A Multi-Perspective Framework of Vision Zero: Toward Collaborative Promotion of Safety, Health and Well-Being at Work.

In the globalized field of safety, health, and well-being, the need to build multi-stakeholder alliances to find solutions to complex challenges is growing. This requires common ground for collaboration, as well as concepts and tools to grasp and manage the areas of interest. Over recent years, Vision Zero has awakened interest and it continues to evolve into many forms of approaches and initiatives, which provide a strategic direction and practical tools for supporting the development of safety, health, and well-being at work. Consequently, there is a need to build a shared understanding of 'zero'. This article reflects the potential of Vision Zero as a bridging concept and an approach for building multi-stakeholder collaboration. Thus, we present a multi-perspective framework of Vision Zero to support further dialoge and collaboration in joint undertakings.

Testing of common electromagnetic environments for risk of interference with cardiac pacemaker function.

BACKGROUND: Cardiac pacemakers are known to be susceptible to strong electromagnetic fields (EMFs). This in vivo study investigated occurrence of electromagnetic interference with pacemakers caused by common environmental sources of EMFs. METHODS: Eleven volunteers with a pacemaker were exposed to EMFs produced by two mobile phone base stations, an electrically powered commuter train, and an overhead high voltage transmission lines. All the pacemakers were programmed in normal clinically selected settings with bipolar sensing and pacing configurations. RESULTS: None of the pacemakers experienced interference in any of these exposure situations. However, often it is not clear whether or not strong EMFs exist in various work environments, and hence an individual risk assessment is needed. CONCLUSIONS: Modern pacemakers are well shielded against external EMFs, and workers with a pacemaker can most often return to their previous work after having a pacemaker implanted. However, an appropriate risk assessment is still necessary after the implantation of a pacemaker, a change of its generator, or major modification of its programming settings.

Electromagnetic interference with cardiac pacemakers and implantable cardioverter-defibrillators from low-frequency electromagnetic fields in vivo.

AIMS: Electromagnetic interference (EMI) can pose a danger to workers with pacemakers and implantable cardioverter-defibrillators (ICDs). At some workplaces electromagnetic fields are high enough to potentially inflict EMI. The purpose of this in vivo study was to evaluate the susceptibility of pacemakers and ICDs to external electromagnetic fields. METHODS AND RESULTS: Eleven volunteers with a pacemaker and 13 with an ICD were exposed to sine, pulse, ramp, and square waveform magnetic fields with frequencies of 2-200 Hz using Helmholtz coil. The magnetic field flux densities varied to 300 µT. We also tested the occurrence of EMI from an electronic article surveillance (EAS) gate, an induction cooktop, and a metal inert gas (MIG) welding machine. All pacemakers were tested with bipolar settings and three of them also with unipolar sensing configurations. None of the bipolar pacemakers or ICDs tested experienced interference in any of the exposure situations. The three pacemakers with unipolar settings were affected by the highest fields of the Helmholtz coil, and one of them also by the EAS gate and the welding cable. The induction cooktop did not interfere with any of the unipolarly programmed pacemakers. CONCLUSION: Magnetic fields with intensities as high as those used in this study are rare even in industrial working environments. In most cases, employees can return to work after implantation of a bipolar pacemaker or an ICD, after an appropriate risk assessment. Pacemakers programmed to unipolar configurations can cause danger to their users in environments with high electromagnetic fields, and should be avoided, if possible.

Interference of low frequency magnetic fields with implantable cardioverter-defibrillators.

OBJECTIVES: The aim of this study was to find the electromagnetic interference (EMI) thresholds for several commonly used implantable cardioverter-defibrillators (ICD). DESIGN: Seventeen ICDs were exposed to magnetic fields with different intensities produced by the Helmholtz coil system. Sinusoidal, pulse, ramp, and square-waveforms with a frequency range of 2 Hz to 1 kHz were used. RESULTS: ICD malfunctions occurred in 11 of the 17 ICDs tested. The ICD malfunctions that occurred were false detections of ventricular tachycardia (6/17 ICDs) and ventricular fibrillation (3/17 ICDs), false detection of atrial tachycardia (4/6 dual chamber ICDs) and tachycardia sensing occurring during atrial or ventricular refractory periods (1/17 ICD). In most cases, no interference occurred at magnetic field levels below the occupational safety limits of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Nevertheless, some frequencies using sine, ramp or square waveforms did interfere with certain ICDs at levels below these limits. No EMI occurred with any of the ICDs below the ICNIRP limits for public exposure. CONCLUSION: Evaluation of EMI should be part of the risk assessment of an employee returning to work after an ICD implantation. The risk assessment should consider magnetic field intensities, frequencies and waveforms.

Inappropriate implantable cardioverter-defibrillator magnet-mode switch induced by a laptop computer.

An implantable cardioverter-defibrillator (ICD) experienced electromagnetic interference from a laptop computer's hard disk. The patient with the ICD was using his laptop computer at home while lying on his bed. The laptop was positioned on his chest, when he heard a beeping sound from the ICD, indicating magnet mode conversion. This situation was replicated in a controlled environment, and the conversion was found to be due to the static magnetic field produced by the laptop's hard disk. The ICD's conversion to magnet mode can be dangerous because it ends all tachyarrhythmia detections and therapies.

