Cellular phones: are they detrimental?

The issue of possible health effects of cellular phones is very much alive in the public's mind where the rapid increase in the number of the users of cell phones in the last decade has increased the exposure of people to the electromagnetic fields (EMFs). Health consequences of long term use of mobile phones are not known in detail but available data indicates the development of non specific annoying symptoms on acute exposure to mobile phone radiations. In an attempt to determine the prevalence of such cell phones associated health manifestations and the factors affecting their occurrence, a cross sectional study was conducted in five randomly selected faculties of Alexandria University. Where, 300 individuals including teaching staff, students and literate employee were equally allocated and randomly selected among the five faculties. Data about mobile phone's users and their medical history, their pattern of mobile usage and the possible deleterious health manifestations associated with cellular phone use was collected. The results revealed 68% prevalence of mobile phone usage, nearly three quarters of them (72.5%) were complainers of the health manifestations. They suffered from headache (43%), earache (38.3%), sense of fatigue (31.6%), sleep disturbance (29.5%), concentration difficulty (28.5%) and face burning sensation (19.2%). Both univariate and multivariate analysis were consistent in their findings. Symptomatic users were found to have significantly higher frequency of calls/day, longer call duration and longer total duration of mobile phone usage/day than non symptomatic users. For headache both call duration and frequency of calls/day were the significant predicting factors for its occurrence (chi2 = 18.208, p = 0.0001). For earache, in addition to call duration, the longer period of owning the mobile phone were significant predictors (chi2 = 16.996, p = 0.0002). Sense of fatigue was significantly affected by both call duration and age of the user (chi2 = 24.214, p = 0.0000), while burning sensation was only affected by frequency of calls/day (chi2 = 5.360, p = 0.020). According to the 95% confidence interval of frequency and duration of calls, the study recommended not to increase the call duration more than four minutes and limit their frequency to less than seven calls/day with total duration of exposure less than 22 min./day.     

Drug treatment courts are popular but do they work and are they ethical and appropriate for Canada?

Currently Canada is experimenting with the implementation of drug treatment courts. Pilot projects are underway in both Toronto and Vancouver. In the U.S., drug courts emerged as a response to the overcrowding of the prison system, the end product of the revolving door of substance dependent people moving through the court system. However, this expansion was not accompanied by any rigorous evaluation or critical reflection as to whether drug treatment courts can achieve their desired outcomes or if they are appropriate for dealing with substance dependent offenders. The purpose of this article is to take a critical look at this phenomenon and to discuss whether the drug court model is suitable for Canada.     

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Insurance expansions: do they hurt those they are designed to help?

Seeking to redress health disparities across income and race, many policy-makers mandate health insurance benefits, presuming that equalized benefits will help equalize use of beneficial health services. This paper tests that presumption by measuring health care use by a diverse population with comprehensive health insurance. Focusing on use of mental health care and pharmaceuticals, it finds that even when insurance benefits and access are constant, whites and those with high incomes consume more of these benefits than other people do. This suggests that privileged classes extract more health care services even when everyone pays equal premiums for equal insurance coverage.     

HIV and STDs: how are they linked?

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

Centralized drug review processes: are they fair?

Numerous countries have implemented centralized drug review processes to assist in making drug coverage decisions. In addition to examining the final recommendations of these bodies, it is also important to ensure fairness in decision making. Accountability for reasonableness is an ethics-based framework for examining the fairness of priority setting processes. The objective of this study was to assess the fairness of four internationally established centralized drug review processes using accountability for reasonableness. Semi-structured telephone interviews were conducted with stakeholders in Canada, New Zealand, Australia and the UK (n=16). Participants were asked to evaluate their country's centralized drug review process against the four conditions of accountability for reasonableness. Each centralized drug review process satisfied at least one of the four ethical conditions, but none satisfied all four conditions. All participants viewed transparency as critical to both the legitimacy and fairness of centralized drug review processes. Additional strides need to be made in each of the four countries under study to improve the fairness of their centralized drug review processes. Ideally, a fair priority setting process should foster constructive stakeholder engagement and enhance the legitimacy of decisions made in assessing pharmaceutical products for funding. As policy makers are under increasing scrutiny in allocating limited resources, fair process should be seen as a critical component of such activity. This study represents the first attempt to conduct an international comparison of the fairness of centralized drug review agencies in the eyes of participating stakeholders.     

HIV and STDS: how are they linked?

The 153-327 million new cases of treatable sexually transmitted diseases (STDs) each year are a critical health problem and are increasingly associated with transmission of HIV infections. There is strong epidemiological evidence that STDs (especially HIV-1 and genital ulcer diseases such as syphilis, herpes, and chancroid) increase a person's ability to transmit or acquire an HIV infection. In addition, HIV may alter the clinical presentation, natural history, diagnosis, and responsiveness to therapy of STDs; and STDs may alter the natural history of HIV infection by inducing immunosuppression, by chronic immune stimulation, or by direct viral interactions. Most reports on HIV infection and syphilis document neurological manifestation of syphilis in HIV-1 infected individuals. HIV-1 may modify an individual's response to syphilis infection, producing more persistent and higher RPR titres, increasing the likelihood of losing reactivity to treponemal tests correlating with advanced HIV disease, and increasing biological false-positive reactions. HIV also appears to reduce the responsiveness of chancroid to standard therapy, especially single-dose therapy, thus requiring multiple-dose therapy over 5-7 days. Herpes simplex viral infections are more frequent and severe in HIV-infected individuals, but dosage adjusted acyclovir therapy is effective in most patients. Gonorrhea does not appear to be affected by the presence of HIV infection, except that HIV-infected women may be more susceptible to cervical gonococcal infection and pelvic inflammatory disease. The clinical presentation of human papilloma virus, however, is altered by HIV infection as is the rate of recurrence and the responsiveness to standard therapy. Because of the recognition of the interaction of HIV and STDs, STD control is now recognized as an essential component of HIV prevention programs. Parallel prevention campaigns, such as condom promotion, could reduce both.