Using digital chatbots to close gaps in healthcare access during the COVID-19 pandemic.

INTRODUCTION: Chatbots have emerged as a first link to care in recent years. The COVID-19 pandemic, and consequent health system disruptions, expanded their use. Socios En Salud (SES) introduced chatbots in Peru, which experienced one of the highest excess COVID mortalities in the world. METHODS: SES and the government identified unmet population health needs, which could be amenable to virtual interventions. Chatbots were developed to screen individuals for these conditions; we describe the period of deployment, number of screenings, and number of people who received services. RESULTS: Between April 2020 and May 2021, SES deployed nine ChatBots: four for mental health, two for maternal and child health, and three for chronic diseases: breast cancer, hypertension, diabetes mellitus, and obesity. Mental health services were provided to 42,932 people, 99.99% of those offered services. The other ChatBots reached fewer people. Overall, more than 50% of eligible people accepted chatbot-based services. DISCUSSION: ChatBot use was highest for mental health. Chatbots may increase connections between a vulnerable population and health services; this is likely dependent on several factors, including condition, population, and penetration of smart phones. Future research will be critical to understand user experience and preferences and to ensure that chatbots link vulnerable populations to appropriate, high-quality care.

INTRODUCTION: Les chatbots se sont imposés comme un premier lien aux soins ces dernières années. La pandémie de COVID-19, et les perturbations du système de santé qui en ont résultées, ont élargi leur champ d'application. Socios En Salud (SES) a introduit les chatbots au Pérou, qui a connu l'une des surmortalités dues au COVID les plus élevées au monde. MÉTHODES: SES et le gouvernement ont identifié des besoins non satisfaits en matière de santé de la population, qui pourraient faire l'objet d'interventions virtuelles. Des chatbots ont été développés pour dépister des individus pour ces conditions ; nous décrivons la période de leur déploiement, le nombre de dépistages et le nombre de personnes qui ont reçu ces services. RÉSULTATS: Entre avril 2020 et mai 2021, SES a déployé neuf ChatBots : quatre pour la santé mentale, deux pour la santé maternelle et infantile et trois pour les maladies chroniques, comme le cancer du sein, l'hypertension, le diabète et l'obésité. Des services de santé mentale ont été fournis à 42 932 personnes, soit 99,99% des personnes proposées. Les autres ChatBots ont touché moins de personnes. Dans l'ensemble, plus de 50% des personnes éligibles ont accepté les services proposés par les chatbots. DISCUSSION: L'utilisation des ChatBots était la plus élevée pour la santé mentale. Les chatbots peuvent augmenter les connexions entre une population vulnérable et les services de santé, mais cela dépende de plusieurs facteurs, dont la condition, la type de population et la pénétration des smartphones. Les recherches futures seront essentielles pour comprendre l'expérience et les préférences des utilisateurs et pour s'assurer que les chatbots relient les populations vulnérables vulnérables aux soins appropriés et de qualité.

Does Delay to Operation Impact Sentinel Lymph Node Status among Patients with Melanoma?

Introduction: After melanoma diagnosis, various factors can delay therapy, including the COVID-19 pandemic. In this study, we examine the significance of surgical delay on sentinel lymph node (SLN) status in melanoma patients. Methods: Using the National Cancer Database, we examined surgical delay, defined as time from biopsy to surgical excision, for patients diagnosed with cutaneous melanoma who underwent tumor resection and SLN biopsy. Patients with clinically positive nodes were excluded. Logistic regression models were constructed to adjust for pertinent clinical factors. Results: From 2012-2017, 21,153 patients were included and 21.2% (n = 4,486) experienced a surgical delay of more than 45 days. Patients experiencing prolonged surgical delay were older (older than 75 years), lived farther from their reporting hospital, had Medicaid or were uninsured, or had multiple comorbidities (all, p < 0.05). Metastatic SLNs were more likely in younger patients (younger than 55 years), ulcerated tumors, and tumors ≥ 1 mm (p > 0.001). In adjusted analyses, the odds of SLN metastasis increased by 1% per day of surgical delay (odds ratio [OR] 1.01;95% CI, 1.00 to 1.01;p = 0.003) and by 19% for surgical delay more than 45 days (OR 1.19;95% CI, 1.02 to 1.39;p = 0.026). Surgical delay more than 45 days was associated with increased risk of SLN metastasis in the following scenarios: nonulcerated tumors (OR 1.23;95% CI, 1.04 to 1.46;p = 0.017), age 65 through 74 years (OR 1.46;95% CI, 1.06 to 2.02;p = 0.019), or thickness 1.00 to 1.99 mm (OR 1.27;95% CI, 1.00 to 1.60;p = 0.048). Conclusions: Tumor ulceration, thickness, and patient age confer increased risk of SLN metastasis when surgical delay occurs. In light of COVID-19-related delays in diagnosis and treatment, particular patients appear to benefit from timely SLN biopsy.

Challenges of virtual education during the Covid-19 pandemic: Experiences of mexican university professors and students

Students' and university professors' challenges due to the COVID-19 worldwide pandemic have been enormous. Without prior notice, they had to switch from traditional education to virtual teaching. This study's objective was to identify the perception of students and professors of the Bachelor in the English Language from the University of Chihuahua, Mexico, during the transition to virtual classes due to the pandemic. Researchers applied a survey of 28 items with a Likert scale to 152 students during the spring semester 2020 and the second instrument of 51 items to 26 professors. The students reported having complications in connectivity (21%) and difficulties interacting with professors and classmates (34%). Many students reported experiencing anxiety (69.1%) and feeling isolated (62.5%). Most agree that they learn better in face-to-face classes (85%). In turn, the professors agree that the students had a lower performance than in a face-to-face semester (69.3%). Despite this, the professors affirm that they followed the program to the letter (92.3%) and completed the programmed contents (84.6%). Besides, 92.3% of the academics are confident to face a new semester in virtual modality, if necessary. Although we can say that the transition from face-to-face to virtual classes in the institution was successful, students and professors encountered difficulties and disadvantages in the use of platforms for online classes. The benefit of this research's findings is understanding the University must have all the necessary elements in place for online teaching. It must establish a formal regulation of virtual programs that includes professor's and student's profile, as well as the strategies to be followed. The students' and professors' perceptions highlight the crucial elements that professors need to consider to teach virtual classes and take advantage of these lessons to face the future better. © 2021 The authors and IJLTER.ORG. All rights reserved.

Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.