Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions.

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

People with type 2 diabetes experiences of using WhatsApp-based diabetes self-management education and support: The process evaluation.

RATIONAL: Online Diabetes Self-Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media-based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences. AIM: This study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp-based DSMES. METHODS: A qualitative descriptive approach was adopted. Data consisted of 23 semi-structured phone interviews with people with T2DM who had received the WhatsApp-based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines. RESULTS: Four themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use. CONCLUSION: This study explored the experiences of people with T2DM participating in a 6-week WhatsApp-based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self-management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp-based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.

Insights on associations between the frequency of use of diverse social media products and social networks use disorder tendencies from a German speaking sample.

OBJECTIVE: In the present work we investigate how individual differences in at least occasionally using distinct social media platforms is linked to social networks use disorder (SNUD) tendencies. A final sample of n = 2200 participants filled in the AICA-C-9 measure to get insights into individual differences in overuse of social media and participants also indicated which platforms they used at least once a month. RESULTS: The analysis revealed a robust positive association between number of at least occasionally used social media apps and SNUD tendencies (r = .44, p < .001). Further, platforms differed in terms of their "addictive potential", if one takes associations between frequency of distinct platforms use and SNUD tendencies as a proxy for this (and of course the actual descriptive statistics of the SNUD scale for the (non-)frequent user groups of the different platforms). In this regard, at least occasionally using some platforms (here Tumblr, Twitter and TikTok) was associated with highest SNUD tendencies. Moreover, largest differences in terms of effect sizes between the occasional and non-occasional user groups regarding SNUD scores could be observed for Instagram, WhatsApp, and TikTok. The present work bases on data from a larger project investigating associations between SNUD and tobacco use disorder.

A text-based conversational agent for asthma support: Mixed-methods feasibility study.

Objective: Millions of people in the UK have asthma, yet 70% do not access basic care, leading to the largest number of asthma-related deaths in Europe. Chatbots may extend the reach of asthma support and provide a bridge to traditional healthcare. This study evaluates 'Brisa', a chatbot designed to improve asthma patients' self-assessment and self-management. Methods: We recruited 150 adults with an asthma diagnosis to test our chatbot. Participants were recruited over three waves through social media and a research recruitment platform. Eligible participants had access to 'Brisa' via a WhatsApp or website version for 28 days and completed entry and exit questionnaires to evaluate user experience and asthma control. Weekly symptom tracking, user interaction metrics, satisfaction measures, and qualitative feedback were utilised to evaluate the chatbot's usability and potential effectiveness, focusing on changes in asthma control and self-reported behavioural improvements. Results: 74% of participants engaged with 'Brisa' at least once. High task completion rates were observed: asthma attack risk assessment (86%), voice recording submission (83%) and asthma control tracking (95.5%). Post use, an 8% improvement in asthma control was reported. User satisfaction surveys indicated positive feedback on helpfulness (80%), privacy (87%), trustworthiness (80%) and functionality (84%) but highlighted a need for improved conversational depth and personalisation. Conclusions: The study indicates that chatbots are effective for asthma support, demonstrated by the high usage of features like risk assessment and control tracking, as well as a statistically significant improvement in asthma control. However, lower satisfaction in conversational flexibility highlights rising expectations for chatbot fluency, influenced by advanced models like ChatGPT. Future health-focused chatbots must balance conversational capability with accuracy and safety to maintain engagement and effectiveness.

Zoom & WhatsApp Digital Information and Communication Technologies (ICTs) Enhance Community Engaged Research with Women Immigrants from Mexico.

This article demonstrates how digital information and communication technologies (ICTs) (Zoom/WhatsApp) unexpectedly and counterintuitively proved to be valuable tools for community-engaged health research when, in the context of the COVID-19 pandemic, they were integrated into a research study testing a peer support group intervention with female immigrants from Mexico. Because of pandemic restrictions, we changed the study protocol to hold meetings remotely via Zoom rather than in person as originally planned. Because we recognized that this would lack some opportunities for participants to interact and develop relationships, we created a WhatsApp chat for each group. Despite challenges for participants to use ICTs and participant-stated preference for in-person meetings, the results demonstrated that participants overwhelmingly endorsed these technologies as promoting access, participation, engagement, and satisfaction. Zoom/WhatsApp created a valuable environment both as a method for conducting research with this population, but also as part of the intervention for immigrant women to support and learn from each other. ICT adaptations have now permanently changed the way we conduct community-engaged health research.

WhatsApp as a Tool in Blended Learning in Dental Education.

