Symptoms in Swiss adolescents in relation to exposure from fixed site transmitters : a prospective cohort study

There is public concern regarding potential health effects of radiofrequency electromagnetic fields (RF-EMF) emitted by fixed site transmitters. We therefore investigated whether self-reported general well-being in adolescents is affected by RF-EMF exposure from mobile phone base stations (downlink) and broadcast transmitters (TV and radio).; In a prospective cohort study, 439 study participants aged 12-17 years, completed questionnaires about their self-reported well-being and possible confounding factors at baseline and one year later. Exposure from fixed site transmitters at home and school was calculated by using a geospatial propagation model. Data were analysed using a mixed-logistic cross-sectional model of a combined dataset consisting of baseline and follow-up data and a longitudinal approach where we investigated whether exposure at baseline (cohort analysis) or changes in exposure between baseline and follow-up (change analysis) were related to a new onset of a symptom between baseline and follow-up. All analyses were adjusted for relevant confounders.; Mean exposure (median; 75(th)) for broadcast transmitters, downlink and total exposure at baseline were 1.9 μW/m(2) (1.0 μW/m(2); 2.8 μW/m(2)), 14.4 μW/m(2) (3.8 μW/m(2); 11.0 μW/m(2)) and 16.3 μW/m(2) (5.8 μW/m(2); 13.4 μW/m(2)), respectively. In cross-sectional analyses no associations were observed between any symptom and RF-EMF exposure from fixed site transmitters. In the cohort and change analyses only a few significant associations were observed including an increased OR for tiredness (2.94, 95%CI: 1.43 to 6.05) for participants in the top 25(th) percentile of total RF-EMF exposure from fixed site transmitters at baseline, in comparison to participants exposed below the median and a decreased OR for exhaustibility (0.50, 95%CI: 0.27 to 0.93) for participants with an exposure increase between baseline and follow-up.; In this cohort study, using a geospatial propagation model, RF-EMF exposure from fixed site transmitters was not consistently associated with self-reported symptoms in Swiss adolescents. The few observed associations have to be interpreted with caution and might represent chance findings

Exposure assessment for mobile phone use and radiofrequency electromagnetic fields and the application in a Swiss cohort study

