A text a day...
Mar 24th 2006
From The Economist print edition
The medical uses of mobile phones show they can be good for your health
WHAT impact can mobile phones have on their users' health? Many people worry about the supposed ill effects caused by radiation from handsets and base stations1, despite the lack of credible evidence of any harm. But evidence for the beneficial effects of mobile phones on health is rather more abundant. Indeed, a systematic review carried out by Rifat Atun and his colleagues at Imperial College, London, ★rounds up[1] 150 examples of the use of text-messaging in the delivery of health care. These uses fall into three categories: efficiency gains; public-health gains; and direct benefits to patients by incorporating text-messaging into treatment regimes. The study, funded by Vodafone2, the world's largest mobile operator, was published this week.
（1）Using ★texting[2] to boost efficiency is not rocket science, but big savings can be achieved. Several trials carried out in England have found that the use of text-messaging reminders reduces the number of missed appointments with family doctors by 26-39%, for example, and the number of missed hospital appointments by 33-50%. If such schemes were ★rolled out[3] nationally, this would translate into annual savings of £256m-364m.
Text messages are also being used to remind patients about blood tests, clinics, scans and dental appointments. Similar schemes in America, Norway and Sweden have had equally satisfying results—though the use of text-message reminders in the Netherlands, where non-attendance rates are low, at 4%, had no effect other than to annoy patients.
Text messages can also be a good way to disseminate public-health information, particularly to groups who are hard to reach by other means, such as teenagers, or in developing countries where other means of communication are unavailable. Text messages have been used in India to inform people about the World Health Organisation's strategy to control tuberculosis, for example, and in Kenya, Nigeria and Mali to provide information about HIV and malaria. In Iraq, text messages were used to support a campaign to vaccinate nearly 5m children against polio.
Finally, there are the uses of text-messaging as part of a treatment regime. These involve sending reminders to patients to take their medicine at the right time, or to encourage compliance with exercise regimes or efforts to stop smoking. （2）The evidence for the effectiveness of such schemes is generally ★anecdotal[4], however, notes Dr Rifat. More quantitative research is needed—which is why his team also published three papers this week looking at the use of mobile phones in health care in more detail. One of these papers, written in conjunction with Victoria Franklin and Stephen GREene of the University of Dundee, in Scotland, reports the results of a trial in which diabetic teenagers' treatment was backed up with text messaging.
Diabetes needs constant management, and requires patients to take an active role in their treatment by measuring blood-sugar levels and administering insulin injections. （3）The most effective form of therapy is an intensive regime in which patients adjust the dose of insulin depending on what they eat. This is more ★onerous[5] for the patient, but allows for a GREater dietary variety. Previous studies have shown that intensive treatment is effective only with close supervision by doctors. Dr Franklin and her colleagues devised a system called Sweet Talk, which sends patients personalised text messages reminding them of the treatment goals they have set themselves, and allowing them to send questions to doctors. The Sweet Talk system was tested over a period of 18 months with teenage patients receiving both conventional and intensive diabetes treatment. A control group received conventional treatment and no text messages.
The researchers found that the use of text-messaging significantly increased “self-efficacy”3 (the effectiveness of treatment, measured by questionnaire). More importantly, among patients receiving intensive therapy, the level of haemoglobin HbA1c4—an indicator of blood-glucose and hence of glycaemic control—was 14% lower than for those in the control group. Since even a 10% decline in HbA1c level is associated with a reduction in complications such as eye and kidney problems, this is an impressive result. It suggests that texting can cheaply and effectively support intensive therapy among teenagers, who often demonstrate poor compliance5.
Despite such promising results, Dr Rifat notes, many of the medical uses of text-messaging have not yet been subjected to clinical trials, because they are so new. And even where the benefits are proven, the technology has not been systematically deployed on a large scale. But when it comes to improving outcomes and reducing costs, （4）text messages would seem to be just what the doctor ordered.
