Electromagnetic fields and epidemiology: An overview inspired by the fourth course at the International School of Bioelectromagnetics

The fourth course at the International School of Bioelectromagnetics addressed various aspects of the epidemiology of exposure to electromagnetic fields (EMF). In this overview, inspired by the lectures and the discussions among participants, we summarize current knowledge on exposure to EMF and disease risk, with emphasis on studies of use of mobile phones and brain tumours and exposure to power lines and childhood leukaemia. Sources of bias and error hamper straightforward conclusions in some areas and, in order to move forward, improvements in study design and exposure assessment are necessary. The scientific evidence available to date on possible long‐term effects from exposure to ELF and RF fields is not strong enough to revise current protection limits based on the known acute effects of such exposures. Precautionary measures may be considered to reduce ELF exposure of children or exposure to RF during mobile phone use, keeping in mind that it is unclear whether they involve any preventive benefit. Possible health effects from mobile phone use in adults and in children should be investigated further by prospective epidemiological studies with improved exposure assessment and brain tumour incidence rates should be monitored. Further studies on the relation between childhood leukaemia and ELF magnetic fields would be worthwhile if they focus on heavily exposed groups and attempt to minimize possible selection bias. In conclusion, epidemiological studies conducted with appropriate diligence can play a key role in finding the answers. Bioelectromagnetics 30:511–524, 2009. © 2009 Wiley‐Liss, Inc.     

Sex differences in the circadian profiles of melatonin and cortisol in plasma and urine matrices under constant routine conditions

Conflicting evidence exists as to whether there are differences between males and females in circadian timing. The aim of the current study was to assess whether sex differences are present in the circadian regulation of melatonin and cortisol in plasma and urine matrices during a constant routine protocol. Thirty-two healthy individuals (16 females taking the oral contraceptive pill (OCP)), aged 23.8 ± 3.7 (mean ± SD) years, participated. Blood (hourly) and urine (4-hourly) samples were collected for measurement of plasma melatonin and cortisol, and urinary 6-sulfatoxymelatonin (aMT6s) and cortisol, respectively. Data from 28 individuals (14 females) showed no significant differences in the timing of plasma and urinary circadian phase markers between sexes. Females, however, exhibited significantly greater levels of plasma melatonin and cortisol than males (AUC melatonin: 937 ± 104 (mean ± SEM) vs. 642 ± 47 pg/ml.h; AUC cortisol: 13581 ± 1313 vs. 7340 ± 368 mmol/L.h). Females also exhibited a significantly higher amplitude rhythm in both hormones (melatonin: 43.8 ± 5.8 vs. 29.9 ± 2.3 pg/ml; cortisol: 241.7 ± 23.1 vs. 161.8 ± 15.9 mmol/L). Males excreted significantly more urinary cortisol than females during the CR (519.5 ± 63.8 vs. 349.2 ± 39.3 mol) but aMT6s levels did not differ between sexes. It was not possible to distinguish whether the elevated plasma melatonin and cortisol levels observed in females resulted from innate sex differences or the OCP affecting the synthetic and metabolic pathways of these hormones. The fact that the sex differences observed in total plasma concentrations for melatonin and cortisol were not reproduced in the urinary markers challenges their use as a proxy for plasma levels in circadian research, especially in OCP users.     

Review of possible modulation-dependent biological effects of radiofrequency fields

The biological effects of modulated radiofrequency (RF) electromagnetic fields have been a subject of debate since early publications more than 30 years ago, suggesting that relatively weak amplitude-modulated RF electromagnetic fields have specific biological effects different from the well-known thermal effects of RF energy. This discussion has been recently activated by the increasing human exposure to RF fields from wireless communication systems. Modulation is used in all wireless communication systems to enable the signal to carry information. A previous review in 1998 indicated that experimental evidence for modulation-specific effects of RF energy is weak. This article reviews recent studies (published after 1998) on the biological effects of modulated RF fields. The focus is on studies that have compared the effects of modulated and unmodulated (continuous wave) RF fields, or compared the effects of different kinds of modulations; studies that used only one type of signal are not included. While the majority of recent studies have reported no modulation-specific effects, there are a few interesting exceptions indicating that there may be specific effects from amplitude-modulated RF fields on the human central nervous system. These findings warrant follow-up studies.     

