On radar and radio exposure and cancer in the military setting.

INTRODUCTION: In 2018, we reported a case series of 47 patients diagnosed with cancer following several years of exposure to high-intensity whole-body radiofrequency radiation (RFR) using the parameter of percentage frequency (PF). Consistent high and statistically significant PFs of hematolymphoid (HL) cancers were found in this group and in four previous reports on RFR-exposed groups in Belgium, Poland and Israel together with increased all-cancers rates. In this paper we report a new series of 46 young cancer patients who were exposed during military service to such radiation. MATERIALS AND METHODS: The new group of patients comprises Israeli soldiers previously exposed to occupational RFR. The patients were self-selected to enroll in the research in cooperation with an NGO assisting patients with administrative counseling and legal and social services. The new group of patients was studied with respect to distribution (proportion) of cancer types using the method of PF. When possible, cancer risk ratios (RR) were estimated too. The results are compared to those of other occupational groups in three countries. RESULTS: Median age at diagnosis was 23 years; duration of exposure was between 1 and 3 years and the latencies were short, median 4.6 years. The PF of HL cancers was 41.3%, 95% CI (27%-57%), versus 22.7% expected in non-exposed subjects matched for age and gender profiles, p = 0.003; 19 out of the 46 patients had HL cancers. The PF of Hodgkin lymphoma cancers was 21.7%, 95%CI (11%-36%), versus 11.6% expected, p = 0.033. For a subgroup of 6 patients, the number of soldiers in the units was known, and we were able estimate approximately the overall cancer risk ratio (RR) after 8 years as being 8.0 with 95% CI (2.9, 17), p < 0.002, with only 0.75 cases expected from the Cancer Registry data. In this subgroup, there were 3 HL cancer cases and 3 non-HL cases. Sarcoma PF was higher than expected, 7 out of the 46 patients were diagnosed with sarcoma, PF = 15.2%, 95%CI (6.3%-28.9%), p = 0.04 versus the expected PF of 7%. CONCLUSION: The HL PF was high and consistent with previous reports. Epidemiological studies on excess risk for HL and other cancers, brain tumors in cellphone users, and experimental studies on RFR and carcinogenicity strongly point to a cause-effect relationship. It is mandatory to reduce the RFR exposure of all personnel to that of the typical community levels, including the peak level of radar pulses. Radiation protection, safety instructions, cancer risk warnings and quantitative data on individual exposure together with regular medical monitoring must be instituted for all personnel exposed to such risks. The findings from our study add to the growing body of evidence underscoring the gross inadequacy of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) thermal standards. Based on our findings and on the previous accumulated research, we endorse the recommendations to reclassify RFR exposure as a human carcinogen, International Agency for Research on Cancer (IARC) group 1.

Incitement, genocide, genocidal terror, and the upstream role of indoctrination: can epidemiologic models predict and prevent?

We apply the models and tools of epidemiology and public health to propose a unified field theory showing the role of ideologies, indoctrination, and incitement, in genocide, genocidal terror, and terror by groups or individuals. We examine the effects of indoctrination and incitement as exposures and risks in relation to genocide and genocidal terror. Incitement has been recognized as a trigger to these outcomes but indoctrination is upstream to incitement. Population-wide exposure to indoctrination increases susceptibility to the effects of incitement. These relationships have been seen in all major genocides and genocidal terror in the late twentieth and twenty-first centuries. There is some insight into the relationship between ideology, incitement, and genocidal acts of violence from the so-called localized genocides in Bosnia, Rwanda, Darfur, Syria, and most recently, among the Rohingya in Myanmar. There is a need to recognize the upstream role of ideologies of hate in order to determine the degree to which indoctrination posed, and continues to pose, a contributing factor. Epidemiologic models, such as the iceberg model of exposure and disease and the concept of "sick individuals" and "sick populations," guide our understanding of the content and spread of indoctrination and incitement and can provide essential insights for prevention. The hateful indoctrination and ideologies behind genocidal violence must be countered and replaced by positive ideologies and role models that emphasize respect for life and human dignity for all.

Radio frequency radiation-related cancer: assessing causation in the occupational/military setting.

