Lung cancer risk and occupational pulmonary fibrosis: systematic review and meta-analysis.

BACKGROUND: Molecular pathways found to be important in pulmonary fibrosis are also involved in cancer pathogenesis, suggesting common pathways in the development of pulmonary fibrosis and lung cancer. RESEARCH QUESTION: Is pulmonary fibrosis from exposure to occupational carcinogens an independent risk factor for lung cancer? STUDY DESIGN AND METHODS: A comprehensive search of PubMed, Embase, Web of Science and Cochrane databases with over 100 search terms regarding occupational hazards causing pulmonary fibrosis was conducted. After screening and extraction, quality of evidence and eligibility criteria for meta-analysis were assessed. Meta-analysis was performed using a random-effects model. RESULTS: 52 studies were identified for systematic review. Meta-analysis of subgroups identified silicosis as a risk factor for lung cancer when investigating odds ratios for silicosis in autopsy studies (OR 1.47, 95% CI 1.13-1.90) and for lung cancer mortality in patients with silicosis (OR 3.21, 95% CI 2.67-3.87). Only considering studies with an adjustment for smoking as a confounder identified a significant increase in lung cancer risk (OR 1.58, 95% CI 1.34-1.87). However, due to a lack of studies including cumulative exposure, no adjustments could be included. In a qualitative review, no definitive conclusion could be reached for asbestosis and silicosis as independent risk factors for lung cancer, partly because the studies did not take cumulative exposure into account. INTERPRETATION: This systematic review confirms the current knowledge regarding asbestosis and silicosis, indicating a higher risk of lung cancer in exposed individuals compared to exposed workers without fibrosis. These individuals should be monitored for lung cancer, especially when asbestosis or silicosis is present.

Systematic review of the physiological and health-related effects of radiofrequency electromagnetic field exposure from wireless communication devices on children and adolescents in experimental and epidemiological human studies.

BACKGROUND: For more than 20 years, the potential health risks of radiofrequency electromagnetic field (RF EMF) exposure from mobile communication devices on children and adolescents have been examined because they are considered sensitive population groups; however, it remains unclear whether such exposure poses any particular risk to them. OBJECTIVES: The aim of this review was to systematically analyze and evaluate the physiological and health-related effects of RF EMF exposures from wireless communication devices (mobile phones, cordless phones, Bluetooth, etc.) on children and adolescents. METHODS: This review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological limitations in individual studies were assessed using the Office of Health Assessment and Translation (OHAT) Risk-of-Bias Rating Tool for Human and Animal Studies. RESULTS: A total of 42 epidemiological and 11 experimental studies were eligible for this review. Most of the studies displayed several methodological weaknesses that limited the internal validity of the results. Due to a lack of consistency regarding the outcomes as well as the lack of scientific rigor in most reviewed studies, the body of evidence for the effects of RF EMF of mobile communication devices on subjective symptoms, cognition, and behavior in children and adolescents was low to inadequate. Evidence from the studies investigating early childhood development, brain activity, cancer, and physiological parameters was considered inadequate for drawing conclusions about possible effects. DISCUSSION: Overall, the body of evidence allows no final conclusion on the question whether exposure to RF EMF from mobile communication devices poses a particular risk to children and adolescents. There has been rapid development in technologies generating RF EMF, which are extensively used by children and adolescents. Therefore, we strongly recommend high-quality systematic research on children and adolescents, since they are generally considered as sensitive age groups.

Human detection thresholds of DC, AC, and hybrid electric fields: a double-blind study.