ELF Noise Fields: A Review

The debate as to whether low-level electromagnetic fields can affect biological systems and in the long term cause health effects has been going on for a long time. Yet the interaction of weak electromagnetic fields (EMF) with living cells, undoubtedly a most important phenomenon, is still not well understood. The exact mechanisms by which the effects are produced have not been identified. Furthermore, it is not possible to clearly define which aspects of an EMF exposure that constitute the “dose.” One of the groups that contributed to solving this problem is the Bioelectromagnetics group at Catholic University of America (CUA), Washington, D.C. Their work has been devoted to investigating the physical parameters that are needed to obtain an effect of EMF exposure on biological systems, and also how to inhibit the effect. This is a review of their work on bioeffects caused by low-level EMF, their dependence on coherence time, constancy, spatial averaging, and also how the effects can be modified by an applied ELF noise magnetic field. The group has been using early chick embryos, and L929 and Daudi cells as their main experimental systems. The review also covers the work of other groups on low-level effects and the inhibition of the effects with an applied noise field. The group at CUA has shown that biological effects can be found after exposure to low-level ELF and RF electromagnetic fields, and when effects are observed, applying an ELF magnetic noise field inhibits the effects. Also, other research groups have tried to replicate the studies from the CUA group, or to apply EMF noise to suppress EMF-induced effects. Replications of the CUA effects have not always been successful. However, in all cases where the noise field has been applied to prevent an observed effect, it has been successful in eliminating the effect.     

No effects of pulsed radio frequency electromagnetic fields on melatonin, cortisol, and selected markers of the immune system in man

There is growing public concern that radio frequency electromagnetic fields may have adverse biological effects. In the present study eight healthy male students were tested to see whether or not radio frequency electromagnetic fields as used in modern digital wireless telecommunication (GSM standard) have noticeable effects on salivary melatonin, cortisol, neopterin, and immunoglobulin A (sIgA) levels during and several hours after exposure. In a specifically designed, shielded experimental chamber, the circularly polarized electromagnetic field applied was transmitted by an antenna positioned 10 cm behind the head of upright sitting test persons. The carrier frequency of 900 MHz was pulsed with 217 Hz (average power flux density 1 W/m2). In double blind trials, each test person underwent a total of 20 randomly allotted 4 hour periods of exposure and sham exposure, equally distributed at day and night. The results obtained show that the salivary concentrations of melatonin, cortisol, neopterin and sIgA did not differ significantly between exposure and sham exposure.     

Environmental stress of mobile phone EM radiation on locomotor activity and melatonin circadian rhythms of rats

Biological clocks are innate timing mechanisms that regulate many behavioral and physiological parameters in most organisms. In our modern life, heavy use of mobile phones (MPs) exerts a massive stress on organisms because their electromagnetic radiation usually results in varying degrees of damage to their biological systems including the biological rhythms. In the present study, the possible effects of exposure to radiofrequency–electromagnetic radiation (RF–EMR) from MPs on two characteristic circadian rhythms, locomotor activity and melatonin hormone rhythms, were investigated. Rats were exposed to RF–EMR from MPs at 900 MHz frequency (2-h/day for 2 weeks) during nighttime (20:00–22:00 h) followed by another two weeks without exposure for recovery. Locomotor activity rhythms of the control and treated groups (n = 5/group) were daily recorded using running wheels along the experimental period. For evaluating melatonin hormone rhythm, blood samples of control and treated groups (n = 12/group), were collected at the end of exposure and recovery periods, at 6-h time intervals per day (at 4:00, 10:00, 16:00, and 22:00 h). Rats exposed to RF–EMR exhibited phase shifting as well as a significant increased acrophase level in locomotor activity. Meanwhile, a significant decrease in serum melatonin levels with retaining lower amplitude rhythmicity was observed. Ceasing exposure for two weeks did not restore melatonin levels and circadian locomotor activity rhythms. It could be concluded that, under the current conditions, exposure to RF–EMR revealed disturbances in locomotor activity and melatonin level, although they maintained rhythmicity.     