Background Mobile phones and other wireless communication devices emitting radiofrequency electromagnetic fields (RF-EMF) are nowadays omnipresent and adolescents are among the heaviest users. This results in ubiquitous RF-EMF exposure, though little is known about the levels of this exposure, especially in adolescents. Exposure to RF-EMF can be divided into two parts, the exposure from the use of wireless communication devices (near-field) and the exposure from environmental sources (far-field). In previous studies, the near-field exposure was quantified using the amount of device use only. The RF-EMF exposure resulting from the device use, however, is not only dependent on the duration of use, but additionally for instance on the mode of use and the network used for mobile phone calls. The far-field exposure from fixed site transmitters such as broadcast transmitters for radio and television (TV) and mobile phone base stations was modelled using geospatial propagation models or measured using portable RF-EMF measurement devices. But this part of the exposure also depends on the duration a person is exposed to modelled or measured exposure levels. Therefore a dosimetric approach is needed that allows taking into account these additional aspects of exposure and to combine the near-field and the far-field exposure to one exposure surrogate. Since the mobile phone use increased in the last decade, there is concern that this use may have a negative impact on adolescents. To date, epidemiological studies in adolescents are scarce. In addition, the ones existing used self-reported device use that is known to be inaccurate and the amount of device use was used as proxy for the RF-EMF exposure not taking into account other RF-EMF sources. Furthermore, most of these studies were of cross-sectional design not allowing to draw conclusions about causal relationships between mobile phone use and health, behaviour and cognitive function of adolescents. To overcome these limitations, the HERMES (Health Effects Related to Mobile phonE use in adolescentS) study was conducted. Objectives The objective of the HERMES study was to prospectively investigate whether mobile phone use and the use of other wireless communication devices or RF-EMF exposure have an impact on the health and the behaviour of adolescents and if cognitive function of adolescents is affected by these exposures. The objectives of this thesis were to improve the exposure assessment for mobile phone use and RF-EMF exposure and to investigate its relations to behavioural problems and concentration capacity of adolescents. Methods The HERMES study was a prospective cohort study with a one year follow-up period. It was conducted in Central Switzerland in adolescents attending the 7th school grade. The investigation took place in the schools during school time and consisted of filling in a paper and pencil questionnaire and performing computerized cognitive tests. In addition, a questionnaire for the parents was distributed that was directly sent back to the study managers. Additionally to the amount of mobile phone and other device use, problematic aspects of mobile phone use such as loss of control, withdrawal, negative life consequences and craving were asked in the questionnaire. In a subgroup of the study participants, personal RF-EMF measurements were conducted. The participating adolescents carried a portable measurement device for three consecutive days and filled in a time-activity diary to record their locations during the measurement period. The questionnaire data and the personal RF-EMF measurements together with geospatial propagation modelling for the exposure originating from fixed site transmitters at home and in the schools as well as operator-recorded mobile phone use data for a subgroup of the study participants were used to develop an RF-EMF exposure surrogate combining the exposure from the use of wireless communication devices and environmental sources. This exposure surrogate was then used to conduct cross-sectional and longitudinal analyses of RF-EMF exposure and behaviour and concentration capacity of adolescents. Results 439 adolescents participated in the HERMES study (participation rate of 36.8%) with a follow-up rate of 96.8%. Operator records were available for 234 adolescents and personal RF-EMF measurements were available for a subgroup of 90 adolescents. We found that problematic mobile phone use in adolescents was related to behavioural problems such as hyperactivity, conduct problems, emotional symptoms and antisocial behaviour and impaired health related quality of life (HRQOL) facets such as home life and school environment. The main contributor to the measured personal RF-EMF exposure was the mobile internet use on the mobile phone. For the adolescents not using mobile internet, mobile phone base stations contributed most to their exposure. Having wireless internet (WLAN) at home and attending a school with WLAN had very little impact on the average measured WLAN exposure. According to the developed RF-EMF exposure surrogate combining near-field and far-field exposure, the exposure from environmental sources such as fixed site transmitters, cordless phone and WLAN base stations and mobile phones in the surroundings plays a minor role compared to the exposure from the use of wireless communication devices (mobile phones, cordless phones, computers, laptops and tablets connected to WLAN). The near-field dose accounted for 98.4% of the brain dose and 94.0% of the whole body dose. In applying the developed RF-EMF dose surrogate in combination with use measures derived from self-reported device use and operator-recorded mobile phone use, the relations to behavioural problems and the concentration capacity of adolescents were investigated. No systematic pattern in relation to RF-EMF exposure was observed indicating no causal relationship between RF-EMF exposure and behavioural problems and concentration capacity of adolescents. Conclusions Environmental sources play a minor role for the RF-EMF exposure of adolescents compared to the use of wireless devices. Having WLAN at home and attending a school with WLAN have very little impact on the average measured WLAN exposure. The use of mobile internet results in higher measured exposure from mobile phones. Therefore, precautionary measures to reduce the exposure to RF-EMF should focus on the use of wireless devices. The behaviour and the concentration capacity of adolescents were not affected by RF-EMF exposure. In contrary, behavioural problems and impaired HRQOL were associated with problematic aspects of mobile phone use. Therefore, problematic mobile phone use should be considered if dealing with adolescents showing behavioural problems or impaired mental health. The HERMES study was the first study applying a comprehensive exposure assessment including operator-recorded mobile phone use and cumulative RF-EMF dose calculations. The study provided new insights into the mobile phone use of Swiss adolescents and its impact on health, behaviour and cognitive function using a longitudinal approach allowing to draw conclusions about causal relationships. The applied methods can be used in future epidemiological studies on RF-EMF exposure and its influence on humans

Problematic mobile phone use of Swiss adolescents : is it linked with mental health or behaviour?

