Malignant lymphoma and occupational exposure to extremely low frequency magnetic fields and electrical shocks: a nested case-control study in a cohort of four Nordic countries.

BACKGROUND: Exposure to extremely low frequency magnetic fields (ELF-MFs) and electric shocks is a common occupational risk factor in many workplaces. Recent investigations have highlighted a possible association between such exposures and lymphoma risk. This study was carried out to further explore the association between occupational exposure to ELF-MFs and electric shocks and risk of lymphoma in a large Nordic census-based cohort. METHODS: We included cases of non-Hodgkin's lymphoma (NHL, n=68 978), chronic lymphocytic leukaemia (CLL, n=20 615) and multiple myeloma (MM, n=35 467) diagnosed between 1961 and 2005 in Finland, Iceland, Norway and Sweden. Cases were matched to five controls by year of birth, sex and country. Lifetime occupational ELF-MF and electric shock exposures were assigned to jobs reported in population censuses using job-exposure matrices. The risk of cancer was assessed based on cumulative exposure to ELF-MF and electric shocks. ORs with 95% CIs were estimated using logistic models adjusted for occupational co-exposures relevant to lymphomas. RESULTS: Less than 7% of the cases experienced high levels of ELF-MF. We observed no increased risks among workers exposed to high levels of ELF-MF for NHL (OR: 0.93; CI 0.90 to 0.97), CLL (OR: 0.98; CI 0.92 to 1.05) or MM (OR: 0.96; CI 0.90 to 1.01). CONCLUSION: Our results do not provide support for an association between occupational exposure to ELF-MFs and electric shocks and lymphoma risk.

Cancer incidence and mortality among firefighters.

Firefighters are exposed to both known and suspected carcinogens. This study aims to systematically review the literature on the association of firefighting occupation and cancer incidence and mortality, overall and for specific cancer sites. A systematic review using PubMed, Embase, and Web of Science was performed up to January 1, 2018. We extracted risk estimates of cancers and calculated summary incidence risk estimates (SIRE), summary mortality risk estimates (SMRE), and their 95% confidence intervals (CI). Publication bias and risk of bias in individual studies were assessed using Begg's and Egger's tests and the Newcastle-Ottawa scale (NOS), respectively. We included 50 papers in the review and 48 in the meta-analysis. We found significantly elevated SIREs for cancer of the colon (1.14; CI 1.06 to 1.21), rectum (1.09; CI 1.00 to 1.20), prostate (1.15; CI 1.05 to 1.27), testis (1.34; CI 1.08 to 1.68), bladder (1.12; CI 1.04 to 1.21), thyroid (1.22; CI 1.01 to 1.48), pleura (1.60; CI 1.09 to 2.34), and for malignant melanoma (1.21; CI 1.02 to 1.45). We found significant SMREs of 1.36 (1.18 to 1.57) and 1.42 (1.05 to 1.90) for rectal cancer and Non-Hodgkin's lymphoma, respectively. Considering the significantly elevated risk of some cancers in this occupational group, we suggest improving preventive measures and securing adequate and relevant medical attention for this group. Further studies with more accurate and in-depth exposure assessments are indicated.

Public exposure to radiofrequency electromagnetic fields in everyday microenvironments: An updated systematic review for Europe.

Communication technologies are rapidly changing and this may affect public exposure to radiofrequency electromagnetic fields (RF-EMF). This systematic review of literature aims to update a previous review on public everyday RF-EMF exposure in Europe, which covered publications until 2015. From 144 eligible records identified by means of a systematic search in PubMed, Embase and Web of Knowledge databases, published between May 2015 and 1 July 2018, 26 records met the inclusion criteria. We extracted quantitative data on public exposure in different indoors, outdoors and transport environments. The data was descriptively analyzed with respect to the exposure patterns between different types of environments. Mean RF-EMF exposure in homes, schools and offices were between 0.04 and 0.76 V/m. Mean outdoor exposure values ranged from 0.07 to 1.27 V/m with downlink signals from mobile phone base stations being the most relevant contributor. RF-EMF levels tended to increase with increasing urbanity. Levels in public transport (bus, train and tram) and cars were between 0.14 and 0.69 V/m. The highest levels, up to 1.97 V/m, were measured in public transport stations with downlink as the most relevant contributor. In line with previous studies, RF-EMF exposure levels were highest in the transportation systems followed by outdoor and private indoor environments. This review does not indicate a noticeable increase in everyday RF-EMF exposure since 2012 despite increasing use of wireless communication devices.