Setting Guidelines for Electromagnetic Exposures and Research Needs

Current limits for exposures to nonionizing electromagnetic fields (EMF) are set, based on relatively short-term exposures. Long-term exposures to weak EMF are not addressed in the current guidelines. Nevertheless, a large and growing amount of evidence indicates that long-term exposure to weak fields can affect biological systems and might have effects on human health. If they do, the public health issues could be important because of the very large fraction of the population worldwide that is exposed. We also discuss research that needs to be done to clarify questions about the effects of weak fields. In addition to the current short-term exposure guidelines, we propose an approach to how weak field exposure guidelines for long-term exposures might be set, in which the responsibility for limiting exposure is divided between the manufacturer, system operator, and individual being exposed. Bioelectromagnetics. © 2020 Bioelectromagnetics Society     

Melatonin down-regulates steroidal hormones,thymocyte apoptosis and inflammatory cytokines in middle-aged T. cruzi infected rats

Chagas disease, triggered by the flagellate protozoan Trypanosoma cruzi (T. cruzi) plays a potentially threat to historically non-endemic areas. Considerable evidence established that the immuno-endocrine balance could deeply influence the experimental T. cruzi progression inside the host's body. A high-resolution multiple reaction monitoring approach (MRM^HR) was used to study the influence of melatonin on adrenal and plasma steroidal hormones profile of T. cruzi infected Wistar rats. Young (5 weeks) and middle-aged (18 months) male Wistar rats received melatonin (5 mg/Kg, orally) during the acute Chagas disease. Corticosterone, 11-dehydrocorticosterone (11-DHC), cortisol, cortisone, aldosterone, progesterone and melatonin concentration were evaluated. Interleukin-1 alpha and β (IL-1α and β), IL-6 and transforming growth factor beta (TGF-β) were also analyzed. Our results revealed an increased production of corticosterone, cortisone, cortisol and aldosterone in middle-aged control animals, thus confirming the aging effects on the steroidal hormone profile. Serum melatonin levels were reduced with age and predominantly higher in young and middle-aged infected rats. Melatonin treatment reduced the corticosterone, 11-DHC, cortisol, cortisone, aldosterone and progesterone in response to T. cruzi infection. Decreased IL-1 α and β concentrations were also found in melatonin treated middle-aged infected animals. Melatonin treated middle-aged control rats displayed reduced concentrations of TGF-β. Melatonin levels were significantly higher in all middle-aged rats treated animals. Reduced percentages of early and late thymocyte apoptosis was found for young and middle-aged melatonin supplemented rats. Finally, our results show a link between the therapeutic and biological effects of melatonin controlling steroidal hormones pathways as well as inflammatory mediators.     

Early‐Life Exposure to Pulsed LTE Radiofrequency Fields Causes Persistent Changes in Activity and Behavior in C57BL/6 J Mice

Despite much research, gaps remain in knowledge about the potential health effects of exposure to radiofrequency (RF) fields. This study investigated the effects of early‐life exposure to pulsed long term evolution (LTE) 1,846 MHz downlink signals on innate mouse behavior. Animals were exposed for 30 min/day, 5 days/week at a whole‐body average specific energy absorption rate (SAR) of 0.5 or 1 W/kg from late pregnancy (gestation day 13.5) to weaning (postnatal day 21). A behavioral tracking system measured locomotor, drinking, and feeding behavior in the home cage from 12 to 28 weeks of age. The exposure caused significant effects on both appetitive behaviors and activity of offspring that depended on the SAR. Compared with sham‐exposed controls, exposure at 0.5 W/kg significantly decreased drinking frequency (P ≤ 0.000) and significantly decreased distance moved (P ≤ 0.001). In contrast, exposure at 1 W/kg significantly increased drinking frequency (P ≤ 0.001) and significantly increased moving duration (P ≤ 0.005). In the absence of other plausible explanations, it is concluded that repeated exposure to low‐level RF fields in early life may have a persistent and long‐term effect on adult behavior. Bioelectromagnetics. 2019;40:498–511. © 2019 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.     

The effects of 884 MHz GSM wireless communication signals on headache and other symptoms: an experimental provocation study

Findings from prior studies of possible health and physiological effects from mobile phone use have been inconsistent. Exposure periods in provocation studies have been rather short and personal characteristics of the participants poorly defined. We studied the effect of radiofrequency field (RF) on self-reported symptoms and detection of fields after a prolonged exposure time and with a well defined study group including subjects reporting symptoms attributed to mobile phone use. The design was a double blind, cross-over provocation study testing a 3-h long GSM handset exposure versus sham. The study group was 71 subjects age 18-45, including 38 subjects reporting headache or vertigo in relation to mobile phone use (symptom group) and 33 non-symptomatic subjects. Symptoms were scored on a 7-point Likert scale before, after 1(1/2) and 2(3/4) h of exposure. Subjects reported their belief of actual exposure status. The results showed that headache was more commonly reported after RF exposure than sham, mainly due to an increase in the non-symptom group. Neither group could detect RF exposure better than by chance. A belief that the RF exposure had been active was associated with skin symptoms. The higher prevalence of headache in the non-symptom group towards the end of RF exposure justifies further investigation of possible physiological correlates. The current study indicates a need to better characterize study participants in mobile phone exposure studies and differences between symptom and non-symptom groups.     