BACKGROUND AND AIM: We reexamine whether radio frequency radiation (RFR) in the occupational and military settings is a human carcinogen. METHODS: We extended an analysis of an already-reported case series of patients with cancer previously exposed to whole-body prolonged RFR, mainly from communication equipment and radar. We focused on hematolymphatic (HL) cancers. We used analysis by percentage frequency (PF) of a cancer type, which is the proportion of a specific cancer type relative to the total number of cancer cases. We also examined and analyzed the published data on three other cohort studies from similar military settings from different countries. RESULTS: The PF of HL cancers in the case series was very high, at 40% with only 23% expected for the series age and gender profile, confidence interval CI95%: 26-56%, p<0.01, 19 out of 47 patients had HL cancers. We also found high PF for multiple primaries. As for the three other cohort studies: In the Polish military sector, the PF of HL cancers was 36% in the exposed population as compared to 12% in the unexposed population, p<0.001. In a small group of employees exposed to RFR in Israeli defense industry, the PF of HL cancers was 60% versus 17% expected for the group age and gender profile, p<0.05. In Belgian radar battalions the HL PF was 8.3% versus 1.4% in the control battalions as shown in a causes of deaths study and HL cancer mortality rate ratio was 7.2 and statistically significant. Similar findings were reported on radio amateurs and Korean war technicians. Elevated risk ratios were previously reported in most of the above studies. CONCLUSIONS: The consistent association of RFR and highly elevated HL cancer risk in the four groups spread over three countries, operating different RFR equipment types and analyzed by different research protocols, suggests a cause-effect relationship between RFR and HL cancers in military/occupational settings. While complete measurements of RFR exposures were not available and rough exposure assessments from patients interviews and from partial exposure data were used instead, we have demonstrated increased HL cancers in occupational groups with relatively high RFR exposures. Our findings, combined with other studies, indicate that exposures incurred in the military settings evaluated here significantly increased the risk of HL cancers. Accordingly, the RFR military exposures in these occupations should be substantially reduced and further efforts should be undertaken to monitor and measure those exposures and to follow cohorts exposed to RFR for cancers and other health effects. Overall, the epidemiological studies on excess risk for HL and other cancers together with brain tumors in cellphone users and experimental studies on RFR and carcinogenicity make a coherent case for a cause-effect relationship and classifying RFR exposure as a human carcinogen (IARC group 1).

Lower Cancer Rates Among Druze Compared to Arab and Jewish Populations in Israel, 1999-2009.

The Druze are a small ethnic minority in Israel amounting to about 130,000 residents (or 1.7 % of the total population of the country). Unlike other population groups, the Druze strive to keep their own traditions and marry mainly inside their own community. During the last decade, cancer morbidity among both Jews and Arabs in Israel has been increasing, while data on the Druze are little known and have not been analyzed and compared to other population groups to date. To compare cancer morbidity rates among Druze, Arabs and Jews in Israel during 1999-2009, gender-specific and age-standardized incidence rates of all site cancers and specific cancers of three population groups (Jews, Arabs and Druze) were received from the Israel National Cancer Registry for the period 1999-2009. Based on these rates, periodical incidence rates were calculated and mutually compared across the groups stratified by gender. As the analysis shows, the Druze had significantly lower cancer rates compared to both Arabs and Jews. Thus, for all site cancers, there were significantly higher cancer rates in Jewish males versus Druze males (RR = 1.39, 95 % CI = 1.16-1.65) and in Jewish females versus Druze females (RR = 1.53, 95 % CI = 1.27-1.85), but not statistically significant for Arab males versus Druze males (RR = 1.12 95 % CI = 0.93-1.35). Lung cancer rates in Arab males were also higher compared to Druze males (RR = 1.84, 95 % CI = 1.13-3.00). Jewish males had statistically significant higher rates of prostate cancer compared to Druze males (RR = 2.47, 95 % CI = 1.55-3.91). For thyroid and colon cancers, risks were not significantly different at the 95 % CI level; however, the risks were significantly different at the 90 % CI level (RR = 3.62, 90 % CI 1.20-11.02 and RR = 1.69, 90 % CI = 1.03-2.77, respectively). Jewish females had significantly higher rates of invasive breast cancer (RR = 2.25, 95 % CI = 1.55-3.25), in situ cervical cancer (RR = 4.01, 95 % CI = 1.27-12.66) and lung cancer (RR = 3.22, 95 % CI = 1.12-9.24) compared to Druze females. We thus observed lower cancer rates among Druze versus Arab and Jewish populations in Israel. A reason for these differences may be due to different nutritional habits. Druze still keep a less processed nutritional lifestyle, than is common in industrial society. There may also be other reasons that have not been identified yet.

