Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields: Influence on Physiotherapy Personnel Morbidity Profile

Abstract

In the practice of the Physical and Rehabilitation Medicine the electromagnetic fields (EMF) are an ordinary factor in the treatment process. Usually the medical equipment generates EMF in low-intensity range. This modality is proven in the clinical medicine as a reliable part of the treatment practice but scarcely studied as a potential hazard to professionals’ health. The question about possible personnel’s health adverse bioeffects unlocking remains neglected, except for a limited number of early and recent publications which assessing only some kinds of compliances and disturbances and dosimetry measurement problems as usual. The collected data on the adverse effects of EMF and our own observations on some specific physiotherapy health deviations and compliances with high possible relation to the specific background conditions have focused our attention to study this group. Here are presented and discussed the physiotherapy personnel clinical answers on chronically expositions with different, stochastically changing by frequency and density low-intensity EMF as a complex somatic-behavioral morbidity profile and the cause relation made, provided to the authors’ knowledge at first. The expositional subgroups’ analyzing with the statistical meaning comments presents the physiotherapy professionals as a group in aggravated risk with specific morbidity and specific needs for prevention and precautions. Periodontitis, cardiovascular disturbances, allergic manifestations, photosensibilisation, skin diseases as well as the musculoskeletal disorders have shown the greatest significance by somatic disorders. The diseases of the female reproductive system – leyomyoma uteri, breast cancer and miscarriages are less presented in personnel’s morbidity profile but they are under high social attention. Neurobehavioral disturbances are dominated from headache, fatigue, heart palpitation, sleep problems. The non-motivated mood changes, irritability, perspirations and shortness of breath are presented in smaller percent but they could affect the general condition seriously. The relation found of periodontitis, photosensibilisation, leiomyoma uteri and osteoporosis debuting, not recognized as predilections in other studies yet is presented and discussed, too. Thus, the medical low-intensity EMF work background adverse potential and it’s interfere on personnel health are better elucidating. The need of research protocols unifying is determinant to obtain comparable results, reliable base of which could be the here presented study. To reduce the over expositional burden and to prevent the adverse cumulating effects, adequate rules and care by the institutions without delay are recommended to be taken.
KEY WORDS: physiotherapy personnel, medical low-intensity EMF, long-term (chronicle) expositions, complex morbidity profile, specific morbidity, specific precautions.

Full text

363
22 Long-Term, Low-Intensity,
Heterogeneous
Electromagnetic Fields
Inuence on Physiotherapy
Personnel Morbidity Prole
Lyubina Vesselinova
22.1 INTRODUCTION
Technical and technological development enables widespread use of articial sources emitting elec-
tromagnetic elds (EMFs) in areas other than specialized practice. In the last 20 years, the major
CONTENTS
22.1 Introduction .......................................................................................................................... 363
22.2 Problem Analyzing ............................................................................................................... 364
22.2.1 Risk Groups .............................................................................................................. 364
22.2.2 “Take and Run” and “Take and Hold” Principle of the EMF in Physiotherapy .......364
22.3 Low-Intensity EMF .............................................................................................................. 366
22.4 Electromagnetic Background in Physiotherapy ....................................................................366
22.5 Recognized Biological Effects on Physiotherapy Personnel ................................................ 367
22.6 First Cause-Related Complex Morbidity Study ....................................................................368
22.6.1 EMF Propagation in Closed Space by More Than One Emitting Source ................ 369
22.6.2 Evaluation of the COSC Results ............................................................................... 371
22.6.3 Demographic Section of the Study Group ................................................................ 371
22.6.4 Exposed Subgroups ..................................................................................................372
22.6.5 Morbidity Distribution in the Exposure Subgroups Assumption ............................. 375
22.6.5.1 Ist EsG ........................................................................................................375
22.6.5.2 IInd EsG ..................................................................................................... 376
22.6.5.3 IIIrd EsG .................................................................................................... 376
22.6.5.4 Manifestation of Periodontal Disease Is Signicant
for All Exposed Subgroups ........................................................................ 376
22.6.6 EMF–Morbidity Correlations ................................................................................... 376
22.6.6.1 Cumulative Effect ...................................................................................... 376
22.7 Discussion ............................................................................................................................. 377
22.8 Conclusions ...........................................................................................................................377
Acknowledgments ..........................................................................................................................378
Abbreviations ................................................................................................................................. 378
References ...................................................................................................................................... 379

364 Electromagnetic Fields in Biology and Medicine
contribution to this technology has come from the worldwide network of mobile and satellite commu-
nications, which have dramatically increased the high-frequency (HF) component of the evolutionary
electromagnetic background, which has thus far been unrecognized. In addition, nuclear accidents
and changes in ozone concentration have repeatedly raised the amount of radiation (Bobrakov and
Kartashev 2001, Markov and Hazlewood 2009), which has set biological objects in a new electro-
ecological situation. This complicated radiation environment poses the problem of reducing the
exposure load, especially for professional groups at risk, with a priority to closely follow the funda-
mental maxima underlying the Precautionary Principle: “better safe than sorry” (Communication on
Precautionary Principle EC 2000, Goldsmith 1997). The need for restricting access as well as shield-
ing both devices and staff as a protective measure is one of the key points of the Benevento Resolution
2006 (Recent Research on EMF and Health Risks 2007). The personnel in physiotherapy were tradi-
tionally exposed to electromagnetic radiation (EMR) till after 1900, when HF currents were included
as a routine therapeutic factor; however, this topic still remains outside research interest. When the rst
book on magnetotherapy was published in Bulgaria by Professor Nentcho Todorov in 1982, magneto-
therapy became yet another basic tool in physiotherapy. Actually, the palette of treatment modalities
is much more varied as it comprises elds and currents in different frequency ranges, optic radiation,
ultrasound, magnet, and laser. Namely, this wide range of physical factors with possible applications in
healing techniques creates the need for serious hazard assessment concerning the health of personnel.
22.2 PROBLEM ANALYZING
22.2.1 Risk GRoups
Today, the high-tech social lifestyle has globalized the problem of overexposure, forming temporary
at-risk groups based on their background characteristics: residential (living in the vicinity of power
lines, base stations, and broadcasting towers) and professional (workers in industry, electronics and
communications, base station operators, technicians, engineers, etc.). For professionals, the level of
risk depends on the distance from the source, the amplitude modulation, and the synergy of bio-
logical, chemical, and physical components of the microclimate. Hence, the occupational security
and health (OSH) classication in the Final Technical Report on Occupational MF Exposure 2008
(EMF-NET MT-2 D49) identies three professional subgroups:
1. Under high exposure: Operators of base stations, radars, power-lines, electrosurgical
knives, diathermy units, where the work conditions cannot be changed and personnel need
precaution and individual risk assessment. Special attention should be paid to the most
vulnerable workers in the EMF group—pregnant women, very young workers, and those
with active or passive metal implants.
2. Under possible risk: Some technological branches. Warning signs and inscriptions are
mandatory. In this subgroup, qualication of generator operators is mandatory and the
assessment must be carried out individually.
3. Nonexposed: Professional group (similar to the public group). The exposure levels are
within the standards and warning is only required for people with pacemakers.
The occupational features of electrophysiotherapy assign professionals in this eld to the rst risk
group, independent of the fact that exposures in physiotherapy are predominantly of low intensity
and that there is no predominance of the contact with high-frequency therapy (HFTh) sources.
22.2.2 “Take and Run” and “Take and Hold” pRinciple of THe eMf in pHysioTHeRapy
In fact, all electrotherapy devices generate an EMF. In therapy, it provokes or accelerates processes
of healing and reparation in the radiated tissue. The physical characteristics of EMFs—electric and
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

365Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
magnetic components, wavelength, penetration depth, processes of refraction, reection, polarization
and oscillation, and superposition—and their cumulative ability determine their potential as powerful
therapeutic agents for the patients termed by us (“take and run” principle) with anti-inammatory, anti-
swelling, pain relief, trophic improvement, chondroprotection, and biostimulating or biosuppressing
(dose-dependent) effects (Aleksiev 2013, Basset 1994, Becker and Marino 1982, Irving 2007, Kositsky
et al. 2001, Markov 2010, 2011, Rasoulia et al. 2012, Vesselinova and Kovatchev 2013) for maximal
functional recovery and, at the same time, by dispersed long-term professional inuence termed by
us (“take and hold” principle), as potentially adverse bioactive factors. Usually the prescription in the
rehabilitation program is complex and combines electrotherapy and natural factors. Monotherapy pre-
scriptions are rare, but more often they don’t exceed three or four factors in a prescription. Prescriptions
for different factors are implemented in sections of the corresponding elds—electro/light therapy,
kinezitherapy, hydrotherapy, thermotherapy, laser therapy, inhalation therapy. Prescribed electrother-
apy procedures have been performed by physiotherapists in the electro/light therapy section (ELTS),
which is normally a big room divided into cubicles. By medical standards, each cubicle should have
one source of articial physical factors for low or intermediate frequency currents, iontophoresis, ultra-
sound, light therapy (ultraviolet (UV) or visible light), and magnetotherapy. In most cases, generators
of HF currents are also placed in the same big room in shielded compartments. This way the medi-
cal devices emitting different frequency ranges—50Hz, 150 kHz, 1MHz, 3MHz, 27.12MHz, and
2450MHz—as well as sources of pulsing magnetotherapy and optic radiation (for UV and infrared
light therapy) can work simultaneously (Israel and Tschobanoff 2006, Vesselinova 2013a). This, how-
ever, generates a specic electromagnetic environment in the physiotherapy–electrotherapy sections
that personnel face daily (Vesselinova 2012a). The overexposure from apparatuses for HF treatment
up to a distance of 1 m is actually absorbed mainly by the staff (Karabetsos et al. 2010, Karpowicz and
Gryz 2013, Markov 2008, Traykov and Israel 1994), and this has been practically proven with a test-
lamp for EMR (Vesselinova 2012a). Chronic exposure can unlock different dose- and time-dependent
adaptive mechanisms or disadaptive events, which may manifest as complications, disturbances, or
disorders that may or may not be reversible. Contradictions in bio effects due to therapeutic applica-
tions and professional long-term absorption are presented in Table 22.1.
In the long history of practical and scientic physiotherapy, very few papers have paid attention
to working conditions and the impact of physical factors on the personnel. In the scientic literature,
TABLE 22.1
Contradiction of the Physiotherapy EMF on Health by Short-Term “Take and Run” and
Long-Term “Take and Hold” Applications
Therapy Application (Short-Term “Take and Run”)
As Professional Background Component
(Long-Term “Take and Hold”)
Short application duration—5 ÷ 30min Long time burden—more than the half or the entire working
time (4 ÷ 7h)
Short term—3 ÷ 20days (max. 3 or 4 courses yearly) Long-term—the entire working experience
Local/regional (commonly peripheral) Whole-body contact or at least the central body sagittal line
by application of the procedure
Dose-limitated characteristics (athermal, olygothermal,
or thermal, measured in W per cm2 or in mA (mV)
Dose unknown burden—indirectly by specic sense
occurrence (the measurement concerns the density of power)
Precise determination of the physical factors demanded
of the health status (as usual 3 or 4 max. by course)
Many kinds of physical factors with accidental prevalence
(depending on performed daily prescriptions)
Focused elds Dispersed elds with or without superposition
Frequency known characteristics Stochastic frequency changes and combinations
In a changed biological medium of disturbance,
disease, or convalescence
On a principally healthy body
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

366 Electromagnetic Fields in Biology and Medicine
the situation is the same. In the last 4 years, there appears to be a tendency to enhance research
focusing on the improvement of the power of density measurement and assessment in physiotherapy.
The complicated and stochastically changing frequency of diverse EMF characteristics of the work
background in the low-intensity range distinguishes physiotherapy personnel from other profes-
sional groups in risky electromagnetic professions that have been recognized and studied so far
among the so-called electrical professions in industry and communications, and therefore needs to
be studied independently and in depth.
22.3 LOW-INTENSITY EMF
The interaction of an EMF with biological structures is currently interpreted by the concepts of two
main mechanisms: thermal and nonthermal. The difference in these perceptions between Western
and East European analysts is based on the assumption of the EMF’s ability to induce biological
effects with or without overheating and tissue shock (Markov 2006, Michaelson 1974, Pilla and
Markov 1994, Ueno 1996, Williams 2009). Data from the last 20years show the increasingly harmful
effect of nonthermal EMFs through important biological effects that have a specic meaning—the
ability to accumulate repeated weak signals, which usually do not provoke momentary recognizable
feelings or biological response (Beal and Fagin 1995, Nordin et al. 2011, Tolgskaya et al. 1987).
Currently, Ishido et al. (2001) have found paradoxical dependence in nonthermal EMFs—a stronger
effect of low-dose elds, which poses even greater threat to human health, as described by other
authors as well (Adair 1991, Adey 1983). It is an axiom that the human body is “transparent” in
static and low-frequency magnetic elds and the permeability of the electric eld depends on the
conductivity of the medium (Becker and Marino 1982, Habash 2008). The main active component
for personnel in physiotherapy is the dispersed low-intensity EMF. The absorbed EMR in the work
background and the inductive currents thereby provoked in the physiotherapy personnel’s bodies
may unlock different biological answers depending on the condition of the operator and the ana-
tomical area of the body that is involved (Vesselinova 2012a, 2013c,d).
22.4 ELECTROMAGNETIC BACKGROUND IN PHYSIOTHERAPY
Apparatuses are placed in the electrotherapy sections for electrotherapy (therapeutic application of
electric currents with low, intermediate, and high frequencies, in permanent or alternating modal-
ity), magnetotherapy, ultrasound therapy, and light therapy (optic radiation sources for UV and
visible light). Hence, these are in fact ELTS. The organization demands that the personnel in every
section perform the prescribed procedures with the physical factors located in the same section
as their duty place. So, the physiotherapists, the patients, and the visiting physiatrists are under
the inuence of nonhomogeneous by spectral and density characteristics of the EMF, which are
strongly dependent on the prescribed physical factors and modalities. The common sources of UV,
visible, and infrared light, and extreme HFTh (mm, cm, and dm waves) in the electrotherapy sec-
tions within the physiotherapy unit together with their energy characteristics (wavelength and fre-
quency) have been presented by Kositsky et al. (2001).
The rst data of overexposure in electrotherapy sections of physiotherapy wards were found
more than 50 years ago mainly by researchers from the former Soviet Union and Bulgaria. In
the publications of Dimitrova (1965) and Todorov et al. (1965) a correlation was found between
building materials in the working environment, shielding of the sources, and the dosimetric char-
acteristics, resulting in the manifestation of certain symptoms: menstrual disturbances, headaches,
tiredness, abnormalities in the white blood cells. These ndings served as an indirect indicator of
the harmful potential of EMR. This fact was already reected in the legislation documents concern-
ing the organization of physiotherapy departments, which recommended shielding the compart-
ments with radiofrequency (RF) generators. However, almost 30years later, in 1994, the Bulgarian
physicists Traykov and Israel (1994) described areas of overexposure in their measurements of work
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

367Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
environmental factors through risk evaluation which are valid for all structures of physical medicine.
The authors emphasized that the values of the measured intensity of the electric eld at a distance
of 50cm from the electrodes of the ultrahigh-frequency (UHF) therapy generator (27.12MHz) are
between three and seven times higher than the maximum allowed 200 V/m.
Manifestation of skin irritation and burning sensation in the upper limbs has been recorded by
our own clinical experience during common application of HFTh. The ICNIRP report (2001) sum-
marized the experience of different authors (Stuchly et al. [1982] and Veit and Bernhardt [1984])
who have identied the risk areas of high-level exposure to personnel at a distance of less than about
1.5–2 m for UHF apparatuses (27.12MHz) or 1 m for apparatuses using microwaves (433MHz and
2.45 GHz). In recent works, Miclaus et al. (2010), Karabetsos et al. (2010), and Karpowitcz and Gryz
(2013) have conrmed the same overexposure zones near the electrodes and cables. The typical
exposure distances and burden levels for patients and personnel involved with shortwave diathermy
(27, 12MHz) and microwave treatment (433 and 2450MHz) have been assessed and compared with
magnetic resonance imaging (MRI) examination (42–300MHz) by Vecchia et al. (2009) in the
ICNIRP report. In their review of the literature on a 20-year period of RF EMF power density mea-
surement, Shah and Farrow (2013) clearly show and recommend revision of the distance for sources
of continuous shortwave diathermy (CSWD) tonot less than 2 m and at least 1.5 m for sources of
pulsing shortwave diathermy (PSWD).
22.5 RECOGNIZED BIOLOGICAL EFFECTS ON PHYSIOTHERAPY PERSONNEL
The human body is a complex biological system whose proper functioning depends on the proper
functioning of its main systems—nervous, endocrine, immune, and vascular circulatory.
These systems are in a dynamic equilibrium, which is dependent on different internal (acid–
base balance, tissues hydration, hormonal balance, enzyme system activity, intact metabolism) and
external factors such as radiation (ionizing and nonionizing), chemical pollution (in the air, water,
and soil), stress, viruses, and microbial agents. In the case of prolonged stimuli that may exceed the
body’s adaptive capacity, a certain pathology, disturbance, or disease, reversible or nonreversible,
may develop depending on the intensity, frequency, and persistency. Work in physiotherapy EMF
environments for months or years may cause some interference with the personnel’s health.
• Radio-sickness (microwave sickness): First described in the 1960s by Sadchikova and
Glotova (1973)—fatigue, weakness, sleep disorders, irritability, and vegetative nervous sys-
tem disturbances. They dened three clinical phases of progression: (1) asthenic (vagothonia,
artherial hypotension, bradycardia); (2) astheno-vegetative: signicant manifested asthenia,
sympathicothonia with vascular dystonia, and hypertension; (3) hypothalamic: the patho-
logical manifestation persists, paroxysmal sympatho-adrenal crises, ischemic heart attacks,
and ophthalmological problems. Later Firstenberg (2001) conrmed this sickness as “micro-
wave sickness” and described the so-called additional syndrome—nonspecic compliances:
respiratory (bronchitis, sinusitis, inuenza-like symptoms), oppression, eyeball pressure,
soreness in the throat, perspirations, “ying” body pain, unspecied pelvic pain, leg and foot
pain, epistaxis, digestive problems, skin irritability, tinnitus, tooth pain with metallic taste.
• Circulatory disturbances: These are described mainly as hypertonia due to irritation of the
sympatho-adrenal system with an increase in stress hormonal secretion (Israel et al. 2007,
Vangelova et al. 2007).
• Reproductive outcomes: The reports of reproductive outcomes are very limited but conse-
quences are serious enough not to be dismissed. Dimitrova (1965) described the majority
of young (30–39years old) female personnel suffering from hypermenorhoea and men-
strual cycle shortening.
• Miscarriages: In the early studies, this is one of the most worrying ndings. Because of
the complexity of such outcomes, no secure factor relation has been established. Reported
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

368 Electromagnetic Fields in Biology and Medicine
cases of pregnancy ending in miscarriage among physiotherapists are very controver-
sial in terms of possible physical factors being the reason. Some of them occur between
6 and 10 weeks of gestation, and others during the rst trimester. Shortwave diathermy,
ultrasound, and transcutaneous electric nerve stimulation (TENS), in combination or sep-
arately, are most likely factors that are attributed to miscarriages (Cromie et al. 2002,
Dimitrova 1965, Lindbom and Taskinen 2000, Taskinen et al. 1990). Magnavita and Fileni
(1994) excluded therapeutical ultrasound as a cause of overexposure due to the fast air-
borne signal desertion.
• Malformations: These have the same uncertainties as miscarriages. The assumed cases
of malformation in offspring, partly ending with habitual abortions and partly with the
impossibility of excluding suspicious physical factors as a reason, present arguments for
the analysts to continue to raise this issue as a likely consequence (Cromie et al. 2002).
Previous studies, however, had “higher than expected” congenital abnormality ndings
(the estimated percentage being 13% versus about 3% in the general community).
• Hematological deviations: Very few papers on changes in blood tissue have been pub-
lished. Leucopenia with lymphocytosis and anemia has been found studied by Dimitrova
in 1965, but it must be noted that the requirement for shielding compartments for HFTh
did not exist at that time.
• Infections and mycoses: These are more often related to hydrotherapy procedures where
personnel come into contact with water, chemicals, or contaminants. In particular, skin
irritation or dermatitis has been related to different kinds of disinfectant use (Cromie
2002). Standford et al. (1995, by Cromie et al. 2002) reported that physiotherapists’ profes-
sional group is among the “high-risk occupations for hepatitis B” and Von Guttenberg and
Spickett (2009) announced on the other hand that in Australia, physiotherapists in hospi-
tals are signicantly exposed to body uids, causing high risk levels compared to other
physiotherapy facilities, especially those practicing acupuncture.
• Low-back pain: This can be caused by musculoskeletal disorders and injuries associated
mainly with lifting and bad posture due to the execution of different physical methods,
for example, massage. The authors considered the need of guidelines to follow a right
ergonomic algorithm to reduce injuries, as well as the musculoskeletal load and vertebral
complications in all regions of the spine (Cromie et al. 2001, 2002).
• Rare nonspecic complaints: Asthma (nonsmoking-related) (Liss et al. 2003); eye, nose,
and throat irritations (Tarlo et al. 2004); however, no signicant statistics have been
obtained for physiotherapists in comparison studies with radiographers. Stress (burn-
out syndrome) is observed as one reason for taking leave by young physiotherapists in
Australia with an inpatient caseload compared with physiotherapists working with outpa-
tients (Lindsay et al. 2008). Wernicky and Karoly (1995, by Cromie at al. 2002) have found
cases of hearing loss.
22.6 FIRST CAUSE-RELATED COMPLEX MORBIDITY STUDY
A total of 267 men and women from 30 physiotherapy units were studied (Vesselinova 2013b) over a
period of 3years (2004–2007) under professional conditions to establish specic types of pathology
and to nd their correlated causes , by means of a complex original survey card (COSC, created and
validated in 1999–2001) on somatic and neurobehavioral health deviations. The information was
coded and processed anonymously according to the ethical principles and legislations for protect-
ing personal information. The combined retroprospective cohort indirect survey with the option
of anonymity among physiotherapy personnel in native work conditions was chosen. Some of the
questions were orientated to estimate the role of the HF component or another environmental factor
as an aggravating factor. Another focus was the assessment of the work algorithm’s ergonomics and
the need to assemble a prevention program (Vesselinova 2013b).
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

369Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
Group structure: The following data were obtained from 30 nationwide physical therapy
facilities of the Republic of Bulgaria: specialists in physical and rehabilitation medicine (phys-
iatrists) (13%), physiotherapists and kinezitherapists from electro/light therapeutic sections (68%)
and from the kinezitherapy section (15%), hospital attendants (4%). The COSC, which focuses on
the so-called target somatic body systems and behavioral deviations recognized in the literature
for the EMF as well as on some additional specic aspects (myoma, osteoporosis, photosensi-
bilization, menopause), has 102 questions, divided into two sections. The rst section contained
82 questions comprising 9 topics: (I) q. 1–13—personal data and general work and health sta-
tus information; (II) q. 14–21—duty obligations and contact with EMF sources; (III) q. 22–31—
screening checkups, skin diseases, musculoskeletal system and blood vessels’ disorders, peripheral
nervous system status, ophthalmology diseases; (IV) q. 32–54—urinary and genital system/female/
concerning menstruation, pregnancies and births, gynecological disorders, operations, menopause;
(V) q. 55–58—neoplasms, localization, diagnostic history; (VI) q. 59–67—cardiovascular prob-
lems, immunological status, dermatophotosensibility, endocrinal disturbances, semen analysis
deviations/male/, offset retrospection; (VII) q. 68–70—somatological status; (VIII) q. 71–80—
personal attitude and recommendations; (IX) q. 81 and 82—height and weight. The second section
of the COSC is focused on some behavioral and psycho-emotional reactions. It includes 20 ques-
tions about occurrence of headache, tremor, acrocyanosis, sudden perspiration, tachycardia, breath-
lessness, faintness, fainting ts, unmotivated changes in mood, tenseness, irritation, ungrounded
anxiety, hot waves, acids, change in libido, sleep problems, satisfaction, overall psychological
adjustment, feelings of euphoria or of capsulation, and harmful habits (Vesselinova 2012a,b).
22.6.1 eMf pRopaGaTion in closed space by MoRe THan one eMiTTinG souRce
As we underlined while analyzing the specic background, the ELTS are overloaded with unhomo-
geneous and stochastically changing EM exposures from simultaneously emitting apparatuses at
different ranges and modalities. For a better understanding of this complicated situation as shown in
Figures 22.1 through 22.4, we strive to show the exposure burden surrounding workers and patients
in every ELTS. A specially orientated experiment with Specic Anthropomorphic Mannequin
SAM1 and SAM2 was conducted. Design: The two phantoms, SAM1 and SAM2, are placed in a
closed space with metal walls with tree active antennas emitting at 900MHz, EM-RF (mobile com-
munication zone) in the usual phone position (on ear), and the third at 6cm for the nose of SAM1.
On the 2D images after emission is activated we clearly see the generated EM power eld, which
FIGURE 22.1 EMF in closed-space sources activating initializations (158 × 10−12 s).
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