Changes in the diurnal rhythms of cortisol,melatonin, and testosterone after 2, 4, and 7 consecutive night shifts in male police officers

Night work is associated with a large range of acute health problems and possibly also health consequences in the long run. Yet, only very few field studies specifically investigate the effects of consecutive night shift on key physiological regulatory systems. In this field study, we investigated the effects of consecutive night shifts on three hormones, melatonin, cortisol, and testosterone, among police officers at work. More specifically, the aim was to investigate how the diurnal rhythms of melatonin, cortisol, and testosterone responded to two, four, and seven consecutive night shifts and a corresponding number of days for recovery. The study was part of the “In the Middle of the Night” project and included 73 male police officers from five different police districts. The participants were exposed to three intervention conditions: “2+2”: two consecutive night shifts followed by two consecutive day recovery days; “4+4”: four consecutive night shifts followed by four consecutive recovery days; “7+7”: seven consecutive night shifts followed by seven consecutive recovery days. On the last day with night shift and the last recovery day in each intervention, the participants collected saliva samples every 4th hour when awake. The diurnal rhythms of melatonin, cortisol, and testosterone were all affected differently by an increasing number of consecutive night shifts: the amplitude of the melatonin rhythm was suppressed by 4.9% per day (95% CI 1.4–8.2% per day; p = 0.006). The diurnal rhythm of cortisol phase was delayed with an increasing number of night shifts by 33 min/day (95% CI 18–48 min per day; p ≤ 0.001), but did not show any changes in amplitude. For the diurnal rhythm of testosterone, there was no effect of the number of consecutive night shifts and the diurnal rhythm completely followed the sleep/wake cycle. We found that there were no differences in the rhythms of melatonin, cortisol, and testosterone after 2, 4, and 7 recovery days, respectively. In conclusion, we found signs of desynchronization in terms of suppressed amplitude of melatonin and phase delay of salivary cortisol as a consequence of the increasing number of consecutive night shifts among police officers at work. Lack of synchronization has been suggested as a possible mechanism linking night work to disease, but this remains to be determined.     

A need to provide explanations for observed biological effects of radiofrequency exposure

Abstract

Although there is scientific consensus that radiofrequency (RF) exposure at high intensity can cause thermal effects, including well-established adverse health effects, there is still considerable controversy on whether low-intensity RF exposure can cause biological effects, especially adverse health effects. The objective of this paper is to describe several reported “non-thermal” effects that were later shown to be due to a weak thermal effect or an experimental artifact by properly conducted and thorough follow-on scientific research. First, the multiple factors that can cause different RF energy absorption in biological tissues are reviewed and second, several examples of experimental artifacts in published papers are described to demonstrate the importance of paying attention to dosimetry and temperature control. For example, isolated nerve response studies show that when temperature of the RF-exposed tissues is controlled, effects disappeared. During RF exposure, conductive electrodes routinely used in physiological studies have been shown to cause field intensification at the tips or contacts of the electrodes with biological tissue; thus, the RF exposure at the site of measurement could be much higher than the incident field. In some in vitro studies, a lack of temperature uniformity in RF-exposed cell cultures and rate of heating explain changes originally reported to be due to low-level RF exposure. In other studies, detailed dosimetry studies have identified artifacts that explain the reasons why so-called “non-thermal” effects were mistakenly reported. Researchers should look for explanations for their own findings, and not expect others to figure out what was the reason for their observed effects.     

Diurnal variation of aldosterone and plasma renin activity: timing relation to melatonin and cortisol and consistency after prolonged bed rest.