Background and Objective: Dental education is unique, with clinical/practical learning much different from other professionals. In dentistry, students are exposed much earlier in their curriculum to patients, performing procedures under direct/indirect supervision. Hence, the present review attempted to assess the standing position of dentistry in blended learning worldwide. Materials and Methods: E-learning modality was at its primitive stage as food for thought among educational task force committees, with only a handful of developed and developing countries equipped with it. During this pandemic, "WhatsApp" became a savior, as it was a widely used educational device among dental teachers and students. Furthermore, it was easily applicable in places where there was difficulty in obtaining regular internet bandwidth, especially in remote/rural areas. It is noteworthy that blended learning/e-learning, when complemented with the conventional teaching method, upskill critical thinking and problem-solving capabilities. Blended learning or virtual reality education should be made feasible without disparity, worldwide. Mind training, both students and staff in hybrid e-learning, is the need of the hour not only to keep pace with digitalized dentistry but to prepare the students to face real-world situations. Conclusion: The sustainability of dental education should be rethought by dental schools with "Complimented Digital learning" wherever feasible, not only to cope with current trends but also to face unforeseen future challenges.

On the Willingness to Pay for social media/messenger services taking into account personality and sent/received messages among WhatsApp users.

WhatsApp has billions of users worldwide. Instead of paying a subscription fee, users provide their data for the use allowance. This data is used by Meta - the company behind WhatsApp - to obtain insights into user characteristics and monetize those insights. However, this data business model is among others criticized for fostering a loss of privacy that arises when platforms analyze user data, and for the use of design elements to attract users to the platform when they are not online or to extend their online time. Therefore, an increasing number of scientists are discussing whether other payment models are needed to overcome those disadvantages, like a monetary payment model. However, users would probably only pay for improved social media products. This paper provides an empirical basis for understanding the user perspective and, in particular, whether and how much users are willing to pay for improved social media products. For this, 2924 WhatsApp users' perspectives on this topic were investigated. They were asked whether and how much they are willing to pay money for a messenger/social media service when its quality would be improved. Variables potentially influencing Willingness to Pay (i.e., personality, sent/received messages) were studied as well. 47% of the participants were unwilling to pay for a healthier messenger service, and about a quarter were willing or stayed neutral. Further analysis revealed that more agreeable people were more willing to pay. Further: Higher Extraversion was associated with more sent/received messages, but the number of sent/received messages was not linked to Willingness to Pay. The present study shows that many users still are not willing to pay for social media (here messengers), which indicates that the advantages of paying for social media with money instead of with one's own data might need to be better communicated.

Uncovering and Expressing our Purpose.

Generative artificial intelligence (AI) is currently a source of angst, because of its ability to give us content that sounds uncannily like a real person, and because of concern that people will not stop at using it as a tool to generate and synthesize ideas, but instead will cede control over our words, and then our thoughts. This editorial details each article in Creative Nursing Vol. 30 Issue 2, highlighting the ways in which social media, different kinds of AI, and other tools for connectivity can be used for good: finding our purpose, uniting people over long distances, expediting knowledge implementation, managing large volumes of literature, advancing health equity, and enriching nursing education.

WhatsApp-based intervention in urban Colombia to support the prevention of arboviral diseases: a feasibility study.

Arboviral diseases remain a significant health concern worldwide, with over half the world's population at risk for dengue alone. Without a vaccine or targeted treatment, the most effective strategy of prevention is vector management with community involvement. mHealth interventions, like WhatsApp, offer promising results for engaging communities and promoting healthier behaviors. This study explores the feasibility of integrating WhatsApp in vector control activities to improve arbovirus prevention in Colombia. A mixed-methods approach was employed to assess the WhatsApp-based intervention. WhatsApp messages were sent to 45 community women for 5 weeks to increase their knowledge and practices about dengue, Zika, and chikungunya. Pre-and-post surveys and focus group discussions were conducted in community settings to measure the feasibility and acceptability of this intervention. Chat reviews were done to assess the usability of users. A total of 1566 messages were exchanged in 45 WhatsApp chats. High acceptance and good usability (82% of users used the app for replying) were reported in this study. WhatsApp messages were perceived as short, clear, and enjoyable. Users liked the frequency, and design of messages. Pre- and post-surveys demonstrated improvements in the knowledge and practices of arboviral diseases. The intention to apply this knowledge in practice was reflected in a significant improvement, particularly in cleaning the laundry tank once a week (pre 62.1% to post 89.6%, p < 0.008). This study suggests that using WhatsApp as an additional tool could be a feasible, acceptable, and affordable strategy for improving the adoption of better practices in the prevention of arboviral diseases.

WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial.

Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.

Effects of a WhatsApp-Assisted Health Educational Intervention for Cardiac Rehabilitation: A Randomized Controlled Clinical Trial Protocol.

