Health complaints related to low-dose environmental exposures : analysis and evaluation of an interdisciplinary environmental medicine pilot project in the Basel area

摘要

BACKGROUND: Over the last decades, adverse effects of the environment on human healthudhave become a major concern both for the scientific community and the general public. Manyudpeople suspect that environmental exposures cause their health problems. According toudsome self-help groups, there are thousands of individuals in Switzerland who are affected byudmultiple chemical sensitivities or electromagnetic hypersensitivity. The number of people whoudbelieve that they are affected, and who will eventually seek medical help and/ or environmentaludcounselling, could thus be an important factor in the availment of health care.udConcerned persons generally either consult their general practitioner or environmentaludprotection agencies responsible for chemical safety or air hygiene. However, both physiciansudand the environmental agencies are hindered by inadequate knowledge of each other's areaudof specialisation. Furthermore, it is well known that psychological factors can contribute toudthe development or maintenance of unspecific health complaints.udAIM: To assess the need, the feasibility and the efficacy of environmental medicineudcounselling in Switzerland. To discuss the implications of the research results for the Swissudhealth care system.udMETHODS: Environmental medicine consultations in general practice were assessed with theudhelp of nearly 250 physicians who participate in the "Swiss Sentinel Surveillance Network". Inud2002, the physicians were asked to record the number of patients who reported healthudproblems attributed to environmental exposures.udDuring 2001, persons who attributed their health problems to environmental exposures wereudcounselled in an interdisciplinary environmental medicine pilot project. Sixty-threeudparticipants, living in the Basel area, had a medical and a psychological-psychiatricudexamination and were visited at home by an environmental hygienist. Electromagnetic fieldud(EMF) measurements were conducted at the homes of 25 participants who attributed theirududhealth complaints specifically to EMF. The results of all the investigations were discussed inudjoint case conferences, and were followed by counselling of the participants. The projectudwas evaluated approximately half a year after participation, using telephone interviews.udRESULTS: Environmental-exposure related consultations in general practice in Switzerlandudwere rare; comprising 0.03 % of all consultations.udThe majority of participants in the environmental medicine project had sought help from audwide range of health care providers before enrolling in the study. Participants had also spentudmore money on health care not covered by health insurance than a representativeud(symptomatic) sample of the population. Presented problems were complex: The proportionudof participants with psychological-psychiatric problems proved to be high; however 40 % ofudparticipants had a plausible theory for the environmental aetiology of at least one of theirudhealth problems. Overall, psychiatric diagnoses did not exclude environmentally causedudsymptoms and vice versa.udThe evaluation of the EMF-cases indicated that few persons were particularly susceptible toudEMF. Legal threshold values for EMF were not exceeded in any of the homes.udMore than a third of the participants reported that they benefited from the project and theirudlong lasting health problems improved following participation.udCONCLUSIONS: The results of the environmental medicine project strongly suggest that onlyudan interdisciplinary structure including medical, psychologic-psychiatric and environmentaludexpertise is likely to be able to adequately diagnose environmental related health problemsudand provide suitable advice to persons who attribute health complaints to environmentaludexposures. Although the proportion of the population affected is low, those affected cannotudobtain adequate advice from existing health care structures. The implementation of anudenvironmental medicine counselling service in the Basel area is currently under discussionud(April 2004).