To investigate the associations between problematic mobile phone use and mental health and behavioural problems in 412 Swiss adolescents owning a mobile phone while controlling for amount of mobile phone use.; Problematic mobile phone use was determined by the MPPUS-10 (Mobile Phone Problem Use Scale) and related to health and behavioural problems by means of multivariable regression modelling.; MPPUS-10 was 4.7 (95 % CI 1.8, 7.6) units higher in girls than in boys, increased significantly with age and was significantly decreased with increasing educational level of the parents. Furthermore, problematic mobile phone use was associated with impaired psychological well-being, impaired parent and school relationships and more behavioural problems but was not related to peer support and social acceptance.; Our study indicates that problematic mobile phone use is associated with external factors such as worse home and school environment and internal factors such as impaired mental health and behavioural problems of the adolescents and thus problematic mobile phone use should be addressed, in particular when dealing with adolescents showing behavioural or emotional problems

Health-related quality of life in adults after pediatric kidney failure in Switzerland.

BACKGROUND Little is known about health-related quality of life (HRQoL) in adults after kidney failure during childhood. In this study, we analyzed HRQoL of adults after pediatric kidney failure in Switzerland and investigated socio-demographic and clinical factors associated with HRQoL. METHODS In this cohort study, we sent questionnaires to 143 eligible patients registered in the Swiss Pediatric Renal Registry with continuous kidney replacement therapy starting before the age of 18 years. We assessed HRQoL using the Short-Form 36 version 1, compared HRQoL scores between our sample and the Swiss general population, and used linear regression models to examine socio-demographic and clinical factors associated with HRQoL. RESULTS We included 79 patients (response rate 55%) with a mean age of 38.6 years (range 19.4-63.1). Compared to the general population, HRQoL scores were lower for physical functioning (- 12.43, p < 0.001), role physical (- 13.85, p = 0.001), general health (- 14.42, p < 0.001), vitality (- 4.98, p = 0.035), and physical HRQoL (- 6.11, p < 0.001), but we found no difference in mental HRQoL (- 0.13, p = 0.932). The socio-demographic factors-lower education, unemployment, and not being in a relationship-were associated with lower HRQoL. The only clinical factor associated with HRQoL was the type of kidney disease. Patients with acquired kidney diseases had lower mental HRQoL than patients with congenital anomalies of the kidney and urinary tract (- 11.4, p = 0.007) or monogenetic hereditary diseases (- 9.5, p = 0.018). CONCLUSIONS Adults after pediatric kidney failure in Switzerland have lower physical, but similar mental HRQoL compared to the general population. Subgroups may require special attention with regard to their HRQoL. A higher resolution version of the Graphical abstract is available as Supplementary information

Long-term social and professional outcomes in adults after pediatric kidney failure.

BACKGROUND Little is known about the long-term social and professional outcomes in adults after pediatric kidney replacement therapy (KRT). In this study, we described social and professional outcomes of adults after kidney failure during childhood and compared these outcomes with the general population. METHODS We sent a questionnaire to 143 individuals registered in the Swiss Pediatric Renal Registry (SPRR) with KRT starting before the age of 18 years. In the questionnaire, we assessed social (partner relationship, living situation, having children) and professional (education, employment) outcomes. Logistic regression models adjusted for age at study and sex were used to compare outcomes with a representative sample of the Swiss general population and to identify socio-demographic and clinical characteristics associated with adverse outcomes. RESULTS Our study included 80 patients (response rate 56%) with a mean age of 39 years (range 19-63). Compared to the general population, study participants were more likely to not have a partner (OR = 3.7, 95%CI 2.3-5.9), live alone (OR = 2.5, 95%CI 1.5-4.1), not have children (OR = 6.8, 95%CI 3.3-14.0), and be unemployed (OR = 3.9, 95%CI 1.8-8.6). No differences were found for educational achievement (p = 0.876). Participants on dialysis at time of study were more often unemployed compared to transplanted participants (OR = 5.0, 95%CI 1.2-21.4) and participants with > 1 kidney transplantation more often had a lower education (OR = 3.2, 95%CI 1.0-10.2). CONCLUSIONS Adults after pediatric kidney failure are at risk to experience adverse social and professional outcomes. Increased awareness among healthcare professionals and additional psycho-social support could contribute to mitigate those risks. A higher resolution version of the Graphical abstract is available as Supplementary information

Education, Employment, and Financial Outcomes in Adolescent and Young Adult Cancer Survivors-A Systematic Review.

