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There is a need to measure and improve the quality of paediatric primary care in Europe where major differences in the delivery and outcomes of child health care exist. A collaborative panel of paediatric senior experts developed a Core Set of Indicators for Paediatric Primary Care in Europe by compiling 42 quality indicators in a modified consensus process following the RAND/UCLA appropriateness method. The aim of this study was to explore the feasibility of the quality indicator set in European paediatric primary care practices. Seventy-nine practices from eight countries participated in a detailed online interview. The practices rated the applicability, relevance, reliability and acceptance of the 42 quality indicator as well as the availability, technical feasibility and effort to retrieve the needed data from their medical records. Most quality indicators were considered applicable, available, reliable, acceptable and relevant for monitoring quality of care in paediatric primary care. Respondents rated feasibility and effort to retrieve the data lowest because of difficulties collecting the data from the medical records.Conclusion: European paediatric primary care practices generally agree with the proposed quality indicator set. They document most of the parameters. However, the collection of specific needed values from available routine patient-data is considered technically difficult and time-consuming. What is Known? • Paediatric primary care systems in Europe show striking differences in their performance. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. • A Core Set of 42 quality indicators for paediatric primary care in Europe was developed by European paediatricians using a systematic literature review and a consensus process following a modified RAND/UCLA appropriateness method. What is New? • Paediatric primary care providers in Europe agree with the idea to use COSI-PPC-EU to monitor and improve the quality of care. The set was considered applicable, available, reliable, acceptable, and relevant for quality improvement. • The score for feasibility and effort to retrieve the data was low, because of technical reasons; the electronical or paper-based medical documentation in most cases does not allow convenient access to all necessary data. [ABSTRACT FROM AUTHOR]

We explored the associations of occupational exposure to extremely low-frequency magnetic fields (ELF-MF) and electric shocks with the risk of amyotrophic lateral sclerosis (ALS) in a pooled case-control study (European Multidisciplinary ALS Network Identification to Cure Motor Neurone Degeneration (Euro-MOTOR)) of data from 3 European countries. ALS patients and population-based controls were recruited in Ireland, Italy, and the Netherlands between 2010 and 2015. Lifetime occupational and lifestyle histories were obtained using structured questionnaires. We applied previously developed job exposure matrices assigning exposure levels to ELF-MF and potential for electric shocks. Odds ratios and 95% confidence intervals were estimated by means of logistic regression for exposure to either ELF-MF or electric shocks, adjusted for age, sex, study center, education, smoking, and alcohol consumption and for the respective other exposure. Complete occupational histories and information on confounding variables were available for 1,323 clinically confirmed ALS cases and 2,704 controls. Both ever having had exposure to ELF-MF above the background level (odds ratio = 1.16, 95% confidence interval: 1.01, 1.33) and ever having had potential exposure above background for electric shocks (odds ratio = 1.23, 95% confidence interval: 1.05, 1.43) were associated with ALS. Adjustment for the respective other exposure resulted in similar risk estimates. Heterogeneity in risks across study centers was significant for both exposures. Our findings support possible independent associations of occupational exposure to ELF-MF and electric shocks with the risk of ALS. [ABSTRACT FROM AUTHOR]

Data are reported from SPD503-318, a phase 3, open-label, safety study of guanfacine extended release (GXR) in European children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants received dose-optimized GXR (1-7 mg/day) for up to 2 years. Of 215 enrolled participants, 214 were included in the safety population and 133 completed the study. Participants’ mean age was 11.7 years and 73.8% were male. Overall, 177 participants (82.7%) experienced a treatment-emergent adverse event (TEAE). TEAEs reported in at least 10% of participants were somnolence (36.0%), headache (28.5%), fatigue (20.1%), and nasopharyngitis (11.7%). Serious TEAEs were reported in 4.7% of participants and TEAEs leading to discontinuation were reported in 3.3% of participants. There were no deaths. Mean z-scores for BMI were stable throughout the study. The incidence of sedative TEAEs (somnolence, sedation, and hypersomnia) peaked during week 3 and decreased thereafter. Small changes from baseline to the final assessment in mean supine pulse [− 5.5 bpm (standard deviation, 12.98)] and blood pressure [systolic, 0.6 mmHg (9.32); diastolic, 0.2 mmHg (9.17)] were reported. ADHD symptoms initially decreased and remained significantly lower than baseline at study endpoint. At the final assessment, the mean change in ADHD-RS-IV total score from baseline was − 19.8 (standard error of mean, 0.84; nominal p < 0.0001). In conclusion, GXR was well tolerated and more than 60% of participants completed the 2-year study. [ABSTRACT FROM AUTHOR]

