Abusive head trauma and the triad: a critique on behalf of RCPCH of 'Traumatic shaking: the role of the triad in medical investigations of suspected traumatic shaking'.

The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) has recently published what they purported to be a systematic review of the literature on 'isolated traumatic shaking' in infants, concluding that 'there is limited evidence that the so-called triad (encephalopathy, subdural haemorrhage, retinal haemorrhage) and therefore its components can be associated with traumatic shaking'. This flawed report, from a national body, demands a robust response. The conclusions of the original report have the potential to undermine medico-legal practice. We have conducted a critique of the methodology used in the SBU review and have found it to be flawed, to the extent that children's lives may be put at risk. Thus, we call on this review to be withdrawn or to be subjected to international scrutiny.

Do people with idiopathic environmental intolerance attributed to electromagnetic fields display physiological effects when exposed to electromagnetic fields? A systematic review of provocation studies.

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is a controversial illness in which people report symptoms that they believe are triggered by exposure to EMF. Double-blind experiments have found no association between the presence of EMF and self-reported outcomes in people with IEI-EMF. No systematic review has assessed whether EMF exposure triggers physiological or cognitive changes in this group. Using a systematic literature search, we identified 29 single or double-blind experiments in which participants with IEI-EMF were exposed to different EMF levels and in which objectively measured outcomes were assessed. Five studies identified significant effects of exposure such as reduced heart rate and blood pressure, altered pupillary light reflex, reduced visual attention and perception, improved spatial memory, movement away from an EMF source during sleep and altered EEG during sleep. In most cases, these were isolated results that other studies failed to replicate. For the sleep EEG findings, the results reflected similar changes in the IEI-EMF participants and a non-IEI-EMF control group. At present, there is no reliable evidence to suggest that people with IEI-EMF experience unusual physiological reactions as a result of exposure to EMF. This supports suggestions that EMF is not the main cause of their ill health.

Can exposure to a terrestrial trunked radio (TETRA)-like signal cause symptoms? A randomised double-blind provocation study.

OBJECTIVES: Concerns have been raised about possible health effects from radiofrequency fields pulsing at around 16 Hz. A radio system used by UK police (TETRA) employs signals which pulse at 17.6 Hz. We tested whether exposure to a continuous wave signal at 385.25 MHz or a TETRA-like signal resulted in symptoms among users reporting sensitivity to TETRA compared to users not reporting sensitivity to TETRA. METHODS: 60 sensitive and 60 non-sensitive users were exposed to three 50 min conditions: a signal with a 16 Hz component, a continuous wave condition and a sham condition. The mean radiated power for the 16 Hz and continuous wave conditions was 250 mW. The order of conditions was randomised and testing was conducted double-blind. Participants reported the severity of eight symptoms during and after each exposure, their mood state at the end of each exposure, and whether they could tell which sessions involved active signals. The study was registered in advance with the ISRCTN register. RESULTS: Exposure to the continuous wave signal increased ratings of headache in all participants, fatigue in non-sensitive participants and difficulty concentrating in sensitive participants. Paradoxically, it reduced sensations of itching in sensitive participants. These effects were not observed in the condition with 16 Hz pulsing, except for those relating to concentration. Adjusting for multiple comparisons removed most significant effects, but not those relating to itch. CONCLUSIONS: The results suggested that exposure to TETRA signals is not responsible for symptoms reported by some users, although exposure to a continuous wave signal may affect symptoms. Clinical trial number ISRCTN 73321766.

Idiopathic environmental intolerance attributed to electromagnetic fields (formerly 'electromagnetic hypersensitivity'): An updated systematic review of provocation studies.

Idiopathic Environmental Intolerance attributed to electromagnetic fields (IEI-EMF; formerly 'electromagetic hypersensitivity') is a medically unexplained illness in which subjective symptoms are reported following exposure to electrical devices. In an earlier systematic review, we reported data from 31 blind provocation studies which had exposed IEI-EMF volunteers to active or sham electromagnetic fields and assessed whether volunteers could detect these fields or whether they reported worse symptoms when exposed to them. In this article, we report an update to that review. An extensive literature search identified 15 new experiments. Including studies reported in our earlier review, 46 blind or double-blind provocation studies in all, involving 1175 IEI-EMF volunteers, have tested whether exposure to electromagnetic fields is responsible for triggering symptoms in IEI-EMF. No robust evidence could be found to support this theory. However, the studies included in the review did support the role of the nocebo effect in triggering acute symptoms in IEI-EMF sufferers. Despite the conviction of IEI-EMF sufferers that their symptoms are triggered by exposure to electromagnetic fields, repeated experiments have been unable to replicate this phenomenon under controlled conditions. A narrow focus by clinicians or policy makers on bioelectromagnetic mechanisms is therefore, unlikely to help IEI-EMF patients in the long-term.

Can evidence change belief? Reported mobile phone sensitivity following individual feedback of an inability to discriminate active from sham signals.

OBJECTIVE: In this study, we tested whether providing individuals, who described being sensitive to mobile phone signals, with accurate feedback about their ability to discriminate an active mobile phone signal from a sham signal had any impact on their subsequent symptom levels or their perceived sensitivity to mobile phones. METHODS: Sixty-nine participants who reported sensitivity to mobile phones took part in a double-blind, placebo-controlled provocation study. Perceived sensitivity to mobile phones was assessed using a version of the Sensitive Soma Assessment Scale (SSAS) and the severity of any symptoms attributed to mobile phones was recorded. Both the overall ("negative") findings of the provocation study and the participant's own individual results ("correct" or "incorrect" at detecting a mobile phone signal) were then described to them. Six months later, perceived sensitivity and symptom severity were measured again. RESULTS: Fifty-eight participants (84%) received feedback and participated in the 6-month follow-up. No significant differences in SSAS scores or in symptom severity scores were found between individuals told that they were correct (n=31) or incorrect (n=27) in their ability to detect mobile phone signals in the provocation study. CONCLUSION: The provision of accurate feedback was insufficient to change attributions or reduce symptoms in this study. However, an overtly negative reaction to feedback was not observed among most participants, and some participants were willing to consider that factors other than electromagnetic field may be relevant in causing or exacerbating their symptoms. Discussing possible psychological factors with electromagnetic hypersensitivity patients may be beneficial for some.