Mobile phone use and brain tumour risk - COSMOS, a prospective cohort study.

BACKGROUND: Each new generation of mobile phone technology has triggered discussions about potential carcinogenicity from exposure to radiofrequency electromagnetic fields (RF-EMF). Available evidence has been insufficient to conclude about long-term and heavy mobile phone use, limited by differential recall and selection bias, or crude exposure assessment. The Cohort Study on Mobile Phones and Health (COSMOS) was specifically designed to overcome these shortcomings. METHODS: We recruited participants in Denmark, Finland, the Netherlands, Sweden, and the UK 2007-2012. The baseline questionnaire assessed lifetime history of mobile phone use. Participants were followed through population-based cancer registers to identify glioma, meningioma, and acoustic neuroma cases during follow-up. Non-differential exposure misclassification was reduced by adjusting estimates of mobile phone call-time through regression calibration methods based on self-reported data and objective operator-recorded information at baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for glioma, meningioma, and acoustic neuroma in relation to lifetime history of mobile phone use were estimated with Cox regression models with attained age as the underlying time-scale, adjusted for country, sex, educational level, and marital status. RESULTS: 264,574 participants accrued 1,836,479 person-years. During a median follow-up of 7.12 years, 149 glioma, 89 meningioma, and 29 incident cases of acoustic neuroma were diagnosed. The adjusted HR per 100 regression-calibrated cumulative hours of mobile phone call-time was 1.00 (95 % CI 0.98-1.02) for glioma, 1.01 (95 % CI 0.96-1.06) for meningioma, and 1.02 (95 % CI 0.99-1.06) for acoustic neuroma. For glioma, the HR for ≥ 1908 regression-calibrated cumulative hours (90th percentile cut-point) was 1.07 (95 % CI 0.62-1.86). Over 15 years of mobile phone use was not associated with an increased tumour risk; for glioma the HR was 0.97 (95 % CI 0.62-1.52). CONCLUSIONS: Our findings suggest that the cumulative amount of mobile phone use is not associated with the risk of developing glioma, meningioma, or acoustic neuroma.

Detección de Staphylococcus aureus en teléfonos móviles de estudiantes de último año de odontología / Detection of Staphylococcus aureus in mobile phones of final year dental students

Objetivo: El propósito de este estudio fue detectar la incidencia de Staphylococcus aureus (S. aureus) en pantallas de teléfonos móviles de estudiantes de último año de odontología mediante técnicas microbiológicas. Métodos: Estudio observacional de tipo transversal descriptivo. Se tomaron 92 muestras de pantallas de teléfonos móviles, se realizó la identificación de S. aureus mediante pruebas microbiológicas: fermentación del manitol, reacciones positivas a las pruebas de desoxirribonucleasa, catalasa y coagulasa. Resultados: Se aisló 16 cepas de S. aureus 16/92 (17,4%) en pantallas de teléfonos móviles. El 100% de las cepas aisladas dieron reacciones positivas a las pruebas de desoxirribonucleasa, catalasa y coagulasa. Conclusiones: Se evidencia la presencia de S. aureus en pantallas de celulares de los teléfonos móviles de los estudiantes de último año lo que representa un riesgo para la diseminación de este patógeno.

Objective: The purpose of this study was to detect the incidence of S. aureus on mobile phone screens of last-year dental students using microbiological techniques. Methodology: Descriptive cross-sectional observational study. 92 samples were taken from mobile phone screens, S. aureus was identified by microbiological tests: mannitol fermentation, positive reactions to deoxyribonuclease, catalase and coagulase tests. Results: 16 strains of S. aureus 16/92 (17.4%) were isolated on mobile phone screens. 100% of the strains emerged positive reactions to deoxyribonuclease, catalase and coagulase tests. Conclusions: The presence of S. aureus is evidenced in cell phone screens of senior students' mobile phones, which represents a risk for the spread of this pathogen.

Do mobile phone surfaces carry SARS-CoV-2 virus? A systematic review warranting the inclusion of a "6th" moment of hand hygiene in healthcare.