We explore a new method to retrieve seasonal glacier mass balances (MBs) from low-resolution optical remote sensing. We derive annual winter and summer snow maps of the Alps during 1998–2014 using SPOT/VEGETATION 1 km resolution imagery. We combine these seasonal snow maps with a DEM to calculate a ‘mean regional’ altitude of snow (Z) in a region surrounding a glacier. Then, we compare the interannual variation of Z with the observed winter/summer glacier MB for 55 Alpine glaciers over 1998–2008, our calibration period. We find strong linear relationships in winter (mean R2 = 0.84) and small errors for the reconstructed winter MB (mean RMSE = 158 mm (w.e.) a−1). This is lower than errors generally assumed for the glaciological MB measurements (200–400 mm w.e. a−1). Results for summer MB are also satisfying (mean R2 and RMSE, respectively, 0.74 and 314 mm w.e. a−1). Comparison with observed seasonal MB available over 2009–2014 (our evaluation period) for 19 glaciers in winter and 13 in summer shows good agreement in winter (RMSE = 405 mm w.e. a−1) and slightly larger errors in summer (RMSE = 561 mm w.e. a−1). These results indicate that our approach might be valuable for remotely determining the seasonal MB of glaciers over large regions. [ABSTRACT FROM PUBLISHER]

The article presents a study which examines the mass balance and ice volume change in glaciers in European Alps from 1900 to 2011. The study performs mass balance extrapolation on data obtained from world glacier monitoring services (WGMS) and field data and modeling for glaciers in France, Austria, and Italy. Result shows that European Alps have mean glacier mass balance of -0.31 ± 0.04 meter w.e. -1 in 1900-2011.

We discuss potential transitions of six climatic subsystems with large-scale impact on Europe, sometimes denoted as tipping elements. These are the ice sheets on Greenland and West Antarctica, the Atlantic thermohaline circulation, Arctic sea ice, Alpine glaciers and northern hemisphere stratospheric ozone. Each system is represented by co-authors actively publishing in the corresponding field. For each subsystem we summarize the mechanism of a potential transition in a warmer climate along with its impact on Europe and assess the likelihood for such a transition based on published scientific literature. As a summary, the 'tipping' potential for each system is provided as a function of global mean temperature increase which required some subjective interpretation of scientific facts by the authors and should be considered as a snapshot of our current understanding. [ABSTRACT FROM AUTHOR]

The contribution of glaciers to runoff from large-scale drainage basins in Europe is analyzed for the major streams originating in the Alps: Rhine, Rhone, Po, and Danube. Detailed information on glacier storage change is available from monthly mass balance data of 50 Swiss glaciers for the period 1908-2008. Storage changes are extrapolated to all glaciers in the European Alps. By comparing monthly runoff yields from glacierized surfaces in the summer months with measured runoff at gauges along the entire length of the streams, the relative portion of water from glacier storage change for each month is calculated. Macroscale drainage basins with a size of 100,000 km2 (1% ice-covered) can show a 25% contribution of glaciers to August runoff over the last century. In the lower Danube (0.06% glacierization) glacier meltwater accounts for 9% of observed runoff in September of the extreme year 2003. The relative importance of glacier contribution to runoff does not scale linearly with the percentage of glacierization, as high glacier runoff in summer dominates lowland areas with little precipitation and high evapotranspiration. Thus, glacial meltwaters are relevant to the hydrological regime of macroscale watersheds and do not only have a regional impact. By transiently modeling future glacier retreat until 2100 using climate scenarios, a reduction of glacierized areas in the Alps to 12% of the current value is found. In consequence, summer runoff contribution from currently glacierized basins will be strongly reduced, intensifying issues with water shortage in summer also in poorly glacierized catchments. [ABSTRACT FROM AUTHOR]