Urinary organophosphate metabolite levels in Palestinian pregnant women: results of the Middle East Regional Cooperation Project.

The purpose of the study was to measure urinary organophosphate (OP) metabolites in Palestinian pregnant women, and to compare levels with those in pregnant women in Jerusalem and women from the general population in Israel. We measured six dialkyl phosphates in urine samples collected from 148 pregnant women from the West Bank area. Median total dimethyl phosphate (DM(total)) levels were significantly lower in Palestinian women compared to Jerusalem pregnant women and women in Israel (p = 0.041). In Palestinian women reporting that their place of residence was near an agricultural field, DM(total) levels were significantly higher (p = 0.037). Lower urinary excretion of dimethyl phosphate pesticide metabolites in Palestinian women compared to Israeli women may result from lower consumption of fruits and vegetables in the Palestinian population. Our findings highlight differences in OP pesticide exposure in populations with close geographical proximity but with differences in culture, diet, lifestyle, and regulatory oversight of pesticides.

Trauma care and case fatality during a period of frequent, violent terror attacks and thereafter.

BACKGROUND: From September 1999 through January 2004 during the second Intifada (al-Aqsa), there were frequent terror attacks in Jerusalem. We assessed the effects on case fatality of introducing a specialized, intensified approach to trauma care at the Hebrew University-Hadassah Hospital Shock Trauma Unit (HHSTU) and other level I Israeli trauma units. This approach included close senior supervision of prehospital triage, transport, and all surgical procedures and longer hospital stays despite high patient-staff ratios and low hospital budgets. Care for lower income patients also was subsidized. METHODS: We tracked case fatality rates (CFRs) initially during a period of terror attacks (1999-2003) in 8,127 patients (190 deaths) at HHSTU in subgroups categorized by age, injury circumstances, and injury severity scores (ISSs). Our comparisons were four other Israeli level I trauma centers (n = 2,000 patients), and 51 level I U.S. trauma centers (n = 265,902 patients; 15,237 deaths). Detailed HHSTU follow-up continued to 2010. RESULTS: Five-year HHSTU CFR (2.62 %) was less than half that in 51 U.S. centers (5.73 %). CFR progressively decreased; in contrast to a rising trend in the US for all age groups, injury types, and ISS groupings, including gunshot wounds (GSW). Patients with ISS > 25 accounted for 170 (89 %) of the 190 deaths in HHSTU. Forty-one lives were saved notionally based on U.S. CFRs within this group. However, far more lives were saved from reductions in low CFRs in large numbers of patients with ISS < 25. CFRs in HHSTU and other Israeli trauma units decreased more through the decade to 1.9 % up to 2010. CONCLUSIONS: Sustained reductions in trauma unit CFRs followed introduction of a specialized, intensified approach to trauma care.

Human biomonitoring in Israel: past, present, future.