[NOTES](LONGMAN)
1. round up v.（赶往）监狱，围捕；归拢，聚集；五入以成整数
1）if police or soldiers round up a particular group of people, they find them and force them to go to prison
e.g. Thousands of men were rounded up and jailed. 数以千计的人被围捕并关进监狱。
2）to find and gather together a group of people, animals or things
e.g. See if you can round up a few friends to help you!我倒要看看你能找着几个朋友帮你。
His dog Nell started to round up the sheep.他的狗奈尔开始把羊朝一起赶。
3）to increase an exact figure to the nearest whole number (+to)
e.g. A charge of 1.90 will be rounded up to 2, and one of 3.10 rounded down to 3. 把 1.90 英镑的费用上调为整数 2 英镑, 把 3.10 英镑下调为整数 3 英镑.
2.text v.发送 短信 to send someone a written message on a mobile phone
3.roll out v.推出，推开；发行，启动 to make a new product available for people to buy or use;=launch
e.g. The company expects to roll out the new software in September.公司计划在9月份推出这款新软件。
4.anecdotal adj.趣闻轶事的，个人见闻的 consisting of short stories based on someone’s personal experience
e.g. His findings are based on anecdotal evidence rather than serious research.他的发现都是基于传闻证据而非认真研究。（anecdotal evidence在心理学上称为“轶事证据”， 即粗浅的证据，经常以故事形式出现：比如“我记得那时……”，“我听说……”。轶事是出了名的不准确。也有人译为“传闻证据”、“观察证据”、“轶闻证据”等。）
5.onerous adj.（正式）（工作或责任）困难且令人焦虑的；累人的 work or a responsibility that is onerous is difficult and worrying or makes you tired.
[TIPS & BACKGROUND]
1. 基站（Base station）：是指采用蜂窝方式组网的GSM移动通信系统、CDMA移动通信系统、数字集群通信系统、PHS无线接入系统以及采用其他技术体制的无线电通信系统的基站及其室外直放站。基站所使用的频率必须已经国家或省级无线电管理机构批准；使用的发射设备必须具有国家无线电管理机构核发的《无线电发射设备型号核准证》。
2. 沃达丰（Vodafone）：是跨国性的移动电话营办商。总部设在英国波克夏郡的纽布利（Newbury）及德国的杜塞尔多夫。现时为世界上最大的流动通讯网络公司之一，在全球27个国家均有投资。在另外14个国家则与当地的移动电话营办商合作，联营移动电话网络。截至2004年12月31日，沃达丰在全球拥有大约一亿五千一百八十万名用户。沃达丰使用沃达丰集团作为名称，分别于伦敦证券交易所（代号VOD.L）及纽约证券交易所（代号VOD）上市。沃达丰（Vodafone）的名称结合了Voice（语音）－Data（数据）－Fone（电话）三个意思。
3. 自我效能感（self-efficacy）：即一个人对自己成功地完成某种任务、达到既定水平的确信程度。