We present a multisite analysis of the relationship between plant diversity and ecosystem functioning within the European BIODEPTH network of plant-diversity manipulation experiments. We report results of the analysis of 11 variables addressing several aspects of key ecosystem processes like biomass production, resource use (space, light, and nitrogen), and decomposition, measured across three years in plots of varying plant species richness at eight different European grassland field sites. Differences among sites explained substantial and significant amounts of the variation of most of the ecosystem processes examined. However, against this background of geographic variation, all the aspects of plant diversity and composition we examined (i.e., both numbers and types of species and functional groups) produced significant, mostly positive impacts on ecosystem processes. Analyses using the additive partitioning method revealed that complementarity effects (greater net yields than predicted from monocultures due to resource partitioning, positive interactions, etc.) were stronger and more consistent than selection effects (the covariance between monoculture yield and change in yield in mixtures) caused by dominance of species with particular traits. In general, communities with a higher diversity of species and functional groups were more productive and utilized resources more completely by intercepting more light; taking up more nitrogen, and occupying more of the available space. Diversity had significant effects through both increased vegetation cover and greater nitrogen retention by plants when this resource was more abundant through N2 fixation by legumes. However, additional positive diversity effects remained even after controlling for differences in vegetation cover and for the presence of legumes in communities. Diversity, effects were stronger on above- than belowground processes. In particular, clear diversity effects on decomposition were only observed at one of the eight sites. The ecosystem effects of plant diversity also varied between sites and years. In general, diversity effects were lowest in the first year and stronger later in the experiment, indicating that they were not transitional due to community establishment. These analyses of our complete ecosystem process data set largely reinforce our previous results, and those from comparable biodiversity experiments, and extend the generality of diversity-ecosystem functioning relationships to multiple sites, years, and processes. [ABSTRACT FROM AUTHOR]

Summary 1. To study the potential for complementarity in nitrogen acquisition from different soil depths, we injected an isotope tracer (15 NH4 Cl) at 5 and 20 cm depths in plant communities containing Achillea millefolium L. and Festuca ovina L. or Phleum pratense L. and Trifolium pratense L. in monocultures and two-species mixtures. 2. In monoculture, Festuca and Phleum took up tracer at 5 and 20 cm depths. In contrast, Achillea and Trifolium monocultures acquired the tracer mainly from 5 cm depth. In two-species mixtures, all four species took up tracer at 5 cm depth. 3. Achillea N acquisition from 20 cm depth increased in mixture with Festuca in comparison to that in monoculture; Festuca N acquisition from 20 cm depth decreased, although not significantly. Trifolium N acquisition remained unchanged when grown in mixture with Phleum . Phleum behaved like Festuca: its N acquisition from 20 cm depth in mixture was reduced in comparison to monoculture. 4. Our data on Festuca and Achillea support spatial partitioning in resource acquisition. This was not evident in Phleum and Trifolium mixture, potentially because Trifolium relied on N2 fixation as N source. 5. These results demonstrate spatial variation among plant species and plant communities in their N acquisition in the field. [ABSTRACT FROM AUTHOR]

Studies the uptake of glycine in four plants common in grasslands in northern Europe. Comparison with the uptake of ammonium and nitrate; Uptake of nitrogen from different sources.

Food-web indicators for marine management are required to describe the functioning and structure of marine food-webs. In Europe, the Marine Strategy Framework Directive (MSFD), intended to lead to a 'good environmental status' of the marine waters, requires indicators of the status of the marine environment that also respond to manageable anthropogenic pressures. Identifying such relationships to pressures is particularly challenging for food-web indicators, as they need to be disentangled from linkages between indicators of different functional groups caused by species interactions. Still, such linkages have not been handled in the indicator development. Here we used multivariate autoregressive time series models to identify how fish indicators in an exploited food-web relate to fishing, climate and eutrophication, while accounting for the linkages between indicators caused by species interactions. We assembled 31-year long time series of indicators of key functional groups of fish in the Central Baltic Sea pelagic food-web, which is characterized by strong trophic links between cod (Gadus morhua) and its main fish prey sprat (Sprattus sprattus) and herring (Clupea harengus). These food-web indicators were either abundance-based indicators of key piscivores (cod) and zooplanktivores (sprat and herring) or size-based indicators of the corresponding trophic groups (biomass of large predatory fish (cod ≥ 38 cm) and biomass of small prey fish (sprat and herring <10 cm)). Comparative analyses of models with and without linkages among indicators showed that for both types of indicators, linkages corresponding to predator-prey feedbacks and intra-specific density-dependence were essential to explain temporal variation in the indicators. Thus, no indicator-pressure relationships could be found that explained the indicators' variation unless such linkages were accounted for. When accounting for these, we found that the indicators overall respond to multiple pressures acting simultaneously rather than to single pressures, as no pressure alone could explain how the indicators developed over time. The manageable pressures fishing and eutrophication, as well as the prevailing hydrological conditions influenced by climate, were all needed to reproduce the inter-annual changes in these food-web indicators combined, although individual relationships differed between the indicators. We conclude that our innovative indicator-testing framework can therefore be used to identify responses of food-web indicators to manageable pressures while accounting for the biotic interactions in food-webs linking such indicators. [ABSTRACT FROM AUTHOR]