BACKGROUND: In the course of the ongoing transition of electric energy systems, transmission corridors are often upgraded to higher voltages and other technologies leading to another quality of human exposure. The study aims to determine human detection thresholds for direct current (DC), alternating current (AC), and hybrid electric fields (various DC; constant AC). METHODS: A total of 203 participants were exposed to DC, AC, and hybrid electric fields (EFs) in a highly specialized whole-body exposure laboratory using a double-blind experimental setting. Additionally, the participants were exposed to ion currents in part of the DC and hybrid sessions. To investigate environmental influences, relative humidity was changed in two subgroups during EF perception. Methods derived from the signal detection theory and the adaptive staircase procedure based on the single interval adjustment matrix were used to assess individual sensitivity and detection thresholds, respectively. RESULTS: The results indicated that detection thresholds of hybrid EF were lower compared to single EF presentation of DC or AC. Ion current exposure enhanced EF perception. High relative humidity facilitated DC EF perception, whereas low relative humidity reinforced the perception of AC EFs. CONCLUSIONS: With this systematic investigation of human perception of DC, AC, and hybrid EFs, detection thresholds were provided, which can help improve the construction processes of energy transmission systems and the prevention of unwanted sensory perception by contributing to the determination of limit values.

Identification of Environmental and Experimental Factors Influencing Human Perception of DC and AC Electric Fields.

As part of the energy transition in Germany, high-voltage direct current (HVDC) lines producing DC electric fields (EF) are in planning. Since the human perception of DC EF was rarely investigated in the past, we aimed to identify environmental and experimental factors influencing the human perception of direct current (DC) EF, alternating current (AC) EF, and the co-exposure of DC EF and AC EF (hybrid EF) under whole-body exposure. Additionally, first estimates of DC EF and AC EF perception thresholds as well as differences in human perception of DC EF and AC EF concerning the type of sensation experienced and the affected body part were evaluated. A highly sophisticated exposure lab was built to expose participants to various EF strengths and ask for their assessment concerning the presence of an EF. To estimate the individual perception thresholds of 11 participants, the signal detection theory as well as the single-interval-adjustment matrix procedure were applied. Relative humidity could be identified as an environmental factor influencing the perception of AC EF and DC EF in different ways. An appropriate ramp slope and an exposure duration for future studies could be elaborated. Additionally, perception thresholds were lower under hybrid EF exposure than under DC EF or AC EF exposure alone. Cutaneous sensations evoked under DC EF and AC EF exposure were individually different and attributed to various parts of the body. Several environmental and experimental factors influencing the human perception of EF could be identified and provide an essential basis for a large-scale study. © 2021 Bioelectromagnetics Society.

Occupational Exposure to Extremely Low-Frequency Magnetic Fields and Risk of Amyotrophic Lateral Sclerosis: Results of a Feasibility Study for a Pooled Analysis of Original Data.

Previous meta-analyses have suggested an increased risk of amyotrophic lateral sclerosis (ALS) associated with occupational exposure to extremely low-frequency magnetic fields (ELF-MF). However, results should be interpreted with caution since studies were methodologically heterogeneous. Here, we assessed the feasibility of a pooling study to harmonize and re-analyze available original data. A systematic literature search was conducted. Published epidemiological studies were identified in PubMed and EMF-Portal from literature databases' inception dates until January 2019. The characteristics of all studies were described, including exposure metrics, exposure categories, and confounders. A survey among the principal investigators (PI) was carried out to assess their willingness to provide their original data. The statistical power of a pooling study was evaluated. We identified 15 articles published between 1997 and 2019. Studies differed in terms of outcome, study population, exposure assessment, and exposure metrics. Most studies assessed ELF-MF as average magnetic flux density per working day; however, exposure categories varied widely. The pattern of adjustment for confounders was heterogeneous between studies, with age, sex, and socioeconomic status being most frequent. Eight PI expressed their willingness to provide original data. A relative risk of ≥1.14 for ALS and occupational exposure to ELF-MF can be detected with a power of more than 80% in a pooled study. The pooling of original data is recommended and could contribute to a better understanding of ELF-MF in the etiology of ALS based on a large database and reduced heterogeneity due to a standardized analysis protocol with harmonized exposure metrics and exposure categories. Bioelectromagnetics. © 2021 Bioelectromagnetics Society.

Biological and health-related effects of weak static magnetic fields (≤ 1 mT) in humans and vertebrates: A systematic review.