Exposure to prolonged bed rest is known to induce changes in the renin-angiotensin-aldosterone system (RAAS) by way of posture, sodium and potassium balance, and stress, which may have serious consequences for patients. We focused on the diurnal variation of the RAAS by investigating changes in the levels of plasma renin activity (PRA) and aldosterone; for comparison to markers of the intrinsic pacemaker and to stress, we measured melatonin and cortisol. PRA, aldosterone, melatonin, and cortisol were measured hourly in 10 normal subjects with standardized sleep patterns, posture, and diet at baseline and after 11 days of prolonged bed rest conducted under a light-dark cycle. Circadian characteristics of hormone secretion patterns were estimated by multiple harmonic regression with excellent goodness-of-fit measures. Variability in the melatonin and cortisol patterns across subjects was minimal. Even for pulsatile hormones, this technique successfully estimated the acrophase, which was the salient feature. Baseline hormone peak times started with melatonin near the middle of the sleep period, followed by PRA, then aldosterone, and then cortisol around wake time. Prolonged bed rest did not induce significant changes in any timing characteristic of the secretion patterns. Baseline and prolonged bed rest peak times for melatonin and cortisol and amplitude characteristics for all hormones were highly correlated, indicating consistency within individuals. These data provide strong evidence that prolonged bed rest of 11 days' duration does not disrupt either the timing characteristics of the RAAS or the intrinsic pacemaker.     

Radiofrequency exposure on fast patrol boats in the Royal Norwegian Navy—an approach to a dose assessment

Epidemiological studies related to radiofrequency (RF) electromagnetic fields (EMF) have mainly used crude proxies for exposure, such as job titles, distance to, or use of different equipment emitting RF EMF. The Royal Norwegian Navy (RNoN) has measured RF field emitted from high‐frequency antennas and radars on several spots where the crew would most likely be located aboard fast patrol boats (FPB). These boats are small, with short distance between the crew and the equipment emitting RF field. We have described the measured RF exposure aboard FPB and suggested different methods for calculations of total exposure and annual dose. Linear and spatial average in addition to percentage of ICNIRP and squared deviation of ICNIRP has been used. The methods will form the basis of a job exposure matrix where relative differences in exposure between groups of crew members can be used in further epidemiological studies of reproductive health. Bioelectromagnetics 31:350–360, 2010. © 2010 Wiley‐Liss, Inc.     

Effects of combined radiofrequency radiation exposure on the cell cycle and its regulatory proteins

The aim of this study was to investigate whether single or combined radio frequency (RF) radiation exposure has effects on the cell cycle and its regulatory proteins. Exposure of MCF7 cells to either single (837 MHz) or combined (837 and 1950 MHz) RF radiation was conducted at specific absorption rate values of 4 W/kg for 1 h. During the exposure period, the chamber was made isothermal by circulating water through the cavity. After RF radiation exposure, DNA synthesis rate and cell cycle distribution were assessed. The levels of cell cycle regulatory proteins, p53, p21, cyclins, and cyclin‐dependent kinases were also examined. The positive control group was exposed to 0.5 and 4 Gy doses of ionizing radiation (IR) and showed changes in DNA synthesis and cell cycle distribution. The levels of p53, p21, cyclin A, cyclin B1, and cyclin D1 were also affected by IR exposure. In contrast to the IR‐exposed group, neither the single RF radiation‐ nor the combined RF radiation‐exposed group elicited alterations in DNA synthesis, cell cycle distribution, and levels of cell cycle regulatory proteins. These results indicate that neither single nor combined RF radiation affect cell cycle progression. Bioelectromagnetics 32:169–178, 2011. © 2010 Wiley‐Liss, Inc.     

Effects of radiation emanating from base transceiver station and mobile phone on sleep,circadian rhythm and cognition in humans – a review

The electromagnetic fields (EMF) are ubiquitous. The base transceiver station (BTS) and mobile phones (MPs) contribute to the generation of EMF around their locations and are regarded as important sources of non-ionizing radiations. The use of mobile phone has increased dramatically in recent years so also the skepticism regarding its effects. In this review, we have made an attempt to scan the key research papers those aimed at elucidating the effects of EMF starting from extreme low frequency (ELF) to radio frequency (RF) through low frequency (LF). We have selected papers that dealt with the effects of radiations emanating from the BTS and MPs on human sleep, circadian rhythm, and cognition. Mostly, we have concentrated on papers published in the last 15 years. We came across conflicting reports. The findings reported in many papers suggest that the exposure to EMF has potentiality to compromise parameters related to sleep quality; in contrast, there are several reports those have given a clean sheet to the EMF exposure. The effects of EMF on circadian rhythms also remain inconclusive. The EMF exposure while did not produce any effect on circadian rhythm of heart rate and blood chemistry, it modulated the rhythms in cortisol and melatonin characterized by a decline in their 24-h circulating levels. The effects of exposure to EMF on cognitive parameters, like performance and memory, are also equivocal. The existing contradictory findings could be attributed to inter-individual variability in tolerance, gender-, and age-dependent differences in response, latitudinal differences in efficacy, variability among employed methodologies and differences in specific absorption rate, frequency of the mobile phone usage, and interaction of EMF with other physiological and environmental factors, among others. The future research should be carried out with added focus on elucidating the modulatory effects of these factors to put an end to the existing controversies on the biological effects of low/RF EMF radiations.     