The relationship between work-related psychosocial factors and burnout among Iranian nurses: Job Demand-Control-Support model.

BACKGROUND: Nursing work environment consists of a number of work-related psychosocial risk factors such as excessive workloads, lack of social support, emotional demands, job insecurity and confronting with challenging situations all of which may induce burnout. The aim of the current study was to investigate the relationship between work-related psychosocial factors and burnout among Iranian nurses. METHODS: A cross-sectional study was carried out among 522 nurses. The data related to work-related psychosocial factors and burnout was gathered using Job Content Questionnaire (JCQ) and Maslach Burnout Inventory (MBI), respectively. Pearson's correlation coefficients were used to examine the relationship between work-related psychosocial factors and burnout. RESULTS: Mean scores of the dimensions of burnout for emotional exhaustion, depersonalization, and reduced personal accomplishment were 13.6 (SD=8.6), 18.42 (SD=7.1), and 28.45 (SD= 9.15), respectively. Psychological and physical job demands were positively correlated with different dimensions of burnout while social support and job control showed negative correlation with them. CONCLUSION: Appropriate interventions on reducing job demands both psychologically and physically and increasing social support and job control are suggested in prevention of burnout among the studied nurses.

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies.

BACKGROUND: Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). OBJECTIVES: The objective is to systematically review the effects of longer-term or repeated local and whole human body radiofrequency electromagnetic field (RF-EMF) exposure on the occurrence of symptoms. Primary hypotheses were tinnitus, migraine and headaches in relation to RF-EMF exposure of the brain, sleep disturbances and composite symptom scores in relation to whole-body RF-EMF exposure. METHODS: Eligibility criteria: We included case-control and prospective cohort studies in the general population or workers estimating local or whole-body RF-EMF exposure for at least one week. INFORMATION SOURCES: We conducted a systematic literature search in various databases including Web of Science and Medline. Risk of bias: We used the Risk of Bias (RoB) tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS: We synthesized studies using random effects meta-analysis. RESULTS: Included studies: We included 13 papers from eight distinct cohort and one case-control studies with a total of 486,558 participants conducted exclusively in Europe. Tinnitus is addressed in three papers, migraine in one, headaches in six, sleep disturbances in five, and composite symptom scores in five papers. Only one study addressed occupational exposure. SYNTHESIS OF RESULTS: For all five priority hypotheses, available research suggests that RF-EMF exposure below guideline values does not cause symptoms, but the evidence is very uncertain. The very low certainty evidence is due the low number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. In terms of non-priority hypotheses numerous exposure-outcome combinations were addressed in the 13 eligible papers without indication for an association related to a specific symptom or exposure source. DISCUSSION: Limitations of evidence: This review topic includes various challenges related to confounding control and exposure assessment. Many of these aspects are inherently present and not easy to be solved in future research. Since near-field exposure from wireless communication devices is related to lifestyle, a particular challenge is to differentiate between potential biophysical effects and other potential effects from extensive use of wireless communication devices that may compete with healthy behaviour such as sleeping or physical activity. Future research needs novel and innovative methods to differentiate between these two hypothetical mechanisms. INTERPRETATION: This is currently the best available evidence to underpin safety of RF-EMF. There is no indication that RF-EMF below guideline values causes symptoms. However, inherent limitations of the research results in substantial uncertainty. OTHER: Funding: This review was partially funded by the WHO radioprotection programme. REGISTRATION: The protocol for this review has been registered in Prospero (reg no CRD42021239432) and published in Environment International (Röösli et al., 2021).

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies.

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES: To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS: Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES: Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS: we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS: Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS: considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION: Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION: available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.

Biological exposure indices of occupational exposure to benzene: A systematic review.