BACKGROUND: There is a rapid development in technologies that generate weak static magnetic fields (SMF) including high-voltage direct current (HVDC) lines, systems operating with batteries, such as electric cars, and devices using permanent magnets. However, few reviews on the effects of such fields on biological systems have been prepared and none of these evaluations have had a particular focus on weak SMF (≤ 1 mT). The aim of this review was to systematically analyze and evaluate possible effects of weak SMF (≤ 1 mT) on biological functioning and to provide an update on the current state of research. METHODS: This review was prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Methodological limitations in individual studies were assessed using the Office of Health Assessment and Translation (OHAT) Risk-of-Bias Rating Tool. RESULTS: Eleven studies fulfilled the eligibility criteria and were included in this review. All included studies were experimental animal studies as no human studies were among the eligible articles. Eight of the eleven studies reported responses of rat, rabbits and quails to weak SMF exposure that were expressed as altered melatonin biosynthesis, reduced locomotor activity, altered vasomotion and blood pressure, transient changes in blood pressure-related biochemical parameters, or in the level of neurotransmitters and increases in enzyme activities. It remained largely unclear from the interpretation of the results whether the reported effects in the evaluated studies were beneficial or detrimental for health. CONCLUSION: The available evidence from the literature reviewed is not sufficient to draw a conclusion for biological and health-related effects of exposure to weak SMF. There was a lack of homogeneity regarding the exposed biological systems and the examined endpoints as well as a lack of scientific rigor in most reviewed studies which lowered credibility in the reported results. We therefore encourage further and more systematic research in this area. Any new studies should particularly address effects of exposure to SMF on biological functioning in humans to evaluate whether SMF pose a risk to human health.

Direct current electrical injuries: A systematic review of case reports and case series.

BACKGROUND: Direct current (DC) powered equipment and devices, including photovoltaic systems, high-voltage direct current power lines and novel concepts in electromobility have become increasingly popular in recent years. However, under adverse circumstances by malfunction or mishandling of these applications electrical injuries may occur when electric current passes through the human body. This review aimed at systematically summarizing the medical consequences of DC electrical injuries described in case reports and case series. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided the methodological conduct and reporting. RESULTS: Sixteen case reports and 3 case series were eligible for this review and included 70 patients. The reviewed articles were very heterogeneous regarding sources of DC electrical injuries and the reported medical consequences, including burns and skin lesions (n=67), neurological consequences (n=11), unconsciousness (n=10), cardiac consequences (n=8) and bone fractures (n=6). Seventeen individuals did not survive the electrical injuries. CONCLUSION: From the few available data and partly incomplete documentations of cases we could gather hints of DC medical consequences, however, it was not possible to identify well-defined medical consequences for various circumstances of DC electrical injuries in occupational and non-occupational settings. To achieve this goal, additional studies are required, each providing a comprehensive description of the medical consequences and the circumstances of the electrical injuries.

Methodological limitations in experimental studies on symptom development in individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) - a systematic review.

BACKGROUND: Hypersensitivity to electromagnetic fields (EMF) is a controversial condition. While individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) claim to experience health complaints upon EMF exposure, many experimental studies have found no convincing evidence for a physical relation. The aim of this systematic review was to evaluate methodological limitations in experimental studies on symptom development in IEI-EMF individuals that might have fostered false positive or false negative results. Furthermore, we compared the profiles of these limitations between studies with positive and negative results. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the methodological conduct and reporting. Eligible were blinded experimental studies that exposed individuals with IEI-EMF to different EMF exposure levels and queried the development of symptoms during or after each exposure trial. Strengths and limitations in design, conduct and analysis of individual studies were assessed using a customized rating tool. RESULTS: Twenty-eight studies met the eligibility criteria and were included in this review. In many studies, both with positive and negative results, we identified methodological limitations that might have either fostered false or masked real effects of exposure. The most common limitations were related to the selection of study participants, the counterbalancing of the exposure sequence and the effectiveness of blinding. Many studies further lacked statistical power estimates. Methodically sound studies indicated that an effect of exposure is unlikely. CONCLUSION: Overall, the evidence points towards no effect of exposure. If physical effects exist, previous findings suggest that they must be very weak or affect only few individuals with IEI-EMF. Given the evidence that the nocebo effect or medical/mental disorders may explain the symptoms in many individuals with IEI-EMF, additional research is required to identify the various factors that may be important for developing IEI-EMF and for provoking the symptoms. We recommend the identification of subgroups and exploring IEI-EMF in the context of other idiopathic environmental intolerances. If further experimental studies are conducted, they should preferably be performed at the individual level. In particular, to increase the likelihood of detecting hypersensitive individuals, if they exist, we encourage researchers to achieve a high credibility of the results by minimizing sources of risk of bias and imprecision.

