Issues in the Implementation of Directive 2013/35/EU Regarding the Protection of Workers against Electromagnetic Fields.

In 2016 the Directive 2013/35/EU regarding the protection of health and safety of workers exposed to electromagnetic fields was transposed in Italy. Since then, the authors of this paper have been faced with several issues related to the implementation of the provisions of the Directive, which pose some interpretative and operative concerns. A primary critical feature of the Directive is that, in some circumstances, conditions of "overexposure", i.e., of exceeding the exposure limits, are allowed. In the case of transient effects, the "flexibility" concerning the compliance with exposure limits is based on the approach introduced by ICNIRP in its guidelines on static magnetic fields and on time-varying electric and magnetic fields. On the contrary, the possibility of exceeding the exposure limits for health effects, formally recognized in the article of the Directive dealing with derogations, is not included in the ICNIRP guidelines. This paper analyzes the main concerns in interpreting and managing some provisions of the Directive with particular reference to the issue of how the employer can manage the situations of overexposure.

[Jurisprudence on occupational radiofrequency diseases]. / La giurisprudenza sulle malattie professionali da radiofrequenze.

SUMMARY: In the last decade, at the conclusion of some civil proceedings concerning appeals against INAIL (the Italian workers' compensation authority), some Italian courts have recognised the occupational origin of tumours in workers exposed to radiofrequency electromagnetic fields (RF EMFs) emitted by wireless phones, despite the fact that a causal role of electromagnetic fields in oncogenesis has not been demonstrated. In some cases, workers' exposures were combined with those due to other RF EMF sources or with exposures to extremely low frequency magnetic fields (ELF MFs). For the sake of completeness, the case of exposure of a worker to ELF MFs only is also considered. These judgements have been widely covered by the media which, on the contrary, have virtually ignored those in which the causal link between occupational exposure to electromagnetic fields and tumours has not been recognised. The author of this communication is aware of two of these "negative" judgements in that he was, in both cases, one of the court-appointed expert witnesses. A key point to understand the scientific bases for the Judges' decisions is how the IARC classifications of ELF magnetic fields (ELF MFs) and radio frequency electromagnetic fields (RF EMFs) as "possibly carcinogenic to humans", and more generally the body of scientific evidence on electromagnetic fields and tumours, have been taken into account in the judgements and court- appointed expert witnesses' reports. The 2009 judgement of the Court of Appeal of Brescia preceded the IARC classification of radio frequency electromagnetic fields in 2011. The judgement of Brescia was confirmed by the Court of Cassation in 2012, but since the Court of Cassation decides on the legitimacy of the judgements without entering into their merits, the fact that this decision was taken after the IARC classification is irrelevant. All other judgements, subsequent to the publication of the IARC monographs, cited the IARC classifications. The bases for the two "negative" judgements of the Courts of Cremona and Milan were as follows: 1) when an agent is classified as "possibly carcinogenic to humans", a causal link between exposure and cancer has not been generally demonstrated, therefore 2) it is not possible to conclude that a tumour was "more likely than not" (as required in civil litigation (4) ), caused by the agent in question whatever the worker's level of exposure. On the contrary, the court appointed expert witnesses' report on the Ivrea proceeding states that "in the present case there is an association between a rare tumour and an exposure as rare as the use since 1995 of high-emission cellular telephony. The rarity of the circumstance is indicative of a causal association". This and other arguments underlying the "positive" judgements.

Impact of climate change on occupational exposure to solar radiation.

Occupational exposure to solar radiation may induce both acute and long-term effects on skin and eyes. Personal exposure is very difficult to assess accurately, as it depends on environmental, organisational and individual factors. The ongoing climate change interacting with stratospheric ozone dynamics may affect occupational exposure to solar radiation. In addition, tropospheric levels of environmental pollutants interacting with solar radiation may be altered by climate dynamics, so introducing another variable affecting the overall exposure to solar radiation. Given the uncertainties regarding the direction of changes in exposure to solar radiation due to climate change, compliance of outdoor workers with protective measures and a proper health surveillance are crucial. At the same time, education and training, along with the promotion of healthier lifestyles, are of paramount importance.

[Health issues and regulatory aspects of the use of ultrasound in physiotherapy]. / Problematiche sanitarie e aspetti normativi dell'utilizzo degli ultrasuoni in fisioterapia.