Although the effectiveness of cardiac rehabilitation (CR) programs in secondary prevention is well-recognized, there is a lack of studies exploring the potential of mobile health to enhance educational interventions within CR. The objective is to assess the impact of a structured WhatsApp-assisted health educational intervention, in conjunction with the usual care, compared to the usual care alone among participants enrolled in a CR program. The trial will recruit 32 participants enrolled in a CR program, who will be randomly assigned to a structured WhatsApp-assisted health educational intervention plus usual care or usual care alone group. The intervention will span 4 weeks, with assessments at baseline, 4 weeks, and 3, 6, and 12 months. The primary outcome measure is the cardiovascular risk factors knowledge score. Secondary outcomes include physical activity levels, anxiety and depression, and quality of life. Expected results include improved knowledge of cardiovascular risk factors, increased physical activity levels, and better mental health outcomes in the intervention group. Additionally, an enhancement in the overall quality of life is anticipated. These findings are expected to underscore the value of integrating mHealth with traditional CR methods, potentially shaping future approaches in chronic disease management and prevention.

Exploring How People Interact With Dental Misinformation on Social Media: A Cross-Sectional Study.

BACKGROUND: Social media has been widely utilized to spread health-related information, which has led to the possibility of spreading medical misinformation. The extent of the issue is unknown, even though policymakers, researchers, and medical professionals agree that health misinformation must be controlled and combated. OBJECTIVE: A cross-sectional study was conducted by the faculty of dentistry at Damascus University. METHODS: This quantitative cross-sectional study used a voluntary questionnaire distributed online in social media groups. Participants were of different ages, genders, and educational levels. RESULTS: Of the 301 questionnaires collected, 291 were analyzed. The study sample comprised secondary education certificates, university students, and postgraduate students. 96.6% of the study sample used two or more SM applications. 71.5% of the study sample uses Facebook more than other applications for dental information research, followed by Instagram (14.8%), Telegram (8.2%), and finally WhatsApp (5.5%). There was a significant difference between the age of the respondents and the SM application they used most (p = 0.027). 46.4% of the study sample were neutral in their answer about what they believed in the trust of information on SM sites, followed by 42.3% who did not agree with the trust of information on SM sites and 11.3 who agreed. 89.7% of the study sample visit the dentist when facing a medical problem, while 10.3% follow advice on SM sites. There was a significant difference between the age of respondents and the source they relied on when facing a medical problem (p = 0.019). 50.2% of the study sample sometimes feels that the advice on SM sites is marketing for a company or product or advertising for doctors and not others. CONCLUSION: In particular, understanding the methods and prevalence of health misinformation, as well as the current gaps in knowledge in this area, will help us to guide future research and, more specifically, to develop evidence-based digital policy action plans targeted at addressing this public health issue through various social media platforms.

Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study.

Background: Adolescent populations face reproductive health challenges. Persisting gaps in Triad Adolescent Reproductive Health (ARH) comprehension and risky behaviors emphasize the necessity of integrating social media apps into health education to address Triad ARH risks among youths. Teenagers commonly use WhatsApp and LINE for social media communication, and determining the effectiveness of these two apps is scarce. Objective: This quasi-experimental study aimed to investigate and compare the impacts of educational interventions delivered through WhatsApp and LINE platforms on enhancing the knowledge, attitudes, and behaviors of adolescents concerning the Triad ARH. Methods: A total of 154 senior high school students were randomly recruited from two public schools in Bandung Regency, West Java, Indonesia. These students were divided into two groups: Group A, consisting of 78 students who received material messages using LINE, and Group B, consisting of 76 students who received material messages using WhatsApp. Participants completed a pre-test prior to the intervention and a post-test one month after the intervention. Data were collected using validated questionnaires and analyzed using Chi-square and Wilcoxon tests. Results: In the LINE group, there was an average increase in knowledge from 15.68 to 20.21, attitudes from 29.05 to 59.12, and behavior from 55.95 to 64.81 before and after the intervention period (p = 0.001). In the WhatsApp group, there was an increase in knowledge from 15.16 to 19.67, in attitudes from 34.71 to 59.54, and behavior from 54.75 to 65.97 before and after the intervention period (p = 0.001). Further analysis showed no significant difference between the LINE and WhatsApp groups in increasing the average level of knowledge (p = 0.973), attitude (p = 0.682), and behavior (p = 0.067) before and after the intervention. However, it was observed that the increase in knowledge and attitude was slightly higher in the LINE group, while the increase in behavior was slightly higher in the WhatsApp group. Conclusion: This study demonstrates that educational interventions using LINE and WhatsApp both increased the knowledge, attitudes, and behavior of adolescents related to the Triad ARH. This finding is valuable, considering the popularity of LINE and WhatsApp as mobile applications. Leveraging these platforms by nurses and other healthcare professionals can significantly improve adolescents' health, influencing their knowledge, attitudes, and behavior regarding reproductive health.

Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. OBJECTIVE: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. METHODS: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children's BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. RESULTS: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. CONCLUSIONS: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. TRIAL REGISTRATION: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54446.