Abstract: Background: Concerns of the general public about potential adverse health effects caused by radio-frequency electromagnetic fields (RF-EMFs) led authorities to introduce precautionary exposure limits, which vary considerably between regions. It may be speculated that precautionary limits affect the base station network in a manner that mean population exposure unintentionally increases. Aims: The objectives of this multicentre study were to compare mean exposure levels in outdoor areas across four different European cities and to compare with regulatory RF-EMF exposure levels in the corresponding areas. Methods: We performed measurements in the cities of Amsterdam (the Netherlands, regulatory limits for mobile phone base station frequency bands: 41–61V/m), Basel (Switzerland, 4–6V/m), Ghent (Belgium, 3–4.5V/m) and Brussels (Belgium, 2.9–4.3V/m) using a portable measurement device. Measurements were conducted in three different types of outdoor areas (central and non-central residential areas and downtown), between 2011 and 2012 at 12 different days. On each day, measurements were taken every 4s for approximately 15 to 30min per area. Measurements per urban environment were repeated 12 times during 1year. Results: Arithmetic mean values for mobile phone base station exposure ranged between 0.22V/m (Basel) and 0.41V/m (Amsterdam) in all outdoor areas combined. The 95th percentile for total RF-EMF exposure varied between 0.46V/m (Basel) and 0.82V/m (Amsterdam) and the 99th percentile between 0.81V/m (Basel) and 1.20V/m (Brussels). Conclusions: All exposure levels were far below international reference levels proposed by ICNIRP (International Commission on Non-Ionizing Radiation Protection). Our study did not find indications that lowering the regulatory limit results in higher mobile phone base station exposure levels. [Copyright &y& Elsevier]

Introduction: ADHD is often unrecognised and untreated, particularly in Europe. There is a need for improved understanding of ADHD in adults and its impact on patients across the lifespan. Registries allow for multiple real-world comparisons based on assessment of patients that are typically excluded from clinical studies. Data describing the cost, burden and consequences of ADHD are essential to inform clinicians, regulatory agencies, payers and patients about the condition. Objectives: To address the gaps in our current understanding of the care and cost of treating adult patients with ADHD by documenting real-life experiences. Methods: A prospective, longitudinal, observational study of adults >18 years with ADHD, designed to follow 2500 patients in the USA, UK, Germany, The Netherlands and Canada for a minimum of 5 years. In year one, patients will be asked questions regarding: the impact of childhood diagnosis and/or treatment on adult ADHD, long- and short-term treatment patterns and their consequences, differences between ADHD treatments, the relationship between disease severity and compliance with treatment, increased tendency to risk behaviour/substance abuse, costs. In subsequent years, topics may be expanded to include the transition into adulthood and healthcare access for young adults. Results: Ten sites are currently recruiting, with 45 patients enrolled up to 7 October 2010. Challenges associated with initiating a global registry in North America and Europe will be discussed. Conclusion: Data generated from CLEAR will help improve the global understanding of the longitudinal impact of ADHD. Supported by Shire Development, Inc. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in the exposome have been found to be complex and highly context-specific, but studies have not been conducted in large population-wide cohorts from multiple countries. This study aims to examine the external exposome, encompassing individual and environmental factors influencing health over the life course, and to perform dimension reduction to derive interpretable characterization of the external exposome for multicountry epidemiological studies. Analyzing data from over 25 million individuals across seven European countries including 12 administrative and traditional cohorts, we utilized domain-specific principal component analysis (PCA) to define the external exposome, focusing on air pollution, the built environment, and air temperature. We conducted linear regression to estimate the association between individual- and area-level socioeconomic position and each domain of the external exposome. Consistent exposure patterns were observed within countries, indicating the representativeness of traditional cohorts for air pollution and the built environment. However, cohorts with limited geographical coverage and Southern European countries displayed lower temperature variability, especially in the cold season, compared to Northern European countries and cohorts including a wide range of urban and rural areas. The individual- and area-level socioeconomic determinants (i.e., education, income, and unemployment rate) of the urban exposome exhibited significant variability across the European region, with area-level indicators showing stronger associations than individual variables. While the PCA approach facilitated common interpretations of the external exposome for air pollution and the built environment, it was less effective for air temperature. The diverse socioeconomic determinants suggest regional variations in environmental health inequities, emphasizing the need for targeted interventions across European countries.