The current study aimed to systematically review the studies concerning the biological monitoring of benzene exposure in occupational settings. A systematic literature review was conducted in Scopus, EMBASE, Web of Science, and Medline from 1985 through July 2021. We included peer-reviewed original articles that investigated the association between occupational exposure to benzene and biological monitoring. We identified 4786 unique citations, of which 64 cross-sectional, one case-control, and one cohort study met our inclusion criteria. The most studied biomarkers were urinary trans-trans muconic acid, S- phenyl mercapturic acid, and urinary benzene, respectively. We found the airborne concentration of benzene as a key indicator for choosing a suitable biomarker. We suggest considering urinary benzene at low (0.5-5.0 TLV), urinary SPMA and TTMA at medium (5.0-25 and 25-50 TLV, respectively), and urinary phenol and hydroquinone and catechol at very high concentrations (500 and 1000 TLV ≤, respectively). Genetic polymorphism of glutathione S-transferase and oral intake of sorbic acid have confounding effects on the level of U-SPMA and U-TTMA, respectively. The airborne concentration, smoking habit, oral consumption of sorbic acid, and genetic polymorphism of workers should be considered in order to choose the appropriate indicator for biological monitoring of benzene exposure.

Increasing frame rate of echocardiography based on a novel 2D spatio-temporal meshless interpolation.

BACKGROUND: Increasing temporal resolution through numerical methods aids clinicians to evaluate fast moving structures of the heart with more confidence. METHODOLOGY: In this study, a spatio-temporal numerical method is proposed to increase the frame rate based on two-dimensional (2D) interpolation. More specifically, we propose a novel intensity variation time surface (IVTS) strategy to incorporate both temporal and spatial information in the reconstruction. In this regard, we exploit radial basis functions (RBFs) for 2D interpolation. The reason for choosing RBFs for this task is manifold. First, RBFs are able to interpolate on large-scale datasets. Moreover, their mathematical implementation is simple. Another important property of this interpolation technique, which is addressed in this study, is its meshless nature. The meshless property enables higher up-sampling (UpS) rates for echocardiography to improve temporal resolution without noticeably degrading image quality. To evaluate the proposed approach, we tested the RBF interpolation on 2D/3D echocardiography datasets. The reconstructed frames were analyzed using different image quality metrics, and the results were compared with two popular techniques from the literature. RESULTS: The findings demonstrated that, with a down-sampling rate of 3, the proposed technique outperformed the best existing method by 42%, 87%, 8%, and 11%, respectively, in terms of mean square error (MSE), contrast to noise ratio (CNR), peak signal-to-noise ratio (PSNR), and figure of merit (FOM). It should be noted that the proposed method is comparable to the best available method in terms of structural similarity (SSIM) index. Furthermore, when compared to the original images, the results of employing our technique on radio-frequency (RF) level analysis demonstrated that the reconstruction accuracy is satisfactory in terms of image quality criterion. CONCLUSION: Finally, it is worthwhile noting that the proposed method is better than (or comparable to) the other methods in terms of reconstruction performance and processing time. Therefore, the RBF interpolation can be a promising alternative to the existing methods.

Correlation of Work Fatigue and Mental Workload in Train Drivers: A Cross-sectional Study.

BACKGROUND: Evidence suggests that train drivers experience a high level of fatigue and mental workload. The present study aimed to assess overall, physical, and mental fatigue levels and their correlations with the mental workload in the metro train operation. Study Design: A cross-sectional study. METHODS: This study was conducted on all 1194 train drivers in the Tehran Metro. The train drivers completed the Samn-Perelli Fatigue Scale and the Fatigue Assessment Scales at the beginning and end of the shift. In addition, they completed the National Aeronautics and Space Administration Task Load Index in the middle and at the end of the shift. Correlation and regression analyses were performed on the data to test the study hypothesis. RESULTS: Overall, physical, and mental fatigue levels increased significantly at the end of the shift compared to the onset of the shift (P<0.001). The mental workload and related dimensions were significantly increased at the end of the shift compared to the middle of the shift (P<0.001). Mental demand was the most important workload problem among the train drivers. The highest correlation was found between overall workload and time pressure (R=0.68, P<0.001). CONCLUSION: The mental workload had a significant correlation with work fatigue in the train drivers. Control measures should be focused on the mental workload and related dimensions, especially mental demand and time pressure.