4. 糖化血红蛋白（HbA1c)：是血红蛋白A组分的某些特殊分子部位和葡萄糖经过缓慢而不可逆的非酶促反应结合而形成的，当血液中葡萄糖浓度较高时，人体所形成的糖化血红蛋白含量也会相对较高。人体内红细胞的寿命一般为120天，在红细胞死亡前，血液中糖化血红蛋白含量也会保持相对不变。因此糖化血红蛋白水平反映的是在检测前120天内的平均血糖水平，而与抽血时间，病人是否空腹，是否使用胰岛素等因素无关，是判定糖尿病长期控制的良好指标。它反映4～8周的体内血糖的平均水平，并可能是造成糖尿病并发症的一个重要原因。
5. 依从性（compliance）：是指患者执行医疗措施的程度，亦即患者执行医嘱的程度。患者能完全按医嘱要求执行者称为依从性好，否则称为不依从性。
每天一条 短信 ……
（陈继龙 学译）
通过医学应用显示，手机可能有益于您的健康。
手机对使用者健康会产生什么样的影响呢？许多人担心手机手持装置及通信基站的辐射会对身体有害，不过始终缺乏可靠依据，而关于手机对健康有益的证据却越来越多。的确，在伦敦皇家学院里法特•亚顿及其同事撰写的一篇系统性综述中，就汇总了150条手机 短信 用于提供医疗保健服务的事例。 短信 的这些用途可以分为三类，即提高工作效率、促进公共卫生宣传以及通过将 短信 与治疗方案进行整合直接惠及病人。本周公诸于众的此项研究是由世界最大的移动电话运营商沃达丰资助的。
利用编发 短信 来提高工作效率并不是多么高深的科学，但是能节省大笔费用。比如，英国有几项试验发现， 短信 提醒功能将同家庭医生的约会错过率降低了26％到39％，同医院的约会错过率则减少了33%到50%。设若这种 短信 提醒系统能推广到全国，则相当于每年节省2.56～3.64亿英镑。
在提醒病人去验血、上诊所、做扫描以及预约牙医等方面， 短信 也正得到应用。在美国、挪威和瑞典，一些类似的系统均已取得了令人满意的效果——不过在荷兰，由于无故缺席率本来就较低（5％），所以 短信 提醒除了打扰患者之外，无任何效果。
手机 短信 也是传播公共卫生信息的一个好途径，对那些通过其他方式难以传达到的人群，比如青少年，或者是在没有其他通信手段的发展中国家，更是如此。比如，印度已使用 短信 来宣传国际卫生组织的结核病防控策略，肯尼亚、尼日利亚和马里也利用 短信 为人们提供艾滋病和疟疾方面的讯息，在伊拉克， 短信 则被用来声援一项给将近5岁的儿童接种天花疫苗的行动。
最后，手机 短信 还可作为治疗方案的一部分，发挥多种作用，其中包括提醒病人适时服药、督促病人按要求进行锻炼以及劝阻患者吸烟。然而，里法特强调，有关这些作用效果的例证一般都是道听途说来的（街谈巷议），尚需进一步定量研究——这也正是里法特研究小组本周着眼于阐明手机对卫生保健的作用所发表的3篇论文的出发点，其中有一篇是与苏格兰邓迪大学的维多利亚•富兰克林和斯蒂芬•格林合作撰写的。该文报告，一项糖尿病青少年病人试验结果表明，手机 短信 对治疗该病有辅助作用。
糖尿病需要持续性治疗，并要求患者在治疗过程中必须积极主动，如测量血糖浓度、注射胰岛素。最有效的治疗形式就是进行强化治疗，即患者根据饮食调整胰岛素用量。这对患者而言是有些勉为其难，但饮食上的多样性决定了别无选择。以前有研究显示，只有在医生密切监控下，强化治疗才有效。富兰克林和他的同事们设计了一种“甜言蜜语”系统，此系统可向患者发送个性化 短信 ，叮嘱其记住既定治疗目标，如有疑问也可发信息给医生。“甜言蜜语”系统经过了18个月的检测，期间少年糖尿病患者同时接受一般性和强化治疗，并设立对照组，即患者仅接受一般性治疗，而不给其发送 短信 。
研究人员发现，应用 短信 显著提高了患者“自我效能感”（即治疗效果，问卷检测）。更重要的是，接受强化治疗的患者中，糖化血红蛋白（HbA1c）（一种血糖指标，用于监控血糖含量）浓度比对照组低14％。一般而言，糖化血红蛋白浓度下降10%，就表明眼、肾等并发症发生率降低，因此这一试验结果令人瞩目，它提示 短信 能够便宜有效地辅助少年患者强化治疗，而这些患者在治疗中往往依从性很差。
里法特指出，结果虽然令人深受鼓舞，但 短信 的很多医疗用途由于太过新颖，还没有接受临床试验，即便是已被证实的用途，也尚未得到系统性推广。但是，随着 短信 对改善治疗效果和减少医疗费用的作用越来越突出，医生们也许将用 短信 来下医嘱。
