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.

Free-field study on auditory localization and discrimination performance in older adults.

Localization accuracy and acuity for low- (0.375-0.75 kHz; LN) and high-frequency (2.25-4.5 kHz; HN) noise bands were examined in young (20-29 years) and older adults (65-83 years) in the acoustic free-field. A pointing task was applied to quantify accuracy, while acuity was inferred from minimum audible angle (MAA) thresholds measured with an adaptive 3-alternative forced-choice procedure. Accuracy decreased with laterality and age. From young to older adults, the accuracy declined by up to 23 % for the low-frequency noise band across all lateralities. The mean age effect was even more pronounced on MAA thresholds. Thus, age was a strong predictor for MAA thresholds for both LN and HN bands. There was no significant correlation between hearing status and localization performance. These results suggest that central auditory processing of space declines with age and is mainly driven by age-related changes in the processing of binaural cues (interaural time difference and interaural intensity difference) and not directly induced by peripheral hearing loss. We conclude that the representation of the location of sound sources becomes blurred with age as a consequence of declined temporal processing, the effect of which becomes particularly evident for MAA thresholds, where two closely adjoining sound sources have to be separated. While localization accuracy and MAA were not correlated in older adults, only a weak correlation was found in young adults. These results point to an employment of different processing strategies for localization accuracy and acuity.

A comparison of visual and auditory representational momentum in spatial tasks.

Similarities have been observed in the localization of the final position of moving visual and moving auditory stimuli: Perceived endpoints that are judged to be farther in the direction of motion in both modalities likely reflect extrapolation of the trajectory, mediated by predictive mechanisms at higher cognitive levels. However, actual comparisons of the magnitudes of displacement between visual tasks and auditory tasks using the same experimental setup are rare. As such, the purpose of the present free-field study was to investigate the influences of the spatial location of motion offset, stimulus velocity, and motion direction on the localization of the final positions of moving auditory stimuli (Experiment 1 and 2) and moving visual stimuli (Experiment 3). To assess whether auditory performance is affected by dynamically changing binaural cues that are used for the localization of moving auditory stimuli (interaural time differences for low-frequency sounds and interaural intensity differences for high-frequency sounds), two distinct noise bands were employed in Experiments 1 and 2. In all three experiments, less precise encoding of spatial coordinates in paralateral space resulted in larger forward displacements, but this effect was drowned out by the underestimation of target eccentricity in the extreme periphery. Furthermore, our results revealed clear differences between visual and auditory tasks. Displacements in the visual task were dependent on velocity and the spatial location of the final position, but an additional influence of motion direction was observed in the auditory tasks. Together, these findings indicate that the modality-specific processing of motion parameters affects the extrapolation of the trajectory.

Crossmodal interactions and multisensory integration in the perception of audio-visual motion -- a free-field study.

Motion perception can be altered by information received through multiple senses. So far, the interplay between the visual and the auditory modality in peripheral motion perception is scarcely described. The present free-field study investigated audio-visual motion perception for different azimuthal trajectories in space. To disentangle effects related to crossmodal interactions (the influence of one modality on signal processing in another modality) and multisensory integration (binding of bimodal streams), we manipulated the subjects' attention in two experiments on a single set of moving audio-visual stimuli. Acoustic and visual signals were either congruent or spatially and temporally disparate at motion offset. (i) Crossmodal interactions were studied in a selective attention task. Subjects were instructed to attend to either the acoustic or the visual stream and to indicate the perceived final position of motion. (ii) Multisensory integration was studied in a divided attention task in which subjects were asked to report whether they perceived unified or separated audio-visual motion offsets. The results indicate that crossmodal interactions in motion perception do not depend on the integration of the audio-visual stream. Furthermore, in the crossmodal task, both visual and auditory motion perception were susceptible to modulation by irrelevant streams, provided that temporal disparities did not exceed a critical range. Concurrent visual streams modulated auditory motion perception in the central field, whereas concurrent acoustic streams attracted visual motion information in the periphery. Differential abilities between the visual and auditory system when attempting to accurately track positional information along different trajectories account for the observed biasing effects.