Current farm systems rely on the use of Plant Protection Products (PPP) to secure high productivity and control threats to the quality of the crops. However, PPP use may have considerable impacts on human health and the environment. A study protocol is presented aiming to determine the occurrence and levels of PPP residues in plants (crops), animals (livestock), humans and other non-target species (ecosystem representatives) for exposure modelling and impact assessment. To achieve this, we designed a cross-sectional study to compare conventional and organic farm systems across Europe. Environmental and biological samples were/are being/will be collected during the 2021 growing season, at 10 case study sites in Europe covering a range of climate zones and crops. An additional study site in Argentina will inform the impact of PPP use on growing soybean which is an important European protein-source in animal feed. We will study the impact of PPP mixtures using an integrated risk assessment methodology. The fate of PPP in environmental media (soil, water and air) and in the homes of farmers will be monitored. This will be complemented by biomonitoring to estimate PPP uptake by humans and farm animals (cow, goat, sheep and chicken), and by collection of samples from non-target species (earthworms, fish, aquatic and terrestrial macroinvertebrates, bats, and farm cats). We will use data on PPP residues in environmental and biological matrices to estimate exposures by modelling. These exposure estimates together with health and toxicity data will be used to predict the impact of PPP use on environment, plant, animal and human health. The outcome of this study will then be integrated with socio-economic information leading to an overall assessment used to identify transition pathways towards more sustainable plant protection and inform decision makers, practitioners and other stakeholders regarding farming practices and land use policy., Competing Interests: The authors have declared that no competing interests exist.