BACKGROUND: Mobile phones, used in billions throughout the world, are high-touch devices subject to a dynamic contamination of microorganisms and rarely considered as an important fomite to sanitise systematically. The emergence of SARS-CoV-2 resulted in the COVID-19 pandemic, arguably the most impactful pandemic of the 21st century with millions of deaths and disruption of all facets of modern life globally. AIM: To perform a systematic review of the literature exploring SARS-CoV-2 presence as a contaminant on mobile phones. METHODS: A systematic search (PubMed and Google Scholar) of literature was undertaken from December 2019 to March 2023 identifying English language studies. Studies included in this review specifically identified or tested for the contamination of the SARS-CoV-2 virus or genome on mobile phones while studies testing for SARS-COV-2 in environments and/or other fomites samples than but not mobile phones were excluded. RESULTS: A total of 15 studies with reports of SARS-CoV-2 contamination on mobile phones between 2020 and 2023 were included. Amongst all studies, which encompassed ten countries, 511 mobile phones were evaluated for the presence of SARS-CoV-2 contamination and 45% (231/511) were positive for SARS-CoV-2. All studies were conducted in the hospital setting and two studies performed additional testing in residential isolation rooms and a patient's house. Four studies (3 in 2020 and one in 2021) reported 0% contamination while two other studies (in 2020 and 2022) reported 100% of mobile phone contamination with SARS-COV-2. All other studies report mobile phones positive for the virus within a range of 4-77%. CONCLUSION: A total of 45% of mobile phones are contaminated with SARS-CoV-2 virus. These devices might be an important fomite vector for viral dissemination worldwide. Competent health authorities are advised/recommended to start a global implementation of mobile phone decontamination by introducing regulations and protocols in public health and health care settings such as the 6th moment of hand washing.

Use of electronic devices in leisure time modifies the prevalence and factors associated with sedentary behavior derived exclusively from excessive television viewing among Brazilian adults.

The growing interest in the study of sedentary behavior is justified by its increasing presence in people's daily lives, particularly in leisure time. The aim of this study was to compare the prevalence and factors associated with sedentary behavior derived exclusively from TV time and from its combination with the time spent using other electronic devices among Brazilian adults (n = 52,443). This cross-sectional study used data from the Vigitel survey (2019), which included subjects ≥ 18 years old who resided in the capitals of the 26 Brazilian states and Federal District. High TV time (≥ 4 h/day), and its combination with computer, tablet, or cell phone use (≥ 4 h/day), as well as sociodemographic, behavioral, and health characteristics were self-reported. Adjusted logistic regression was used to estimate odds ratios and 95% confidence intervals (95%CI). The prevalence of high sedentary behavior almost tripled when TV viewing was added to the time spent using other electronic devices (from 12.2%; 95%CI: 11.6; 12.8, to 34.7%; 95%CI: 33.8; 35.6), notably among the youngest (32.0 percentage points). Individuals living without a partner, who smoked, consumed alcohol and processed foods excessively, were physically inactive, and had hypertension were more likely to have both outcomes than their counterparts. Older and less educated individuals were more likely to spend excessive time watching TV and less likely to have high use of other electronic devices in addition to TV viewing than their peers. Including computer, tablet, or cell phone led to an increase in the prevalence of high sedentary behavior. The magnitude and direction of the associations of age and education with high sedentary behavior varied according to the method how high sedentary behavior was defined. Projects, programs, and policies must consider the different indicators of sedentary behavior in monitoring and promoting a healthier lifestyle.

Drive in the Moment: An evaluation of a web-based tool designed to reduce smartphone use among young drivers.

OBJECTIVE: Young drivers are overrepresented in road traffic crashes and fatalities. Distracted driving, including use of a smartphone while driving (SWD), is a major risk factor for crashes for this age group. We evaluated a web-based tool (Drive in the Moment or DITM) designed to reduce SWD among young drivers. METHODS: A pretest-posttest experimental design with a follow-up was used to assess the efficacy of the DITM intervention on SWD intentions and behaviors, and perceived risk (of having a crash and of being apprehended by the police) associated with SWD. One hundred and eighty young drivers (aged 17-25 years old) were randomly assigned to either the DITM intervention or a control group where participants completed an unrelated activity. Self-reported measures of SWD and perceptions of risk were obtained pre-intervention, immediately post-intervention and at a follow-up 25 days after the intervention. RESULTS: Participants who engaged with the DITM showed a significant reduction in the number of times they used their SWD at follow-up compared to their pre-intervention scores. Future intentions to SWD were also reduced from pre-intervention to post-intervention and follow-up. There was also an increase in the perceived risk of SWD following the intervention. CONCLUSIONS: Our evaluation of DITM suggests that the intervention had an impact on reducing SWD among young drivers. Further research is needed to establish which particular elements of the DITM are associated with reductions in SWD and whether similar findings would be identified in other age groups.

Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging-Based Information Campaign: Mixed Methods Study.

BACKGROUND: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. OBJECTIVE: The primary aim of this study was to assess whether an SMS text messaging-based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. METHODS: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants' knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging-based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. RESULTS: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. CONCLUSIONS: The SMS text messaging campaign effectively improved Deaf women's knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people's health knowledge. However, attention should be paid to Deaf participants' specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. TRIAL REGISTRATION: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe.

Addressing immediate public health needs as part of Afghan evacuees' resettlement to the United States during the COVID-19 pandemic.

OBJECTIVES: Since the removal of US troops from Afghanistan in 2021, the United States welcomed Afghan evacuees through Operation Allies Welcome. Using cell phone accessibility, the CDC Foundation worked with public-private partners to protect evacuees from the spread of COVID-19 and provide accessibility to resources. STUDY DESIGN: This was a mixed methods study. METHODS: The CDC Foundation activated its Emergency Response Fund to accelerate public health components of Operation Allies Welcome, including testing, vaccination, and COVID-19 mitigation and prevention. The CDC Foundation began the provision of cell phones to evacuees to ensure access to public health and resettlement resources. RESULTS: The provision of cell phones provided connections between individuals and access to public health resources. Cell phones provided means to supplement in-person health education sessions, capture and store medical records, maintain official resettlement documents, and assist in registration for state-administered benefits. CONCLUSIONS: Phones provided necessary connectivity to friends and family for displaced Afghan evacuees and higher accessibility to public health and resettlement resources. As many evacuees did not have access to US-based phone services upon entry, provision of cell phones and plans for a fixed amount of service time provided a helpful start in resettlement while also being a mechanism to easily share resources. Such connectivity solutions helped to minimize disparities among Afghan evacuees seeking asylum in the United States. Provision of cell phones by public health or governmental agencies can help to provide equitable resources to evacuees entering the United States for social connection, healthcare resources, and resources to assist in the process of resettlement. Further research is needed to understand the generalizability of these findings to other displaced populations.

A Preliminary Evaluation of the Effects of a Contingency Management + Deposit Contract Intervention on Problematic Smartphone Use With College Students.

Problematic smartphone use (PSU) is smartphone usage that is, in some way, damaging to the user. PSU represents a growing public health concern that could be addressed via behavioral intervention. We recruited six college students who reported negative side effects of smartphone use and sought to decrease their PSU. The effects of a contingency management (CM) + deposit contract intervention on PSU was evaluated. During the CM + deposit contract condition, participants deposited $40 and had the opportunity to earn back their entire deposit by meeting daily smartphone usage goals. To promote adherence to study protocols, participants also had the opportunity to earn a $20 cooperation bonus. For all participants, lower levels of PSU were observed during intervention relative to baseline. The CM + deposit contract intervention produced consistent decreases in PSU for four participants (mean reduction percentages above 40% were obtained) and had inconsistent effects on PSU for two participants (mean reduction percentages below 20%). Maintenance of intervention effects was limited for all participants. Although preliminary, results suggest that CM + deposit contract interventions could be a viable, low-cost approach to addressing PSU. Potential explanations for our findings and avenues for future research are discussed.

Young drivers and smartphone use: The impact of legal and non-legal deterrents.

INTRODUCTION: Young drivers continue to be overrepresented in road crash statistics and smartphone use has been identified as a dangerous form of driver distraction. Previous research has identified factors encouraging drivers to use their mobile phone, with few examining what deters drivers. This study examines the influence of legal and non-legal deterrents on smartphone use while driving (SWD) in a young adult sample. METHOD: An online survey was administered to a sample of 524 Australian drivers aged 17-25 years. Measures included demographic variables, legal deterrents (certainty, severity, and swiftness), and non-legal deterrents: social loss (peers and parents), internal loss (anticipated regret) and physical loss (injury to self/others). Self-reported SWD was the outcome variable, measured separately for initiating SWD and responding SWD behaviors. RESULTS: Responding behaviors were reported more frequently than initiating, and social, internal, and physical loss were perceived as higher for initiating versus responding behaviors. Anticipated action regret and physical loss were significant negative predictors of SWD across both modalities of communication. Anticipated inaction regret was also a significant positive predictor of initiating behaviors. Both legal deterrents and social loss were non-significant predictors for both modalities of SWD. CONCLUSIONS: The results reinforce previous evidence showing that legal deterrence variables are not consistently effective at reducing offending behaviors. Future research should continue to explore the effect of non-legal deterrents across different modalities of SWD. PRACTICAL APPLICATIONS: Road safety interventions aimed at young drivers should evaluate the impact of highlighting anticipated regret and potential injury to self and others associated with risky driving behaviors, such as SWD.