370 Electromagnetic Fields in Biology and Medicine
FIGURE 22.2 The eld on the 543 × 10−12 s of sources activating.
FIGURE 22.3 The propagated electrical eld on the 2084 × 10−12 s of emission activating.
FIGURE 22.4 The same eld dissemination in the whole space volume on the 18455 × 10−12 s of emission
activating.
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

371Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
is virtually almost instantly dispersed, with overlapping zones, signal reverberation from the walls,
and electrical eld point conuences, which monotonically decreased with distance from the source
(Figu res 22.1 through 22.4). The space overload dependence on emission duration and the short
time needed to reach this phenomenon are perfectly recognizable. One more very important visual
detail that has been shown is that, practically, the electro/light section is not unexposed or free of
EMF load zone (Figure 22.4).
22.6.2 evaluaTion of THe cosc ResulTs
For the evaluation of the results, data were statistically analyzed by SPSS 13.0 (for Windows).
The critical level of signicance is α = 0.05.
22.6.3 deMoGRapHic secTion of THe sTudy GRoup
From the 267 examined respondents, 240 were women (90.15%) and 27 men (9.85%). The average
age of the researched personnel was 45.3years (between 22 and 71years), and demographic section
of the group studied is presented in Table 22.2.
The data show that the average length of work experience was 13.8years, with a signicant
number of employees having worked for more than 10years (p < 0.05). The temporary absences
from work for different reasons (maternity, acute infections, operations) did not exceed 17.98% of
the studied occupational group and could not reect the continuity of the staff in the work environ-
ment. The average duration of work in the ELTS was 5.8h, which exceeded the statutory law in
Bulgaria of up to 4h risk-free stay in such an environment. The results were reliable and allowed
for correlation to be conducted.
The sources emitting EMF with which the personnel from ELTS are in contact and are exposed
to are presented in Table 22.3.
In 82.45% of the facilities, the sources of HFTh are placed in shielded compartments; therefore,
in the interpretations this indicator is accepted as available. From the data presented, the objective
results could not describe the contact with sources of HFTh during extended work as dominant,
with 47.53% negative responses (p > 0.05).
The general somatic morbidity and the subnosology analysis (percentage of the main system
nosology) in the group investigated have been presented in a previous publication (Vesselinova
2013a). General morbidity has indicated some unexpected events such as periodontitis to be the
leading focus and photosensibilization and osteoporosis as being signicantly present. Periodontitis,
cardiovascular disturbances, especially arterial hypertension, allergic manifestations, photosensi-
bilization, and musculoskeletal disorders, especially osteoporosis, seem to be the common clinical
manifestations of physiotherapy personnel (equal to or over 30%). Using the condence interval
TABLE 22.2
Presentation of Demographic Section Studied
Assessed Index Validation Average Mean
Age (years) 263 45.3 (22 ÷ 71)
Work experience extent (years) 256 13.8
Duration of stay of personnel
in the ELTS (hours)
203 5.8 (1 ÷ 8)
Absence from work (months) 48 15.7 (2 ÷ 48)
Height (cm) 236 165.27 (155 ÷ 190)
Wight (kg) 237 65.71 (48 ÷ 115)
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

372 Electromagnetic Fields in Biology and Medicine
(CI) method, the relative rate for developing these events in the general active physiotherapy popu-
lation was checked (95% condence in optimistic [<] and pessimistic [>] ranges). Anxiously pes-
simistic ranges (over 30%) were found for periodontitis (47.9%); cardiovascular disorders (47.5%);
allergic manifestations (46.7%); photosensibilization (39.8%); skin diseases (37.0%), among which
were herpes simplex (51.0%) and erythema (35.6%); musculo skeletal disorders (35.5%), among
which was osteoporosis (54.6%), whose optimistic ranges were also high (32.9%) (Table 22.4).
The huge percentage of periodontitis and cases with low mineral bone density opens the ques-
tion of the EMF’s interaction mechanism and its possible interrelationship with manifestation. Only
two aspects of interaction could be proposed: osteoblast suppression and osteoclast stimulation,
and probably vitamin D–induced insufciency due to malabsorption or blockage of absorption
processes.
The EMF’s inuence on the circulatory system is not a surprising nding and its effects on the
studied group were expected. Hypertension (45.05%) can be referred as a positive nding among
the results for increased stress-hormonal levels by EMF radiation, which is suspected as a delete-
rious factor on the cardiovascular system as described in many studies (Bortkiewicz et al. 1995,
Hillman 2005, Vangelova et al. 2006, Vecchia et al. 2009). Bulgarian research among a group
of 52 physiotherapists reported similar effects, witharterial hypertension and metabolite changes
(Israel et al. 2007).
Hypotensive effects are another signicant aspect of vessel microcirculatory reaction after EMF
exposure. Our results showing 33.33% with hypothonia, 11.71% with dystonia, and 22.7% with isch-
emic strokes support the manifestation of this process, described in experiments as a rst response
mainly to low-frequency elds due to vasodilatation (Traikov et al. 2005) or to chronic exposures
to EMF (Grigoriev et al. 2010).
It is interesting to note the distribution and the variations of morbidity in the exposure criteria
of the subgroups. They are formed to observe how occupational nonionizing radiation burden can
interfere with health.
22.6.4 exposed subGRoups
Three exposed subgroups (EsGs) were formed according to the duty obligations of daily work in
the ELTS: Ist EsG ≤ 4h (n = 51% – 19. 1%), IInd EsG > 4h (whole working day, n = 153% –57.3%),
and IIIrd EsG = 0h (personnel without electro/light contact, n = 63 %– 23 .6 %). This way the real
exposure effects (complaint manifestation and further pathology) could be observed. As it is clearly
evident, the group mainly affected is the second subgroup of personnel, whose location of duty is
in the ELTS (Table 22.4).
TABLE 22.3
Apparatuses for Electro/Light Therapy That
Personnel Are in Contact with Simultaneously
Therapeutic Source
Personnel in Contact
Total Percentage
Magnet 193 72.28
Ultrasound 193 72.25
Optical light (visible, UV light) 183 68.52
Radar 178 66.67
High frequency 176 65.87
D’Arsonval 137 51.34
Monochromatic light (laser) 62 23.22
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

373Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
The analysis of the results leads to the conclusion that the rst clinical manifestations of any
disturbances take place almost after 1 year of work (CI 13.1%–22.8%) and most of these are revers-
ible. In female physiotherapists and physiatrists, often the rst signs of interference in the body
are menstrual disturbances (menorrhagia) in the rst 6months of working in specic occupational
EMF conditions in physiotherapy (29.7%). The percentage of miscarriages, which were recorded
in 28.26% of female respondents, goes outside the referent 10%–15% of the general community.
However, it is too difcult to suspect EMF work conditions as the main cause to this nding on this
TABLE 22.4
General Morbidity, Expositional Subgroups (ESG) Distribution, Condence Intervals
and Statistical Signicance
General Morbidity
Percentage
(n = 267)
Condence
Interval
ESG Predilection and Statistical Signicance
Ist EsG IInd EsG IIIrd EsG
≤4h >4h 0h
(%; n = 51) (%; n = 153) (%; n = 63)
Periodontitis 41.95 36.0 47.9 45.1 45.8 30.2
Cardiovascular 41.57 35.7 47.5
Arterial hypertension 45.05 27.45 20.91 6.3
Hypotonia 33.33 11.8 17.0 (p < 0.0001) 7.9
Dystonia 11.71 13.7 3.3 1.6
Stenocardia 5.41
Allergic manifestations 40.82 34.9 46.7 19.6 28.8 9.5
Urticaria 55.0
Severe 45.0
Photosensibilization 34.08 28.4 39.8 29.4 36.6 31.7
Skin diseases 31.50 25.9 37.0 13.7 22.9 12.7
Herpes symplex 40.48 30.0 51.0 11.8 14.4 9.5
Erythema 26.19 16.8 35.6 5.9 11.1 3.2
Staphyloccal infection 14.28 — 5.2 6.3
Musculoskeletal disorders 30.00 24.5 35.5 — — —
Osteoporosis 43.75 32.9 54.6 13.7 15.0 (p < 0.0001) 7.9
Degenerative 32.5 19.6 9.2 3.2
Fractures 21.3 3.9 8.5 (p < 0.0001) 3.2
Excretory system 18.35 13.7 23.0
Kidney diseases 67.3 21.6 10.5 9.5
Other 32.7 3.9 6.5 6.3
Ophthalmology 17.98 13.4 22.6 — —
Inammations 81.3 9.8 19.6 (p < 0.0001) 6.3
Retinopathy 18.8 3.9 3.3 3.2
Endocrinal 13.48 9.4 17.6 MD MD MD
Cerebrovascular 8.24 4.9 11.5 — —
Ins.haemorragicus 45.5 2.0 5.2 (p = 0.010) 1.6
Transitory disturbances 31.8 0 3.9 (p = 0.010) 0
Ins.ischaemicus 22.7 3.9 2 1.6
Peripheral nervous system 6.00 3.1 8.8
Hypestesy 37.5 1.96 2.6 1.6
Neuropathy 37.5 3.9 2.6 0
Hyperestesy 25.0 1.96 0.65 3.2
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

374 Electromagnetic Fields in Biology and Medicine
basis alone; therefore, a correlation with the possible causes was made. Two factors—predominant
contact with HF sources (p = 0.036) and the second EsG’s daily work in the ELTS (p = 0.02 5)—were
statistically signicant for the interruption of pregnancy due to miscarriage. The problem is that in
most cases the rst week of pregnancy are “silent” and no precaution is therefore taken. The data
obtained from offspring’s malformations are difcult to typify by systems because of missing or
incorrectly lled out data in the COSC. Hence, to avoid hyperdiagnosis the rate was calculated on
the total count of female staff (n = 240), and not only on the pregnancies took place (n = 152). The
12 self-reported cases are a serious warning and need further clarication. The medical personnel
in the fertility age should be paid special attention and this pathology has to be set in the observed
professional pathologies.
The question about the neogenesis potential of the EMF is still controversial in the literature
because of the impossibility of setting aside other possible carcinogens nowadays. The conrma-
tory ndings for the prevalence of breast cancer cases among physiotherapy personnel over the
other types not only cause anxiety but could also lead to possible disturbances in hormonal balance.
The second signicant cancer pathology, which we established as the second most prevalent, was
ovarial cancer, which led to the same correlation. As a whole, the possible neogenesis unlocking
in the second EsG has been statistically conrmed (p = 0.033). The established tendency for breast
cancer predominance among neoplasms (10 cases out of 18 with neoplasms per whole group) con-
rmed this EMF predilection burden, as reported in subject-related researches (Coogan et al. 1996,
Demers et al. 1991, Sellman 2007). Disturbances and diseases of the female reproductive system in
the general group by EsG are presented in Table 22.5.
From data obtained from 38.2% of respondents who were smokers, a separate cross-tabulation of
the main disease, whose development could have originated from smoking as an accepted universal
noxious factor, was made and showed independent smoking manifestation (p > 0.05).
The results on neurobehavioral changes are very interesting. Some consistency is noted in the
statistical signicance. Sleep disturbances, irritability, hot waves, headaches, and sudden per-
spiration at work are evidenced for second EsG for sure by “p value” examination (p < 0.0001).
This not only conrms the radio-sickness symptoms’ manifestation in the physiotherapy pro-
fessional group, but also questions the severity of consequences that are obviously caused by
TABLE 22.5
Disturbances and Diseases of the Female Reproductive System, Condence Intervals,
Expositional Subgroups (ESG), Distribution with Statistical Signicance
Reproductive System
Disturbances
Percentage
(n = 240)
Condence
Interval
ESG Predilection and Statistical Signicance
Ist EsG IInd EsG IIIrd EsG
≤ 4h > 4h 0h
(%, n = 51) (%, n = 153) (%, n = 63)
Dysmenorrhoea/as
menstrual disturbance/
20.0 17.1 25.4 19.6 (p < 0.0001) 14.4 3.2
Myoma uteri 15.83 11.2 20.5 15.7 17.0 6.3
Hysterectomy 10.0 6.2 13.8 9.8 9.2 4.8
Miscarriages 28.26% (n = 92) 19.1 37.5 (p = 0.001) (p = 0.001)
Offspring’s malformations 5% 2.2 7.8 2.0 4.6 6.3
Neoplasms 7.5 4.2 10.8 3.9 7.2 (p = 0.033) 7.9
Ca gl.mamme 55.6 2.0 4.6 3.2
Ca ovarii 27.8 3.9 2.0 0
Mel. malignum 11.1 0 1.3 0
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

375Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
body stress and the disturbed ability for relaxation and recovery. The neurobehavioral distur-
bances provide conclusive evidence of the existence of radio-sickness symptoms among this
EMF professional group. These are very important reactions to an exteriorly applied irritant
(low-intensity EMF) (Table 22.6).
22.6.5 MoRbidiTy disTRibuTion in THe exposuRe subGRoups assuMpTion
22.6.5.1 Ist EsG
In this subgroup, which works with EMF sources irregularly and less than 4h per working day,
a prevalent tendency of the association with the following diseases is shown: disturbance in the
menstrual cycle (termed as dysmenorrhea in the questionaire), leyomyoma uteri development,
malignancy of ovarian cancer, cardiovascular disorders—hypertension and dystonia, degenera-
tive diseases of the musculoskeletal system, and kidney diseases; and from the neurobehavioral
interferences—heart palpitations, breathlessness, seizures, heartburns, and changes in libido. Due
to the small number of reported cases of cerebrovascular disorders, peripheral nervous system,
and retinopathy (less than 10% of the studied professional population), we could only express an
TABLE 22.6
Neurobehavioral Disturbances and Compliances, Condence Intervals, Expositional
Subgroups (ESG) Distribution with Statistical Signicance
Neurobehavioral Disturbances
Percentage
(n = 267)
ESG Predilection and Statistical Signicance
Ist EsG IInd EsG IIIrd EsG
≤ 4h > 4h 0h
(%, n = 51) (%, n = 153) (%, n = 63)
Haedache 42.7 23.5 36.6 (p < 0.0001) 17
Faintness
At the end of the working day 40.4 43.1 43.8 30.2
During work hours 13.1 15.7 16.3 3.2
Heart palpitations 34.1 47.1 33.3 25.4
Sleep disturbance
In quality 31.5 25.5 37.9 (p < 0.0001) 17.5
In the duration 21.0 21.6 22.2 (p < 0.0001) 17.5
At falling asleep 18.4 15.7 20.9 (p < 0.0001) 14.3
Nonmotivated mood changes 9.8 19.0 9.5
At the end of the working day 26.6
During work hours 13.5
Irritability
At the end of the working day 26.6 23.5 30.7 (p < 0.0001) 19.0
During work hours 13.5 5.9 18.3 (p < 0.0001) 7.9
Perspiration 25.5 25.5 29.4 15.9
Suddenly at work 13.9 (p < 0.0001)
Breathlessness 13.1 19.6 11.1 12.7
Tremor 9.4 5.9 13.1 3.2
Acrocyanosis 3.4 2 4.6 1.6
Hot waves 22.09 19.6 26.2 (p < 0.0001) 14.3
Libido changes 7.1 11.8 7.2 3.2
Agitation 40.07 5.9 19.6 11.1
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