Experimental study on malfunction of pacemakers due to exposure to different external magnetic fields.

PURPOSE: Cardiac pacemaker malfunction due to exposure to magnetic fields may cause serious problems in some work environments for workers having cardiac pacemakers. The aim of this study was to find the magnetic field interference thresholds for several commonly used pacemaker models. METHODS: We investigated 16 pacemakers from three different manufacturers with the frequency range of 2 to 1,000 Hz, using sinusoidal, pulse, ramp, and square waveforms. The magnetic fields were produced by a computer-controlled Helmholtz coil system. RESULTS: Pacemaker malfunction occurred in six of 16 pacemakers. Interaction developed almost immediately after high-intensity magnetic field exposure started. With each waveform, at least two pacemakers exhibited interference. In most exposure settings, there was no interference at magnetic field levels below the international occupational safety limits. Nevertheless, some frequencies using ramp or square waveforms interfered with pacemakers even at levels below public exposure limits. The occurrence of interference depended greatly on the waveform, frequency, magnetic field intensity, and the sensing configuration of the pacemaker. Unipolar configurations were more susceptible for interference than the bipolar ones. In addition, magnetic fields perpendicular to the pacemaker loops were more likely to cause interference than parallel fields. CONCLUSION: There is a need for further investigations on pacemaker interference caused by different external magnetic fields to ensure safe working environment to workers with a pacemaker.

No effects of short-term GSM mobile phone radiation on cerebral blood flow measured using positron emission tomography.

The present study investigated the effects of 902.4 MHz global system for mobile communications (GSM) mobile phone radiation on cerebral blood flow using positron emission tomography (PET) with the (15) O-water tracer. Fifteen young, healthy, right-handed male subjects were exposed to phone radiation from three different locations (left ear, right ear, forehead) and to sham exposure to test for possible exposure effects on brain regions close to the exposure source. Whole-brain [¹5O]H2O-PET images were acquired 12 times, 3 for each condition, in a counterbalanced order. Subjects were exposed for 5 min in each scan while performing a simple visual vigilance task. Temperature was also measured in the head region (forehead, eyes, cheeks, ear canals) during exposure. The exposure induced a slight temperature rise in the ear canals but did not affect brain hemodynamics and task performance. The results provided no evidence for acute effects of short-term mobile phone radiation on cerebral blood flow.

GSM mobile phone radiation suppresses brain glucose metabolism.

We investigated the effects of mobile phone radiation on cerebral glucose metabolism using high-resolution positron emission tomography (PET) with the (18)F-deoxyglucose (FDG) tracer. A long half-life (109 minutes) of the (18)F isotope allowed a long, natural exposure condition outside the PET scanner. Thirteen young right-handed male subjects were exposed to a pulse-modulated 902.4 MHz Global System for Mobile Communications signal for 33 minutes, while performing a simple visual vigilance task. Temperature was also measured in the head region (forehead, eyes, cheeks, ear canals) during exposure. (18)F-deoxyglucose PET images acquired after the exposure showed that relative cerebral metabolic rate of glucose was significantly reduced in the temporoparietal junction and anterior temporal lobe of the right hemisphere ipsilateral to the exposure. Temperature rise was also observed on the exposed side of the head, but the magnitude was very small. The exposure did not affect task performance (reaction time, error rate). Our results show that short-term mobile phone exposure can locally suppress brain energy metabolism in humans.

Thermal effects of mobile phone RF fields on children: a provocation study.

The aim of this study was to examine thermal and local blood flow responses in the head area of the preadolescent boys during exposure to radiofrequency (RF) electromagnetic fields produced by a GSM mobile phone. The design was a double-blinded sham-controlled study of 26 boys, aged 14-15 years. The SAR distribution was calculated and modelled in detail. The duration of the sham periods and exposures with GSM 900 phone was 15 min each, and the tests were carried out in a climatic chamber in controlled thermoneutral conditions. The ear canal temperatures were registered from both ear canals, and the skin temperatures at several sites of the head, trunk and extremities. The local cerebral blood flow was monitored by a near-infrared spectroscopy (NIRS), and the autonomic nervous system function by recordings of ECG and continuous blood pressure. During the short-term RF exposure, local cerebral blood flow did not change, the ear canal temperature did not increase significantly and autonomic nervous system was not interfered. The strengths of this study were the age of the population, multifactorial physiological monitoring and strictly controlled thermal environment. The limitations of the study were large inter-individual variation in the physiological responses, and short duration of the exposure. Longer provocation protocols, however, might cause in children distress related confounding physiological responses.

Assessment of exposure to intermediate frequency electric fields and contact currents from a plasma ball.