The first human biomonitoring (HBM) studies in Israel in the 1970s and 80s focused on measuring exposure to polychlorinated biphenyls (PCBs) and organochlorine insecticides in the general population and organophosphate pesticides in agricultural workers. In the late 1990 s, a regional human biomonitoring study found differences in blood lead levels in children from Israel, Jordan, and the Palestinian Authority. Taken together with data on time trends in lead emissions in Israel, the study indicated the benefits from phasing out of leaded gasoline. More recently, a pilot study in pregnant women in Jerusalem, conducted in collaboration with the US-CDC, found widespread exposure to phthalates, organophosphate pesticides, and the carbamate bendiocarb. Creatinine-adjusted total dimethyl (DM) metabolite concentrations were between 4 and 6 times higher than populations of pregnant women in the United States. The Israel Ministry of Health is currently collaborating with the Hebrew University of Jerusalem and Al Quds University to study exposures to phthalates and organophosphates in pregnant women in Israel and the Palestinian Authority. The Israel Ministry of Health has also begun the first National Biomonitoring Study to measure exposures to bisphenol A, phthalates, organophosphates, polyaromatic hydrocarbons, the phytoestrogens genistein and daidzein, and cotinine in the Israeli adult population. This study is being carried out in collaboration with the University of Erlangen-Nuremberg in Germany. Until recently, HBM programs in Israel were targeted at selected occupational groups (workers potentially exposed to metals, volatile organic compounds (VOCs), and cholinesterase inhibitors) and naval divers potentially exposed to environmental contaminants. The future of HBM in Israel lies in extending such programs to measuring exposures in representative samples of the general population, increasing international collaboration in this field, developing analytical capacity and expertise, and increasing use of human biomonitoring studies in forming and evaluating environmental health policy.

Cancer risks in the Druze Isifya Village: Reasons and RF/MW antennas.

BACKGROUND: The present study was initiated to examine the claims of the residents of the Druze Isifya Village in Northern Israel that their high cancer rates were associated with the past exposures to radiation from radio and cellular transmitters. OBJECTIVE: To investigate the association between past exposure to RF/MW transmitters and cancer risks, taking into account familial cancer history, occupational exposures and indicators of life-style. METHODS: We carried out a population-based case-control study involving 307 residents, of whom 47 were diagnosed between 1989 and 2007 with different types of cancer and 260 controls. Cancer diagnoses were obtained from medical the records. Exposure status of individual houses were determined from a map, based on the distances between each house and RF/MW antennas, and were calculated using geographic information systems (GIS) tools. Data on additional risk factors for cancer, like smoking and occupation, were obtained from individual questionnaires. The analysis was adjusted for measures of life style and occupational exposure, and Binary multiple logistic regressions was used, for all cancer sites and for individual cancer types for those cancers with at least 5 documented cases. RESULTS: Past occupational exposures to chemicals (e.g., pesticides) and electronics, were found to be strongly associated with increased cancer risks (all sites: OR=2.79; CI=1.14-6.82; P<0.05), but no discernible trend in overall cancer risk was associated with proximity to sources of past RF/MW radiation exposure (n=47 OR=1.00; CI=0.99-1.02; P>0.4). Colorectal cancer showed a negligible elevated adjusted risk associated with radiation intensity (n=11 OR=1.03; CI=1.01-1.05; P<0.01). CONCLUSION: There was evidence for an increased risk of cancers which were associated with chemicals in manufacturing and agriculture and electronics, where there may have been exposures to EMF, but the study did not confirm the suspicion of increased cancer risks associated with radiation for most cancer types in this village. Misclassification of past exposures could explain the negative finding.

Pesticide exposure among pregnant women in Jerusalem, Israel: results of a pilot study.

BACKGROUND: Pesticides have been shown to disrupt neurodevelopment in laboratory animals and in human populations. To date, there have been no studies on exposure to pesticides in pregnant women in Israel, despite reports of widespread exposure in other populations of pregnant women and the importance of evaluating exposure in this susceptible sub-population. METHODS: We measured urinary concentrations of organophosphorus (OP) insecticide metabolites and plasma concentrations of OP and other pesticides in 20 pregnant women, recruited in Jerusalem, Israel in 2006, and collected questionnaire data on demographic factors and consumer habits from these women. We compared geometric mean concentrations in subgroups using the Mann-Whitney U-test for independent samples. We compared creatinine-adjusted OP pesticide metabolite concentrations, as well as plasma pesticide concentrations, with other populations of pregnant women. RESULTS: Creatinine-adjusted total dimethyl (DM) metabolite concentrations were between 4 and 6 times higher in this population compared to other populations of pregnant women in the United States while total diethyl (DE) metabolite concentrations were lower. Dimethylphosphate (DMP) was detected in 74% of the urine samples whereas dimethylthiophosphate (DMTP) was detected in 90% of the urine samples. The carbamate bendiocarb was detected in 89% of the plasma samples, while the OP insecticide chlorpyrifos was detected in 42% of the samples. Mean plasma concentrations of bendiocarb and chlorpyrifos in our sample were 4.4 and 3.9 times higher, respectively, than that of an urban minority cohort from New York City. Twelve women (63%) reported using some form of household pest control during their pregnancy and five (26%) reported using household pest control during the past month. Women with a graduate degree had significantly higher geometric mean concentrations of total urinary DM metabolite concentrations compared to other women (P=0.006). Finally, one woman in the study had exceptionally high concentrations of DMP, DMTP, DMDTP compared to the other women in the study, despite reporting no current occupational exposure to OP pesticides and no other significant exposure sources. CONCLUSIONS: Pregnant women in the Jerusalem area are exposed to OP pesticides and to the carbamate pesticide bendiocarb. It is unclear why total DM metabolites concentrations were much higher in this population compared to other populations of pregnant women in the United States and Netherlands. Finally, the finding of very high DM metabolite concentrations in one woman who reported being moved from her regular laboratory work to administrative work upon becoming pregnant, raises questions about the adequacy of measures to protect pregnant women from pesticide exposures during pregnancy.