Personal Cell Phones among Children: Parental Perception of Content-Related Threats and Attempts to Control Them in a Lithuanian Sample.

Background and Objectives: Various content-related threats such as provocative content, disinformation, cyberbullying, or sexual and commercial messages might reach children by phone and have a negative effect on their health. Amongst parents who are able to control it, we aimed to assess parental attitudes towards the use of mobile phones among children and control measures taken. Materials and Methods: A total number of 619 parents of primary school children from a middle-sized town in Lithuania participated in this study. Parents anonymously filled out our original questionnaire. Distribution of the respondents was assessed according to control measures taken, threat awareness, and sociodemographic factors. Results: Most of the respondents (79.8%) thought that personal mobile phones might be harmful to children's health, 99.5% of the parents used at least one control measure. Further, 91.9% of the respondents did not think that children might receive messages from strangers. Respectively, 85.5% and 95.2% of the parents thought that children do not receive offensive or sexual content messages. Many parents (25.5%) helped their children register to social networks. Parents with lower education and parents of younger children had lower awareness of threats (p < 0.05). Fathers, higher educated, single, and unemployed parents indicated application of fewer control measures (p < 0.05). Other sociodemographic factors were not related with threat awareness or control measures taken (p > 0.05). Conclusions: Nearly all parents of primary school children take measures in order to control their children's usage of mobile phones but most of them underestimate content-related threats brought by mobile phones.

Worrying levels of antimicrobial resistance in Gram-negative bacteria isolated from cell phones and uniforms of Peruvian intensive care unit workers.

BACKGROUND: Healthcare worker (HCW) uniforms and cell phones are involved in pathogen transmission. This study aimed to characterize pathogenic microorganism isolates from HCW uniforms and cell phones. METHODS: Gram-negative microorganisms were recovered from HCW uniforms and cell phones. Antimicrobial susceptibility and the presence of extended-spectrum ß-lactamases (ESBL) and carbapenemases were determined. RESULTS: Escherichia coli was the most prevalent microorganism. Overall, high levels of resistance to cephalosporins, quinolones, co-trimoxazole and colistin were found. ESBL were mainly related to blaCTX-M-15 and blaSHV- genes. Carbapenem-resistant isolates presented as blaKPC or blaNDM. CONCLUSIONS: High levels of antimicrobial resistance, including colistin, were detected. Therefore, strategies are urgently needed to prevent bacterial dissemination.

Coverage and Acceptability of Mobile Phone Messages for Cancer Prevention: a Population-Based Study in a Latin American Country.

Mobile health (m-health) has shown positive effects on disease prevention; however, several factors might influence its effectiveness, particularly in low- and middle-income countries. Randomized trials provide data with high internal validity but no major information on population impact. We conducted a pilot population-based study to assess the feasibility of cancer prevention through m-health in a Latin American population. A sample of affiliates to a health insurance company in Colombia was randomly selected and assigned to receive a short message service (SMS) or voice messages (VMS) during 4 weeks; weekly frequencies 2 and 7. Baseline and post-intervention surveys were conducted. Overall, 797 affiliates were contacted (SMS 393, VMS 404) but only 15.3% and 24.8% enrolled, respectively. Over 80% acceptability was observed among participants for all items evaluated (usefulness, understandability, timing, and frequency); however, 2-VMS per week was the only frequency consistent with the declared number of messages received and listened. Other frequencies resulted in high reception recall but low willingness to read/listen the messages. The willingness to be part of future programs was 20.0%. The gap between declared acceptability and practice, low participation rates, and low willingness to read/listen messages indicate m-health should be part of multicomponent interventions and should not be conceived as the sole intervention.

Effects of Cell Phone Use on Caregiver Supervision and Child Injury Risk.