The use of ultrasounds in medicine requires, like all physical agents potentially harmful to human health, an accurate assessment of the risks to the health of patients. The nature and extent of these risks depend on exposure levels which in turn are differentiated according to the specific diagnostic or therapeutic applications. Intermediate exposure levels are associated to physiotherapic applications. To analyze specific issues relating to the effectiveness and safety of physiotherapic treatments, a review of the scientific literature and technical standards was carried out. At present, the actual effectiveness of ultrasound physiotherapy is still far from being clearly assessed: further clinical and experimental studies are needed in order to optimize therapies, determining the benefits and risks of treatments and deepening the understanding of the action mechanisms of the physical agent, even on the basis of a better characterization of those physical quantities mostly significant for biological effects. The examination of technical standards defining the security requirements of the equipment allowed the identification of some critical issues; on these bases some proposals are suggested for the improvement of quality and safety of treatments.

SETIL: Italian multicentric epidemiological case-control study on risk factors for childhood leukaemia, non hodgkin lymphoma and neuroblastoma: study population and prevalence of risk factors in Italy.

BACKGROUND: Aetiology of childhood leukaemia and childhood neoplasm is poorly understood. Information on the prevalence of risk factors in the childhood population is limited. SETIL is a population based case-control study on childhood leukaemia, conducted with two companion studies on non-Hodgkin Lymphoma (NHL) and neuroblastoma. The study relies on questionnaire interviews and 50 Hz magnetic field (ELF-MF) indoor measurements. This paper discusses the SETIL study design and includes descriptive information. METHODS: The study was carried out in 14 Italian regions (78.3% of Italian population aged 0-10). It included leukaemia, NHL and neuroblastoma cases incident in 0-10 year olds in 1998-2001, registered by the Italian Association of Paediatric Haematology and Oncology (AIEOP) (accrual over 95% of estimated incidence). Two controls for each leukaemia case were randomly sampled from the Local Health Authorities rolls, matched by gender, birthdate and residence. The same controls were used in NHL and neuroblastoma studies. Parents were interviewed at home on: physical agents (ELF-MF and ionizing radiation), chemicals (smoking, solvents, traffic, insecticides), occupation, medical and personal history of children and parents, infectious diseases, immunizations and associated factors. Occupational exposure was collected using job specific modules. ELF-MF was measured in the main rooms (spot measurement) and close to child's bed (48 hours measurement). RESULTS: The study included: 683 leukaemia cases (87% ALL, 13% AnLL), 97 NHL, 155 neuroblastomas, and 1044 controls. CONCLUSIONS: SETIL represents a data source on exposure of Italian children to a broad array of potential carcinogenic factors.

Risk of childhood leukaemia and non-Hodgkin's lymphoma after parental occupational exposure to solvents and other agents: the SETIL Study.

AIM: In the context of the Italian Multicentric Epidemiological Study on Risk Factors for Childhood Leukaemia and Non-Hodgkin's Lymphoma (SETIL), the risk of childhood cancer was investigated in relation to parental occupational exposures. METHODS: All cases of childhood leukaemia and non-Hodgkin's lymphoma (NHL) in children aged 0-10 years were identified. Controls were chosen at random from the local population in each region. Parents were interviewed using a structured questionnaire. The collected data were blindly reviewed by expert industrial hygienists in order to estimate exposure to a list of agents. Statistical analyses were performed for each agent using unconditional multivariable logistic regression models, taking into account timing of exposure. RESULTS: 683 cases of acute childhood leukaemia, 97 cases of NHL and 1044 controls were identified. Increased risk of childhood leukaemia was found for maternal exposure to aliphatic (OR 4.3) or aromatic hydrocarbons (OR 3.8) in the preconception period, and for paternal exposure to diesel exhaust (OR 1.4), lead exposure (OR 1.7) and mineral oils (OR 1.4)[corrected]. Risk of NHL appeared to be related to paternal exposure to oxygenated solvents (OR 2.5) and petrol exhaust (OR 2.2). CONCLUSIONS: We found increased risk for childhood leukaemia associated with maternal occupational exposure to aromatic and aliphatic hydrocarbons, particularly in the preconception period; increased risks were also observed for paternal exposure to diesel exhaust fumes, mineral oils and lead. The risk of NHL appeared to be related to paternal exposure to oxygenated solvent and petrol exhausts.