While electric fields at intermediate frequencies are not widely utilized for industrial technologies, surprisingly, certain toys emit the highest electric fields found in our living environment. These toys, plasma balls, are devices that use high voltage to create ionized light discharges. In this study, we assessed exposure to electric fields and contact/induced current from a recreational plasma ball device. The electric field strength was measured as a function of distance from the device, and the contact/induced current was measured with a current clamp in different exposure situations with point or grasping contact. The characteristic spectra of the electric field and contact current were measured, and both the multiple frequency rule and weighting of the spectra were applied according to the International Commission on Non-Ionizing Radiation Protection (ICNIRP) 1998 and 2010 guidelines. The results indicate that the recommended reference levels for the general public are exceeded at distances <1.2 m, and that the contact currents in the hand may be twice higher than recommended by the general public guidelines.

Occupational exposure measurements of static and pulsed gradient magnetic fields in the vicinity of MRI scanners.

Recent advances in magnetic resonance imaging (MRI) have increased occupational exposure to magnetic fields. In this study, we examined the assessment of occupational exposure to gradient magnetic fields and time-varying magnetic fields generated by motion in non-homogeneous static magnetic fields of MRI scanners. These magnetic field components can be measured simultaneously with an induction coil setup that detects the time rate of change of magnetic flux density (dB/dt). The setup developed was used to measure the field components around two MRI units (1 T open and 3 T conventional). The measured values can be compared with dB/dt reference levels derived from magnetic flux density reference levels given by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The measured motion-induced dB/dt values were above the dB/dt reference levels for both MRI units. The measured values for the gradient fields (echo planar imaging (EPI) and fast field echo (FFE) sequences) also exceeded the dB/dt reference levels in positions where the medical staff may have access during interventional procedures. The highest motion-induced dB/dt values were 0.7 T s(-1) for the 1 T scanner and 3 T s(-1) for the 3 T scanner when only the static field was present. Even higher values (6.5 T s(-1)) were measured for simultaneous exposure to motion-induced and gradient fields in the vicinity of the 3 T scanner.

Exposure of workers to electromagnetic fields. A review of open questions on exposure assessment techniques.

European Directive 2004/40/EC on occupational exposure to electromagnetic fields (EMF), based on the guidelines of the International Commission on Non-Ionizing Radiation Protection, was to be implemented in the Member States of the European Union by 2008. Because of some unexpected problems the deadline was postponed until 2012. This paper reviews some of the problems identified and presents some suggestions for possible solutions based on the authors' experience in assessing occupational exposure to EMF. Among the topics discussed are movement in static magnetic fields, ways to time average extreme low frequency signals, the difference between emission and exposure standards, and ways of dealing with those issues.

A practical method to evaluate radiofrequency exposure of mast workers.

Assessment of occupational exposure to radiofrequency (RF) fields in telecommunication transmitter masts is a challenging task. For conventional field strength measurements using manually operated instruments, it is difficult to document the locations of measurements while climbing up a mast. Logging RF dosemeters worn by the workers, on the other hand, do not give any information about the location of the exposure. In this study, a practical method was developed and applied to assess mast workers' exposure to RF fields and the corresponding location. This method uses a logging dosemeter for personal RF exposure evaluation and two logging barometers to determine the corresponding height of the worker's position on the mast. The procedure is not intended to be used for compliance assessments, but to indicate locations where stricter assessments are needed. The applicability of the method is demonstrated by making measurements in a TV and radio transmitting mast.

Effects of cellular phone use on ear canal temperature measured by NTC thermistors.

The earlier studies using phantom models and human subjects concerning warming effects during cellular phone use have been controversial, partly because radiofrequency (RF) exposures have been variable. In this randomized, double-blind, placebo-controlled crossover trial, 30 healthy subjects were submitted to 900 MHz (2W) and 1800 MHz (1W) cellular phone RF exposure, and to sham exposure in separate study sessions. Temperature signals were recorded continuously in both ear canals before, during and after the 35-min RF exposure and the 35-min sham exposure sessions. Temperature was measured by using small-sized NTC thermistors placed in the ear canals through disposable ear plugs. The mean temperature changes were determined during a set cardiovascular autonomic function studies: during a 5-min controlled breathing test, during a 5-min spontaneous breathing test, during 7-min head-up tilting, 1-min before, during and after two consecutive Valsalva manoeuvres and during a deep breathing test. Temperatures in the exposed ear were significantly higher during RF exposures compared with sham exposure in both 900 and 1800 MHz studies with maximum differences of 1 x 2 +/- 0 x 5 degrees C (900 MHz exposure) and 1 x 3 +/- 0 x 7 degrees C (1800 MHz exposure). Temperatures in the RF-exposed ear were also significantly higher during the postexposure period compared with post-sham exposure period with maximum differences of 0 x 6 +/- 0 x 3 degrees C for 900 MHz and 0 x 5 +/- 0 x 5 degrees C for 1800 MHz. The results of this study suggest that RF exposure to a cellular phone, either using 900 or 1800 MHz with their maximal allowed antenna powers, increases the temperature in the ear canal. The reason for the ear canal temperature rising is a consequence of mobile phone battery warming during maximal antenna power use. The earlier published articles do not indicate that temperature rising in the ear canal has any significant contribution from the RF fields emitted from mobile phones.