OBJECTIVE: Unintentional injuries are the leading killer of children in the United States. Caregiver supervision decreases child injury risk; however, little research has examined the effects of distractions (e.g., cell phone use) on caregiver supervision and subsequent ability to protect children from injury. In particular, despite the prevalence of cell phone use, no research has examined the degree to which caregiver cell phone use may impair caregivers' ability to supervise their children effectively. The present study used a within-subjects design to examine whether caregiver cell phone use impacted caregiver vigilance and child engagement with potential hazards. METHODS: A total of 51 caregiver-child dyads were observed in a pseudo hazards room across three conditions (cell phone distraction, pen-and-paper distraction, no distraction) to examine the effects of cell phone use on caregiver vigilance and child behavior (i.e., engagement with hazards) related to injury risk. RESULTS: Caregiver vigilance was higher in the no distraction condition compared to the two distraction conditions (cell phone and pen-and-paper). Moreover, child engagement with hazards was lower in the no distraction condition than in the two distraction conditions. Although both distraction conditions impaired caregiver vigilance, caregivers were more impaired in the pen-and-paper condition compared to the cell phone condition. DISCUSSION: Regardless the form, distracting tasks (both cell phone use and pen-and-paper task) impacted both caregiver and child behavior associated with injury risk. It is important that professionals working with parents educate them about the risks of supervising children while distracted and encourage mindful supervision to ensure safety.

Detección de genes que codifican hemolisinas en cepas de Staphylococcus aureus aisladas en pantallas de teléfonos móviles de estudiantes de último año de odontología en Cuenca-Ecuador, 2020-2021 / Detection of hemolysin-encoding genes in Staphylococcus aureus strains isolated from cell phone screens of senior dental students in Cuenca-Ecuador, 2020-2021

Staphylococcus aureus es la especie más común implicada en las enfermedades infecciosas que causan morbilidad y mortalidad a nivel mundial. Posee los genes hla, hlb, hld, hlg, hlg-v que codifican para hemolisinas. Las hemolisinas son reconocidas como un factor de virulencia potencial que ataca a la membrana y produce destrucción de las plaquetas y necrosis. Tienen la capacidad de sobrevivir por largos periodos en superficies inertes como en pantallas de teléfonos móviles. Estudio observacional de tipo transversal descriptivo. Se aislaron en un estudio previo 16 cepas de Staphylococcus aureus a partir de 92 muestras de pantallas de teléfonos móviles de estudiantes de odontología. Se utilizó la técnica de reacción en cadena de la polimerasa para detectar los genes que codifican para hemolisinas. El gen hla se detectó en 75% (12/16) de cepas de Staphylococcus aureus, hlb en 25% (4/16), hld 75% (12/16), hlg 75% (12/16), hlg-v 13% (2/16). Este estudio evidencia el alto porcentaje de cepas virulentas que poseen genes que codifican para hemolisinas en pantallas de teléfonos móviles, lo que puede contribuir a la diseminación de este patógeno. Es imperioso implementar medidas para la desinfección de teléfonos móviles (AU)

Staphylococcus aureus is the most common species implicated in infectious diseases causing morbidity and mortality worldwide. It has the hla, hlb, hld, hlg, hlg-v genes encoding for hemolysins. Hemolysins are recognized as a potential virulence factor that attacks the membrane and causes platelet destruction and necrosis. They have the ability to survive for long periods on inert surfaces such as cell phone screens. Observational descriptive cross-sectional study. Sixteen strains of Staphylococcus aureus were isolated in a previous study from 92 samples of cell phone screens of dental students; the polymerase chain reaction technique was used to detect genes coding for hemolysins. The hla gene was detected in 75% (12/16) of Staphylococcus aureus strains, hlb in 25% (4/16), hld 75% (12/16), hlg 75% (12/16), hlg-v 13 % (2/16). This study evidences the high percentage of virulent strains that possess genes encoding for hemolysins in cell phone screens, which may contribute to the dissemination of this pathogen. It is imperative to implement measures for the disinfection of cell phones (AU)

Interpretation of Timetrends (1996-2017) of the Incidence of Selected Cancers in England in Relation to Mobile Phone Use as a Possible Risk Factor.

