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Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: In the last decade, at the conclusion of some civil proceedings concerning appeals against INAIL (the Italian workers' compensation authority), some Italian courts have recognised the occupational origin of tumours in workers exposed to radiofrequency electromagnetic fields (RF EMFs) emitted by wireless phones, despite the fact that a causal role of electromagnetic fields in oncogenesis has not been demonstrated. In some cases, workers' exposures were combined with those due to other RF EMF sources or with exposures to extremely low frequency magnetic fields (ELF MFs). For the sake of completeness, the case of exposure of a worker to ELF MFs only is also considered. These judgements have been widely covered by the media which, on the contrary, have virtually ignored those in which the causal link between occupational exposure to electromagnetic fields and tumours has not been recognised. The author of this communication is aware of two of these "negative" judgements in that he was, in both cases, one of the court-appointed expert witnesses. A key point to understand the scientific bases for the Judges' decisions is how the IARC classifications of ELF magnetic fields (ELF MFs) and radio frequency electromagnetic fields (RF EMFs) as "possibly carcinogenic to humans", and more generally the body of scientific evidence on electromagnetic fields and tumours, have been taken into account in the judgements and court- appointed expert witnesses' reports. The 2009 judgement of the Court of Appeal of Brescia preceded the IARC classification of radio frequency electromagnetic fields in 2011. The judgement of Brescia was confirmed by the Court of Cassation in 2012, but since the Court of Cassation decides on the legitimacy of the judgements without entering into their merits, the fact that this decision was taken after the IARC classification is irrelevant. All other judgements, subsequent to the publication of the IARC monographs, cited the IARC classifications. The bases for the two "negative" judgements of the Courts of Cremona and Milan were as follows: 1) when an agent is classified as "possibly carcinogenic to humans", a causal link between exposure and cancer has not been generally demonstrated, therefore 2) it is not possible to conclude that a tumour was "more likely than not" (as required in civil litigation (4) ), caused by the agent in question whatever the worker's level of exposure. On the contrary, the court appointed expert witnesses' report on the Ivrea proceeding states that "in the present case there is an association between a rare tumour and an exposure as rare as the use since 1995 of high-emission cellular telephony. The rarity of the circumstance is indicative of a causal association". This and other arguments underlying the "positive" judgements., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

The use of ultrasounds in medicine requires, like all physical agents potentially harmful to human health, an accurate assessment of the risks to the health of patients. The nature and extent of these risks depend on exposure levels which in turn are differentiated according to the specific diagnostic or therapeutic applications. Intermediate exposure levels are associated to physiotherapic applications. To analyze specific issues relating to the effectiveness and safety of physiotherapic treatments, a review of the scientific literature and technical standards was carried out. At present, the actual effectiveness of ultrasound physiotherapy is still far from being clearly assessed: further clinical and experimental studies are needed in order to optimize therapies, determining the benefits and risks of treatments and deepening the understanding of the action mechanisms of the physical agent, even on the basis of a better characterization of those physical quantities mostly significant for biological effects. The examination of technical standards defining the security requirements of the equipment allowed the identification of some critical issues; on these bases some proposals are suggested for the improvement of quality and safety of treatments.

Objective: To investigate cause-specific mortality in a population exposed to high levels of 50 Hz magnetic fields, in a district of Rome., Design: A cohort of 357 subjects that are resident in an area of about 100 meters on the two sides of a 60 kV power line was studied. Exposure to 50 Hz magnetic fields was evaluated by spot and long-term measurements and by adopting a model based on current load, characteristics of the line and distance of dwellings from conductors. The mortality experience of the cohort was observed from January 1st, 1980 through December 31st, 2003. Analysis took into account duration of residence and latency. Separate analyses were performed for three subcohorts characterized by different distances from the line and different estimated and measured field levels., Main Outcomes: Cause-specific standardized mortality ratios (SMRs) were computed comparing the observed number of deaths with the corresponding expected figures derived from the Latium Region mortality rates. This was done both in the overall cohort and in the subcohorts., Results: All-causes mortality of the cohort did not differ from expected values (SMR 0.99; 95% CI 0.73-1.35; 40 observed). All cancers mortality showed a non-significant increase (SMR 1.34; 95% CI 0.82-2.18; 16 observed), that reached statistical significance in the analyses limited to subjects with more than 30 years of residence (SMR 2.09; 95% CI 1.05-4.19; 8 observed). Mortality from lymphohaematopoietic malignancies was increased, based on two cases of leukemia. All cancers mortality was highest in the subcohort closest to the power line and exposed to highest levels of magnetic fields. An increased risk for digestive tract neoplasms (SMR 3.57; 95% CI 1.49-8.58; 5 observed) was observed, which was mainly caused by pancreatic cancer., Discussion and Conclusion: Some increase in mortality of the overall cohort and especially of the highly exposed sub cohort was detected, notwithstanding the low power of the study. Other studies are currently on-going in the same area: a cross-sectional investigation on health status, an analysis of hospital discharge cards, a project for estimating individual exposure levels and a research in veterinary epidemiology. It is recommended to replicate the present study in areas presenting similar exposure patterns, in order to be able to pool data with the aim of estimating risk associated with the exposure levels of interest.