376 Electromagnetic Fields in Biology and Medicine
assumption of the risk of an increased likelihood of developing ischemic cerebrovascular disorders,
peripheral affecting of the nervous system of the neuropathy type, and retinopathy.
22.6.5.2 IInd EsG
In this group, with the highest level of exposure burden, a prevalence of 79% of the studied indices
is established, associated with the manifestation of skin diseases (herpes and erythema), allergy,
diseases of the musculoskeletal system (bone fractures and osteoporosis), inammations of the
peripheral urinary system, meno- and metrorrhagia, eye inammatory diseases, breast cancer
(and because of limited cases, a tendency to melanoma malignum), circulatory disorders display-
ing hypotension, photosensibilization, headache, sudden perspiration, fatigue (tiredness), tremor,
acrocyanosis, unmotivated mood changes, increased irritability, agitation, feeling of euphoria, and
sleeping problems. Menopause in this EsG covers the largest percentage of women and the addi-
tional data processing in this direction shows a shortening of its age at occurrence: average age
49.5years (between ages of 48 and 51years). We hypothesize and relate this shortness as an attempt
of the body to protect itself from elevated estrogen levels, indirect indications of what we found in
the established morbidity in the investigated group.
Due to the small number of reported cases of cerebrovascular disorders and disorders of the
peripheral nervous system (less than 10% in all three EsG for each nosology) we could only express
an assumption of the risk of an increased likelihood of developing transient and hemorrhagic cere-
brovascular disorders, which has shown a great degree of importance and peripheral hypoesthesia.
Statistical signicance for this group shows that inammatory eye diseases have a prevalence of
p < 0.0001, independent of the limited self-reported cases.
22.6.5.3 IIIrd EsG
This group works outside the ELTS. The main concern is the appearance of a bias of migraine
headache and stomach acids at work. The number of cases of periodontitis, photosensibilization,
and retinopathy among this group are close to the ndings in the two other EsGs, which can be
explained because of the diffused effects of the EMF in the far zone as well as its dissemination in
closed spaces, as was shown in the designed experiment with phantoms SAM1 and SAM2 (Figures
22.1 through 22.4). Due to the small number of reported cases (less than 10% of the studied popu-
lation) we could only express an assumption of the risk of an increased likelihood of developing
staphylococcal infections and hyperesthesia, maybe attributed to the nature of the work of this group
in which personnel come into direct contact with organic materials (patient’s body).
22.6.5.4 Manifestation of Periodontal Disease Is Signicant for All Exposed Subgroups
Analysis of these detailed data shows that all physiotherapy staff are affected to various degrees and
emphasizes the necessity of taking specic measures for prevention to reduce the overexposure risk
among professional groups in an EMF environment.
22.6.6 eMf–MoRbidiTy coRRelaTions
By ANOVA Fisher’s exact test calculation, the EMF–morbidity correlation was studied. The casel-
oad of the ELTS is statistically signicant for causing the development of breast cancer (p = 0.0 06)
and provoking carcinogenesis in general (p = 0.044). The prevalent contact with sources of HFTh is
the cause for the manifestation of photosensibilization (p = 0.013).
22.6.6.1 Cumulative Effect
Around 80% of personnel have over 10years of extended work experience. Many authors specify
this index as one of the crucial factors for reviewing the provoked pathology due to chronic elec-
trostress (Kositsky et al. 2001, Sadchikova and Glotova 1973). The main affected indices in our
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

377Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
study that have major signicance for health are as follows: in general—enhancement of carcino-
genesis potential (p = 0.025) and predisposition to ovarian cancer development (p = 0.027); for the
IIIrd EsG—endocrine disorders (p = 0.036), leomyoma uteri (p = 0.036), and anxiety (p = 0.0 24).
On the cumulation index (length of service >10years), the logistic regression analysis conclusively
shows signicant increase in the risk for development of erythema by about 11 times. Skin problems
such as erythema, hypersensitivity, and herpes simplex were rst described by videodisplay workers
in Norway, and later many researches obtain such conrmatory results from residents or ofce staff
(Arnetz et al. 1997, Johansson and Liu 1995, Leitgeb and Schrottner 2003). Data obtained through
our research show 40.82% for allergies and a non-negligible percentage of physiotherapists with
herpes simplex (14.2%), which can be explained as the EMF’s inuence on immunity (Grigoriev
et al. 2010, Kositsky et al. 2001).
22.7 DISCUSSION
To the best of our knowledge, this rst not only for Bulgaria complex research studying causal
correlations shows that adverse effects caused by chronical low-intensity disparate EMFs on phys-
iotherapy personnel health are well recognizable. The evidenced relation to specic work con-
ditions rst established disorders such as periodontitis, myoma uteri, photosensibilization, and
osteoporosis, as well as the age-shortening of menopause (praecox menopause), which indirectly
elucidates hormonal (estrogen) interference as one of the main mechanisms in pathogenesis, sup-
porting the already recognized effect of EMR for breast cancer, conrmed by us, too. This com-
promise could also have a deeper relation. If we consider observed sleep disturbances in all sleep
components (falling asleep, duration and quality of sleep) in the second EsG, it could be suggested
that the melatonin balance is compromised. As a result, one can understand melatonin’s protec-
tive role against elevated estrogen levels. By Fisher’s exact criteria, statistically signicant causal
relations have been evidenced: ELTS caseload, predominant work with sources of HFTh, external
radiation cofactor existence, and high BMI (p < 0.05). Because specic work conditions are not
only due to the RF component (it is not always a prevalent and permanent factor in daily special-
ized practice), the persisting problem enhancing morbidity is the combined placement and simul-
taneous working of sources at different frequency ranges: low frequency, intermediate frequency,
HF, optic radiation, magnetic eld, with complete stochastic changes in the work environment
(sometimes there is an additional radiating source in the vicinity) which interfere with normal
body functioning. The complicated radiation conditions in ELTS demands measures to reduce
the overexposure burden and to “separate” the diverse frequency interferences by administra-
tive decisions and appropriate new risk-mitigated work ergonomy. The evidence of the enhanced
burden of cumulative and extended work experience elucidates the adversity of long-term, low-
intensity, heterogenous NIR (EM) radiation. The established potential of the enhancement of
carcinogenesis is concerning enough to plead for immediate action of precaution and prevention.
Outside of the boundaries of physiotherapy professional group the established interrelations can
play a key-role in understanding and revealing the nonthermal interactions and bio-activeness of
chronically exposed, low-intensity, frequency nonhomogenous EMFs which occur in recent real
life and are a silent menace with possibly detrimental potential for the living world.
22.8 CONCLUSIONS
In summary, the results of the analyses of personnel health consequences due to factors of physi-
cal medicine undoubtedly show that the specic low-intensity EMF background in clinical phys-
iotherapy practice is an evidenced hazard for personnel health. This is especially convincingly
presented in the results of the rst cause related complex morbidity study. The work exposure situ-
ation is similar wherever physical medicine is practiced integratively. The reported pathology and
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