Mesothelioma and asbestosis in a young woman following occupational asbestos exposure: Short latency and long survival: Case Report.

A 27-year-old female white-collar worker was diagnosed in 1998 with mesothelioma eight and one-half years following first exposure as a bystander to debris in a site in which asbestos-containing building materials were being dismantled and rebuilding work took place. Prodromal back pain had been present for a year and a half. She underwent extrapleural pneumectomy and received an intrapleural infusion of cisplatin post-operatively. Exposure to asbestos was verified by contemporary reports and lung biopsy, which demonstrated asbestos bodies and microscopic interstitial fibrosis -conforming evidence for asbestosis. The patient is alive and well 12 years after diagnosis and 14 years after onset of symptoms. The combination of an extremely short latency period and long survival following occupational exposure to asbestos dust is unique.

Exposure and susceptibility: schizophrenia in a young man following prolonged high exposures to organic solvents.

There is an abundant literature on the adverse effects of solvents on the neurobehavioral performance, higher brain functions, and chronic solvent-induced encephalopathy. However, the occurrence of solvent-related schizophrenia is rare, with few reports on the link between solvent exposure and schizophrenia. Here, we report on a patient with schizophrenia, presenting after a sustained period of 6 months of everyday exposure to neurotoxic solvents in an unprotected occupational setting in Haifa, Israel. In light of the similarity of symptoms of schizophrenia and chronic solvent encephalopathy, we call for further epidemiologic studies to examine the potential contribution of solvent exposure to the etiology and evolution of schizophrenia in selected cases. This case study and review of relevant literature underscores the importance of obtaining detailed histories on occupational exposures to search for agents which can trigger psychotic episodes. In the meantime, policies to prevent such exposures at the source can be expected to contribute to the prevention of a non-trivial proportion of neurotoxic diseases, including, possibly, schizophrenia in worker populations.

Peaceful use of disastrous neurotoxicants.

The increasing exposure to environmental neurotoxicants in the last decades caused serious health problems in the world population. Some of the neurotoxic agents are being used in agriculture and household such as insecticides and rodenticides and others are of natural origin like snake and scorpion venoms. Additional group of harmful substances is the chemical warfare agents including nerve and blistering agents that are known for their disastrous effects on neuronal tissues. The present paper presents a combination of epidemiological/clinical and molecular approaches for investigating the effect of certain groups of neurotoxicants on a variety of pathologies. The work of Finkelstein and coworkers describes epidemiological and clinical studies on acute and chronic organophosphate (OP)-induced neurotoxicity in certain populations in Israel. They mainly investigated the neurotoxic effects of low-level long-term exposure to OP in agricultural areas but also dealt with acute exposures as well. A molecular approach to OP mechanism of neuronal injury was described by Milatovic and coworkers. They demonstrated OP-induced oxidative injury in pyramidal neurons in the CA1 hippocampal area and its suppression by antioxidants. Lecht and coworkers described the novel snake venom angioneurins as important mediators of the physiological cross-talk between the cardiovascular and nervous systems. They also showed that under certain conditions these angioneurins may induce pathologies such as tumor development or disruption of the vascular barrier function during envenomation. Additional mechanistic/therapeutic approach was presented by Brodsky, Rosengarten, Proscura, Shapira and Wormser. They developed a novel anti-inflammatory peptide that reduced skin irritation induced by heat and sulfur mustard (SM) stimuli. Since SM causes neuropsychiatric symptoms and alterations in neurological functions this peptide may serve as a potential treatment of neuronal injuries caused by environmental neurotoxicants. These reviews highlight different aspects of neurotoxicity, addressing epidemiology and mechanisms of toxicity; and identifying novel potential therapies.