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) from mobile communication technologies is changing rapidly. To characterize sources and associated variability, we studied the differences and correlations in exposure patterns between children aged 8 to 18 and their parents, over the course of the day, by age, by activity pattern, and for different metrics of exposure., Methods: Using portable RF-EMF measurement devices, we collected simultaneous real-time personal measurements of RF-EMF over 24 to 72 h in 294 parent-child pairs from Denmark, the Netherlands, Slovenia, Switzerland, and Spain. The devices measured the power flux density (mW/m 2 ) in 16 different frequency bands every 4 s, and activity diary Apps kept by the participants were used to collect time-activity information in real-time. We analyzed their exposures by activity, for the different source constituents of exposure: downlink (radiation emitted from mobile phone base stations), uplink (transmission from phone to base station), broadcast, DECT (digital enhanced cordless telecommunications) and Wi-Fi. We looked at the correlations between parents and children overall, during day (06:00-22.00) and night (22:00-06:00) and while spending time at home., Results: The mean of time-weighted average personal exposures was 0.16 mW/m 2 for children and 0.15 mW/m 2 for parents, on average predominantly originating from downlink sources (47% for children and 45% for parents), followed by uplink (18% and 27% respectively) and broadcast (25% and 19%). On average, exposure for downlink and uplink were highest during the day, and for Wi-Fi and DECT during the evening. Exposure during activities where most of the time is spent (home, school and work) was relatively low whereas exposure during travel and outside activities was higher. Exposure to uplink increased with age among young people, while DECT decreased slightly. Exposure to downlink, broadcast, and Wi-Fi showed no obvious trend with age. We found that exposure to total RF-EMF is correlated among children and their parents (R spearman  = 0.45), especially while at home (0.62) and during the night (0.60). Correlations were higher for environmental sources such as downlink (0.57) and broadcast (0.62) than for usage-related exposures such as uplink (0.29)., Conclusion: The generation gap between children and their parents is mostly evident in uplink exposure, due to more and longer uplink and cordless phone calls among parents, and their tendency to spend slightly more time in activities with higher environmental RF-EMF exposure, such as travel. Despite these differences in personal behavior, exposure to RF-EMF is moderately correlated between children and their parents, especially exposures resulting from environmental RF-EMF sources., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) has rapidly increased and little is known about exposure levels in children. This study describes personal RF-EMF environmental exposure levels from handheld devices and fixed site transmitters in European children, the determinants of this, and the day-to-day and year-to-year repeatability of these exposure levels., Methods: Personal environmental RF-EMF exposure (μW/m 2 , power flux density) was measured in 529 children (ages 8-18 years) in Denmark, the Netherlands, Slovenia, Switzerland, and Spain using personal portable exposure meters for a period of up to three days between 2014 and 2016, and repeated in a subsample of 28 children one year later. The meters captured 16 frequency bands every 4 s and incorporated a GPS. Activity diaries and questionnaires were used to collect children's location, use of handheld devices, and presence of indoor RF-EMF sources. Six general frequency bands were defined: total, digital enhanced cordless telecommunications (DECT), television and radio antennas (broadcast), mobile phones (uplink), mobile phone base stations (downlink), and Wireless Fidelity (WiFi). We used adjusted mixed effects models with region random effects to estimate associations of handheld device use habits and indoor RF-EMF sources with personal RF-EMF exposure. Day-to-day and year-to-year repeatability of personal RF-EMF exposure were calculated through intraclass correlations (ICC)., Results: Median total personal RF-EMF exposure was 75.5 μW/m 2 . Downlink was the largest contributor to total exposure (median: 27.2 μW/m 2 ) followed by broadcast (9.9 μW/m 2 ). Exposure from uplink (4.7 μW/m 2 ) was lower. WiFi and DECT contributed very little to exposure levels. Exposure was higher during day (94.2 μW/m 2 ) than night (23.0 μW/m 2 ), and slightly higher during weekends than weekdays, although varying across regions. Median exposures were highest while children were outside (157.0 μW/m 2 ) or traveling (171.3 μW/m 2 ), and much lower at home (33.0 μW/m 2 ) or in school (35.1 μW/m 2 ). Children living in urban environments had higher exposure than children in rural environments. Older children and users of mobile phones had higher uplink exposure but not total exposure, compared to younger children and those that did not use mobile phones. Day-to-day repeatability was moderate to high for most of the general frequency bands (ICCs between 0.43 and 0.85), as well as for total, broadcast, and downlink for the year-to-year repeatability (ICCs between 0.49 and 0.80) in a small subsample., Conclusion: The largest contributors to total personal environmental RF-EMF exposure were downlink and broadcast, and these exposures showed high repeatability. Urbanicity was the most important determinant of total exposure and mobile phone use was the most important determinant of uplink exposure. It is important to continue evaluating RF-EMF exposure in children as device use habits, exposure levels, and main contributing sources may change., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Electric shocks have been suggested as a potential risk factor for neurological disease, in particular for amyotrophic lateral sclerosis. While actual exposure to shocks is difficult to measure, occurrence and variation of electric injuries could serve as an exposure proxy. We assessed risk of electric injury, using occupational accident registries across Europe to develop an electric shock job-exposure-matrix (JEM)., Materials and Methods: Injury data were obtained from five European countries, and the number of workers per occupation and country from EUROSTAT was compiled at a 3-digit International Standard Classification of Occupations 1988 level. We pooled accident rates across countries with a random effects model and categorised jobs into low, medium and high risk based on the 75th and 90th percentile. We next compared our JEM to a JEM that classified extremely low frequency magnetic field exposure of jobs into low, medium and high., Results: Of 116 job codes, occupations with high potential for electric injury exposure were electrical and electronic equipment mechanics and fitters, building frame workers and finishers, machinery mechanics and fitters, metal moulders and welders, assemblers, mining and construction labourers, metal-products machine operators, ships' decks crews and power production and related plant operators. Agreement between the electrical injury and magnetic field JEM was 67.2%., Conclusions: Our JEM classifies occupational titles according to risk of electric injury as a proxy for occurrence of electric shocks. In addition to assessing risk potentially arising from electric shocks, this JEM might contribute to disentangling risks from electric injury from those of extremely low frequency magnetic field exposure.