Systematic review on the biological effects of electric, magnetic and electromagnetic fields in the intermediate frequency range (300 Hz to 1 MHz).

BACKGROUND: Many novel technologies, including induction cookers or wireless power transfer, produce electric fields (EF), magnetic fields (MF) or electromagnetic fields (EMF) in the intermediate frequency (IF) range. The effects of such fields on biological systems, however, have been poorly investigated. The aim of this systematic review was to provide an update of the state of research and to evaluate the potential for adverse effects of EF, MF and EMF in the IF range (300 Hz to 1 MHz) on biological systems. METHODS: The review was prepared in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methodical limitations in individual studies were assessed using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool for Human and Animal Studies. RESULTS: Fifty-six studies exposing humans, animals or in vitro systems were eligible for this review. In these studies, many different endpoints were examined and most of the findings were obtained in studies with exposure to MF. For most endpoints, however, the reviewed studies yielded inconsistent results, with some studies indicating no effect and some linking IF exposure with adverse effects. In the majority of the included studies, the applied field strengths were above the International Commission on Non-Ionizing Radiation Protection (ICNIRP) reference levels for the general public and the applied frequencies were mainly below 100 kHz. Furthermore, many of the reviewed studies suffered from methodical limitations which lowered the credibility of the reported results. CONCLUSION: Due to the large heterogeneity in study designs, endpoints and exposed systems, as well as the inconsistent results and methodical limitations in many studies, the quality of evidence for adverse effects remains inadequate for drawing a conclusion on investigated biological effects of IF fields for most endpoints. We recommend that in future studies, effects of EF, MF and EMF in the IF range should be investigated more systematically, i.e., studies should consider various frequencies to identify potential frequency-dependent effects and apply different field strengths, especially if threshold-dependent effects are expected. Priority should be given to the investigation of acute effects, like induction of phosphenes, perception, excitation of nerves or muscles and thermal effects. This would be an important step towards the validation of the reference levels recommended by ICNIRP. Furthermore, we recommend that any new studies aim at implementing high quality dosimetry and minimizing sources of risk of bias.

Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review.

Electromagnetic fields (EMF) in the intermediate frequency (IF) range are generated by many novel electrical appliances, including electric vehicles, radiofrequency identification systems, induction hobs, or energy supply systems, such as wireless charging systems. The aim of this systematic review is to evaluate whether cardiovascular implantable electronic devices (CIEDs) are susceptible to electromagnetic interference (EMI) in the IF range (1 kHz-1 MHz). Additionally, we discuss the advantages and disadvantages of the different types of studies used to investigate EMI. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we collected and evaluated studies examining EMI in in vivo studies, in vitro studies (phantom studies, benchmark tests), and simulation studies. Our analysis revealed that cardiac implants are susceptible to malfunction induced by EMF in the IF range. Electromagnetic interference may in particular be provoked by security systems and induction hobs. The results of the studies evaluated in this systematic review further indicate that the likelihood for EMI is dependent on exposure-related parameters (field strength, frequency, and modulation) and on implant- as well as on lead-related parameters (model, type of implant, implant sensitivity setting, lead configuration, and implantation site). The review shows that the factors influencing EMI are not sufficiently characterized and EMF limit values for CIED patients cannot be derived yet. Future studies should therefore, consider exposure-related parameters as well as implant- and lead-related parameters systematically. Additionally, worst-case scenarios should be considered in all study types where possible.

