RCTs were found to produce statistically significant cognitive benefits (defined as improved neuropsychological test scores). Nevertheless, the clinical meaningfulness of such findings was not adequately discussed and appears controversial. In parallel, only 2 studies investigated between-group differences concerning incident dementia and mild cognitive impairment cases, reporting conflicting results. Results of the present review suggest that several dietary patterns and nutritional components may constitute promising strategies in postponing, slowing, and preventing cognitive decline. However, supporting evidence is overall weak and further studies are needed.     

Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

Background  

The aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF) in Germany.     

Polluted places or polluted minds? An experimental sham-exposure study on background psychological factors of symptom formation in ‘Idiophatic Environmental Intolerance attributed to electromagnetic fields’

Introduction

‘Idiophatic Environmental Intolerance attributed to electromagnetic fields’ (IEI-EMF) refers to the perception of subjective symptoms during or following EMF exposure. IEI-EMF has become disproved to be a mostly biologic entity by now, and evidences accumulate to support the role of nocebo effect in the phenomenon. The two aims of this study were to demonstrate the significant role of the nocebo effect in physical symptoms reported at 50 Hz frequency of EMF exposure, as well as to explore some psychological factors which may predispose to IEI-EMF.

Methods

A total of 40 volunteer university students have completed a battery of psychological questionnaires (expectations; IEI-EMF; state anxiety – STAI-S; dispositional optimism – LOT-R; somatisation – PHQ-15; somatosensory amplification – SSAS) before, and checklists of physical symptoms during sham exposure to “weak” and “strong” EMFs, respectively. Participants were also asked about the extent to which they had perceived the presence of the presumed EMF.

Results

Participants with higher IEI-EMF scores expected and experienced more symptoms. Suggestion of stronger EMF exposure resulted in larger symptom scores and enhanced EMF-perception as compared to the presumed weaker exposure. Experienced symptom scores were predicted primarily by somatisation scores, whereas self-rating of IEI-EMF was predicted by somatosensory amplification scores.

Conclusion

The results confirm that there is considerable nocebo effect in symptom reports related to 50 Hz frequency EMFs. IEI-EMF seems to be formed through a vicious circle of psychosocial factors, such as enhanced perception of risk and expectations, self-monitoring, somatisation and somatosensory amplification, causalization and misattribution.     

Do probiotics reduce adult lactose intolerance? A systematic review

PURPOSE: To assess the efficacy of oral probiotics in adults with lactose intolerance through a systematic review of its effects on symptoms and breath hydrogen tests, and whether adding probiotics to nonfermented dairy products decreases lactose intolerance at that meal. METHODS: We searched randomized controlled trials published between 1966 and December 2002. Databases in the search strategy included Medline and AMED. We reviewed references of clinical trials and contacted authors of major articles and manufacturers of probiotic commercial products. Quality assessment was based on the McMaster guides and was performed by 5 independent reviewers. Data extraction was performed by 2 reviewers. RESULTS: A master list of 90 articles was compiled. Ten articles met inclusion and exclusion criteria and were consistent with our clinical question. Of the 9 studies that measured breath hydrogen, 3 were positive, 3 were negative, and 3 had both positive and negative results. Of the 7 studies that measured symptoms, 1 yielded positive results, 5 were negative, and 1 had both positive and negative outcomes. CONCLUSIONS: Probiotic supplementation in general did not alleviate the symptoms and signs of lactose intolerance in adults in this review. Some evidence suggests that specific strains, concentrations, and preparations are effective. Further clinical trials of specific strains and concentrations are necessary to delineate this potential therapeutic relationship.     

Systematic review of the epidemiologic and trial evidence of an association between antidepressant medication and breast cancer

Biologic studies have suggested that antidepressant use may increase breast cancer risk. We conducted a systematic review of trials and controlled epidemiologic studies to assess this association. Pooled data from 31 primary efficacy drug company trials of fluoxetine suggested no increased risk but the short duration of these trials may have been insufficient to detect an association. In one prospective cohort study antidepressant use was associated with breast cancer, but this study was conducted among women attending for breast screening, and only limited data on antidepressant use were available. In a second large prospective drugs screening study no association was found between either amitriptyline or imipramine and breast cancer. In a large well-conducted retrospective cohort study there was no association between antidepressant use and breast cancer. A second retrospective cohort study was flawed, with exposure in those who developed breast cancer being measured over a shorter time period than in those who remained disease free. Two of four case-control studies found no association between antidepressant use and breast cancer after control for a number of potential confounding factors. We conclude that epidemiologic evidence does not support an association between antidepressant use and breast cancer.     

Association between occupational exposure to power frequency electromagnetic fields and amyotrophic lateral sclerosis: a review

BACKGROUND: For the past two decades, there has been concern over electromagnetic exposure and human health. While most research has focused on cancer and reproductive outcomes, there is interest in the relationship between electromagnetic fields (EMF) and neurodegenerative diseases. METHODS: We review epidemiological findings and evidence regarding the association between occupational exposure to power frequency EMFs and amyotrophic lateral sclerosis (ALS). Medline was searched for citations related to occupational hazards and ALS, literature reviews and epidemiological evaluations. RESULTS: Nine out of the ten epidemiological studies that have been conducted on the risk of ALS in relation to occupational exposure to EMF show moderate to strong relative risk estimates that supported a link between them. Although data from these studies was consistent, the causal inference to a link between EMF exposure and ALS is restricted mainly due to the lack of direct information on EMF exposure and incomplete consideration of the other potential risk factors for ALS at workplaces. For instance, electric shock, in particular, is more common in electrical occupations than in any other occupations. CONCLUSIONS: This review concludes that further studies should consider investigating the separate effect of EMF exposure and electrical shocks to make more specific interpretations. On-site measurements of EMF should be conducted to include information on EMF exposure from residences as well as workplaces to improve exposure assessment.