Neighborhood Disorder and Sleep Problems in Older Adults: Subjective Social Power as Mediator and Moderator.

BACKGROUND AND OBJECTIVES: Contextual contributors to sleep problems are important to examine among older adults because sleep problems are associated with a number of adverse outcomes in late life. We examine whether disordered neighborhoods are a key contextual determinant of sleep problems in late life, as well as how subjective social power-a sense of personal control and subjective social status-mediates and moderates this association. Central to this contribution is the use of econometric techniques that holistically control for time-stable factors that may bias estimated associations. RESEARCH DESIGN AND METHODS: Three waves (2006, 2010, 2014) of the psychosocial subsample of the Health and Retirement Study (N = 7,130) are analyzed with random-effects models that adjust for repeated observations, as well as fixed-effects models that additionally control for all time-stable confounders. RESULTS: Neighborhood disorder is associated with greater sleep problems in random-effects models, but this association is substantially weakened in a fixed-effects model. Personal control mediates this association, but does not moderate it. Subjective social status does not mediate the association, but does moderate it. DISCUSSION AND IMPLICATIONS: Although neighborhood disorder is associated with sleep problems in older adults, this association is likely to be overestimated in analyses that do not compressively control for time-stable confounders. Rather than acting as dual mediators and moderators, perceived control and subjective social status play distinct roles in this association, with seniors at lower levels of subjective social status especially at risk for sleep problems due to neighborhood disorder.

EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses.

Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take "new exposures" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer's disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment. In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis. The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

[Environmental medicine counselling in daily medical practice]. / Erfahrungen des Pilotprojektes "Umweltmedizinisches Beratungsnetz" des Vereins Ärztinnen und Ärzte für Umweltschutz (AefU).

Since 2008, the Swiss Society of Doctors for the Environment runs a small interdisciplinary environmental medicine counselling structure for patients with complaints attributed to environmental exposures. The model is embedded in everyday practice with a central coordination and consultation office as well as a network of general practitioners interested in environmental medicine who make environmental medical assessments and consultations based on a standardised protocol in their practices. If necessary, environmental experts are consulted and home investigations are conducted. An evaluation study concluded that this model is feasible and addresses an existing need. The assessment option is experienced as helpful by patients. The interdisciplinary collaboration with environmental experts has proved to be effective. The aim of the assessment is to detect or to rule out common diseases and to analyse the impact of suspected environmental burden on the complaints in order to find individual therapeutic approaches. The progression of common medical and psychiatric illnesses can be negatively affected by environmental influences, too. The main instrument of the assessment is an extensive medical and psycho-social history with an additional environmental history including a systematic questionnaire and environmental key questions. Close collaboration with the family doctor is crucial. Assessment steps can be streamlined and consultation suggestions can be embedded in the family doctors holistic and lasting concept of treatment. Where possible our society gladly provides family doctors with our practical environment-related expertise. It is an important concern for us to make environmental medicine an integral part of primary care, also in the process of informing the patient about the prevention of and precautions against harmful or potentially harmful environmental burdens. We hope that the experiences made in our project will contribute to this goal.

Environmental origins of congenital heart disease: the heart-placenta connection.

Although the mammalian embryo is well protected in the uterus, environmental chemicals, drugs, and maternal nutritional imbalances can interfere with regulatory pathways directing placental and embryonic development early in gestation. Embryonic cells are most susceptible to environmental influences during cellular specification and differentiation stages. Because biochemical differentiation precedes morphological outcome often by days, the period of susceptibility to environmental chemicals expectedly precedes visible morphogenic effects. The cellular mechanisms by which drugs and other environmental factors disrupt embryonic development and induce cardiac abnormalities have remained undefined.

The search for reliable biomarkers of disease in multiple chemical sensitivity and other environmental intolerances.

Whilst facing a worldwide fast increase of food and environmental allergies, the medical community is also confronted with another inhomogeneous group of environment-associated disabling conditions, including multiple chemical sensitivity (MCS), fibromyalgia, chronic fatigue syndrome, electric hypersensitivity, amalgam disease and others. These share the features of poly-symptomatic multi-organ cutaneous and systemic manifestations, with postulated inherited/acquired impaired metabolism of chemical/physical/nutritional xenobiotics, triggering adverse reactions at exposure levels far below toxicologically-relevant values, often in the absence of clear-cut allergologic and/or immunologic involvement. Due to the lack of proven pathogenic mechanisms generating measurable disease biomarkers, these environmental hypersensitivities are generally ignored by sanitary and social systems, as psychogenic or "medically unexplained symptoms". The uncontrolled application of diagnostic and treatment protocols not corresponding to acceptable levels of validation, safety, and clinical efficacy, to a steadily increasing number of patients demanding assistance, occurs in many countries in the absence of evidence-based guidelines. Here we revise available information supporting the organic nature of these clinical conditions. Following intense research on gene polymorphisms of phase I/II detoxification enzyme genes, so far statistically inconclusive, epigenetic and metabolic factors are under investigation, in particular free radical/antioxidant homeostasis disturbances. The finding of relevant alterations of catalase, glutathione-transferase and peroxidase detoxifying activities significantly correlating with clinical manifestations of MCS, has recently registered some progress towards the identification of reliable biomarkers of disease onset, progression, and treatment outcomes.