Systematic review of biological effects of exposure to static electric fields. Part II: Invertebrates and plants.

BACKGROUND: The construction of high-voltage direct current (HVDC) lines for the long-distance transport of energy is becoming increasingly popular. This has raised public concern about potential environmental impacts of the static electric fields (EF) produced under and near HVDC power lines. As the second part of a comprehensive literature analysis, the aim of this systematic review was to assess the effects of static EF exposure on biological functions in invertebrates and plants and to provide the basis for an environmental impact assessment of such exposures. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide the methodological conduct and reporting. RESULTS: Thirty-three studies - 14 invertebrate and 19 plant studies - met the eligibility criteria and were included in this review. The reported behavioral responses of insects and planarians upon exposure strongly suggest that invertebrates are able to perceive the presence of a static EF. Many other studies reported effects on physiological functions that were expressed as, for example, altered metabolic activity or delayed reproductive and developmental stages in invertebrates. In plants, leaf damage, alterations in germination rates, growth and yield, or variations in the concentration of essential elements, for example, have been reported. However, these physiological responses and changes in plant morphology appear to be secondary to surface stimulation by the static EF or caused by concomitant parameters of the electrostatic environment. Furthermore, all of the included studies suffered from methodological flaws, which lowered credibility in the results. CONCLUSION: At field levels encountered from natural sources or HVDC lines (< 35kV/m), the available data provide reliable evidence that static EF can trigger behavioral responses in invertebrates, but they do not provide evidence for adverse effects of static EF on other biological functions in invertebrates and plants. At far higher field levels (> 35kV/m), adverse effects on physiology and morphology, presumably caused by corona-action, appear to be more likely. Higher quality studies are needed to unravel the role of air ions, ozone, nitric oxide and corona current on alterations in physiological functions and morphology.

Biological effects of exposure to static electric fields in humans and vertebrates: a systematic review.

BACKGROUND: High-voltage direct current (HVDC) lines are the technology of choice for the transport of large amounts of energy over long distances. The operation of these lines produces static electric fields (EF), but the data reviewed in previous assessments were not sufficient to assess the need for any environmental limit. The aim of this systematic review was to update the current state of research and to evaluate biological effects of static EF. METHODS: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations, we collected and evaluated experimental and epidemiological studies examining biological effects of exposure to static EF in humans (n = 8) and vertebrates (n = 40). RESULTS: There is good evidence that humans and animals are able to perceive the presence of static EF at sufficiently high levels. Hair movements caused by electrostatic forces may play a major role in this perception. A large number of studies reported responses of animals (e.g., altered metabolic, immunologic or developmental parameters) to a broad range of static EF strengths as well, but these responses are likely secondary physiological responses to sensory stimulation. Furthermore, the quality of many of the studies reporting physiological responses is poor, which raises concerns about confounding. CONCLUSION: The weight of the evidence from the literature reviewed did not indicate that static EF have adverse biological effects in humans or animals. The evidence strongly supported the role of superficial sensory stimulation of hair and skin as the basis for perception of the field, as well as reported indirect behavioral and physiological responses. Physical considerations also preclude any direct effect of static EF on internal physiology, and reports that some physiological processes are affected in minor ways may be explained by other factors. While this literature does not support a level of concern about biological effects of exposure to static EF, the conditions that affect thresholds for human detection and possible annoyance at suprathreshold levels should be investigated.

Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment?

Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure. The current review aims to provide a contemporary overview of cardiovascular implantable electronic devices, their function and susceptibility of non-medical EMFs and provide recommendations for physicians caring for cardiac device patients presenting with EMI.