Scientific panel on electromagnetic field health risks: consensus points, recommendations, and rationales.

In November, 2009, a scientific panel met in Seletun, Norway, for three days of intensive discussion on existing scientific evidence and public health implications of the unprecedented global exposures to artificial electromagnetic fields (EMF). EMF exposures (static to 300 GHz) result from the use of electric power and from wireless telecommunications technologies for voice and data transmission, energy, security, military and radar use in weather and transportation. The Scientific Panel recognizes that the body of evidence on EMF requires a new approach to protection of public health; the growth and development of the fetus, and of children; and argues for strong preventative actions. New, biologically-based public exposure standards are urgently needed to protect public health worldwide.

Long-term effects of repealing the national maximum speed limit in the United States.

OBJECTIVES: We examined the long-term effects of the 1995 repeal of federal speed limit controls on road fatalities and injuries in fatal crashes. METHODS: We used a Poisson mixed-regression model to assess changes in the number of fatalities and injuries in fatal crashes between 1995 and 2005 on rural interstates, where all US states have raised speed limits since the repeal, as well as on urban interstates and noninterstate roads, where many states have raised speed limits. RESULTS: We found a 3.2% increase in road fatalities attributable to the raised speed limits on all road types in the United States. The highest increases were on rural interstates (9.1%) and urban interstates (4.0%). We estimated that 12 545 deaths (95% confidence interval [CI] = 8739, 16 352) and 36 583 injuries in fatal crashes (95% CI = 29 322, 43 844) were attributable to increases in speed limits across the United States. CONCLUSIONS: Reduced speed limits and improved enforcement with speed camera networks could immediately reduce speeds and save lives, in addition to reducing gas consumption, cutting emissions of air pollutants, saving valuable years of productivity, and reducing the cost of motor vehicle crashes.

Phthalate exposure among pregnant women in Jerusalem, Israel: results of a pilot study.

BACKGROUND: Phthalates can disrupt endocrine function and induce reproductive and developmental toxicity in laboratory animals. Few studies have evaluated exposure to phthalates in pregnant women, despite the potential sensitivity of the developing fetus to adverse effects of phthalates. METHODS: We measured urinary concentrations of 11 phthalate metabolites in 19 pregnant women, recruited in Jerusalem, Israel in 2006, and collected questionnaire data on demographic factors and consumer habits from these women. We compared geometric mean concentrations in subgroups and used the Mann-Whitney U-test for independent samples to determine significant differences between groups. RESULTS: Nine metabolites were detected in at least 95% of the samples: mono(2-ethyl-5-carboxypentyl) phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate, mono(2-ethyl-5-oxohexyl) phthalate, mono(3-carboxypropyl) phthalate, mono(n-butyl) phthalate, monobenzyl phthalate (MBzP), monoethyl phthalate (MEP), mono(2-ethylhexyl) phthalate and monoisobutyl phthalate. Phthalate metabolite concentrations in these pregnant women were remarkably similar to those in the general United States female population. MBzP geometric mean concentrations were higher in women living in buildings existing 40 years or more (P=0.04). In women who used four or more personal care products (perfume, deodorant, lipstick, nail polish, or hand/face cream) in the 48 h prior to providing the urine sample, geometric mean MEP concentrations were more than 4 times higher than concentrations in women using only two or three of the aforementioned products (P=0.07). CONCLUSIONS: Pregnant women in Jerusalem are exposed to a wide range of phthalates. Building materials used in old constructions may be a source of exposure to benzylbutyl phthalate, the parent compound of MBzP. Personal care products may be sources of exposure to diethyl phthalate, the parent compound of MEP.