Public health indicators for the EU: the joint action for ECHIM (European Community Health Indicators & Monitoring).

BACKGROUND: Public health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998-2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system. It has generated EU added value by defining the ECHI shortlist with 88 common and comparable key health indicators for Europe. METHODS: In the 2009-2012 Joint Action for ECHIM project the ECHI shortlist was updated through consultation with Member State representatives. Guidelines for implementation of the ECHI Indicators at national level were developed and a pilot data collection was carried out. RESULTS: 67 of the ECHI Indicators are already part of regular international data collections and thus available for a majority of Member States, 14 are close to ready and 13 still need development work. By mid-2012 half of the countries have incorporated ECHI indicators in their national health information systems and the process is ongoing in the majority of the countries. Twenty-five countries were able to provide data in a Pilot Data Collection for 20 ECHI Indicators that were not yet (fully) available in the international databases. CONCLUSIONS: The EU needs a permanent health monitoring and reporting system. The Joint Action for ECHIM has set an example for the implementation of a system that can develop and maintain the ECHI indicators,, and promote and encourage the use of ECHI in health reporting and health policy making. The aim for sustainable public health monitoring is also supported by a Eurostat regulation on public health statistics requiring that health statistics shall be provided according to the ECHI methodology. Further efforts at DG SANCO and Eurostat are needed towards a permanent health monitoring system.

Health indicators in Europe: availability and data needs.

BACKGROUND: The European Union (EU) lacks adequate capacity for public health monitoring. The creation of a stable European Health Information System would help Member States to carry out evidence-based health policy. Such a system would also benefit EU health priorities by providing European wide comparable information. This study is the first comprehensive assessment of the availability of general health data in Europe. METHODS: The main aim was to assess the availability of the European Community Health Indicators (ECHI) in each EU Member State. This was done by means of a review of international health databases, an online survey and face-to-face discussions with experts in 31 European countries. RESULTS: The European average availability score for all ECHI indicators was 74% ranging from 56% to 84%. In most countries, about half of the ECHI indicators can be derived from routinely collected health information. This is true for demographic information, mortality and hospital discharge-based morbidity. However, many important ECHI indicators are lacking in most European countries. These include population representative data for health determinants, the provision and use of health care services, injuries, the quality of health care and health promotion. CONCLUSION: Valid health information is essential for improving people's health across Europe. There is an urgent need to develop harmonized methods for gathering and disseminating representative health data. These methods should be developed jointly by DG Health and Consumers, Eurostat and EU Member States.

Space efficient system for whole-body exposure of unrestrained rats to 900 MHz electromagnetic fields.

The aim of this study was to design, implement and analyze a space-efficient setup for the whole-body exposure of unrestrained Wistar rats to radiofrequency (RF) electromagnetic fields at 900 MHz. The setup was used for 2 years in a cocarcinogenesis study and part of it for 5 weeks in a central nervous system (CNS) study. Up to 216 rats could be placed in separate cages in nine different exposure chambers on three racks requiring only 9 m2 of floor area (24 rats per m2). Chambers were radial transmission lines (RTL), where the rats could freely move in their cages where food and drinking water was provided ad libitum except during RF exposure periods. Dosimetrical analysis was based on FDTD computations with heterogeneous rat models and was validated with calorimetrical measurements carried out with homogeneous phantoms. The estimated whole-body average specific absorption rates (SAR) of rats were 0 (sham), 0.4, and 1.3 W/kg in the cocarcinogenesis study and 0 (sham), 0.27, and 2.7 W/kg in the CNS study with an estimated uncertainty of 3 dB (K = 2). The instantaneous and lifetime variations of whole-body average SAR due to the movement of rats were estimated to be 2.3 and 1.3 dB (K = 1), respectively.

Measured and computed induced body currents in front of an experimental RF dielectric heater.

