Short message service (SMS) applications for disease prevention in developing countries

Background

The last decade has witnessed unprecedented growth in the number of mobile phones in the developing world, thus linking millions of previously unconnected people. The ubiquity of mobile phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention efforts.

Objective

The aim of this review was to describe the characteristics and outcomes of SMS interventions for disease prevention in developing countries and provide recommendations for future work.

Methods

A systematic search of peer-reviewed and gray literature was performed for papers published in English, French, and German before May 2011 that describe SMS applications for disease prevention in developing countries.

Results

A total of 34 SMS applications were described, among which 5 had findings of an evaluation reported. The majority of SMS applications were pilot projects in various levels of sophistication; nearly all came from gray literature sources. Many applications were initiated by the project with modes of intervention varying between one-way or two-way communication, with or without incentives, and with educative games. Evaluated interventions were well accepted by the beneficiaries. The primary barriers identified were language, timing of messages, mobile network fluctuations, lack of financial incentives, data privacy, and mobile phone turnover.

Conclusion

This review illustrates that while many SMS applications for disease prevention exist, few have been evaluated. The dearth of peer-reviewed studies and the limited evidence found in this systematic review highlight the need for high-quality efficacy studies examining behavioral, social, and economic outcomes of SMS applications and mobile phone interventions aimed to promote health in developing country contexts.     

基于SMS的血压远程监护系统的研究

血压远程监护系统利用移动通讯GSM网的SMS短信息服务功能．对高血压患者的血压进行实时自动监测、分析、语音告警和指导治疗．并建立病人的血压电子病历档案和网络共享，运行费用低廉，具有临床应用意义。     

Mobile phone SMS messages can enhance healthy behaviour: a meta-analysis of randomised controlled trials

Healthy behaviour, such as smoking cessation and adherence to prescribed medications, mitigates illness risk factors but health behaviour change can be challenging. Mobile phone short-message service (SMS) messages are increasingly used to deliver interventions designed to enhance healthy behaviour. This meta-analysis used a random-effects model to synthesise 38 randomised controlled trials that investigated the efficacy of SMS messages to enhance healthy behaviour. Participants (N = 19,641) lived in developed and developing countries and were diverse with respect to age, ethnicity, socioeconomic background and health behaviours targeted for change. SMS messages had a small, positive, significant effect (g = 0.291) on a broad range of healthy behaviour. This effect was maximised when multiple SMS messages per day were used (g = 0.395) compared to using lower frequencies (daily, multiple per week and once-off) (g = 0.244). The low heterogeneity in this meta-analysis (I ² = 38.619) supports reporting a summary effect size and implies that the effect of SMS messaging is robust, regardless of population characteristics or healthy behaviour targeted. SMS messaging is a simple, cost-effective intervention that can be automated and can reach any mobile phone owner. While the effect size is small, potential health benefits are well worth achieving.     

Effectiveness and Acceptability of a Mobile Phone Text Messaging Intervention to Improve Blood Pressure Control (TEXT4BP) among Patients with Hypertension in Nepal: A Feasibility Randomised Controlled Trial

Background:Uncontrolled blood pressure (BP) is the leading cause of preventable deaths in low- and middle-income countries. mHealth interventions, such as mobile phone text messaging, are a promising tool to improve BP control, but research on feasibility and effectiveness in resource-limited settings remains limited.Objective:This feasibility study assessed the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve BP control and treatment adherence among patients with hypertension in Nepal.Methods:The TEXT4BP study was a two-arm, parallel-group, unblinded, randomised controlled pilot trial that included 200 participants (1:1) (mean age: 50.5 years, 44.5% women) with hypertension at a tertiary referral hospital in Kathmandu, Nepal. Patients in the intervention arm (n = 100) received text messages three times per week for three months. The control arm (n = 100) received standard care. The COM-B model informed contextual co-designed text messages. Primary outcomes were change in BP and medication adherence at three months. Secondary outcomes included BP control, medication adherence self-efficacy and knowledge of hypertension. A nested qualitative study assessed the acceptability of the intervention.Results:At three months, the intervention group had greater reductions in systolic and diastolic BP vs usual care [–7.09/–5.86 (p ≤ 0.003) vs –0.77/–1.35 (p ≥ 0.28) mmHg] [adjusted difference: systolic β = –6.50 (95% CI, –12.6; –0.33) and diastolic BP β = –4.60 (95% CI, –8.16; –1.04)], coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006). The intervention arm showed an improvement in compliance to antihypertensive therapy (p < 0.001), medication adherence (p < 0.001), medication adherence self-efficacy (p = 0.023) and knowledge on hypertension and its treatment (p = 0.013). Participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention.Conclusion:The TEXT4BP study provides promising evidence that text messaging intervention is feasible, acceptable, and effective to improve BP control in low-resource settings.Trial registration:anzctr.org.au Identifier ACTRN12619001213134.     

Activation of ceramide synthase 6 by celecoxib leads to a selective induction of C16:0-ceramide

Ceramides serve as bioactive molecules with important roles in cell proliferation and apoptosis. Ceramides (Cer) with different N-acyl side chains (C_14:0-Cer-C_26:0-Cer) possess distinctive roles in cell signaling and are differentially expressed in HCT-116 colon cancer cells. Celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, exhibiting antiproliferative effects, activates the sphingolipid pathway. To elucidate the mechanism, HCT-116 cells were treated with 50 μM celecoxib leading to a significant increase of C_16:0-Cer. Interestingly, 50 μM celecoxib resulted in a 2.8-fold increase of ceramide synthase (CerS) activity as measured by a cell-based activity assay. siRNA against several CerSs revealed that CerS6 was predominantly responsible for the increase of C_16:0-Cer in HCT-116 cells. Moreover, the silencing of CerS6 partially protected HCT-116 cells from the toxic effects induced by celecoxib. Treatment of cells with celecoxib and fumonisin B1 (inhibitor of CerSs) or myriocin (inhibitor of l-serine palmitoyl transferase) or desipramine (inhibitor of acid sphingomyelinase and acid ceramidase) revealed that the increase of C_16:0-Cer results predominantly from activation of the salvage pathway. Using the nude mouse model we demonstrated that celecoxib induces also in vivo a significant increase of C_16:0-Cer in stomach, small intestine and tumor tissue. In conclusion, celecoxib causes a specific increase of C_16:0-Cer by activating CerS6 and the salvage pathway, which contribute to the toxic effects of celecoxib.     

新生儿住院管理系统的研究与设计

通过对医院现有信息系统的分析,针对当前系统在新生儿管理上的诸多不足,提出一套以新生儿为核心的信息管理方案。系统采用目前常用的多层架构,结合http协议、Web服务及API接口技术,与现有的医院信息平台集成,实现了新生儿从出生登记到出院结算完整的医疗过程信息化管理,提升了医院整体医疗服务水平。     

短信平台的密码服务在病案复印中的应用

由于病案在诸多方面具有不可替代的作用,病案复印工作显得尤为重要。因病案内容的隐私性,复印病案必须经过身份的审核,而患者及代理人常常因忘记携带有效证件而造成复印流程受阻。本文参照服务行业的密码服务理念,设计让患者通过短息平台设立病案的服务密码,使之在日常的申请审核中,如遇代理人没有携带患者有效身份证件时,病案室工作人员提示代理人可以在病案管理系统中输入已知的服务密码,该密码与在医院服务器中预存的服务密码进行核对。如果输入正确,则视为身份审核成功。目的是为患者及其代理人提供另一种申请模式,提供人性化的服务,实现以病人为中心,提高医疗服务质量。