Introduction

To perform this study, it was necessary to understand how the mobile phone works.
Wireless communication is existed for a long time since the ancient period people use
fire, smoke, flag and etc. to communicate with each other from long distance(Schiller,
2003).

Nowadays, with rapid development, mobile phones play a significant role in our daily
lives, as it is indispensable, convenient and fast. Mobile phones function in
radiofrequencies that range between 450, 800/900 and 1,800/1,900 MHz(Steele &
Hanzo, 1999). The Advanced Mobile Phone Service (AMPS) is the first analog
network produced, then during the 1990s, two digital networks CDMA and GSM are
arrived(Anon., 2007). These second-generation (2G) networks has the ability to
spread voice calls across several wireless spectrum and bring highly interactive
experience to the mobile phone users. The 3G networks can be used by a number of
users at the same time, and the frequency channels have 5-MHz bandwidths
(Pederson, 1999). These cordless phones are used at very short ranges between a base
station located at the telephone socket outlet within the house and the cordless phone
handset(Adair, et al., 1999). Because the high mobility of mobile phone, it is very
popular in modern world. And with more entertainment and useful functions as GPS
and music are integrated, it becomes essential part in our lives.

As discussed above, including mobile phone, development and use of wireless

communication are increased rapidly in past a few decades. Widespread concerns
have been raised about the possibility that mobile phones could affect people’s health.
In this literature review, the emphases will be on the potential health dangers of the
use of mobile phone based on the previous studies.

Brain Tumours

The mobile phone owners are under the increasing health risks of the extensive use of
mobile phone as they are severely exposed to the electromagnetic wave radiation
which is emitted by mobile phone(Kshetrimayum, 2008). The potential health risk
comes from absorbing the a comparatively large amount of electromagnetic energy,
especially the human head, when mobile phone is used(Hardell, et al., 2007). Because
the radiation of mobile phone is concentrated on a small area in human brain from
hot-spot(Kshetrimayum, 2008).

In previous studies, both initial and recent years’, most evidences on the relationship
between brain tumor and mobile phone are insufficient based on the low numbers of
the research. In the study of Inskip, et al.(2001, pp. 79-86), 782 hospital cases are
enrolled with 489 malignant brain tumours, 197 with meningioma and 96 with
acoustic neuroma. And there are only 11 glioma patients, 6 meningioma patients and 5
acoustic neuroma patients have at least 5 years’ regular use of mobile phone. Regular
use of mobile phones gave OR(standardised incidence ratio)=0.8 (0.6 to 1.2) for
glioma, OR=0.8 (0.4 to 1.3) for meningioma and OR=1.0 (0.5 to 1.9) for acoustic
neuroma. Duration of use more than 5 years did not increase the risk for glioma and
meningioma, but for acoustic neuroma, OR increased to 1.9 (0.6 to 5.9). Based on
different types of glioma, anaplastic astrocytoma has OR=1.8 (0.7 to 5.1).

In a case-control study of acoustic neuroma reported by Lonn, et al.(2004, pp. 653-9)

from Karolinska Institute in Sweden, they were in collaboration with hospitals to
indentify cases and check cases with the cancer registry. Published data were
collected from 148 cases and 604 controls. Use of digital phones more than 5 years
since the first use gave OR=1.2 (0.7 to 2.1). Use of analogue phones of a duration 5 to
9 years gave OR=1.3 (0.6 to 2.9), and for more than 10 years OR=1.8 (0.8 to 4.3).

From those typical researches, there is a potential relationship between use of mobile
phone and brain tumour. Long-term use of the mobile phone may increase the
incidence ratio of the risk on brain tumour. But there are not strongly evidences to
support this result and the potential relation so further more high quality studies are
needed.

Though the clue is not clear for the effect on the brain tumour, it also should be
avoided as possible to reduce such risk from long-term use of mobile phone. The
mobile phone users must learn some safety practices to avoid risk as possible such as
keeping phone conversations short and use a plug-in earpiece to lessen the health risk
imposed by these phones( Kshetrimayum, 2008; Repacholi, et al., 2001).

Bacteria on the phone

As mentioned above, including the healthcare workers(HCWs), more and more

people own mobile phones nowadays. Lots of innovations in mobile communications
lead to significant improvements in quality of medical communication, healthcare
efficiency and better patient control in many areas as diabetes and asthma (Ramesh, et
al., 2008; Soto, et al., 2006). The better work experience and connectivity brought by
the mobile communication devices(MCDs) are really accepted by the HCWs to
reduce miscommunication and medical error (Brady, et al., 2009). In the recently
study of Brady, et al.(2009, pp.295-300), approximately 78% HCWs expressed
support by doctors’ use of mobile phones within hospital. The proportion for nurses
and patients were 56% and 49% respectively.

However, along with the benefits and popularity, some problems that are potential to
increase the risk of patients are raised. These issues include environmental noise,
patient confidentiality and bacterial contamination of MCDs(Brady, et al., 2009).
Except the bacterial contamination of the MCDs, other issues are emphasized and
have resulted in comprehensive policy to avoid such risks(Bhattacharya, 2005).
 