Do people with idiopathic environmental intolerance attributed to electromagnetic fields display physiological effects when exposed to electromagnetic fields? A systematic review of provocation studies

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI‐EMF) is a controversial illness in which people report symptoms that they believe are triggered by exposure to EMF. Double‐blind experiments have found no association between the presence of EMF and self‐reported outcomes in people with IEI‐EMF. No systematic review has assessed whether EMF exposure triggers physiological or cognitive changes in this group. Using a systematic literature search, we identified 29 single or double‐blind experiments in which participants with IEI‐EMF were exposed to different EMF levels and in which objectively measured outcomes were assessed. Five studies identified significant effects of exposure such as reduced heart rate and blood pressure, altered pupillary light reflex, reduced visual attention and perception, improved spatial memory, movement away from an EMF source during sleep and altered EEG during sleep. In most cases, these were isolated results that other studies failed to replicate. For the sleep EEG findings, the results reflected similar changes in the IEI‐EMF participants and a non‐IEI‐EMF control group. At present, there is no reliable evidence to suggest that people with IEI‐EMF experience unusual physiological reactions as a result of exposure to EMF. This supports suggestions that EMF is not the main cause of their ill health. Bioelectromagnetics. Bioelectromagnetics 32:593–609, 2011. © 2011 Wiley Periodicals, Inc.     

An evaluation of exposure metrics in an epidemiologic study on radio and television broadcast transmitters and the risk of childhood leukemia

Electric field strength values calculated by wave propagation modeling were applied as an exposure metric in a case–control study conducted in Germany to investigate a possible association between radio frequency electromagnetic fields (RF‐EMF) emitted from television and radio broadcast transmitters and the risk of childhood leukemia. To validate this approach it was examined at 850 measurement sites whether calculated RF‐EMF are an improvement to an exposure proxy based on distance from the place of residence to a transmitter. Further, the agreement between measured and calculated RF‐EMF was explored. For dichotomization at the 90% quantiles of the exposure distributions it was found that distance agreed less with measured RF‐EMF (Kappa coefficient: 0.55) than did calculated RF‐EMF (Kappa coefficient: 0.74). Distance was a good exposure proxy for a single transmitter only which uses the frequency bands of amplitude modulated radio, whereas it appeared to be of limited informative value in studies involving several transmitters, particularly if these are operating in different frequency bands. The analysis of the agreement between calculated RF‐EMF and measured RF‐EMF showed a sensitivity of 76.6% and a specificity of 97.4%, leading to an exposure misclassification that still allows one to detect a true odds ratio as low as 1.4 with a statistical power of >80% at a two‐sided significance level of 5% in a study with 2,000 cases and 6,000 controls. Thus, calculated RF‐EMF is confirmed to be an appropriate exposure metric in large‐scale epidemiological studies on broadcast transmitters. Bioelectromagnetics 30:81–91, 2009. © 2008 Wiley‐Liss, Inc.     

Circadian Typology: A Comprehensive Review

The interest in the systematic study of the circadian typology (CT) is relatively recent and has developed rapidly in the two last decades. All the existing data suggest that this individual difference affects our biological and psychological functioning, not only in health, but also in disease. In the present study, we review the current literature concerning the psychometric properties and validity of CT measures as well as individual, environmental and genetic factors that influence the CT. We present a brief overview of the biological markers that are used to define differences between CT groups (sleep–wake cycle, body temperature, cortisol and melatonin), and we assess the implications for CT and adjustment to shiftwork and jet lag. We also review the differences between CT in terms of cognitive abilities, personality traits and the incidence of psychiatric disorders. When necessary, we have emphasized the methodological limitations that exist today and suggested some future avenues of work in order to overcome these. This is a new field of interest to professionals in many different areas (research, labor, academic and clinical), and this review provides a state of the art discussion to allow professionals to integrate chronobiological aspects of human behavior into their daily practice.