Radiofrequency (RF) radiation from mobile phones has been classified as possibly carcinogenic to humans (2b) by IARC. However, to date, the discussion on whether mobile phone use is a cancer risk factor has not been solved. In this context of continuing uncertainty, it is important to continue to monitor cancer incidence trends. Annual incidence rates and directly age-standardized rates of selected cancers by sex and 5-year age groups for 1996 to 2017 for England were obtained from the UK Office for National Statistics. Interpretation in light of mobile phone use as a contributing risk factor was conducted for cancers of the brain, parotid gland, thyroid, and colorectal cancer, which have all been hypothesized to be associated with RF exposure. Brain and parotid gland cancers were updated by an additional 10 years following a previous publication, and continue to provide little evidence of an association with mobile phone use. Although mobile phone use as a potential risk factor contributing to increased incidence of colorectal or thyroid cancer could not be excluded based on these ecological data, it is implausible that it is an important risk factor for either. In the absence of clarity from epidemiological studies, it remains important to continue to monitor trends. However, for the time being, and in agreement with data from other countries, there is little evidence of an association between mobile phone use and brain or parotid gland cancer, while the hypotheses of associations with thyroid or colorectal cancer are similarly weak. © 2021 Bioelectromagnetics Society.

An Exploration of the Effects of Radiofrequency Radiation Emitted by Mobile Phones and Extremely Low Frequency Radiation on Thyroid Hormones and Thyroid Gland Histopathology.

The use of mobile phones has widely increased over the last two decades. Mobile phones produce a radiofrequency electromagnetic field (RF-EMF), a form of non-ionizing radiation. In contrast to the ionizing radiation proven to cause DNA damage, the harmful effects of non-ionizing radiation on the human body have not been discovered yet. The thyroid gland is among the most susceptible organs to mobile phone radiation due to its location in the anterior neck. Our purpose in this literature review is to explore the effects of the electromagnetic field (EMF), especially radiofrequency emitted from mobile phones, on thyroid hormones and thyroid gland histopathology. We searched PubMed and Google Scholar databases for relevant studies published after the year 2000, using the following keywords: 'cell phones', 'mobile phones', 'telephones', 'electromagnetic fields', 'radiofrequency radiation', 'microwaves', 'thyroid gland', 'thyroid hormones', and 'thyroid cancer'. Our review revealed that mobile phone radiofrequency radiation (RFR) might be associated with thyroid gland insufficiency and alterations in serum thyroid hormone levels, with a possible disruption in the hypothalamic-pituitary-thyroid axis. The review also showed histopathological changes in the thyroid gland follicles after exposure of rats to non-ionizing radiation. The results were directly related to the amount and duration of exposure to EMF radiation. Further human studies exploring thyroid gland hormones, microscopic morphology, and thyroid cancer are highly recommended for future researches.

Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection.

BACKGROUND: The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone-based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. OBJECTIVE: We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. METHODS: We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. RESULTS: The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. CONCLUSIONS: The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone-based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31236.

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research.

BACKGROUND: Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system-level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. OBJECTIVE: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. METHODS: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. RESULTS: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. CONCLUSIONS: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.

The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV.

BACKGROUND: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. OBJECTIVE: The aim of this study is to describe the current state of AYAs' phone use in the region and trace out the implications for mobile health interventions. METHODS: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. RESULTS: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. CONCLUSIONS: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention.

Mobile Phone Access and Implications for Digital Health Interventions Among Adolescents and Young Adults in Zimbabwe: Cross-Sectional Survey.

BACKGROUND: Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP's phone and internet access to inform the feasibility of implementing digital health interventions. OBJECTIVE: We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. METHODS: A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. RESULTS: A total of 634/719 (88.2%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6% (397/634) females, participated. Of the YP interviewed, 62.6% (396/633; 95% CI 58.5-66.5) reported owning a phone and a further 4.3% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0% (43/159) of 13-15-year olds, 61.0% (72/118) of 16-17-year olds, 71.5% (103/144) of 18-19-year olds, and 84.7% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0% (236/387; 95% CI 55.6-66.1) versus 64.8% (153/236; 95% CI 57.8-71.2), age-adjusted OR 0.7 (95% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1% (346/516; 95% CI 62.6-71.2) versus 26% (21/82; 95% CI 16.4-37.7), age-adjusted OR 2.3 (95% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2%, 282/396), and 16.4% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5%; 95% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2%, 136/465) and violent (13.1%, 61/465) content. CONCLUSIONS: Mobile phone-based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use.