Magnetic fields produced by power lines do not affect growth, serum melatonin, leukocytes and fledging success in wild kestrels.

Nesting on high voltage transmission line towers exposes birds to electric and magnetic fields for long periods. Nestlings are exposed from their development in ovo until fledging. This is a critical period for them because the quality of the developmental environment may affect their fitness at adulthood. We carried out a field study on Eurasian kestrels, Falco tinnunculus, to compare chicks from pairs nesting on high voltage power lines vs. those nesting in control sites in similar habitats. The magnetic field (MF) was measured in each nest-box and analysed in relation to growth curves, melatonin levels, leukocyte counts, and fledging success. None of the variables differed between exposed and control nestlings. Wing length (proxy of age) showed a negative covariation with serum melatonin concentration. Our findings suggest that exposure to MFs produced by high voltage power lines during the embryonic and post-hatching period (until fledging) does not have significant short-term physiological effects on kestrel nestlings.

Morbidity experience in populations residentially exposed to 50 hz magnetic fields: methodology and preliminary findings of a cohort study.

A morbidity study of the population of a district of Rome built in part under a 60 kV electric distribution line, included 345 subjects resident in the study area in any period between 1954 and 2003, excluding those deceased before 1998. Residential magnetic field levels were estimated based on current load, line characteristics, and distance of the dwellings from the power line, and the study area was divided into sub-areas with differing magnetic field levels. Standardized morbidity ratios were computed from hospital discharge records dated 1998-2003. Non statistically significant increases were observed for all and primary cancers; primary cancers were significantly increased among subjects with > 30 years' residence and latency. A significant increase for all, primary, and secondary cancers, and a two-fold increase for ischaemic diseases, was observed in subjects in the sub-area with the highest exposure. No increase was seen in neoplastic haematological diseases.

[Preliminary study of cause-specific mortality of a population exposed to 50 Hz magnetic fields, in a district of Rome municipality]. / Studio preliminare di mortalità per causa di una popolazione con esposizione residenziale a campi magnetici a 50 Hz, in un quartiere del comune di Roma.

OBJECTIVE: To investigate cause-specific mortality in a population exposed to high levels of 50 Hz magnetic fields, in a district of Rome. DESIGN: A cohort of 357 subjects that are resident in an area of about 100 meters on the two sides of a 60 kV power line was studied. Exposure to 50 Hz magnetic fields was evaluated by spot and long-term measurements and by adopting a model based on current load, characteristics of the line and distance of dwellings from conductors. The mortality experience of the cohort was observed from January 1st, 1980 through December 31st, 2003. Analysis took into account duration of residence and latency. Separate analyses were performed for three subcohorts characterized by different distances from the line and different estimated and measured field levels. MAIN OUTCOMES: Cause-specific standardized mortality ratios (SMRs) were computed comparing the observed number of deaths with the corresponding expected figures derived from the Latium Region mortality rates. This was done both in the overall cohort and in the subcohorts. RESULTS: All-causes mortality of the cohort did not differ from expected values (SMR 0.99; 95% CI 0.73-1.35; 40 observed). All cancers mortality showed a non-significant increase (SMR 1.34; 95% CI 0.82-2.18; 16 observed), that reached statistical significance in the analyses limited to subjects with more than 30 years of residence (SMR 2.09; 95% CI 1.05-4.19; 8 observed). Mortality from lymphohaematopoietic malignancies was increased, based on two cases of leukemia. All cancers mortality was highest in the subcohort closest to the power line and exposed to highest levels of magnetic fields. An increased risk for digestive tract neoplasms (SMR 3.57; 95% CI 1.49-8.58; 5 observed) was observed, which was mainly caused by pancreatic cancer. DISCUSSION AND CONCLUSION: Some increase in mortality of the overall cohort and especially of the highly exposed sub cohort was detected, notwithstanding the low power of the study. Other studies are currently on-going in the same area: a cross-sectional investigation on health status, an analysis of hospital discharge cards, a project for estimating individual exposure levels and a research in veterinary epidemiology. It is recommended to replicate the present study in areas presenting similar exposure patterns, in order to be able to pool data with the aim of estimating risk associated with the exposure levels of interest.