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies.

BACKGROUND: The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE: Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA: We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS: Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.

Effects of whole body vibration and backrest angle on perceived mental workload and performance.

Mental Workload (MWL) and human performance are widely contributing concepts in human factors. The objective of the current study is to investigate the perceived MWL and human performance during whole-body vibration (WBV) exposure while seated at different backrest angles. Nineteen healthy male participants completed both the NASA-TLX and rating scale mental effort (RSME) after performing two difficulty levels of computerized dual tasks. The participants' performance was measured in these conditions while seated with a backrest angle of 100 and 120 degrees and exposed to WBV (intensity: 0.5 m/s2; frequency 3-20 Hz) for 5 minutes. No significant effect on performance or perceived MWL (p<0.05) was found when changes were made to the backrest angles. Exposure to WBV under two backrest angles increased mental demand (p=0.04), effort (p=0.03) and frustration (p=0.03) and negatively affected human performance (p<0.05). The present study showed that exposure to WBV could be an important variable for designing work environments that require a high level of performance and mental demand while seated. However, the findings exhibited no association between inclining backrest angle and human performance or perceived MWL.

Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis.

Exposure to extremely low frequency magnetic fields (ELF-MF) and electric shocks occurs in many workplaces and occupations but it is unclear whether any of these exposures cause Amyotrophic lateral sclerosis (ALS). The aim of this systematic review and meta-analysis is to explore whether occupational exposure to ELF-MF and/or electric shocks are risk factor for ALS. We searched PubMed, Embase, and Web of Science databases up to the end of 2019. Pooled risk estimates were calculated using random-effects meta-analysis including exploration of the sources of heterogeneity between studies and publication bias. Twenty-seven publications fulfilled the inclusion criteria. We found a weak, significant, association between occupational exposure to ELF-MF and the risk of ALS (RRPooled estimate: 1.20; 95%CI: 1.05, 1.38) with moderate to high heterogeneity (I2=66.3%) and indication of publication bias (PEgger's test=0.03). No association was observed between occupational exposure to electric shocks and risk of ALS (RRPooled estimate: 0.97; 95%CI: 0.80, 1.17) with high heterogeneity (I2=80.5%), and little indication for publication bias (PEgger's test=0.24). The findings indicate that occupational exposure to ELF-MF, but not electric shocks, might be a risk factor for ALS. However, given the moderate to high heterogeneity and potential publication bias, the results should be interpreted with caution.

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies.

BACKGROUND: Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES: To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS: We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA: Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES: We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD: Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS: The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL: To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING: This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION: PROSPERO CRD42021239432.

Autonomic Nervous System Responses to Whole-Body Vibration and Mental Workload: A Pilot Study.

BACKGROUND: Whole-body vibration (WBV) and mental workload (MWL) are common stressors among drivers who attempt to control numerous variables while driving a car, bus, or train. OBJECTIVE: To examine the individual and combined effects of the WBV and MWL on the autonomic nervous system. METHODS: ECG of 24 healthy male students was recorded using NeXus-4 while performing two difficulty levels of a computerized dual task and when they were exposing to WBV (intensity 0.5 m/s2; frequency 3-20 Hz). Each condition was examined for 5 min individually and combined. Inter-beat intervals were extracted from ECG records. The time-domain and frequency-domain heart rate variability parameters were then extracted from the inter-beat intervals data. RESULTS: A significant (p=0.008) increase was observed in the mean RR interval while the participants were exposed to WBV; there was a significant (p=0.02) reduction in the mean RR interval while the participants were performing the MWL. WBV (p=0.02) and MWL significantly (p<0.001) increased the standard deviation of normal-to-normal intervals with a moderate-to-large effect size. All active periods increased the low-frequency component and low-frequency/high-frequency ratio. However, only the WBV significantly increased the highfrequency component. A significant (p=0.01) interaction was observed between the WBV and MWL on low-frequency component and low-frequency/high-frequency ratio. CONCLUSION: Exposure to WBV and MWL can dysregulate the autonomic nervous system. WBV stimulates both sympathetic and parasympathetic nervous system; MWL largely affects sympathetic nervous system. Both variables imbalance the sympatho-vagal control as well.