資料出處 https://www.ncbi.nlm.nih.gov/pubmed/27454111
2016年歐洲EMF指引: EMF相關健康問題和疾病之預防，診斷和治療
慢性疾病和非特異性症狀的疾病正呈上升趨勢。除了在社會和工作環境的慢性壓力，在家中、工作中及休閒活動時的物理性和化學性曝露，是值得由全科醫生以及由醫療衛生界的所有其他成員來關注的因果性或促成性的環境壓力源。現在看來有必要將如“電磁場（EMF）之類的新風險”考慮在風險因子之內。
醫生正日益面臨著越來越多的原因不明的健康問題。研究，經驗觀察和病人報告清楚地表明電磁場暴露與健康問題之間的相互作用。個體易感性和環境因素經常被忽視。
新的無線技術和應用一直引進普及，卻沒有確定他們對健康的影響性(health effect)，因此成為醫藥和社會的新挑戰。例如，所謂的非熱效應和低劑量曝露的潛在長期影響的問題在引入這些技術之前很少被評估考察過。
常見的電磁場或EMF來源：(1)高頻/無線電頻/射頻（RF）（3M~300G Hz）是從電台和電視廣播的天線、Wi-Fi接入點、路由器和客戶端發出的（如智慧型手機/平板電腦/無線電話/一般手機，包括它們的基地台/藍牙設備）。(2)極低頻電場（ELF-EF）和磁場（ELF-MF）（3~3k Hz）是從電線、燈具和一般電器發射出的。(3)非常低頻電場（VLF-EF）和磁場（VLF-MF）（3k~3M Hz），成因是諧波電壓和電流的失真，是從電線、燈（例如緊湊型螢光燈），及電子設備螢幕發射出的。
一方面，有確鑿的證據表明長期暴露於某些電磁場是某些癌症、阿茲海默氏病、和男性不育症的危險因素。在另一方面，新興的電磁波過敏症（EHS）被衛生部門，殘疾管理人員和工作人員的情況下，政治家，以及法庭上越來越多的認可。我們建議在臨床治療的EHS作為組慢性多系統疾病（CMI）的一部分，但仍然認識到潛在的原因仍是環境。
在開始的時候，出現症狀EHS只是偶爾的，但隨著時間的推移，他們可能會頻率和嚴重程度增加。常見EHS的症狀包括頭痛，注意力難以集中，睡眠障礙，抑鬱症，缺乏活力，疲勞和流感樣症狀。
完整的病史，其中應包括在空間和時間方面和EMF暴露的環境中的所有症狀，它們的出現，關鍵是使診斷。 EMF暴露通常是由EMF測試在家庭和工作的評估。某些類型的電磁場暴露可以通過詢問常見的EMF的來源進行評估。取個體易感性考慮這是很重要的。
主要的治療方法應該主要集中在預防或減少電磁場暴露，即減少或消除在家庭和工作場所的高電磁場暴露的所有來源。電磁場暴露的減少也應該擴大到公共場所，如學校，醫院，公共交通和圖書館，以實現讓EHS的人能不受阻礙地使用（可近性量測）。如果能充分降低不利的電磁場暴露，對身體有一定機率恢復，EHS症狀就會減輕，甚至消失。很多例子表明，這些措施可以證明是有效的。
為了提高治療的有效性，與總身體負擔有關的其他廣泛範圍的環境因素也應予以關注/處理。支持衡定(homeostasis)的任一因素將會增加一個人的對抗疾病的復原力/彈性 (resillience)，因此對電磁場的不利影響也較能復原。
有越來越多的證據表明，電磁場對受影響的人的氧化和氮化 (nitrosative) 調節能力產生重大影響。這一概念也許能解釋為什麼EMF的易感性水平可以改變，為什麼EMF暴露下的症狀報告的範圍是如此之大。基於我們目前的了解，『將過氧化亞硝酸鹽(peroxynitrite )的不利影響最小化 的治療取向』是效果最好的 --- 它也越來越多地使用在多系統疾病的治療 。
這份EMF指引給出了目前的知識對EMF相關的健康風險的概述以及EHS的診斷，治療和輔助措施，改善和恢復個人健康狀況，以及為戰略預防的發展提供建議。
資料出處:
Rev Environ Health.(國際期刊論文) 2016 Sep 1;31(3):363-97.
EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses.
Belyaev I, Dean A, Eger H, Hubmann G, Jandrisovits R, Kern M, Kundi M, Moshammer H, Lercher P, Müller K, Oberfeld G, Ohnsorge P, Pelzmann P, Scheingraber C, Thill R.
Abstract
Chronic diseases and illnesses associated with non-specific symptoms are on the rise. In addition to chronic stress in social and work environments, physical and chemical exposures at home, at work, and during leisure activities are causal or contributing environmental stressors that deserve attention by the general practitioner as well as by all other members of the health care community. It seems necessary now to take "new exposures" like electromagnetic fields (EMF) into account. Physicians are increasingly confronted with health problems from unidentified causes. Studies, empirical observations, and patient reports clearly indicate interactions between EMF exposure and health problems. Individual susceptibility and environmental factors are frequently neglected. New wireless technologies and applications have been introduced without any certainty about their health effects, raising new challenges for medicine and society. For instance, the issue of so-called non-thermal effects and potential long-term effects of low-dose exposure were scarcely investigated prior to the introduction of these technologies. Common electromagnetic field or EMF sources: Radio-frequency radiation (RF) (3 MHz to 300 GHz) is emitted from radio and TV broadcast antennas, Wi-Fi access points, routers, and clients (e.g. smartphones, tablets), cordless and mobile phones including their base stations, and Bluetooth devices. Extremely low frequency electric (ELF EF) and magnetic fields (ELF MF) (3 Hz to 3 kHz) are emitted from electrical wiring, lamps, and appliances. Very low frequency electric (VLF EF) and magnetic fields (VLF MF) (3 kHz to 3 MHz) are emitted, due to harmonic voltage and current distortions, from electrical wiring, lamps (e.g. compact fluorescent lamps), and electronic devices. On the one hand, there is strong evidence that long-term exposure to certain EMFs is a risk factor for diseases such as certain cancers, Alzheimer's disease, and male infertility. On the other hand, the emerging electromagnetic hypersensitivity (EHS) is more and more recognized by health authorities, disability administrators and case workers, politicians, as well as courts of law. We recommend treating EHS clinically as part of the group of chronic multisystem illnesses (CMI), but still recognizing that the underlying cause remains the environment.
In the beginning, EHS symptoms occur only occasionally, but over time they may increase in frequency and severity. Common EHS symptoms include headaches, concentration difficulties, sleep problems, depression, a lack of energy, fatigue, and flu-like symptoms. A comprehensive medical history, which should include all symptoms and their occurrences in spatial and temporal terms and in the context of EMF exposures, is the key to making the diagnosis.
The EMF exposure is usually assessed by EMF measurements at home and at work. Certain types of EMF exposure can be assessed by asking about common EMF sources. It is very important to take the individual susceptibility into account. The primary method of treatment should mainly focus on the prevention or reduction of EMF exposure, that is, reducing or eliminating all sources of high EMF exposure at home and at the workplace. The reduction of EMF exposure should also be extended to public spaces such as schools, hospitals, public transport, and libraries to enable persons with EHS an unhindered use (accessibility measure). If a detrimental EMF exposure is reduced sufficiently, the body has a chance to recover and EHS symptoms will be reduced or even disappear. Many examples have shown that such measures can prove effective. To increase the effectiveness of the treatment, the broad range of other environmental factors that contribute to the total body burden should also be addressed. Anything that supports homeostasis will increase a person's resilience against disease and thus against the adverse effects of EMF exposure. There is increasing evidence that EMF exposure has a major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best.
This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention. PMID: 27454111 DOI: 10.1515/reveh-2016-0011
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