Operators of industrial high-frequency dielectric heaters are exposed to electromagnetic fields that are high enough to significantly increase body temperature. The assessment of exposure based on the measurement of external field strengths is, however, inaccurate due to the non-uniformity of the fields. This paper presents an exposure assessment method based on the measurement of the current induced by the external electric field in the body of the operator. Body current distributions were measured at 27.12 MHz using various current meters under a condition simulating the exposure to stray fields emitted by a dielectric heater. The specific absorption rates and induced body currents were computed with the finite-difference time-domain method using heterogeneous and homogeneous human models. The numerical analysis indicated that the basic restrictions for occupational exposure are not exceeded when the current induced in the limbs is lower than the action level (100 mA), even though the maximum electric field significantly exceeds the action value (61 V m(-1)). For the heterogeneous human model the exposure limit for local specific absorption rate was exceeded when the current induced in the ankle was 166 mA at a distance of 0.3 m from the electrode of the device. The vertical component of current density proved to be much more significant than the horizontal components. The importance of the horizontal components was highest near the electrode. The computations showed no concentration of the induced current to the superficial tissues due to the skin effect.

Numerical assessment of induced ELF currents in the human head due to the battery current of a digital mobile phone.

In this study, the extremely low frequency (ELF) fields induced in the human head by the battery currents of a mobile phone are considered. The magnetic field induced by the phone was measured, and this data was used to calculate the resulting currents induced in the human head and brain. Both the finite element method (FEM) and finite integration technique (FIT) were used for numerical computations. The computed current density values were then compared with the guidelines given by the International Commission on Non-Ionising Radiation Protection (ICNIRP). The comparison showed that the computed exposure is well within the limits of those guidelines.

Apoptosis induced by ultraviolet radiation is enhanced by amplitude modulated radiofrequency radiation in mutant yeast cells.

The aim of this study was to investigate whether radiofrequency (RF) electromagnetic field (EMF) exposure affects cell death processes of yeast cells. Saccharomyces cerevisiae yeast cells of the strains KFy417 (wild-type) and KFy437 (cdc48-mutant) were exposed to 900 or 872 MHz RF fields, with or without exposure to ultraviolet (UV) radiation, and incubated simultaneously with elevated temperature (+37 degrees C) to induce apoptosis in the cdc48-mutated strain. The RF exposure was carried out in a special waveguide exposure chamber where the temperature of the cell cultures can be precisely controlled. Apoptosis was analyzed using the annexin V-FITC method utilizing flow cytometry. Amplitude modulated (217 pulses per second) RF exposure significantly enhanced UV induced apoptosis in cdc48-mutated cells, but no effect was observed in cells exposed to unmodulated fields at identical time-average specfic absorption rates (SAR, 0.4 or 3.0 W/kg). The findings suggest that amplitude modulated RF fields, together with known damaging agents, can affect the cell death process in mutated yeast cells. Bioelectromagnetics 25:127-133, 2004.

Assessment of the magnetic field exposure due to the battery current of digital mobile phones.

Hand-held digital mobile phones generate pulsed magnetic fields associated with the battery current. The peak value and the waveform of the battery current were measured for seven different models of digital mobile phones, and the results were applied to compute approximately the magnetic flux density and induced currents in the phone-user's head. A simple circular loop model was used for the magnetic field source and a homogeneous sphere consisting of average brain tissue equivalent material simulated the head. The broadband magnetic flux density and the maximal induced current density were compared with the guidelines of ICNIRP using two various approaches. In the first approach the relative exposure was determined separately at each frequency and the exposure ratios were summed to obtain the total exposure (multiple-frequency rule). In the second approach the waveform was weighted in the time domain with a simple low-pass RC filter and the peak value was divided by a peak limit, both derived from the guidelines (weighted peak approach). With the maximum transmitting power (2 W) the measured peak current varied from 1 to 2.7 A. The ICNIRP exposure ratio based on the current density varied from 0.04 to 0.14 for the weighted peak approach and from 0.08 to 0.27 for the multiple-frequency rule. The latter values are considerably greater than the corresponding exposure ratios 0.005 (min) to 0.013 (max) obtained by applying the evaluation based on frequency components presented by the new IEEE standard. Hence, the exposure does not seem to exceed the guidelines. The computed peak magnetic flux density exceeded substantially the derived peak reference level of ICNIRP, but it should be noted that in a near-field exposure the external field strengths are not valid indicators of exposure. Currently, no biological data exist to give a reason for concern about the health effects of magnetic field pulses from mobile phones.