378 Electromagnetic Fields in Biology and Medicine
symptoms should to be assessed as a need to assemble special precaution and risk communica-
tion without delay. The diseases of the female reproductive system (leiomyoma uteri, miscarriages,
cancer, praecox menopause), the circulatory system (hypertonia), and the musculoskeletal system
(osteoporosis), with the manifestation of periodontitis as well as the typical “radio-sickness,” have
important social signicance in the authors’ knowledge, while other conditions have yet to be con-
rmed by observations in professional pathology. Mobile phone usage in these sections has to be
prohibited not because this might “disturb the generators’ proper work,” as many facilities underline
in their warning, but because it disturbs the exposure climate with adverse effects risk raising for
both personnel and patients. Another less obvious important factor that remains to be realized is the
improvement in the—staff’s “radiation” competence. This will have to be mobilized as a special
part of risk communication, which would be a powerful motivating factor to respect both private
and public occupational electro “hygiene” and discipline. Personal attitude to precaution and pre-
vention can be a big contribution.
Even though the hazards of long-term exposure to low-intensity EMF for physiotherapy person-
nel have been clearly revealed. More efforts are needed to secure protection of both personnel and
patients by legislation changes of regulations of such conditions. The conclusive scientic evidence
of the causal relationship needs to appropriately adapt precaution and prevention. Thereby, the work-
space of physiotherapy personnel will become a safe area to successfully practice the noble medical
profession.
In a century that has faced big human losses because of local military conicts, disasters,
accidents, and terrorism, every safe and healthy member of the society is a victory against the civi-
lization’s monstrous threats of an advanced society so as the catastrophic spread the EMF sources.
ACKNOWLEDGMENTS
For the presentation of the experiment with Specic Anthropomorphic Mannequin SAM1 and
SAM2 to dene and gure out the propagation of the EMF in closed space, I owe my thanks to
Associate Professor Nikolay Atanasov, PhD, Eng. from the College of Telecommunications, Soa,
Bulgaria.
For the investigation of the physiotherapies in Bulgaria, part of my dissertation was realized
with the contribution of Associate Professor Marin Marinkev, PhD, President of the Association of
Physical Medicine and Rehabilitation in Bulgaria (2001–2010), and of Associate Professor Michel
Izrael, PhD, President of the National committee of NIR.
ABBREVIATIONS
COSC complex original survey card
CSWD continuous shortwave diathermy
ELTS electro/light therapy section
EMF electromagnetic eld
EMR electromagnetic radiation
EsG exposed subgroup
EU European Union
HF high frequency
HFTh high-frequency therapy
MF magnetic eld
MRI magnetic resonance imaging
NIR nonionising radiation
PSWD pulsing shortwave diathermy
RF radio frequency
UV ultraviolet
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

379Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
REFERENCES
Adair RK (1991) Constraints on biological effects of weak extremely-low frequency electromagnetic elds.
Phys. Rev. Ann. 43, 1039–1048.
Adey WR (1983) Some fundamental aspects of biological effects of extremely low frequency (ELF). In:
Biological Effects and Dosimetry of Nonionizing Electromagnetic Fields, Grandolfo M, Michaelson,
SM, eds. Plenum, New York, pp. 561–580.
Ahlbom A, E Cardis, A Green, M Linet, D Savitz, A Swerdlow (2001) Review of the epidemiologic literature
on EMR and health: ICNIRP (International Commission for Non-Ionizing Radiation Protection) stand-
ing committee on epidemiology. Environ. Health Perspect. 109(Suppl 6), 911–933.
Aleksiev A (2013) Comparative analysis between electro-analgesia with or without iontophoresis in exacer-
bated low back pain. Phys. Med. Rehabilit. Health J. XII (4), 11–18. (Abstract in English.)
Arnetz BB, M Berg (1996) Melatonin and adrenocorticotropic hormone levels in video display unit workers
during work and leisure. J. Occup. Med. 38, 1108–1110.
Arnetz BB, M Berg, J Arnetz (1997) Mental strain and physical symptoms among employees in modern ofces.
Arch. Environ. Health 52, 63–67.
Basset A (1994) Therapeutical uses of electric and magnetic elds in orthopedics. In: Biological Effects of
Electric and Magnetic Fields, Carpenter DO, Ayrapetyan S, eds. Academic Press, San Diego, CA, Vol. 2,
pp. 13–48.
Beal J, D Fagin (1995) Are you at risk from sick building syndrome? Family Circle, April 25, pp. 70–73.
Becker RO, AA Marino (1982) Electromagnetism and Life. State University of New York Press, Albany, NY,
p. 156.
Bobrakov SN, AG Kartashev (2001) The electromagnetic component of modern urbanized environment. Rad.
Biol. Radioecol. J. 41(6), 706–711. (in Russian.)
Bortkiewicz A, M Zmyslony, C Palczynski, E Gadzicka, S Szmigielski (1995) Dysregulation of autonomic
control of cardiac function in workers at AM broadcasting stations (0.738–1.503 MHz). Electro.
Magnetobiol. 14(3), 177–191.
Commission of the European communities (2000) Communication from the commission on the precautionary
principle, Brussels. http://ec.europa.eu/dgs/health_consumer/library/pub/pub07_en.pdf.
Coogan PF, RW Clapp, PA Newcomb et al. (1996) Occupational exposure to 60-Hertz magnetic elds and risk
of breast cancer. Women Epidemiol. 7, 459–564.
Cromie JE, VJ Robertson, MO Best (2001) Occupational health and safety in physiotherapy: Guidelines for
practice. Aus. J. Physiother. 47, 43–51.
Cromie JE, VJ Robertson, MO Best (2002) Occupational health in physiotherapy: General health and reproduc-
tive outcomes. Aus. J. Physiother. 48, 287–294.
Demers PA, DB Thomas, KA Rosenblatt et al. (1991) Satariano occupational exposure to electromagnetic
elds and breast cancer in men. Am. J. Epidemiol. 134(4), 340–347.
Dimitrova SV (1965) On hygiene in electro-light ofces of physiotherapy departments. Resorts Physiother.
J. II(1), 31–35. (in Bulgarian.)
Final technical report on Occ EMF exposure. EMF-NET: Effects of the exposure to electromagnetic elds:
from science to public health and safer workplace, 2008; D49:44.
Firstenberg A (2001) Radio Wave Packet Cellular Phone Taskforce. September 4.
Goldsmith JR (1997) Epidemiologic evidence relevant to radar (microwave) effects. Environ. Health Perspect.
105, 1579–1587.
Grigoriev YG, OA Grigoriev, AA Ivanov et al. (2010) Conrmation studies of Soviet research on immunologi-
cal effects of microwaves: Russian immunology results. Bioelectromagnetics 31, 589–602.
Habash RWY (2008) Bioeffects and Therapeutic Applications of Electromagnetic Energy. Taylor & Francis
Group, Boca Raton, FL.
Hillman D (2005) Exposure to electric and magnetic elds (EMF) linked to neuro-endocrine stress syndrome:
Increased cardiovascular disease, diabetes and cancer. Shocking News 8, 1–8.
Irving PH (2007) Physics of the Human Body. Springer-Verlag, Berlin, Germany, p. 845.
Ishido M, H Nitta, M Kabuto (2001) Magnetic elds (MF) of 50Hz at 1.2 µT as well as 100 µT cause uncou-
pling of inhibitory pathways of adenylyl cyclase mediated by melatonin 1a receptor in MF-sensitive
MCF-7 cells. Carcinogenesis 22(7), 1043–1048.
Israel M, K Vangelova, M Ivanova (2007) Cardiovascular risk under electromagnetic exposure in physiother-
apy. Environmentalist 27(4), 539–543.
Israel MS, P Tschobanoff (2006) Exposure to non-ionizing radiation of personnel in Physiotherapy. In:
Bioelectromagnetics: Current Concepts, Ayrapetyan SN, Markov MS, eds. Springer. pp. 367–376.
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