[Preclinical health changes upon exposure to hydrocarbons of petroleum genesis].

A full-scale toxicological experiment established a complex of biochemical, clinical, and immunological parameters for the diagnosis of preconditions upon exposure to hydrocarbons, which was tested on children from two towns differing in the degree of ambient air pollution owing to hydrocarbons.

[Naturally caused imbalance of elements in the population of the Yamal Region (a review)].

The study has indicated that microelementosis in the natives and newcomers of Yamal is caused by the geochemical features of the region and supplemented by inadequate zinc intake. The region's waters differ in their hygienic standards and high levels of iron and the air is characterized by the latter's deficiency. Fe is ingested equally with water and foodstuffs while Cu and Zn are mainly with foods. The trace element status of the newcomers is considerably close to that in the natives of the North and associated with the chemical composition of the region's waters.

Environmental evaluation of a child with developmental disability.

Children's health can be affected adversely by the environment in which they live. It is well recognized that some environmental chemicals are harmful to the brain, but the role these chemicals play in the development of specific disabilities such as attention deficit hyperactivity disorder and autism is not certain. Parents of children who have developmental disabilities often ask the primary care physician whether certain environmental toxicants might be the cause of the illness. A detailed environmental history and physical examination may help clarify whether there is a plausible relationship between an environmental toxicant and a child's disability.

[Allergic diseases and immunological resistance in children from a petroleum area].

The incidence of allergic diseases was studied in the children living in an oil-extracting region of the Republic of Udmurtia. A hygienic assessment of the level of environmental pollution was made in the study areas. The increased atmospheric contamination was ascertained to cause an increase in the incidence of allergic diseases in children. There was a correlation between the concentration of noxious substances as part of the ambient air and the prevalence of allergic diseases in children. The studies suggest that the children living in the oil-extracting area have worse parameters of nonspecific resistance than do the control children. The findings serve as the basis for developing measure to lower environmental pollution and to reduce the incidence of allergic diseases in children.

[Multiple chemical sensitivity (MCS) -- a case series]. / Multiple Chemikalienüberempfindlichkeit (MCS) - eine Fallserie.

BACKGROUND AND OBJECTIVE: The phenomenon of Multiple Chemical Sensitivity which generally cannot be explained organically is frequently associated with psychic impairment. This case series deals with the question if in addition to a standardized interview a routine psychiatric-psychosomatic examination alters the classification if a patient suffers from symptoms compatible with MCS or not. METHODS: Nine consecutive outpatients (m = 3, f = 6, mean age 44 yrs) of the environmental medicine centre were investigated. Somatic diseases were evaluated by standard medical procedures and emotional disturbances were assessed by the Munich Composite International Diagnostic Interview (M-CIDI) and a psychiatric-psychosomatic examination. RESULTS: In all but one patients emotional disturbances (F-codes of the ICD-10) were diagnosed by the M-CIDI and the psychiatric-psychosomatic examination. The diagnoses of the M-CIDI and the psychiatric-psychosomatic examination often did not match. MCS was ruled out in seven patients. CONCLUSIONS: According to the criteria defined by Cullen (5), emotional disturbances must be ruled out before MCS is diagnosed. Therefore, an examination by a specialist in psychiatry or psychosomatics is mandatory because evaluation solely based on the M-CIDI is insufficient. Performing a routine psychiatric-psychosomatic examination, MCS could be ruled out much more often than previously.

Symptoms attributed to the environment--a systematic, interdisciplinary assessment.