Table I Number of cellphone in which a specific type of bacteria was isolated(Brady, et al., 2006, p124) 
                                          Number of mobile phones in which a specific 
Bacterial type type of bacteria was isolated (total 105)
Coagulase‐negative staphyloccocus 98
Micrococcus spp. 41
Bacillus spp.              21
Diptheroids              7
Methicillin‐sensitive Staphyloccus aureus    6
Streptococcus viridians 6
Coliforms 5
Methicillin‐resistant Staphyloccus aureus 2
Enterococci faecalis 1
Clostridium perfringens 1

In the study of Brady, et al.(2006, pp.123-125), in 105 HCWs who owns mobile
phone and are available to participate the mobile phone bacteria sampling, 84.5% of
them took their mobile phones to hospital every day and 40.1% used mobile phone at
least once per day during work. As figured in Table I, the evidence of bacteria
contamination is found on approximately 97% of phones, and the bacteria that can
cause nosocomial infection are grown on 14.3% sampled phones. Besides, 38.1%
phones are contaminated by one species, 38% are contaminated by two different
species and 20.95% are contaminated by three or even more different bacteria species.
This study shows the very high rate of mobile phones are contaminated by bacteria
which may increase the risk of patient’s health, especially in operating theatre
environment.

To avoid these issues as possible, previous studies have discussed and recommended
many ways as staff education, strict hand hygiene and restrictions of mobile phone
use. Staff education can be improved by group study or posting posters and leaflet to
the area where they congregate to remind them(Naikoba & Hayward, 2001). The
importance of strict hand hygiene is strongly emphasized and recommended by the
most authors(Goldblatt, et al., 2007; Karabay, et al., 2007; Namias, et al., 2000).
Some reports call for complete ban on mobile phone in general clinic environment but
it is not feasible as such MCDs are widely used in general clinical care. The most
possibility is restrictedly control the use of mobile phones and completely ban the
mobile phones in some special areas(Jeske, et al., 2007).

Auditory system effect

In the study of Aal-Abduljawad(2008, pp. 72-74), volunteers are divided into 3 groups.
Group one used mobile phones frequently and spoken approximately 3-4 hours per
day for two years. Group two used mobile phones for 1-2 hours per day for two years.
Group three never used mobile phones (control group). At last, the result showed four
volunteers from group one had reported ear pain, headache, tinnitus, weddings noise,
and party noise in the used ear but only one suffered tinnitus and headache from
group two. From group three, there two volunteers suffered from tinnitus.

In another study of Noritoshi, et al.(2003, pp. 1390-1394) on the effect of auditory

system, healthy normal volunteers were exposed to mobile phone radiation for 30 min
and were suffered different electrophysiological examinations, including ABR
(auditory brainstem responses) and MLR (middle latencies responses). From the
result that no electrophysiological changes in ABR, the author indicated that
“short-term exposure to mobile phone EMR (electromagnetic radiation) does not
affect stimulus transmission along the auditory pathway”.

Based on the small number of participators and limited time, long-term use of mobile
phone seems increasing the risk of effects on auditory system much more than
short-term use, but unfortunately, current lack of solid scientific evidence on the
biological effects of auditory system of EMFs(electromagnetic fields) leads to
confusion. Therefore, new studies are urgently needed to further clarify and identify
the effects of EMR on the human body and also more strongly evidence
needed(Kaprana, et al., 2008).

Metal allergens and skin hypersensitivity

On the topic of Metal allergens of growing significance: Epidemiology,

immunotoxicology, strategies for testing and prevention, Forte, at el.(2008, pp.
145-162) states:

“Metal-induced allergic contact dermatitis (ACD) is expressed in a wide range of

cutaneous reactions following dermal and systemic exposure to products.”

Metals such as aluminium, chromium, copper, gold, iridium, platinum and titanium
are the common elements of mobile phone which may cause skin hypersensitivity.
The report of Basketter(2008, pp. 267-273) indicates that although the total content of
such metal elements are limited by European Union, the diffusion of metal-induced
ACD is still quite high. In another study,

Kadyk, et al.(2003, pp. 1037-1048) focused on the quality of life of people suffered
by the skin hypersensitivity. It indicated that responders were bothered most by
itching, skin irritation, and persistence of the condition. Of the four scales presented in
the QoL(quality of life) questionnaire, the emotions scale had the worst composite
QoL score, followed by symptoms, functioning, and occupational impact. Patients
were significantly more bothered by the appearance of their skin with ACD of the face.
within the occupational impact and functioning scales, hand skin hypersensitivity and
occupationally related ACD were associated with worse QoL scores. As known,
mobile phone contacts hand and face frequently during daily life, so such skin
hypersensitivity may lead further disease and affect emotions significantly. The
patients will suffer the health risk both on mental and physical.

Forte, et al.(2008, pp. 145-162), also discussed the approaches for ACD prevention
and therapy such as observe the maximum allowable metal levels, optimize
metallurgic characteristics and take personal protection. Whereas, these avenues are
quite general and lack of details for precaution and prevention on the conditions of
mobile phone use. In this aspect of health dangers of mobile phone use, there are not
lot of studies focus on the metal allergens and skin hypersensitivity with mobile
phone use.

Conclusion

On the basis of health dangerous from the mobile phones study, most potential and
existed risks have been discussed and reviewed in this literature review. Though there
are lots of previous studies emphasis on the health risk related with mobile phone,
only the directly contactable factors can give clear and strong evidences. Most studies
on brain tumour, auditory system, eye, central nervous system and etc. do not have
sufficient support evidences, but there are still potential risks with use of mobile
phone especially long-term use. Further more, more quality studies are needed to find
the effects of mobile phones on human body. As a kind of mobile communication
devices, this study should absorb more relevant information on other MCDs, and this
will be helpful to investigate and cover more aspects of the effects from mobile
phone.
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