Adolescents and young adults (AYAs) with cancer face unique challenges. We aimed to describe (i) education, employment, and financial outcomes and (ii) determinants for adverse outcomes in AYA cancer survivors. We performed a systematic literature search. We included original research articles on AYA (15-39 years of age) cancer survivors (≥2 years after diagnosis) and our outcomes of interest. We narratively synthesized the results of the included articles. We included 35 articles (24 quantitative and 11 qualitative studies). Patients in education had to interrupt their education during cancer treatment, and re-entry after treatment was challenging. After treatment, most survivors were employed but started their employment at an older age than the general population. Overall, no disadvantages in income were found. Survivors reported more absent workdays than comparisons. We identified chemotherapy, radiotherapy, late effects or health problems, female sex, migration background, and lower education associated with adverse outcomes. Although most AYA cancer survivors were able to re-enter education and employment, they reported difficulties with re-entry and delays in their employment pathway. To facilitate successful re-entry, age-tailored support services should be developed and implemented

COVID-19 Information-Seeking, Health Literacy, and Worry and Anxiety During the Early Stage of the Pandemic in Switzerland: A Cross-Sectional Study.

Objectives: To describe COVID-19 information-seeking behavior (CISB) during the first stage of the pandemic in Switzerland and identify its determinants. Methods: We conducted an online cross-sectional survey (4 May to 6 July 2020). Participants self-reported their CISB (information sources and frequency), personal COVID-19 situation (e.g., perception about having had COVID-19), sociodemographic information, and completed validated measures of health literacy, and worry and anxiety. Data were analyzed using descriptive statistics and logistic regressions. Results: We included 1,505 participants (24.7% male; mean age = 43.0 years, SD = 13.9). Most participants reported searching for information daily (n = 1,023, 68.0%) and referring to multiple information sources (mean 3.7, SD = 1.5). Commonly used sources were official websites (n = 1,129, 75.0%) and newspapers (n = 997, 66.2%). Participants with higher health literacy were more likely to seek information daily and use online resources, but less likely to use personal networks than those with lower health literacy. We did not find any association between CISB and worry and anxiety. Conclusion: More opportunities for personal dialogue and education about reliable online information resources should be encouraged to optimize the CISB of groups with lower health literacy

Health-related quality of life before and during the COVID-19 pandemic in Switzerland: a cross-sectional study.

INTRODUCTION The COVID-19 pandemic forced people to give up their daily routines and adjust to new circumstances. This might have affected health-related quality of life (HRQOL). We aimed to compare HRQOL during the first COVID-19 wave in 2020 to HRQOL before the pandemic and to identify determinants of HRQOL during the pandemic in Switzerland. METHODS We conducted a cross-sectional online survey during the pandemic (between May and July 2020; CoWELL sample; convenience sample). Before the pandemic (2015-2016), we had conducted a cross-sectional paper-based survey among a representative random sample of the Swiss general population (SGP sample). In both samples, we assessed physical and mental HRQOL (Short Form-36) and socio-demographic characteristics. In the CoWELL sample, we additionally assessed health- and COVID-19-related characteristics. Data were analysed using linear regressions. RESULTS The CoWELL sample included 1581 participants (76% women; mean age = 43 years, SD = 14 years) and the SGP sample 1209 participants (58% women, mean age = 49 years, SD = 15 years). Adjusted for sex, age, and education, the CoWELL sample reported higher physical HRQOL (PCS, +5.8 (95% CI: 5.1, 6.6), p < 0.001) and lower mental HRQOL (MCS, -6.9 (-7.8, -6.0), p < 0.001) than the SGP sample. In the CoWELL sample, especially persons with lower health literacy, who had no support network or who have had COVID-19, reported lower HRQOL. DISCUSSION Aspects unique to the COVID-19 pandemic affected HRQOL. Vulnerable persons such as those having had COVID-19, less support opportunities, and with lower health literacy are especially prone to impaired HRQOL during the COVID-19 pandemic