Utilisation of WhatsApp for Emergency Medical Services in Garissa, Kenya.

Garissa county, Kenya is a geographically large county with a mobile pastoralist population that has developed a method for emergency medical services (EMS) coordination using the WhatsApp communication platform. This work was based on a site visit, to better understand and describe the current operations, strengths, and weaknesses of the EMS communication system in Garissa. The use of WhatsApp in Garissa county seems to work well in the local context and has the potential to serve as a cost-effective solution for other EMS systems in Kenya, Africa, and other LMICs.

Assessing effectiveness of WhatsApp messaging program in oral hygiene care for orthodontic patients: A randomised controlled trial.

OBJECTIVE: To evaluate the difference in the oral hygiene status of participants with fixed appliances between a 'weekly WhatsApp application oral hygiene message reminders' trial group and a 'verbal instructions' control group over a follow-up duration of 12 weeks. DESIGN: Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up. SETTING: Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia. PARTICIPANTS: A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances. METHODS: The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2). RESULTS: The mean age was 17 years, and 80% were female patients. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial. CONCLUSION: The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.

Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study.

BACKGROUND: Health misinformation can adversely affect individuals' quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. OBJECTIVE: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. METHODS: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants' ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. RESULTS: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants' abilities to identify misinformation in WhatsApp messages (z=-6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the "forwarded" label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). CONCLUSIONS: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants' abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions.

Monitoring negative pressure wound therapy for diabetic foot ulcers using WhatsApp.

Foot complications of patients with diabetes could lead to amputations and early death. Diabetic foot ulcers (DFU) are usually difficult to treat and impose huge financial burden. Monitoring wound progress is the mainstay of any treatment and alternatives to face-to-face consultations such as tele-medicine have been proposed. Very few papers explored the utility and effectiveness of monitoring DFU through instant messaging application such as WhatsApp. The aim of this study is to evaluate the validity of WhatsApp in monitoring diabetic wounds treated with negative pressure wound therapy (NPWT). Twenty-two patients were prospectively recruited. All patients had an initial face-to-face consultation and debridement. Dressings were changed twice per week at patient's residence and media files were sent by the wound nurse via Short Message Service (SMS). A subsequent face to face consultation was scheduled whenever a complication was suspected. The primary outcomes were the percentages of accurate cases a) where a new or recurrent infection was suspected, and a b) where a debridement was thought to be needed. Complete healing of the defect using NPWT was achieved in 10 patients and a skin graft procedure was needed in another 4 patients. Five patients needed further surgical debridement. Failure to heal was observed in 3 patients. Out of the seven cases where a new infection was suspected, five (71.5%) were confirmed on face-to-face consultation. No confirmed cases of infection were observed during follow-up for those estimated as clean. Out of the 11 cases where debridement was favored based on WhatsApp media files, confirmation of a needed debridement was recorded in 8 (73%) cases. NPWT monitoring of for diabetic foot and leg ulcers using WhatsApp application was found to be an excellent method to document and track the wound process and complications. The excellent specificity and high sensibility should encourage for common use by healthcare. The results of this study could be also valuable for patients living in rural areas and in case of future pandemics.

Knowledge, Attitudes, and Subjective Norms Associated with COVID-19 Vaccination among Pregnant Women in Kenya: An Online Cross-Sectional Pilot Study Using WhatsApp.

COVID-19 vaccination during pregnancy has been recommended, but the perceptions related to uptake remain unexplored. This pilot study aimed to explore how perceptions influence COVID-19 vaccine uptake among a sample of 115 pregnant women in Kenya, recruited via WhatsApp. Data were collected using an adapted online questionnaire between May and October 2022. Logistic analyses assessed the relationship between COVID-19 vaccination uptake and the Theory of Reasoned Action (TRA) constructs: attitudes and subjective norms. COVID-19 vaccination coverage was 73%, with vaccine hesitancy estimated at 41.4% among the unvaccinated group. Most participants had completed college education and had good knowledge of COVID-19 vaccines. There was no significant effect of enrollment in WhatsApp pregnancy groups on attitudes toward COVID-19 vaccination. Pregnant women were concerned about vaccine effectiveness (31.1%), and almost one-half (47.3%) were discouraged from receiving COVID-19 vaccines. Positive attitudes towards vaccination were associated with COVID-19 vaccination (aOR 2.81; 95% CI 1.12-7.04; p = 0.027), but no significant relationship was found between COVID-19 vaccination and strong subjective norms (influences to get COVID-19 vaccines). Our findings suggest that strategies to improve vaccination should consider targeting attitudes and proximal social networks (friends/family) to facilitate vaccination decision-making. WhatsApp can be used for research distribution and enhance the dissemination of accurate information.

Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic?

This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19-89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.