PROBLEM: To assess symptoms attributed to the environment from an interdisciplinary perspective and to evaluate the plausibility of the participants' individual theory of a causal relationship between exposure and health impairment. METHOD: We assessed the medical, psychiatric and environmental background in every participant in an environmental medicine project and discussed the explanatory value of our findings for each reported symptom. RESULTS: Every second participant had at least one symptom that could be plausibly explained by simultaneously occurring medical, psychological or environmental findings. In 40% of the participants the research team rated the association between an environmental exposure and the health complaints to be 'plausible'. Psychiatric disorders were frequent, but did not exclude environmentally caused symptoms. CONCLUSION: Only an interdisciplinary structure including medical, psychiatric and environmental expertise is likely to adequately diagnose and advise persons with environmentally related symptoms.

[Evaluation of the impact of emissions from the oil-refining plants on human health]. / Otsenka vozdeistviia vybrosov neftepererabatyvaiushchikh proizvodsstv na zdorov'e naseleniia.

The entry of complexes of organic compounds, the components of the emissions from petrochemical and oil-refining plants into the environment leads to its quality and can have an adverse impact on the health status of the population in the area adjacent to the petrochemical plant. This paper deals with the formation of an evidence base for evaluating the etiopathogenetic role of the chemical components of emissions from a petrochemical plant in the development of diseases in the population under environmental conditions. The files of data accumulated in the period of 1994-2001 were analytically generalized in the electron database in accordance with the content of the priority chemical components of emissions in the body of 250 children living in the industrial area where the study plant is situated. The estimation of the level and time course of changes in toxicants in the blood of children identified health indicators to optimize monitoring and to evaluate the efficiency of environment-protective and therapeutic-and-prophylactic programs. The findings suggest that the elevated level of some organic compounds that exert a polytropic toxic effect on the vital organs and systems is a risk factor for diseases and requires a systemic monitoring.

[Evaluation of the influence of chemical factors of petroleum organic synthesis enterprises on the health status of their workers]. / Otsenka vozdeistviia khimicheskikh faktorov predpriiatii nefteorgsinteza na zdorov'e rabotaiushchikh.

Recent studies conducted by a number of authors have given a good idea of the toxic effects of petroleum and its products on man. The combined effects of chemical and physical factors are known to potentiate their toxic effects and to cause an increase in morbidity among the workers of oil-refining plants. The paper substantiates the basic health indices to reduce the risk of industrial influences of the chemical components of emissions from an oil-producing plant on its workers' health. The workers were examined in accordance with the developed algorithm of hygienic evaluation under the influence of a combination of chemical factors, which makes it possible to define health indicators to optimize monitoring and to evaluate the efficiency of therapeutic-and-prophylactic programs. The results of the study suggest that in the workers, the elevated blood level of organic compounds exerting a polytropic toxic effect on the vital organs and systems is a risk factor for diseases and requires a systemic monitoring. Thus, program-specific planning of therapeutic and prophylactic measures implemented at an oil-producing plant should be accomplished by taking into account the optimum complex of diagnostic studies to evaluate the workers' health status.

[From industrial hygiene and toxicology to environmental hygiene and toxicology: problems and prospects]. / Dall'igiene e tossicologia industriale all'igiene e tossicologia ambientale: problemi e prospettive.

BACKGROUND: Low-dose exposures to mixtures of substances have received increasing interest and they involve many different occupational and environmental situations. The presence in the population (working and general) of groups of susceptible individuals is an important public health issue that poses new challenges to science and society. OBJECTIVES: To discuss the evolution from traditional occupational hygiene and toxicology to the new environmental (general and occupational) hygiene and toxicology. RESULTS: Environmental hygiene and toxicology have remarkably improved analytical tools available to solve most of the analytical issues posed by the present exposure scenario. Biomarkers of low-dose exposure, early effects and individual susceptibility are being intensively investigated. CONCLUSIONS: The challenge in this field for the coming years appears to be not the analytical but the medical and ethical implications.

[Significance of environmental medicine from the viewpoint of the medical review board of the social health insurance program]. / Die Bedeutung der Umweltmedizin aus der Sicht des Medizinischen Dienstes der Krankenversicherung (MDK).

Tasks concerning environmental medicine are a significant aspect of the expert work done by the medical review board of the social health insurance fund. Thus far there are no commonly accepted theories and/or criteria with regard to the cause of environmental incompatibilities, nor are there generally accepted criteria/standards for clinical diagnostic procedures and therapy. Problems arise from the fact that the field of environmental medicine not only offers scientifically accepted and verified diagnostic and therapeutic methods, but also numerous unconventional procedures without verified validity. The decision of the scientific expert has to be based on the legal principles of social legislation and jurisdiction. His/her opinion must be competent, objective and independent. Further research is urgently needed to improve the scientific data pool. With it, well-grounded methods and standards can be offered.