380 Electromagnetic Fields in Biology and Medicine
Johansson O, PY Liu (1995) Electrosensitivity, electrosupersensitivity and screen dermatitis: Preliminary
observations from on-going studies in the human skin. In: Proceedings of the COST 244: Biomedical
Effects of Electromagnetic Fields-Workshop on Electromagnetic Hypersensitivity, Simunic D, ed.,
Brusse, Belgium, EU/EC (DG XIII), pp. 52–57.
Karabetsos E, M Basiouka, A Zissimopoulos (2010) Occupational exposure of physical therapists to radio
frequency radiation-the situation in Greece. Workshop on biological effects of electromagnetic
elds. In: Sixth International Workshop on Biological Effects of Electromagnetic Fields, October,
Bodrum, Turkey.
Karpowicz J, Gryz K (2013) An assessment of hazards caused by electromagnetic interaction on humans pres-
ent near short-wave physiotherapeutic devices of various types including hazards for users of electronic
active implantable medical devices (AIMD). BioMed Research International, p. 8. Article ID 150143,
http://dx.doi.org/10.1155/2013/150143
Kositsky NN, AI Nizhelska, GV Ponezha (2001) Inuence of High-frequency Electromagnetic Radiation at
Non-thermal Intensities on the Human Body (A review of work by Russian and Ukrainian researchers)
No Place To Hide—Newsletter of the Cellular Phone Taskforce Inc., 3(1 Suppl), 1–33.
Leitgeb N, J Schrottner (2003) Electrosensibility and electromagnetic hypersensitivity. Bioelectromagnetics
24(6), 387–394.
Lindbom ML, H Taskinen (2000) Reproductive hazards in the work place. In: Women and Health, Goldman
MB and Hatch MC, eds. Academic Press, San Diego, CA, pp. 463–473.
Lindsay R, L Hanson, M Taylor, H McBurney (2008) Workplace stressors experienced by physiotherapists
working in regional public hospitals. Aust. J. Rural Health 16(4), 194–200.
Liss GM, SM Tarlo, J Doherty et al. (2003) Physician diagnosed asthma, respiratory symptoms, and asso-
ciations with workplace tasks among radiographers in Ontario, Canada. Occup. Environ. Med. 60(4),
254–261.
Magnavita N, A Fileni (1994) Occupational risk caused by ultrasound in medicine. Radiol. Med. 88(1–2),
107–111. PMID:8066232 (abstract in English).
Markov DV (2008) Hygienic evaluation and optimization of the electromagnetic environment of modern phys-
iotherapy ofces. PhD degree dissertation, Moscow, Russia. (in Russian.)
Markov MS (2006) Thermal vs. Nonthermal mechanisms of interactions between electromagnetic elds and
biological systems. In: Bioelectromagnetics, Ayrapetyan SN, Markov MS, eds. Springer, pp. 1–15.
Markov MS (2010) Angiogenesis, magnetic elds and “window” effects. Cardiology 117(1), 154–156. DOI
10.1159/000315433.
Markov MS (2011) Nonthermal mechanism of interactions between electromagnetic elds and biological
systems: A calmodulin example. Environmentalist 31, 114–120. DOI 10.1007/s10669-011-9321-1.
Markov MS, Hazlewood CF (2009) Electromagnetic eld dosimetry for clinical application. Environmentalist
29, 161–168.
Michaelson SM (1974) Thermal effects of single and repeated exposures to microwaves—A review. In:
Proceedings of Biological Effects and Health Hazards of Microwave Radiation, Warsaw, Poland, pp. 1–14.
Miclaus S, P Bechet, C Iftode (2010) Near eld radiofrequency measurements for occupational exposure
assessment by personal exposimeter: Possibilities and limitations. In: Proceedings of Sixth International
Workshop on Biological Effects of Electromagnetic Fields, October, Bodrum, Turkey, pp. 10–14.
Nordin NAM, JH Leonard, NC Thye (2011) Work-related injuries among physiotherapists in public hospitals—
A southeast Asian picture. Clinics 66(3), 373–378. DOI 10.1590/S1807-59322011000300002.
Pilla AA, Markov MS (1994) Weak electromagnetic eld bioeffects. Rev. Environ. Health 10, 155–169.
Rasoulia J, R Lekhraj, NM White, ES Flamm, AA Pilla, B Strauch, D Caspera (2012) Attenuation of interleu-
kin-1beta by pulsed electromagnetic elds after traumatic brain injury. Neurosci. Lett. 519, 4–8.
Recent Research on EMF and Health Risks (2007) Fifth Annual Report from SSI: Independent Expert Group
on Electromagnetic Fields, SSI, Rapport, 2008:12.
Sadchikova MN and HW Glotova (1973) Clinic, pathogenesis and disease outcomes radiowave. In Proceedings
of the Laboratory of Radio Frequency Electromagnetic Fields of the Institute of Hygiene and Occupational
Diseases of the USSR Academy of Medical Sciences, 4, pp. 43–48. (in Russian.)
Sarwar Shah SG, A Farrow (2013) Assessment of physiotherapists’ occupational exposure to radiofrequency
electromagnetic elds from shortwave and microwave diathermy devices: A literature review. J. Occup.
Environ. Hygiene 10(6), 312–327. DOI 10.1080/15459624.2013.782203.
Sellman S (2007) Electropollution, Hormones and Cancer NEXUS, August–September, pp. 1–7.
Tarlo SM, GM Liss, JM Greene et al. (2004) Work-attributed symptom clusters (darkroom disease) among
radiographers versus physiotherapists: Associations between self-reported exposures and psychosocial
stressors. Am. J. Ind. Med. 45(6), 513–521.
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

381Long-Term, Low-Intensity, Heterogeneous Electromagnetic Fields
Taskinen H, P Kyyronen, K Hemminki (1990) Effects of ultrasound, shortwaves, and physical exertion on
pregnancy outcome in physiotherapists. J. Epidemiol. Commun. Health 44, 196–201.
Todorov T, Sv. Dimitrova, T Dragiev, V Marinov (1965) Proffesional imparement by medical personnel work-
ing in the area of UHF and MW EMF of the physiotherapy departments. Resorts Physiother. J. II (3),
118–123. (in Bulgarian.)
Tolgskaya MS, ZV Gordon, VV Markov, VS Vorontsov (1987) Change in the secretory activity of the hypo-
thalamus and certain endocrine glands to intermittent and continuous irradiation modalities. Medicine,
Moscow, No. 4, pp. 87–90. (in Russian.)
Traikov I, M Israel (1994) Determining the risk of medical personnel servicing equipment for UHF therapy.
Phys. Resort Rehabilit. Med. J. XXVI(2), 38–40./in Bulgarian/
Traikov L, A Ushiyama, G Lawlor, R Sasaki, K Ohkubo (2005) Subcutaneous Arteriolar Vasomotion Changes
during and after ELF-EMF Exposure in mice in vivo. Environmentalist, 25, 93–101.
Ueno S ed. (1996) Biological Effects of Magnetic and Electromagnetic Fields, 1st edn. Plenum Press,
New York.
Vangelova K, C Deyanov, M Izrael (2006) RF exposure adversely affected cardiovascular system. Int. J. Hyg.
Env. Health 209(2), 133–138.
Vangelova K, M Israel, D Velkova, M Ivanova (2007) Changes in excretion rates of stress hormones in medical
staff exposed to electromagnetic radiation. Environmentalist 27(4), 551–555.
Vecchia P, R Matthes, G Ziegelberger, J Lin, R Saunders, A Swerdlow (2009) Exposure to high frequency elec-
tromagnetic elds, biological effects and health consequences (100 kHz–300 GHz): ICNIRP 16/2009,
ISBN 978-3-934994-10-2.
Vesselinova L (2012a) Electromagnetic elds in clinical practice of physical and rehabilitation medicine: A health
hazard assessment of personnel. Environmentalist 32(2), 249–255. DOI 10.1007/s10669-011-9379-9.
Vesselinova L (2012b) Presentation the complex original survey card for biological effects of the electro-
magnetic elds on physiotherapy medical personnel assessment. Phys. Med. Rehabilit. Health J. XI(2),
20–27. (Abstract in English.)
Vesselinova L (2013a) Biosomatic effects of the electromagnetic elds on view of the physiotherapy personnel
health. EBM J. 32(2), 192–199. DOI 10.3109/15368378.2013.776429.
Vesselinova L (2013b) The bioeffects of the electromagnetic elds on the personnel in the practice the physical
and rehabilitation medicine: A potential for risk mitigation and leading. PhD degree dissertation, MMA,
Soa. (Abstract in English.)
Vesselinova L (2013c) On the risk communication in the wards of physical and rehabilitation medicine. Phys.
Med. Rehabilit. Health J. XII(2), 22–27. (Abstract in English.)
Vesselinova L (2013d) Analysis of the specic exposition background in physical and rehabilitation facilities.
Phys. Med. Rehabilit. Health J. XII(3), 10–18. (Abstract in English.)
Vesselinova L, St. Kovatchev (2013) Constant low-intensive magnetic eld by complications after radical gyn-
aecologic oncology operations (case report). Phys. Med. Rehabilit. Health J. XII(1), 20–24. (Abstract in
English.)
Von Guttenberg Y, JA Spickett (2009) Survey of occupational exposure to blood and body uids in physiothera-
pists in Western Australia. Asia Pac. J. Public Health 21(4), 508–519.
Williams JM (2009). Biological Effects of Microwaves: Thermal and Nonthermal Mechanisms. Basic ISP, CA
94064.
Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016

Downloaded by [Lyubina Vesselinova] at 11:36 14 April 2016